Does Jacksonville Memorial Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Jacksonville Memorial Hospital. In a medical emergency, call 911.

Where is Jacksonville Memorial Hospital?

1600 W Walnut St, Jacksonville, IL 62650, in Morgan County, Illinois.

What is the phone number of Jacksonville Memorial Hospital?

(217) 245-9551, as listed by Medicare (CMS).

What is the Medicare star rating of Jacksonville Memorial Hospital?

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.

Jacksonville Memorial Hospital

Quick answers

Does Jacksonville Memorial Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Jacksonville Memorial Hospital. In a medical emergency, call 911.
Where is Jacksonville Memorial Hospital?: 1600 W Walnut St, Jacksonville, IL 62650, in Morgan County, Illinois.
What is the phone number of Jacksonville Memorial Hospital?: (217) 245-9551, as listed by Medicare (CMS).
What is the Medicare star rating of Jacksonville Memorial Hospital?: 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]

Cancer care
Crisis services (behavioral health)
Diabetes care
Emergency care
Heart care
Imaging and radiology
Intensive care
Laboratory
Lung and respiratory care
Maternity care
Neurological care
Orthopedic care
Pain care
Sleep care
Surgical services
Therapy care
Wellness care
Women's health
Wound care
Behavioral health
Primary care

Treatments^[4]

Home hospice
Home care
Outpatient services
Virtual care

Programs and centers^[4]

Behavioral health
Home care
Hospice
Primary care
Senior Life Solutions
Cardiovascular and pulmonary rehabilitation
JMH Family Maternity Suites

Emergency care (hospital website)^[4]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Visiting hours daily 8 a.m.-8 p.m^[4]

Recognition^[4]

Magnet Recognition (ANCC), four consecutive designations
Critical Access Hospital
AACVPR certification, cardiovascular and pulmonary rehabilitation
Baby-Friendly Hospital (Baby-Friendly USA), JMH Family Maternity Suites

Doctors and clinicians (247)

247 doctors and other clinicians list Jacksonville Memorial Hospital 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

And 223 more: the button below opens the full list.

Other emergency rooms nearby

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

Sarah D Culbertson Memorial Hospital30 mi · Rushville, IL · Critical Access Hospital
Illini Community Hospital31 mi · Pittsfield, IL · Critical Access Hospital
Thomas H Boyd Memorial Hospital32 mi · Carrollton, IL · Critical Access Hospital
Memorial Medical Center32 mi · Springfield, IL · Acute Care Hospital
St Johns Hospital33 mi · Springfield, IL · Acute Care Hospital

Other hospitals nearby

Andrew McFarland Mental Hlth Ctr33 mi · Springfield, IL · Psychiatric 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

Jacksonville SKLD Nur & Rehab0.1 mi · Jacksonville, IL · 3 of 5 stars
Prairie Village Healthcare Ctr0.7 mi · Jacksonville, IL · 1 of 5 stars
Arcadia Care Jacksonville1.3 mi · Jacksonville, IL · 1 of 5 stars

All nursing homes in the state →

Hospice providers

Cass-Schuyler Area Hospice15 mi · Virginia, IL · 5 of 5 stars

All hospice providers in the state →

Home health agencies

Cass County Home Health Agency15 mi · Virginia, IL

All home health agencies in the state →

Dialysis facilities

DaVita Jacksonville Dialysis2.1 mi · Jacksonville, IL · 2 of 5 stars

All dialysis facilities in the state →

Community care nearby

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

Community health centers

SIU Center for Family Medicine-Jacksonville2.0 mi · Jacksonville, IL · Community health center
Cass County Health Department - Cass County Health Clinic14 mi · Virginia, IL · Community health center
Cass County Health Clinic Beardstown20 mi · Beardstown, IL · Community health center

Clinics and urgent care

Memorial Physician Services2.1 mi · Jacksonville, IL · Rural health clinic
Memorial Physician Services2.1 mi · Jacksonville, IL · Rural health clinic
Springfield Clinic Jacksonville Rural Health2.1 mi · Jacksonville, IL · Rural health clinic

Pharmacies

Hy-Vee Inc2.1 mi · Jacksonville, IL · Community/retail pharmacy
MBRX Inc2.1 mi · Jacksonville, IL · Community/retail pharmacy
R & D Pharmacies, Inc2.1 mi · Jacksonville, IL · Community/retail 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 Jacksonville Memorial Hospital 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.

Emergency room volume (patients per year)	Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	178 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	4%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 Illinois Best hospitals in Illinois

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 54 common services exactly as Jacksonville Memorial Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

$ 54 amounts are marked with “!”: they are 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. They are shown exactly as listed; ask the hospital before relying on them.

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) · Hospital (facility) fee In the file: FMS-New PT Visit Only Lvl III	$473	$473	$69.26 – $473
New patient office visit (about 30–44 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $283.80 Aetna — Aetna PPO: $330.63 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $473 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $69.26 Cigna — Cigna: $327.79 Commercial Workers Compensation — Commercial Workers Compensation: $239.05 Corvel/CorCare — Corvel/CorCare: $463.54 Coventry — Coventry Advantra Medicare Advantage HMO: $74.47 Current Health Network — Current Health Network: $354.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $321.64
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: IR/NIR New Patient Charging Levels -> Level 3	$359	$359	$52.56 – $359
New patient office visit (about 30–44 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $215.40 Aetna — Aetna PPO: $250.94 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $359 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $52.56 Cigna — Cigna: $248.79 Commercial Workers Compensation — Commercial Workers Compensation: $181.44 Corvel/CorCare — Corvel/CorCare: $351.82 Coventry — Coventry Advantra Medicare Advantage HMO: $56.52 Current Health Network — Current Health Network: $269.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $244.12
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HVC-NEW PT VISIT ONLY LVL III	$359	$359	$52.56 – $359
New patient office visit (about 30–44 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $215.40 Aetna — Aetna PPO: $250.94 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $359 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $52.56 Cigna — Cigna: $248.79 Commercial Workers Compensation — Commercial Workers Compensation: $181.44 Corvel/CorCare — Corvel/CorCare: $351.82 Coventry — Coventry Advantra Medicare Advantage HMO: $56.52 Current Health Network — Current Health Network: $269.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $244.12
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FMS-New PT Visit Only Lvl IV	$661	$661	$96.79 – $661
New patient office visit (about 45–59 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $396.60 Aetna — Aetna PPO: $462.04 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $661 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $96.79 Cigna — Cigna: $458.07 Commercial Workers Compensation — Commercial Workers Compensation: $334.07 Corvel/CorCare — Corvel/CorCare: $647.78 Coventry — Coventry Advantra Medicare Advantage HMO: $104.07 Current Health Network — Current Health Network: $495.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $449.48
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: IR/NIR New Patient Charging Levels -> Level 4	$384	$384	$56.23 – $384
New patient office visit (about 45–59 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $230.40 Aetna — Aetna PPO: $268.42 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $384 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $56.23 Cigna — Cigna: $266.11 Commercial Workers Compensation — Commercial Workers Compensation: $194.07 Corvel/CorCare — Corvel/CorCare: $376.32 Coventry — Coventry Advantra Medicare Advantage HMO: $60.46 Current Health Network — Current Health Network: $288 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $261.12
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HVC-NEW PT VISIT ONLY LVL IV	$384	$384	$56.23 – $384
New patient office visit (about 45–59 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $230.40 Aetna — Aetna PPO: $268.42 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $384 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $56.23 Cigna — Cigna: $266.11 Commercial Workers Compensation — Commercial Workers Compensation: $194.07 Corvel/CorCare — Corvel/CorCare: $376.32 Coventry — Coventry Advantra Medicare Advantage HMO: $60.46 Current Health Network — Current Health Network: $288 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $261.12
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FMS-New PT Visit Only Lvl V	$832	$832	$121.82 – $832
New patient office visit (about 60–74 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $499.20 Aetna — Aetna PPO: $581.57 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $832 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $121.82 Cigna — Cigna: $576.58 Commercial Workers Compensation — Commercial Workers Compensation: $420.49 Corvel/CorCare — Corvel/CorCare: $815.36 Coventry — Coventry Advantra Medicare Advantage HMO: $130.99 Current Health Network — Current Health Network: $624 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $565.76
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: IR/NIR New Patient Charging Levels -> Level 5	$407	$407	$59.59 – $407
New patient office visit (about 60–74 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $244.20 Aetna — Aetna PPO: $284.49 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $407 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $59.59 Cigna — Cigna: $282.05 Commercial Workers Compensation — Commercial Workers Compensation: $205.70 Corvel/CorCare — Corvel/CorCare: $398.86 Coventry — Coventry Advantra Medicare Advantage HMO: $64.08 Current Health Network — Current Health Network: $305.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $276.76
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HVC-NEW PT VISIT ONLY LVL V	$407	$407	$59.59 – $407
New patient office visit (about 60–74 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $244.20 Aetna — Aetna PPO: $284.49 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $407 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $59.59 Cigna — Cigna: $282.05 Commercial Workers Compensation — Commercial Workers Compensation: $205.70 Corvel/CorCare — Corvel/CorCare: $398.86 Coventry — Coventry Advantra Medicare Advantage HMO: $64.08 Current Health Network — Current Health Network: $305.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $276.76
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FMS-EST PT Visit Only Lvl III	$457	$457	$66.91 – $457
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $274.20 Aetna — Aetna PPO: $319.44 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $457 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $66.91 Cigna — Cigna: $316.70 Commercial Workers Compensation — Commercial Workers Compensation: $230.97 Corvel/CorCare — Corvel/CorCare: $447.86 Coventry — Coventry Advantra Medicare Advantage HMO: $71.95 Current Health Network — Current Health Network: $342.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $310.76
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PRE-Est Pt Visit Only Lvl 3	$311	$311	$45.53 – $311
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $186.60 Aetna — Aetna PPO: $217.39 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $311 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $45.53 Cigna — Cigna: $215.52 Commercial Workers Compensation — Commercial Workers Compensation: $157.18 Corvel/CorCare — Corvel/CorCare: $304.78 Coventry — Coventry Advantra Medicare Advantage HMO: $48.96 Current Health Network — Current Health Network: $233.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $211.48
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: IR/NIR Charging Levels -> Level 3	$311	$311	$45.53 – $311
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $186.60 Aetna — Aetna PPO: $217.39 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $311 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $45.53 Cigna — Cigna: $215.52 Commercial Workers Compensation — Commercial Workers Compensation: $157.18 Corvel/CorCare — Corvel/CorCare: $304.78 Coventry — Coventry Advantra Medicare Advantage HMO: $48.96 Current Health Network — Current Health Network: $233.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $211.48
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FMS-EST PT Visit Only Lvl IV	$624	$624	$91.36 – $624
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $374.40 Aetna — Aetna PPO: $436.18 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $624 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $91.36 Cigna — Cigna: $432.43 Commercial Workers Compensation — Commercial Workers Compensation: $315.37 Corvel/CorCare — Corvel/CorCare: $611.52 Coventry — Coventry Advantra Medicare Advantage HMO: $98.24 Current Health Network — Current Health Network: $468 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $424.32
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PRE-Est Pt Visit Only Lvl 4	$338	$338	$49.49 – $338
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $202.80 Aetna — Aetna PPO: $236.26 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $338 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $49.49 Cigna — Cigna: $234.23 Commercial Workers Compensation — Commercial Workers Compensation: $170.83 Corvel/CorCare — Corvel/CorCare: $331.24 Coventry — Coventry Advantra Medicare Advantage HMO: $53.21 Current Health Network — Current Health Network: $253.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $229.84
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: IR/NIR Charging Levels -> Level 4	$338	$338	$49.49 – $338
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $202.80 Aetna — Aetna PPO: $236.26 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $338 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $49.49 Cigna — Cigna: $234.23 Commercial Workers Compensation — Commercial Workers Compensation: $170.83 Corvel/CorCare — Corvel/CorCare: $331.24 Coventry — Coventry Advantra Medicare Advantage HMO: $53.21 Current Health Network — Current Health Network: $253.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $229.84
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER Visit W/Adtl Proc Level III	$1,374	$1,374	$201.18 – $2,546
Emergency room visit (moderate): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $824.40 Aetna — Aetna PPO: $960.43 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,374 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $201.18 Cigna — Cigna: $952.18 Commercial Workers Compensation — Commercial Workers Compensation: $694.42 Corvel/CorCare — Corvel/CorCare: $1,346.52 Coventry — Coventry Advantra Medicare Advantage HMO: $216.32 Current Health Network — Current Health Network: $1,030.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $893.10
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER Medical Visit Only L3	$1,374	$1,374	$201.18 – $2,546
Emergency room visit (moderate): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $824.40 Aetna — Aetna PPO: $960.43 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,374 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $201.18 Cigna — Cigna: $952.18 Commercial Workers Compensation — Commercial Workers Compensation: $694.42 Corvel/CorCare — Corvel/CorCare: $1,346.52 Coventry — Coventry Advantra Medicare Advantage HMO: $216.32 Current Health Network — Current Health Network: $1,030.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $893.10
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBED-Medical Visit Only Lv III	$1,300	$1,300	$190.34 – $2,546
Emergency room visit (moderate): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $780 Aetna — Aetna PPO: $908.70 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,300 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $190.34 Cigna — Cigna: $900.90 Commercial Workers Compensation — Commercial Workers Compensation: $657.02 Corvel/CorCare — Corvel/CorCare: $1,274 Coventry — Coventry Advantra Medicare Advantage HMO: $204.67 Current Health Network — Current Health Network: $975 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $845
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER Visit W/Addtl Proc Level IV	$1,717	$1,717	$251.40 – $4,828
Emergency room visit (moderately high): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,030.20 Aetna — Aetna PPO: $1,200.18 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,717 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $251.40 Cigna — Cigna: $1,189.88 Commercial Workers Compensation — Commercial Workers Compensation: $867.77 Corvel/CorCare — Corvel/CorCare: $1,682.66 Coventry — Coventry Advantra Medicare Advantage HMO: $270.32 Current Health Network — Current Health Network: $1,287.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,116.05
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER Medical Visit Only L4	$1,717	$1,717	$251.40 – $4,828
Emergency room visit (moderately high): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,030.20 Aetna — Aetna PPO: $1,200.18 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,717 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $251.40 Cigna — Cigna: $1,189.88 Commercial Workers Compensation — Commercial Workers Compensation: $867.77 Corvel/CorCare — Corvel/CorCare: $1,682.66 Coventry — Coventry Advantra Medicare Advantage HMO: $270.32 Current Health Network — Current Health Network: $1,287.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,116.05
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBED-Medical Visit OnlyLvl IV	$1,904	$1,904	$278.79 – $4,828
Emergency room visit (moderately high): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,142.40 Aetna — Aetna PPO: $1,330.90 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,904 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $278.79 Cigna — Cigna: $1,319.47 Commercial Workers Compensation — Commercial Workers Compensation: $962.28 Corvel/CorCare — Corvel/CorCare: $1,865.92 Coventry — Coventry Advantra Medicare Advantage HMO: $299.77 Current Health Network — Current Health Network: $1,428 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,237.60
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER Visit W/Addtl Proc Level V	$3,721	$3,721	$544.82 – $7,002
Emergency room visit (high): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,232.60 Aetna — Aetna PPO: $2,600.98 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $3,721 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $544.82 Cigna — Cigna: $2,578.65 Commercial Workers Compensation — Commercial Workers Compensation: $1,880.59 Corvel/CorCare — Corvel/CorCare: $3,646.58 Coventry — Coventry Advantra Medicare Advantage HMO: $585.83 Current Health Network — Current Health Network: $2,790.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $2,250
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER Medical Visit Only L5	$3,721	$3,721	$544.82 – $7,002
Emergency room visit (high): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,232.60 Aetna — Aetna PPO: $2,600.98 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $3,721 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $544.82 Cigna — Cigna: $2,578.65 Commercial Workers Compensation — Commercial Workers Compensation: $1,880.59 Corvel/CorCare — Corvel/CorCare: $3,646.58 Coventry — Coventry Advantra Medicare Advantage HMO: $585.83 Current Health Network — Current Health Network: $2,790.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $2,250
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBED-Medical Visit OnlyLvl V	$2,463	$2,463	$360.63 – $7,002
Emergency room visit (high): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,477.80 Aetna — Aetna PPO: $1,721.64 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $2,463 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $360.63 Cigna — Cigna: $1,706.86 Commercial Workers Compensation — Commercial Workers Compensation: $1,244.80 Corvel/CorCare — Corvel/CorCare: $2,413.74 Coventry — Coventry Advantra Medicare Advantage HMO: $387.77 Current Health Network — Current Health Network: $1,847.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,600.95

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic Metabolic Profile	$272	$272	$39.66 – $272
Basic metabolic panel (blood test): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $163.20 Aetna — Aetna PPO: $190.13 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $272 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $39.66 Cigna — Cigna: $188.50 Commercial Workers Compensation — Commercial Workers Compensation: $106 Corvel/CorCare — Corvel/CorCare: $87.07 Coventry — Coventry Advantra Medicare Advantage HMO: $42.65 Current Health Network — Current Health Network: $204 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $184.96
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Basic Metabolic Profile	$272	$272	$0.46 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $258.40
Basic metabolic panel (blood test): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $163.20 Aetna — Aetna PPO: $217.60 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $7.87 Cigna — Cigna: $188.50 Commercial Workers Compensation — Commercial Workers Compensation: $0.46 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $43.11 Coventry — Coventry Advantra Medicare Advantage HMO: $8.29 Current Health Network — Current Health Network: $204 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $184.96 Health Alliance — Health Alliance Medicare Advantage: $8.29
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Basic Metabolic Profile	$272	$272	$125.12 – $272
Basic metabolic panel (blood test): 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $163.20 Aetna — Aetna PPO: $190.13 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $272 Cigna — Cigna: $188.50 Current Health Network — Current Health Network: $149.60 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $125.12 HFN — HFN PPO: $258.40 HFN — HFN Workers Compensation: $258.40 Hope Trust — Hope Trust: $163.20 HST — HST: $163.20
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Prof.	$380	$380	$55.41 – $380
Comprehensive metabolic panel (blood test): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $228 Aetna — Aetna PPO: $265.62 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $380 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $55.41 Cigna — Cigna: $263.34 Commercial Workers Compensation — Commercial Workers Compensation: $152.81 Corvel/CorCare — Corvel/CorCare: $116.65 Coventry — Coventry Advantra Medicare Advantage HMO: $59.58 Current Health Network — Current Health Network: $285 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $258.40
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Comprehensive Metabolic Prof.	$380	$380	$0.59 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $361
Comprehensive metabolic panel (blood test): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $228 Aetna — Aetna PPO: $304 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $9.82 Cigna — Cigna: $263.34 Commercial Workers Compensation — Commercial Workers Compensation: $0.59 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $55.08 Coventry — Coventry Advantra Medicare Advantage HMO: $10.35 Current Health Network — Current Health Network: $285 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $258.40 Health Alliance — Health Alliance Medicare Advantage: $10.35
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Prof.	$380	$380	$174.80 – $380
Comprehensive metabolic panel (blood test): 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $228 Aetna — Aetna PPO: $265.62 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $380 Cigna — Cigna: $263.34 Current Health Network — Current Health Network: $209 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $174.80 HFN — HFN PPO: $361 HFN — HFN Workers Compensation: $361 Hope Trust — Hope Trust: $228 HST — HST: $228
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric Panel - Order Set	$258	$258	$37.62 – $258
Obstetric blood test panel: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $154.80 Aetna — Aetna PPO: $180.34 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $258 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $37.62 Cigna — Cigna: $178.79 Commercial Workers Compensation — Commercial Workers Compensation: $197.75 Corvel/CorCare — Corvel/CorCare: $104.13 Coventry — Coventry Advantra Medicare Advantage HMO: $40.45 Current Health Network — Current Health Network: $193.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $175.44
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Obstetric Panel - Order Set	$258	$258	$1.30 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $245.10
Obstetric blood test panel: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $154.80 Aetna — Aetna PPO: $206.40 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $44.46 Cigna — Cigna: $178.79 Commercial Workers Compensation — Commercial Workers Compensation: $1.30 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $121.26 Coventry — Coventry Advantra Medicare Advantage HMO: $46.85 Current Health Network — Current Health Network: $193.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $175.44 Health Alliance — Health Alliance Medicare Advantage: $46.85
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Obstetric Panel - Order Set	$258	$258	$118.68 – $258
Obstetric blood test panel: 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $154.80 Aetna — Aetna PPO: $180.34 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $258 Cigna — Cigna: $178.79 Current Health Network — Current Health Network: $141.90 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $118.68 HFN — HFN PPO: $245.10 HFN — HFN Workers Compensation: $245.10 Hope Trust — Hope Trust: $154.80 HST — HST: $154.80
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel w/ Calculated LDL	$315	$315	$45.93 – $315
Cholesterol panel (lipid panel): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $189 Aetna — Aetna PPO: $220.19 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $315 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $45.93 Cigna — Cigna: $218.29 Commercial Workers Compensation — Commercial Workers Compensation: $120.94 Corvel/CorCare — Corvel/CorCare: $88.87 Coventry — Coventry Advantra Medicare Advantage HMO: $49.39 Current Health Network — Current Health Network: $236.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $214.20
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Lipid Panel w/ Calculated LDL	$315	$315	$0.73 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $299.25
Cholesterol panel (lipid panel): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $189 Aetna — Aetna PPO: $252 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $12.45 Cigna — Cigna: $218.29 Commercial Workers Compensation — Commercial Workers Compensation: $0.73 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $67.65 Coventry — Coventry Advantra Medicare Advantage HMO: $13.12 Current Health Network — Current Health Network: $236.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $214.20 Health Alliance — Health Alliance Medicare Advantage: $13.12
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Lipid Panel w/ Calculated LDL	$315	$315	$144.90 – $315
Cholesterol panel (lipid panel): 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $189 Aetna — Aetna PPO: $220.19 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $315 Cigna — Cigna: $218.29 Current Health Network — Current Health Network: $173.25 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $144.90 HFN — HFN PPO: $299.25 HFN — HFN Workers Compensation: $299.25 Hope Trust — Hope Trust: $189 HST — HST: $189
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel	$314	$314	$45.79 – $314
Kidney function panel: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $188.40 Aetna — Aetna PPO: $219.49 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $314 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $45.79 Cigna — Cigna: $217.60 Commercial Workers Compensation — Commercial Workers Compensation: $126.08 Corvel/CorCare — Corvel/CorCare: $121.14 Coventry — Coventry Advantra Medicare Advantage HMO: $49.24 Current Health Network — Current Health Network: $235.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $213.52
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Renal Function Panel	$314	$314	$0.49 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $298.30
Kidney function panel: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $188.40 Aetna — Aetna PPO: $251.20 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $8.07 Cigna — Cigna: $217.60 Commercial Workers Compensation — Commercial Workers Compensation: $0.49 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $45.82 Coventry — Coventry Advantra Medicare Advantage HMO: $8.51 Current Health Network — Current Health Network: $235.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $213.52 Health Alliance — Health Alliance Medicare Advantage: $8.51
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Renal Function Panel	$314	$314	$144.44 – $314
Kidney function panel: 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $188.40 Aetna — Aetna PPO: $219.49 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $314 Cigna — Cigna: $217.60 Current Health Network — Current Health Network: $172.70 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $144.44 HFN — HFN PPO: $298.30 HFN — HFN Workers Compensation: $298.30 Hope Trust — Hope Trust: $188.40 HST — HST: $188.40
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$332	$332	$48.42 – $332
Liver function panel: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $199.20 Aetna — Aetna PPO: $232.07 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $332 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $48.42 Cigna — Cigna: $230.08 Commercial Workers Compensation — Commercial Workers Compensation: $119.50 Corvel/CorCare — Corvel/CorCare: $88.85 Coventry — Coventry Advantra Medicare Advantage HMO: $52.06 Current Health Network — Current Health Network: $249 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $225.76
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Hepatic Function Panel	$332	$332	$0.48 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $315.40
Liver function panel: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $199.20 Aetna — Aetna PPO: $265.60 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $7.60 Cigna — Cigna: $230.08 Commercial Workers Compensation — Commercial Workers Compensation: $0.48 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $44.60 Coventry — Coventry Advantra Medicare Advantage HMO: $8.01 Current Health Network — Current Health Network: $249 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $225.76 Health Alliance — Health Alliance Medicare Advantage: $8.01
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$332	$332	$152.72 – $332
Liver function panel: 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $199.20 Aetna — Aetna PPO: $232.07 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $332 Cigna — Cigna: $230.08 Current Health Network — Current Health Network: $182.60 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $152.72 HFN — HFN PPO: $315.40 HFN — HFN Workers Compensation: $315.40 Hope Trust — Hope Trust: $199.20 HST — HST: $199.20
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RTUA	$161	$161	$23.47 – $161
Urine test (automated, with microscope): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $96.60 Aetna — Aetna PPO: $112.54 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $161 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $23.47 Cigna — Cigna: $111.57 Commercial Workers Compensation — Commercial Workers Compensation: $47.69 Corvel/CorCare — Corvel/CorCare: $43.30 Coventry — Coventry Advantra Medicare Advantage HMO: $25.24 Current Health Network — Current Health Network: $120.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $109.48
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UACS	$161	$161	$23.47 – $161
Urine test (automated, with microscope): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $96.60 Aetna — Aetna PPO: $112.54 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $161 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $23.47 Cigna — Cigna: $111.57 Commercial Workers Compensation — Commercial Workers Compensation: $47.69 Corvel/CorCare — Corvel/CorCare: $43.30 Coventry — Coventry Advantra Medicare Advantage HMO: $25.24 Current Health Network — Current Health Network: $120.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $109.48
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: RTUA	$161	$161	$0.23 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $152.95
Urine test (automated, with microscope): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $96.60 Aetna — Aetna PPO: $128.80 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $2.95 Cigna — Cigna: $111.57 Commercial Workers Compensation — Commercial Workers Compensation: $0.23 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $21.75 Coventry — Coventry Advantra Medicare Advantage HMO: $3.11 Current Health Network — Current Health Network: $120.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $109.48 Health Alliance — Health Alliance Medicare Advantage: $3.11
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: pH Urine Random Specimen	$47	$47	$6.85 – $47
Urine test (manual, without microscope): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $28.20 Aetna — Aetna PPO: $32.85 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $47 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $6.85 Cigna — Cigna: $32.57 Commercial Workers Compensation — Commercial Workers Compensation: $22.85 Corvel/CorCare — Corvel/CorCare: $14.16 Coventry — Coventry Advantra Medicare Advantage HMO: $7.37 Current Health Network — Current Health Network: $35.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $31.96
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Specific Gravity Urine Random Specimen	$47	$47	$6.85 – $47
Urine test (manual, without microscope): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $28.20 Aetna — Aetna PPO: $32.85 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $47 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $6.85 Cigna — Cigna: $32.57 Commercial Workers Compensation — Commercial Workers Compensation: $22.85 Corvel/CorCare — Corvel/CorCare: $14.16 Coventry — Coventry Advantra Medicare Advantage HMO: $7.37 Current Health Network — Current Health Network: $35.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $31.96
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urine Ketone Dipstick	$47	$47	$6.85 – $47
Urine test (manual, without microscope): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $28.20 Aetna — Aetna PPO: $32.85 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $47 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $6.85 Cigna — Cigna: $32.57 Commercial Workers Compensation — Commercial Workers Compensation: $22.85 Corvel/CorCare — Corvel/CorCare: $14.16 Coventry — Coventry Advantra Medicare Advantage HMO: $7.37 Current Health Network — Current Health Network: $35.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $31.96
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RALS URFLX	$50	$50	$7.29 – $50
Urine test (automated, without microscope): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $30 Aetna — Aetna PPO: $34.95 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $50 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $7.29 Cigna — Cigna: $34.65 Commercial Workers Compensation — Commercial Workers Compensation: $36.90 Corvel/CorCare — Corvel/CorCare: $37.70 Coventry — Coventry Advantra Medicare Advantage HMO: $7.84 Current Health Network — Current Health Network: $37.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $34
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urine Dipstick Random	$50	$50	$7.29 – $50
Urine test (automated, without microscope): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $30 Aetna — Aetna PPO: $34.95 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $50 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $7.29 Cigna — Cigna: $34.65 Commercial Workers Compensation — Commercial Workers Compensation: $36.90 Corvel/CorCare — Corvel/CorCare: $37.70 Coventry — Coventry Advantra Medicare Advantage HMO: $7.84 Current Health Network — Current Health Network: $37.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $34
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: RALS URFLX	$50	$50	$0.18 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $47.50
Urine test (automated, without microscope): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $30 Aetna — Aetna PPO: $40 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $2.09 Cigna — Cigna: $34.65 Commercial Workers Compensation — Commercial Workers Compensation: $0.18 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $17.17 Coventry — Coventry Advantra Medicare Advantage HMO: $2.21 Current Health Network — Current Health Network: $37.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $34 Health Alliance — Health Alliance Medicare Advantage: $2.21
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prostate Specific Antigen	$375	$375	$54.68 – $375
PSA (prostate specific antigen) blood test: 10 of 29 insurance plan rates 6 Degrees Health — 6 Degrees Health: $225 Aetna — Aetna PPO: $262.13 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $375 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $54.68 Cigna — Cigna: $259.88 Commercial Workers Compensation — Commercial Workers Compensation: $115.68 Corvel/CorCare — Corvel/CorCare: $84.07 Coventry — Coventry Advantra Medicare Advantage HMO: $58.80 Current Health Network — Current Health Network: $281.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $255
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA Screening	$375	$375	$54.68 – $375
PSA (prostate specific antigen) blood test: 10 of 29 insurance plan rates 6 Degrees Health — 6 Degrees Health: $225 Aetna — Aetna PPO: $262.13 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $375 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $54.68 Cigna — Cigna: $259.88 Commercial Workers Compensation — Commercial Workers Compensation: $115.68 Corvel/CorCare — Corvel/CorCare: $84.07 Coventry — Coventry Advantra Medicare Advantage HMO: $58.80 Current Health Network — Current Health Network: $281.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $255
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Prostate Specific Antigen	$375	$375	$0.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $356.25
PSA (prostate specific antigen) blood test: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $225 Aetna — Aetna PPO: $300 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $17.10 Cigna — Cigna: $259.88 Commercial Workers Compensation — Commercial Workers Compensation: $0.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $76.29 Coventry — Coventry Advantra Medicare Advantage HMO: $18.02 Current Health Network — Current Health Network: $281.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $255 Health Alliance — Health Alliance Medicare Advantage: $18.02
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ultra Thyroid Stimulating Hormone	$324	$324	$47.24 – $324
Thyroid stimulating hormone (TSH) test: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $194.40 Aetna — Aetna PPO: $226.48 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $324 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $47.24 Cigna — Cigna: $224.53 Commercial Workers Compensation — Commercial Workers Compensation: $110.40 Corvel/CorCare — Corvel/CorCare: $84.39 Coventry — Coventry Advantra Medicare Advantage HMO: $50.80 Current Health Network — Current Health Network: $243 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $220.32
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ultra TSH w/Reflex Free T4	$324	$324	$47.24 – $324
Thyroid stimulating hormone (TSH) test: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $194.40 Aetna — Aetna PPO: $226.48 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $324 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $47.24 Cigna — Cigna: $224.53 Commercial Workers Compensation — Commercial Workers Compensation: $110.40 Corvel/CorCare — Corvel/CorCare: $84.39 Coventry — Coventry Advantra Medicare Advantage HMO: $50.80 Current Health Network — Current Health Network: $243 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $220.32
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Ultra Thyroid Stimulating Hormone	$324	$324	$0.73 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $307.80
Thyroid stimulating hormone (TSH) test: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $194.40 Aetna — Aetna PPO: $259.20 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $15.62 Cigna — Cigna: $224.53 Commercial Workers Compensation — Commercial Workers Compensation: $0.73 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $67.54 Coventry — Coventry Advantra Medicare Advantage HMO: $16.46 Current Health Network — Current Health Network: $243 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $220.32 Health Alliance — Health Alliance Medicare Advantage: $16.46
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC w/ Auto Diff	$163	$163	$23.77 – $163
Complete blood count (CBC) with differential: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $97.80 Aetna — Aetna PPO: $113.94 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $163 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $23.77 Cigna — Cigna: $112.96 Commercial Workers Compensation — Commercial Workers Compensation: $68.21 Corvel/CorCare — Corvel/CorCare: $61.64 Coventry — Coventry Advantra Medicare Advantage HMO: $25.56 Current Health Network — Current Health Network: $122.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $110.84
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NCBC	$163	$163	$23.77 – $163
Complete blood count (CBC) with differential: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $97.80 Aetna — Aetna PPO: $113.94 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $163 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $23.77 Cigna — Cigna: $112.96 Commercial Workers Compensation — Commercial Workers Compensation: $68.21 Corvel/CorCare — Corvel/CorCare: $61.64 Coventry — Coventry Advantra Medicare Advantage HMO: $25.56 Current Health Network — Current Health Network: $122.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $110.84
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CBC w/ Auto Diff	$163	$163	$0.38 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $154.85
Complete blood count (CBC) with differential: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $97.80 Aetna — Aetna PPO: $130.40 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $7.23 Cigna — Cigna: $112.96 Commercial Workers Compensation — Commercial Workers Compensation: $0.38 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $34.98 Coventry — Coventry Advantra Medicare Advantage HMO: $7.61 Current Health Network — Current Health Network: $122.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $110.84 Health Alliance — Health Alliance Medicare Advantage: $7.61
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBAT	$151	$151	$22.02 – $151
Complete blood count (CBC), automated: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $90.60 Aetna — Aetna PPO: $105.55 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $151 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $22.02 Cigna — Cigna: $104.64 Commercial Workers Compensation — Commercial Workers Compensation: $54.21 Corvel/CorCare — Corvel/CorCare: $44.05 Coventry — Coventry Advantra Medicare Advantage HMO: $23.68 Current Health Network — Current Health Network: $113.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $102.68
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CBAT	$151	$151	$0.33 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $143.45
Complete blood count (CBC), automated: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $90.60 Aetna — Aetna PPO: $120.80 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $6.02 Cigna — Cigna: $104.64 Commercial Workers Compensation — Commercial Workers Compensation: $0.33 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $30.38 Coventry — Coventry Advantra Medicare Advantage HMO: $6.34 Current Health Network — Current Health Network: $113.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $102.68 Health Alliance — Health Alliance Medicare Advantage: $6.34
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBAT	$151	$151	$69.46 – $151
Complete blood count (CBC), automated: 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $90.60 Aetna — Aetna PPO: $105.55 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $151 Cigna — Cigna: $104.64 Current Health Network — Current Health Network: $83.05 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $69.46 HFN — HFN PPO: $143.45 HFN — HFN Workers Compensation: $143.45 Hope Trust — Hope Trust: $90.60 HST — HST: $90.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Point of care INR	$65	$65	$9.48 – $65
Blood clotting time test (prothrombin time, PT): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $39 Aetna — Aetna PPO: $45.44 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $65 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $9.48 Cigna — Cigna: $45.04 Commercial Workers Compensation — Commercial Workers Compensation: $47.48 Corvel/CorCare — Corvel/CorCare: $41.80 Coventry — Coventry Advantra Medicare Advantage HMO: $10.19 Current Health Network — Current Health Network: $48.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $44.20
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time	$147	$147	$21.44 – $147
Blood clotting time test (prothrombin time, PT): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $88.20 Aetna — Aetna PPO: $102.75 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $147 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $21.44 Cigna — Cigna: $101.87 Commercial Workers Compensation — Commercial Workers Compensation: $47.48 Corvel/CorCare — Corvel/CorCare: $41.80 Coventry — Coventry Advantra Medicare Advantage HMO: $23.05 Current Health Network — Current Health Network: $110.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $99.96
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Point of care INR	$65	$65	$0.26 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $61.75
Blood clotting time test (prothrombin time, PT): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $39 Aetna — Aetna PPO: $52 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $3.99 Cigna — Cigna: $45.04 Commercial Workers Compensation — Commercial Workers Compensation: $0.26 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $24.59 Coventry — Coventry Advantra Medicare Advantage HMO: $4.20 Current Health Network — Current Health Network: $48.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $44.20 Health Alliance — Health Alliance Medicare Advantage: $4.20
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: APTT	$199	$199	$29.02 – $199
Blood clotting test (partial thromboplastin time, PTT): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $119.40 Aetna — Aetna PPO: $139.10 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $199 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $29.02 Cigna — Cigna: $137.91 Commercial Workers Compensation — Commercial Workers Compensation: $61.89 Corvel/CorCare — Corvel/CorCare: $54.87 Coventry — Coventry Advantra Medicare Advantage HMO: $31.20 Current Health Network — Current Health Network: $149.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $135.32
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: APTT	$199	$199	$0.33 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $189.05
Blood clotting test (partial thromboplastin time, PTT): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $119.40 Aetna — Aetna PPO: $159.20 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $5.59 Cigna — Cigna: $137.91 Commercial Workers Compensation — Commercial Workers Compensation: $0.33 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $30.91 Coventry — Coventry Advantra Medicare Advantage HMO: $5.89 Current Health Network — Current Health Network: $149.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $135.32 Health Alliance — Health Alliance Medicare Advantage: $5.89
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: APTT	$199	$199	$91.54 – $199
Blood clotting test (partial thromboplastin time, PTT): 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $119.40 Aetna — Aetna PPO: $139.10 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $199 Cigna — Cigna: $137.91 Current Health Network — Current Health Network: $109.45 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $91.54 HFN — HFN PPO: $189.05 HFN — HFN Workers Compensation: $189.05 Hope Trust — Hope Trust: $119.40 HST — HST: $119.40

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) · Hospital (facility) fee In the file: CT Head without contrast	$3,707	$3,707	$542.78 – $3,707
CT scan of the head or brain, without contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,224.20 Aetna — Aetna PPO: $2,591.19 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $3,707 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $542.78 Cigna — Cigna: $2,568.95 Commercial Workers Compensation — Commercial Workers Compensation: $988.33 Corvel/CorCare — Corvel/CorCare: $948.56 Coventry — Coventry Advantra Medicare Advantage HMO: $583.63 Current Health Network — Current Health Network: $2,780.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,645
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Head Dual Energy wo Post Stroke Only	$3,138	$3,138	$459.47 – $3,138
CT scan of the head or brain, without contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,882.80 Aetna — Aetna PPO: $2,193.46 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $3,138 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $459.47 Cigna — Cigna: $2,174.63 Commercial Workers Compensation — Commercial Workers Compensation: $988.33 Corvel/CorCare — Corvel/CorCare: $948.56 Coventry — Coventry Advantra Medicare Advantage HMO: $494.05 Current Health Network — Current Health Network: $2,353.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,645
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CT Head without contrast	$3,707	$3,707	$8.77 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $3,521.65
CT scan of the head or brain, without contrast: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,224.20 Aetna — Aetna PPO: $2,965.60 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $93.92 Cigna — Cigna: $2,568.95 Commercial Workers Compensation — Commercial Workers Compensation: $8.77 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $816.30 Coventry — Coventry Advantra Medicare Advantage HMO: $99.37 Current Health Network — Current Health Network: $2,780.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $2,520.76 Health Alliance — Health Alliance Medicare Advantage: $99.37
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Brain w/wo contrast	$7,396	$7,396	$1,082.92 – $7,396
MRI of the brain, before and after contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $4,437.60 Aetna — Aetna PPO: $5,169.80 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $7,396 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,082.92 Cigna — Cigna: $5,125.43 Commercial Workers Compensation — Commercial Workers Compensation: $2,292.69 Corvel/CorCare — Corvel/CorCare: $1,960.43 Coventry — Coventry Advantra Medicare Advantage HMO: $1,164.43 Current Health Network — Current Health Network: $5,547 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,734
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Internal Auditory Canal w/wo contrast	$7,396	$7,396	$1,082.92 – $7,396
MRI of the brain, before and after contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $4,437.60 Aetna — Aetna PPO: $5,169.80 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $7,396 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,082.92 Cigna — Cigna: $5,125.43 Commercial Workers Compensation — Commercial Workers Compensation: $2,292.69 Corvel/CorCare — Corvel/CorCare: $1,960.43 Coventry — Coventry Advantra Medicare Advantage HMO: $1,164.43 Current Health Network — Current Health Network: $5,547 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,734
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Sella w/wo contrast	$7,396	$7,396	$1,082.92 – $7,396
MRI of the brain, before and after contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $4,437.60 Aetna — Aetna PPO: $5,169.80 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $7,396 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,082.92 Cigna — Cigna: $5,125.43 Commercial Workers Compensation — Commercial Workers Compensation: $2,292.69 Corvel/CorCare — Corvel/CorCare: $1,960.43 Coventry — Coventry Advantra Medicare Advantage HMO: $1,164.43 Current Health Network — Current Health Network: $5,547 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,734
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: D Chest 2 Views	$676	$676	$98.98 – $676
Chest X-ray, 2 views: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $405.60 Aetna — Aetna PPO: $472.52 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $676 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $98.98 Cigna — Cigna: $468.47 Commercial Workers Compensation — Commercial Workers Compensation: $341.65 Corvel/CorCare — Corvel/CorCare: $352.44 Coventry — Coventry Advantra Medicare Advantage HMO: $106.43 Current Health Network — Current Health Network: $507 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $459.68
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: D Chest 2 Views Fighter Wing	$92	$92	$13.47 – $92
Chest X-ray, 2 views: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $55.20 Aetna — Aetna PPO: $64.31 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $92 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $13.47 Cigna — Cigna: $63.76 Commercial Workers Compensation — Commercial Workers Compensation: $46.49 Corvel/CorCare — Corvel/CorCare: $47.97 Coventry — Coventry Advantra Medicare Advantage HMO: $14.48 Current Health Network — Current Health Network: $69 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $62.56
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: D Chest with Inspiration and Expiration	$676	$676	$98.98 – $676
Chest X-ray, 2 views: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $405.60 Aetna — Aetna PPO: $472.52 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $676 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $98.98 Cigna — Cigna: $468.47 Commercial Workers Compensation — Commercial Workers Compensation: $341.65 Corvel/CorCare — Corvel/CorCare: $352.44 Coventry — Coventry Advantra Medicare Advantage HMO: $106.43 Current Health Network — Current Health Network: $507 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $459.68
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: D Lumbar Spine minimum 4 Views	$1,163	$1,163	$170.28 – $1,163
X-ray of the lower spine, at least 4 views: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $697.80 Aetna — Aetna PPO: $812.94 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,163 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $170.28 Cigna — Cigna: $805.96 Commercial Workers Compensation — Commercial Workers Compensation: $385.91 Corvel/CorCare — Corvel/CorCare: $278.81 Coventry — Coventry Advantra Medicare Advantage HMO: $183.10 Current Health Network — Current Health Network: $872.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $790.84
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: D Lumbar Spine minimum 4 Views	$1,163	$1,163	$1.77 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $1,104.85
X-ray of the lower spine, at least 4 views: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $697.80 Aetna — Aetna PPO: $930.40 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $46.66 Cigna — Cigna: $805.96 Commercial Workers Compensation — Commercial Workers Compensation: $1.77 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $164.40 Coventry — Coventry Advantra Medicare Advantage HMO: $49.37 Current Health Network — Current Health Network: $872.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $790.84 Health Alliance — Health Alliance Medicare Advantage: $49.37
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: D Lumbar Spine minimum 4 Views	$1,163	$1,163	$534.98 – $1,163
X-ray of the lower spine, at least 4 views: 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $697.80 Aetna — Aetna PPO: $812.94 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,163 Cigna — Cigna: $805.96 Current Health Network — Current Health Network: $639.65 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $534.98 HFN — HFN PPO: $1,104.85 HFN — HFN Workers Compensation: $1,104.85 Hope Trust — Hope Trust: $697.80 HST — HST: $697.80
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Lumbar Spine wo contrast	$5,540	$5,540	$811.16 – $5,540
MRI of the lower back (lumbar spine), without contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $3,324 Aetna — Aetna PPO: $3,872.46 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $5,540 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $811.16 Cigna — Cigna: $3,839.22 Commercial Workers Compensation — Commercial Workers Compensation: $1,663.03 Corvel/CorCare — Corvel/CorCare: $1,542.62 Coventry — Coventry Advantra Medicare Advantage HMO: $872.22 Current Health Network — Current Health Network: $4,155 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,734
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Lum Spine w/o for Vert Comp Fx	$5,540	$5,540	$811.16 – $5,540
MRI of the lower back (lumbar spine), without contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $3,324 Aetna — Aetna PPO: $3,872.46 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $5,540 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $811.16 Cigna — Cigna: $3,839.22 Commercial Workers Compensation — Commercial Workers Compensation: $1,663.03 Corvel/CorCare — Corvel/CorCare: $1,542.62 Coventry — Coventry Advantra Medicare Advantage HMO: $872.22 Current Health Network — Current Health Network: $4,155 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,734
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Thor Spine w/o for Vert Comp Fx	$5,540	$5,540	$811.16 – $5,540
MRI of the lower back (lumbar spine), without contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $3,324 Aetna — Aetna PPO: $3,872.46 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $5,540 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $811.16 Cigna — Cigna: $3,839.22 Commercial Workers Compensation — Commercial Workers Compensation: $1,663.03 Corvel/CorCare — Corvel/CorCare: $1,542.62 Coventry — Coventry Advantra Medicare Advantage HMO: $872.22 Current Health Network — Current Health Network: $4,155 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,734
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Pelvis w contrast	$4,783	$4,783	$700.33 – $4,783
CT scan of the pelvis, with contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,869.80 Aetna — Aetna PPO: $3,343.32 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $4,783 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $700.33 Cigna — Cigna: $3,314.62 Commercial Workers Compensation — Commercial Workers Compensation: $1,422.29 Corvel/CorCare — Corvel/CorCare: $1,197.12 Coventry — Coventry Advantra Medicare Advantage HMO: $753.04 Current Health Network — Current Health Network: $3,587.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,645
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NM CT Pelvis w contrast	$4,783	$4,783	$700.33 – $4,783
CT scan of the pelvis, with contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,869.80 Aetna — Aetna PPO: $3,343.32 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $4,783 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $700.33 Cigna — Cigna: $3,314.62 Commercial Workers Compensation — Commercial Workers Compensation: $1,422.29 Corvel/CorCare — Corvel/CorCare: $1,197.12 Coventry — Coventry Advantra Medicare Advantage HMO: $753.04 Current Health Network — Current Health Network: $3,587.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,645
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NM CT Pelvis w contrast for Bone Scan	$4,521	$4,521	$661.96 – $4,521
CT scan of the pelvis, with contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,712.60 Aetna — Aetna PPO: $3,160.18 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $4,521 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $661.96 Cigna — Cigna: $3,133.05 Commercial Workers Compensation — Commercial Workers Compensation: $1,422.29 Corvel/CorCare — Corvel/CorCare: $1,197.12 Coventry — Coventry Advantra Medicare Advantage HMO: $711.79 Current Health Network — Current Health Network: $3,390.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,645
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: MR Lower Ext Jt Rt wo contrast	$4,800	$4,800	$702.81 – $4,800
MRI of a leg joint (such as the knee), without contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,880 Aetna — Aetna PPO: $3,355.20 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $4,800 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $702.81 Cigna — Cigna: $3,326.40 Commercial Workers Compensation — Commercial Workers Compensation: $1,599.43 Corvel/CorCare — Corvel/CorCare: $1,362.86 Coventry — Coventry Advantra Medicare Advantage HMO: $755.71 Current Health Network — Current Health Network: $3,600 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,734
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: MR Lower Ext Jt Lt wo contrast	$4,800	$4,800	$702.81 – $4,800
MRI of a leg joint (such as the knee), without contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,880 Aetna — Aetna PPO: $3,355.20 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $4,800 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $702.81 Cigna — Cigna: $3,326.40 Commercial Workers Compensation — Commercial Workers Compensation: $1,599.43 Corvel/CorCare — Corvel/CorCare: $1,362.86 Coventry — Coventry Advantra Medicare Advantage HMO: $755.71 Current Health Network — Current Health Network: $3,600 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,734
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier RT In the file: MR Lower Ext Jt Rt wo contrast	$4,800	$4,800	$14.29 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $4,560
MRI of a leg joint (such as the knee), without contrast: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,880 Aetna — Aetna PPO: $3,840 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $178.95 Cigna — Cigna: $3,326.40 Commercial Workers Compensation — Commercial Workers Compensation: $14.29 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $1,330.89 Coventry — Coventry Advantra Medicare Advantage HMO: $189.34 Current Health Network — Current Health Network: $3,600 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $3,264 Health Alliance — Health Alliance Medicare Advantage: $189.34
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Abd/Pel w contrast	$7,344	$7,344	$1,050 – $7,344
CT scan of the abdomen and pelvis, with contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $4,406.40 Aetna — Aetna PPO: $5,133.46 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $7,344 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,075.30 Cigna — Cigna: $5,089.39 Commercial Workers Compensation — Commercial Workers Compensation: $3,711.66 Corvel/CorCare — Corvel/CorCare: $3,828.87 Coventry — Coventry Advantra Medicare Advantage HMO: $1,156.24 Current Health Network — Current Health Network: $5,508 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,645
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NM CT Abd/Pel w contrast	$7,344	$7,344	$1,050 – $7,344
CT scan of the abdomen and pelvis, with contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $4,406.40 Aetna — Aetna PPO: $5,133.46 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $7,344 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,075.30 Cigna — Cigna: $5,089.39 Commercial Workers Compensation — Commercial Workers Compensation: $3,711.66 Corvel/CorCare — Corvel/CorCare: $3,828.87 Coventry — Coventry Advantra Medicare Advantage HMO: $1,156.24 Current Health Network — Current Health Network: $5,508 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,645
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NM CT Abd/Pel w contrast for Bone Scan	$7,822	$7,822	$1,050 – $7,822
CT scan of the abdomen and pelvis, with contrast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $4,693.20 Aetna — Aetna PPO: $5,467.58 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $7,822 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,145.30 Cigna — Cigna: $5,420.65 Commercial Workers Compensation — Commercial Workers Compensation: $3,953.24 Corvel/CorCare — Corvel/CorCare: $4,078.08 Coventry — Coventry Advantra Medicare Advantage HMO: $1,231.50 Current Health Network — Current Health Network: $5,866.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,645
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Abdomen	$1,947	$1,947	$285.08 – $1,947
Ultrasound of the abdomen, complete: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,168.20 Aetna — Aetna PPO: $1,360.95 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,947 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $285.08 Cigna — Cigna: $1,349.27 Commercial Workers Compensation — Commercial Workers Compensation: $544.56 Corvel/CorCare — Corvel/CorCare: $449.41 Coventry — Coventry Advantra Medicare Advantage HMO: $306.54 Current Health Network — Current Health Network: $1,460.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,323.96
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: US Abdomen	$1,947	$1,947	$4.05 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $1,849.65
Ultrasound of the abdomen, complete: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,168.20 Aetna — Aetna PPO: $1,557.60 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $100.34 Cigna — Cigna: $1,349.27 Commercial Workers Compensation — Commercial Workers Compensation: $4.05 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $377.46 Coventry — Coventry Advantra Medicare Advantage HMO: $106.16 Current Health Network — Current Health Network: $1,460.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,323.96 Health Alliance — Health Alliance Medicare Advantage: $106.16
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Abdomen	$1,947	$1,947	$895.62 – $1,947
Ultrasound of the abdomen, complete: 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,168.20 Aetna — Aetna PPO: $1,360.95 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,947 Cigna — Cigna: $1,349.27 Current Health Network — Current Health Network: $1,070.85 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $895.62 HFN — HFN PPO: $1,849.65 HFN — HFN Workers Compensation: $1,849.65 Hope Trust — Hope Trust: $1,168.20 HST — HST: $1,168.20
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Pregnancy Complete	$1,212	$1,212	$177.46 – $1,212
Pregnancy ultrasound (after the first trimester): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $727.20 Aetna — Aetna PPO: $847.19 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,212 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $177.46 Cigna — Cigna: $839.92 Commercial Workers Compensation — Commercial Workers Compensation: $452.17 Corvel/CorCare — Corvel/CorCare: $426.82 Coventry — Coventry Advantra Medicare Advantage HMO: $190.82 Current Health Network — Current Health Network: $909 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $824.16
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: US Pregnancy Complete	$1,212	$1,212	$3.28 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $1,151.40
Pregnancy ultrasound (after the first trimester): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $727.20 Aetna — Aetna PPO: $969.60 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $119.18 Cigna — Cigna: $839.92 Commercial Workers Compensation — Commercial Workers Compensation: $3.28 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $305.23 Coventry — Coventry Advantra Medicare Advantage HMO: $126.10 Current Health Network — Current Health Network: $909 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $824.16 Health Alliance — Health Alliance Medicare Advantage: $126.10
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Pregnancy Complete	$1,212	$1,212	$557.52 – $1,212
Pregnancy ultrasound (after the first trimester): 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $727.20 Aetna — Aetna PPO: $847.19 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,212 Cigna — Cigna: $839.92 Current Health Network — Current Health Network: $666.60 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $557.52 HFN — HFN PPO: $1,151.40 HFN — HFN Workers Compensation: $1,151.40 Hope Trust — Hope Trust: $727.20 HST — HST: $727.20
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Vaginal	$1,320	$1,320	$193.27 – $1,320
Transvaginal ultrasound: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $792 Aetna — Aetna PPO: $922.68 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,320 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $193.27 Cigna — Cigna: $914.76 Commercial Workers Compensation — Commercial Workers Compensation: $368.85 Corvel/CorCare — Corvel/CorCare: $320.42 Coventry — Coventry Advantra Medicare Advantage HMO: $207.82 Current Health Network — Current Health Network: $990 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $897.60
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: US Vaginal	$1,320	$1,320	$3.36 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $1,254
Transvaginal ultrasound: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $792 Aetna — Aetna PPO: $1,056 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $102.85 Cigna — Cigna: $914.76 Commercial Workers Compensation — Commercial Workers Compensation: $3.36 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $312.57 Coventry — Coventry Advantra Medicare Advantage HMO: $108.82 Current Health Network — Current Health Network: $990 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $897.60 Health Alliance — Health Alliance Medicare Advantage: $108.82
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Vaginal	$1,320	$1,320	$607.20 – $1,320
Transvaginal ultrasound: 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $792 Aetna — Aetna PPO: $922.68 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,320 Cigna — Cigna: $914.76 Current Health Network — Current Health Network: $726 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $607.20 HFN — HFN PPO: $1,254 HFN — HFN Workers Compensation: $1,254 Hope Trust — Hope Trust: $792 HST — HST: $792
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: MAM Post LT	$521	$521	$76.29 – $521
Diagnostic mammogram, one breast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $312.60 Aetna — Aetna PPO: $364.18 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $521 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $76.29 Cigna — Cigna: $361.05 Commercial Workers Compensation — Commercial Workers Compensation: $263.31 Corvel/CorCare — Corvel/CorCare: $271.63 Coventry — Coventry Advantra Medicare Advantage HMO: $82.03 Current Health Network — Current Health Network: $390.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $354.28
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: MAM Post RT	$521	$521	$76.29 – $521
Diagnostic mammogram, one breast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $312.60 Aetna — Aetna PPO: $364.18 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $521 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $76.29 Cigna — Cigna: $361.05 Commercial Workers Compensation — Commercial Workers Compensation: $263.31 Corvel/CorCare — Corvel/CorCare: $271.63 Coventry — Coventry Advantra Medicare Advantage HMO: $82.03 Current Health Network — Current Health Network: $390.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $354.28
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: MAM Digital Diagnostic Lt	$521	$521	$76.29 – $521
Diagnostic mammogram, one breast: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $312.60 Aetna — Aetna PPO: $364.18 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $521 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $76.29 Cigna — Cigna: $361.05 Commercial Workers Compensation — Commercial Workers Compensation: $263.31 Corvel/CorCare — Corvel/CorCare: $271.63 Coventry — Coventry Advantra Medicare Advantage HMO: $82.03 Current Health Network — Current Health Network: $390.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $354.28
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MAM Digital Diagnostic Bi	$742	$742	$108.64 – $742
Diagnostic mammogram, both breasts: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $445.20 Aetna — Aetna PPO: $518.66 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $742 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $108.64 Cigna — Cigna: $514.21 Commercial Workers Compensation — Commercial Workers Compensation: $375 Corvel/CorCare — Corvel/CorCare: $386.85 Coventry — Coventry Advantra Medicare Advantage HMO: $116.82 Current Health Network — Current Health Network: $556.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $504.56
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MAM Digital Diagnostic Bi w Implants	$742	$742	$108.64 – $742
Diagnostic mammogram, both breasts: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $445.20 Aetna — Aetna PPO: $518.66 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $742 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $108.64 Cigna — Cigna: $514.21 Commercial Workers Compensation — Commercial Workers Compensation: $375 Corvel/CorCare — Corvel/CorCare: $386.85 Coventry — Coventry Advantra Medicare Advantage HMO: $116.82 Current Health Network — Current Health Network: $556.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $504.56
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MAM Baylis 2D Diagnostic Bi	$696	$696	$101.91 – $696
Diagnostic mammogram, both breasts: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $417.60 Aetna — Aetna PPO: $486.50 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $696 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $101.91 Cigna — Cigna: $482.33 Commercial Workers Compensation — Commercial Workers Compensation: $351.76 Corvel/CorCare — Corvel/CorCare: $362.87 Coventry — Coventry Advantra Medicare Advantage HMO: $109.58 Current Health Network — Current Health Network: $522 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $473.28
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MAM Digital Screening	$538	$538	$74.61 – $538
Screening mammogram, both breasts: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $322.80 Aetna — Aetna PPO: $376.06 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $538 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $74.61 Cigna — Cigna: $372.83 Commercial Workers Compensation — Commercial Workers Compensation: $271.91 Corvel/CorCare — Corvel/CorCare: $280.49 Coventry — Coventry Advantra Medicare Advantage HMO: $80.23 Current Health Network — Current Health Network: $403.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $365.84
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MAM Baylis 2D Screening	$578	$578	$74.61 – $578
Screening mammogram, both breasts: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $346.80 Aetna — Aetna PPO: $404.02 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $578 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $74.61 Cigna — Cigna: $400.55 Commercial Workers Compensation — Commercial Workers Compensation: $292.13 Corvel/CorCare — Corvel/CorCare: $301.35 Coventry — Coventry Advantra Medicare Advantage HMO: $80.23 Current Health Network — Current Health Network: $433.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $393.04
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: MAM Digital Screening	$538	$538	$2.86 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $511.10
Screening mammogram, both breasts: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $322.80 Aetna — Aetna PPO: $430.40 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $110.21 Cigna — Cigna: $372.83 Commercial Workers Compensation — Commercial Workers Compensation: $2.86 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $280.50 Coventry — Coventry Advantra Medicare Advantage HMO: $116.14 Current Health Network — Current Health Network: $403.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $365.84 Health Alliance — Health Alliance Medicare Advantage: $116.14

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CCLP-LEFT HEART CATH LT VENT	$10,461	$10,461	$1,531.69 – $10,461
Left heart catheterization (diagnostic): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $6,276.60 Aetna — Aetna PPO: $7,312.24 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $10,461 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,531.69 Cigna — Cigna: $7,249.47 Commercial Workers Compensation — Commercial Workers Compensation: $5,286.99 Corvel/CorCare — Corvel/CorCare: $10,251.78 Coventry — Coventry Advantra Medicare Advantage HMO: $1,646.98 Current Health Network — Current Health Network: $7,845.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $7,113.48
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CCLP-LEFT HEART CATH LT VENT	$10,461	$10,461	$11.59 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $9,937.95
Left heart catheterization (diagnostic): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $6,276.60 Aetna — Aetna PPO: $8,368.80 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $774.49 Cigna — Cigna: $7,249.47 Commercial Workers Compensation — Commercial Workers Compensation: $11.59 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $1,079.61 Coventry — Coventry Advantra Medicare Advantage HMO: $819.47 Current Health Network — Current Health Network: $7,845.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $7,113.48 Health Alliance — Health Alliance Medicare Advantage: $819.47
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CCLP-LEFT HEART CATH LT VENT	$10,461	$10,461	$4,812.06 – $10,461
Left heart catheterization (diagnostic): 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $6,276.60 Aetna — Aetna PPO: $7,312.24 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $10,461 Cigna — Cigna: $7,249.47 Current Health Network — Current Health Network: $5,753.55 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $4,812.06 HFN — HFN PPO: $9,937.95 HFN — HFN Workers Compensation: $9,937.95 Hope Trust — Hope Trust: $6,276.60 HST — HST: $6,276.60
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CCLP-EP EVAL W/O INDUCTION	$11,738	$11,738	$1,718.67 – $11,738
Heart rhythm study (electrophysiology evaluation): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $7,042.80 Aetna — Aetna PPO: $8,204.86 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $11,738 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,718.67 Cigna — Cigna: $8,134.43 Commercial Workers Compensation — Commercial Workers Compensation: $5,932.39 Corvel/CorCare — Corvel/CorCare: $11,503.24 Coventry — Coventry Advantra Medicare Advantage HMO: $1,848.03 Current Health Network — Current Health Network: $8,803.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $7,981.84
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CCLP-EP EVAL W/O INDUCTION	$11,738	$11,738	$42.30 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $11,151.10
Heart rhythm study (electrophysiology evaluation): 10 of 17 insurance plan rates 6 Degrees Health — 6 Degrees Health: $7,042.80 Aetna — Aetna PPO: $9,390.40 Cigna — Cigna: $8,134.43 Commercial Workers Compensation — Commercial Workers Compensation: $42.30 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $3,938.23 Current Health Network — Current Health Network: $8,803.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $7,981.84 Healthlink — Healthlink HMO: $9,977.30 HFN — HFN PPO: $11,151.10 HFN — HFN Workers Compensation: $11,151.10
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CCLP-EP EVAL W/O INDUCTION	$11,738	$11,738	$5,399.48 – $11,738
Heart rhythm study (electrophysiology evaluation): 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $7,042.80 Aetna — Aetna PPO: $8,204.86 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $11,738 Cigna — Cigna: $8,134.43 Current Health Network — Current Health Network: $6,455.90 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $5,399.48 HFN — HFN PPO: $11,151.10 HFN — HFN Workers Compensation: $11,151.10 Hope Trust — Hope Trust: $7,042.80 HST — HST: $7,042.80
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CCLP-EP EVAL TRANSEPTAL AFIB	$68,879	$68,879	$10,085.21 – $68,879
Heart rhythm study with ablation for atrial fibrillation: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $41,327.40 Aetna — Aetna PPO: $48,146.42 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $68,879 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $10,085.21 Cigna — Cigna: $47,733.15 Commercial Workers Compensation — Commercial Workers Compensation: $34,811.45 Corvel/CorCare — Corvel/CorCare: $67,501.42 Coventry — Coventry Advantra Medicare Advantage HMO: $10,844.31 Current Health Network — Current Health Network: $51,659.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $46,837.72
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CCLP-EP EVALTRNSPLAFIBLA-CS	$68,879	$68,879	$10,085.21 – $68,879
Heart rhythm study with ablation for atrial fibrillation: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $41,327.40 Aetna — Aetna PPO: $48,146.42 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $68,879 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $10,085.21 Cigna — Cigna: $47,733.15 Commercial Workers Compensation — Commercial Workers Compensation: $34,811.45 Corvel/CorCare — Corvel/CorCare: $67,501.42 Coventry — Coventry Advantra Medicare Advantage HMO: $10,844.31 Current Health Network — Current Health Network: $51,659.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $46,837.72
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CCLP-EP EVAL TRANSEPTAL AFIB	$68,879	$68,879	$366.44 – $65,435.05
Heart rhythm study with ablation for atrial fibrillation: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $41,327.40 Aetna — Aetna PPO: $55,103.20 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $808.65 Cigna — Cigna: $47,733.15 Commercial Workers Compensation — Commercial Workers Compensation: $366.44 Corvel/CorCare — Corvel/CorCare: $35,910.76 Coventry — Coventry Advantra Medicare Advantage HMO: $855.61 Current Health Network — Current Health Network: $51,659.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $46,837.72 Health Alliance — Health Alliance Medicare Advantage: $855.61
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SL-POLYSOMNOGRAM>6YRS	$8,669	$8,669	$1,269.31 – $8,669
Sleep study (overnight, in a sleep lab): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $5,201.40 Aetna — Aetna PPO: $6,059.63 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $8,669 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,269.31 Cigna — Cigna: $6,007.62 Commercial Workers Compensation — Commercial Workers Compensation: $4,381.31 Corvel/CorCare — Corvel/CorCare: $8,495.62 Coventry — Coventry Advantra Medicare Advantage HMO: $1,364.85 Current Health Network — Current Health Network: $6,501.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $5,894.92
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SL-POLYSOMNOGRAM>6YRS-REDUCED	$8,669	$8,669	$1,269.31 – $8,669
Sleep study (overnight, in a sleep lab): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $5,201.40 Aetna — Aetna PPO: $6,059.63 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $8,669 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,269.31 Cigna — Cigna: $6,007.62 Commercial Workers Compensation — Commercial Workers Compensation: $4,381.31 Corvel/CorCare — Corvel/CorCare: $8,495.62 Coventry — Coventry Advantra Medicare Advantage HMO: $1,364.85 Current Health Network — Current Health Network: $6,501.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $5,894.92
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SL-Polysomnogram>6Yrs	$8,669	$8,669	$1,269.31 – $8,669
Sleep study (overnight, in a sleep lab): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $5,201.40 Aetna — Aetna PPO: $6,059.63 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $8,669 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $1,269.31 Cigna — Cigna: $6,007.62 Commercial Workers Compensation — Commercial Workers Compensation: $4,381.31 Corvel/CorCare — Corvel/CorCare: $8,495.62 Coventry — Coventry Advantra Medicare Advantage HMO: $1,364.85 Current Health Network — Current Health Network: $6,501.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $5,894.92

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) · Hospital (facility) fee In the file: PT-THERAPEUTIC EXERCISE/15MIN-7395	$247	$247	$36.17 – $247
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $148.20 Aetna — Aetna PPO: $172.65 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $247 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $36.17 Cigna — Cigna: $171.17 Commercial Workers Compensation — Commercial Workers Compensation: $81.20 Corvel/CorCare — Corvel/CorCare: $81.06 Coventry — Coventry Advantra Medicare Advantage HMO: $38.89 Current Health Network — Current Health Network: $185.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $130
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OT-THERAPEUTIC EXERCISE/15MIN-7395	$247	$247	$36.17 – $247
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $148.20 Aetna — Aetna PPO: $172.65 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $247 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $36.17 Cigna — Cigna: $171.17 Commercial Workers Compensation — Commercial Workers Compensation: $81.20 Corvel/CorCare — Corvel/CorCare: $81.06 Coventry — Coventry Advantra Medicare Advantage HMO: $38.89 Current Health Network — Current Health Network: $185.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $130
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OTA-Therc Exercise/15 Min	$247	$247	$36.17 – $247
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $148.20 Aetna — Aetna PPO: $172.65 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $247 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $36.17 Cigna — Cigna: $171.17 Commercial Workers Compensation — Commercial Workers Compensation: $81.20 Corvel/CorCare — Corvel/CorCare: $81.06 Coventry — Coventry Advantra Medicare Advantage HMO: $38.89 Current Health Network — Current Health Network: $185.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $130
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT-EVALUATION LOW COMPLX-7395	$492	$492	$72.04 – $492
Physical therapy evaluation (low complexity): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $295.20 Aetna — Aetna PPO: $343.91 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $492 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $72.04 Cigna — Cigna: $340.96 Commercial Workers Compensation — Commercial Workers Compensation: $248.65 Corvel/CorCare — Corvel/CorCare: $256.51 Coventry — Coventry Advantra Medicare Advantage HMO: $77.46 Current Health Network — Current Health Network: $369 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $130
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT-FCE LOW COMPLX-7395	$1,230	$1,230	$130 – $1,230
Physical therapy evaluation (low complexity): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $738 Aetna — Aetna PPO: $859.77 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,230 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $180.09 Cigna — Cigna: $852.39 Commercial Workers Compensation — Commercial Workers Compensation: $621.64 Corvel/CorCare — Corvel/CorCare: $641.27 Coventry — Coventry Advantra Medicare Advantage HMO: $193.65 Current Health Network — Current Health Network: $922.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $130
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PT-EVALUATION LOW COMPLX-7395	$492	$492	$1.13 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $467.40
Physical therapy evaluation (low complexity): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $295.20 Aetna — Aetna PPO: $393.60 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $87.75 Cigna — Cigna: $340.96 Commercial Workers Compensation — Commercial Workers Compensation: $1.13 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $105.29 Coventry — Coventry Advantra Medicare Advantage HMO: $92.84 Current Health Network — Current Health Network: $369 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $334.56 Health Alliance — Health Alliance Medicare Advantage: $92.84
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT-EVALUATION MOD COMPLX-7395	$574	$574	$84.04 – $574
Physical therapy evaluation (moderate complexity): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $344.40 Aetna — Aetna PPO: $401.23 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $574 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $84.04 Cigna — Cigna: $397.78 Commercial Workers Compensation — Commercial Workers Compensation: $290.10 Corvel/CorCare — Corvel/CorCare: $299.26 Coventry — Coventry Advantra Medicare Advantage HMO: $90.37 Current Health Network — Current Health Network: $430.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $130
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT-FCE MOD COMPLX-7395	$1,756	$1,756	$130 – $1,756
Physical therapy evaluation (moderate complexity): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,053.60 Aetna — Aetna PPO: $1,227.44 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,756 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $257.11 Cigna — Cigna: $1,216.91 Commercial Workers Compensation — Commercial Workers Compensation: $887.48 Corvel/CorCare — Corvel/CorCare: $915.51 Coventry — Coventry Advantra Medicare Advantage HMO: $276.46 Current Health Network — Current Health Network: $1,317 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $130
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PT-EVALUATION MOD COMPLX-7395	$574	$574	$1.13 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $545.30
Physical therapy evaluation (moderate complexity): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $344.40 Aetna — Aetna PPO: $459.20 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $87.75 Cigna — Cigna: $397.78 Commercial Workers Compensation — Commercial Workers Compensation: $1.13 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $105.29 Coventry — Coventry Advantra Medicare Advantage HMO: $92.84 Current Health Network — Current Health Network: $430.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $390.32 Health Alliance — Health Alliance Medicare Advantage: $92.84
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT-EVALUATION HIGH COMPLX-7395	$667	$667	$97.66 – $667
Physical therapy evaluation (high complexity): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $400.20 Aetna — Aetna PPO: $466.23 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $667 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $97.66 Cigna — Cigna: $462.23 Commercial Workers Compensation — Commercial Workers Compensation: $337.10 Corvel/CorCare — Corvel/CorCare: $347.75 Coventry — Coventry Advantra Medicare Advantage HMO: $105.01 Current Health Network — Current Health Network: $500.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $130
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT-FCE HIGH COMPLX-7395	$2,283	$2,283	$130 – $2,283
Physical therapy evaluation (high complexity): 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,369.80 Aetna — Aetna PPO: $1,595.82 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $2,283 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $334.28 Cigna — Cigna: $1,582.12 Commercial Workers Compensation — Commercial Workers Compensation: $1,153.83 Corvel/CorCare — Corvel/CorCare: $1,190.26 Coventry — Coventry Advantra Medicare Advantage HMO: $359.44 Current Health Network — Current Health Network: $1,712.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $130
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PT-EVALUATION HIGH COMPLX-7395	$667	$667	$1.13 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $633.65
Physical therapy evaluation (high complexity): 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $400.20 Aetna — Aetna PPO: $533.60 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $87.75 Cigna — Cigna: $462.23 Commercial Workers Compensation — Commercial Workers Compensation: $1.13 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $105.29 Coventry — Coventry Advantra Medicare Advantage HMO: $92.84 Current Health Network — Current Health Network: $500.25 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $453.56 Health Alliance — Health Alliance Medicare Advantage: $92.84

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: IR-EGD W/BX SINGLE OR MULTIPLE	$1,900	$1,900	$278.20 – $1,962.79
Upper GI endoscopy with biopsy: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,140 Aetna — Aetna PPO: $1,328.10 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,900 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $278.20 Cigna — Cigna: $1,316.70 Commercial Workers Compensation — Commercial Workers Compensation: $1,864.65 Corvel/CorCare — Corvel/CorCare: $1,558.45 Coventry — Coventry Advantra Medicare Advantage HMO: $299.14 Current Health Network — Current Health Network: $1,425 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,035.50
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: IR-EGD W/BX SINGLE OR MULTIPLE	$1,900	$1,900	$7.99 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $1,805
Upper GI endoscopy with biopsy: 10 of 23 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,140 Aetna — Aetna PPO: $1,520 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $367.39 Cigna — Cigna: $1,316.70 Commercial Workers Compensation — Commercial Workers Compensation: $7.99 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Corvel/CorCare — Corvel/CorCare: $743.96 Coventry — Coventry Advantra Medicare Advantage HMO: $388.72 Current Health Network — Current Health Network: $1,425 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,292 Health Alliance — Health Alliance Medicare Advantage: $388.72
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: IR-EGD W/BX SINGLE OR MULTIPLE	$1,900	$1,900	$874 – $1,900
Upper GI endoscopy with biopsy: 10 of 12 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,140 Aetna — Aetna PPO: $1,328.10 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $1,900 Cigna — Cigna: $1,316.70 Current Health Network — Current Health Network: $1,045 Health Alliance MH Employee plan — Health Alliance MH Employee plan: $874 HFN — HFN PPO: $1,805 HFN — HFN Workers Compensation: $1,805 Hope Trust — Hope Trust: $1,140 HST — HST: $1,140
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Bx Prostate	$4,001	$4,001	$585.83 – $4,001
Prostate biopsy: 10 of 29 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,400.60 Aetna — Aetna PPO: $2,796.70 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $4,001 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $585.83 Cigna — Cigna: $2,772.69 Commercial Workers Compensation — Commercial Workers Compensation: $1,261.30 Corvel/CorCare — Corvel/CorCare: $1,054.17 Coventry — Coventry Advantra Medicare Advantage HMO: $629.92 Current Health Network — Current Health Network: $3,000.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $2,180.55
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Bx Prostate	$4,001	$4,001	$585.83 – $4,001
Prostate biopsy: 10 of 29 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,400.60 Aetna — Aetna PPO: $2,796.70 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $4,001 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $585.83 Cigna — Cigna: $2,772.69 Commercial Workers Compensation — Commercial Workers Compensation: $1,261.30 Corvel/CorCare — Corvel/CorCare: $1,054.17 Coventry — Coventry Advantra Medicare Advantage HMO: $629.92 Current Health Network — Current Health Network: $3,000.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $2,180.55
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Ndl Bx Prostate	$4,001	$4,001	$585.83 – $4,001
Prostate biopsy: 10 of 29 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,400.60 Aetna — Aetna PPO: $2,796.70 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $4,001 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $585.83 Cigna — Cigna: $2,772.69 Commercial Workers Compensation — Commercial Workers Compensation: $1,261.30 Corvel/CorCare — Corvel/CorCare: $1,054.17 Coventry — Coventry Advantra Medicare Advantage HMO: $629.92 Current Health Network — Current Health Network: $3,000.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $2,180.55
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Nerve Root Inj Lumbar or Sacral	$2,450	$2,450	$358.73 – $2,450
Spinal injection, lower back (epidural), with imaging guidance: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,470 Aetna — Aetna PPO: $1,712.55 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $2,450 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $358.73 Cigna — Cigna: $1,697.85 Commercial Workers Compensation — Commercial Workers Compensation: $1,238.23 Corvel/CorCare — Corvel/CorCare: $1,277.33 Coventry — Coventry Advantra Medicare Advantage HMO: $385.73 Current Health Network — Current Health Network: $1,837.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,335.25
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: D Spinal Puncture For Injection of Isotope	$2,450	$2,450	$358.73 – $2,450
Spinal injection, lower back (epidural), with imaging guidance: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,470 Aetna — Aetna PPO: $1,712.55 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $2,450 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $358.73 Cigna — Cigna: $1,697.85 Commercial Workers Compensation — Commercial Workers Compensation: $1,238.23 Corvel/CorCare — Corvel/CorCare: $1,277.33 Coventry — Coventry Advantra Medicare Advantage HMO: $385.73 Current Health Network — Current Health Network: $1,837.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,335.25
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: IR-INJ-EPIDRLLUMB/SACR W/IMG	$4,138	$4,138	$605.89 – $4,138
Spinal injection, lower back (epidural), with imaging guidance: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $2,482.80 Aetna — Aetna PPO: $2,892.46 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $4,138 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $605.89 Cigna — Cigna: $2,867.63 Commercial Workers Compensation — Commercial Workers Compensation: $2,091.35 Corvel/CorCare — Corvel/CorCare: $2,157.39 Coventry — Coventry Advantra Medicare Advantage HMO: $651.49 Current Health Network — Current Health Network: $3,103.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $2,255.21
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: IR-STERIOD-LUMB/SACR-SNG LVL	$5,053	$5,053	$739.85 – $5,053
Nerve root injection, lower back, with imaging guidance: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $3,031.80 Aetna — Aetna PPO: $3,532.05 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $5,053 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $739.85 Cigna — Cigna: $3,501.73 Commercial Workers Compensation — Commercial Workers Compensation: $1,425.88 Corvel/CorCare — Corvel/CorCare: $1,191.72 Coventry — Coventry Advantra Medicare Advantage HMO: $795.54 Current Health Network — Current Health Network: $3,789.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $2,753.89
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PC-LUMB/SACR TRANSFORAMINAL-SNG LVL	$2,450	$2,450	$358.73 – $2,450
Nerve root injection, lower back, with imaging guidance: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $1,470 Aetna — Aetna PPO: $1,712.55 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $2,450 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $358.73 Cigna — Cigna: $1,697.85 Commercial Workers Compensation — Commercial Workers Compensation: $1,425.87 Corvel/CorCare — Corvel/CorCare: $1,191.72 Coventry — Coventry Advantra Medicare Advantage HMO: $385.73 Current Health Network — Current Health Network: $1,837.50 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $1,335.25
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: D Lumbar Transforaminal Inj	$5,053	$5,053	$739.85 – $5,053
Nerve root injection, lower back, with imaging guidance: 10 of 30 insurance plan rates 6 Degrees Health — 6 Degrees Health: $3,031.80 Aetna — Aetna PPO: $3,532.05 Blue Cross Blue Shield — BCBS PPO/HMO/Employee: $5,053 Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $739.85 Cigna — Cigna: $3,501.73 Commercial Workers Compensation — Commercial Workers Compensation: $1,425.88 Corvel/CorCare — Corvel/CorCare: $1,191.72 Coventry — Coventry Advantra Medicare Advantage HMO: $795.54 Current Health Network — Current Health Network: $3,789.75 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $2,753.89

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$3,025.28 – $211,601.96
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 27 insurance plan rates Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $3,359.72 Commercial Workers Compensation — Commercial Workers Compensation: $160,500.87 Corvel/CorCare — Corvel/CorCare: $135,520.83 Coventry — Coventry Advantra Medicare Advantage HMO: $3,359.72 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $145,695.24 Health Alliance — Health Alliance Medicare Advantage: $3,359.72 Healthlink — Healthlink HMO: $90,911.56 Humana — Humana/ChoiceCare Medicare Advantage PPO/HMO: $3,359.72 Illinois Workers Compensation — Illinois Workers Compensation: $168,948.28 Medicare — Medicare: $3,359.72
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) · Hospital (facility) fee In the file: SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	Not listed in the file	Not listed in the file	$3,025.28 – $79,728.89
Spinal fusion (not neck), without major complications: 10 of 24 insurance plan rates Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $3,359.72 Commercial Workers Compensation — Commercial Workers Compensation: $34,392.44 Corvel/CorCare — Corvel/CorCare: $31,138.32 Coventry — Coventry Advantra Medicare Advantage HMO: $3,359.72 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $79,728.89 Health Alliance — Health Alliance Medicare Advantage: $3,359.72 Humana — Humana/ChoiceCare Medicare Advantage PPO/HMO: $3,359.72 Illinois Workers Compensation — Illinois Workers Compensation: $36,202.57 Medicare — Medicare: $3,359.72 UHC VA CCN — UHC VA CCN: $3,025.28
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$3,025.28 – $41,722.11
Hip or knee replacement (major joint of the leg), without major complications: 10 of 26 insurance plan rates Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $3,359.72 Commercial Workers Compensation — Commercial Workers Compensation: $21,649.13 Corvel/CorCare — Corvel/CorCare: $20,009.79 Coventry — Coventry Advantra Medicare Advantage HMO: $3,359.72 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $28,727.11 Health Alliance — Health Alliance Medicare Advantage: $3,359.72 Healthlink — Healthlink HMO: $17,925.27 Humana — Humana/ChoiceCare Medicare Advantage PPO/HMO: $3,359.72 Illinois Workers Compensation — Illinois Workers Compensation: $22,788.56 Medicare — Medicare: $3,359.72
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$3,025.28 – $52,805.32
Neck (cervical) spinal fusion, without complications: 10 of 26 insurance plan rates Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $3,359.72 Commercial Workers Compensation — Commercial Workers Compensation: $20,456.90 Corvel/CorCare — Corvel/CorCare: $18,902.16 Coventry — Coventry Advantra Medicare Advantage HMO: $3,359.72 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $36,358.28 Health Alliance — Health Alliance Medicare Advantage: $3,359.72 Healthlink — Healthlink HMO: $22,687 Humana — Humana/ChoiceCare Medicare Advantage PPO/HMO: $3,359.72 Illinois Workers Compensation — Illinois Workers Compensation: $21,533.58 Medicare — Medicare: $3,359.72
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$3,025.28 – $26,836.34
Uterus and ovary surgery (not for cancer), without complications: 10 of 26 insurance plan rates Blue Cross Blue Shield — Blue Cross Community MMAI/Dual Eligible: $3,359.72 Commercial Workers Compensation — Commercial Workers Compensation: $12,347.95 Corvel/CorCare — Corvel/CorCare: $9,564.43 Coventry — Coventry Advantra Medicare Advantage HMO: $3,359.72 Health Alliance — Health Alliance Fully Insured/Self Funded/ACA: $18,477.75 Health Alliance — Health Alliance Medicare Advantage: $3,359.72 Healthlink — Healthlink HMO: $11,529.83 Humana — Humana/ChoiceCare Medicare Advantage PPO/HMO: $3,359.72 Illinois Workers Compensation — Illinois Workers Compensation: $12,997.85 Medicare — Medicare: $3,359.72

Source: Jacksonville Memorial Hospital’s standard charges file (memorial.health, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on September 17, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Critical Access Hospital
Address	1600 W Walnut St, Jacksonville, IL 62650
County	Morgan County
State	Illinois
Phone	(217) 245‑9551
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	Not rated by CMS
CMS Certification Number	141352
Name in Medicare records	JACKSONVILLE MEMORIAL HOSPITAL
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(217) 245‑9541^[4]
Official website	memorial.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.

Jacksonville Memorial Hospital — memorial.health