Does Ascension St John Medical Center have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Ascension St John Medical Center. In a medical emergency, call 911.

Where is Ascension St John Medical Center?

1923 South Utica Avenue, Tulsa, OK 74104, in Tulsa County, Oklahoma.

What is the phone number of Ascension St John Medical Center?

(918) 744-2296, as listed by Medicare (CMS).

What is the Medicare star rating of Ascension St John Medical Center?

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

Ascension St John Medical Center — Tulsa, OK

Quick answers

Does Ascension St John Medical Center have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Ascension St John Medical Center. In a medical emergency, call 911.
Where is Ascension St John Medical Center?: 1923 South Utica Avenue, Tulsa, OK 74104, in Tulsa County, Oklahoma.
What is the phone number of Ascension St John Medical Center?: (918) 744-2296, as listed by Medicare (CMS).
What is the Medicare star rating of Ascension St John Medical Center?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4]

Heart care
Cancer care
Stroke care
Orthopedics
Women's health
Obstetrics and gynecology (OB-GYN) maternity care
Neonatal care
Trauma surgery

Conditions treated^[4]

Stroke

Procedures^[4]

Robotic-assisted minimally invasive surgery

Programs and centers^[4]

Level 1 Trauma Center
Comprehensive stroke center
Birthing Center
Transcatheter Valve Center

Emergency care (hospital website)^[4]

Emergency room	Yes
Open 24/7	Yes
Trauma designation	Level 1 (American College of Surgeons-verified)
Stroke designation	Comprehensive Stroke Center (Joint Commission-certified)

Doctors and clinicians (939)

939 doctors and other clinicians list Ascension St John Medical Center 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

Internal Medicine148
Nurse Practitioner121
Family Practice108
Diagnostic Radiology96
Physician Assistant75
Certified Registered Nurse Anesthetist (CRNA)54
Anesthesiology29
Neurology25
General Surgery22
Obstetrics/Gynecology21
Pathology21
Urology18

And 915 more: the button below opens the full list.

Other emergency rooms nearby

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

Oklahoma State University Medical Center2.0 mi · Tulsa, OK · Acute Care Hospital
Saint Francis Hospital, Inc4.8 mi · Tulsa, OK · Acute Care Hospital
Hillcrest Medical Center5.1 mi · Tulsa, OK · Acute Care Hospital
Tulsa Spine & Specialty Hospital5.1 mi · Tulsa, OK · Acute Care Hospital
Oklahoma Surgical Hospital, LLC7.4 mi · Tulsa, OK · Acute Care Hospital

Other hospitals nearby

Parkside, Inc0.7 mi · Tulsa, OK · Psychiatric Hospital
Tulsa Center for Behavioral Health1.6 mi · Tulsa, OK · Psychiatric Hospital
Select Specialty Hospital - Tulsa/Midtown, LLC2.0 mi · Tulsa, OK · Long-Term Acute Care Hospital
PAM Specialty Hospital of Tulsa4.4 mi · Tulsa, OK · Long-Term Acute Care Hospital

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Oklahoma Memory Care Institute1.7 mi · Tulsa, OK · 3 of 5 stars
Trinity Woods, Inc.2.3 mi · Tulsa, OK · 5 of 5 stars
Colonial Manor Nursing Home3.1 mi · Tulsa, OK · 3 of 5 stars

All nursing homes in the state →

Hospice providers

Luminos Hospice2.6 mi · Tulsa, OK · 4 of 5 stars
Traditions Health of Tulsa2.6 mi · Tulsa, OK
Truheart Hospice LLC2.6 mi · Tulsa, OK

All hospice providers in the state →

Home health agencies

Truheart Home Health2.6 mi · Tulsa, OK
Ascension at Home - Tulsa3.6 mi · Tulsa, OK · 3 of 5 stars
Elara Caring XXV3.6 mi · Tulsa, OK · 5 of 5 stars

All home health agencies in the state →

Dialysis facilities

DaVita Central Tulsa Dialysis Center1.2 mi · Tulsa, OK · 1 of 5 stars
Fmcna - Richard Medlock2.6 mi · Tulsa, OK · 2 of 5 stars
DaVita Tulsa Dialysis Center3.6 mi · Tulsa, OK · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

Cherry Street Surgery Center LLC1.1 mi · Tulsa, OK
Scissortail Surgery Center LLC1.1 mi · Tulsa, OK
Tulsa Ambulatory Procedure Center, LLC1.1 mi · Tulsa, OK

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Morton Family & Children's Health Center1.6 mi · Tulsa, OK · Community health center
K-W- Clinical Construction Project1.6 mi · Tulsa, OK · Community health center
Youth Services Tulsa1.7 mi · Tulsa, OK · Community health center

Clinics and urgent care

Hillcrest Urgent Care, LLC1.1 mi · Tulsa, OK · Urgent care center
St John Urgent Care Clinics Inc1.1 mi · Tulsa, OK · Urgent care center
Pedistat, PLLC3.6 mi · Tulsa, OK · Urgent care center

Pharmacies

Brookshire Grocery Company1.1 mi · Tulsa, OK · Community/retail pharmacy
CFP Acquisitions, Inc.1.1 mi · Tulsa, OK · Community/retail pharmacy
Equity Pharmacy Inc1.1 mi · Tulsa, OK · Community/retail pharmacy

Assisted living nearby

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

The Grove at Midtown Senior Living2.6 mi · Tulsa, OK
The Villages at Southern Hills2.6 mi · Tulsa, OK
Trinity Woods, Inc3.6 mi · Tulsa, OK
Saint Simeons Episcopal Home4.1 mi · Tulsa, OK

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

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	2 of 5 stars
Overall rating of the hospital	2 of 5 stars
Would recommend the hospital	2 of 5 stars
Nurses communicated well	1 of 5 stars
Doctors communicated well	2 of 5 stars
Staff explained medicines	1 of 5 stars
Information about recovery at home	2 of 5 stars
Room and bathroom kept clean	2 of 5 stars
Quiet at night	2 of 5 stars
Rated the hospital 9 or 10 out of 10	57%National average: 72%
Would definitely recommend the hospital	60%National average: 71%
Nurses “always” communicated well	68%National average: 80%
Doctors “always” communicated well	70%National average: 80%
Staff “always” explained medicines before giving them	52%National average: 62%
Were given information about recovery at home	80%National average: 86%
Room and bathroom “always” clean	61%National average: 74%
Area around the room “always” quiet at night	48%National average: 60%
Completed surveys	456Response rate: 15%

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	0.875No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.487Better than the national benchmark
Surgical site infections after colon surgery	2.008Worse than the national benchmark
Surgical site infections after abdominal hysterectomy	2.053Worse than the national benchmark
MRSA bloodstream infections	0.378Better than the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.338Better than the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	11.6%
Deaths within 30 days: heart failure patients	11.4%
Deaths within 30 days: pneumonia patients	16.7%
Deaths within 30 days: COPD patients	6.9%
Deaths within 30 days: stroke patients	14.7%
Deaths within 30 days: coronary bypass surgery (CABG)	2.3%
Serious complications (patient safety indicator PSI-90)	1.11No different from the national rate
Complications after hip or knee replacement	Too few cases to report

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	14.2%
Readmitted within 30 days: heart failure	21.5%
Readmitted within 30 days: pneumonia	18.6%
Readmitted within 30 days: COPD	20.7%
Readmitted within 30 days: coronary bypass surgery	10.5%
Readmitted within 30 days: hip or knee replacement	Too few cases to report

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; data from July 2023 to June 2025.

Emergency room times and sepsis care

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

Average (median) time patients spent in the emergency room before leaving (OP-18b)	197 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	Not reported to Medicare
Sepsis patients who got all the recommended early care (SEP-1)	47%National average: 65%

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in Tulsa Best hospitals in Tulsa

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 St John Medical Center lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient In the file: NEW PT 30 MIN MOD 25 12626	$447	$165.39	$83.81 – $147.94
New patient office visit (about 30–44 minutes): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $84.90 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $147.94 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $147.94 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $147.94 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $147.94 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $147.94 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $83.81
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient In the file: NEW VISIT 30 MIN 99203	$447	$165.39	$84.90 – $147.94
New patient office visit (about 30–44 minutes): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $84.90 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $147.94 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $147.94 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $147.94 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $147.94 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $147.94
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient In the file: NEW PT/INIT LACT 30 MIN 34268	$447	$165.39	$84.90 – $147.94
New patient office visit (about 30–44 minutes): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $84.90 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $147.94 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $147.94 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $147.94 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $147.94 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $147.94
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient In the file: NEW PT 45 MIN MOD 25 12625	$616.75	$228.20	$140.86 – $252.48
New patient office visit (about 45–59 minutes): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $143.69 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $252.48 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $252.48 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $252.48 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $252.48 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $252.48 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $140.86
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient In the file: NEW VISIT 45 MIN 99204	$616.75	$228.20	$143.69 – $252.48
New patient office visit (about 45–59 minutes): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $143.69 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $252.48 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $252.48 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $252.48 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $252.48 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $252.48
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient In the file: NEWVISIT 11 24HR MOB 99204	$342	$126.54	$143.69 – $252.48
New patient office visit (about 45–59 minutes): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $143.69 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $252.48 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $252.48 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $252.48 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $252.48 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $252.48
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient In the file: NEW PT 60 MIN MOD 25 12624	$750.50	$277.69	$183.33 – $325.03
New patient office visit (about 60–74 minutes): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $187.18 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $325.03 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $325.03 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $325.03 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $325.03 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $325.03 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $183.33
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient In the file: NEW VISIT 60 MIN 99205	$750.50	$277.69	$187.18 – $325.03
New patient office visit (about 60–74 minutes): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $187.18 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $325.03 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $325.03 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $325.03 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $325.03 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $325.03
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient In the file: NEW VISIT>24HRS MOBS 99205	$425	$157.25	$187.18 – $325.03
New patient office visit (about 60–74 minutes): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $187.18 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $325.03 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $325.03 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $325.03 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $325.03 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $325.03
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: EST PT 20 MIN MOD 25 12631	$447	$165.39	$55.58 – $98.14
Established patient office visit (about 20–29 minutes): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $56.44 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $98.14 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $98.14 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $98.14 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $98.14 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $98.14 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $55.58
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: ESTAB VISIT 20 MIN 99213	$447	$165.39	$56.44 – $98.14
Established patient office visit (about 20–29 minutes): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $56.44 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $98.14 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $98.14 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $98.14 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $98.14 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $98.14
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: ESTAB PT/LACT VISIT 20 MIN 34225	$447	$165.39	$56.44 – $98.14
Established patient office visit (about 20–29 minutes): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $56.44 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $98.14 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $98.14 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $98.14 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $98.14 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $98.14
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: EST PT 30 MIN MOD 25 12630	$576.25	$213.21	$85.98 – $151.50
Established patient office visit (about 30–39 minutes): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.04 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.50 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.50 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $151.50 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $151.50 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.50 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $85.98
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: ESTAB VISIT 30 MIN 99214	$576.25	$213.21	$87.04 – $151.50
Established patient office visit (about 30–39 minutes): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.04 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.50 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.50 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $151.50 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $151.50 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.50
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: ESTAB PT/LACT VISIT 30 MIN 34307	$576.25	$213.21	$87.04 – $151.50
Established patient office visit (about 30–39 minutes): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.04 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.50 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.50 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $151.50 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $151.50 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.50
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$106.12 – $186.34
Office consultation with a specialist (moderate): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $106.12 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $186.34 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $186.34 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $186.34 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $186.34 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $186.34 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $119.47
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$170.57 – $295.87
Office consultation with a specialist (moderate to high): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $170.57 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $295.87 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $295.87 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $295.87 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $295.87 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $295.87 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $189.74
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$94.62 – $190.61
Preventive checkup, new patient, age 18–39: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $108.82 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $190.61 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $190.61 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $190.61 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $190.61 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $190.61 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $94.62
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient In the file: PREV VISIT NEW AGE 40-64	Not listed in the file	Not listed in the file	$116.11 – $230.43
Preventive checkup, new patient, age 40–64: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $132.38 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $230.43 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $230.43 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $230.43 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $230.43 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $230.43 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $116.11
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: LEVEL III 4463	$1,431	$529.47	$69.41 – $1,061
Emergency room visit (moderate): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $69.41 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $120.19 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $120.19 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $120.19 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $120.19 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $120.19 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $500
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: L&D ED LEVEL III 4463	$1,431	$529.47	$69.41 – $1,061
Emergency room visit (moderate): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $69.41 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $120.19 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $120.19 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $120.19 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $120.19 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $120.19 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $500
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: PHYSICIAN LEVEL III 89	$198.50	$73.45	$69.41 – $120.19
Emergency room visit (moderate): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $69.41 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $120.19 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $120.19 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $120.19 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $120.19 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $120.19 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $76.23
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: LEVEL IV 4464	$2,048.50	$757.95	$131.75 – $1,591
Emergency room visit (moderately high): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $131.75 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $229.72 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $229.72 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $229.72 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $229.72 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $229.72 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $500
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: L&D ED LEVEL IV 4464	$2,048.50	$757.95	$131.75 – $1,591
Emergency room visit (moderately high): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $131.75 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $229.72 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $229.72 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $229.72 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $229.72 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $229.72 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $500
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: PHYSICIAN LEVEL IV 95	$363.25	$134.40	$131.75 – $229.72
Emergency room visit (moderately high): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $131.75 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $229.72 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $229.72 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $229.72 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $229.72 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $229.72 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $142.88
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: PHYSICIAN LEVEL V 93	$542.75	$200.82	$194.56 – $500
Emergency room visit (high): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $194.56 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $336.41 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $336.41 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $336.41 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $336.41 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $336.41 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $500
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: LEVEL V 4465	$517	$191.29	$194.56 – $500
Emergency room visit (high): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $194.56 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $336.41 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $336.41 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $336.41 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $336.41 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $336.41 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $500
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: PHYSICIAN LEVEL V 5015	$542.75	$200.82	$194.56 – $500
Emergency room visit (high): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $194.56 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $336.41 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $336.41 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $336.41 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $336.41 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $336.41 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $500

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: CHEM 8- 48337	$85.75	$31.73	$8.86 – $85.75
Basic metabolic panel (blood test): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $13.17 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $23.60 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $23.60 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $23.60 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $23.60 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $23.60 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $85.75
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: CHEM 8- 48337	$85.75	$31.73	$8.86 – $85.75
Basic metabolic panel (blood test): rates for 2 insurance plans COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $85.75 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $85.75
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) In the file: METABOLIC PANEL TOTAL CA	Not listed in the file	Not listed in the file	$8.46 – $33.84
Basic metabolic panel (blood test): 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $8.88 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $11 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $8.46 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $10.15 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $8.46 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $12.69 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $12.69 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $9.31 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $8.46 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $16.92
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: CHEM 14- 48338	$110.25	$40.79	$11.20 – $110.25
Comprehensive metabolic panel (blood test): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $16.45 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $22.50 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $22.50 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $22.50 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $22.50 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $22.50 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $110.25
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: CHEM 14- 48338	$110.25	$40.79	$11.20 – $110.25
Comprehensive metabolic panel (blood test): rates for 2 insurance plans COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $110.25 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $110.25
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) In the file: COMPREHEN METABOLIC PANEL	Not listed in the file	Not listed in the file	$10.56 – $42.24
Comprehensive metabolic panel (blood test): 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $11.09 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $13.73 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $10.56 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $12.67 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $10.56 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $15.84 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $15.84 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $11.62 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $10.56 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $21.12
Obstetric blood test panel CPT 80055 · Inpatient or outpatient In the file: PREN80055- 45629	$205.50	$76.04	$42.47 – $205.50
Obstetric blood test panel: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $74.43 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $166.50 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $166.50 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $166.50 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $166.50 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $166.50 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $205.50
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: PREN80055- 45629	$205.50	$76.04	$42.47 – $205.50
Obstetric blood test panel: rates for 2 insurance plans COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $205.50 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $205.50
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$47.81 – $191.24
Obstetric blood test panel: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $50.20 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $62.15 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $47.81 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $57.37 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $47.81 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $71.72 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $71.72 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $52.59 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $47.81 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $95.62
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: LIPID GRP PHENOTYPING 44752	$74.60	$27.60	$16.94 – $74.60
Cholesterol panel (lipid panel): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $20.85 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $28.52 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $28.52 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $28.52 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $28.52 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $28.52 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $74.60
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: GROUP LIPID- 48643	$179.50	$66.42	$16.94 – $179.50
Cholesterol panel (lipid panel): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $20.85 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $28.52 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $28.52 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $28.52 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $28.52 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $28.52 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $179.50
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: LIPID GRP PHENOTYPING 44752	$74.60	$27.60	$16.94 – $74.60
Cholesterol panel (lipid panel): rates for 2 insurance plans COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $74.60 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $74.60
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: RENAL PR- 48340	$71.75	$26.55	$9.12 – $71.75
Kidney function panel: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $13.52 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $24.23 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $24.23 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $24.23 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $24.23 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $24.23 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $71.75
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL PR- 48340	$71.75	$26.55	$9.12 – $71.75
Kidney function panel: rates for 2 insurance plans COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $71.75 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $71.75
Kidney function panel CPT 80069 · Inpatient (hospital stay) In the file: RENAL FUNCTION PANEL	Not listed in the file	Not listed in the file	$8.68 – $34.72
Kidney function panel: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $9.11 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $11.28 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $8.68 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $10.42 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $8.68 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $13.02 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $13.02 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $9.55 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $8.68 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $17.36
Liver function panel CPT 80076 · Inpatient or outpatient In the file: LIVER PNL- 48339	$119.75	$44.31	$8.60 – $119.75
Liver function panel: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $12.72 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $22.79 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $22.79 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $22.79 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $22.79 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $22.79 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $119.75
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: LIVER PNL- 48339	$119.75	$44.31	$8.60 – $119.75
Liver function panel: rates for 2 insurance plans COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $119.75 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $119.75
Liver function panel CPT 80076 · Inpatient (hospital stay) In the file: HEPATIC FUNCTION PANEL	Not listed in the file	Not listed in the file	$8.17 – $32.68
Liver function panel: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $8.58 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $10.62 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $8.17 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $9.80 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $8.17 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $12.25 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $12.25 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $8.99 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $8.17 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $16.34
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: URINALYSIS COMPLETE- 46480	$89.25	$33.02	$3.39 – $44.63
Urine test (automated, with microscope): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $4.94 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $8.82 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $8.82 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $8.82 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $8.82 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $8.82
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) In the file: URINALYSIS AUTO W/SCOPE	Not listed in the file	Not listed in the file	$3.17 – $12.68
Urine test (automated, with microscope): 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $3.33 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $4.12 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $3.17 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $3.80 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $3.17 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $4.75 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $4.75 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $3.49 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $3.17 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $6.34
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: URINALYSIS AUTO W/SCOPE	Not listed in the file	Not listed in the file	$3.17 – $12.68
Urine test (automated, with microscope): 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $3.33 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $3.17 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $3.80 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $3.17 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $7.61 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $7.29 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $3.17 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $6.34 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $6.34 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $3.20
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: REDUCING SUBSTANCES- 46465	$50.25	$18.59	$2.61 – $50.25
Urine test (manual, without microscope): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $3.64 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $6.54 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $6.54 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $6.54 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $6.54 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $6.54 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $50.25
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: BILIRUBIN ICTOTEST- 46517	$50.25	$18.59	$2.61 – $50.25
Urine test (manual, without microscope): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $3.64 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $6.54 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $6.54 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $6.54 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $6.54 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $6.54 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $50.25
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: URINE DIP 81002	$50.25	$18.59	$2.61 – $50.25
Urine test (manual, without microscope): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $3.64 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $6.54 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $6.54 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $6.54 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $6.54 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $6.54 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $50.25
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: UA DIPSTICK KID STONE SAT 44712	$26.12	$9.66	$2.35 – $26.12
Urine test (automated, without microscope): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $3.50 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $6.28 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $6.28 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $6.28 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $6.28 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $6.28 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $26.12
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: SPECIFIC GRAVITY UR- 46471	$58	$21.46	$2.35 – $58
Urine test (automated, without microscope): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $3.50 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $6.28 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $6.28 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $6.28 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $6.28 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $6.28 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $58
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: UA W/O MICROSCOPIC- 46514	$58	$21.46	$2.35 – $58
Urine test (automated, without microscope): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $3.50 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $6.28 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $6.28 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $6.28 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $6.28 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $6.28 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $58
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: PSA- 48514	$208	$76.96	$19.28 – $208
PSA (prostate specific antigen) blood test: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $28.64 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $39.15 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $39.15 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $39.15 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $39.15 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $39.15 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $208
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA- 48514	$208	$76.96	$19.28 – $208
PSA (prostate specific antigen) blood test: rates for 2 insurance plans COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $208 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $208
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) In the file: ASSAY OF PSA TOTAL	Not listed in the file	Not listed in the file	$18.39 – $73.56
PSA (prostate specific antigen) blood test: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $19.31 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $23.91 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $18.39 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $22.07 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $18.39 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $27.59 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $27.59 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $20.23 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $18.39 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $36.78
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: THYROID ANALYZER 38819	$110.50	$40.89	$17.72 – $110.50
Thyroid stimulating hormone (TSH) test: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $26.16 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $35.76 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $35.76 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $35.76 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $35.76 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $35.76 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $110.50
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: ASSAY OF TSH STIM HORMONE 41736	$111.50	$41.26	$17.72 – $111.50
Thyroid stimulating hormone (TSH) test: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $26.16 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $35.76 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $35.76 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $35.76 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $35.76 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $35.76 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $111.50
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: NBS TSH SCREEN 41872	$60.25	$22.29	$17.72 – $60.25
Thyroid stimulating hormone (TSH) test: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $26.16 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $35.76 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $35.76 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $35.76 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $35.76 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $35.76 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2629_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $60.25
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: CBC- 47048	$122.50	$45.33	$8.08 – $61.25
Complete blood count (CBC) with differential: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $12.10 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $16.55 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $16.55 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $16.55 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $16.55 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $16.55
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) In the file: COMPLETE CBC W/AUTO DIFF WBC	Not listed in the file	Not listed in the file	$7.77 – $31.08
Complete blood count (CBC) with differential: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $8.16 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $10.10 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $7.77 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $9.32 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $7.77 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $11.65 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $11.65 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $8.55 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $7.77 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $15.54
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: COMPLETE CBC W/AUTO DIFF WBC	Not listed in the file	Not listed in the file	$7.77 – $31.08
Complete blood count (CBC) with differential: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $8.16 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $7.77 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $9.32 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $7.77 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $18.65 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $17.87 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $7.77 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $15.54 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $15.54 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $7.85
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: CBC NO DIFF- 46545	$80	$29.60	$6.78 – $40
Complete blood count (CBC), automated: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $10.07 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $18.04 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $18.04 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $18.04 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $18.04 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $18.04
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) In the file: COMPLETE CBC AUTOMATED	Not listed in the file	Not listed in the file	$6.47 – $25.88
Complete blood count (CBC), automated: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $6.79 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $8.41 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $6.47 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $7.76 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $6.47 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $9.71 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $9.71 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $7.12 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $6.47 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $12.94
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: COMPLETE CBC AUTOMATED	Not listed in the file	Not listed in the file	$6.47 – $25.88
Complete blood count (CBC), automated: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $6.79 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $6.47 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $7.76 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $6.47 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $15.53 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $14.88 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $6.47 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $12.94 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $12.94 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $6.53
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: PROTHROMBIN TIME 46742	$80	$29.60	$4.17 – $40
Blood clotting time test (prothrombin time, PT): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $6.12 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $10.96 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $10.96 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $10.96 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $10.96 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $10.96 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $4.88
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: PT WITH INR 41795	$33.75	$12.49	$4.17 – $16.88
Blood clotting time test (prothrombin time, PT): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $6.12 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $10.96 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $10.96 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $10.96 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $10.96 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $10.96
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: PROTHROMBIN TIME- 46742	$80	$29.60	$4.17 – $40
Blood clotting time test (prothrombin time, PT): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $6.12 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $10.96 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $10.96 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $10.96 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $10.96 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $10.96
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: APTT- 46733	$59.75	$22.11	$6.25 – $29.88
Blood clotting test (partial thromboplastin time, PTT): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $9.35 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $16.75 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $16.75 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $16.75 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $16.75 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $16.75
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: APTT 46733	$59.75	$22.11	$6.25 – $29.88
Blood clotting test (partial thromboplastin time, PTT): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $9.35 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $16.75 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $16.75 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $16.75 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $16.75 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $16.75
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) In the file: THROMBOPLASTIN TIME PARTIAL	Not listed in the file	Not listed in the file	$6.01 – $24.04
Blood clotting test (partial thromboplastin time, PTT): 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $6.31 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $7.81 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $6.01 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $7.21 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $6.01 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $9.02 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $9.02 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $6.61 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $6.01 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $12.02

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: MR/IAC/W/O 30035	$2,410.25	$891.79	$53.78 – $294.56
CT scan of the head or brain, without contrast: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $74.01 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $294.56 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $294.56 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $274.92 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $274.92 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $294.56 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $244.46
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: CT HEAD RAPID 43267	$2,410.25	$891.79	$53.78 – $294.56
CT scan of the head or brain, without contrast: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $74.01 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $294.56 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $294.56 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $274.92 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $274.92 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $294.56
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: CT HEAD PLAIN 70450	$2,410.25	$891.79	$53.78 – $294.56
CT scan of the head or brain, without contrast: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $74.01 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $294.56 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $294.56 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $274.92 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $274.92 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $294.56
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: MR BRAIN W/O&W/CONTR 70553	$3,456.50	$1,278.91	$148.26 – $1,000.65
MRI of the brain, before and after contrast: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $265.51 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $1,000.65 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $1,000.65 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $933.94 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $933.94 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $1,000.65
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$339.71 – $1,358.84
MRI of the brain, before and after contrast: 10 of 21 insurance plan rates AETNA HMO/PPO — 2658_MCOK, BAOK, OHOK AETNA HMO 20241001: $1,591 BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $356.70 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $339.71 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $407.65 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $339.71 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $815.30 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $781.33 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $339.71 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $679.42 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $679.42
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$339.71 – $1,358.84
MRI of the brain, before and after contrast: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $356.70 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $441.62 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $339.71 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $407.65 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $339.71 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $509.56 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $509.56 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $373.68 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $339.71 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $679.42
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: CHEST XRAY 2 VIEWS 71046	$320	$118.40	$23.34 – $34.44
Chest X-ray, 2 views: rates for 5 insurance plans BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $34.44 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $34.44 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $32.14 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $32.14 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $34.44
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: CHEST XRAY 2 VIEWS 71046	$320	$118.40	$23.34 – $34.44
Chest X-ray, 2 views: rates for 1 insurance plan AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $23.34
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: X-RAY EXAM CHEST 2 VIEWS	Not listed in the file	Not listed in the file	$83.75 – $335
Chest X-ray, 2 views: 10 of 21 insurance plan rates AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $23.34 BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $87.94 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $83.75 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $100.50 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $83.75 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $201 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $192.62 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $83.75 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $167.50 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $167.50
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: L SPINE 5V 72110	$613.50	$227	$19.21 – $102.19
X-ray of the lower spine, at least 4 views: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $33.41 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $102.19 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $102.19 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $102.19 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $102.19 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $102.19
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) In the file: X-RAY EXAM L-2 SPINE 4/>VWS	Not listed in the file	Not listed in the file	$101.15 – $404.60
X-ray of the lower spine, at least 4 views: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $106.21 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $131.50 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $101.15 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $121.38 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $101.15 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $151.73 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $151.73 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $111.27 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $101.15 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $202.30
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: X-RAY EXAM L-2 SPINE 4/>VWS	Not listed in the file	Not listed in the file	$101.15 – $404.60
X-ray of the lower spine, at least 4 views: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $106.21 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $101.15 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $121.38 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $101.15 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $242.76 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $232.64 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $101.15 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $202.30 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $202.30 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $102.16
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: MR L SPINE WO LIM 50449	$2,499.50	$924.82	$92.97 – $1,591
MRI of the lower back (lumbar spine), without contrast: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $150.55 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $667.32 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $667.32 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $622.83 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $622.83 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $667.32 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $587.24
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: MRI SPINE LUMBAR WO 50449	$2,499.50	$924.82	$92.97 – $1,591
MRI of the lower back (lumbar spine), without contrast: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $150.55 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $667.32 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $667.32 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $622.83 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $622.83 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $667.32 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $587.24
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: MRI L SPINE W/O 72148	$2,499.50	$924.82	$92.97 – $667.32
MRI of the lower back (lumbar spine), without contrast: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $150.55 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $667.32 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $667.32 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $622.83 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $622.83 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $667.32
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: CT PELVIS INFUSED 72193	$2,625	$971.25	$73 – $486.38
CT scan of the pelvis, with contrast: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $169.58 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $486.38 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $486.38 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $453.95 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $453.95 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $486.38
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) In the file: CT PELVIS W/DYE	Not listed in the file	Not listed in the file	$169.34 – $677.36
CT scan of the pelvis, with contrast: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $177.81 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $220.14 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $169.34 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $203.21 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $169.34 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $254.01 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $254.01 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $186.27 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $169.34 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $338.68
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W/DYE	Not listed in the file	Not listed in the file	$169.34 – $677.36
CT scan of the pelvis, with contrast: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $177.81 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $169.34 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $203.21 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $169.34 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $406.42 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $389.48 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $169.34 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $338.68 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $338.68 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $171.03
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: MR JT U WO LIM LT 23797	$2,640	$976.80	$84.59 – $1,591
MRI of a leg joint (such as the knee), without contrast: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $170.67 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $495.23 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $495.23 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $462.21 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $462.21 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $495.23 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $602.99
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: MR JT U WO LIM RT 23798	$2,640	$976.80	$84.59 – $1,591
MRI of a leg joint (such as the knee), without contrast: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $170.67 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $495.23 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $495.23 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $462.21 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $462.21 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $495.23 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $602.99
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: MR JT L W/O L 61320	$2,640	$976.80	$84.59 – $1,591
MRI of a leg joint (such as the knee), without contrast: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $170.67 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $495.23 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $495.23 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $462.21 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $462.21 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $495.23 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $602.99
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: CT ABDOMEN PELVIS W CONTR 74177	$3,209.75	$1,187.61	$222.39 – $615.63
CT scan of the abdomen and pelvis, with contrast: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $222.39 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $615.63 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $615.63 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $574.59 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $574.59 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $615.63
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: CT ABD PELVIS W 74177	$3,209.75	$1,187.61	$222.39 – $615.63
CT scan of the abdomen and pelvis, with contrast: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $222.39 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $615.63 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $615.63 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $574.59 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $574.59 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $615.63
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$339.71 – $1,358.84
CT scan of the abdomen and pelvis, with contrast: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $356.70 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $441.62 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $339.71 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $407.65 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $339.71 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $509.56 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $509.56 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $373.68 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $339.71 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $679.42
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: UPPER ABD GENERAL 76700	$1,423.75	$526.79	$50.71 – $252.38
Ultrasound of the abdomen, complete: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $83.72 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $252.38 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $252.38 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $235.55 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $235.55 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $252.38
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) In the file: US EXAM ABDOM COMPLETE	Not listed in the file	Not listed in the file	$101.15 – $404.60
Ultrasound of the abdomen, complete: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $106.21 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $131.50 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $101.15 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $121.38 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $101.15 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $151.73 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $151.73 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $111.27 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $101.15 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $202.30
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US EXAM ABDOM COMPLETE	Not listed in the file	Not listed in the file	$101.15 – $404.60
Ultrasound of the abdomen, complete: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $106.21 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $101.15 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $121.38 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $101.15 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $242.76 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $232.64 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $101.15 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $202.30 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $202.30 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $102.16
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: OB US >14WK 76805	$1,530.50	$566.29	$61.14 – $306.56
Pregnancy ultrasound (after the first trimester): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $94.14 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $306.56 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $306.56 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $306.56 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $306.56 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $306.56
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) In the file: OB US >= 14 WKS SNGL FETUS	Not listed in the file	Not listed in the file	$101.15 – $404.60
Pregnancy ultrasound (after the first trimester): 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $106.21 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $131.50 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $101.15 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $121.38 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $101.15 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $151.73 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $151.73 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $111.27 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $101.15 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $202.30
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: OB US >= 14 WKS SNGL FETUS	Not listed in the file	Not listed in the file	$101.15 – $404.60
Pregnancy ultrasound (after the first trimester): 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $106.21 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $101.15 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $121.38 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $101.15 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $242.76 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $232.64 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $101.15 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $202.30 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $202.30 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $102.16
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: TRANSVAGINAL SONOGRA 76830	$1,024	$378.88	$42.80 – $136.73
Transvaginal ultrasound: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $89.46 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $136.72 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $136.73 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $127.61 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $127.61 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $136.73
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) In the file: TRANSVAGINAL US NON-OB	Not listed in the file	Not listed in the file	$101.15 – $404.60
Transvaginal ultrasound: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $106.21 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $131.50 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $101.15 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $121.38 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $101.15 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $151.73 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $151.73 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $111.27 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $101.15 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $202.30
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: TRANSVAGINAL US NON-OB	Not listed in the file	Not listed in the file	$101.15 – $404.60
Transvaginal ultrasound: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $106.21 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $101.15 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $121.38 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $101.15 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $242.76 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $232.64 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $101.15 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $202.30 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $202.30 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $102.16
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient In the file: MAM DIGTL DIAG RT 30111	$437	$161.69	$95.22 – $239.64
Diagnostic mammogram, one breast: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $95.22 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $239.64 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $239.64 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $223.66 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $223.66 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $239.64
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient In the file: MAM DIGTL DIAG LT 77065	$437	$161.69	$95.22 – $239.64
Diagnostic mammogram, one breast: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $95.22 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $239.64 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $239.64 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $223.66 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $223.66 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $239.64
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) In the file: DX MAMMO INCL CAD UNI	Not listed in the file	Not listed in the file	$75.75 – $303
Diagnostic mammogram, one breast: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $79.54 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $98.48 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $75.75 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $90.90 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $75.75 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $113.63 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $113.63 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $83.33 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $75.75 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $151.50
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient In the file: MAM DIGTL DIAG BILAT 77066	$564.50	$208.87	$121.80 – $304.29
Diagnostic mammogram, both breasts: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $121.80 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $304.29 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $304.29 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $284 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $284 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $304.29
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) In the file: DX MAMMO INCL CAD BI	Not listed in the file	Not listed in the file	$96.50 – $386
Diagnostic mammogram, both breasts: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $101.33 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $125.45 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $96.50 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $115.80 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $96.50 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $144.75 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $144.75 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $106.15 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $96.50 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $193
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: DX MAMMO INCL CAD BI	Not listed in the file	Not listed in the file	$96.50 – $386
Diagnostic mammogram, both breasts: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $101.33 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $96.50 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $115.80 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $96.50 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $231.60 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $221.95 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $96.50 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $193 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $193 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $97.47
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: MAM DIG SCRN LT 30106	$380	$140.60	$100.61 – $245.27
Screening mammogram, both breasts: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $100.61 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $245.26 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $245.27 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $228.91 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $228.91 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $245.27
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: MAM DIG SCRN RT 30110	$380	$140.60	$100.61 – $245.27
Screening mammogram, both breasts: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $100.61 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $245.26 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $245.27 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $228.91 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $228.91 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $245.27
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: MAMMO DIG SCREEN BIL 77067	$380	$140.60	$100.61 – $245.27
Screening mammogram, both breasts: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $100.61 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $245.26 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $245.27 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $228.91 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $228.91 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $245.27

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient In the file: ELECTROCARDIOGRAM COMPLETE	Not listed in the file	Not listed in the file	$18.08 – $151.63
Electrocardiogram (ECG/EKG) with reading: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $18.08 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.63 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.63 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $151.63 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $151.63 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.63 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $24
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	$18.08 – $151.63
Electrocardiogram (ECG/EKG) with reading: rates for 1 insurance plan AETNA HMO/PPO — 2658_MCOK, BAOK, OHOK AETNA HMO 20241001: 67% (a percentage in the contract, not a dollar amount)
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient In the file: LT HEART CATH W ANGIO 93452	$10,352	$3,830.24	$591.02 – $1,588.38
Left heart catheterization (diagnostic): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $591.02 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $1,588.38 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $1,588.38 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $1,482.49 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $1,482.49 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $1,588.38
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	$591.02 – $6,935.84
Left heart catheterization (diagnostic): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $591.02 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $1,588.38 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $1,588.38 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $1,482.49 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $1,482.49 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $1,588.38
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	$591.02 – $6,935.84
Left heart catheterization (diagnostic): rates for 1 insurance plan AETNA HMO/PPO — 2658_MCOK, BAOK, OHOK AETNA HMO 20241001: $6,935.84
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient In the file: EP EVALUATION STUDY 77631	$18,753.75	$6,938.89	$343.32 – $8,949
Heart rhythm study (electrophysiology evaluation): rates for 5 insurance plans BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $742.83 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $742.83 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $693.31 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $693.31 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $742.83
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: EP EVALUATION STUDY 77631	$18,753.75	$6,938.89	$343.32 – $8,949
Heart rhythm study (electrophysiology evaluation): rates for 2 insurance plans UHC — 2948_JPOK, BAOK, OHOK UNITED HEALTH CARE 20250701: $8,949 UHC — 2949_MCOK UNITED HEALTH CARE 20250701: $8,798
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$343.32 – $8,949
Heart rhythm study (electrophysiology evaluation): rates for 6 insurance plans BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $742.83 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $742.83 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $693.31 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $693.31 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $742.83 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $850.51
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient In the file: TX ATRIALFIB PULM VEIN ISOL93656	$48,376	$17,899.12	$1,273.90 – $11,285
Heart rhythm study with ablation for atrial fibrillation: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $1,273.90 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $2,039.38 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $2,039.39 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $1,903.43 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $1,903.43 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $2,039.39
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: TX ATRIALFIB PULM VEIN ISOL93656	$48,376	$17,899.12	$1,273.90 – $11,285
Heart rhythm study with ablation for atrial fibrillation: rates for 2 insurance plans UHC — 2948_JPOK, BAOK, OHOK UNITED HEALTH CARE 20250701: $11,285 UHC — 2949_MCOK UNITED HEALTH CARE 20250701: $11,094
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$1,273.90 – $11,285
Heart rhythm study with ablation for atrial fibrillation: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $1,273.90 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $2,039.38 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $2,039.39 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $1,903.43 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $1,903.43 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $2,039.39
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: POLYSOMNGRPH COMPLEX <6HR 62570	$5,848.25	$2,163.85	$209.89 – $3,918.33
Sleep study (overnight, in a sleep lab): rates for 8 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $507.72 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $1,127.85 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $1,127.85 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $1,052.66 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $1,052.66 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $1,127.85 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $866.67 UHC — 2949_MCOK UNITED HEALTH CARE 20250701: $1,163
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: POLYSOMNGRPH COMPLEX 95810	$5,848.25	$2,163.85	$209.89 – $3,918.33
Sleep study (overnight, in a sleep lab): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $507.72 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $1,127.85 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $1,127.85 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $1,052.66 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $1,052.66 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $1,127.85 UHC — 2949_MCOK UNITED HEALTH CARE 20250701: $1,163
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: POLYSOMNGRPH COMPLEX <6HR 62570	$5,848.25	$2,163.85	$209.89 – $3,918.33
Sleep study (overnight, in a sleep lab): rates for 3 insurance plans AETNA HMO/PPO — 2658_MCOK, BAOK, OHOK AETNA HMO 20241001: $3,918.33 UHC — 2948_JPOK, BAOK, OHOK UNITED HEALTH CARE 20250701: $3,492 UHC — 2950_SPOK, NHOK UNITED HEALTH CARE 20250701: $3,688

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: TELEH THERAPEUTIC EXER 15M 40932	$89.25	$33.02	$34.04 – $59.80
Physical therapy: therapeutic exercise (each 15 minutes): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $35.23 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $59.17 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $59.18 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $55.23 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $55.23 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $59.18 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $34.04
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: THERAPEUTIC EXER 15M 62962	$89.25	$33.02	$34.04 – $59.80
Physical therapy: therapeutic exercise (each 15 minutes): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $35.23 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $59.17 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $59.18 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $55.23 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $55.23 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $59.18 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $34.04
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: THER PROCEDURE 15M 38113	$89.25	$33.02	$34.04 – $59.80
Physical therapy: therapeutic exercise (each 15 minutes): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $35.23 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $59.17 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $59.18 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $55.23 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $55.23 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $59.18 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $34.04
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: PT EVAL 97161	$201.50	$74.56	$87.76 – $151.10
Physical therapy evaluation (low complexity): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.76 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.09 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.10 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $141.02 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $141.02 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.10
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: PT EVAL 24494	$201.50	$74.56	$87.76 – $151.10
Physical therapy evaluation (low complexity): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.76 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.09 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.10 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $141.02 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $141.02 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.10
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: PT EVAL 25696	$201.50	$74.56	$87.76 – $151.10
Physical therapy evaluation (low complexity): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.76 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.09 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.10 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $141.02 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $141.02 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.10
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: PT EVAL 25700	$201.50	$74.56	$87.76 – $151.10
Physical therapy evaluation (moderate complexity): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.76 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.09 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.10 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $141.02 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $141.02 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.10
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: PT EVAL 25701	$201.50	$74.56	$87.76 – $151.10
Physical therapy evaluation (moderate complexity): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.76 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.09 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.10 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $141.02 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $141.02 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.10
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: PT EVAL 25702	$201.50	$74.56	$87.76 – $151.10
Physical therapy evaluation (moderate complexity): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.76 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.09 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.10 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $141.02 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $141.02 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.10
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: PT EVAL 25705	$201.50	$74.56	$87.76 – $151.10
Physical therapy evaluation (high complexity): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.76 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.09 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.10 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $141.02 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $141.02 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.10
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: PT EVAL 24495	$201.50	$74.56	$87.76 – $151.10
Physical therapy evaluation (high complexity): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.76 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.09 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.10 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $141.02 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $141.02 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.10
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: PT EVAL 24496	$201.50	$74.56	$87.76 – $151.10
Physical therapy evaluation (high complexity): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $87.76 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.09 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.10 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $141.02 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $141.02 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.10
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient In the file: THERAPY W PT 30 MINUTES 51260	$568.75	$210.44	$70.84
Psychotherapy, 30 minutes: rates for 1 insurance plan AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $70.84
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) In the file: PSYTX W PT 30 MINUTES	Not listed in the file	Not listed in the file	$152.83 – $611.32
Psychotherapy, 30 minutes: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $160.47 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $198.68 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $152.83 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $183.40 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $152.83 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $229.25 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $229.25 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $168.11 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $152.83 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $305.66
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	$152.83 – $611.32
Psychotherapy, 30 minutes: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $160.47 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $152.83 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $183.40 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $152.83 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $366.79 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $351.51 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $152.83 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $305.66 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $305.66 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $154.36
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient In the file: THERAPY W PT 45 MINUTES 90834	$568.75	$210.44	$94.45
Psychotherapy, 45 minutes: rates for 1 insurance plan AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $94.45
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) In the file: PSYTX W PT 45 MINUTES	Not listed in the file	Not listed in the file	$152.83 – $611.32
Psychotherapy, 45 minutes: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $160.47 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $198.68 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $152.83 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $183.40 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $152.83 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $229.25 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $229.25 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $168.11 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $152.83 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $305.66
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	$152.83 – $611.32
Psychotherapy, 45 minutes: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $160.47 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $152.83 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $183.40 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $152.83 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $366.79 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $351.51 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $152.83 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $305.66 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $305.66 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $154.36
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient In the file: THERAPY W PT 60 MINUTES 51261	$568.75	$210.44	$142.05
Psychotherapy, 60 minutes: rates for 1 insurance plan AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $142.05
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) In the file: PSYTX W PT 60 MINUTES	Not listed in the file	Not listed in the file	$152.83 – $611.32
Psychotherapy, 60 minutes: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $160.47 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $198.68 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $152.83 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $183.40 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $152.83 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $229.25 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $229.25 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $168.11 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $152.83 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $305.66
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	$152.83 – $611.32
Psychotherapy, 60 minutes: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $160.47 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $152.83 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $183.40 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $152.83 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $366.79 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $351.51 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $152.83 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $305.66 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $305.66 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $154.36
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient In the file: FAMILY THERPY W/O PT 50MIN 57449	$568.75	$210.44	$114.35 – $151.02
Family psychotherapy, without the patient: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $114.35 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $151.02 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $151.02 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $140.95 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $140.95 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $151.02
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$152.83 – $611.32
Family psychotherapy, without the patient: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $160.47 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $198.68 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $152.83 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $183.40 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $152.83 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $229.25 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $229.25 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $168.11 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $152.83 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $305.66
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$152.83 – $611.32
Family psychotherapy, without the patient: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $160.47 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $152.83 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $183.40 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $152.83 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $366.79 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $351.51 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $152.83 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $305.66 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $305.66 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $154.36
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient In the file: FAMILY THERAPY W/PT 50 MIN 54342	$568.75	$210.44	$118.79 – $178.91
Family psychotherapy, with the patient: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $118.79 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $178.91 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $178.91 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $166.98 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $166.98 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $178.91
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$152.83 – $611.32
Family psychotherapy, with the patient: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $160.47 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $198.68 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $152.83 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $183.40 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $152.83 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $229.25 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $229.25 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $168.11 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $152.83 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $305.66
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	$152.83 – $611.32
Family psychotherapy, with the patient: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $160.47 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $152.83 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $183.40 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $152.83 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $366.79 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $351.51 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $152.83 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $305.66 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $305.66 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $154.36
Group psychotherapy CPT 90853 · Inpatient or outpatient In the file: GROUP THERAPY 54514	$568.75	$210.44	$28.36 – $47.63
Group psychotherapy: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $28.36 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $47.63 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $47.63 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $44.45 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $44.45 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $47.63
Group psychotherapy CPT 90853 · Inpatient (hospital stay) In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$87.99 – $351.96
Group psychotherapy: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $92.39 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $114.39 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $87.99 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $105.59 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $87.99 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $131.98 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $131.98 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $96.79 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $87.99 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $175.98
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$87.99 – $351.96
Group psychotherapy: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $92.39 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $87.99 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $105.59 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $87.99 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $211.18 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $202.38 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $87.99 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $175.98 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $175.98 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $88.87

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
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	$428.79 – $761.21
Removal of breast growth (open surgery): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $456.29 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $761.21 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $761.21 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $710.46 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $710.46 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $761.21 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $428.79
Total hip replacement CPT 27130 · Inpatient or outpatient In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$1,507.65 – $2,667.26
Total hip replacement: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $1,507.65 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $2,667.26 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $2,667.26 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $2,489.44 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $2,489.44 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $2,667.26 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $1,617.76
Total knee replacement CPT 27447 · Inpatient or outpatient In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$1,506.93 – $2,847.53
Total knee replacement: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $1,506.93 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $2,847.53 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $2,847.53 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $2,657.69 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $2,657.69 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $2,847.53 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $1,731.60
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	$198.08 – $735.71
Shoulder arthroscopy: shaving of shoulder bone: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $198.08 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $326.52 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $326.52 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $304.75 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $304.75 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $326.52 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $735.71
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	$593.82 – $1,001.33
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $593.82 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $1,001.33 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $1,001.33 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $934.57 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $934.57 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $1,001.33 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $698.99
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	$319.64 – $548.28
Removal of tonsils and adenoids (under age 12): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $319.64 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $548.28 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $548.28 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $511.73 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $511.73 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $548.28 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $324.59
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient In the file: EGD COMPLEX 43235	$2,564.25	$948.77	$139.96 – $273.47
Upper GI endoscopy (diagnostic): rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $139.96 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $273.46 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $273.47 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $255.23 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $255.23 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $273.47
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$891.83 – $3,567.32
Upper GI endoscopy (diagnostic): 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $936.42 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $1,159.38 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $891.83 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $1,070.20 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $891.83 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $1,337.75 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $1,337.75 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $981.01 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $891.83 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $1,783.66
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	$891.83 – $3,567.32
Upper GI endoscopy (diagnostic): 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $936.42 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $891.83 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $1,070.20 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $891.83 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $2,140.39 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $2,051.21 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $891.83 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $1,783.66 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $1,783.66 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $900.75
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient In the file: EGD W/BIOPSY 43239	$2,564.25	$948.77	$158.31 – $323.12
Upper GI endoscopy with biopsy: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $158.31 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $323.12 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $323.12 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $301.57 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $301.57 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $323.12
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$891.83 – $3,567.32
Upper GI endoscopy with biopsy: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $936.42 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $1,159.38 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $891.83 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $1,070.20 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $891.83 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $1,337.75 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $1,337.75 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $981.01 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $891.83 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $1,783.66
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	$891.83 – $3,567.32
Upper GI endoscopy with biopsy: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $936.42 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $891.83 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $1,070.20 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $891.83 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $2,140.39 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $2,051.21 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $891.83 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $1,783.66 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $1,783.66 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $900.75
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$867.24 – $3,468.96
Colonoscopy (diagnostic): 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $910.60 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $1,127.41 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $867.24 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $1,040.69 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $867.24 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $1,300.86 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $1,300.86 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $953.96 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $867.24 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $1,734.48
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$867.24 – $3,468.96
Colonoscopy (diagnostic): 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $910.60 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $867.24 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $1,040.69 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $867.24 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $2,081.38 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $1,994.65 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $867.24 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $1,734.48 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $1,734.48 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $875.91
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$867.24 – $3,468.96
Colonoscopy (diagnostic): rates for 8 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $211.46 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $408.82 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $408.83 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $381.57 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $381.57 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $408.83 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $252.77 VETERANS ADMINISTRATION — 2992_VETERANS ADMINISTRATION 20251001: $867.24
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$229.43 – $487.74
Colonoscopy with biopsy: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $229.43 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $487.74 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $487.74 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $455.22 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $455.22 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $487.74 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $304.48
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	$291.15 – $579.57
Colonoscopy with removal of polyps (snare): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $291.15 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $579.57 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $579.57 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $540.93 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $540.93 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $579.57 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $361.68
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	$295.07 – $557.13
Ultrasound of the lower bowel by endoscope: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $295.07 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $557.13 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $557.13 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $519.99 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $519.99 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $557.13 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $349.84
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$735.82 – $1,219.01
Gallbladder removal by laparoscope: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $735.82 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $1,219.01 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $1,219.01 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $1,137.74 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $1,137.74 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $1,219.01 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $800.23
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	$556.37 – $963.92
Groin (inguinal) hernia repair, age 5 or older: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $579.97 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $963.91 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $963.92 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $899.65 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $899.65 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $963.92 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $556.37
Prostate biopsy CPT 55700 · Inpatient or outpatient In the file: BX PROSTATE PERCU 55700	$6,519.50	$2,412.22	$148.39 – $257.82
Prostate biopsy: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $148.39 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $257.82 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $257.82 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $240.63 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $240.63 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $257.82
Prostate biopsy CPT 55700 · Inpatient or outpatient In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$148.39 – $257.82
Prostate biopsy: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $148.39 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $257.82 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $257.82 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $240.63 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $240.63 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $257.82 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $172.82
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$1,630.58 – $3,206.03
Prostate removal by laparoscope (radical prostatectomy): rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $1,630.58 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $3,206.03 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $3,206.03 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $2,992.29 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $2,992.29 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $3,206.03 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $2,203.98
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	$261.86 – $504.06
Hysteroscopy with biopsy of the uterus lining: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $261.86 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $504.06 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $504.06 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $470.46 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $470.46 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $504.06 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $312.73
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: SC EPIDURL STEROID INJ LUMB62323	$1,785.75	$660.73	$112.63 – $193.97
Spinal injection, lower back (epidural), with imaging guidance: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $112.63 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $193.97 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $193.97 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $181.03 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $181.03 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $193.97
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: SC EPIDURL STEROID INJ LUMB 62323	$1,785.75	$660.73	$112.63 – $193.97
Spinal injection, lower back (epidural), with imaging guidance: rates for 6 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $112.63 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $193.97 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $193.97 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $181.03 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $181.03 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $193.97
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$658.74 – $2,634.96
Spinal injection, lower back (epidural), with imaging guidance: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $691.68 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $856.36 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $658.74 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $790.49 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $658.74 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $988.11 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $988.11 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $724.61 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $658.74 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $1,317.48
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient In the file: L/S TRANS EPI UNILAT LT 6545	$1,736.75	$642.60	$123.80 – $214.97
Nerve root injection, lower back, with imaging guidance: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $124.57 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $214.97 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $214.97 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $200.63 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $200.63 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $214.97 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $123.80
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient In the file: L/S TRANS EPI UNILAT RT 45133	$1,736.75	$642.60	$123.80 – $214.97
Nerve root injection, lower back, with imaging guidance: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $124.57 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $214.97 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $214.97 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $200.63 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $200.63 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $214.97 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $123.80
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient In the file: INJ LUMB/SAC EPID SGL LEV BILAT	$3,473.50	$1,285.20	$123.80 – $214.97
Nerve root injection, lower back, with imaging guidance: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $124.57 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $214.97 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $214.97 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $200.63 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $200.63 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $214.97 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $123.80
Carpal tunnel release CPT 64721 · Inpatient or outpatient In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$442.88 – $782.30
Carpal tunnel release: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $464.01 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $782.29 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $782.30 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $730.14 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $730.14 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $782.30 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $442.88
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$521.84 – $2,087.36
Laser treatment of clouding after cataract surgery: 10 of 21 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $547.93 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $678.39 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $521.84 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $626.21 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $521.84 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $782.76 COMMUNITYCARE (SELECT) — 2975_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $782.76 COMMUNITYCARE (STANDARD) — 711_COMMUNITYCARE STANDARD INPATIENT 20180101: $574.02 COMMUNITYCARE SENIOR — 2978_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE INPATIENT GOVERNME: $521.84 CONNECT HEALTH BENEFIT — 2980_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT MEDICARE : $1,043.68
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	$521.84 – $2,087.36
Laser treatment of clouding after cataract surgery: 10 of 20 insurance plan rates BLUE CROSS BLUE SHIELD MEDICARE — 2695_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $547.93 CHAMPVA — 2690_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA OUTPA: $521.84 COMMUNITY CARE (SELECT) 7/1/13 — 2682_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT SELF FU: $626.21 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2683_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NETWORK OU: $521.84 COMMUNITY CARE SMARTHEALTH — 2680_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT - SELF : $1,252.42 COMMUNITYCARE (SELECT) — 2684_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE STANDARD - SELECT : $1,200.23 COMMUNITYCARE SENIOR — 2681_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE OUTPATIENT GOVERNM: $521.84 CONNECT HEALTH BENEFIT — 2696_BAOK, JPOK, MCOK, OHOK CONNECT HEALTH BENEFIT OUTPATIEN: $1,043.68 EVOLUTIONS — 2677_EVOLUTIONS AND RESOURCE ONE ADMINISTRATORS OUTPATIENT 2: $1,043.68 HUMANA MCR — 2700_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE HUMANA PPO OU: $527.06
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	$521.84 – $2,087.36
Laser treatment of clouding after cataract surgery: rates for 8 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $333.15 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $585.69 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $585.69 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $546.64 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $546.64 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $585.69 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $299.98 VETERANS ADMINISTRATION — 2992_VETERANS ADMINISTRATION 20251001: $521.84
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	$693.12 – $1,215.60
Cataract removal with lens implant: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $693.12 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $1,215.60 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $1,215.60 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $1,134.56 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $1,134.56 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $1,215.60 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $774.59

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
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	$2,004.50 – $4,496.82
Vaginal delivery, with care before and after: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $2,325.90 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $4,496.82 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $4,496.82 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $4,496.82 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $4,496.82 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $4,496.82 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $2,004.50
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	$2,269.84 – $4,968.74
Cesarean delivery (C-section), with care before and after: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $2,581.82 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $4,968.74 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $4,968.74 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $4,968.74 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $4,968.74 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $4,968.74 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $2,269.84
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	$2,110.97 – $4,108.71
Vaginal delivery after a previous C-section, with care before and after: rates for 7 insurance plans AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $2,448.74 BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $4,108.71 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $4,108.71 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $3,834.80 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $3,834.80 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $4,108.71 FIRST HEALTH — 2649_BAOK, JPOK, MCOK, OHOK FIRST HEALTH 20241001: $2,110.97

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	$60,671.95 – $136,511.89
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 33 insurance plan rates AETNA HMO/PPO — 2658_MCOK, BAOK, OHOK AETNA HMO 20241001: $11,033 AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $6,781 BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $63,705.55 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $78,873.54 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $60,671.95 CIGNA — 2655_MCOK CIGNA 20241001: $8,761 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $72,806.34 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $60,671.95 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $91,007.92 COMMUNITYCARE (SELECT) — 2641_NHOK, SPOK COMMUNITYCARE STANDARD - SELECT INPATIENT 20: $2,734.80
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	$1,100 – $16,493
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 5 insurance plans BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $1,100 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $1,100 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $1,100 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $1,100 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $1,100
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	$11,962.84 – $26,916.39
Hip or knee replacement (major joint of the leg), without major complications: 10 of 33 insurance plan rates AETNA HMO/PPO — 2658_MCOK, BAOK, OHOK AETNA HMO 20241001: $11,033 AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $6,781 BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $12,560.98 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $15,551.69 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $11,962.84 CIGNA — 2655_MCOK CIGNA 20241001: $8,761 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $14,355.41 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $11,962.84 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $17,944.26 COMMUNITYCARE (SELECT) — 2641_NHOK, SPOK COMMUNITYCARE STANDARD - SELECT INPATIENT 20: $2,734.80
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	$700 – $16,493
Hip or knee replacement (major joint of the leg), without major complications: rates for 5 insurance plans BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $700 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $700 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $700 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $700 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $700
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$15,140.70 – $34,066.58
Neck (cervical) spinal fusion, without complications: 10 of 33 insurance plan rates AETNA HMO/PPO — 2658_MCOK, BAOK, OHOK AETNA HMO 20241001: $11,033 AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $6,781 BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $15,897.74 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $19,682.91 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $15,140.70 CIGNA — 2655_MCOK CIGNA 20241001: $8,761 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $18,168.84 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $15,140.70 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $22,711.05 COMMUNITYCARE (SELECT) — 2641_NHOK, SPOK COMMUNITYCARE STANDARD - SELECT INPATIENT 20: $2,734.80
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	$700 – $16,493
Neck (cervical) spinal fusion, without complications: rates for 5 insurance plans BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $700 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $700 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $700 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $700 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $700
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$7,694.70 – $17,313.08
Uterus and ovary surgery (not for cancer), without complications: 10 of 33 insurance plan rates AETNA HMO/PPO — 2658_MCOK, BAOK, OHOK AETNA HMO 20241001: $11,033 AETNA WHOLE HEALTH — 2659_MCOK, BAOK, OHOK AETNA WHOLE HEALTH 20241001: $6,781 BLUE CROSS BLUE SHIELD MEDICARE — 2965_BAOK, JPOK, MCOK, OHOK BLUE CROSS BLUE SHIELD MEDICARE : $8,079.44 CCL&H — 2968_BAOK, JPOK, OHOK, MCOK COMMUNITY CARE LIFE AND HEALTH I: $10,003.11 CHAMPVA — 2969_MCOK, BAOK, OHOK, JPOK MEDICARE ADVANTAGE CHAMPVA INPAT: $7,694.70 CIGNA — 2655_MCOK CIGNA 20241001: $8,761 COMMUNITY CARE (SELECT) 7/1/13 — 2971_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP SELF FUNDED NON: $9,233.64 COMMUNITY CARE - ST JOHN NETWORK SENIOR - GOVT — 2970_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE ST JOHN NEWTORK IN: $7,694.70 COMMUNITY CARE SMARTHEALTH — 2973_JPOK, BAOK, MCOK, OHOK COMMUNITYCARE IP - SELF FUNDED A: $11,542.05 COMMUNITYCARE (SELECT) — 2641_NHOK, SPOK COMMUNITYCARE STANDARD - SELECT INPATIENT 20: $2,734.80
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	$700 – $16,493
Uterus and ovary surgery (not for cancer), without complications: rates for 5 insurance plans BLUE CROSS BLUE SHIELD BLUE ADVANTAGE — 2719_MCOK BLUE CROSS BLUE SHIELD BLUE ADVANTAGE INPATIENT 20: $700 BLUE CROSS BLUE SHIELD CHOICE — 2727_MCOK BLUE CROSS BLUE SHIELD BLUE CHOICE INPATIENT 20250: $700 BLUE CROSS BLUE SHIELD LINCS — 2731_MCOK BLUE CROSS BLUE SHIELD BLUE LINCS INPATIENT 202502: $700 BLUE CROSS BLUE SHIELD PREFERRED — 2736_MCOK BLUE CROSS BLUE SHIELD BLUE PREFERRED INPATIENT 20: $700 BLUE CROSS BLUE SHIELD TRADITIONAL — 2741_MCOK BLUE CROSS BLUE SHIELD BLUE TRADITIONAL INPATIENT : $700

Source: Ascension St John Medical Center’s standard charges file (healthcare.ascension.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on January 1, 2026; retrieved November 5, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	1923 South Utica Avenue, Tulsa, OK 74104
County	Tulsa County
State	Oklahoma
Phone	(918) 744‑2296
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	3 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	370114
Name in Medicare records	ASCENSION ST JOHN MEDICAL CENTER
Profile level	Medicare data + hospital website
Official website	healthcare.ascension.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

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

Ascension St. John Medical Center | Ascension — healthcare.ascension.org

Ascension St John Medical Center

Summary

Profile from official sources

At a glance