Does Mercy Hospital Watonga, Inc have an emergency room?

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

Where is Mercy Hospital Watonga, Inc?

500 North Clarence Nash Boulevard, Watonga, OK 73772, in Blaine County, Oklahoma.

What is the phone number of Mercy Hospital Watonga, Inc?

(580) 623-7211, as listed by Medicare (CMS).

What is the Medicare star rating of Mercy Hospital Watonga, Inc?

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

Mercy Hospital Watonga, Inc — Watonga, OK

Quick answers

Does Mercy Hospital Watonga, Inc have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Mercy Hospital Watonga, Inc. In a medical emergency, call 911.
Where is Mercy Hospital Watonga, Inc?: 500 North Clarence Nash Boulevard, Watonga, OK 73772, in Blaine County, Oklahoma.
What is the phone number of Mercy Hospital Watonga, Inc?: (580) 623-7211, as listed by Medicare (CMS).
What is the Medicare star rating of Mercy Hospital Watonga, Inc?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas^[4]

Primary care

Treatments^[4][5]

Therapy services (physical, occupational, speech)
Respiratory care
Diagnostic radiology
Laboratory services
Infusion therapy
IV fluids and hydration
IV antibiotics
Blood transfusions
Iron infusions
Port draws and flushes
PICC line maintenance
Immunotherapy and specialty injections

Procedures^[5]

Therapeutic phlebotomy
Cortisol stimulation testing

Programs and centers^[4][5]

Swing bed program
Infusion therapy services

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

Emergency room	Yes
Stroke designation	Level 3 stroke center (State of Oklahoma designation)

Visiting and practical information

Visiting	Open visiting 24/7; up to two visitors per room; children under 12 need adult supervision^[5]
Interpreters and languages	Free language interpreters and translation services; hearing-impaired aids at no cost^[5]

Recognition^[4]

Named one of rural America's best hospitals (Chartis Center for Rural Health, 2026)

Doctors and clinicians (47)

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

Main specialties

And 23 more: the button below opens the full list.

Other emergency rooms nearby

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

Okeene Municipal Hospital19 mi · Okeene, OK · Critical Access Hospital
Mercy Hospital Kingfisher, Inc27 mi · Kingfisher, OK · Critical Access Hospital
Weatherford Regional Hospital, Inc of Weatherford29 mi · Weatherford, OK · Critical Access Hospital
Fairview Regional Medical Center Authority30 mi · Fairview, OK · Critical Access Hospital
Seiling Municipal Hospital35 mi · Seiling, OK · Critical Access Hospital

Other hospitals nearby

Clinton Regional Hospital40 mi · Clinton, OK · Rural Emergency Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Summers Healthcare, LLC19 mi · Okeene, OK · 4 of 5 stars
Maple Lawn Nursing and Rehabilitation22 mi · Hydro, OK · 4 of 5 stars

All nursing homes 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

GSP Health Canton17 mi · Canton, OK · Community health center

Clinics and urgent care

Watonga Family Care1.1 mi · Watonga, OK · Rural health clinic

Pharmacies

Cityrx LLC1.1 mi · Watonga, OK · Community/retail pharmacy

About the Medicare star rating

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

Medicare quality data

What Mercy Hospital Watonga, Inc 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)	Not reported to Medicare
Overall rating of the hospital	Not reported to Medicare
Would recommend the hospital	Not reported to Medicare
Nurses communicated well	Not reported to Medicare
Doctors communicated well	Not reported to Medicare
Staff explained medicines	Not reported to Medicare
Information about recovery at home	Not reported to Medicare
Room and bathroom kept clean	Not reported to Medicare
Quiet at night	Not reported to Medicare
Rated the hospital 9 or 10 out of 10	82%National average: 72%
Would definitely recommend the hospital	84%National average: 71%
Nurses “always” communicated well	83%National average: 80%
Doctors “always” communicated well	81%National average: 80%
Staff “always” explained medicines before giving them	65%National average: 62%
Were given information about recovery at home	92%National average: 86%
Room and bathroom “always” clean	88%National average: 74%
Area around the room “always” quiet at night	80%National average: 60%
Completed surveys	37Response rate: 26%

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

Infections caught in the hospital

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

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

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	Not reported to Medicare
Deaths within 30 days: heart failure patients	Too few cases to report
Deaths within 30 days: pneumonia patients	Too few cases to report
Deaths within 30 days: COPD patients	Too few cases to report
Deaths within 30 days: stroke patients	Too few cases to report
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	Not reported to Medicare
Complications after hip or knee replacement	Not reported to Medicare

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026.

Return visits to the hospital (readmissions)

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

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

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026.

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	92 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	0%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	Not reported to Medicare

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in 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 37 common services exactly as Mercy Hospital Watonga, Inc lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CAH OP Visit Level III New Pt Mlp	$259	$168.35	$67.95 – $187.15
New patient office visit (about 30–44 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $197.36 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $177.16 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $98.08 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $67.95 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $220.15 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $220.15 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $93.51 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $220.15 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $220.15 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $67.95
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	$306	$198.90	$98.08 – $187.15
New patient office visit (about 30–44 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $233.17 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $209.30 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $98.08 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $123.07 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $260.10 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $260.10 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $91.80 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $260.10 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $260.10 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $123.07
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 Pf	$306	$198.90	$67.95 – $187.15
New patient office visit (about 30–44 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $233.17 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $209.30 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $98.08 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $67.95 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $260.10 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $260.10 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $93.51 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $260.10 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $260.10 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $67.95
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CAH OP Visit Level IV New Pt Mlp	$353	$229.45	$111.17 – $283.46
New patient office visit (about 45–59 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $268.99 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $241.45 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $147.66 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $111.17 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $300.05 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $300.05 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $152.98 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $300.05 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $300.05 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $111.17
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	$351	$228.15	$147.66 – $283.46
New patient office visit (about 45–59 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $267.46 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $240.08 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $147.66 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $141.17 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $298.35 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $298.35 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $105.30 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $298.35 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $298.35 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $141.17
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 Pf	$416	$270.40	$111.17 – $283.46
New patient office visit (about 45–59 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $316.99 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $284.54 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $147.66 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $111.17 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $353.60 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $353.60 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $152.98 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $353.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $353.60 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $111.17
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CAH OP Visit Level V New Pt Mlp	$458	$297.70	$152.10 – $378.40
New patient office visit (about 60–74 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $349 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $313.27 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $194.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $152.10 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $389.30 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $389.30 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $209.32 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $389.30 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $389.30 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $152.10
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	$439	$285.35	$194.93 – $378.40
New patient office visit (about 60–74 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $334.52 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $300.28 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $194.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $176.57 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $373.15 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $373.15 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $131.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $373.15 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $373.15 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $176.57
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 Pf	$538	$349.70	$152.10 – $378.40
New patient office visit (about 60–74 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $409.96 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $367.99 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $194.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $152.10 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $457.30 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $457.30 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $209.32 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $457.30 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $457.30 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $152.10
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CAH OP Visit Level III Est Pt Mlp	$191	$124.15	$54.82 – $151.81
Established patient office visit (about 20–29 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $145.54 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $130.64 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $79.99 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $54.82 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $162.35 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $162.35 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $75.44 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $162.35 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $162.35 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $54.82
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level III Est Pt	$249	$161.85	$79.99 – $151.81
Established patient office visit (about 20–29 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $189.74 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $170.32 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $79.99 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $100.15 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $211.65 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $211.65 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $74.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $211.65 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $211.65 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $100.15
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level III Est Pt Pf	$224	$145.60	$54.82 – $151.81
Established patient office visit (about 20–29 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $170.69 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $153.22 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $79.99 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $54.82 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $190.40 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $190.40 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $75.44 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $190.40 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $190.40 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $54.82
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CAH OP Visit Level IV Est Pt Mlp	$247	$160.55	$80.63 – $216.61
Established patient office visit (about 30–39 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $188.21 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $168.95 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $113.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $80.63 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $209.95 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $209.95 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $110.96 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $209.95 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $209.95 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $80.63
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	$269	$174.85	$113.10 – $216.61
Established patient office visit (about 30–39 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $204.98 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $184 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $113.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $108.19 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $228.65 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $228.65 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $80.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $228.65 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $228.65 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $108.19
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 Pf	$290	$188.50	$80.63 – $216.61
Established patient office visit (about 30–39 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $220.98 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $198.36 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $113.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $80.63 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $246.50 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $246.50 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $110.96 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $246.50 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $246.50 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $80.63
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Care Level 3	$1,307	$849.55	$246.57 – $418.34
Emergency room visit (moderate): 10 of 106 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $246.57 HEALTH CHOICE CONTRACTED [320166] — HB ADA, ARDM, HMH, KGFER, LGNOK, LHCP, TISH, WTGA HEALTHCHOI: $418.34 HUMANA MEDICAID CONTRACTED [320486] — HB WTGA OK MEDICAID (SOONERCARE): $246.57 MEDICAID [20240] — HB WTGA OK MEDICAID (SOONERCARE): $246.57 OKLAHOMA COMPLETE HEALTH MEDICAID CONTRACTED [320485] — HB WTGA OK MEDICAID (SOONERCARE): $246.57 AETNA CONTRACTED [320008] — HB WTGA AETNA: 76.2% (a percentage in the contract, not a dollar amount) AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: 68.4% (a percentage in the contract, not a dollar amount) AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: 40.22% (a percentage in the contract, not a dollar amount) AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: 85% (a percentage in the contract, not a dollar amount) AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: 85% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Phys Care Level 3 Mlp	$309	$200.85	$66.04 – $418.34
Emergency room visit (moderate): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $235.46 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $211.36 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $246.57 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $66.04 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $262.65 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $262.65 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $90.88 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $262.65 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $262.65 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $66.04
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Phys Care Level 3 Pf	$362	$235.30	$66.04 – $418.34
Emergency room visit (moderate): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $275.84 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $247.61 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $246.57 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $66.04 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $307.70 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $307.70 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $90.88 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $307.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $307.70 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $66.04
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Care Level 4	$2,147.92	$1,396.15	$379.20 – $639.45
Emergency room visit (moderately high): 10 of 106 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $379.20 HEALTH CHOICE CONTRACTED [320166] — HB ADA, ARDM, HMH, KGFER, LGNOK, LHCP, TISH, WTGA HEALTHCHOI: $639.45 HUMANA MEDICAID CONTRACTED [320486] — HB WTGA OK MEDICAID (SOONERCARE): $379.20 MEDICAID [20240] — HB WTGA OK MEDICAID (SOONERCARE): $379.20 OKLAHOMA COMPLETE HEALTH MEDICAID CONTRACTED [320485] — HB WTGA OK MEDICAID (SOONERCARE): $379.20 AETNA CONTRACTED [320008] — HB WTGA AETNA: 76.2% (a percentage in the contract, not a dollar amount) AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: 68.4% (a percentage in the contract, not a dollar amount) AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: 40.22% (a percentage in the contract, not a dollar amount) AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: 85% (a percentage in the contract, not a dollar amount) AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: 85% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Phys Care Level 4 Mlp	$454	$295.10	$112.41 – $639.45
Emergency room visit (moderately high): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $345.95 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $310.54 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $379.20 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $112.41 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $385.90 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $385.90 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $154.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $385.90 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $385.90 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $112.41
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Phys Care Level 4 Pf	$532	$345.80	$112.41 – $639.45
Emergency room visit (moderately high): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $405.38 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $363.89 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $379.20 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $112.41 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $452.20 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $452.20 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $154.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $452.20 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $452.20 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $112.41
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Care Level 5	$4,955	$3,220.75	$545.97 – $912.65
Emergency room visit (high): 10 of 106 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $545.97 HEALTH CHOICE CONTRACTED [320166] — HB ADA, ARDM, HMH, KGFER, LGNOK, LHCP, TISH, WTGA HEALTHCHOI: $912.65 HUMANA MEDICAID CONTRACTED [320486] — HB WTGA OK MEDICAID (SOONERCARE): $545.97 MEDICAID [20240] — HB WTGA OK MEDICAID (SOONERCARE): $545.97 OKLAHOMA COMPLETE HEALTH MEDICAID CONTRACTED [320485] — HB WTGA OK MEDICAID (SOONERCARE): $545.97 AETNA CONTRACTED [320008] — HB WTGA AETNA: 76.2% (a percentage in the contract, not a dollar amount) AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: 68.4% (a percentage in the contract, not a dollar amount) AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: 40.22% (a percentage in the contract, not a dollar amount) AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: 85% (a percentage in the contract, not a dollar amount) AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: 85% (a percentage in the contract, not a dollar amount)
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Phys Care Level 5 Mlp	$772	$501.80	$163.11 – $912.65
Emergency room visit (high): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $588.26 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $528.05 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $545.97 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $163.11 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $656.20 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $656.20 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $224.46 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $656.20 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $656.20 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $163.11
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Phys Care Level 5 Pf	$907	$589.55	$163.11 – $912.65
Emergency room visit (high): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $691.13 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $620.39 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $545.97 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $163.11 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $770.95 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $770.95 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $224.46 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $770.95 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $770.95 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $163.11

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	$137	$89.05	$7.53 – $10.58
Basic metabolic panel (blood test): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $104.39 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $93.71 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $7.53 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $55.10 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $116.45 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $116.45 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $41.10 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $116.45 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $116.45 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $55.10
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$195	$126.75	$9.39 – $13.20
Comprehensive metabolic panel (blood test): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $148.59 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $133.38 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $9.39 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $78.43 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $165.75 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $165.75 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $58.50 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $165.75 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $165.75 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $78.43
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel	$142	$92.30	$11.91 – $16.74
Cholesterol panel (lipid panel): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $108.20 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $97.13 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $11.91 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $57.11 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $120.70 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $120.70 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $42.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $120.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $120.70 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $57.11
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Lipid Panel	$142	$92.30	$11.91 – $16.74
Cholesterol panel (lipid panel): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $108.20 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $97.13 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $11.91 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $57.11 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $120.70 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $120.70 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $42.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $120.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $120.70 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $57.11
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel	$192	$124.80	$7.72 – $11.72
Kidney function panel: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $146.30 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $131.33 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $7.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $77.22 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $163.20 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $163.20 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $57.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $163.20 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $163.20 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $77.22
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$146	$94.90	$7.27 – $10.21
Liver function panel: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $111.25 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $99.86 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $7.27 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $58.72 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $124.10 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $124.10 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $43.80 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $124.10 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $124.10 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $58.72
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Automated W Micro	$79	$51.35	$2.82 – $5.23
Urine test (automated, with microscope): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $60.20 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $54.04 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $2.82 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $3.11 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $67.15 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $67.15 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $4.28 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $67.15 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $67.15 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $3.11
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Urinalysis Non-Auto	$43	$27.95	$3.10 – $4.35
Urine test (manual, without microscope): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $32.77 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $29.41 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $3.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $17.29 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $36.55 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $36.55 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $12.90 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $36.55 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $36.55 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $17.29
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Non Automated WO Micro	$42	$27.30	$3.10 – $4.35
Urine test (manual, without microscope): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $32 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $28.73 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $3.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $16.89 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $35.70 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $35.70 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $12.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $35.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $35.70 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $16.89
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urine Ketones Nonautomated	$43	$27.95	$3.10 – $4.35
Urine test (manual, without microscope): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $32.77 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $29.41 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $3.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $17.29 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $36.55 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $36.55 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $12.90 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $36.55 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $36.55 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $17.29
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Specific Gravity Urine Automated	$54	$35.10	$2 – $3.71
Urine test (automated, without microscope): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $41.15 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $36.94 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $2 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $2.21 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $45.90 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $45.90 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $3.04 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $45.90 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $45.90 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $2.21
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Automated W/O Micro	$54	$35.10	$2 – $3.71
Urine test (automated, without microscope): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $41.15 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $36.94 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $2 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $2.21 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $45.90 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $45.90 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $3.04 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $45.90 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $45.90 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $2.21
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urine Ketones Automated	$50	$32.50	$2 – $3.71
Urine test (automated, without microscope): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $38.10 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $34.20 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $2 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $2.21 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $42.50 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $42.50 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $3.04 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $42.50 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $42.50 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $2.21
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psa Total Diagnostic	$163	$105.95	$16.36 – $22.99
PSA (prostate specific antigen) blood test: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $124.21 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $111.49 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $16.36 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $65.56 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $138.55 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $138.55 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $48.90 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $138.55 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $138.55 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $65.56
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psa Ultrasensitive	$169	$109.85	$16.36 – $22.99
PSA (prostate specific antigen) blood test: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $128.78 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $115.60 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $16.36 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $67.97 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $143.65 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $143.65 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $50.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $143.65 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $143.65 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $67.97
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tsh Newborn	$24	$15.60	$14.94 – $21
Thyroid stimulating hormone (TSH) test: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $18.29 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $16.42 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $14.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $9.65 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $20.40 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $20.40 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $7.20 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $20.40 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $20.40 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $9.65
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tsh Thyroid Stimulating Hormone	$149	$96.85	$14.94 – $21
Thyroid stimulating hormone (TSH) test: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $113.54 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $101.92 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $14.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $59.93 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $126.65 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $126.65 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $44.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $126.65 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $126.65 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $59.93
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc W Auto Diff	$98	$63.70	$6.91 – $9.71
Complete blood count (CBC) with differential: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $74.68 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $67.03 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $6.91 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $39.42 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $83.30 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $83.30 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $29.40 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $83.30 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $83.30 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $39.42
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc Automated WO Diff	$88	$57.20	$5.75 – $8.73
Complete blood count (CBC), automated: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $67.06 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $60.19 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $5.75 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $35.39 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $74.80 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $74.80 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $26.40 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $74.80 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $74.80 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $35.39
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time	$62	$40.30	$3.82 – $5.36
Blood clotting time test (prothrombin time, PT): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $47.24 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $42.41 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $3.82 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $24.94 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $52.70 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $52.70 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $18.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $52.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $52.70 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $24.94
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ptt Partial Thromboplastin Time	$109	$70.85	$5.35 – $7.51
Blood clotting test (partial thromboplastin time, PTT): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $83.06 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $74.56 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $5.35 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $43.84 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $92.65 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $92.65 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $32.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $92.65 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $92.65 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $43.84

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	$1,577	$1,025.05	$57.46 – $293.73
CT scan of the head or brain, without contrast: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $1,201.67 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $1,078.67 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $57.46 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $634.27 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $1,340.45 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $1,340.45 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $473.10 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $1,340.45 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $1,340.45 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $634.27
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	$3,951	$2,568.15	$183.49 – $980.18
MRI of the brain, before and after contrast: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $3,010.66 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $2,702.48 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $183.49 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $1,589.09 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $3,358.35 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $3,358.35 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $1,185.30 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $3,358.35 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $3,358.35 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $1,589.09
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xr Chest 2 Views	$284	$184.60	$19.41 – $200.05
Chest X-ray, 2 views: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $216.41 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $194.26 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $19.41 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $114.22 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $241.40 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $241.40 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $85.20 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $241.40 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $241.40 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $114.22
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	$444	$288.60	$33.02 – $240.32
X-ray of the lower spine, at least 4 views: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $338.33 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $303.70 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $33.02 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $178.58 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $377.40 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $377.40 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $133.20 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $377.40 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $377.40 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $178.58
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	$2,703	$1,756.95	$105.76 – $670.37
MRI of the lower back (lumbar spine), without contrast: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $2,059.69 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $1,848.85 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $105.76 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $1,087.15 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $2,297.55 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $2,297.55 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $810.90 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $2,297.55 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $2,297.55 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $1,087.15
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Pelvis W Cont	$2,155	$1,400.75	$158.53 – $492.80
CT scan of the pelvis, with contrast: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $1,642.11 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $1,474.02 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $158.53 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $866.74 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $1,831.75 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $1,831.75 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $646.50 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $1,831.75 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $1,831.75 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $866.74
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	$2,762	$1,795.30	$120.47 – $548.48
MRI of a leg joint (such as the knee), without contrast: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $2,104.64 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $1,889.21 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $120.47 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $1,110.88 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $2,347.70 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $2,347.70 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $828.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $2,347.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $2,347.70 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $1,110.88
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	$2,762	$1,795.30	$120.47 – $548.48
MRI of a leg joint (such as the knee), without contrast: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $2,104.64 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $1,889.21 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $120.47 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $1,110.88 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $2,347.70 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $2,347.70 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $828.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $2,347.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $2,347.70 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $1,110.88
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	$3,287	$2,136.55	$188.51 – $801.97
CT scan of the abdomen and pelvis, with contrast: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $2,504.69 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $2,248.31 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $188.51 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $1,322.03 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $2,793.95 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $2,793.95 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $986.10 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $2,793.95 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $2,793.95 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $1,322.03
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Abdomen Complete	$759	$493.35	$65.49 – $240.32
Ultrasound of the abdomen, complete: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $578.36 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $519.16 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $65.49 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $305.27 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $645.15 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $645.15 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $227.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $645.15 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $645.15 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $305.27
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Preg Uter 14 Wks Or>	$698	$453.70	$94.70 – $240.32
Pregnancy ultrasound (after the first trimester): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $531.88 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $477.43 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $94.70 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $280.74 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $593.30 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $593.30 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $209.40 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $593.30 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $593.30 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $280.74
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Transvaginal Non OB	$526	$341.90	$72.43 – $240.32
Transvaginal ultrasound: 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $400.81 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $359.78 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $72.43 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $211.56 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $447.10 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $447.10 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $157.80 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $447.10 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $447.10 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $211.56

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	$116	$75.40	$25.94 – $46.78
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $88.39 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $79.34 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $25.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $46.66 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $98.60 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $98.60 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $34.80 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $98.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $98.60 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $46.66
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	$116	$75.40	$25.94 – $46.78
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $88.39 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $79.34 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $25.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $46.66 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $98.60 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $98.60 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $34.80 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $98.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $98.60 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $46.66
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level I 105 Min	$436	$283.40	$88.72 – $158.37
Physical therapy evaluation (low complexity): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $332.23 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $298.22 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $175.36 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $370.60 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $370.60 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $130.80 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $370.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $370.60 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $175.36
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level I 120 Min	$480	$312	$88.72 – $158.37
Physical therapy evaluation (low complexity): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $365.76 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $328.32 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $193.06 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $408 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $408 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $144 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $408 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $408 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $193.06
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level I 135 Min	$524	$340.60	$88.72 – $158.37
Physical therapy evaluation (low complexity): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $399.29 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $358.42 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $210.75 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $445.40 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $445.40 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $157.20 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $445.40 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $445.40 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $210.75
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level II 105 Min	$475	$308.75	$88.72 – $158.37
Physical therapy evaluation (moderate complexity): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $361.95 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $324.90 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $191.05 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $403.75 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $403.75 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $142.50 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $403.75 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $403.75 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $191.05
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level II 120 Min	$519	$337.35	$88.72 – $158.37
Physical therapy evaluation (moderate complexity): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $395.48 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $355 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $208.74 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $441.15 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $441.15 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $155.70 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $441.15 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $441.15 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $208.74
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level II 135 Min	$563	$365.95	$88.72 – $158.37
Physical therapy evaluation (moderate complexity): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $429.01 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $385.09 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $226.44 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $478.55 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $478.55 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $168.90 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $478.55 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $478.55 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $226.44
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level III 105 Min	$524	$340.60	$88.72 – $158.37
Physical therapy evaluation (high complexity): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $399.29 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $358.42 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $210.75 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $445.40 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $445.40 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $157.20 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $445.40 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $445.40 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $210.75
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level III 120 Min	$568	$369.20	$88.72 – $158.37
Physical therapy evaluation (high complexity): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $432.82 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $388.51 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $228.45 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $482.80 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $482.80 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $170.40 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $482.80 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $482.80 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $228.45
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level III 135 Min	$612	$397.80	$88.72 – $158.37
Physical therapy evaluation (high complexity): 10 of 105 insurance plan rates AETNA CONTRACTED [320008] — HB WTGA AETNA: $466.34 AETNA CONTRACTED [320008] — HB WTGA AETNA NBD: $418.61 AETNA MEDICAID CONTRACTED [320009] — HB WTGA OK MEDICAID (SOONERCARE): $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $246.15 AITHER HEALTH CONTRACTED [320449] — HB HMH, KGFER, LGNOK, TISH, WTGA WOODARD DEC: $520.20 AITHER HEALTH CONTRACTED [320449] — HB TISH WTGA LGNOK KGFER HMH LHCP LACLEDE CHAIN DEC: $520.20 AMBETTER CONTRACTED [320452] — HB WTGA AMBETTER EXCHANGE MEDICARE: $183.60 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP BUCHHEIT DEC: $520.20 AUXIANT CONTRACTED [320462] — HB TISH WTGA LGNOK KGFER HMH LHCP CITY OF JACKSON DEC: $520.20 BCBS MEDICARE ADVANTAGE [20047] — HB WTGA MANAGED MEDICARE 100% W/SEQ: $246.15

Source: Mercy Hospital Watonga, Inc’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	Critical Access Hospital
Address	500 North Clarence Nash Boulevard, Watonga, OK 73772
County	Blaine County
State	Oklahoma
Phone	(580) 623‑7211
Emergency services	Yes
Ownership	Proprietary
Medicare overall rating	Not rated by CMS
CMS Certification Number	371302
Name in Medicare records	MERCY HOSPITAL WATONGA, INC
Profile level	Medicare data + hospital website
Name on the hospital’s website	Mercy Hospital Watonga
Official website	mercy.net
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

Mercy Hospital Watonga Quick Facts — mercy.net
Mercy Hospital Watonga — mercy.net

Mercy Hospital Watonga, Inc

Summary

Profile from official sources

At a glance

Quick answers

Specialties and care areas^[4]

Treatments^[4][5]

Procedures^[5]

Programs and centers^[4][5]

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

Visiting and practical information

Recognition^[4]

Doctors and clinicians (47)

Main specialties

Doctors with a page on this site (47)

Other emergency rooms nearby

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

Nursing homes

Community care nearby

Community health centers

Clinics and urgent care

Pharmacies

About the Medicare star rating

Medicare quality data

What patients said (patient survey)

Infections caught in the hospital

Complications and deaths

Return visits to the hospital (readmissions)

Emergency room times and sepsis care

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

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

Physical therapy and mental health

Hospital information

Sources

From the hospital’s website

Mercy Hospital Watonga, Inc

Summary

Profile from official sources

At a glance

Quick answers

Specialties and care areas[4]

Treatments[4][5]

Procedures[5]

Programs and centers[4][5]

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

Visiting and practical information

Recognition[4]

Doctors and clinicians (47)

Main specialties

Doctors with a page on this site (47)

Other emergency rooms nearby

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

Nursing homes

Community care nearby

Community health centers

Clinics and urgent care

Pharmacies

About the Medicare star rating

Medicare quality data

What patients said (patient survey)

Infections caught in the hospital

Complications and deaths

Return visits to the hospital (readmissions)

Emergency room times and sepsis care

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

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

Physical therapy and mental health

Hospital information

Sources

From the hospital’s website

Specialties and care areas^[4]

Treatments^[4][5]

Procedures^[5]

Programs and centers^[4][5]

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

Recognition^[4]