Does Central Montana Medical Center have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Central Montana Medical Center. In a medical emergency, call 911.

Where is Central Montana Medical Center?

408 Wendell Ave, Lewistown, MT 59457, in Fergus County, Montana.

What is the phone number of Central Montana Medical Center?

(406) 535-7711, as listed by Medicare (CMS).

What is the Medicare star rating of Central Montana Medical Center?

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

Central Montana Medical Center — Lewistown, MT

Quick answers

Does Central Montana Medical Center have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Central Montana Medical Center. In a medical emergency, call 911.
Where is Central Montana Medical Center?: 408 Wendell Ave, Lewistown, MT 59457, in Fergus County, Montana.
What is the phone number of Central Montana Medical Center?: (406) 535-7711, as listed by Medicare (CMS).
What is the Medicare star rating of Central Montana Medical Center?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas^{[4][5][6][10][13]}

Primary care
Emergency medicine
Maternity
Behavioral health
General surgery
Orthopedics
Podiatry and foot and ankle surgery
Oncology (Helmsley Cancer Center)
Pain management (non-surgical)
Physical, occupational and speech therapy
Cardiac rehabilitation
Pulmonary rehabilitation
Home health
Hospice
Occupational health
Obstetrics
Radiology

Conditions treated^[9]

Cancer

Treatments^[5][9]

Radiation oncology
Medical oncology
Diabetes education
Nutrition counseling
Chemotherapy
Radiation therapy
Immunotherapy

Procedures^{[4][5][10][13]}

PET/CT imaging (mobile)
Concussion testing
PADnet testing
Diagnostic X-ray
CT scan
MRI
Ultrasound
Nuclear medicine
Mammography
DEXA scan
Cesarean delivery
Newborn screening (including audiometry)

Programs and centers^{[4][5][10][12][14]}

Cardiovascular Disease and Diabetes Prevention Program
Care coordination
Fitness center
Cardiac rehabilitation
Pulmonary rehabilitation
Women's Cancer Support Group
Shh...Nap Time (OB visiting program)
Ambulance services

Emergency care (hospital website)^[6][8]

Emergency room	Yes
Open 24/7	Yes
Trauma designation	Level IV

Visiting and practical information

Visiting	Generally 7 a.m. to 9 p.m.; after-hours visits need prior approval from nursing leadership^[7]
Patient portal	PatientConnect

Doctors and clinicians (95)

95 doctors and other clinicians list Central Montana 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

Doctors with a page on this site (95)

Adam E. Dowell, MDUrology
Adam M. Zelka, MDFamily Practice
Amber L. Close, NPNurse Practitioner
Amie N. BaguerNurse Practitioner
Amy Goffena, NPNurse Practitioner
Anastasios Saliaris, MDCardiac Electrophysiology
Annette C. Comes, MDFamily Practice
Bruno S. Oliveira, MDRheumatology
Bryan E. Martin, MDMedical Oncology
Caleb Hixson, DODermatology
Charles Ellis, MDUrology
Charles Perricone, MDFamily Practice
Chelsea Rambo, DOFamily Practice
Christina A. Kavran, DOPathology
Christopher C. Goulet, MDRadiation Oncology
Christopher K. Schreiber, MDUrology
Cindy H. Swan, NPNurse Practitioner
Clancy J. Hartman, NPNurse Practitioner
Dale Hoekema, MDInternal Medicine
Daniel E. Swanson, MDUrology
Daniel Hebert, MDOrthopedic Surgery
Daniel Offerdahl, CNACertified Registered Nurse Anesthetist (CRNA)
David A. Boes, MDOphthalmology
David F. Christianson, MDHematology/Oncology

And 71 more: the button below opens the full list.

Other emergency rooms nearby

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

Wheatland Memorial Hospital47 mi · Harlowton, MT · Critical Access Hospital
Roundup Memorial Healthcare60 mi · Roundup, MT · Critical Access Hospital
Mountainview Medical Center78 mi · White Sulphur Spring, MT · Critical Access Hospital
Missouri River Medical Center78 mi · Fort Benton, MT · Critical Access Hospital
Big Sandy Medical Center83 mi · Big Sandy, MT · Critical Access Hospital

Other hospitals nearby

Pioneer Medical Center88 mi · Big Timber, MT · Critical Access 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

Valle Vista Rehabilitation and Nursing LLC0.8 mi · Lewistown, MT · 4 of 5 stars
Montana Mental Health Nursing Home1.1 mi · Lewistown, MT · 4 of 5 stars

All nursing homes in the state →

Hospice providers

Hospice of Central Montana8.3 mi · Lewistown, MT

All hospice providers in the state →

Home health agencies

Central Montana MC Home Health8.3 mi · Lewistown, MT

All home health agencies 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

One Health - Lewistown0.8 mi · Lewistown, MT · Community health center

Pharmacies

Albertsons LLC8.3 mi · Lewistown, MT · Community/retail pharmacy
Bighorn Valley Health Center, Incorporated8.3 mi · Lewistown, MT · Community/retail pharmacy
Montana Mental Health Nursing Care Center8.3 mi · Lewistown, MT · Pharmacy

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 Central Montana 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)	4 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	4 of 5 stars
Staff explained medicines	4 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	66%National average: 72%
Would definitely recommend the hospital	63%National average: 71%
Nurses “always” communicated well	80%National average: 80%
Doctors “always” communicated well	82%National average: 80%
Staff “always” explained medicines before giving them	67%National average: 62%
Were given information about recovery at home	87%National average: 86%
Room and bathroom “always” clean	71%National average: 74%
Area around the room “always” quiet at night	65%National average: 60%
Completed surveys	123Response rate: 32%

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)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	Not reported to Medicare

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026.

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	Too few cases to report
Deaths within 30 days: heart failure patients	Too few cases to report
Deaths within 30 days: pneumonia patients	15.1%
Deaths within 30 days: COPD patients	Too few cases to report
Deaths within 30 days: stroke patients	Too few cases to report
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	Not reported to Medicare
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	Not reported to Medicare
Readmitted within 30 days: heart failure	Too few cases to report
Readmitted within 30 days: pneumonia	17.1%
Readmitted within 30 days: COPD	Too few cases to report
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
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.

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	102 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	0%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	Not reported to Medicare

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

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 Montana

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 74 common services exactly as Central Montana 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 · Outpatient (no overnight stay) In the file: New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	$123	$104.55	$65.19 – $222.63
New patient office visit (about 30–44 minutes): 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $118.08 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $222.63 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $110.70 BCBS FEP — BCBS FEP: $125.45 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $110.70 BCBS MCR ADV — BCBS MCR ADV: $65.19 BCBS POS — BCBS POS: $110.70 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $123 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $114.39 EBMS - ALL PLANS — EBMS - ALL PLANS: $116.85
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	$159	$135.15	$84.27 – $287.79
New patient office visit (about 45–59 minutes): 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $152.64 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $287.79 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $143.10 BCBS FEP — BCBS FEP: $214.55 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $143.10 BCBS MCR ADV — BCBS MCR ADV: $84.27 BCBS POS — BCBS POS: $143.10 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $159 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $147.87 EBMS - ALL PLANS — EBMS - ALL PLANS: $151.05
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	$187	$158.95	$99.11 – $338.47
New patient office visit (about 60–74 minutes): 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $179.52 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $338.47 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $168.30 BCBS FEP — BCBS FEP: $280.20 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $168.30 BCBS MCR ADV — BCBS MCR ADV: $99.11 BCBS POS — BCBS POS: $168.30 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $187 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $173.91 EBMS - ALL PLANS — EBMS - ALL PLANS: $177.65
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Established patient office or other outpatient visit with low level of decision making, if using time, 20 minutes or more	$105	$89.25	$55.65 – $190.05
Established patient office visit (about 20–29 minutes): 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $100.80 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $190.05 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $94.50 BCBS FEP — BCBS FEP: $85 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $94.50 BCBS MCR ADV — BCBS MCR ADV: $55.65 BCBS POS — BCBS POS: $94.50 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $105 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $97.65 EBMS - ALL PLANS — EBMS - ALL PLANS: $99.75
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$119	$101.15	$63.07 – $215.39
Established patient office visit (about 30–39 minutes): 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $114.24 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $215.39 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $107.10 BCBS FEP — BCBS FEP: $130.72 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $107.10 BCBS MCR ADV — BCBS MCR ADV: $63.07 BCBS POS — BCBS POS: $107.10 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $119 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $110.67 EBMS - ALL PLANS — EBMS - ALL PLANS: $113.05
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: Office or other outpatient consultation with low level of medical decision making, if using time, 30 minutes or more	$251	$213.35	$148.78 – $158.92
Office consultation with a specialist (moderate): rates for 5 insurance plans ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $155 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $155 EBMS - ALL PLANS — EBMS - ALL PLANS: $158.92 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $150.70 MONTANA HEALTH CO-OP - ALL PLANS — MONTANA HEALTH CO-OP - ALL PLANS: $148.78
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: Office or other outpatient consultation with moderate level of medical decision making, if using time, 40 minutes or more	$376	$319.60	$239.46 – $255.78
Office consultation with a specialist (moderate to high): rates for 5 insurance plans ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $249.47 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $249.47 EBMS - ALL PLANS — EBMS - ALL PLANS: $255.78 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $242.55 MONTANA HEALTH CO-OP - ALL PLANS — MONTANA HEALTH CO-OP - ALL PLANS: $239.46
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) In the file: Initial new patient preventive medicine evaluation (18-39 years)	$79	$67.15	$148.25 – $164.72
Preventive checkup, new patient, age 18–39: rates for 10 insurance plans ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $158.96 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $158.96 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $148.25 BCBS FEP — BCBS FEP: $164.72 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $148.25 BCBS POS — BCBS POS: $148.25 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $151.54 EBMS - ALL PLANS — EBMS - ALL PLANS: $162.98 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $154.55 MONTANA HEALTH CO-OP - ALL PLANS — MONTANA HEALTH CO-OP - ALL PLANS: $152.58
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) In the file: Initial new patient preventive medicine evaluation (40-64 years)	$79	$67.15	$179.90 – $199.89
Preventive checkup, new patient, age 40–64: rates for 10 insurance plans ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $192.90 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $192.90 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $179.90 BCBS FEP — BCBS FEP: $199.89 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $179.90 BCBS POS — BCBS POS: $179.90 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $183.90 EBMS - ALL PLANS — EBMS - ALL PLANS: $197.78 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $187.55 MONTANA HEALTH CO-OP - ALL PLANS — MONTANA HEALTH CO-OP - ALL PLANS: $185.16
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: Emergency department visit with low level of medical decision making	$611	$519.35	$323.83 – $1,105.91
Emergency room visit (moderate): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $586.56 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $1,105.91 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $549.90 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $549.90 BCBS MCR ADV — BCBS MCR ADV: $323.83 BCBS POS — BCBS POS: $549.90 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $611 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $568.23 EBMS - ALL PLANS — EBMS - ALL PLANS: $580.45 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $586.56
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: Emergency department visit with low level of medical decision making	$558	$474.30	$68.14 – $107.86
Emergency room visit (moderate): 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $104.09 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $104.09 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $97.07 BCBS FEP — BCBS FEP: $107.86 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $97.07 BCBS MCR ADV — BCBS MCR ADV: $68.14 BCBS POS — BCBS POS: $97.07 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $99.23 EBMS - ALL PLANS — EBMS - ALL PLANS: $106.72 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $101.20
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: Emergency department visit with moderate level of medical decision making	$1,048	$890.80	$555.44 – $1,896.88
Emergency room visit (moderately high): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $1,006.08 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $1,896.88 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $943.20 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $943.20 BCBS MCR ADV — BCBS MCR ADV: $555.44 BCBS POS — BCBS POS: $943.20 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $1,048 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $974.64 EBMS - ALL PLANS — EBMS - ALL PLANS: $995.60 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $1,006.08
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: Emergency department visit with moderate level of medical decision making	$836	$710.60	$116.24 – $198.14
Emergency room visit (moderately high): 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $191.21 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $191.21 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $178.33 BCBS FEP — BCBS FEP: $198.14 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $178.33 BCBS MCR ADV — BCBS MCR ADV: $116.24 BCBS POS — BCBS POS: $178.33 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $182.29 EBMS - ALL PLANS — EBMS - ALL PLANS: $196.04 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $185.90
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: Emergency department visit with high level of medical decision making	$1,540	$1,309	$816.20 – $2,787.40
Emergency room visit (high): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $1,478.40 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $2,787.40 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $1,386 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $1,386 BCBS MCR ADV — BCBS MCR ADV: $816.20 BCBS POS — BCBS POS: $1,386 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $1,540 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $1,432.20 EBMS - ALL PLANS — EBMS - ALL PLANS: $1,463 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $1,478.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: Emergency department visit with high level of medical decision making	$1,210	$1,028.50	$168.54 – $287.82
Emergency room visit (high): 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $277.76 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $277.76 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $259.04 BCBS FEP — BCBS FEP: $287.82 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $259.04 BCBS MCR ADV — BCBS MCR ADV: $168.54 BCBS POS — BCBS POS: $259.04 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $264.79 EBMS - ALL PLANS — EBMS - ALL PLANS: $284.78 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $270.05

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: Blood test, basic group of blood chemicals (Calcium, total)	$102.25	$86.91	$8.65 – $185.07
Basic metabolic panel (blood test): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $98.16 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $185.07 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $92.03 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $18.27 BCBS MCR ADV — BCBS MCR ADV: $54.19 BCBS POS — BCBS POS: $92.03 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $18.27 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $95.09 EBMS - ALL PLANS — EBMS - ALL PLANS: $97.14 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $98.16
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: Blood test, comprehensive group of blood chemicals	$118.75	$100.94	$12.54 – $214.94
Comprehensive metabolic panel (blood test): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $114 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $214.94 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $106.88 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $22.82 BCBS MCR ADV — BCBS MCR ADV: $62.94 BCBS POS — BCBS POS: $106.88 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $22.82 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $110.44 EBMS - ALL PLANS — EBMS - ALL PLANS: $112.81 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $114
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: Obstetric blood test panel	$454.75	$386.54	$103.26 – $823.10
Obstetric blood test panel: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $436.56 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $823.10 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $409.28 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $103.26 BCBS MCR ADV — BCBS MCR ADV: $241.02 BCBS POS — BCBS POS: $409.28 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $103.26 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $422.92 EBMS - ALL PLANS — EBMS - ALL PLANS: $432.01 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $436.56
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: Blood test, lipids (cholesterol and triglycerides)	$124	$105.40	$16.60 – $224.44
Cholesterol panel (lipid panel): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $119.04 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $224.44 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $111.60 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $28.93 BCBS MCR ADV — BCBS MCR ADV: $65.72 BCBS POS — BCBS POS: $111.60 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $28.93 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $115.32 EBMS - ALL PLANS — EBMS - ALL PLANS: $117.80 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $119.04
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: Kidney function blood test panel	$107	$90.95	$9.29 – $193.67
Kidney function panel: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $102.72 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $193.67 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $96.30 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $18.75 BCBS MCR ADV — BCBS MCR ADV: $56.71 BCBS POS — BCBS POS: $96.30 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $18.75 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $99.51 EBMS - ALL PLANS — EBMS - ALL PLANS: $101.65 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $102.72
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: Liver function blood test panel	$109.75	$93.29	$8.97 – $198.65
Liver function panel: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $105.36 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $198.65 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $98.78 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $17.65 BCBS MCR ADV — BCBS MCR ADV: $58.17 BCBS POS — BCBS POS: $98.78 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $17.65 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $102.07 EBMS - ALL PLANS — EBMS - ALL PLANS: $104.26 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $105.36
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: Manual urinalysis test with examination using microscope, automated	$53.25	$45.26	$1.69 – $96.38
Urine test (automated, with microscope): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $51.12 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $96.38 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $47.93 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $6.85 BCBS MCR ADV — BCBS MCR ADV: $28.22 BCBS POS — BCBS POS: $47.93 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $6.85 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $49.52 EBMS - ALL PLANS — EBMS - ALL PLANS: $50.59 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $51.12
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: Urinalysis, manual test	$11.25	$9.56	$0.39 – $20.36
Urine test (manual, without microscope): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $10.80 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $20.36 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $10.13 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $7.52 BCBS MCR ADV — BCBS MCR ADV: $5.96 BCBS POS — BCBS POS: $10.13 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $7.52 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $10.46 EBMS - ALL PLANS — EBMS - ALL PLANS: $10.69 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $10.80
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: Automated urinalysis test	$42.25	$35.91	$0.95 – $76.47
Urine test (automated, without microscope): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $40.56 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $76.47 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $38.03 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $4.86 BCBS MCR ADV — BCBS MCR ADV: $22.39 BCBS POS — BCBS POS: $38.03 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $4.86 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $39.29 EBMS - ALL PLANS — EBMS - ALL PLANS: $40.14 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $40.56
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · modifier QW In the file: Automated urinalysis test	$17	$14.45	$2.25 – $54.30
Urine test (automated, without microscope): rates for 9 insurance plans ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $50 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $50 BCBS MCR ADV — BCBS MCR ADV: $2.25 EBMS - ALL PLANS — EBMS - ALL PLANS: $47.50 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $48 HUMANA MCR ADV - ALL PLANS — HUMANA MCR ADV - ALL PLANS: $2.25 MONTANA HEALTH CO-OP - ALL PLANS — MONTANA HEALTH CO-OP - ALL PLANS: $54.30 TRIWEST - ALL PLANS — TRIWEST - ALL PLANS: $2.25 VETERANS AFFAIRS - ALL PLANS — VETERANS AFFAIRS - ALL PLANS: $2.25
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA (prostate specific antigen) measurement, total	$128.50	$109.23	$23.63 – $232.59
PSA (prostate specific antigen) blood test: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $123.36 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $232.59 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $115.65 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $39.73 BCBS MCR ADV — BCBS MCR ADV: $68.11 BCBS POS — BCBS POS: $115.65 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $39.73 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $119.51 EBMS - ALL PLANS — EBMS - ALL PLANS: $122.08 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $123.36
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: Blood test, thyroid stimulating hormone (TSH)	$110.25	$93.71	$18.52 – $199.55
Thyroid stimulating hormone (TSH) test: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $105.84 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $199.55 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $99.23 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $36.29 BCBS MCR ADV — BCBS MCR ADV: $58.43 BCBS POS — BCBS POS: $99.23 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $36.29 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $102.53 EBMS - ALL PLANS — EBMS - ALL PLANS: $104.74 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $105.84
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	$82.75	$70.34	$6.43 – $149.78
Complete blood count (CBC) with differential: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $79.44 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $149.78 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $74.48 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $16.78 BCBS MCR ADV — BCBS MCR ADV: $43.86 BCBS POS — BCBS POS: $74.48 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $16.78 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $76.96 EBMS - ALL PLANS — EBMS - ALL PLANS: $78.61 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $79.44
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: Complete blood cell count (red cells, white blood cell, platelets), automated test	$66.50	$56.53	$4.30 – $120.37
Complete blood count (CBC), automated: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $63.84 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $120.37 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $59.85 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $13.97 BCBS MCR ADV — BCBS MCR ADV: $35.25 BCBS POS — BCBS POS: $59.85 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $13.97 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $61.85 EBMS - ALL PLANS — EBMS - ALL PLANS: $63.18 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $63.84
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: Blood test, clotting time	$53.50	$45.48	$2.30 – $96.84
Blood clotting time test (prothrombin time, PT): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $51.36 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $96.84 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $48.15 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $9.26 BCBS MCR ADV — BCBS MCR ADV: $28.36 BCBS POS — BCBS POS: $48.15 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $9.26 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $49.76 EBMS - ALL PLANS — EBMS - ALL PLANS: $50.83 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $51.36
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: Coagulation assessment blood test, plasma or whole blood	$117.25	$99.66	$7.05 – $212.22
Blood clotting test (partial thromboplastin time, PTT): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $112.56 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $212.22 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $105.53 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $12.98 BCBS MCR ADV — BCBS MCR ADV: $62.14 BCBS POS — BCBS POS: $105.53 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $12.98 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $109.04 EBMS - ALL PLANS — EBMS - ALL PLANS: $111.39 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $112.56

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT scan head or brain without contrast	$1,485	$1,262.25	$190.35 – $2,687.85
CT scan of the head or brain, without contrast: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $1,425.60 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $2,687.85 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $1,336.50 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $190.35 BCBS MCR ADV — BCBS MCR ADV: $787.05 BCBS POS — BCBS POS: $1,336.50 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $190.35 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $1,381.05 EBMS - ALL PLANS — EBMS - ALL PLANS: $1,410.75 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $1,425.60
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · modifier 26 In the file: CT scan head or brain without contrast	$222.75	$189.34	$38.79 – $72.60
CT scan of the head or brain, without contrast: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $68.45 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $68.45 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $63.84 BCBS FEP — BCBS FEP: $70.93 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $63.84 BCBS MCR ADV — BCBS MCR ADV: $38.79 BCBS POS — BCBS POS: $63.84 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $65.26 EBMS - ALL PLANS — EBMS - ALL PLANS: $72.60 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $70.18
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI scan of brain before and after contrast	$2,980.50	$2,533.43	$655.06 – $5,394.71
MRI of the brain, before and after contrast: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,861.28 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $5,394.71 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,682.45 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $655.06 BCBS MCR ADV — BCBS MCR ADV: $1,579.67 BCBS POS — BCBS POS: $2,682.45 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $655.06 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,771.87 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,831.48 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $2,861.28
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · modifier 52 In the file: MRI scan of brain before and after contrast	$2,980.50	$2,533.43	$655.06 – $5,394.71
MRI of the brain, before and after contrast: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,861.28 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $5,394.71 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,682.45 BCBS FEP — BCBS FEP: $190.52 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $655.06 BCBS MCR ADV — BCBS MCR ADV: $1,579.67 BCBS POS — BCBS POS: $2,682.45 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $655.06 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,771.87 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,831.48
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · modifier 26 In the file: MRI scan of brain before and after contrast	$446.50	$379.53	$104.71 – $195
MRI of the brain, before and after contrast: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $183.85 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $183.85 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $171.47 BCBS FEP — BCBS FEP: $190.52 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $171.47 BCBS MCR ADV — BCBS MCR ADV: $104.71 BCBS POS — BCBS POS: $171.47 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $175.28 EBMS - ALL PLANS — EBMS - ALL PLANS: $195 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $188.50
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: X-ray of chest, 2 views	$351.50	$298.78	$186.30 – $636.22
Chest X-ray, 2 views: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $337.44 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $636.22 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $316.35 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $316.35 BCBS MCR ADV — BCBS MCR ADV: $186.30 BCBS POS — BCBS POS: $316.35 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $351.50 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $326.90 EBMS - ALL PLANS — EBMS - ALL PLANS: $333.93 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $337.44
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · modifier 26 In the file: X-ray of chest, 2 views	$41	$34.85	$10.02 – $18.60
Chest X-ray, 2 views: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $17.54 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $17.54 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $16.35 BCBS FEP — BCBS FEP: $18.17 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $16.35 BCBS MCR ADV — BCBS MCR ADV: $10.02 BCBS POS — BCBS POS: $16.35 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $16.72 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $326.90 EBMS - ALL PLANS — EBMS - ALL PLANS: $18.60
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: X-ray of lower and sacral spine, minimum of 4 views	$676	$574.60	$92.38 – $1,223.56
X-ray of the lower spine, at least 4 views: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $648.96 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $1,223.56 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $608.40 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $92.38 BCBS MCR ADV — BCBS MCR ADV: $358.28 BCBS POS — BCBS POS: $608.40 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $92.38 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $628.68 EBMS - ALL PLANS — EBMS - ALL PLANS: $642.20 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $648.96
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · modifier 26 In the file: X-ray of lower and sacral spine, minimum of 4 views	$76.50	$65.03	$12.28 – $22.20
X-ray of the lower spine, at least 4 views: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $20.93 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $20.93 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $19.52 BCBS FEP — BCBS FEP: $21.69 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $19.52 BCBS MCR ADV — BCBS MCR ADV: $12.28 BCBS POS — BCBS POS: $19.52 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $19.95 EBMS - ALL PLANS — EBMS - ALL PLANS: $22.20 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $21.46
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI scan of lower spinal canal without contrast	$2,327.75	$1,978.59	$374.18 – $4,213.23
MRI of the lower back (lumbar spine), without contrast: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,234.64 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $4,213.23 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,094.98 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $374.18 BCBS MCR ADV — BCBS MCR ADV: $1,233.71 BCBS POS — BCBS POS: $2,094.98 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $374.18 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,164.81 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,211.36 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $2,234.64
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · modifier 52 In the file: MRI scan of lower spinal canal without contrast	$2,327.75	$1,978.59	$374.18 – $4,213.23
MRI of the lower back (lumbar spine), without contrast: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,234.64 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $4,213.23 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,094.98 BCBS FEP — BCBS FEP: $123.69 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $374.18 BCBS MCR ADV — BCBS MCR ADV: $1,233.71 BCBS POS — BCBS POS: $2,094.98 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $374.18 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,164.81 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,211.36
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · modifier 26 \| 52 In the file: MRI scan of lower spinal canal without contrast	$348.25	$296.01	$67.55 – $126.60
MRI of the lower back (lumbar spine), without contrast: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $119.36 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $119.36 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $111.32 BCBS FEP — BCBS FEP: $123.69 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $111.32 BCBS MCR ADV — BCBS MCR ADV: $67.55 BCBS POS — BCBS POS: $111.32 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $113.79 EBMS - ALL PLANS — EBMS - ALL PLANS: $126.60 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $122.38
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT scan of pelvis with contrast	$2,217.75	$1,885.09	$482.42 – $4,014.13
CT scan of the pelvis, with contrast: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,129.04 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $4,014.13 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $1,995.98 BCBS FEP — BCBS FEP: $96.14 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $482.42 BCBS MCR ADV — BCBS MCR ADV: $1,175.41 BCBS POS — BCBS POS: $1,995.98 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $482.42 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,062.51 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,106.86
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · modifier 26 In the file: CT scan of pelvis with contrast	$332.50	$282.63	$52.69 – $98.40
CT scan of the pelvis, with contrast: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $92.77 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $92.77 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $86.53 BCBS FEP — BCBS FEP: $96.14 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $86.53 BCBS MCR ADV — BCBS MCR ADV: $52.69 BCBS POS — BCBS POS: $86.53 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $88.45 EBMS - ALL PLANS — EBMS - ALL PLANS: $98.40 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $95.12
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier 52 \| LT In the file: MRI scan of leg joint without contrast	$2,351	$1,998.35	$421.78 – $4,255.31
MRI of a leg joint (such as the knee), without contrast: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,256.96 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $4,255.31 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,115.90 BCBS FEP — BCBS FEP: $112.55 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $421.78 BCBS MCR ADV — BCBS MCR ADV: $1,246.03 BCBS POS — BCBS POS: $2,115.90 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $421.78 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,186.43 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,233.45
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier 52 \| RT In the file: MRI scan of leg joint without contrast	$2,351	$1,998.35	$421.78 – $4,255.31
MRI of a leg joint (such as the knee), without contrast: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,256.96 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $4,255.31 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,115.90 BCBS FEP — BCBS FEP: $112.55 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $421.78 BCBS MCR ADV — BCBS MCR ADV: $1,246.03 BCBS POS — BCBS POS: $2,115.90 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $421.78 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,186.43 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,233.45
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier LT In the file: MRI scan of leg joint without contrast	$2,351	$1,998.35	$421.78 – $4,255.31
MRI of a leg joint (such as the knee), without contrast: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,256.96 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $4,255.31 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,115.90 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $421.78 BCBS MCR ADV — BCBS MCR ADV: $1,246.03 BCBS POS — BCBS POS: $2,115.90 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $421.78 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,186.43 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,233.45 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $2,256.96
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT scan of abdomen and pelvis with contrast	$2,342.75	$1,991.34	$617.73 – $4,240.38
CT scan of the abdomen and pelvis, with contrast: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,249.04 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $4,240.38 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,108.48 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $617.73 BCBS MCR ADV — BCBS MCR ADV: $1,241.66 BCBS POS — BCBS POS: $2,108.48 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $617.73 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,178.76 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,225.61 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $2,249.04
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · modifier 26 In the file: CT scan of abdomen and pelvis with contrast	$351	$298.35	$83.38 – $155.40
CT scan of the abdomen and pelvis, with contrast: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $146.52 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $146.52 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $136.65 BCBS FEP — BCBS FEP: $151.83 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $136.65 BCBS MCR ADV — BCBS MCR ADV: $83.38 BCBS POS — BCBS POS: $136.65 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $139.68 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,178.76 EBMS - ALL PLANS — EBMS - ALL PLANS: $155.40
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: Complete ultrasound scan of abdomen	$852	$724.20	$215.55 – $1,542.12
Ultrasound of the abdomen, complete: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $817.92 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $1,542.12 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $766.80 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $215.55 BCBS MCR ADV — BCBS MCR ADV: $451.56 BCBS POS — BCBS POS: $766.80 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $215.55 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $792.36 EBMS - ALL PLANS — EBMS - ALL PLANS: $809.40 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $817.92
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · modifier 26 In the file: Complete ultrasound scan of abdomen	$129	$109.65	$36.85 – $69.60
Ultrasound of the abdomen, complete: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $65.62 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $65.62 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $61.20 BCBS FEP — BCBS FEP: $68 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $61.20 BCBS MCR ADV — BCBS MCR ADV: $36.85 BCBS POS — BCBS POS: $61.20 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $62.56 EBMS - ALL PLANS — EBMS - ALL PLANS: $69.60 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $67.28
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: Ultrasound scan of pregnant uterus (14 weeks or more), single or first fetus	$493.50	$419.48	$237.01 – $893.24
Pregnancy ultrasound (after the first trimester): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $473.76 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $893.24 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $444.15 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $237.01 BCBS MCR ADV — BCBS MCR ADV: $261.56 BCBS POS — BCBS POS: $444.15 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $237.01 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $458.96 EBMS - ALL PLANS — EBMS - ALL PLANS: $468.83 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $473.76
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · modifier 26 In the file: Ultrasound scan of pregnant uterus (14 weeks or more), single or first fetus	$143.25	$121.76	$45.58 – $84.60
Pregnancy ultrasound (after the first trimester): 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $79.76 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $79.76 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $74.39 BCBS FEP — BCBS FEP: $82.65 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $74.39 BCBS MCR ADV — BCBS MCR ADV: $45.58 BCBS POS — BCBS POS: $74.39 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $76.04 EBMS - ALL PLANS — EBMS - ALL PLANS: $84.60 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $81.78
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina	$646.50	$549.53	$232.35 – $1,170.17
Transvaginal ultrasound: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $620.64 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $1,170.17 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $581.85 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $232.35 BCBS MCR ADV — BCBS MCR ADV: $342.65 BCBS POS — BCBS POS: $581.85 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $232.35 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $601.25 EBMS - ALL PLANS — EBMS - ALL PLANS: $614.18 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $620.64
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · modifier 26 In the file: Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina	$97.75	$83.09	$31.68 – $58.80
Transvaginal ultrasound: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $55.44 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $55.44 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $51.71 BCBS FEP — BCBS FEP: $57.45 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $51.71 BCBS MCR ADV — BCBS MCR ADV: $31.68 BCBS POS — BCBS POS: $51.71 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $52.85 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $601.25 EBMS - ALL PLANS — EBMS - ALL PLANS: $58.80
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: Diagnostic mammography of 1 breast	$312.25	$265.41	$165.49 – $565.17
Diagnostic mammogram, one breast: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $299.76 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $565.17 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $281.03 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $244.48 BCBS MCR ADV — BCBS MCR ADV: $165.49 BCBS POS — BCBS POS: $281.03 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $244.48 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $290.39 EBMS - ALL PLANS — EBMS - ALL PLANS: $296.64 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $299.76
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · modifier 26 In the file: Diagnostic mammography of 1 breast	$85.75	$72.89	$36.85 – $69.60
Diagnostic mammogram, one breast: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $65.62 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $65.62 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $61.20 BCBS FEP — BCBS FEP: $68 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $61.20 BCBS MCR ADV — BCBS MCR ADV: $36.85 BCBS POS — BCBS POS: $61.20 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $62.56 EBMS - ALL PLANS — EBMS - ALL PLANS: $69.60 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $67.28
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: Diagnostic mammography of both breasts	$419.25	$356.36	$222.20 – $758.84
Diagnostic mammogram, both breasts: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $402.48 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $758.84 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $377.33 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $311.66 BCBS MCR ADV — BCBS MCR ADV: $222.20 BCBS POS — BCBS POS: $377.33 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $311.66 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $389.90 EBMS - ALL PLANS — EBMS - ALL PLANS: $398.29 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $402.48
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · modifier 26 In the file: Diagnostic mammography of both breasts	$107	$90.95	$45.26 – $85.20
Diagnostic mammogram, both breasts: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $80.33 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $80.33 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $74.92 BCBS FEP — BCBS FEP: $83.24 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $74.92 BCBS MCR ADV — BCBS MCR ADV: $45.26 BCBS POS — BCBS POS: $74.92 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $76.58 EBMS - ALL PLANS — EBMS - ALL PLANS: $85.20 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $82.36
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: Screening mammography	$321	$272.85	$170.13 – $581.01
Screening mammogram, both breasts: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $308.16 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $581.01 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $288.90 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $258.48 BCBS MCR ADV — BCBS MCR ADV: $170.13 BCBS POS — BCBS POS: $288.90 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $258.48 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $298.53 EBMS - ALL PLANS — EBMS - ALL PLANS: $304.95 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $308.16
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · modifier 52 In the file: Screening mammography	$321	$272.85	$170.13 – $581.01
Screening mammogram, both breasts: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $308.16 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $581.01 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $288.90 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $258.48 BCBS MCR ADV — BCBS MCR ADV: $170.13 BCBS POS — BCBS POS: $288.90 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $258.48 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $298.53 EBMS - ALL PLANS — EBMS - ALL PLANS: $304.95 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $308.16
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · modifier 26 In the file: Screening mammography	$83	$70.55	$34.91 – $65.40
Screening mammogram, both breasts: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $61.66 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $61.66 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $57.51 BCBS FEP — BCBS FEP: $63.90 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $57.51 BCBS MCR ADV — BCBS MCR ADV: $34.91 BCBS POS — BCBS POS: $57.51 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $58.79 EBMS - ALL PLANS — EBMS - ALL PLANS: $65.40 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $63.22

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · modifier 26 In the file: Sleep study in sleep lab (6 years or older)	$4,056.25	$3,447.81	$1,283.97 – $7,341.81
Sleep study (overnight, in a sleep lab): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $3,894 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $7,341.81 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $3,650.63 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $1,283.97 BCBS MCR ADV — BCBS MCR ADV: $2,149.81 BCBS POS — BCBS POS: $3,650.63 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $1,283.97 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $3,772.31 EBMS - ALL PLANS — EBMS - ALL PLANS: $3,853.44 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $3,894

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier GO In the file: Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes	$125.50	$106.68	$56.10 – $227.16
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $120.48 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $227.16 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $112.95 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $56.10 BCBS MCR ADV — BCBS MCR ADV: $66.52 BCBS POS — BCBS POS: $112.95 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $56.10 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $116.72 EBMS - ALL PLANS — EBMS - ALL PLANS: $119.23 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $120.48
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier GP In the file: Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes	$125.50	$106.68	$56.10 – $227.16
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $120.48 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $227.16 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $112.95 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $56.10 BCBS MCR ADV — BCBS MCR ADV: $66.52 BCBS POS — BCBS POS: $112.95 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $56.10 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $116.72 EBMS - ALL PLANS — EBMS - ALL PLANS: $119.23 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $120.48
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · modifier GP In the file: Evaluation for physical therapy, typically 20 minutes	$250.25	$212.71	$132.63 – $452.95
Physical therapy evaluation (low complexity): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $240.24 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $452.95 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $225.23 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $156.70 BCBS MCR ADV — BCBS MCR ADV: $132.63 BCBS POS — BCBS POS: $225.23 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $156.70 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $232.73 EBMS - ALL PLANS — EBMS - ALL PLANS: $237.74 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $240.24
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · modifier GP In the file: Evaluation for physical therapy, typically 30 minutes	$295	$250.75	$156.35 – $533.95
Physical therapy evaluation (moderate complexity): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $283.20 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $533.95 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $265.50 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $156.70 BCBS MCR ADV — BCBS MCR ADV: $156.35 BCBS POS — BCBS POS: $265.50 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $156.70 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $274.35 EBMS - ALL PLANS — EBMS - ALL PLANS: $280.25 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $283.20
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · modifier GP In the file: Evaluation for physical therapy, typically 45 minutes	$343	$291.55	$156.70 – $620.83
Physical therapy evaluation (high complexity): 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $329.28 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $620.83 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $308.70 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $156.70 BCBS MCR ADV — BCBS MCR ADV: $181.79 BCBS POS — BCBS POS: $308.70 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $156.70 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $318.99 EBMS - ALL PLANS — EBMS - ALL PLANS: $325.85 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $329.28
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: Psychotherapy, 30 minutes	$142	$120.70	$48 – $103.76
Psychotherapy, 30 minutes: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $100.13 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $100.13 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $93.38 BCBS FEP — BCBS FEP: $103.76 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $93.38 BCBS MCR ADV — BCBS MCR ADV: $68.87 BCBS POS — BCBS POS: $93.38 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $95.46 EBMS - ALL PLANS — EBMS - ALL PLANS: $102.66 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $48
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: Psychotherapy, 45 minutes	$190	$161.50	$48 – $138.34
Psychotherapy, 45 minutes: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $133.51 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $133.51 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $124.51 BCBS FEP — BCBS FEP: $138.34 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $124.51 BCBS MCR ADV — BCBS MCR ADV: $90.86 BCBS POS — BCBS POS: $124.51 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $127.27 EBMS - ALL PLANS — EBMS - ALL PLANS: $136.88 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $48
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: Psychotherapy, 1 hour	$284	$241.40	$48 – $206.93
Psychotherapy, 60 minutes: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $199.69 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $199.69 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $186.24 BCBS FEP — BCBS FEP: $206.93 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $186.24 BCBS MCR ADV — BCBS MCR ADV: $134.50 BCBS POS — BCBS POS: $186.24 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $190.38 EBMS - ALL PLANS — EBMS - ALL PLANS: $204.74 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $48
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: Family psychotherapy without patient, 50 minutes	$229	$194.65	$48 – $167.07
Family psychotherapy, without the patient: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $161.22 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $161.22 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $150.36 BCBS FEP — BCBS FEP: $167.07 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $150.36 BCBS MCR ADV — BCBS MCR ADV: $98.29 BCBS POS — BCBS POS: $150.36 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $153.70 EBMS - ALL PLANS — EBMS - ALL PLANS: $165.30 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $48
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: Family psychotherapy with patient, 50 minutes	$238	$202.30	$48 – $173.52
Family psychotherapy, with the patient: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $167.45 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $167.45 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $156.17 BCBS FEP — BCBS FEP: $173.52 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $156.17 BCBS MCR ADV — BCBS MCR ADV: $102.50 BCBS POS — BCBS POS: $156.17 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $159.64 EBMS - ALL PLANS — EBMS - ALL PLANS: $171.68 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $48
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: Group psychotherapy	$58	$49.30	$24.25 – $48
Group psychotherapy: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $39.60 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $39.60 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $36.93 BCBS FEP — BCBS FEP: $41.03 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $36.93 BCBS MCR ADV — BCBS MCR ADV: $24.25 BCBS POS — BCBS POS: $36.93 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $37.75 EBMS - ALL PLANS — EBMS - ALL PLANS: $40.60 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $48

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: Removal of growth and tissue of breast, duct, or nipple	$915	$777.75	$411.70 – $720
Removal of breast growth (open surgery): 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $678.84 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $678.84 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $633.10 BCBS FEP — BCBS FEP: $703.44 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $633.10 BCBS MCR ADV — BCBS MCR ADV: $411.70 BCBS POS — BCBS POS: $633.10 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $647.16 EBMS - ALL PLANS — EBMS - ALL PLANS: $720 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $720
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: Replacement of thigh bone and hip joint with prosthesis	$2,814	$2,391.90	$1,256.41 – $2,352.60
Total hip replacement: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,218.11 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $2,218.11 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,068.64 BCBS FEP — BCBS FEP: $2,298.49 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $2,068.64 BCBS MCR ADV — BCBS MCR ADV: $1,256.41 BCBS POS — BCBS POS: $2,068.64 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $2,114.61 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,352.60 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $2,352.60
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: Replacement of knee joint, both sides of knee	$2,810	$2,388.50	$1,254.80 – $2,349.60
Total knee replacement: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $2,215.28 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $2,215.28 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,066 BCBS FEP — BCBS FEP: $2,295.56 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $2,066 BCBS MCR ADV — BCBS MCR ADV: $1,254.80 BCBS POS — BCBS POS: $2,066 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $2,111.92 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,349.60 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $2,349.60
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: Shaving of part of shoulder bone and repair of ligament using an endoscope	$388	$329.80	$166.16 – $303
Shoulder arthroscopy: shaving of shoulder bone: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $285.68 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $285.68 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $266.43 BCBS FEP — BCBS FEP: $296.03 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $266.43 BCBS MCR ADV — BCBS MCR ADV: $166.16 BCBS POS — BCBS POS: $266.43 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $272.35 EBMS - ALL PLANS — EBMS - ALL PLANS: $303 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $303
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: Removal of knee cartilage using an endoscope	$1,198	$1,018.30	$537.26 – $936
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $882.49 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $882.49 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $823.02 BCBS FEP — BCBS FEP: $914.47 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $823.02 BCBS MCR ADV — BCBS MCR ADV: $537.26 BCBS POS — BCBS POS: $823.02 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $841.31 EBMS - ALL PLANS — EBMS - ALL PLANS: $936 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $936
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: Removal of tonsils and adenoid glands (younger than 12 years)	$635	$539.75	$287.13 – $495.60
Removal of tonsils and adenoids (under age 12): 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $467.27 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $467.27 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $435.78 BCBS FEP — BCBS FEP: $484.20 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $435.78 BCBS MCR ADV — BCBS MCR ADV: $287.13 BCBS POS — BCBS POS: $435.78 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $445.46 EBMS - ALL PLANS — EBMS - ALL PLANS: $495.60 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $495.60
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope	$278	$236.30	$117.87 – $212.40
Upper GI endoscopy (diagnostic): 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $200.26 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $200.26 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $186.76 BCBS FEP — BCBS FEP: $207.51 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $186.76 BCBS MCR ADV — BCBS MCR ADV: $117.87 BCBS POS — BCBS POS: $186.76 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $190.91 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,333.84 EBMS - ALL PLANS — EBMS - ALL PLANS: $212.40
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	$3,147.41	$2,675.30	$1,668.13 – $5,696.81
Upper GI endoscopy with biopsy: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $3,021.51 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $5,696.81 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $2,832.67 BCBS FEP — BCBS FEP: $233.89 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $2,832.67 BCBS MCR ADV — BCBS MCR ADV: $1,668.13 BCBS POS — BCBS POS: $2,832.67 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $3,147.41 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,927.09 EBMS - ALL PLANS — EBMS - ALL PLANS: $2,990.04
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: Diagnostic exam of large bowel using a flexible endoscope	$418	$355.30	$176.95 – $321
Colonoscopy (diagnostic): 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $302.65 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $302.65 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $282.26 BCBS FEP — BCBS FEP: $313.62 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $282.26 BCBS MCR ADV — BCBS MCR ADV: $176.95 BCBS POS — BCBS POS: $282.26 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $288.53 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $2,860.23 EBMS - ALL PLANS — EBMS - ALL PLANS: $321
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: Biopsy of large bowel using a flexible endoscope	$454	$385.90	$192.45 – $347.40
Colonoscopy with biopsy: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $327.54 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $327.54 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $305.47 BCBS FEP — BCBS FEP: $339.41 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $305.47 BCBS MCR ADV — BCBS MCR ADV: $192.45 BCBS POS — BCBS POS: $305.47 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $312.26 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $3,148.67 EBMS - ALL PLANS — EBMS - ALL PLANS: $347.40
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: Removal of polyps or growths of large bowel using an endoscope with mechanical snare	$575	$488.75	$242.52 – $441
Colonoscopy with removal of polyps (snare): 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $415.79 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $415.79 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $387.77 BCBS FEP — BCBS FEP: $430.86 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $387.77 BCBS MCR ADV — BCBS MCR ADV: $242.52 BCBS POS — BCBS POS: $387.77 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $396.39 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $6,496.12 EBMS - ALL PLANS — EBMS - ALL PLANS: $441
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK	$418	$355.30	$47.50 – $314.20
Screening colonoscopy (not high risk): 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $303.22 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $303.22 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $282.78 BCBS FEP — BCBS FEP: $314.20 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $282.78 BCBS MCR ADV — BCBS MCR ADV: $177.27 BCBS POS — BCBS POS: $282.78 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $289.06 EBMS - ALL PLANS — EBMS - ALL PLANS: $47.50 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $48
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: Removal of gallbladder using an endoscope	$1,462	$1,242.70	$647.01 – $1,151.40
Gallbladder removal by laparoscope: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $1,085.58 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $1,085.58 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $1,012.43 BCBS FEP — BCBS FEP: $1,124.92 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $1,012.43 BCBS MCR ADV — BCBS MCR ADV: $647.01 BCBS POS — BCBS POS: $1,012.43 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $1,034.93 EBMS - ALL PLANS — EBMS - ALL PLANS: $1,151.40 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $1,151.40
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: Repair of groin hernia (5 years or older)	$1,155	$981.75	$514.19 – $910.20
Groin (inguinal) hernia repair, age 5 or older: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $858.17 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $858.17 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $800.34 BCBS FEP — BCBS FEP: $889.27 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $800.34 BCBS MCR ADV — BCBS MCR ADV: $514.19 BCBS POS — BCBS POS: $800.34 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $818.13 EBMS - ALL PLANS — EBMS - ALL PLANS: $910.20 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $910.20
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · modifier 50 In the file: Repair of groin hernia (5 years or older)	$2,309	$1,962.65	$514.19 – $910.20
Groin (inguinal) hernia repair, age 5 or older: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $858.17 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $858.17 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $800.34 BCBS FEP — BCBS FEP: $889.27 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $800.34 BCBS MCR ADV — BCBS MCR ADV: $514.19 BCBS POS — BCBS POS: $800.34 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $818.13 EBMS - ALL PLANS — EBMS - ALL PLANS: $910.20 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $910.20
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: Biopsy of prostate gland	$615	$522.75	$325.95 – $1,113.15
Prostate biopsy: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $590.40 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $1,113.15 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $553.50 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $553.50 BCBS MCR ADV — BCBS MCR ADV: $325.95 BCBS POS — BCBS POS: $553.50 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $615 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $571.95 EBMS - ALL PLANS — EBMS - ALL PLANS: $584.25 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $590.40
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: Injection of substance into lower spine canal using imaging guidance	$1,930	$1,640.50	$1,022.90 – $3,493.30
Spinal injection, lower back (epidural), with imaging guidance: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $1,852.80 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $3,493.30 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $1,737 BCBS FEP — BCBS FEP: $167.65 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $1,737 BCBS MCR ADV — BCBS MCR ADV: $1,022.90 BCBS POS — BCBS POS: $1,737 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $1,930 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $1,794.90 EBMS - ALL PLANS — EBMS - ALL PLANS: $1,833.50
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level	$125	$106.25	$107.60 – $192.60
Nerve root injection, lower back, with imaging guidance: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $181.59 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $181.59 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $169.35 BCBS FEP — BCBS FEP: $188.17 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $169.35 BCBS MCR ADV — BCBS MCR ADV: $107.60 BCBS POS — BCBS POS: $169.35 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $173.12 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $1,029.51 EBMS - ALL PLANS — EBMS - ALL PLANS: $192.60
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · modifier 50 In the file: Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level	$1,107	$940.95	$586.71 – $2,003.67
Nerve root injection, lower back, with imaging guidance: 10 of 19 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $1,062.72 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $2,003.67 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $996.30 BCBS FEP — BCBS FEP: $188.17 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $996.30 BCBS MCR ADV — BCBS MCR ADV: $586.71 BCBS POS — BCBS POS: $996.30 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $1,107 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $1,029.51 EBMS - ALL PLANS — EBMS - ALL PLANS: $1,051.65
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: Release and/or relocation of hand nerve	$963	$818.55	$435.65 – $742.20
Carpal tunnel release: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $699.77 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $699.77 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $652.62 BCBS FEP — BCBS FEP: $725.13 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $652.62 BCBS MCR ADV — BCBS MCR ADV: $435.65 BCBS POS — BCBS POS: $652.62 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $667.12 EBMS - ALL PLANS — EBMS - ALL PLANS: $742.20 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $742.20
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · modifier 50 In the file: Release and/or relocation of hand nerve	$1,925	$1,636.25	$435.65 – $742.20
Carpal tunnel release: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $699.77 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $699.77 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $652.62 BCBS FEP — BCBS FEP: $725.13 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $652.62 BCBS MCR ADV — BCBS MCR ADV: $435.65 BCBS POS — BCBS POS: $652.62 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $667.12 EBMS - ALL PLANS — EBMS - ALL PLANS: $742.20 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $742.20
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) In the file: Removal of cataract with insertion of prosthetic lens	$3,420.75	$2,907.64	$1,813 – $6,191.56
Cataract removal with lens implant: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $3,283.92 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $6,191.56 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $3,078.68 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $3,078.68 BCBS MCR ADV — BCBS MCR ADV: $1,813 BCBS POS — BCBS POS: $3,078.68 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $3,420.75 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $3,181.30 EBMS - ALL PLANS — EBMS - ALL PLANS: $3,249.71 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $3,283.92

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) In the file: Vaginal delivery with care before and after delivery	$4,600	$3,910	$2,348.31 – $3,691.80
Vaginal delivery, with care before and after: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $3,480.75 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $3,480.75 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $3,246.20 BCBS FEP — BCBS FEP: $3,606.89 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $3,246.20 BCBS MCR ADV — BCBS MCR ADV: $2,348.31 BCBS POS — BCBS POS: $3,246.20 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $3,318.34 EBMS - ALL PLANS — EBMS - ALL PLANS: $3,691.80 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $3,691.80
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) In the file: Cesarean delivery with care before and after delivery	$5,103	$4,337.55	$2,607.76 – $4,094.40
Cesarean delivery (C-section), with care before and after: 10 of 14 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $3,860.34 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $3,860.34 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $3,600.21 BCBS FEP — BCBS FEP: $4,000.23 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $3,600.21 BCBS MCR ADV — BCBS MCR ADV: $2,607.76 BCBS POS — BCBS POS: $3,600.21 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $3,680.21 EBMS - ALL PLANS — EBMS - ALL PLANS: $4,094.40 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $4,094.40

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
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	$26,545.55	$22,563.72	$4,548 – $59,349.44
Hip or knee replacement (major joint of the leg), without major complications: 10 of 18 insurance plan rates ALLEGIANCE COMM - ALL OTHER PLANS — ALLEGIANCE COMM - ALL OTHER PLANS: $25,483.73 ALLEGIANCE RBPHP — ALLEGIANCE RBPHP: $59,349.44 BCBS CLOSED NETWORK — BCBS CLOSED NETWORK: $23,890.99 BCBS HEALTHLINK NETWORK — BCBS HEALTHLINK NETWORK: $23,890.99 BCBS MCR ADV — BCBS MCR ADV: $4,548 BCBS POS — BCBS POS: $23,890.99 BCBS TRAD - ALL OTHER PLANS — BCBS TRAD - ALL OTHER PLANS: $26,545.55 COVENTRY/FIRST HEALTH - ALL PLANS — COVENTRY/FIRST HEALTH - ALL PLANS: $24,687.36 EBMS - ALL PLANS — EBMS - ALL PLANS: $25,218.27 HEALTH INFONET - ALL PLANS — HEALTH INFONET - ALL PLANS: $25,483.73

Source: Central Montana Medical Center’s standard charges file (cmmc.health, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on November 21, 2025; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the price transparency link on the hospital’s website (cmmc.health), because the hospital has no cms-hpt.txt file; both are required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Critical Access Hospital
Address	408 Wendell Ave, Lewistown, MT 59457
County	Fergus County
State	Montana
Phone	(406) 535‑7711
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	Not rated by CMS
CMS Certification Number	271345
Name in Medicare records	CENTRAL MONTANA MEDICAL CENTER
Profile level	Medicare data + hospital website
Official website	cmmc.health
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

Central Montana Medical Center — cmmc.health
Health Services — cmmc.health
Emergency Department — cmmc.health
Visiting Hours — cmmc.health
Central Montana Medical Center | Care Close to Home in Lewistown — cmmc.health
Helmsley Cancer Center | Central Montana Medical Center — cmmc.health
Maternity | Central Montana Medical Center — cmmc.health
Fitness Center | Central Montana Medical Center — cmmc.health
Radiology / Imaging | Central Montana Medical Center — cmmc.health
Women's Cancer Support Group | Central Montana Medical Center — cmmc.health

Central Montana Medical Center

Summary

Profile from official sources

At a glance