Does Mercy Hospital Ada have an emergency room?

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

Where is Mercy Hospital Ada?

430 North Monte Vista, Ada, OK 74820, in Pontotoc County, Oklahoma.

What is the phone number of Mercy Hospital Ada?

(580) 332-2323, as listed by Medicare (CMS).

What is the Medicare star rating of Mercy Hospital Ada?

4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).

Does Medicare reduce its payments to Mercy Hospital Ada for hospital-acquired conditions?

No. For fiscal year 2026, CMS lists no Medicare payment reduction for Mercy Hospital Ada under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.2935; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Mercy Hospital Ada — Phone, Address, ER & Ratings

Quick answers

Does Mercy Hospital Ada have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Mercy Hospital Ada. In a medical emergency, call 911.
Where is Mercy Hospital Ada?: 430 North Monte Vista, Ada, OK 74820, in Pontotoc County, Oklahoma.
What is the phone number of Mercy Hospital Ada?: (580) 332-2323, as listed by Medicare (CMS).
What is the Medicare star rating of Mercy Hospital Ada?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to Mercy Hospital Ada for hospital-acquired conditions?: No. For fiscal year 2026, CMS lists no Medicare payment reduction for Mercy Hospital Ada under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.2935; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas^{[4][5][8][10]}

Emergency services
Imaging
Rehabilitation
Cardiopulmonary services
Sleep and neuro services
Maternity (birthplace)
Neonatal intensive care
Cancer center
Cardiology
Dialysis
Behavioral health
Oncology
Sleep medicine
Obstetrics
Neonatology
Addiction medicine

Conditions treated^[5][8][12]

Treatments^[4][5][8][9]

Cardiac rehab
Remote outpatient blood pressure monitoring
Cardiopulmonary rehabilitation
Substance withdrawal management
Dialysis
Wound care
Linear accelerator (LINAC) radiation therapy

Procedures^[4][5][11]

Pacemaker insertion and replacement
Stent and angioplasty
Cardiac catheterization
Diagnostic heart catheterization
Balloon angioplasty and stent placement
Thrombectomy
Atherectomy
Holter monitoring
Loop recorder
Echocardiogram
Nuclear stress test
Vascular Doppler study
Ankle-brachial index
Carotid artery screening
Cardiac CT
CT scan
MRI
Mammogram and 3D mammogram
Stereotactic breast biopsy
Breast ultrasound
Bone density scan
X-ray
Nuclear medicine

Programs and centers^{[4][5][6][9][12][13]}

Substance Abuse Treatment Program
BreakThru Medical Withdrawal Program
Neonatal intensive care unit
Birthplace
Cancer Center
Cardiac rehab program
Inpatient rehabilitation unit (20 beds)
Community paramedic home visits
Surgery center
Endoscopy center
Ambulance service for Pontotoc County

Emergency care (hospital website)^[4][5][6]

Emergency room	Yes

Visiting and practical information

Visiting	Open visiting policy: visitors allowed 24/7; ICU limits two visitors at a time; some quiet-hour guidance applies^[7]
Interpreters and languages	Interpreter, assistive listening devices and closed captioning at no cost for hearing-impaired patients^[7]

Recognition^[5]

Gold Seal of Approval, The Joint Commission
Accreditation of Mercy Cancer Center by the American College of Surgeons Commission on Cancer

Doctors and clinicians (312)

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

Main specialties

Doctors with a page on this site (312)

Aaron C. Ruger, PAPhysician Assistant
Abdul Khan-Sahibzada, MDNephrology
Abhilash Makkar, MDHospitalist
Adam Billen, CNACertified Registered Nurse Anesthetist (CRNA)
Adam D. Sharp, MDDiagnostic Radiology
Adam M. Savage, MDAnesthesiology
Akshaya Gopalakrishnan, MDInternal Medicine
Alex B. Jones, MDUrology
Alexis N. Schutz, MDHospitalist
Alicia R. Gosey, NPNurse Practitioner
Allen P. Heeger, DONuclear Medicine
Allyn E. Ross, NPNurse Practitioner
Amanda Austin, NPNurse Practitioner
Amanda L. Cubit, NPNurse Practitioner
Amanda Rushing, NPNurse Practitioner
Amanda Satterwhite, MDEmergency Medicine
Amber E. Holbein, MDFamily Practice
Amer El-Arid, PAPhysician Assistant
Amy M. Ashley, NPNurse Practitioner
Andres R. Caero Romero, MDInternal Medicine
Andrew G. Park, DOEmergency Medicine
Andrew L. Warren, MDDiagnostic Radiology
Anna B. Vass, PAPhysician Assistant
Anne Kingori, NPNurse Practitioner

And 288 more: the button below opens the full list.

Other emergency rooms nearby

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

Chickasaw Nation Medical Center5.0 mi · Ada, OK · Acute Care Hospital
Holdenville General Hospital26 mi · Holdenville, OK · Critical Access Hospital
Arbuckle Memorial Hospital Authority28 mi · Sulphur, OK · Critical Access Hospital
Coal County General Hospital, Inc.29 mi · Coalgate, OK · Critical Access Hospital
Valley Community Hospital33 mi · Pauls Valley, OK · Acute Care Hospital

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

Other hospitals near Ada

Rolling Hills Hospital, LLC0.6 mi · Ada, OK · Psychiatric Hospital

All hospitals in Ada · Hospitals in Pontotoc County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Jan Frances Care Center1.1 mi · Ada, OK · 1 of 5 stars
Ada Care Center1.1 mi · Ada, OK · 2 of 5 stars
Ballard Nursing Center2.6 mi · Ada, OK · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Choice Health at Home - Southeastern Oklahoma Hospice5.0 mi · Ada, OK
Elara Caring Xxiii5.0 mi · Ada, OK · 4 of 5 stars
Halo Hospice5.0 mi · Ada, OK

All hospice providers in the state →

Home health agencies

A Path of Care Home Health I, Inc5.0 mi · Ada, OK · 4.5 of 5 stars
Elara Caring Xxiii5.0 mi · Ada, OK · 4.5 of 5 stars
Mays Housecall Home Health of Ada, LLC5.0 mi · Ada, OK · 4 of 5 stars

All home health agencies in the state →

Dialysis facilities

Fmcna - Ada Dialysis Center5.0 mi · Ada, OK · 2 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

Apex Surgery Center5.0 mi · Ada, OK

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Decommission0.1 mi · Ada, OK · Community health center
Central Oklahoma Family Medical Center - Ada Dental/MVP/X-Ray0.2 mi · Ada, OK · Community health center
Central Oklahoma Family Medical Center - Primary Care 20.2 mi · Ada, OK · Community health center

Clinics and urgent care

HRH Medical Group, Primary Care of Ada5.0 mi · Ada, OK · Rural health clinic
Xpress Wellness Urgent Care5.0 mi · Ada, OK · Rural health clinic

Pharmacies

Broderick Enterprises, LLC5.0 mi · Ada, OK · Community/retail pharmacy
Central Oklahoma Family Medical Center, Inc.5.0 mi · Ada, OK · Community/retail pharmacy
Central Oklahoma Family Medical Center, Inc.5.0 mi · Ada, OK · Community/retail pharmacy

Assisted living nearby

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

Featherstone Assisted Living Community of Ada5.0 mi · Ada, OK
Kyrie Assisted Living, LLC5.0 mi · Ada, OK
The Neighborhoods at Baptist Village of Ada5.0 mi · Ada, OK

About the Medicare star rating

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

Medicare quality data

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

What patients said (patient survey)

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

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	3 of 5 stars
Patients got help quickly from staff	4 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Restfulness of Environment	4 of 5 stars
Care Coordination	3 of 5 stars
Symptoms After Stay	4 of 5 stars
Rated the hospital 9 or 10 out of 10	68%National average: 72%
Would definitely recommend the hospital	73%National average: 71%
Nurses “always” communicated well	80%National average: 80%
Doctors “always” communicated well	78%National average: 80%
“Always” got help as soon as they wanted	67%National average: 64%
Staff “always” explained medicines before giving them	54%National average: 62%
Were given information about recovery at home	86%National average: 86%
Room and bathroom “always” clean	70%National average: 73%
Completed surveys	567Response rate: 18%

Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged January 2025 to December 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)	2.904No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.444No different from the national benchmark
Not reported to Medicare	Surgical site infections after colon surgery; Surgical site infections after abdominal hysterectomy; MRSA bloodstream infections

Source: Healthcare Associated Infections - Hospital — CMS, released October 19, 2026; data from January 2025 to December 2025.

Complications and deaths

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

Deaths within 30 days: heart failure patients	9.9%
Deaths within 30 days: pneumonia patients	13.3%
Deaths within 30 days: COPD patients	7%
Deaths within 30 days: stroke patients	12.8%
Serious complications (patient safety indicator PSI-90)	0.9No different from the national rate
Complications after hip or knee replacement	4%
Not reported to Medicare	Deaths within 30 days: coronary bypass surgery (CABG)
Too few cases to report	Deaths within 30 days: heart attack patients

Source: Complications and Deaths - Hospital — CMS, released October 20, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	15.9%
Readmitted within 30 days: heart attack	15%
Readmitted within 30 days: heart failure	22%
Readmitted within 30 days: pneumonia	17.7%
Readmitted within 30 days: COPD	18.8%
Readmitted within 30 days: hip or knee replacement	5.7%
Not reported to Medicare	Readmitted within 30 days: coronary bypass surgery

Source: Unplanned Hospital Visits - Hospital — CMS, released October 20, 2026; data from July 2024 to June 2025.

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	134 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	0%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	86%National average: 66%

Source: Timely and Effective Care - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

Medicare payment programs

Medicare (CMS) uses these federal programs to adjust what it pays hospitals, based on quality, safety and cost results. This is a payment to the hospital for Medicare patients, not a price you pay, and not a prediction for any one person. Results for Mercy Hospital Ada, fiscal year 2026 (October 2025 to September 2026).

Show the Medicare payment program results

Hospital-Acquired Condition Reduction Program

What this means: Medicare gives each hospital a Total HAC Score built from patient-safety complications and from infections caught in the hospital. The quarter of hospitals with the highest (worst) scores gets a reduction in its Medicare payments. A lower score is better.

CMS says: Hospitals with a Total HAC Score above the 75th percentile of the Total HAC Score distribution will be subject to a 1-percent payment reduction.

Medicare payment reduction, fiscal year 2026	NoCMS lists no payment reduction for this hospital.
Total HAC Score	-0.2935Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

Source: Hospital-Acquired Condition (HAC) Reduction Program — CMS, released January 26, 2026; patient-safety data from July 2022 to June 2024 and infection data from January 2023 to December 2024.

Hospital Readmissions Reduction Program

What this means: For six conditions, Medicare compares how often this hospital’s patients had to go back into a hospital within 30 days with how often that happens at an average hospital with similar patients. The ratio is that comparison: 1 means as many readmissions as expected, above 1 means more than expected (CMS calls these “excess readmissions”), below 1 means fewer.

CMS says: In October 2012, CMS began reducing Medicare payments for subsection(d) hospitals with excess readmissions under the Hospital Readmissions Reduction Program (HRRP).

Heart failure	1.0736More readmissions than expected
Pneumonia	1.0798More readmissions than expected
COPD (chronic lung disease)	1.0002More readmissions than expected
Hip or knee replacement	1.0032More readmissions than expected
No result published	Heart attack; Coronary bypass surgery (CABG) (not reported, or too few cases)

Source: Hospital Readmissions Reduction Program — CMS, released January 26, 2026; patients discharged July 2021 to June 2024.

Hospital Value-Based Purchasing Program

What this means: Medicare scores hospitals in four areas, each from 0 to 100, and combines them into a Total Performance Score from 0 to 100. A higher score means better results on these measures. Medicare uses the score to adjust what it pays the hospital.

CMS says: This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver.

Total Performance Score	33.25 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)	25.00 out of 100
Person and community engagement (patient survey)	36.00 out of 100
Safety (infections and sepsis care)	52.00 out of 100
Efficiency and cost reduction (Medicare spending)	20.00 out of 100

Source: Hospital Value-Based Purchasing (HVBP) - Total Performance Score — CMS, released January 26, 2026, fiscal year 2026. Program description: The Hospital Value-Based Purchasing (VBP) Program — CMS, page last modified September 10, 2024.

Medicare spending per patient (MSPB)

What this means: This compares what Medicare spent on a hospital stay, counting the 3 days before it and the 30 days after, with the national median hospital, after adjusting for the patient’s age and health and for local prices. A ratio of 1.00 is the national median hospital; below 1.00 means Medicare spent less, above 1.00 means more. It measures the cost to Medicare, not the quality of care.

CMS says: The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (episode) at a specific hospital compared to all hospitals nationally.

Medicare spending per patient, ratio	1.00Same as the national median hospital

Source: Medicare Spending Per Beneficiary - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

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 Oklahoma Best hospitals in Oklahoma

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 64 common services exactly as Mercy Hospital Ada lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

Show the prices of 64 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level III New Patient	$340	$221	$132.60 – $340
New patient office visit (about 30–44 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $250.92 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $208.76 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $98.08 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $67.95 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $204 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $204 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $93.51 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $204 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $204 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $204
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level III New Pt	$340	$221	$67.95 – $187.15
New patient office visit (about 30–44 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $250.92 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $208.76 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $98.08 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $67.95 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $204 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $204 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $93.51 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $204 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $204 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $204
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level IV New Pt	$451	$293.15	$111.17 – $283.46
New patient office visit (about 45–59 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $332.84 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $276.91 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $147.66 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $111.17 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $270.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $270.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $152.98 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $270.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $270.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $270.60
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level V New Patient	$797	$518.05	$310.83 – $797
New patient office visit (about 60–74 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $588.19 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $489.36 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $194.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $152.10 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $478.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $478.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $209.32 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $478.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $478.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $478.20
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level V New Pt	$541	$351.65	$152.10 – $378.40
New patient office visit (about 60–74 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $399.26 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $332.17 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $194.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $152.10 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $324.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $324.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $209.32 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $324.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $324.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $324.60
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: L&D Level II, 12-18 Hrs	$2,855	$1,855.75	$1,113.45 – $2,855
Established patient office visit (about 20–29 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $2,106.99 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $1,752.97 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $79.99 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $54.82 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $1,713 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $1,713 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $75.44 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $1,713 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $1,713 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $1,713
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: L&D Level II, 6-12 Hrs	$2,034	$1,322.10	$793.26 – $2,034
Established patient office visit (about 20–29 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $1,501.09 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $1,248.88 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $79.99 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $54.82 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $1,220.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $1,220.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $75.44 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $1,220.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $1,220.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $1,220.40
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lactation Consult 31-45 Minutes	$148	$96.20	$57.72 – $148
Established patient office visit (about 20–29 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $109.22 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $90.87 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $79.99 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $54.82 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $88.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $88.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $75.44 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $88.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $88.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $88.80
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lactation Consult 46-60 Minutes	$251	$163.15	$97.89 – $251
Established patient office visit (about 30–39 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $185.24 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $154.11 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $113.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $80.63 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $150.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $150.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $110.96 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $150.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $150.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $150.60
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level IV Est Pt	$368	$239.20	$143.52 – $368
Established patient office visit (about 30–39 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $271.58 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $225.95 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $113.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $80.63 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $220.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $220.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $110.96 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $220.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $220.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $220.80
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Care Level 3	$827	$537.55	$476 – $4,136
Emergency room visit (moderate): 10 of 109 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $610.33 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $507.78 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $246.57 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $270.32 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $496.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $496.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $372 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $496.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $496.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $496.20
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Care Level 4	$1,702	$1,106.30	$819 – $4,136
Emergency room visit (moderately high): 10 of 109 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $379.20 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $413.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $568.63 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $413.20 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $413.20 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $115.85 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $426.30 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $426.30 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $426.30 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $694.99
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Care Level 5	$2,606	$1,693.90	$589.74 – $1,326.94
Emergency room visit (high): 10 of 109 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $1,923.23 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $1,600.08 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $545.97 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $589.74 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $1,563.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $1,563.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $811.57 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $1,563.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $1,563.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $1,563.60

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 Pnl Calcium Total	$29	$18.85	$7.53 – $18.67
Basic metabolic panel (blood test): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $21.40 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $17.81 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $7.53 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $8.30 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $17.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $17.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $11.42 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $17.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $17.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $17.40
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$36	$23.40	$9.39 – $23.31
Comprehensive metabolic panel (blood test): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $26.57 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $22.10 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $9.39 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $10.36 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $21.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $21.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $14.26 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $21.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $21.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $21.60
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric Panel	$498	$323.70	$194.22 – $498
Obstetric blood test panel: 10 of 101 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $367.52 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $305.77 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $42.53 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $46.90 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $298.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $298.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $64.54 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $298.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $298.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $298.80
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel	$74	$48.10	$28.86 – $74
Cholesterol panel (lipid panel): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $54.61 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $45.44 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $11.91 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $13.14 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $44.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $44.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $18.08 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $44.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $44.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $44.40
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Lipid Panel	$184	$119.60	$11.91 – $29.56
Cholesterol panel (lipid panel): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $135.79 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $112.98 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $11.91 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $13.14 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $110.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $110.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $18.08 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $110.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $110.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $110.40
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel	$48	$31.20	$7.72 – $19.16
Kidney function panel: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $35.42 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $29.47 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $7.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $8.52 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $28.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $28.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $11.72 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $28.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $28.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $28.80
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$34	$22.10	$13.26 – $34
Liver function panel: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $25.09 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $20.88 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $7.27 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $8.01 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $20.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $20.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $11.03 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $20.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $20.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $20.40
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Automated W Micro	$17	$11.05	$6.63 – $17
Urine test (automated, with microscope): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $12.55 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $10.44 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $2.82 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $3.11 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $10.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $10.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $4.28 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $10.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $10.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $10.20
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Urinalysis Non-Auto	$46	$29.90	$3.10 – $7.68
Urine test (manual, without microscope): 10 of 104 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $33.95 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $28.24 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $3.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $3.41 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $27.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $27.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $4.70 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $27.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $27.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $27.60
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urine Ph Nonautomated	$46	$29.90	$17.94 – $46
Urine test (manual, without microscope): 10 of 104 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $33.95 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $28.24 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $3.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $3.41 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $27.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $27.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $4.70 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $27.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $27.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $27.60
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Non Automated WO Micro	$46	$29.90	$17.94 – $46
Urine test (manual, without microscope): 10 of 104 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $33.95 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $28.24 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $3.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $3.41 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $27.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $27.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $4.70 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $27.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $27.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $27.60
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Urinalysis Automated W/O Micro	$112	$72.80	$2 – $4.97
Urine test (automated, without microscope): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $82.66 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $68.77 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $2 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $2.21 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $67.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $67.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $3.04 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $67.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $67.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $67.20
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Specific Gravity Urine Automated	$112	$72.80	$2 – $4.97
Urine test (automated, without microscope): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $82.66 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $68.77 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $2 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $2.21 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $67.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $67.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $3.04 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $67.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $67.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $67.20
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urine Ph Automated	$94	$61.10	$2 – $4.97
Urine test (automated, without microscope): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $69.37 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $57.72 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $2 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $2.21 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $56.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $56.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $3.04 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $56.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $56.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $56.40
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psa Total Diagnostic	$101	$65.65	$39.39 – $101
PSA (prostate specific antigen) blood test: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $74.54 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $62.01 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $16.36 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $18.04 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $60.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $60.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $24.83 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $60.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $60.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $60.60
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psa Ultrasensitive	$195	$126.75	$76.05 – $195
PSA (prostate specific antigen) blood test: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $143.91 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $119.73 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $16.36 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $18.04 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $117 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $117 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $24.83 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $117 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $117 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $117
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tsh Newborn	$17	$11.05	$6.63 – $17
Thyroid stimulating hormone (TSH) test: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $12.55 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $10.44 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $14.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $16.48 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $10.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $10.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $22.68 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $10.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $10.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $10.20
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tsh Thyroid Stimulating Hormone	$92	$59.80	$35.88 – $92
Thyroid stimulating hormone (TSH) test: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $67.90 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $56.49 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $14.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $16.48 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $55.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $55.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $22.68 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $55.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $55.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $55.20
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc W Auto Diff	$27	$17.55	$10.53 – $27
Complete blood count (CBC) with differential: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $19.93 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $16.58 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $6.91 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $7.62 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $16.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $16.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $10.49 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $16.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $16.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $16.20
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc Automated WO Diff	$22	$14.30	$8.58 – $22
Complete blood count (CBC), automated: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $16.24 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $13.51 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $5.75 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $6.35 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $13.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $13.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $8.73 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $13.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $13.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $13.20
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Prothrombin Time	$73	$47.45	$3.82 – $9.47
Blood clotting time test (prothrombin time, PT): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $53.87 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $44.82 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $3.82 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $4.21 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $43.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $43.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $5.79 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $43.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $43.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $43.80
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time	$22	$14.30	$3.82 – $9.47
Blood clotting time test (prothrombin time, PT): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $16.24 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $13.51 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $3.82 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $4.21 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $13.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $13.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $5.79 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $13.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $13.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $13.20
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time Mixing Test	$104	$67.60	$40.56 – $104
Blood clotting time test (prothrombin time, PT): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $76.75 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $63.86 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $3.82 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $4.21 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $62.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $62.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $5.79 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $62.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $62.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $62.40
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ptt Mixing	$123	$79.95	$47.97 – $123
Blood clotting test (partial thromboplastin time, PTT): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $90.77 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $75.52 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $5.35 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $5.90 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $73.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $73.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $8.11 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $73.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $73.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $73.80
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ptt Partial Thromboplastin Time	$41	$26.65	$5.35 – $13.27
Blood clotting test (partial thromboplastin time, PTT): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $30.26 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $25.17 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $5.35 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $5.90 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $24.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $24.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $8.11 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $24.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $24.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $24.60

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/Brain WO Cont	$1,861	$1,209.65	$103.53 – $232.95
CT scan of the head or brain, without contrast: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $1,373.42 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $1,142.65 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $57.46 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $103.53 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $1,116.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $1,116.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $142.47 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $1,116.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $1,116.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $1,116.60
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Brain W/WO Cont	$5,586	$3,630.90	$183.49 – $980.18
MRI of the brain, before and after contrast: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $4,122.47 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $3,429.80 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $183.49 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $345.48 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $3,351.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $3,351.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $475.43 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $3,351.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $3,351.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $3,351.60
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xr Chest 2 Views	$553	$359.45	$86.18 – $193.91
Chest X-ray, 2 views: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $408.11 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $339.54 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $19.41 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $86.18 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $331.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $331.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $118.59 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $331.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $331.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $331.80
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xr Spine Lumbar Min 4 Views	$764	$496.60	$297.96 – $764
X-ray of the lower spine, at least 4 views: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $563.83 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $469.10 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $33.02 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $103.53 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $458.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $458.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $142.47 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $458.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $458.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $458.40
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Lumbar Spine WO Cont	$4,061	$2,639.65	$236.28 – $531.65
MRI of the lower back (lumbar spine), without contrast: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $2,997.02 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $2,493.45 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $105.76 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $236.28 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $2,436.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $2,436.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $325.16 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $2,436.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $2,436.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $2,436.60
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Pelvis W Cont	$2,929	$1,903.85	$439
CT scan of the pelvis, with contrast: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $2,161.60 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $1,798.41 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $158.53 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $173.70 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $1,757.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $1,757.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $239.03 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $1,757.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $1,757.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $1,757.40
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Extr Lwr Jt WO Cont Lt	$2,593	$1,685.45	$120.47 – $548.48
MRI of a leg joint (such as the knee), without contrast: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $1,913.63 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $1,592.10 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $120.47 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $236.28 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $1,555.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $1,555.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $325.16 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $1,555.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $1,555.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $1,555.80
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Extr Lwr Jt WO Cont Rt	$2,593	$1,685.45	$733
MRI of a leg joint (such as the knee), without contrast: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $1,913.63 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $1,592.10 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $120.47 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $236.28 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $1,555.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $1,555.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $325.16 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $1,555.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $1,555.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $1,555.80
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Extr Lwr Jt WO Cont Bi	$3,951	$2,568.15	$733
MRI of a leg joint (such as the knee), without contrast: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $2,915.84 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $2,425.91 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $120.47 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $236.28 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $2,370.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $2,370.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $325.16 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $2,370.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $2,370.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $2,370.60
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Abd Pelvis With Contrast	$5,455	$3,545.75	$439
CT scan of the abdomen and pelvis, with contrast: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $4,025.79 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $3,349.37 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $188.51 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $345.48 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $3,273 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $3,273 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $475.43 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $3,273 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $3,273 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $3,273
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Abdomen Complete	$1,036	$673.40	$65.49 – $240.32
Ultrasound of the abdomen, complete: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $764.57 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $636.10 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $65.49 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $103.53 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $621.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $621.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $142.47 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $621.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $621.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $621.60
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Preg Uter 14 Wks Or>	$530	$344.50	$94.70 – $240.32
Pregnancy ultrasound (after the first trimester): 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $391.14 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $325.42 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $94.70 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $103.53 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $318 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $318 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $142.47 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $318 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $318 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $318
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Transvaginal Non OB	$1,092	$709.80	$425.88 – $1,092
Transvaginal ultrasound: 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $805.90 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $670.49 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $72.43 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $103.53 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $655.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $655.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $142.47 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $655.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $655.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $655.20
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Diagnostic Unilat Lt W Cad	$228	$148.20	$72.73 – $259.08
Diagnostic mammogram, one breast: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $168.26 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $139.99 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $72.73 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $75.83 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $136.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $136.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $104.36 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $136.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $136.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $136.80
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Diagnostic Unilat Rt W Cad	$228	$148.20	$72.73 – $259.08
Diagnostic mammogram, one breast: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $168.26 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $139.99 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $72.73 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $75.83 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $136.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $136.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $104.36 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $136.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $136.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $136.80
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Diagnostic Bilat W Cad	$318	$206.70	$93.26 – $327.99
Diagnostic mammogram, both breasts: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $234.68 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $195.25 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $93.26 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $97.26 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $190.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $190.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $133.84 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $190.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $190.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $190.80
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Scrn Right W Cad	$294	$191.10	$76.90 – $264.60
Screening mammogram, both breasts: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $216.97 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $180.52 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $76.90 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $80.24 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $176.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $176.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $110.42 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $176.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $176.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $176.40
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Scrn Bilat Implant W Cad	$441	$286.65	$76.90 – $264.60
Screening mammogram, both breasts: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $325.46 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $270.77 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $76.90 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $80.24 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $264.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $264.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $110.42 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $264.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $264.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $264.60
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Scrn Bilateral W Cad	$441	$286.65	$76.90 – $264.60
Screening mammogram, both breasts: 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $325.46 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $270.77 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $76.90 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $80.24 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $264.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $264.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $110.42 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $264.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $264.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $264.60

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: Lt Heart Cath Including Inj Lt Ventriculography, S/I	$15,518	$10,086.70	$585.01 – $6,624.30
Left heart catheterization (diagnostic): 10 of 106 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $11,452.28 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $9,528.05 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $749.56 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,210.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $9,310.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $9,310.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $4,417.99 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $9,310.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $9,310.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $9,310.80
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom Attended >3 Chn 6/> Yrs	$6,969	$4,529.85	$850.39 – $1,913.42
Sleep study (overnight, in a sleep lab): 10 of 108 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $5,143.12 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $4,278.97 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $527.77 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $850.39 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $4,181.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $4,181.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $1,170.26 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $4,181.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $4,181.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $4,181.40

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: Ot Ther Exer 1 or > Area Ea 15m	$199	$129.35	$25.94 – $61.05
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $146.86 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $122.19 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $25.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $27.13 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $119.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $119.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $37.34 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $119.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $119.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $119.40
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Ther Exer 1 or > Area Ea 15m	$199	$129.35	$95
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $146.86 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $122.19 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $25.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $27.13 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $119.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $119.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $37.34 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $119.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $119.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $119.40
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level I 60 Min	$294	$191.10	$88.72 – $205.99
Physical therapy evaluation (low complexity): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $216.97 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $180.52 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $91.55 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $176.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $176.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $125.98 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $176.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $176.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $176.40
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level I 75 Min	$326	$211.90	$127.14 – $326
Physical therapy evaluation (low complexity): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $240.59 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $200.16 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $91.55 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $195.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $195.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $125.98 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $195.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $195.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $195.60
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level I 90 Min	$357	$232.05	$95
Physical therapy evaluation (low complexity): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $263.47 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $219.20 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $91.55 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $214.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $214.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $125.98 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $214.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $214.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $214.20
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level II 120 Min	$462	$300.30	$95
Physical therapy evaluation (moderate complexity): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $340.96 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $283.67 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $91.55 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $277.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $277.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $125.98 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $277.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $277.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $277.20
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level II 135 Min	$494	$321.10	$88.72 – $205.99
Physical therapy evaluation (moderate complexity): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $364.57 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $303.32 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $91.55 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $296.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $296.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $125.98 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $296.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $296.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $296.40
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level II 150 Min	$525	$341.25	$204.75 – $525
Physical therapy evaluation (moderate complexity): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $387.45 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $322.35 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $91.55 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $315 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $315 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $125.98 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $315 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $315 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $315
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level III 135 Min	$536	$348.40	$88.72 – $205.99
Physical therapy evaluation (high complexity): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $395.57 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $329.10 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $91.55 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $321.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $321.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $125.98 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $321.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $321.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $321.60
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level III 15 Min	$284	$184.60	$95
Physical therapy evaluation (high complexity): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $209.59 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $174.38 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $91.55 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $170.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $170.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $125.98 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $170.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $170.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $170.40
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level III 60 Min	$378	$245.70	$147.42 – $378
Physical therapy evaluation (high complexity): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $278.96 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $232.09 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $91.55 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $226.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $226.80 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $125.98 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $226.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $226.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $226.80
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cd Ther 30 Min W Patient	$343	$222.95	$133.77 – $343
Psychotherapy, 30 minutes: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $253.13 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $210.60 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $71.19 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $205.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $205.80 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $205.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $205.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $205.80 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $171.50 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $222.95
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psych Ther 30 Min With Patient	$343	$222.95	$70.04 – $362.68
Psychotherapy, 30 minutes: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $253.13 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $210.60 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $71.19 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $205.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $205.80 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $205.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $205.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $205.80 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $171.50 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $222.95
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Straight CSF Grant Counseling 30 Minutes	$343	$222.95	$133.77 – $343
Psychotherapy, 30 minutes: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $253.13 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $210.60 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $71.19 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $205.80 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $205.80 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $205.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $205.80 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $205.80 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $171.50 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $222.95
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cd Ther 45 Min W Patient	$416	$270.40	$92.56 – $362.68
Psychotherapy, 45 minutes: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $307.01 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $255.42 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $93.92 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $249.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $249.60 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $249.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $249.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $249.60 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $208 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $270.40
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psych Ther 45 Min With Patient	$416	$270.40	$92.56 – $362.68
Psychotherapy, 45 minutes: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $307.01 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $255.42 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $93.92 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $249.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $249.60 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $249.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $249.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $249.60 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $208 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $270.40
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Straight CSF Grant Counseling 45 Minutes	$416	$270.40	$92.56 – $362.68
Psychotherapy, 45 minutes: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $307.01 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $255.42 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $93.92 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $249.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $249.60 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $249.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $249.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $249.60 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $208 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $270.40
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cd Ther 60 Min W Patient	$472	$306.80	$136.38 – $362.68
Psychotherapy, 60 minutes: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $348.34 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $289.81 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $138.48 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $283.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $283.20 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $283.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $283.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $283.20 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $236 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $306.80
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psych Ther 60 Min With Patient	$472	$306.80	$136.38 – $362.68
Psychotherapy, 60 minutes: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $348.34 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $289.81 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $138.48 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $283.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $283.20 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $283.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $283.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $283.20 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $236 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $306.80
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Straight CSF Grant Counseling 60 Minutes	$472	$306.80	$136.38 – $362.68
Psychotherapy, 60 minutes: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $348.34 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $289.81 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $138.48 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $283.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $283.20 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $283.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $283.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $283.20 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $236 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $306.80
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cd Fam Ther WO Patient 50 Min (Max Qty 2)	$432	$280.80	$89.72 – $181.34
Family psychotherapy, without the patient: 10 of 62 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $318.82 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $265.25 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $89.72 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $259.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $259.20 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $259.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $259.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $259.20 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $216 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $280.80
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psych Fam Ther WO Pt 50min (Max Qty 2)	$432	$280.80	$89.72 – $181.34
Family psychotherapy, without the patient: 10 of 62 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $318.82 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $265.25 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $89.72 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $259.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $259.20 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $259.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $259.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $259.20 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $216 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $280.80
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cd Fam Ther W Patient 50 Min (Max Qty 2)	$487	$316.55	$93.98 – $362.68
Family psychotherapy, with the patient: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $359.41 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $299.02 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $93.98 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $292.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $292.20 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $292.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $292.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $292.20 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $243.50 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $316.55
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psych Fam Ther W Pt 50min (Max Qty 2)	$487	$316.55	$93.98 – $362.68
Family psychotherapy, with the patient: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $359.41 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $299.02 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $93.98 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $292.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $292.20 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $292.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $292.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $292.20 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $243.50 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $316.55
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Group Tx-Iop	$850	$552.50	$24.52 – $207.58
Group psychotherapy: 10 of 63 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $627.30 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $521.90 AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $25.11 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $510 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $510 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $510 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $510 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $510 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $425 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $552.50

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls	$34,709.96	$22,561.47	$142.31 – $14,826.76
Shoulder arthroscopy: shaving of shoulder bone: 10 of 109 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $6,361.60 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $7,185.65 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $9,888.50 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $7,185.65 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $7,185.65 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $142.31 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $8,319.82 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $12,855.66 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $9,731.30 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS TRADITIONAL: $14,782.65
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg	$13,401.35	$8,710.88	$487.28 – $6,685.74
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 106 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $2,889.37 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,240.18 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $4,458.96 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,240.18 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,240.18 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $487.28 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $3,342.87 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $3,342.87 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $3,342.87 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $5,449.84
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tonsillectomy & Adenoidectomy <Age 12	$7,950.78	$5,168.01	$5,862.26 – $13,190.38
Removal of tonsils and adenoids (under age 12): 10 of 106 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $5,267.98 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $5,862.26 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $8,067.33 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $5,862.26 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $5,862.26 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $249.29 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $6,048.05 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $6,048.05 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $6,048.05 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $9,860.07
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GI Upper Endoscopy Complex	$1,757	$1,142.05	$175.70 – $1,757
Upper GI endoscopy (diagnostic): 10 of 103 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $1,296.67 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $1,078.80 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $898.16 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $1,054.20 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $1,054.20 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $527.10 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $1,054.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $1,054.20 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $1,054.20 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $898.16
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GI Egd W/Biopsy Pf	$5,814.95	$3,779.72	$898.16 – $2,020.92
Upper GI endoscopy with biopsy: 10 of 102 insurance plan rates AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $898.16 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $1,236.01 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $898.16 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $898.16 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $119.53 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $926.63 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $926.63 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $926.63 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $1,510.67 CHEROKEE NATION HEALTH SERV CONTRACTED [320066] — HB ADA MEDICARE/MGD MEDICARE 100%: $898.16
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GI Colonoscopy	$2,454	$1,595.10	$245.40 – $2,454
Colonoscopy (diagnostic): 10 of 102 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $1,811.05 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $1,506.76 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $920.91 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $1,472.40 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $1,472.40 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $736.20 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $1,472.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $1,472.40 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $1,472.40 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $920.91
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GI Colo Biopsy Cold Pf	$5,393.96	$3,506.07	$1,185 – $2,666.32
Colonoscopy with biopsy: 10 of 102 insurance plan rates AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,185 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $1,630.74 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,185 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,185 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $172.17 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $1,222.56 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $1,222.56 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $1,222.56 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $1,993.13 CHEROKEE NATION HEALTH SERV CONTRACTED [320066] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,185
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GI Colo Biopsy Snare Pf	$4,965.61	$3,227.65	$1,185 – $2,666.32
Colonoscopy with removal of polyps (snare): 10 of 102 insurance plan rates AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,185 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $1,630.74 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,185 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,185 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $216.93 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $1,222.56 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $1,222.56 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $1,222.56 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $1,993.13 CHEROKEE NATION HEALTH SERV CONTRACTED [320066] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,185
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lap,Cholecystectomy Pf	$18,587.91	$12,082.14	$599.95 – $12,352.94
Gallbladder removal by laparoscope: 10 of 106 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $5,195.58 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $5,986.73 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $8,238.62 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $5,986.73 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $5,986.73 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $599.95 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $6,176.47 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $6,176.47 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $6,176.47 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $10,069.43
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Rx Ing Hernia,5+Y/O,Reducibl Pf	$16,581.48	$10,777.96	$481.05 – $7,315.90
Groin (inguinal) hernia repair, age 5 or older: 10 of 106 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $3,142.68 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,545.58 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $4,879.24 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,545.58 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,545.58 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $481.05 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $3,657.95 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $3,657.95 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $3,657.95 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $5,963.51
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Bx Prostate Needle/Punch	$17,409.29	$11,316.04	$3,490.70 – $7,854.25
Prostate biopsy: 10 of 106 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $3,071.36 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,490.70 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $4,803.71 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,490.70 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,490.70 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $502.53 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $3,601.33 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $3,601.33 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $3,601.33 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $5,871.21
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$15,546.73	$10,105.37	$3,205.64 – $7,212.86
Hysteroscopy with biopsy of the uterus lining: 10 of 106 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $2,831.42 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,205.64 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $4,411.44 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,205.64 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $3,205.64 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $197.42 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $3,307.24 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $3,307.24 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $3,307.24 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $5,391.76
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Inject Interlaminar Lumbar or Sacral W Imag	$4,146	$2,694.90	$414.60 – $4,146
Spinal injection, lower back (epidural), with imaging guidance: 10 of 55 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $3,059.75 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $2,545.64 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $2,487.60 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $2,487.60 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $1,243.80 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $2,487.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $2,487.60 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $2,487.60 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $2,073 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $2,694.90
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Inj Transforminal Epi/Lumb/Sacral Sngl Level	$3,860	$2,509	$386 – $3,860
Nerve root injection, lower back, with imaging guidance: 10 of 55 insurance plan rates AETNA CONTRACTED [320008] — HB ADA AETNA: $2,848.68 AETNA CONTRACTED [320008] — HB ADA AETNA NBD: $2,370.04 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM LACLEDE CHAIN DEC: $2,316 AITHER HEALTH CONTRACTED [320449] — HB OKLC ADA ARDM WOODARD DEC NEW 040124: $2,316 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $1,158 AUXIANT CONTRACTED [320462] — HB ADA NETWORK AFFILIATION: $2,316 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM BUCHHEIT DEC: $2,316 AUXIANT CONTRACTED [320462] — HB OKLC ADA ARDM CITY OF JACKSON DEC: $2,316 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA COFMC: $1,930 BENEFIT MANAGEMENT CONTRACTED [320052] — HB ADA, ARDM, KGFER, OKLC, WTGA OZARKS COMMUNITY HOSPITAL: $2,509
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Neuroplas/ Tranposit Median Nerve at Carp Tiunn Pf	$10,541.88	$6,852.22	$397.69 – $3,990.04
Carpal tunnel release: 10 of 106 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB ADA OK MEDICAID (SOONERCARE): $1,738.97 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,933.73 AMBETTER CONTRACTED [320452] — HB ADA AMBETTER EXCHANGE MEDICARE: $2,661.10 BCBS MEDICARE ADVANTAGE [20047] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,933.73 BCBS MEDICARE ADVANTAGE CONTRACTED [320047] — HB ADA MEDICARE/MGD MEDICARE 100%: $1,933.73 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BCBS OF OK NATIVEBLUE MCR 103%: $397.69 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS ADVANTAGE PPO: $1,995.02 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS CHOICE: $1,995.02 BLUE CROSS AND BLUE SHIELD [20053] — HB ADA BLUE CROSS PREFERRED: $1,995.02 CENTIVO CONTRACTED [320505] — HB ADA CENTIVO MCR 165%: $3,252.46

Source: Mercy Hospital Ada’s standard charges file (mercy.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on June 11, 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	Acute Care Hospital
Address	430 North Monte Vista, Ada, OK 74820
County	Pontotoc County
State	Oklahoma
Phone	(580) 332‑2323
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	370020
Name in Medicare records	MERCY HOSPITAL ADA
Profile level	Medicare data + hospital website
Official website	mercy.net
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

Mercy Hospital Ada — mercy.net
Mercy Hospital Ada | Mercy — mercy.net
Mercy Emergency Department - Ada | Mercy — mercy.net
Visitor & Guest Information | Ada Hospital | Mercy — mercy.net
BreakThru Medical Withdrawal Management | Ada OK | Mercy — mercy.net
Mercy Cardiopulmonary Rehabilitation - Ada | Mercy — mercy.net
Mercy Sleep Center - Ada | Mercy — mercy.net
Hospital Imaging & Radiology Services Ada OK | Mercy — mercy.net
Mercy Rehabilitation Services - Ada | Mercy — mercy.net
Community Paramedic | Ada Hospital | Mercy — mercy.net

Mercy Hospital Ada

Summary

Profile from official sources

At a glance