Quick answers Does Driscoll Children's Hospital Rio Grande Valley have an emergency room? Yes. Medicare (CMS) data lists emergency services at Driscoll Children's Hospital Rio Grande Valley. In a medical emergency, call 911. Where is Driscoll Children's Hospital Rio Grande Valley? 2820 W Michaelangelo Drive, Edinburg, TX 78539, in Hidalgo County, Texas. What is the phone number of Driscoll Children's Hospital Rio Grande Valley? (361) 694-5041, as listed by Medicare (CMS). What is the Medicare star rating of Driscoll Children's Hospital Rio Grande Valley? 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] Procedures[5] Acute inpatient and outpatient surgery with pediatric anesthesiologists Programs and centers[4] [5] Level III NICU (63 beds) Pediatric intensive care unit (8 beds) Level III Neonatal Intensive Care Unit (63 beds) Child Life program Pediatric residency program Emergency care (hospital website)[4] [5] Emergency room Yes Open 24/7 Yes
Visiting and practical information Interpreters and languages Interpretation Services program listed; site available in English and Spanish [4]
Doctors and clinicians (2) 2 doctors and other clinicians list Driscoll Children's Hospital Rio Grande Valley 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 (2) See all 2 clinicians Other emergency rooms nearby Hospitals that list emergency services, by straight-line distance (not driving distance).
Assisted living nearby Licensed homes from the official state licence list, by straight-line distance.
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 Driscoll Children's Hospital Rio Grande Valley 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.
Not reported to Medicare
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 Not reported to Medicare Deaths within 30 days: heart failure patients Not reported to Medicare Deaths within 30 days: pneumonia patients Not reported to Medicare Deaths within 30 days: COPD patients Not reported to Medicare Deaths within 30 days: stroke patients Not reported to Medicare 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 Not reported to Medicare
Source: Complications and Deaths - Hospital — CMS, released September 10, 2026.
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 Not reported to Medicare Readmitted within 30 days: pneumonia Not reported to Medicare Readmitted within 30 days: COPD Not reported to Medicare Readmitted within 30 days: coronary bypass surgery Not reported to Medicare Readmitted within 30 days: hip or knee replacement Not reported to Medicare
Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026.
Emergency room times and sepsis care What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.
Average (median) time patients spent in the emergency room before leaving (OP-18b) Not reported to Medicare Patients who left the emergency room before being seen (OP-22) Not reported to Medicare Sepsis patients who got all the recommended early care (SEP-1) Not reported to Medicare
Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026.
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.
Prices Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 48 common services exactly as Driscoll Children's Hospital Rio Grande Valley 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 →
$! 1 amount is marked with “!”: it is more than 100 times higher or lower than what other hospitals list for the same service, which usually means an error or a different unit in the hospital’s file. It is shown exactly as listed; ask the hospital before relying on it.
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: Hchg Evi New Patient Level 3 $888.80 $177.76 $165.82 New patient office visit (about 30–44 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: Hchg Quick Care New III $1,113.20 $222.64 $165.82 New patient office visit (about 30–44 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: Hchg Office O/P New Low 30 Min $1,113.20 $222.64 $165.82 New patient office visit (about 30–44 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: Hchg Evi New Patient Level 4 $1,415.70 $283.14 $165.82 New patient office visit (about 45–59 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: Hchg Quick Care New IV $1,326.60 $265.32 $165.82 New patient office visit (about 45–59 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: Hchg Office O/P New Mod 45 Min $1,325.72 $265.14 $165.82 New patient office visit (about 45–59 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: Hchg Evi New Patient Level 5 $1,658.80 $331.76 $165.82 New patient office visit (about 60–74 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: Hchg Quick Care New Level V $1,552.16 $310.43 $165.82 New patient office visit (about 60–74 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: C-New Patient Level 5 $1,508.10 $301.62 $165.82 New patient office visit (about 60–74 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Hchg Evi Estb Patient Level 3 $711.70 $142.34 $165.82 Established patient office visit (about 20–29 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Hchg Quick Care Estab III $892.10 $178.42 $165.82 Established patient office visit (about 20–29 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Hchg Office O/P Est Low 20 Min $891.83 $178.37 $165.82 Established patient office visit (about 20–29 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Hchg Evi Estb Patient Level 4 $1,188 $237.60 $165.82 Established patient office visit (about 30–39 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Hchg Quick Care Estab IV $1,113.20 $222.64 $165.82 Established patient office visit (about 30–39 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Hchg Office O/P Est Mod 30 Min $1,113.20 $222.64 $165.82 Established patient office visit (about 30–39 minutes): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: Hchg Office Consultation for a New or Established Patient, Which Requires These 3 Key Components: a Detailed History; a Detailed Examination $429 $85.80 $165.82 Office consultation with a specialist (moderate): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: Dietary Consult IV $609.40 $121.88 $132.23 – $165.82 Office consultation with a specialist (moderate to high): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $132.23 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $132.23 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $132.23 TRICARE [50162] — TRICARE EAST [5016201] : $132.23 TRICARE [50162] — TRICARE NTH/WST [5016203] : $132.23 TRICARE [50162] — TRICARE STANDARD [5016206] : $132.23 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $132.23 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $132.23 Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: ER Level 3 $2,052.75 $410.55 $51.36 – $2,499 Emergency room visit (moderate): 10 of 143 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $51.36 AETNA [50175] — STAR - AETNA [5017501] : $51.36 BCBS DCH EMPLOYEE INSURANCE [50324] — BCBS DCH EMPLOYEE INSURANCE [5032401] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - CALIFORNIA [5015206] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - FEDERAL EMPLOYEE [5015204] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - HEALTHSELECT [5015205] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - HMO BLUE S.TX [5015201] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - KIDNEY [5015207] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - OUT OF STATE [5015202] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - PPO/POS [5015203] : $2,499 Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: ED Level 3 $1,661.75 $332.35 $51.36 – $2,499 Emergency room visit (moderate): 10 of 143 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $51.36 AETNA [50175] — STAR - AETNA [5017501] : $51.36 BCBS DCH EMPLOYEE INSURANCE [50324] — BCBS DCH EMPLOYEE INSURANCE [5032401] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - CALIFORNIA [5015206] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - FEDERAL EMPLOYEE [5015204] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - HEALTHSELECT [5015205] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - HMO BLUE S.TX [5015201] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - KIDNEY [5015207] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - OUT OF STATE [5015202] : $2,499 BLUE CROSS BLUE SHIELD [50152] — BCBS - PPO/POS [5015203] : $2,499 Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: ER Level 4 $2,487.10 $497.42 $165.82 – $3,900 Emergency room visit (moderately high): 10 of 21 insurance plan rates BCBS DCH EMPLOYEE INSURANCE [50324] — BCBS DCH EMPLOYEE INSURANCE [5032401] : $3,900 BLUE CROSS BLUE SHIELD [50152] — BCBS - CALIFORNIA [5015206] : $3,900 BLUE CROSS BLUE SHIELD [50152] — BCBS - FEDERAL EMPLOYEE [5015204] : $3,900 BLUE CROSS BLUE SHIELD [50152] — BCBS - HEALTHSELECT [5015205] : $3,900 BLUE CROSS BLUE SHIELD [50152] — BCBS - HMO BLUE S.TX [5015201] : $3,900 BLUE CROSS BLUE SHIELD [50152] — BCBS - KIDNEY [5015207] : $3,900 BLUE CROSS BLUE SHIELD [50152] — BCBS - OUT OF STATE [5015202] : $3,900 BLUE CROSS BLUE SHIELD [50152] — BCBS - PPO/POS [5015203] : $3,900 BLUE CROSS BLUE SHIELD [50152] — BCBS 3000 BROAD EPO [5015212] : $3,900 BLUE CROSS BLUE SHIELD [50152] — BCBS 3000 SAVINGS CHOICE [5015210] : $3,900 Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: ER Level 5 $3,371.10 $674.22 $165.82 – $7,800 Emergency room visit (high): 10 of 21 insurance plan rates BCBS DCH EMPLOYEE INSURANCE [50324] — BCBS DCH EMPLOYEE INSURANCE [5032401] : $7,800 BLUE CROSS BLUE SHIELD [50152] — BCBS - CALIFORNIA [5015206] : $7,800 BLUE CROSS BLUE SHIELD [50152] — BCBS - FEDERAL EMPLOYEE [5015204] : $7,800 BLUE CROSS BLUE SHIELD [50152] — BCBS - HEALTHSELECT [5015205] : $7,800 BLUE CROSS BLUE SHIELD [50152] — BCBS - HMO BLUE S.TX [5015201] : $7,800 BLUE CROSS BLUE SHIELD [50152] — BCBS - KIDNEY [5015207] : $7,800 BLUE CROSS BLUE SHIELD [50152] — BCBS - OUT OF STATE [5015202] : $7,800 BLUE CROSS BLUE SHIELD [50152] — BCBS - PPO/POS [5015203] : $7,800 BLUE CROSS BLUE SHIELD [50152] — BCBS 3000 BROAD EPO [5015212] : $7,800 BLUE CROSS BLUE SHIELD [50152] — BCBS 3000 SAVINGS CHOICE [5015210] : $7,800 Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: Sexual Assault Exam Fee $1,798.50 $359.70 $165.82 Emergency room visit (high): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82
Lab tests Service Hospital charge Cash price Insurance rates (lowest – highest) Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: Basic Metabolic Panel $1,175.30 $235.06 $7.11 – $165.82 Basic metabolic panel (blood test): 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $7.11 AETNA [50175] — STAR - AETNA [5017501] : $7.11 CHAMP VA [50319] — CHAMP VA [5031901] : $9.16 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $7.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $7.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $7.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $7.11 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $7.11 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $7.11 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $7.11 Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: Comp Metabolic Panel $1,606.55 $321.31 $8.87 – $165.82 Comprehensive metabolic panel (blood test): 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $8.87 AETNA [50175] — STAR - AETNA [5017501] : $8.87 CHAMP VA [50319] — CHAMP VA [5031901] : $11.43 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $8.87 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $8.87 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $8.87 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $8.87 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $8.87 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $8.87 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $8.87 Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: Lipid Profile $1,199.45 $239.89 $11.25 – $165.82 Cholesterol panel (lipid panel): 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $11.25 AETNA [50175] — STAR - AETNA [5017501] : $11.25 CHAMP VA [50319] — CHAMP VA [5031901] : $14.49 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $11.25 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $11.25 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $11.25 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $11.25 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $11.25 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $11.25 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $11.25 Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: Hchg Renal Function Panel $354.20 $70.84 $7.29 – $165.82 Kidney function panel: 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $7.29 AETNA [50175] — STAR - AETNA [5017501] : $7.29 CHAMP VA [50319] — CHAMP VA [5031901] : $9.39 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $7.29 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $7.29 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $7.29 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $7.29 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $7.29 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $7.29 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $7.29 Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: Liver Profile $1,428.30 $285.66 $6.86 – $165.82 Liver function panel: 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $6.86 AETNA [50175] — STAR - AETNA [5017501] : $6.86 CHAMP VA [50319] — CHAMP VA [5031901] : $8.84 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $6.86 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $6.86 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $6.86 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $6.86 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $6.86 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $6.86 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $6.86 Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: Urinalysis Routine $324.30 $64.86 $2.66 – $165.82 Urine test (automated, with microscope): 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $2.66 AETNA [50175] — STAR - AETNA [5017501] : $2.66 CHAMP VA [50319] — CHAMP VA [5031901] : $3.43 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $2.66 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $2.66 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $2.66 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $2.66 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $2.66 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $2.66 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $2.66 Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: Hchg POCT Urinalysis Visual $157.55 $31.51 $2.92 – $165.82 Urine test (manual, without microscope): 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $2.92 AETNA [50175] — STAR - AETNA [5017501] : $2.92 CHAMP VA [50319] — CHAMP VA [5031901] : $3.77 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $2.92 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $2.92 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $2.92 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $2.92 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $2.92 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $2.92 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $2.92 Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: Urine Sg/Ph/Ketones $157.55 $31.51 $2.92 – $165.82 Urine test (manual, without microscope): 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $2.92 AETNA [50175] — STAR - AETNA [5017501] : $2.92 CHAMP VA [50319] — CHAMP VA [5031901] : $3.77 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $2.92 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $2.92 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $2.92 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $2.92 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $2.92 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $2.92 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $2.92 Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: Hchg an Urine Dipstick $167.90 $33.58 $2.92 – $165.82 Urine test (manual, without microscope): 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $2.92 AETNA [50175] — STAR - AETNA [5017501] : $2.92 CHAMP VA [50319] — CHAMP VA [5031901] : $3.77 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $2.92 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $2.92 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $2.92 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $2.92 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $2.92 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $2.92 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $2.92 Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: Hchg POCT Ua Clinitek Status $157.55 $31.51 $1.89 – $165.82 Urine test (automated, without microscope): 10 of 11 insurance plan rates CHAMP VA [50319] — CHAMP VA [5031901] : $2.44 POINT COMFORT UNDERWRITE INC [50215] — POINT COMFORT UNDERWRITER INC [5021500] : $1.89 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $2.44 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $2.44 TRICARE [50162] — TRICARE EAST [5016201] : $2.44 TRICARE [50162] — TRICARE NTH/WST [5016203] : $2.44 TRICARE [50162] — TRICARE STANDARD [5016206] : $2.44 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $2.44 Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: Urinalysis, Auto, W/O Scope $197.80 $39.56 $1.89 – $165.82 Urine test (automated, without microscope): 10 of 11 insurance plan rates CHAMP VA [50319] — CHAMP VA [5031901] : $2.44 POINT COMFORT UNDERWRITE INC [50215] — POINT COMFORT UNDERWRITER INC [5021500] : $1.89 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $2.44 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $2.44 TRICARE [50162] — TRICARE EAST [5016201] : $2.44 TRICARE [50162] — TRICARE NTH/WST [5016203] : $2.44 TRICARE [50162] — TRICARE STANDARD [5016206] : $2.44 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $2.44 Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: Hchg Urinalysis Auto W/O Scope $198.38 $39.68 $1.89 – $165.82 Urine test (automated, without microscope): 10 of 11 insurance plan rates CHAMP VA [50319] — CHAMP VA [5031901] : $2.44 POINT COMFORT UNDERWRITE INC [50215] — POINT COMFORT UNDERWRITER INC [5021500] : $1.89 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $2.44 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $2.44 TRICARE [50162] — TRICARE EAST [5016201] : $2.44 TRICARE [50162] — TRICARE NTH/WST [5016203] : $2.44 TRICARE [50162] — TRICARE STANDARD [5016206] : $2.44 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $2.44 PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: Assay of Psa, Total $511.75 $102.35 $15.45 – $165.82 PSA (prostate specific antigen) blood test: 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $15.45 AETNA [50175] — STAR - AETNA [5017501] : $15.45 CHAMP VA [50319] — CHAMP VA [5031901] : $19.90 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $15.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $15.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $15.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $15.45 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $15.45 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $15.45 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $15.45 PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: Evi Psa Screen $885.50 $177.10 $15.45 – $165.82 PSA (prostate specific antigen) blood test: 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $15.45 AETNA [50175] — STAR - AETNA [5017501] : $15.45 CHAMP VA [50319] — CHAMP VA [5031901] : $19.90 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $15.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $15.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $15.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $15.45 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $15.45 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $15.45 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $15.45 Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: Assay Thyroid Stim Hormone $813.05 $162.61 $14.11 – $165.82 Thyroid stimulating hormone (TSH) test: 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $14.11 AETNA [50175] — STAR - AETNA [5017501] : $14.11 CHAMP VA [50319] — CHAMP VA [5031901] : $18.18 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $14.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $14.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $14.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $14.11 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $14.11 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $14.11 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $14.11 Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: Trf/Tsh $576.15 $115.23 $14.11 – $165.82 Thyroid stimulating hormone (TSH) test: 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $14.11 AETNA [50175] — STAR - AETNA [5017501] : $14.11 CHAMP VA [50319] — CHAMP VA [5031901] : $18.18 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $14.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $14.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $14.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $14.11 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $14.11 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $14.11 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $14.11 Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: Tsh, Third Generation Srm $40.25 $8.05 $14.11 – $165.82 Thyroid stimulating hormone (TSH) test: 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $14.11 AETNA [50175] — STAR - AETNA [5017501] : $14.11 CHAMP VA [50319] — CHAMP VA [5031901] : $18.18 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $14.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $14.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $14.11 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $14.11 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $14.11 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $14.11 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $14.11 Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: Auto Bld Cnt & Auto Diff $286.35 $57.27 $6.53 – $165.82 Complete blood count (CBC) with differential: 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $6.53 AETNA [50175] — STAR - AETNA [5017501] : $6.53 CHAMP VA [50319] — CHAMP VA [5031901] : $8.41 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $6.53 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $6.53 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $6.53 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $6.53 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $6.53 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $6.53 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $6.53 Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: Automated Bld CT & Diff $226.55 $45.31 $6.53 – $165.82 Complete blood count (CBC) with differential: 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $6.53 AETNA [50175] — STAR - AETNA [5017501] : $6.53 CHAMP VA [50319] — CHAMP VA [5031901] : $8.41 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $6.53 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $6.53 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $6.53 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $6.53 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $6.53 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $6.53 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $6.53 Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: Abcsl $307.05 $61.41 $5.43 – $165.82 Complete blood count (CBC), automated: 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $5.43 AETNA [50175] — STAR - AETNA [5017501] : $5.43 CHAMP VA [50319] — CHAMP VA [5031901] : $7 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $5.43 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $5.43 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $5.43 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $5.43 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $5.43 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $5.43 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $5.43 Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: Prothrombin Time $386.40 $77.28 $3.60 – $165.82 Blood clotting time test (prothrombin time, PT): 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $3.60 AETNA [50175] — STAR - AETNA [5017501] : $3.60 CHAMP VA [50319] — CHAMP VA [5031901] : $4.64 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $3.60 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $3.60 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $3.60 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $3.60 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $3.60 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $3.60 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $3.60 Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: Thromboplastin Time, Partial $213.90 $42.78 $5.05 – $165.82 Blood clotting test (partial thromboplastin time, PTT): 10 of 112 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $5.05 AETNA [50175] — STAR - AETNA [5017501] : $5.05 CHAMP VA [50319] — CHAMP VA [5031901] : $6.50 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $5.05 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $5.05 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $5.05 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $5.05 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $5.05 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $5.05 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $5.05
Imaging (X-ray, CT, MRI, ultrasound, mammogram) Service Hospital charge Cash price Insurance rates (lowest – highest) CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT Head WO Contrast $9,210.88 $1,842.18 $108.97 – $165.82 CT scan of the head or brain, without contrast: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $108.97 AETNA [50175] — STAR - AETNA [5017501] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $108.97 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $108.97 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $108.97 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $108.97 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $108.97 CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT Limited,Brain WO Cont $1,531.04 $306.21 $108.97 – $165.82 CT scan of the head or brain, without contrast: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $108.97 AETNA [50175] — STAR - AETNA [5017501] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $108.97 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $108.97 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $108.97 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $108.97 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $108.97 MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI Brain W/O W Contrast $16,281.44 $3,256.29 $165.82 – $347.16 MRI of the brain, before and after contrast: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $347.16 AETNA [50175] — STAR - AETNA [5017501] : $347.16 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $347.16 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $347.16 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $347.16 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $347.16 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $347.16 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $347.16 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $347.16 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $347.16 Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: Chest 2v W/Fluoro $1,032.64 $206.53 $32.75 – $165.82 Chest X-ray, 2 views: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $32.75 AETNA [50175] — STAR - AETNA [5017501] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $32.75 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $32.75 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $32.75 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $32.75 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $32.75 Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: Chest Spec Vw Decub Bu $891.52 $178.30 $32.75 – $165.82 Chest X-ray, 2 views: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $32.75 AETNA [50175] — STAR - AETNA [5017501] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $32.75 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $32.75 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $32.75 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $32.75 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $32.75 Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: Chest; 2v W/Fluoro $1,032.64 $206.53 $32.75 – $165.82 Chest X-ray, 2 views: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $32.75 AETNA [50175] — STAR - AETNA [5017501] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $32.75 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $32.75 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $32.75 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $32.75 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $32.75 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $32.75 X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: Spne Lumbar Comp $1,252.16 $250.43 $49.45 – $165.82 X-ray of the lower spine, at least 4 views: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $49.45 AETNA [50175] — STAR - AETNA [5017501] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $49.45 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $49.45 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $49.45 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $49.45 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $49.45 X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: Spine Ls Ap/Lat/Oblqs 4v $1,078.56 $215.71 $49.45 – $165.82 X-ray of the lower spine, at least 4 views: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $49.45 AETNA [50175] — STAR - AETNA [5017501] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $49.45 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $49.45 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $49.45 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $49.45 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $49.45 X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: Spine Lumbar Comp $1,924.16 $384.83 $49.45 – $165.82 X-ray of the lower spine, at least 4 views: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $49.45 AETNA [50175] — STAR - AETNA [5017501] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $49.45 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $49.45 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $49.45 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $49.45 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $49.45 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $49.45 MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI Spine Lumbar W/O Cont $9,124.64 $1,824.93 $165.82 – $206.83 MRI of the lower back (lumbar spine), without contrast: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $206.83 AETNA [50175] — STAR - AETNA [5017501] : $206.83 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $206.83 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $206.83 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $206.83 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $206.83 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $206.83 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $206.83 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $206.83 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $206.83 CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT Pelvis W Contrast $12,356.96 $2,471.39 $165.82 – $178.55 CT scan of the pelvis, with contrast: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $178.55 AETNA [50175] — STAR - AETNA [5017501] : $178.55 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $178.55 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $178.55 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $178.55 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $178.55 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $178.55 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $178.55 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $178.55 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $178.55 MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI Joint Low Ext W/O Con $8,100.96 $1,620.19 $165.82 – $218.53 MRI of a leg joint (such as the knee), without contrast: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $218.53 AETNA [50175] — STAR - AETNA [5017501] : $218.53 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $218.53 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $218.53 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $218.53 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $218.53 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $218.53 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $218.53 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $218.53 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $218.53 CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: Hchg CT Pelvis & Abd W Cont $19,712 $3,942.40 $165.82 – $324.78 CT scan of the abdomen and pelvis, with contrast: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $324.78 AETNA [50175] — STAR - AETNA [5017501] : $324.78 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $324.78 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $324.78 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $324.78 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $324.78 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $324.78 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $324.78 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $324.78 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $324.78 Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: Echo Abdomen Complete $2,688 $537.60 $108.97 – $165.82 Ultrasound of the abdomen, complete: 10 of 104 insurance plan rates AETNA [50175] — CHIPS - AETNA [5017502] : $108.97 AETNA [50175] — STAR - AETNA [5017501] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [5021001] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — CHIPS-CHRISTUS HEALTH [56] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [5021002] : $108.97 CHRISTUS HEALTH PLAN MEDICAID [50210] — STAR - CHRISTUS HEALTH [58] : $108.97 COMM CENTENNIAL BLUE CROSS [50260] — COMM CENTENNIAL BLUE CROSS [5026001] : $108.97 COMMUNITY FIRST PLAN [50184] — CHIPS - COMMUNITY FIRST [5018402] : $108.97 COMMUNITY FIRST PLAN [50184] — STAR - COMMUNITY FIRST [5018401] : $108.97 COMMUNITY FIRST PLAN [50184] — STAR KIDS-COMMUNITY FIRST [5018403] : $108.97
Heart tests and sleep study Service Hospital charge Cash price Insurance rates (lowest – highest) Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: Hchg Lt Hrt Cath W/Ventric $14,285.70 $2,857.14 $165.82 – $7,166 Left heart catheterization (diagnostic): 10 of 21 insurance plan rates BCBS DCH EMPLOYEE INSURANCE [50324] — BCBS DCH EMPLOYEE INSURANCE [5032401] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - CALIFORNIA [5015206] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - FEDERAL EMPLOYEE [5015204] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - HEALTHSELECT [5015205] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - HMO BLUE S.TX [5015201] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - KIDNEY [5015207] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - OUT OF STATE [5015202] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - PPO/POS [5015203] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS 3000 BROAD EPO [5015212] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS 3000 SAVINGS CHOICE [5015210] : $7,166 Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: Ep Ra,Rv&His W/O Induct $14,069 $2,813.80 $165.82 Heart rhythm study (electrophysiology evaluation): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: Hchg Ep W Afib Abl Vt P.V.I. $23,387.10 $4,677.42 $165.82! (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $7,166 Heart rhythm study with ablation for atrial fibrillation: 10 of 21 insurance plan rates BCBS DCH EMPLOYEE INSURANCE [50324] — BCBS DCH EMPLOYEE INSURANCE [5032401] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - CALIFORNIA [5015206] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - FEDERAL EMPLOYEE [5015204] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - HEALTHSELECT [5015205] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - HMO BLUE S.TX [5015201] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - KIDNEY [5015207] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - OUT OF STATE [5015202] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS - PPO/POS [5015203] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS 3000 BROAD EPO [5015212] : $7,166 BLUE CROSS BLUE SHIELD [50152] — BCBS 3000 SAVINGS CHOICE [5015210] : $7,166 Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: Psc Age 6-20 4+ Param $9,590.90 $1,918.18 $165.82 Sleep study (overnight, in a sleep lab): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: Npsg 4 or > Parameters, 6yr or > $13,272.60 $2,654.52 $165.82 Sleep study (overnight, in a sleep lab): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82
Physical therapy and mental health Service Hospital charge Cash price Insurance rates (lowest – highest) Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: Hchg at Ther Ex Cotx 15 $249.70 $49.94 $29.03 – $165.82 Physical therapy: therapeutic exercise (each 15 minutes): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $29.03 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $29.03 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $29.03 TRICARE [50162] — TRICARE EAST [5016201] : $29.03 TRICARE [50162] — TRICARE NTH/WST [5016203] : $29.03 TRICARE [50162] — TRICARE STANDARD [5016206] : $29.03 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $29.03 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $29.03 Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: Hchg Ther Ex Cotx 15 $502.70 $100.54 $29.03 – $165.82 Physical therapy: therapeutic exercise (each 15 minutes): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $29.03 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $29.03 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $29.03 TRICARE [50162] — TRICARE EAST [5016201] : $29.03 TRICARE [50162] — TRICARE NTH/WST [5016203] : $29.03 TRICARE [50162] — TRICARE STANDARD [5016206] : $29.03 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $29.03 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $29.03 Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: At-Ther Ex,Ndt or St (15 $306.90 $61.38 $29.03 – $165.82 Physical therapy: therapeutic exercise (each 15 minutes): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $29.03 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $29.03 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $29.03 TRICARE [50162] — TRICARE EAST [5016201] : $29.03 TRICARE [50162] — TRICARE NTH/WST [5016203] : $29.03 TRICARE [50162] — TRICARE STANDARD [5016206] : $29.03 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $29.03 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $29.03 Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: Hchg at Pt Eval Low Comp $458.70 $91.74 $98.93 – $165.82 Physical therapy evaluation (low complexity): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $98.93 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $98.93 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $98.93 TRICARE [50162] — TRICARE EAST [5016201] : $98.93 TRICARE [50162] — TRICARE NTH/WST [5016203] : $98.93 TRICARE [50162] — TRICARE STANDARD [5016206] : $98.93 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $98.93 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $98.93 Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: Hchg Pt Eval Low Comp $557.70 $111.54 $98.93 – $165.82 Physical therapy evaluation (low complexity): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $98.93 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $98.93 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $98.93 TRICARE [50162] — TRICARE EAST [5016201] : $98.93 TRICARE [50162] — TRICARE NTH/WST [5016203] : $98.93 TRICARE [50162] — TRICARE STANDARD [5016206] : $98.93 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $98.93 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $98.93 Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: Hchg at Pt Eval Moderate Comp $918.50 $183.70 $98.93 – $165.82 Physical therapy evaluation (moderate complexity): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $98.93 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $98.93 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $98.93 TRICARE [50162] — TRICARE EAST [5016201] : $98.93 TRICARE [50162] — TRICARE NTH/WST [5016203] : $98.93 TRICARE [50162] — TRICARE STANDARD [5016206] : $98.93 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $98.93 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $98.93 Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: Hchg Pt Eval Moderate Comp $1,116.50 $223.30 $98.93 – $165.82 Physical therapy evaluation (moderate complexity): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $98.93 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $98.93 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $98.93 TRICARE [50162] — TRICARE EAST [5016201] : $98.93 TRICARE [50162] — TRICARE NTH/WST [5016203] : $98.93 TRICARE [50162] — TRICARE STANDARD [5016206] : $98.93 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $98.93 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $98.93 Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: Hchg Pt Eval Standard Workers Comp $685.30 $137.06 $98.93 – $165.82 Physical therapy evaluation (moderate complexity): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $98.93 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $98.93 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $98.93 TRICARE [50162] — TRICARE EAST [5016201] : $98.93 TRICARE [50162] — TRICARE NTH/WST [5016203] : $98.93 TRICARE [50162] — TRICARE STANDARD [5016206] : $98.93 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $98.93 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $98.93 Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: Hchg at Pt Eval High Comp $1,632.40 $326.48 $98.93 – $165.82 Physical therapy evaluation (high complexity): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $98.93 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $98.93 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $98.93 TRICARE [50162] — TRICARE EAST [5016201] : $98.93 TRICARE [50162] — TRICARE NTH/WST [5016203] : $98.93 TRICARE [50162] — TRICARE STANDARD [5016206] : $98.93 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $98.93 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $98.93 Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: Hchg Pt Eval High Comp $1,982.20 $396.44 $98.93 – $165.82 Physical therapy evaluation (high complexity): rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $98.93 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $98.93 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $98.93 TRICARE [50162] — TRICARE EAST [5016201] : $98.93 TRICARE [50162] — TRICARE NTH/WST [5016203] : $98.93 TRICARE [50162] — TRICARE STANDARD [5016206] : $98.93 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $98.93 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $98.93 Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: Psychotherapy, 30 Minutes With Patient $534.60 $106.92 $65.72 – $165.82 Psychotherapy, 30 minutes: rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $65.72 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $65.72 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $65.72 TRICARE [50162] — TRICARE EAST [5016201] : $65.72 TRICARE [50162] — TRICARE NTH/WST [5016203] : $65.72 TRICARE [50162] — TRICARE STANDARD [5016206] : $65.72 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $65.72 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $65.72 Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: Psychotherapy, 45 Minutes With Patient $665.50 $133.10 $87.11 – $165.82 Psychotherapy, 45 minutes: rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $87.11 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $87.11 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $87.11 TRICARE [50162] — TRICARE EAST [5016201] : $87.11 TRICARE [50162] — TRICARE NTH/WST [5016203] : $87.11 TRICARE [50162] — TRICARE STANDARD [5016206] : $87.11 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $87.11 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $87.11 Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: Psychotherapy, 60 Minutes With Patient $760.10 $152.02 $128.07 – $165.82 Psychotherapy, 60 minutes: rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $128.07 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $128.07 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $128.07 TRICARE [50162] — TRICARE EAST [5016201] : $128.07 TRICARE [50162] — TRICARE NTH/WST [5016203] : $128.07 TRICARE [50162] — TRICARE STANDARD [5016206] : $128.07 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $128.07 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $128.07 Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: Fam Psych W/O Pt Present $538.21 $107.64 $94.07 – $165.82 Family psychotherapy, without the patient: rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $94.07 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $94.07 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $94.07 TRICARE [50162] — TRICARE EAST [5016201] : $94.07 TRICARE [50162] — TRICARE NTH/WST [5016203] : $94.07 TRICARE [50162] — TRICARE STANDARD [5016206] : $94.07 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $94.07 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $94.07 Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: Fam Psych W/Pt Present $538.21 $107.64 $98.11 – $165.82 Family psychotherapy, with the patient: rates for 10 insurance plans CHAMP VA [50319] — CHAMP VA [5031901] : $98.11 POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82 TRICARE [50162] — CHAMP VA [5016202] : $98.11 TRICARE [50162] — TRICARE - KIDNEY [5016204] : $98.11 TRICARE [50162] — TRICARE EAST [5016201] : $98.11 TRICARE [50162] — TRICARE NTH/WST [5016203] : $98.11 TRICARE [50162] — TRICARE STANDARD [5016206] : $98.11 TRICARE [50162] — TRICAREOVERSEAS EURASIA-AFRICA [5016205] : $98.11 TRIWEST HC ALLIANCE [50269] — TRIWEST [5026901] : $98.11 Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: Group Psychotherapy (Other Than of a Multiple-Family Group) $783.20 $156.64 $165.82 Group psychotherapy: rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82
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: Hchg Excision of Cyst, Fibroadenoma, or Other Benign or Malignant Tumor, Aberrant Breast Tissue, Duct Lesion, Nipple or Areolar Lesion (Exce $12,509.20 $2,501.84 $165.82 Removal of breast growth (open surgery): rates for 2 insurance plans POLICE DEPARTMENTS [50065] — POLICE DEPTS [5006501] : $1,000 TEXAS REHABILITATION COMM [50038] — TEXAS REHABILITATION COMM [5003801] : $165.82
Source: Driscoll Children's Hospital Rio Grande Valley’s standard charges file (driscollchildrens.org, CSV, CMS template 2.0.0; it can be a very large file), last updated by the hospital on October 6, 2025; retrieved November 1, 2026. The hospital’s price transparency page →
Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS) . We show a selection of common services; the file has every item and service.