Quick answers Does Methodist Midlothian Medical Center have an emergency room? Yes. Medicare (CMS) data lists emergency services at Methodist Midlothian Medical Center. In a medical emergency, call 911. Where is Methodist Midlothian Medical Center? 1201 E Highway 287, Midlothian, TX 76065, in Ellis County, Texas. What is the phone number of Methodist Midlothian Medical Center? (469) 846-2000, as listed by Medicare (CMS). What is the Medicare star rating of Methodist Midlothian Medical Center? 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26). Does Medicare reduce its payments to Methodist Midlothian Medical Center for hospital-acquired conditions? No. For fiscal year 2026, CMS lists no Medicare payment reduction for Methodist Midlothian Medical Center under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.1743; 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). Angioplasty and stenting Implantable cardiac devices Heart failure medications and lifestyle changes Robotic-assisted joint replacement Casts, braces, and splints Robotic-assisted hysterectomy Robotic-assisted myomectomy Robotic-assisted oophorectomy Robotic-assisted sacrocolpopexy OrthoCare joint replacement program High-risk breast cancer surveillance program Saturday Mammos Emergency care (hospital website)[5] [7] Emergency room Yes Trauma designation Level IV
Visiting and practical information Visiting Visiting hours 8 a.m. to 8 p.m [8] Interpreters and languages Free sign language and oral interpreters offered system-wide, plus aids for deaf or hard-of-hearing patients [9] Patient portal MyChart
Level IV Trauma Center Level 1 Maternal Facility Level 1 Neonatal Facility Press Ganey HX Guardian of Excellence Award (2023) Level I Maternal Facility (The Joint Commission) Level I Neonatal Facility (The Joint Commission) American College of Radiology (ACR) mammography accreditation Doctors and clinicians (205) 205 doctors and other clinicians list Methodist Midlothian Medical Center as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.
Main specialties Doctors with a page on this site (205) Adam D. Maners, MD Emergency Medicine Adil Habib, MD Gastroenterology Aja Taylor, NP Nurse Practitioner Akash Ghai, MD Cardiovascular Disease (Cardiology) Alan M. Taylor Ii, MD Cardiovascular Disease (Cardiology) Alap Desai, MD Interventional Radiology Alexander C. Deri, MD Emergency Medicine Allan C. Vanhorn, MD Urology Allyson Nguyen, NP Nurse Practitioner Amanda I. Jimenez, NP Nurse Practitioner Amelia C. Wayhs, MD Family Practice Amir M. Khan, MD Internal Medicine Amish R. Patel, DO Emergency Medicine Ammar A. Haque, MD Nephrology Amna Ilahe, MD Nephrology Ananth K. Arjunan, MD Hematology/Oncology Andrew Standerwick, MD General Surgery Angela S. Cheatham, NP Nurse Practitioner Ankit Parikh, NP Nurse Practitioner Anna Maria B. Toker, MD Colorectal Surgery (Proctology) Anuj R. Kandel, MD Colorectal Surgery (Proctology) Anuoluwapo I. Adelodun Hospitalist Arash Manzori, DO Interventional Cardiology Ashley N. Pirisino, MD Family Practice And 181 more: the button below opens the full list.
See all 205 clinicians Assisted living nearby Licensed homes from the official state license list, by straight-line distance.
About the Medicare star rating CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →
Medicare quality data What Methodist Midlothian Medical Center reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.
What patients said (patient survey) What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.
Summary star rating (all survey topics) ★★★★★ 4 of 5 stars Overall rating of the hospital 5 of 5 stars Would recommend the hospital 5 of 5 stars Nurses communicated well 4 of 5 stars Doctors communicated well 4 of 5 stars Patients got help quickly from staff 4 of 5 stars Staff explained medicines 3 of 5 stars Information about recovery at home 3 of 5 stars Room and bathroom kept clean 5 of 5 stars Restfulness of Environment 4 of 5 stars Care Coordination 4 of 5 stars Symptoms After Stay 4 of 5 stars Rated the hospital 9 or 10 out of 10 85% National average: 72% Would definitely recommend the hospital 85% National average: 71% Nurses “always” communicated well 82% National average: 80% Doctors “always” communicated well 81% National average: 80% “Always” got help as soon as they wanted 68% National average: 64% Staff “always” explained medicines before giving them 64% National average: 62% Were given information about recovery at home 88% National average: 86% Room and bathroom “always” clean 85% National average: 73% Completed surveys 393Response rate: 21%
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.
Clostridioides difficile (C. diff) intestinal infections 0.487 No different from the national benchmark Not reported to Medicare Central line bloodstream infections (CLABSI); Catheter-associated urinary tract infections (CAUTI); 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 10.1% Deaths within 30 days: pneumonia patients 14.5% Deaths within 30 days: COPD patients 8.8% Deaths within 30 days: stroke patients 13% Serious complications (patient safety indicator PSI-90) 0.95 No different from the national rate Not reported to Medicare Deaths within 30 days: coronary bypass surgery (CABG) Too few cases to report Deaths within 30 days: heart attack patients; Complications after hip or knee replacement
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) 15.1% Readmitted within 30 days: heart attack 14.6% Readmitted within 30 days: heart failure 19.4% Readmitted within 30 days: pneumonia 15.6% Readmitted within 30 days: COPD 19.4% Not reported to Medicare Readmitted within 30 days: coronary bypass surgery Too few cases to report Readmitted within 30 days: hip or knee replacement
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) 156 minutes National average: 162 minutes Patients who left the emergency room before being seen (OP-22) 1% National average: 2% Sepsis patients who got all the recommended early care (SEP-1) 96% 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 Methodist Midlothian Medical Center, 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 No CMS lists no payment reduction for this hospital. Total HAC Score -0.1743 Lower 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 0.9782 Fewer readmissions than expected Pneumonia 0.9886 Fewer readmissions than expected COPD (chronic lung disease) 0.9917 Fewer readmissions than expected No result published Heart attack; Hip or knee replacement; 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 40.83 out of 100Median of the 2,455 hospitals in the program: 29.50 Clinical outcomes (deaths and complications) 3.33 out of 100Person and community engagement (patient survey) 75.00 out of 100Safety (infections and sepsis care) 75.00 out of 100Efficiency and cost reduction (Medicare spending) 10.00 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 1.12 Above the national median hospital (1.00): Medicare spent more
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.
Prices Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 53 common services exactly as Methodist Midlothian Medical Center lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.
What the prices mean Hospital charge The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount. Cash price The price the hospital offers if you pay yourself, without insurance (“discounted cash price”). Insurance rates The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance. Hospital and doctor fees A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services. How to use hospital prices: estimates, financial assistance and your rights →
Show the prices of 53 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 · Inpatient or outpatient In the file: HC Pt Visit New Level III $422 $126.60 $211 – $422 New patient office visit (about 30–44 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $117.40 AETNA [3000] — MHS HB AETNA CVS MLMC : $115.26 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $115.26 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $117.40 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $88.94 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $121.67 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient In the file: HC Urgent Care New Level III $422 $126.60 $211 – $422 New patient office visit (about 30–44 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $117.40 AETNA [3000] — MHS HB AETNA CVS MLMC : $115.26 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $115.26 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $117.40 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $88.94 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $121.67 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient In the file: HC Pt Visit New Level IV $642 $192.60 $321 – $642 New patient office visit (about 45–59 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $192.16 AETNA [3000] — MHS HB AETNA CVS MLMC : $188.67 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $188.67 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $192.16 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $145.58 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $199.15 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient In the file: HC Urgent Care New Level IV $642 $192.60 $321 – $642 New patient office visit (about 45–59 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $192.16 AETNA [3000] — MHS HB AETNA CVS MLMC : $188.67 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $188.67 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $192.16 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $145.58 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $199.15 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient In the file: HC Pt Visit New Level V $735 $220.50 $367.50 – $735 New patient office visit (about 60–74 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $263.24 AETNA [3000] — MHS HB AETNA CVS MLMC : $258.45 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $258.45 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $263.24 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $199.43 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $272.81 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient In the file: HC Urgent Care New Level V $735 $220.50 $367.50 – $735 New patient office visit (about 60–74 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $263.24 AETNA [3000] — MHS HB AETNA CVS MLMC : $258.45 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $258.45 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $263.24 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $199.43 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $272.81 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: HC Pt Visit Est Level III $422 $126.60 $211 – $422 Established patient office visit (about 20–29 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $94.66 AETNA [3000] — MHS HB AETNA CVS MLMC : $92.94 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $92.94 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $94.66 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $71.71 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $98.10 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: HC Urgent Care Est Level III $422 $126.60 $211 – $422 Established patient office visit (about 20–29 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $94.66 AETNA [3000] — MHS HB AETNA CVS MLMC : $92.94 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $92.94 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $94.66 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $71.71 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $98.10 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: HC OP Newborn Exam $642 $192.60 $321 – $642 Established patient office visit (about 30–39 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $139.18 AETNA [3000] — MHS HB AETNA CVS MLMC : $136.65 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $136.65 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $139.18 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $105.44 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $144.24 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: HC Pt Visit Est Level IV $642 $192.60 $321 – $642 Established patient office visit (about 30–39 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $139.18 AETNA [3000] — MHS HB AETNA CVS MLMC : $136.65 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $136.65 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $139.18 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $105.44 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $144.24 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: HC Urgent Care Est Level IV $642 $192.60 $321 – $642 Established patient office visit (about 30–39 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $139.18 AETNA [3000] — MHS HB AETNA CVS MLMC : $136.65 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $136.65 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $133.74 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $139.18 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $105.44 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $144.24 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $140.43 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $133.74 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $141.77 Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: HC Sane Em Lvl 99283 W/O Photo $233 $69.90 $116.50 – $233 Emergency room visit (moderate): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $452.47 AETNA [3000] — MHS HB AETNA CVS MLMC : $444.24 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $444.24 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $274.22 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $452.47 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $342.78 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $468.92 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $287.93 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $274.22 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $290.67 Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: HC ER Level III 99283 $1,956 $586.80 $978 – $1,956 Emergency room visit (moderate): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $452.47 AETNA [3000] — MHS HB AETNA CVS MLMC : $444.24 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $444.24 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $274.22 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $452.47 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $342.78 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $468.92 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $287.93 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $274.22 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $290.67 Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: HC ER OB Level III 99283 $1,956 $586.80 $978 – $1,956 Emergency room visit (moderate): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $452.47 AETNA [3000] — MHS HB AETNA CVS MLMC : $444.24 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $444.24 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $274.22 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $452.47 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $342.78 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $468.92 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $287.93 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $274.22 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $290.67 Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: HC ER OB Level IV 99284 $2,582 $774.60 $1,291 – $2,582 Emergency room visit (moderately high): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $691.62 AETNA [3000] — MHS HB AETNA CVS MLMC : $679.05 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $679.05 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $419.16 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $691.62 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $523.95 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $716.77 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $440.12 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $419.16 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $444.31 Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: HC ER Level IV 99284 $2,582 $774.60 $1,291 – $2,582 Emergency room visit (moderately high): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $691.62 AETNA [3000] — MHS HB AETNA CVS MLMC : $679.05 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $679.05 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $419.16 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $691.62 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $523.95 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $716.77 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $440.12 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $419.16 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $444.31 Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: HC ER OB Level V 99285 $3,549 $1,064.70 $1,774.50 – $3,549 Emergency room visit (high): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $987.10 AETNA [3000] — MHS HB AETNA CVS MLMC : $969.16 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $969.16 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $598.24 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $987.10 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $747.81 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $1,023 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $628.16 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $598.24 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $634.14 Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: HC ER Level V 99285 $3,549 $1,064.70 $1,774.50 – $3,549 Emergency room visit (high): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $987.10 AETNA [3000] — MHS HB AETNA CVS MLMC : $969.16 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $969.16 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $598.24 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $987.10 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $747.81 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $1,023 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $628.16 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $598.24 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $634.14 Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: HC Sane Em Lvl 99285 W/O Photo $233 $69.90 $116.50 – $233 Emergency room visit (high): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $987.10 AETNA [3000] — MHS HB AETNA CVS MLMC : $969.16 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $969.16 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $598.24 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $987.10 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $747.81 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $1,023 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $628.16 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $598.24 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $634.14
Lab tests Service Hospital charge Cash price Insurance rates (lowest – highest) Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: HC Basic Metabolic Panel $699 $209.70 $349.50 – $699 Basic metabolic panel (blood test): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $13.96 AETNA [3000] — MHS HB AETNA CVS MLMC : $13.71 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $13.71 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $8.46 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $13.96 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $10.58 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $14.47 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $8.88 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $8.46 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $8.97 Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: HC Comprehensive Metabolic Panel $810 $243 $405 – $810 Comprehensive metabolic panel (blood test): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $17.42 AETNA [3000] — MHS HB AETNA CVS MLMC : $17.11 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $17.11 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $10.56 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $17.42 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $13.20 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $18.06 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $11.09 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $10.56 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $11.19 Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: HC Lipid Panel $494 $148.20 $247 – $494 Cholesterol panel (lipid panel): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $22.09 AETNA [3000] — MHS HB AETNA CVS MLMC : $21.69 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $21.69 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $13.39 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $22.09 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $16.74 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $22.90 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $14.06 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $13.39 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $14.19 Kidney function panel CPT 80069 · Inpatient or outpatient In the file: HC Renal Function Panel $774 $232.20 $387 – $774 Kidney function panel: 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $14.32 AETNA [3000] — MHS HB AETNA CVS MLMC : $14.06 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $14.06 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $8.68 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $14.32 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $10.85 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $14.84 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $9.11 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $8.68 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $9.20 Liver function panel CPT 80076 · Inpatient or outpatient In the file: HC Hepatic Function Panel $576 $172.80 $288 – $576 Liver function panel: 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $13.48 AETNA [3000] — MHS HB AETNA CVS MLMC : $13.24 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $13.24 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $8.17 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $13.48 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $10.21 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $13.97 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $8.58 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $8.17 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $8.66 Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: HC Urinalysis With Microscopy $234 $70.20 $117 – $234 Urine test (automated, with microscope): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $5.23 AETNA [3000] — MHS HB AETNA CVS MLMC : $5.14 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $5.14 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $3.17 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $5.23 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $3.96 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $5.42 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $3.33 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $3.17 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $3.36 Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: HC Ua Visual $42 $12.60 $21 – $42 Urine test (manual, without microscope): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $5.74 AETNA [3000] — MHS HB AETNA CVS MLMC : $5.64 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $5.64 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $3.48 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $5.74 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $4.35 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $5.95 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $3.65 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $3.48 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $3.69 Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: HC Hemoglobin Urine $4 $1.20 $2 – $4 Urine test (automated, without microscope): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $3.71 AETNA [3000] — MHS HB AETNA CVS MLMC : $3.65 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $3.65 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $2.25 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $3.71 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $2.81 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $3.85 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $2.36 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $2.25 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $2.39 Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: HC Urinalysis Chemical $94 $28.20 $47 – $94 Urine test (automated, without microscope): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $3.71 AETNA [3000] — MHS HB AETNA CVS MLMC : $3.65 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $3.65 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $2.25 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $3.71 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $2.81 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $3.85 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $2.36 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $2.25 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $2.39 PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: HC Prostate Specific Antigen $332 $99.60 $166 – $332 PSA (prostate specific antigen) blood test: 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $30.34 AETNA [3000] — MHS HB AETNA CVS MLMC : $29.79 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $29.79 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $18.39 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $30.34 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $22.99 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $31.45 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $19.31 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $18.39 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $19.49 PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: HC Assay of Prostate Specific Antigen Total $34 $10.20 $17 – $34 PSA (prostate specific antigen) blood test: 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $30.34 AETNA [3000] — MHS HB AETNA CVS MLMC : $29.79 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $29.79 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $18.39 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $30.34 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $22.99 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $31.45 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $19.31 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $18.39 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $19.49 Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: HC Thyroid Stimulatin Hormone-Tsh $690 $207 $345 – $690 Thyroid stimulating hormone (TSH) test: 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $27.72 AETNA [3000] — MHS HB AETNA CVS MLMC : $27.22 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $27.22 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $16.80 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $27.72 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $21 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $28.73 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $17.64 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $16.80 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $17.81 Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: HC Complete Blood Count Cbc $313 $93.90 $156.50 – $313 Complete blood count (CBC) with differential: 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $12.82 AETNA [3000] — MHS HB AETNA CVS MLMC : $12.59 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $12.59 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $7.77 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $12.82 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $9.71 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $13.29 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $8.16 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $7.77 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $8.24 Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: HC Prothrombin Time $234 $70.20 $117 – $234 Blood clotting time test (prothrombin time, PT): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $7.08 AETNA [3000] — MHS HB AETNA CVS MLMC : $6.95 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $6.95 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $4.29 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $7.08 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $5.36 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $7.34 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $4.50 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $4.29 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $4.55 Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: HC Lupus Anticoagulant Inr Protim $17 $5.10 $8.50 – $17 Blood clotting time test (prothrombin time, PT): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $7.08 AETNA [3000] — MHS HB AETNA CVS MLMC : $6.95 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $6.95 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $4.29 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $7.08 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $5.36 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $7.34 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $4.50 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $4.29 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $4.55 Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: HC Pt W Inr $64 $19.20 $32 – $64 Blood clotting time test (prothrombin time, PT): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $7.08 AETNA [3000] — MHS HB AETNA CVS MLMC : $6.95 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $6.95 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $4.29 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $7.08 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $5.36 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $7.34 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $4.50 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $4.29 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $4.55 Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: HC Lupus Anticoagulant Aptt $17 $5.10 $8.50 – $17 Blood clotting test (partial thromboplastin time, PTT): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $9.92 AETNA [3000] — MHS HB AETNA CVS MLMC : $9.74 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $9.74 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $6.01 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $9.92 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $7.51 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $10.28 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $6.31 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $6.01 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $6.37 Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: HC Factor Inhibitor Ptt $63 $18.90 $31.50 – $63 Blood clotting test (partial thromboplastin time, PTT): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $9.92 AETNA [3000] — MHS HB AETNA CVS MLMC : $9.74 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $9.74 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $6.01 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $9.92 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $7.51 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $10.28 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $6.31 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $6.01 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $6.37 Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: HC Reflex Ptt 1 Hr Incubation $21 $6.30 $10.50 – $21 Blood clotting test (partial thromboplastin time, PTT): 10 of 64 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $9.92 AETNA [3000] — MHS HB AETNA CVS MLMC : $9.74 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $9.74 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $6.01 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $9.92 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $7.51 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $10.28 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $6.31 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $6.01 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $6.37
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 · Inpatient or outpatient In the file: HC CT Head Brain Woc $3,578 $1,073.40 $1,789 – $3,578 CT scan of the head or brain, without contrast: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $173.29 AETNA [3000] — MHS HB AETNA CVS MLMC : $170.14 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $170.14 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $105.02 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $173.29 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $131.28 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $179.59 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $110.27 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $105.02 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $111.32 MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: HC MRI Head Wowc $6,042 $1,812.60 $3,021 – $6,042 MRI of the brain, before and after contrast: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $578.26 AETNA [3000] — MHS HB AETNA CVS MLMC : $567.75 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $567.75 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $350.46 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $578.26 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $438.08 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $599.29 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $367.99 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $350.46 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $371.49 Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: HC Chest 2 Views $649 $194.70 $324.50 – $649 Chest X-ray, 2 views: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $144.25 AETNA [3000] — MHS HB AETNA CVS MLMC : $141.62 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $141.62 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $87.42 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $144.25 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $109.28 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $149.49 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $91.79 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $87.42 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $92.67 X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: HC Spinelumbosacral Minimum 4 Views $1,062 $318.60 $531 – $1,062 X-ray of the lower spine, at least 4 views: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $173.29 AETNA [3000] — MHS HB AETNA CVS MLMC : $170.14 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $170.14 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $105.02 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $173.29 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $131.28 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $179.59 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $110.27 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $105.02 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $111.32 MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: HC MRI Spinal Canal Lumbar Woc $4,910 $1,473 $2,455 – $4,910 MRI of the lower back (lumbar spine), without contrast: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $395.49 AETNA [3000] — MHS HB AETNA CVS MLMC : $388.30 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $388.30 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $239.69 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $395.49 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $299.61 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $409.87 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $251.67 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $239.69 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $254.07 CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: HC CT Pelvis WC $4,503 $1,350.90 $2,251.50 – $4,503 CT scan of the pelvis, with contrast: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $290.73 AETNA [3000] — MHS HB AETNA CVS MLMC : $285.44 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $285.44 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $176.20 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $290.73 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $220.25 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $301.30 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $185.01 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $176.20 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $186.77 MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: HC MRI Extremity Lwr Joint Woc $4,878 $1,463.40 $2,439 – $4,878 MRI of a leg joint (such as the knee), without contrast: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $395.49 AETNA [3000] — MHS HB AETNA CVS MLMC : $388.30 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $388.30 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $239.69 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $395.49 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $299.61 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $409.87 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $251.67 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $239.69 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $254.07 CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: HC CT Abd Pelvis WC $8,670 $2,601 $4,335 – $8,670 CT scan of the abdomen and pelvis, with contrast: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $578.26 AETNA [3000] — MHS HB AETNA CVS MLMC : $567.75 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $567.75 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $350.46 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $578.26 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $438.08 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $599.29 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $367.99 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $350.46 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $371.49 Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: HC US Abdomen Complete $1,566 $469.80 $783 – $1,566 Ultrasound of the abdomen, complete: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $173.29 AETNA [3000] — MHS HB AETNA CVS MLMC : $170.14 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $170.14 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $105.02 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $173.29 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $131.28 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $179.59 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $110.27 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $105.02 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $111.32 Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: HC US OB >14 Wks Single Gestation $1,134 $340.20 $567 – $1,134 Pregnancy ultrasound (after the first trimester): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $173.29 AETNA [3000] — MHS HB AETNA CVS MLMC : $170.14 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $170.14 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $105.02 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $173.29 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $131.28 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $179.59 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $110.27 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $105.02 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $111.32 Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: HC US Transvaginal $1,323 $396.90 $661.50 – $1,323 Transvaginal ultrasound: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $173.29 AETNA [3000] — MHS HB AETNA CVS MLMC : $170.14 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $170.14 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $105.02 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $173.29 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $131.28 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $179.59 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $110.27 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $105.02 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $111.32 Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · modifier 52 In the file: HC US Transvaginal|REDUCED SERVICES $1,323 $396.90 $661.50 – $1,323 Transvaginal ultrasound: 10 of 60 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $173.29 AETNA [3000] — MHS HB AETNA CVS MLMC : $170.14 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $170.14 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $105.02 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $173.29 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $131.28 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $179.59 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $110.27 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $105.02 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $111.32 Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient In the file: HC Diag Mammoomputer-Aided Detcj Uni $938 $281.40 $469 – $938 Diagnostic mammogram, one breast: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $203.76 AETNA [3000] — MHS HB AETNA CVS MLMC : $200.05 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $200.05 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $123.49 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $203.76 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $154.36 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $211.17 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $129.66 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $123.49 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $130.90 Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient In the file: HC Diag Mammocomputer-Aided Detcj Bi $1,160 $348 $580 – $1,160 Diagnostic mammogram, both breasts: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $258.08 AETNA [3000] — MHS HB AETNA CVS MLMC : $253.38 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $253.38 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $156.41 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $258.08 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $195.51 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $267.46 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $164.23 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $156.41 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $165.79 Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: HC Screening Mammo Bi 2-View Breast Inc Cad $762 $228.60 $381 – $762 Screening mammogram, both breasts: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $207.64 AETNA [3000] — MHS HB AETNA CVS MLMC : $203.86 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $203.86 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $125.84 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $207.64 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $157.30 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $215.19 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $132.13 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $125.84 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $133.39 Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: HC Screening Mammo Bi 2-View Breast Inc Cad/Uni $671 $201.30 $335.50 – $671 Screening mammogram, both breasts: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $207.64 AETNA [3000] — MHS HB AETNA CVS MLMC : $203.86 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $203.86 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $125.84 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $207.64 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $157.30 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $215.19 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $132.13 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $125.84 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $133.39
Heart tests and sleep study Service Hospital charge Cash price Insurance rates (lowest – highest) Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) In the file: HC Ecg Routine Ecg W/Least 12 Lds W/I&R $669 $200.70 $334.50 – $669 Electrocardiogram (ECG/EKG) with reading: 10 of 22 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $25.21 AETNA [3000] — MHS HB AETNA CVS MLMC : $24.75 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $24.75 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $26.13 BRIGHT HEALTHCARE [2222] — MHS HB BRIGHT HEALTH MLMC : $21.39 CIGNA [3004] — MHS HB CUSTOM INK MLMC : $28.27 DART MEMBER CARE [3039] — MHS HB DART MEMBER CARE MLMC : $41.26 ENTRUST/90 DEGREE [2058] — MHS HB 90 DEGREE MLMC : $25.21 EVRY HEALTH [1013] — MHS HB EVRY MLMC : $30.56 FRIDAY HEALTH PLAN [2061] — MHS HB FRIDAY HEALTH MLMC : $25.98 Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient In the file: HC Heart Cath Lt W Intra Inj $17,388 $5,216.40 $8,694 – $17,388 Left heart catheterization (diagnostic): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $5,373.56 AETNA [3000] — MHS HB AETNA CVS MLMC : $5,275.86 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $5,275.86 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $3,256.70 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $5,373.56 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $4,070.88 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $5,568.96 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $3,419.54 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $3,256.70 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $3,452.11 Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient In the file: HC Eps Comp Eval WO Arrhy Ra/Rv $8,838 $2,651.40 $4,419 – $8,838 Heart rhythm study (electrophysiology evaluation): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $12,928.09 AETNA [3000] — MHS HB AETNA CVS MLMC : $12,693.03 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $12,693.03 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $7,835.21 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $12,928.09 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $9,794.01 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $13,398.20 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $8,226.97 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $7,835.21 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $8,305.32 Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient In the file: HC Eps W Arrhy Afib Abl W Pvi $55,582 $16,674.60 $27,791 – $55,582 Heart rhythm study with ablation for atrial fibrillation: 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $43,323.99 AETNA [3000] — MHS HB AETNA CVS MLMC : $42,536.28 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $42,536.28 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $26,256.97 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $43,323.99 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $32,821.21 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $44,899.41 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $27,569.81 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $26,256.97 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $27,832.38 Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: HC Polysomnography $7,469 $2,240.70 $3,734.50 – $7,469 Sleep study (overnight, in a sleep lab): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $1,423.38 AETNA [3000] — MHS HB AETNA CVS MLMC : $1,397.50 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $1,397.50 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $862.65 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $1,423.38 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $1,078.32 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $1,475.14 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $905.79 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $862.65 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $914.41 Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: HC Sleep Polysomnagram $7,469 $2,240.70 $3,734.50 – $7,469 Sleep study (overnight, in a sleep lab): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $1,423.38 AETNA [3000] — MHS HB AETNA CVS MLMC : $1,397.50 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $1,397.50 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $862.65 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $1,423.38 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $1,078.32 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $1,475.14 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $905.79 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $862.65 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $914.41
Physical therapy and mental health Service Hospital charge Cash price Insurance rates (lowest – highest) Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: HC Therapeutic Exercise Ea 15 Min $224 $67.20 $112 – $224 Physical therapy: therapeutic exercise (each 15 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $48.25 AETNA [3000] — MHS HB AETNA CVS MLMC : $47.37 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $47.37 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $29.24 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $48.25 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $36.55 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $50 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $30.70 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $29.24 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $30.99 Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: HC Therapeutic Rx Each 15 Min $224 $67.20 $112 – $224 Physical therapy: therapeutic exercise (each 15 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $48.25 AETNA [3000] — MHS HB AETNA CVS MLMC : $47.37 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $47.37 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $29.24 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $48.25 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $36.55 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $50 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $30.70 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $29.24 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $30.99 Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: HC Therapeutic Treatment $224 $67.20 $112 – $224 Physical therapy: therapeutic exercise (each 15 minutes): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $48.25 AETNA [3000] — MHS HB AETNA CVS MLMC : $47.37 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $47.37 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $29.24 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $48.25 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $36.55 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $50 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $30.70 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $29.24 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $30.99 Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: HC Pt Eval Complexity Low $891 $267.30 $445.50 – $891 Physical therapy evaluation (low complexity): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $162.67 AETNA [3000] — MHS HB AETNA CVS MLMC : $159.72 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $159.72 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $98.59 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $162.67 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $123.24 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $168.59 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $103.52 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $98.59 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $104.51 Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: HC Pt Eval Complexity Mod $927 $278.10 $463.50 – $927 Physical therapy evaluation (moderate complexity): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $162.67 AETNA [3000] — MHS HB AETNA CVS MLMC : $159.72 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $159.72 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $98.59 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $162.67 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $123.24 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $168.59 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $103.52 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $98.59 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $104.51 Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: HC Pt Eval Complexity High $963 $288.90 $481.50 – $963 Physical therapy evaluation (high complexity): 10 of 63 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $162.67 AETNA [3000] — MHS HB AETNA CVS MLMC : $159.72 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $159.72 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $98.59 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $162.67 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $123.24 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $168.59 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $103.52 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $98.59 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $104.51 Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient In the file: HC Psytx W Pt 30 Min $312 $93.60 $156 – $312 Psychotherapy, 30 minutes: rates for 3 insurance plans MOLINA MEDICAID MANAGED CARE [5005] — MHS HB MEDICAID 110% STAR PLUS MLMC : $227.14 SUPERIOR MEDICAID MANAGED CARE [5007] — MHS HB MEDICAID 110% STAR PLUS MLMC : $227.14 UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] — MHS HB UNITED MEDICAID STAR PLUS MLMC : $52.73 Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient In the file: HC Psytx W Pt 60 Minutes $345 $103.50 $172.50 – $345 Psychotherapy, 60 minutes: rates for 3 insurance plans MOLINA MEDICAID MANAGED CARE [5005] — MHS HB MEDICAID 110% STAR PLUS MLMC : $251.16 SUPERIOR MEDICAID MANAGED CARE [5007] — MHS HB MEDICAID 110% STAR PLUS MLMC : $251.16 UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] — MHS HB UNITED MEDICAID STAR PLUS MLMC : $58.31
Procedures and surgery Service Hospital charge Cash price Insurance rates (lowest – highest) Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: HC Inj Ther Dx Drug Lumb Sacr Img $2,215 $664.50 $1,107.50 – $2,215 Spinal injection, lower back (epidural), with imaging guidance: rates for 10 insurance plans AETNA [3000] — MHS HB AETNA CVS MLMC : $1,041.05 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $1,041.05 EVRY HEALTH [1013] — MHS HB EVRY MLMC : $1,107.50 KEMPTON GROUP ADMINISTRATORS, TOWER EXTRUSIONS [3061] — MHS HB TOWER EXTRUSIONS MLMC : $1,107.50 MEDICAL COST CONTAINMENT PROFESSIONALS [3059] — MHS HB MEDICAL COST CONTAINMENT MLMC : $1,329 MOLINA MEDICAID MANAGED CARE [5005] — MHS HB MEDICAID 110% STAR PLUS MLMC : $1,612.52 PROVIDER PARTNERS HEALTH PLAN [7025] — MHS HB PROVIDERS PARTNER HEALTH MLMC : $1,329 SUPERIOR MEDICAID MANAGED CARE [5007] — MHS HB MEDICAID 110% STAR PLUS MLMC : $1,612.52 UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] — MHS HB UNITED MEDICAID STAR PLUS MLMC : $374.34 VELOCITY [3070] — MHS HB VELOCITY MLMC : $1,439.75 Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient In the file: HC Inj Tr Foram Epidur Lumbar $2,227 $668.10 $1,113.50 – $2,227 Nerve root injection, lower back, with imaging guidance: rates for 10 insurance plans AETNA [3000] — MHS HB AETNA CVS MLMC : $1,046.69 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $1,046.69 EVRY HEALTH [1013] — MHS HB EVRY MLMC : $1,113.50 KEMPTON GROUP ADMINISTRATORS, TOWER EXTRUSIONS [3061] — MHS HB TOWER EXTRUSIONS MLMC : $1,113.50 MEDICAL COST CONTAINMENT PROFESSIONALS [3059] — MHS HB MEDICAL COST CONTAINMENT MLMC : $1,336.20 MOLINA MEDICAID MANAGED CARE [5005] — MHS HB MEDICAID 110% STAR PLUS MLMC : $1,621.26 PROVIDER PARTNERS HEALTH PLAN [7025] — MHS HB PROVIDERS PARTNER HEALTH MLMC : $1,336.20 SUPERIOR MEDICAID MANAGED CARE [5007] — MHS HB MEDICAID 110% STAR PLUS MLMC : $1,621.26 UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] — MHS HB UNITED MEDICAID STAR PLUS MLMC : $376.36 VELOCITY [3070] — MHS HB VELOCITY MLMC : $1,447.55 Carpal tunnel release CPT 64721 · Inpatient or outpatient In the file: HC Carpal Tunnel Surgery $4,071 $1,221.30 $2,035.50 – $4,071 Carpal tunnel release: rates for 10 insurance plans AETNA [3000] — MHS HB AETNA CVS MLMC : $1,913.37 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $1,913.37 EVRY HEALTH [1013] — MHS HB EVRY MLMC : $2,035.50 KEMPTON GROUP ADMINISTRATORS, TOWER EXTRUSIONS [3061] — MHS HB TOWER EXTRUSIONS MLMC : $2,035.50 MEDICAL COST CONTAINMENT PROFESSIONALS [3059] — MHS HB MEDICAL COST CONTAINMENT MLMC : $2,442.60 MOLINA MEDICAID MANAGED CARE [5005] — MHS HB MEDICAID 110% STAR PLUS MLMC : $2,963.69 PROVIDER PARTNERS HEALTH PLAN [7025] — MHS HB PROVIDERS PARTNER HEALTH MLMC : $2,442.60 SUPERIOR MEDICAID MANAGED CARE [5007] — MHS HB MEDICAID 110% STAR PLUS MLMC : $2,963.69 UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] — MHS HB UNITED MEDICAID STAR PLUS MLMC : $688 VELOCITY [3070] — MHS HB VELOCITY MLMC : $2,646.15
Hospital stays (whole stay, MS-DRG) Service Hospital charge Cash price Insurance rates (lowest – highest) Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC $349,070.47 $104,721.14 $174,535.24 – $349,070.47 Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 62 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $116,289.13 AETNA [3000] — MHS HB AETNA CVS MLMC : $114,174.78 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $114,174.78 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $70,478.26 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $116,289.13 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $88,097.83 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $120,517.82 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $74,002.17 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $70,478.26 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $74,706.96 Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC $60,741.49 $18,222.45 $28,229.13 – $88,071.50 Hip or knee replacement (major joint of the leg), without major complications: 10 of 62 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $22,929.03 AETNA [3000] — MHS HB AETNA CVS MLMC : $22,512.14 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $22,512.14 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $13,896.38 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $22,929.03 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $17,370.48 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $23,762.81 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $14,591.20 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $13,896.38 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $14,730.16 Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC $99,241.19 $29,772.36 $49,620.60 – $99,241.19 Neck (cervical) spinal fusion, without complications: 10 of 62 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $29,019.99 AETNA [3000] — MHS HB AETNA CVS MLMC : $28,492.35 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $28,492.35 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $17,587.87 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $29,019.99 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $21,984.84 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $30,075.26 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $18,467.26 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $17,587.87 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $18,643.14 Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC $38,728.35 $11,618.51 $19,364.18 – $38,728.35 Uterus and ovary surgery (not for cancer), without complications: 10 of 62 insurance plan rates 90 DEGREE BENEFIT [3057] — MHS HB 90 DEGREE MLMC : $14,748.33 AETNA [3000] — MHS HB AETNA CVS MLMC : $14,480.18 AETNA [3000] — MHS HB AETNA EXCHANGE MLMC : $14,480.18 AETNA MEDICARE MANAGED CARE [7000] — MHS HB AETNA GOLDEN MLMC : $8,938.38 ALLIED NATIONAL [2031] — MHS HB 90 DEGREE MLMC : $14,748.33 ALTERNATIVE SERVICE CONCEPTS [8005] — MHS HB CITY OF PLANO MLMC : $11,172.98 AMBETTER SUPERIOR [3051] — MHS HB AMBETTER SUPERIOR MLMC : $15,284.63 AMERICAN HEALTH ADVANTAGE OF TEXAS [7099] — MHS HB 105% MEDICARE MLMC : $9,385.30 BCBS MEDICARE MANAGED CARE [7002] — MHS HB BCBS MEDICARE ADVANTAGE MLMC : $8,938.38 BCBS MEDICARE MANAGED CARE [7002] — MHS HB MANAGED MEDICARE 106% MLMC : $9,474.68
Source: Methodist Midlothian Medical Center’s standard charges file (methodisthealthsystem.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on March 21, 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 1201 E Highway 287, Midlothian, TX 76065 County Ellis County State Texas Phone (469) 846‑2000 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 670300 Name in Medicare records METHODIST MIDLOTHIAN MEDICAL CENTER Profile level Medicare data + hospital website Official website methodisthealthsystem.org Corrections Report an error or suggest an update →