Does Saint Joseph Mount Sterling have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Saint Joseph Mount Sterling. In a medical emergency, call 911.

Where is Saint Joseph Mount Sterling?

225 Falcon Drive, Mount Sterling, KY 40353, in Montgomery County, Kentucky.

What is the phone number of Saint Joseph Mount Sterling?

(859) 497-5018, as listed by Medicare (CMS).

What is the Medicare star rating of Saint Joseph Mount Sterling?

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

Does Medicare reduce its payments to Saint Joseph Mount Sterling for hospital-acquired conditions?

Yes. For fiscal year 2026, CMS applies a 1-percent reduction to Medicare payments to Saint Joseph Mount Sterling under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 1.0215; 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).

Saint Joseph Mount Sterling — Mount Sterling, KY

Quick answers

Does Saint Joseph Mount Sterling have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Saint Joseph Mount Sterling. In a medical emergency, call 911.
Where is Saint Joseph Mount Sterling?: 225 Falcon Drive, Mount Sterling, KY 40353, in Montgomery County, Kentucky.
What is the phone number of Saint Joseph Mount Sterling?: (859) 497-5018, as listed by Medicare (CMS).
What is the Medicare star rating of Saint Joseph Mount Sterling?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to Saint Joseph Mount Sterling for hospital-acquired conditions?: Yes. For fiscal year 2026, CMS applies a 1-percent reduction to Medicare payments to Saint Joseph Mount Sterling under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 1.0215; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas^[4]

Cardiology (Heart Care)
Critical Care
Diagnostic Imaging and Radiology
Emergency Medicine
Gastroenterology
General Surgery
Neurology (Brain and Spine)
Oncology (Cancer Care)
Orthopedic Surgery
Physical Therapy and Rehabilitation
Primary Care
Pulmonary (Lung and Respiratory Care)
Women's Health
Diagnostic radiology
Orthopedic oncology
Diabetes and nutrition care
Digestive health

Conditions treated^[4]

Gallbladder problems
Hernias
Appendicitis
Reflux
Tumors
Stroke
TIA

Treatments^[4]

Blood and platelet transfusions
Hydration therapy
Chemotherapy
Bladder instillation

Procedures^[4]

Minimally invasive surgery
Robotic-assisted surgery

Programs and centers^[4]

Emergency room (open 24 hours)
Maternity and newborn care (birth center)
Breast care
Cancer center
Infusion center
Outpatient rehabilitation

Emergency care (hospital website)^[4]

Emergency room	Yes
Open 24/7	Yes

Doctors and clinicians (259)

259 doctors and other clinicians list Saint Joseph Mount Sterling 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 (259)

Abby R. Moore MasonPhysician Assistant
Abdolreza Rabiee, MDEmergency Medicine
Adam ThetfordCertified Registered Nurse Anesthetist (CRNA)
Ahmad H. Abuarqoub, MDCardiovascular Disease (Cardiology)
Alexander C. Cooke, DOEmergency Medicine
Alexander D. Brown, MDRheumatology
Alexandra M. BerryPhysician Assistant
Alexis Budine-Utter, PAPhysician Assistant
Ali Turfah, MDInternal Medicine
Allen D. Westerfield Iv, MDDiagnostic Radiology
Amanda J. Reid, NPNurse Practitioner
Amanda KeetonNurse Practitioner
Amanda M. Applegate, MDInternal Medicine
Amina Shalash, MDFamily Practice
Amy E. BrubakerNurse Practitioner
Anand Modadugu, MDInternal Medicine
Andrea L. Banks, MDInternal Medicine
Andrew J. Ladd, CNACertified Registered Nurse Anesthetist (CRNA)
Andrew R. Bouwkamp, DPMPodiatry
Andrew T. BrayPhysician Assistant
Ansley N. Buckhalter, PAPhysician Assistant
Anthony Gutierrez, MDEmergency Medicine
Anup S. Chattha, MDOrthopedic Surgery
Apurva Subbaswamy, MDInternal Medicine

And 235 more: the button below opens the full list.

Other emergency rooms nearby

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

Clark Regional Medical Center13 mi · Winchester, KY · Acute Care Hospital
Bourbon Community Hospital19 mi · Paris, KY · Acute Care Hospital
Marcum and Wallace Memorial Hospital26 mi · Irvine, KY · Critical Access Hospital
Fleming County Hospital26 mi · Flemingsburg, KY · Rural Emergency Hospital
Saint Joseph East27 mi · Lexington, KY · Acute Care Hospital

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

Other hospitals near Mount Sterling

The Ridge Behavioral Health System27 mi · Lexington, KY · Psychiatric Hospital

Hospitals in Montgomery County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Mt. Sterling Health & Rehab, LLC2.0 mi · Mount Sterling, KY · 1 of 5 stars
Ridgeway Nursing & Rehabilitation Facility12 mi · Owingsville, KY · 3 of 5 stars
Fountain Circle Care & Rehabilitation Center15 mi · Winchester, KY · 1 of 5 stars

All nursing homes in the state →

Home health agencies

Amedisys Sp-Ky, LLC dba Adoration Home Health0.7 mi · Mount Sterling, KY · 4 of 5 stars
Commonspirit Health at Home - Lexington24 mi · Lexington, KY · 3.5 of 5 stars
Family Home Health Care, LLC dba Adoration Home Health24 mi · Lexington, KY · 4 of 5 stars

All home health agencies in the state →

Dialysis facilities

FMC - Mt. Sterling0.7 mi · Mount Sterling, KY · 2 of 5 stars
FMC - Winchester13 mi · Winchester, KY · 3 of 5 stars
DaVita Bourbon County Dialysis17 mi · Paris, KY · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

Baptist Health Surgery Center LLC24 mi · Lexington, KY
Bluegrass Specialty Surgery Center24 mi · Lexington, KY
Dermatology Associates of KY PSC24 mi · Lexington, KY

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Montgomery Dental Center0.2 mi · Mount Sterling, KY · Community health center
Sterling Women's Care0.2 mi · Mount Sterling, KY · Community health center
Sterling Health Care - Mobile Unit0.2 mi · Mount Sterling, KY · Community health center

Clinics and urgent care

Centerpoint Family Medicine - Mt. Sterling0.7 mi · Mt Sterling, KY · Rural health clinic
Community Family Clinic PLLC0.7 mi · Mt Sterling, KY · Rural health clinic
Fast Pace Health0.7 mi · Mt Sterling, KY · Rural health clinic

Pharmacies

Apothe-Care Inc.0.7 mi · Mount Sterling, KY · Community/retail pharmacy
Corner Tech Inc0.7 mi · Mt Sterling, KY · Community/retail pharmacy
Corner Tech, Inc dba Camargo Drug Company0.7 mi · Mt Sterling, KY · Community/retail pharmacy

Assisted living nearby

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

Sterling Meadows Assisted Living0.7 mi · Mount Sterling, KY
Boonesboro Trail Senior Living13 mi · Winchester, KY
Rose Mary C Brooks Place13 mi · Winchester, KY

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 Saint Joseph Mount Sterling 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	4 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	5 of 5 stars
Doctors communicated well	4 of 5 stars
Patients got help quickly from staff	5 of 5 stars
Staff explained medicines	4 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	5 of 5 stars
Restfulness of Environment	4 of 5 stars
Care Coordination	5 of 5 stars
Symptoms After Stay	5 of 5 stars
Rated the hospital 9 or 10 out of 10	73%National average: 72%
Would definitely recommend the hospital	73%National average: 71%
Nurses “always” communicated well	88%National average: 80%
Doctors “always” communicated well	85%National average: 80%
“Always” got help as soon as they wanted	76%National average: 64%
Staff “always” explained medicines before giving them	71%National average: 62%
Were given information about recovery at home	89%National average: 86%
Room and bathroom “always” clean	86%National average: 73%
Completed surveys	248Response rate: 17%

Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged 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	11.2%
Deaths within 30 days: pneumonia patients	13.5%
Serious complications (patient safety indicator PSI-90)	1.03No 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; Deaths within 30 days: COPD patients; Deaths within 30 days: stroke 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)	16.8%
Readmitted within 30 days: heart failure	20.4%
Readmitted within 30 days: pneumonia	18.2%
Readmitted within 30 days: COPD	19.2%
Not reported to Medicare	Readmitted within 30 days: heart attack; 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)	133 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)	73%National average: 66%

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

Not reported to Medicare: infections caught in the hospital. For these topics Medicare shows no result for this hospital (not reported, or too few cases).

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 Saint Joseph Mount Sterling, 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	YesCMS applies a 1-percent payment reduction to this hospital.
Total HAC Score	1.0215Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

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

Hospital Readmissions Reduction Program

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

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

Heart failure	1.0116More readmissions than expected
Pneumonia	0.9998Fewer readmissions than expected
No result published	Heart attack; COPD (chronic lung disease); 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	47.25 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)	30.00 out of 100
Person and community engagement (patient survey)	79.00 out of 100
Safety (infections and sepsis care)	60.00 out of 100
Efficiency and cost reduction (Medicare spending)	20.00 out of 100

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

Medicare spending per patient (MSPB)

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

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

Medicare spending per patient, ratio	1.02Above 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.

ER wait times in Kentucky Best hospitals in Kentucky

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 68 common services exactly as Saint Joseph Mount Sterling 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 68 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: HC CLINIC VISIT LEVEL 3 NEW	$328	$120.21	$68.66 – $298.48
New patient office visit (about 30–44 minutes): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $219.76 Aetna — Commercial\|HMO: $219.76 Aetna — Commercial\|PPO: $219.76 Aetna — Medicaid\|Better Health: $75.44 BCBS - Anthem — Commercial\|HMO PPO: $268.96 BCBS - Anthem — Commercial\|Pathway: $236.16 BCBS - Anthem — Medicaid\|All Plans: $79.22 Humana — Commercial\|All Plans: $141.04 Humana — Medicaid\|All Plans: $76.20 Multiplan — Commercial\|All Plans: $298.48
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) In the file: HC CLINIC VISIT LEVEL 3 NEW	$328	$120.21	$298.48
New patient office visit (about 30–44 minutes): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $298.48
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: HC CLINIC VISIT LEVEL 4 NEW	$434	$159.06	$90.84 – $394.94
New patient office visit (about 45–59 minutes): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $290.78 Aetna — Commercial\|HMO: $290.78 Aetna — Commercial\|PPO: $290.78 Aetna — Medicaid\|Better Health: $99.82 BCBS - Anthem — Commercial\|HMO PPO: $355.88 BCBS - Anthem — Commercial\|Pathway: $312.48 BCBS - Anthem — Medicaid\|All Plans: $104.82 Humana — Commercial\|All Plans: $186.62 Humana — Medicaid\|All Plans: $100.82 Multiplan — Commercial\|All Plans: $394.94
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) In the file: HC CLINIC VISIT LEVEL 4 NEW	$434	$159.06	$394.94
New patient office visit (about 45–59 minutes): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $394.94
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: HC CLINIC VISIT LEVEL 5 NEW	$595	$218.06	$124.54 – $541.45
New patient office visit (about 60–74 minutes): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $398.65 Aetna — Commercial\|HMO: $398.65 Aetna — Commercial\|PPO: $398.65 Aetna — Medicaid\|Better Health: $136.85 BCBS - Anthem — Commercial\|HMO PPO: $487.90 BCBS - Anthem — Commercial\|Pathway: $428.40 BCBS - Anthem — Medicaid\|All Plans: $143.70 Humana — Commercial\|All Plans: $255.85 Humana — Medicaid\|All Plans: $138.22 Multiplan — Commercial\|All Plans: $541.45
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) In the file: HC CLINIC VISIT LEVEL 5 NEW	$595	$218.06	$541.45
New patient office visit (about 60–74 minutes): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $541.45
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: HC CLINIC VISIT LEVEL 3 EST	$248	$90.89	$51.91 – $225.68
Established patient office visit (about 20–29 minutes): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $166.16 Aetna — Commercial\|HMO: $166.16 Aetna — Commercial\|PPO: $166.16 Aetna — Medicaid\|Better Health: $57.04 BCBS - Anthem — Commercial\|HMO PPO: $203.36 BCBS - Anthem — Commercial\|Pathway: $178.56 BCBS - Anthem — Medicaid\|All Plans: $59.90 Humana — Commercial\|All Plans: $106.64 Humana — Medicaid\|All Plans: $57.62 Multiplan — Commercial\|All Plans: $225.68
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) In the file: HC CLINIC VISIT LEVEL 3 EST	$248	$90.89	$225.68
Established patient office visit (about 20–29 minutes): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $225.68
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: HC CLINIC VISIT LEVEL 4 EST	$328	$120.21	$68.66 – $298.48
Established patient office visit (about 30–39 minutes): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $219.76 Aetna — Commercial\|HMO: $219.76 Aetna — Commercial\|PPO: $219.76 Aetna — Medicaid\|Better Health: $75.44 BCBS - Anthem — Commercial\|HMO PPO: $268.96 BCBS - Anthem — Commercial\|Pathway: $236.16 BCBS - Anthem — Medicaid\|All Plans: $79.22 Humana — Commercial\|All Plans: $141.04 Humana — Medicaid\|All Plans: $76.20 Multiplan — Commercial\|All Plans: $298.48
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) In the file: HC CLINIC VISIT LEVEL 4 EST	$328	$120.21	$298.48
Established patient office visit (about 30–39 minutes): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $298.48
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: HC ED LEVEL 3	$756	$277.06	$158.24 – $730
Emergency room visit (moderate): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $506.52 Aetna — Commercial\|HMO: $506.52 Aetna — Commercial\|PPO: $506.52 Aetna — Medicaid\|Better Health: $173.88 Aetna — Medicare\|All Plans: $268.15 BCBS - Anthem — Commercial\|HMO PPO: $730 BCBS - Anthem — Commercial\|Pathway: $618 BCBS - Anthem — Medicaid\|All Plans: $182.58 BCBS - Anthem — Medicare\|All Plans: $260.34 CareSource — Commercial\|All Plans: $520.68
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) In the file: HC ED LEVEL 3	$756	$277.06	$687.96
Emergency room visit (moderate): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $687.96
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: HC ED LEVEL 4	$963	$352.93	$201.56 – $876.33
Emergency room visit (moderately high): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $645.21 Aetna — Commercial\|HMO: $645.21 Aetna — Commercial\|PPO: $645.21 Aetna — Medicaid\|Better Health: $221.49 Aetna — Medicare\|All Plans: $412.38 BCBS - Anthem — Commercial\|HMO PPO: $730 BCBS - Anthem — Commercial\|Pathway: $618 BCBS - Anthem — Medicaid\|All Plans: $232.57 BCBS - Anthem — Medicare\|All Plans: $400.37 CareSource — Commercial\|All Plans: $800.74
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) In the file: HC ED LEVEL 4	$963	$352.93	$876.33
Emergency room visit (moderately high): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $876.33
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: HC ED LEVEL 5	$1,218	$446.38	$254.93 – $1,152.92
Emergency room visit (high): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $816.06 Aetna — Commercial\|HMO: $816.06 Aetna — Commercial\|PPO: $816.06 Aetna — Medicaid\|Better Health: $280.14 Aetna — Medicare\|All Plans: $593.75 BCBS - Anthem — Commercial\|HMO PPO: $730 BCBS - Anthem — Commercial\|Pathway: $618 BCBS - Anthem — Medicaid\|All Plans: $294.15 BCBS - Anthem — Medicare\|All Plans: $576.46 CareSource — Commercial\|All Plans: $1,152.92
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) In the file: HC ED LEVEL 5	$1,218	$446.38	$1,108.38
Emergency room visit (high): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $1,108.38

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: HC LAB BASIC METABOLIC PANEL	$228	$83.56	$5.69 – $207.48
Basic metabolic panel (blood test): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $152.76 Aetna — Commercial\|HMO: $152.76 Aetna — Commercial\|PPO: $152.76 Aetna — Medicaid\|Better Health: $8.46 Aetna — Medicare\|All Plans: $8.71 BCBS - Anthem — Commercial\|HMO PPO: $5.69 BCBS - Anthem — Commercial\|Pathway: $5.69 BCBS - Anthem — Medicaid\|All Plans: $8.88 BCBS - Anthem — Medicare\|All Plans: $8.46 CareSource — Commercial\|All Plans: $16.92
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) In the file: HC LAB BASIC METABOLIC PANEL	$228	$83.56	$207.48
Basic metabolic panel (blood test): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $207.48
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: HC LAB COMP METABOLIC PANEL	$236	$86.49	$7.15 – $214.76
Comprehensive metabolic panel (blood test): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $158.12 Aetna — Commercial\|HMO: $158.12 Aetna — Commercial\|PPO: $158.12 Aetna — Medicaid\|Better Health: $10.56 Aetna — Medicare\|All Plans: $10.88 BCBS - Anthem — Commercial\|HMO PPO: $7.15 BCBS - Anthem — Commercial\|Pathway: $7.15 BCBS - Anthem — Medicaid\|All Plans: $11.09 BCBS - Anthem — Medicare\|All Plans: $10.56 CareSource — Commercial\|All Plans: $21.12
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) In the file: HC LAB COMP METABOLIC PANEL	$236	$86.49	$214.76
Comprehensive metabolic panel (blood test): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $214.76
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: HC OBSTETRIC PANEL	$236	$86.49	$47.81 – $214.76
Obstetric blood test panel: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $158.12 Aetna — Commercial\|HMO: $158.12 Aetna — Commercial\|PPO: $158.12 Aetna — Medicaid\|Better Health: $47.81 Aetna — Medicare\|All Plans: $49.24 BCBS - Anthem — Commercial\|HMO PPO: $53.28 BCBS - Anthem — Commercial\|Pathway: $53.28 BCBS - Anthem — Medicaid\|All Plans: $50.20 BCBS - Anthem — Medicare\|All Plans: $47.81 CareSource — Commercial\|All Plans: $95.62
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) In the file: HC OBSTETRIC PANEL	$236	$86.49	$214.76
Obstetric blood test panel: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $214.76
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: HC LAB LIPID PANEL	$132	$48.38	$9.68 – $120.12
Cholesterol panel (lipid panel): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $88.44 Aetna — Commercial\|HMO: $88.44 Aetna — Commercial\|PPO: $88.44 Aetna — Medicaid\|Better Health: $13.39 Aetna — Medicare\|All Plans: $13.79 BCBS - Anthem — Commercial\|HMO PPO: $9.68 BCBS - Anthem — Commercial\|Pathway: $9.68 BCBS - Anthem — Medicaid\|All Plans: $14.06 BCBS - Anthem — Medicare\|All Plans: $13.39 CareSource — Commercial\|All Plans: $26.78
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) In the file: HC LAB LIPID PANEL	$132	$48.38	$120.12
Cholesterol panel (lipid panel): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $120.12
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: HC RENAL PROFILE	$249	$91.26	$5.69 – $226.59
Kidney function panel: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $166.83 Aetna — Commercial\|HMO: $166.83 Aetna — Commercial\|PPO: $166.83 Aetna — Medicaid\|Better Health: $8.68 Aetna — Medicare\|All Plans: $8.94 BCBS - Anthem — Commercial\|HMO PPO: $5.69 BCBS - Anthem — Commercial\|Pathway: $5.69 BCBS - Anthem — Medicaid\|All Plans: $9.11 BCBS - Anthem — Medicare\|All Plans: $8.68 CareSource — Commercial\|All Plans: $17.36
Kidney function panel CPT 80069 · Inpatient (hospital stay) In the file: HC RENAL PROFILE	$249	$91.26	$226.59
Kidney function panel: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $226.59
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HC LAB HEPATIC FUNCTION PANEL	$130	$47.65	$5.69 – $118.30
Liver function panel: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $87.10 Aetna — Commercial\|HMO: $87.10 Aetna — Commercial\|PPO: $87.10 Aetna — Medicaid\|Better Health: $8.17 Aetna — Medicare\|All Plans: $8.42 BCBS - Anthem — Commercial\|HMO PPO: $5.69 BCBS - Anthem — Commercial\|Pathway: $5.69 BCBS - Anthem — Medicaid\|All Plans: $8.58 BCBS - Anthem — Medicare\|All Plans: $8.17 CareSource — Commercial\|All Plans: $16.34
Liver function panel CPT 80076 · Inpatient (hospital stay) In the file: HC LAB HEPATIC FUNCTION PANEL	$130	$47.65	$118.30
Liver function panel: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $118.30
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: HC LAB AUTO URINALYS W/ MICRO	$84	$30.79	$2.69 – $76.44
Urine test (automated, with microscope): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $56.28 Aetna — Commercial\|HMO: $56.28 Aetna — Commercial\|PPO: $56.28 Aetna — Medicaid\|Better Health: $3.17 Aetna — Medicare\|All Plans: $3.27 BCBS - Anthem — Commercial\|HMO PPO: $2.69 BCBS - Anthem — Commercial\|Pathway: $2.69 BCBS - Anthem — Medicaid\|All Plans: $3.33 BCBS - Anthem — Medicare\|All Plans: $3.17 CareSource — Commercial\|All Plans: $6.34
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) In the file: HC LAB AUTO URINALYS W/ MICRO	$84	$30.79	$76.44
Urine test (automated, with microscope): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $76.44
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: HC LAB N-AUTO URINALYS OT POC	$2	$0.74	$0.86 – $4
Urine test (manual, without microscope): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $1.34 Aetna — Commercial\|HMO: $1.34 Aetna — Commercial\|PPO: $1.34 Aetna — Medicaid\|Better Health: $3.48 Aetna — Medicare\|All Plans: $2.06 BCBS - Anthem — Commercial\|HMO PPO: $2 BCBS - Anthem — Commercial\|Pathway: $2.05 BCBS - Anthem — Medicaid\|All Plans: $3.65 BCBS - Anthem — Medicare\|All Plans: $2 CareSource — Commercial\|All Plans: $4
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) In the file: HC LAB N-AUTO URINALYS OT POC	$2	$0.74	$1.82
Urine test (manual, without microscope): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $1.82
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: HC LAB AUTO URINALYS WO MICRO	$52	$19.06	$1.91 – $47.32
Urine test (automated, without microscope): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $34.84 Aetna — Commercial\|HMO: $34.84 Aetna — Commercial\|PPO: $34.84 Aetna — Medicaid\|Better Health: $2.25 Aetna — Medicare\|All Plans: $2.32 BCBS - Anthem — Commercial\|HMO PPO: $1.91 BCBS - Anthem — Commercial\|Pathway: $1.91 BCBS - Anthem — Medicaid\|All Plans: $2.36 BCBS - Anthem — Medicare\|All Plans: $2.25 CareSource — Commercial\|All Plans: $4.50
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) In the file: HC LAB AUTO URINALYS WO MICRO	$52	$19.06	$47.32
Urine test (automated, without microscope): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $47.32
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: HC LAB PROSTATIC SPECIFIC ANTIGEN	$212	$77.70	$15.64 – $192.92
PSA (prostate specific antigen) blood test: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $142.04 Aetna — Commercial\|HMO: $142.04 Aetna — Commercial\|PPO: $142.04 Aetna — Medicaid\|Better Health: $18.39 Aetna — Medicare\|All Plans: $18.94 BCBS - Anthem — Commercial\|HMO PPO: $15.64 BCBS - Anthem — Commercial\|Pathway: $15.64 BCBS - Anthem — Medicaid\|All Plans: $19.31 BCBS - Anthem — Medicare\|All Plans: $18.39 CareSource — Commercial\|All Plans: $36.78
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) In the file: HC LAB PROSTATIC SPECIFIC ANTIGEN	$212	$77.70	$192.92
PSA (prostate specific antigen) blood test: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $192.92
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: HC LAB TSH	$169	$61.94	$14.28 – $153.79
Thyroid stimulating hormone (TSH) test: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $113.23 Aetna — Commercial\|HMO: $113.23 Aetna — Commercial\|PPO: $113.23 Aetna — Medicaid\|Better Health: $16.80 Aetna — Medicare\|All Plans: $17.30 BCBS - Anthem — Commercial\|HMO PPO: $14.28 BCBS - Anthem — Commercial\|Pathway: $14.28 BCBS - Anthem — Medicaid\|All Plans: $17.64 BCBS - Anthem — Medicare\|All Plans: $16.80 CareSource — Commercial\|All Plans: $33.60
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) In the file: HC LAB TSH	$169	$61.94	$153.79
Thyroid stimulating hormone (TSH) test: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $153.79
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: HC LAB CBC W/AUTO DIFF	$123	$45.08	$6.61 – $111.93
Complete blood count (CBC) with differential: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $82.41 Aetna — Commercial\|HMO: $82.41 Aetna — Commercial\|PPO: $82.41 Aetna — Medicaid\|Better Health: $7.77 Aetna — Medicare\|All Plans: $8 BCBS - Anthem — Commercial\|HMO PPO: $6.61 BCBS - Anthem — Commercial\|Pathway: $6.61 BCBS - Anthem — Medicaid\|All Plans: $8.16 BCBS - Anthem — Medicare\|All Plans: $7.77 CareSource — Commercial\|All Plans: $15.54
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) In the file: HC LAB CBC W/AUTO DIFF	$123	$45.08	$111.93
Complete blood count (CBC) with differential: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $111.93
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: HC LAB CBC (W/PLT&HEMOGRAM)	$70	$25.66	$5.50 – $63.70
Complete blood count (CBC), automated: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $46.90 Aetna — Commercial\|HMO: $46.90 Aetna — Commercial\|PPO: $46.90 Aetna — Medicaid\|Better Health: $6.47 Aetna — Medicare\|All Plans: $6.66 BCBS - Anthem — Commercial\|HMO PPO: $5.50 BCBS - Anthem — Commercial\|Pathway: $5.50 BCBS - Anthem — Medicaid\|All Plans: $6.79 BCBS - Anthem — Medicare\|All Plans: $6.47 CareSource — Commercial\|All Plans: $12.94
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) In the file: HC LAB CBC (W/PLT&HEMOGRAM)	$70	$25.66	$63.70
Complete blood count (CBC), automated: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $63.70
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: HC LAB PT	$101	$37.02	$3.34 – $91.91
Blood clotting time test (prothrombin time, PT): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $67.67 Aetna — Commercial\|HMO: $67.67 Aetna — Commercial\|PPO: $67.67 Aetna — Medicaid\|Better Health: $4.29 Aetna — Medicare\|All Plans: $4.42 BCBS - Anthem — Commercial\|HMO PPO: $3.34 BCBS - Anthem — Commercial\|Pathway: $3.34 BCBS - Anthem — Medicaid\|All Plans: $4.50 BCBS - Anthem — Medicare\|All Plans: $4.29 CareSource — Commercial\|All Plans: $8.58
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) In the file: HC LAB PT	$101	$37.02	$91.91
Blood clotting time test (prothrombin time, PT): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $91.91
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: HC LAB PTT	$121	$44.35	$5.10 – $110.11
Blood clotting test (partial thromboplastin time, PTT): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $81.07 Aetna — Commercial\|HMO: $81.07 Aetna — Commercial\|PPO: $81.07 Aetna — Medicaid\|Better Health: $6.01 Aetna — Medicare\|All Plans: $6.19 BCBS - Anthem — Commercial\|HMO PPO: $5.10 BCBS - Anthem — Commercial\|Pathway: $5.10 BCBS - Anthem — Medicaid\|All Plans: $6.31 BCBS - Anthem — Medicare\|All Plans: $6.01 CareSource — Commercial\|All Plans: $12.02
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) In the file: HC LAB PTT	$121	$44.35	$110.11
Blood clotting test (partial thromboplastin time, PTT): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $110.11

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: HC CT BRAIN	$1,947	$713.54	$99.99 – $1,771.77
CT scan of the head or brain, without contrast: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $1,304.49 Aetna — Commercial\|HMO: $1,304.49 Aetna — Commercial\|PPO: $1,304.49 Aetna — Medicaid\|Better Health: $447.81 Aetna — Medicare\|All Plans: $102.99 BCBS - Anthem — Commercial\|HMO PPO: $873 BCBS - Anthem — Commercial\|Pathway: $738 BCBS - Anthem — Medicaid\|All Plans: $470.21 BCBS - Anthem — Medicare\|All Plans: $99.99 CareSource — Commercial\|All Plans: $199.98
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) In the file: HC CT BRAIN	$1,947	$713.54	$1,771.77
CT scan of the head or brain, without contrast: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $1,771.77
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: HC MR BRAIN WOW CONTRAST	$2,982	$1,092.85	$335.79 – $2,713.62
MRI of the brain, before and after contrast: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $1,997.94 Aetna — Commercial\|HMO: $1,997.94 Aetna — Commercial\|PPO: $1,997.94 Aetna — Medicaid\|Better Health: $685.86 Aetna — Medicare\|All Plans: $345.86 BCBS - Anthem — Commercial\|HMO PPO: $1,116 BCBS - Anthem — Commercial\|Pathway: $943 BCBS - Anthem — Medicaid\|All Plans: $720.16 BCBS - Anthem — Medicare\|All Plans: $335.79 CareSource — Commercial\|All Plans: $671.58
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) In the file: HC MR BRAIN WOW CONTRAST	$2,982	$1,092.85	$2,713.62
MRI of the brain, before and after contrast: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $2,713.62
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: HC XR CHEST 2 VIEWS	$577	$211.46	$82.79 – $525.07
Chest X-ray, 2 views: 10 of 20 insurance plan rates Aetna — Commercial\|All Other Plans: $386.59 Aetna — Commercial\|HMO: $386.59 Aetna — Commercial\|PPO: $386.59 Aetna — Medicaid\|Better Health: $132.71 Aetna — Medicare\|All Plans: $85.27 BCBS - Anthem — Medicaid\|All Plans: $139.35 BCBS - Anthem — Medicare\|All Plans: $82.79 CareSource — Commercial\|All Plans: $165.58 Humana — Commercial\|All Plans: $248.11 Humana — Medicaid\|All Plans: $134.04
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) In the file: HC XR CHEST 2 VIEWS	$577	$211.46	$525.07
Chest X-ray, 2 views: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $525.07
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: HC XR SPINE LUMBAR 4-5 VIEW	$1,072	$392.87	$99.99 – $975.52
X-ray of the lower spine, at least 4 views: 10 of 20 insurance plan rates Aetna — Commercial\|All Other Plans: $718.24 Aetna — Commercial\|HMO: $718.24 Aetna — Commercial\|PPO: $718.24 Aetna — Medicaid\|Better Health: $246.56 Aetna — Medicare\|All Plans: $102.99 BCBS - Anthem — Medicaid\|All Plans: $258.89 BCBS - Anthem — Medicare\|All Plans: $99.99 CareSource — Commercial\|All Plans: $199.98 Humana — Commercial\|All Plans: $460.96 Humana — Medicaid\|All Plans: $249.03
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) In the file: HC XR SPINE LUMBAR 4-5 VIEW	$1,072	$392.87	$975.52
X-ray of the lower spine, at least 4 views: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $975.52
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: HC MR SPINE LUMBAR	$2,994	$1,097.25	$227.27 – $2,724.54
MRI of the lower back (lumbar spine), without contrast: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $2,005.98 Aetna — Commercial\|HMO: $2,005.98 Aetna — Commercial\|PPO: $2,005.98 Aetna — Medicaid\|Better Health: $688.62 Aetna — Medicare\|All Plans: $234.09 BCBS - Anthem — Commercial\|HMO PPO: $1,116 BCBS - Anthem — Commercial\|Pathway: $943 BCBS - Anthem — Medicaid\|All Plans: $723.06 BCBS - Anthem — Medicare\|All Plans: $227.27 CareSource — Commercial\|All Plans: $454.54
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: HC MRIG LIMITED LUMBAR	$2,474	$906.68	$227.27 – $2,251.34
MRI of the lower back (lumbar spine), without contrast: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $1,657.58 Aetna — Commercial\|HMO: $1,657.58 Aetna — Commercial\|PPO: $1,657.58 Aetna — Medicaid\|Better Health: $569.02 Aetna — Medicare\|All Plans: $234.09 BCBS - Anthem — Commercial\|HMO PPO: $1,116 BCBS - Anthem — Commercial\|Pathway: $943 BCBS - Anthem — Medicaid\|All Plans: $597.48 BCBS - Anthem — Medicare\|All Plans: $227.27 CareSource — Commercial\|All Plans: $454.54
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) In the file: HC MR SPINE LUMBAR	$2,994	$1,097.25	$2,724.54
MRI of the lower back (lumbar spine), without contrast: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $2,724.54
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: HC CT PELVIS W CONTRAST	$2,063	$756.05	$167.38 – $1,877.33
CT scan of the pelvis, with contrast: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $1,382.21 Aetna — Commercial\|HMO: $1,382.21 Aetna — Commercial\|PPO: $1,382.21 Aetna — Medicaid\|Better Health: $474.49 Aetna — Medicare\|All Plans: $172.40 BCBS - Anthem — Commercial\|HMO PPO: $873 BCBS - Anthem — Commercial\|Pathway: $738 BCBS - Anthem — Medicaid\|All Plans: $498.22 BCBS - Anthem — Medicare\|All Plans: $167.38 CareSource — Commercial\|All Plans: $334.76
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) In the file: HC CT PELVIS W CONTRAST	$2,063	$756.05	$1,877.33
CT scan of the pelvis, with contrast: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $1,877.33
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: HC MR LOWER EXTREM JNT WO CONT	$2,162	$792.34	$227.27 – $1,967.42
MRI of a leg joint (such as the knee), without contrast: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $1,448.54 Aetna — Commercial\|HMO: $1,448.54 Aetna — Commercial\|PPO: $1,448.54 Aetna — Medicaid\|Better Health: $497.26 Aetna — Medicare\|All Plans: $234.09 BCBS - Anthem — Commercial\|HMO PPO: $1,116 BCBS - Anthem — Commercial\|Pathway: $943 BCBS - Anthem — Medicaid\|All Plans: $522.13 BCBS - Anthem — Medicare\|All Plans: $227.27 CareSource — Commercial\|All Plans: $454.54
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: HC MRIG LOWER EXTREM JOINT LIM	$2,983	$1,093.22	$227.27 – $2,714.53
MRI of a leg joint (such as the knee), without contrast: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $1,998.61 Aetna — Commercial\|HMO: $1,998.61 Aetna — Commercial\|PPO: $1,998.61 Aetna — Medicaid\|Better Health: $686.09 Aetna — Medicare\|All Plans: $234.09 BCBS - Anthem — Commercial\|HMO PPO: $1,116 BCBS - Anthem — Commercial\|Pathway: $943 BCBS - Anthem — Medicaid\|All Plans: $720.40 BCBS - Anthem — Medicare\|All Plans: $227.27 CareSource — Commercial\|All Plans: $454.54
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) In the file: HC MR LOWER EXTREM JNT WO CONT	$2,162	$792.34	$1,967.42
MRI of a leg joint (such as the knee), without contrast: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $1,967.42
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: HC CT ABD&PEL W CONTRAST	$4,544	$1,665.29	$335.79 – $4,135.04
CT scan of the abdomen and pelvis, with contrast: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $3,044.48 Aetna — Commercial\|HMO: $3,044.48 Aetna — Commercial\|PPO: $3,044.48 Aetna — Medicaid\|Better Health: $1,045.12 Aetna — Medicare\|All Plans: $345.86 BCBS - Anthem — Commercial\|HMO PPO: $873 BCBS - Anthem — Commercial\|Pathway: $738 BCBS - Anthem — Medicaid\|All Plans: $1,097.38 BCBS - Anthem — Medicare\|All Plans: $335.79 CareSource — Commercial\|All Plans: $671.58
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) In the file: HC CT ABD&PEL W CONTRAST	$4,544	$1,665.29	$4,135.04
CT scan of the abdomen and pelvis, with contrast: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $4,135.04
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: HC U/S ABDOMINAL COMP	$2,254	$826.05	$99.99 – $2,051.14
Ultrasound of the abdomen, complete: 10 of 20 insurance plan rates Aetna — Commercial\|All Other Plans: $1,510.18 Aetna — Commercial\|HMO: $1,510.18 Aetna — Commercial\|PPO: $1,510.18 Aetna — Medicaid\|Better Health: $518.42 Aetna — Medicare\|All Plans: $102.99 BCBS - Anthem — Medicaid\|All Plans: $544.35 BCBS - Anthem — Medicare\|All Plans: $99.99 CareSource — Commercial\|All Plans: $199.98 Humana — Commercial\|All Plans: $969.22 Humana — Medicaid\|All Plans: $523.61
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) In the file: HC U/S ABDOMINAL COMP	$2,254	$826.05	$2,051.14
Ultrasound of the abdomen, complete: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $2,051.14
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: HC U/S OB>=14 WKS-1 FETUS	$850	$311.51	$99.99 – $773.50
Pregnancy ultrasound (after the first trimester): 10 of 20 insurance plan rates Aetna — Commercial\|All Other Plans: $569.50 Aetna — Commercial\|HMO: $569.50 Aetna — Commercial\|PPO: $569.50 Aetna — Medicaid\|Better Health: $195.50 Aetna — Medicare\|All Plans: $102.99 BCBS - Anthem — Medicaid\|All Plans: $205.28 BCBS - Anthem — Medicare\|All Plans: $99.99 CareSource — Commercial\|All Plans: $199.98 Humana — Commercial\|All Plans: $365.50 Humana — Medicaid\|All Plans: $197.46
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) In the file: HC U/S OB>=14 WKS-1 FETUS	$850	$311.51	$773.50
Pregnancy ultrasound (after the first trimester): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $773.50
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: HC U/SENDO VAG (EV)	$1,602	$587.11	$99.99 – $1,457.82
Transvaginal ultrasound: 10 of 20 insurance plan rates Aetna — Commercial\|All Other Plans: $1,073.34 Aetna — Commercial\|HMO: $1,073.34 Aetna — Commercial\|PPO: $1,073.34 Aetna — Medicaid\|Better Health: $368.46 Aetna — Medicare\|All Plans: $102.99 BCBS - Anthem — Medicaid\|All Plans: $386.89 BCBS - Anthem — Medicare\|All Plans: $99.99 CareSource — Commercial\|All Plans: $199.98 Humana — Commercial\|All Plans: $688.86 Humana — Medicaid\|All Plans: $372.15
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) In the file: HC U/SENDO VAG (EV)	$1,602	$587.11	$1,457.82
Transvaginal ultrasound: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $1,457.82
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: HC MAMMO DIAG UNI & CAD	$323	$118.38	$67.61 – $293.93
Diagnostic mammogram, one breast: 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $216.41 Aetna — Commercial\|HMO: $216.41 Aetna — Commercial\|PPO: $216.41 Aetna — Medicaid\|Better Health: $74.29 BCBS - Anthem — Commercial\|HMO PPO: $178 BCBS - Anthem — Commercial\|Pathway: $150 BCBS - Anthem — Medicaid\|All Plans: $78.01 Humana — Commercial\|All Plans: $138.89 Humana — Medicaid\|All Plans: $75.04 Multiplan — Commercial\|All Plans: $293.93
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) In the file: HC MAMMO DIAG UNI & CAD	$323	$118.38	$293.93
Diagnostic mammogram, one breast: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $293.93
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: HC MAMMO DIAG BIL & CAD	$399	$146.23	$83.52 – $363.09
Diagnostic mammogram, both breasts: 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $267.33 Aetna — Commercial\|HMO: $267.33 Aetna — Commercial\|PPO: $267.33 Aetna — Medicaid\|Better Health: $91.77 BCBS - Anthem — Commercial\|HMO PPO: $178 BCBS - Anthem — Commercial\|Pathway: $150 BCBS - Anthem — Medicaid\|All Plans: $96.36 Humana — Commercial\|All Plans: $171.57 Humana — Medicaid\|All Plans: $92.69 Multiplan — Commercial\|All Plans: $363.09
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) In the file: HC MAMMO DIAG BIL & CAD	$399	$146.23	$363.09
Diagnostic mammogram, both breasts: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $363.09
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: HC DIG SCREEN MAMMO UNI	$263	$96.39	$55.05 – $287
Screening mammogram, both breasts: 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $176.21 Aetna — Commercial\|HMO: $176.21 Aetna — Commercial\|PPO: $176.21 Aetna — Medicaid\|Better Health: $60.49 BCBS - Anthem — Commercial\|HMO PPO: $178 BCBS - Anthem — Commercial\|Pathway: $150 BCBS - Anthem — Medicaid\|All Plans: $63.52 Humana — Commercial\|All Plans: $113.09 Humana — Medicaid\|All Plans: $61.10 Multiplan — Commercial\|All Plans: $239.33
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: HC MAMMO SCRN BIL & CAD	$325	$119.11	$68.03 – $295.75
Screening mammogram, both breasts: 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $217.75 Aetna — Commercial\|HMO: $217.75 Aetna — Commercial\|PPO: $217.75 Aetna — Medicaid\|Better Health: $74.75 BCBS - Anthem — Commercial\|HMO PPO: $178 BCBS - Anthem — Commercial\|Pathway: $150 BCBS - Anthem — Medicaid\|All Plans: $78.49 Humana — Commercial\|All Plans: $139.75 Humana — Medicaid\|All Plans: $75.50 Multiplan — Commercial\|All Plans: $295.75
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: HC MAMMO SCRN DIGITAL BIL IMP	$289	$105.92	$60.49 – $287
Screening mammogram, both breasts: 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $193.63 Aetna — Commercial\|HMO: $193.63 Aetna — Commercial\|PPO: $193.63 Aetna — Medicaid\|Better Health: $66.47 BCBS - Anthem — Commercial\|HMO PPO: $178 BCBS - Anthem — Commercial\|Pathway: $150 BCBS - Anthem — Medicaid\|All Plans: $69.80 Humana — Commercial\|All Plans: $124.27 Humana — Medicaid\|All Plans: $67.14 Multiplan — Commercial\|All Plans: $262.99

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: HC POLYSOMNOGRAPHY	$5,804	$2,127.06	$956.59 – $5,281.64
Sleep study (overnight, in a sleep lab): 10 of 20 insurance plan rates Aetna — Commercial\|All Other Plans: $3,888.68 Aetna — Commercial\|HMO: $3,888.68 Aetna — Commercial\|PPO: $3,888.68 Aetna — Medicaid\|Better Health: $1,334.92 Aetna — Medicare\|All Plans: $985.29 BCBS - Anthem — Medicaid\|All Plans: $1,401.67 BCBS - Anthem — Medicare\|All Plans: $956.59 CareSource — Commercial\|All Plans: $1,913.18 Humana — Commercial\|All Plans: $2,495.72 Humana — Medicaid\|All Plans: $1,348.27
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) In the file: HC POLYSOMNOGRAPHY	$5,804	$2,127.06	$5,281.64
Sleep study (overnight, in a sleep lab): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $5,281.64

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: HC OT THER EXERCISE 15 MIN	$146	$53.51	$29.70 – $132.86
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $97.82 Aetna — Commercial\|HMO: $97.82 Aetna — Commercial\|PPO: $97.82 Aetna — Medicaid\|Better Health: $33.58 BCBS - Anthem — Commercial\|HMO PPO: $29.70 BCBS - Anthem — Commercial\|Pathway: $29.70 BCBS - Anthem — Medicaid\|All Plans: $35.26 Humana — Commercial\|All Plans: $62.78 Humana — Medicaid\|All Plans: $33.92 Multiplan — Commercial\|All Plans: $132.86
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: HC PT THER EXERCISE 15 MIN	$146	$53.51	$29.70 – $132.86
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $97.82 Aetna — Commercial\|HMO: $97.82 Aetna — Commercial\|PPO: $97.82 Aetna — Medicaid\|Better Health: $33.58 BCBS - Anthem — Commercial\|HMO PPO: $29.70 BCBS - Anthem — Commercial\|Pathway: $29.70 BCBS - Anthem — Medicaid\|All Plans: $35.26 Humana — Commercial\|All Plans: $62.78 Humana — Medicaid\|All Plans: $33.92 Multiplan — Commercial\|All Plans: $132.86
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) In the file: HC OT THER EXERCISE 15 MIN	$146	$53.51	$132.86
Physical therapy: therapeutic exercise (each 15 minutes): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $132.86
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: HC PT EVAL LOW COMPLEX 20 MIN	$545	$199.74	$81.47 – $495.95
Physical therapy evaluation (low complexity): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $365.15 Aetna — Commercial\|HMO: $365.15 Aetna — Commercial\|PPO: $365.15 Aetna — Medicaid\|Better Health: $125.35 BCBS - Anthem — Commercial\|HMO PPO: $81.47 BCBS - Anthem — Commercial\|Pathway: $81.47 BCBS - Anthem — Medicaid\|All Plans: $131.62 Humana — Commercial\|All Plans: $234.35 Humana — Medicaid\|All Plans: $126.61 Multiplan — Commercial\|All Plans: $495.95
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) In the file: HC PT EVAL LOW COMPLEX 20 MIN	$545	$199.74	$495.95
Physical therapy evaluation (low complexity): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $495.95
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: HC PT EVAL MOD COMPLEX	$817	$299.42	$81.47 – $743.47
Physical therapy evaluation (moderate complexity): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $547.39 Aetna — Commercial\|HMO: $547.39 Aetna — Commercial\|PPO: $547.39 Aetna — Medicaid\|Better Health: $187.91 BCBS - Anthem — Commercial\|HMO PPO: $81.47 BCBS - Anthem — Commercial\|Pathway: $81.47 BCBS - Anthem — Medicaid\|All Plans: $197.31 Humana — Commercial\|All Plans: $351.31 Humana — Medicaid\|All Plans: $189.79 Multiplan — Commercial\|All Plans: $743.47
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) In the file: HC PT EVAL MOD COMPLEX	$817	$299.42	$743.47
Physical therapy evaluation (moderate complexity): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $743.47
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: HC PT EVAL HIGH COMPLEX	$518	$189.84	$81.47 – $471.38
Physical therapy evaluation (high complexity): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $347.06 Aetna — Commercial\|HMO: $347.06 Aetna — Commercial\|PPO: $347.06 Aetna — Medicaid\|Better Health: $119.14 BCBS - Anthem — Commercial\|HMO PPO: $81.47 BCBS - Anthem — Commercial\|Pathway: $81.47 BCBS - Anthem — Medicaid\|All Plans: $125.10 Humana — Commercial\|All Plans: $222.74 Humana — Medicaid\|All Plans: $120.34 Multiplan — Commercial\|All Plans: $471.38
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: HC PT EVAL HIGH COMPLEX 60 MIN	$1,232	$451.51	$81.47 – $1,121.12
Physical therapy evaluation (high complexity): 10 of 15 insurance plan rates Aetna — Commercial\|All Other Plans: $825.44 Aetna — Commercial\|HMO: $825.44 Aetna — Commercial\|PPO: $825.44 Aetna — Medicaid\|Better Health: $283.36 BCBS - Anthem — Commercial\|HMO PPO: $81.47 BCBS - Anthem — Commercial\|Pathway: $81.47 BCBS - Anthem — Medicaid\|All Plans: $297.53 Humana — Commercial\|All Plans: $529.76 Humana — Medicaid\|All Plans: $286.20 Multiplan — Commercial\|All Plans: $1,121.12
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) In the file: HC PT EVAL HIGH COMPLEX	$518	$189.84	$471.38
Physical therapy evaluation (high complexity): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $471.38

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$2,613 – $7,200.88
Removal of breast growth (open surgery): 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $3,708.45 BCBS - Anthem — Commercial\|HMO PPO: $3,087 BCBS - Anthem — Commercial\|Pathway: $2,613 BCBS - Anthem — Medicare\|All Plans: $3,600.44 CareSource — Commercial\|All Plans: $7,200.88 Humana — Medicare\|All Plans: $3,600.44 Passport by Molina — Medicare\|All Plans: $3,780.46 United — Medicare\|All Plans: $3,672.45 Wellcare — Medicare\|All Plans: $3,600.44 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$12,097.90 – $24,195.80
Total hip replacement: 10 of 20 insurance plan rates Aetna — Medicare\|All Plans: $12,460.84 BCBS - Anthem — Medicare\|All Plans: $12,097.90 CareSource — Commercial\|All Plans: $24,195.80 Humana — Medicare\|All Plans: $12,097.90 Passport by Molina — Medicare\|All Plans: $12,702.80 United — Medicare\|All Plans: $12,339.86 Wellcare — Medicare\|All Plans: $12,097.90 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount) Aetna — Commercial\|HMO: 67% (a percentage in the contract, not a dollar amount) Aetna — Commercial\|PPO: 67% (a percentage in the contract, not a dollar amount)
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$12,097.90 – $24,195.80
Total knee replacement: 10 of 20 insurance plan rates Aetna — Medicare\|All Plans: $12,460.84 BCBS - Anthem — Medicare\|All Plans: $12,097.90 CareSource — Commercial\|All Plans: $24,195.80 Humana — Medicare\|All Plans: $12,097.90 Passport by Molina — Medicare\|All Plans: $12,702.80 United — Medicare\|All Plans: $12,339.86 Wellcare — Medicare\|All Plans: $12,097.90 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount) Aetna — Commercial\|HMO: 67% (a percentage in the contract, not a dollar amount) Aetna — Commercial\|PPO: 67% (a percentage in the contract, not a dollar amount)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$2,613 – $3,087
Shoulder arthroscopy: shaving of shoulder bone: 10 of 15 insurance plan rates BCBS - Anthem — Commercial\|HMO PPO: $3,087 BCBS - Anthem — Commercial\|Pathway: $2,613 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount) Aetna — Commercial\|HMO: 67% (a percentage in the contract, not a dollar amount) Aetna — Commercial\|PPO: 67% (a percentage in the contract, not a dollar amount) Aetna — Medicaid\|Better Health: 23% (a percentage in the contract, not a dollar amount) BCBS - Anthem — Medicaid\|All Plans: 24.15% (a percentage in the contract, not a dollar amount) Humana — Commercial\|All Plans: 43% (a percentage in the contract, not a dollar amount) Humana — Medicaid\|All Plans: 23.23% (a percentage in the contract, not a dollar amount) Multiplan — Commercial\|All Plans: 91% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: KNEE ARTHROSCOPY/SURGERY	Not listed in the file	Not listed in the file	$2,958 – $6,101.42
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $3,142.23 BCBS - Anthem — Commercial\|HMO PPO: $3,496 BCBS - Anthem — Commercial\|Pathway: $2,958 BCBS - Anthem — Medicare\|All Plans: $3,050.71 CareSource — Commercial\|All Plans: $6,101.42 Humana — Medicare\|All Plans: $3,050.71 Passport by Molina — Medicare\|All Plans: $3,203.25 United — Medicare\|All Plans: $3,111.72 Wellcare — Medicare\|All Plans: $3,050.71 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$2,613 – $11,124.28
Removal of tonsils and adenoids (under age 12): 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $5,729 BCBS - Anthem — Commercial\|HMO PPO: $3,087 BCBS - Anthem — Commercial\|Pathway: $2,613 BCBS - Anthem — Medicare\|All Plans: $5,562.14 CareSource — Commercial\|All Plans: $11,124.28 Humana — Medicare\|All Plans: $5,562.14 Passport by Molina — Medicare\|All Plans: $5,840.25 United — Medicare\|All Plans: $5,673.38 Wellcare — Medicare\|All Plans: $5,562.14 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: HC EGD DIAGNOSTIC BRUSH WASH	$2,500	$916.21	$523.25 – $2,275
Upper GI endoscopy (diagnostic): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $1,675 Aetna — Commercial\|HMO: $1,675 Aetna — Commercial\|PPO: $1,675 Aetna — Medicaid\|Better Health: $575 Aetna — Medicare\|All Plans: $907.98 BCBS - Anthem — Commercial\|HMO PPO: $1,834 BCBS - Anthem — Commercial\|Pathway: $1,551 BCBS - Anthem — Medicaid\|All Plans: $603.75 BCBS - Anthem — Medicare\|All Plans: $881.53 CareSource — Commercial\|All Plans: $1,763.06
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) In the file: HC EGD DIAGNOSTIC BRUSH WASH	$2,500	$916.21	$2,275
Upper GI endoscopy (diagnostic): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $2,275
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: HC EGD WITH BIOPSY	$2,467	$904.11	$516.35 – $2,244.97
Upper GI endoscopy with biopsy: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $1,652.89 Aetna — Commercial\|HMO: $1,652.89 Aetna — Commercial\|PPO: $1,652.89 Aetna — Medicaid\|Better Health: $567.41 Aetna — Medicare\|All Plans: $907.98 BCBS - Anthem — Commercial\|HMO PPO: $2,006 BCBS - Anthem — Commercial\|Pathway: $1,698 BCBS - Anthem — Medicaid\|All Plans: $595.79 BCBS - Anthem — Medicare\|All Plans: $881.53 CareSource — Commercial\|All Plans: $1,763.06
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) In the file: HC EGD WITH BIOPSY	$2,467	$904.11	$2,244.97
Upper GI endoscopy with biopsy: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $2,244.97
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$857.23 – $2,006
Colonoscopy (diagnostic): 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $882.95 BCBS - Anthem — Commercial\|HMO PPO: $2,006 BCBS - Anthem — Commercial\|Pathway: $1,698 BCBS - Anthem — Medicare\|All Plans: $857.23 CareSource — Commercial\|All Plans: $1,714.46 Humana — Medicare\|All Plans: $857.23 Passport by Molina — Medicare\|All Plans: $900.09 United — Medicare\|All Plans: $874.37 Wellcare — Medicare\|All Plans: $857.23 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: HC COLONOSCOPY AND BIOPSY	$3,589	$1,315.30	$751.18 – $3,265.99
Colonoscopy with biopsy: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $2,404.63 Aetna — Commercial\|HMO: $2,404.63 Aetna — Commercial\|PPO: $2,404.63 Aetna — Medicaid\|Better Health: $825.47 Aetna — Medicare\|All Plans: $1,141.88 BCBS - Anthem — Commercial\|HMO PPO: $2,006 BCBS - Anthem — Commercial\|Pathway: $1,698 BCBS - Anthem — Medicaid\|All Plans: $866.75 BCBS - Anthem — Medicare\|All Plans: $1,108.62 CareSource — Commercial\|All Plans: $2,217.24
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) In the file: HC COLONOSCOPY AND BIOPSY	$3,589	$1,315.30	$3,265.99
Colonoscopy with biopsy: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $3,265.99
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: HC COLONOSCOPY W/LESION REMOVAL	$2,405	$881.39	$503.37 – $2,217.24
Colonoscopy with removal of polyps (snare): 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $1,611.35 Aetna — Commercial\|HMO: $1,611.35 Aetna — Commercial\|PPO: $1,611.35 Aetna — Medicaid\|Better Health: $553.15 Aetna — Medicare\|All Plans: $1,141.88 BCBS - Anthem — Commercial\|HMO PPO: $2,006 BCBS - Anthem — Commercial\|Pathway: $1,698 BCBS - Anthem — Medicaid\|All Plans: $580.81 BCBS - Anthem — Medicare\|All Plans: $1,108.62 CareSource — Commercial\|All Plans: $2,217.24
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) In the file: HC COLONOSCOPY W/LESION REMOVAL	$2,405	$881.39	$2,188.55
Colonoscopy with removal of polyps (snare): rates for 1 insurance plan Multiplan — Commercial\|All Plans: $2,188.55
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$1,108.62 – $2,217.24
Ultrasound of the lower bowel by endoscope: 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $1,141.88 BCBS - Anthem — Commercial\|HMO PPO: $2,006 BCBS - Anthem — Commercial\|Pathway: $1,698 BCBS - Anthem — Medicare\|All Plans: $1,108.62 CareSource — Commercial\|All Plans: $2,217.24 Humana — Medicare\|All Plans: $1,108.62 Passport by Molina — Medicare\|All Plans: $1,164.05 United — Medicare\|All Plans: $1,130.79 Wellcare — Medicare\|All Plans: $1,108.62 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$3,246 – $10,971.40
Gallbladder removal by laparoscope: 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $5,650.27 BCBS - Anthem — Commercial\|HMO PPO: $3,837 BCBS - Anthem — Commercial\|Pathway: $3,246 BCBS - Anthem — Medicare\|All Plans: $5,485.70 CareSource — Commercial\|All Plans: $10,971.40 Humana — Medicare\|All Plans: $5,485.70 Passport by Molina — Medicare\|All Plans: $5,759.98 United — Medicare\|All Plans: $5,595.41 Wellcare — Medicare\|All Plans: $5,485.70 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$2,958 – $6,636.32
Groin (inguinal) hernia repair, age 5 or older: 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $3,417.70 BCBS - Anthem — Commercial\|HMO PPO: $3,496 BCBS - Anthem — Commercial\|Pathway: $2,958 BCBS - Anthem — Medicare\|All Plans: $3,318.16 CareSource — Commercial\|All Plans: $6,636.32 Humana — Medicare\|All Plans: $3,318.16 Passport by Molina — Medicare\|All Plans: $3,484.07 United — Medicare\|All Plans: $3,384.52 Wellcare — Medicare\|All Plans: $3,318.16 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: BIOPSY PROSTATE NEEDLE	$4,327	$1,585.77	$905.65 – $3,937.57
Prostate biopsy: 10 of 22 insurance plan rates Aetna — Commercial\|All Other Plans: $2,899.09 Aetna — Commercial\|HMO: $2,899.09 Aetna — Commercial\|PPO: $2,899.09 Aetna — Medicaid\|Better Health: $995.21 Aetna — Medicare\|All Plans: $1,983.87 BCBS - Anthem — Commercial\|HMO PPO: $2,006 BCBS - Anthem — Commercial\|Pathway: $1,698 BCBS - Anthem — Medicaid\|All Plans: $1,044.98 BCBS - Anthem — Medicare\|All Plans: $1,926.09 CareSource — Commercial\|All Plans: $3,852.18
Prostate biopsy CPT 55700 · Inpatient (hospital stay) In the file: BIOPSY PROSTATE NEEDLE	$4,327	$1,585.77	$3,937.57
Prostate biopsy: rates for 1 insurance plan Multiplan — Commercial\|All Plans: $3,937.57
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) In the file: LAPARO RADICAL PROSTATECTOMY	Not listed in the file	Not listed in the file	$9,789.05 – $19,578.10
Prostate removal by laparoscope (radical prostatectomy): 10 of 20 insurance plan rates Aetna — Medicare\|All Plans: $10,082.72 BCBS - Anthem — Medicare\|All Plans: $9,789.05 CareSource — Commercial\|All Plans: $19,578.10 Humana — Medicare\|All Plans: $9,789.05 Passport by Molina — Medicare\|All Plans: $10,278.50 United — Medicare\|All Plans: $9,984.83 Wellcare — Medicare\|All Plans: $9,789.05 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount) Aetna — Commercial\|HMO: 67% (a percentage in the contract, not a dollar amount) Aetna — Commercial\|PPO: 67% (a percentage in the contract, not a dollar amount)
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$2,613 – $5,979.04
Hysteroscopy with biopsy of the uterus lining: 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $3,079.21 BCBS - Anthem — Commercial\|HMO PPO: $3,087 BCBS - Anthem — Commercial\|Pathway: $2,613 BCBS - Anthem — Medicare\|All Plans: $2,989.52 CareSource — Commercial\|All Plans: $5,979.04 Humana — Medicare\|All Plans: $2,989.52 Passport by Molina — Medicare\|All Plans: $3,139 United — Medicare\|All Plans: $3,049.31 Wellcare — Medicare\|All Plans: $2,989.52 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$651.14 – $1,834
Spinal injection, lower back (epidural), with imaging guidance: 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $670.67 BCBS - Anthem — Commercial\|HMO PPO: $1,834 BCBS - Anthem — Commercial\|Pathway: $1,551 BCBS - Anthem — Medicare\|All Plans: $651.14 CareSource — Commercial\|All Plans: $1,302.28 Humana — Medicare\|All Plans: $651.14 Passport by Molina — Medicare\|All Plans: $683.70 United — Medicare\|All Plans: $664.16 Wellcare — Medicare\|All Plans: $651.14 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: INJ FORAMEN EPIDURAL L/S	Not listed in the file	Not listed in the file	$837.09 – $1,834
Nerve root injection, lower back, with imaging guidance: 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $862.20 BCBS - Anthem — Commercial\|HMO PPO: $1,834 BCBS - Anthem — Commercial\|Pathway: $1,551 BCBS - Anthem — Medicare\|All Plans: $837.09 CareSource — Commercial\|All Plans: $1,674.18 Humana — Medicare\|All Plans: $837.09 Passport by Molina — Medicare\|All Plans: $878.94 United — Medicare\|All Plans: $853.83 Wellcare — Medicare\|All Plans: $837.09 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$1,698 – $3,672.14
Carpal tunnel release: 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $1,891.15 BCBS - Anthem — Commercial\|HMO PPO: $2,006 BCBS - Anthem — Commercial\|Pathway: $1,698 BCBS - Anthem — Medicare\|All Plans: $1,836.07 CareSource — Commercial\|All Plans: $3,672.14 Humana — Medicare\|All Plans: $1,836.07 Passport by Molina — Medicare\|All Plans: $1,927.87 United — Medicare\|All Plans: $1,872.79 Wellcare — Medicare\|All Plans: $1,836.07 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$515.82 – $2,006
Laser treatment of clouding after cataract surgery: 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $531.29 BCBS - Anthem — Commercial\|HMO PPO: $2,006 BCBS - Anthem — Commercial\|Pathway: $1,698 BCBS - Anthem — Medicare\|All Plans: $515.82 CareSource — Commercial\|All Plans: $1,031.64 Humana — Medicare\|All Plans: $515.82 Passport by Molina — Medicare\|All Plans: $541.61 United — Medicare\|All Plans: $526.14 Wellcare — Medicare\|All Plans: $515.82 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$2,144.43 – $4,288.86
Cataract removal with lens implant: 10 of 22 insurance plan rates Aetna — Medicare\|All Plans: $2,208.76 BCBS - Anthem — Commercial\|HMO PPO: $2,917 BCBS - Anthem — Commercial\|Pathway: $2,468 BCBS - Anthem — Medicare\|All Plans: $2,144.43 CareSource — Commercial\|All Plans: $4,288.86 Humana — Medicare\|All Plans: $2,144.43 Passport by Molina — Medicare\|All Plans: $2,251.65 United — Medicare\|All Plans: $2,187.32 Wellcare — Medicare\|All Plans: $2,144.43 Aetna — Commercial\|All Other Plans: 67% (a percentage in the contract, not a dollar amount)

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	Not listed in the file	Not listed in the file	$64,586.27 – $151,078.98
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 19 insurance plan rates Aetna — Medicaid\|Better Health: $64,586.27 Aetna — Medicare\|All Plans: $77,805.68 BCBS - Anthem — Commercial\|HMO PPO: $104,907 BCBS - Anthem — Commercial\|Pathway: $93,818 BCBS - Anthem — Medicaid\|All Plans: $75,350.65 BCBS - Anthem — Medicare\|All Plans: $75,917.19 CareSource — Commercial\|All Plans: $151,078.98 Humana — Commercial\|All Plans: $94,778 Humana — Medicaid\|All Plans: $71,762.52 Humana — Medicare\|All Plans: $75,539.49
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	Not listed in the file	Not listed in the file	$13,149.67 – $30,759.44
Hip or knee replacement (major joint of the leg), without major complications: 10 of 19 insurance plan rates Aetna — Medicaid\|Better Health: $13,149.67 Aetna — Medicare\|All Plans: $15,841.12 BCBS - Anthem — Commercial\|HMO PPO: $20,495 BCBS - Anthem — Commercial\|Pathway: $18,329 BCBS - Anthem — Medicaid\|All Plans: $15,341.28 BCBS - Anthem — Medicare\|All Plans: $15,456.62 CareSource — Commercial\|All Plans: $30,759.44 Humana — Commercial\|All Plans: $18,516 Humana — Medicaid\|All Plans: $14,610.74 Humana — Medicare\|All Plans: $15,379.72
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$16,341.61 – $38,225.96
Neck (cervical) spinal fusion, without complications: 10 of 19 insurance plan rates Aetna — Medicaid\|Better Health: $16,341.61 Aetna — Medicare\|All Plans: $19,686.37 BCBS - Anthem — Commercial\|HMO PPO: $25,734 BCBS - Anthem — Commercial\|Pathway: $23,013 BCBS - Anthem — Medicaid\|All Plans: $19,065.21 BCBS - Anthem — Medicare\|All Plans: $19,208.55 CareSource — Commercial\|All Plans: $38,225.96 Humana — Commercial\|All Plans: $23,249 Humana — Medicaid\|All Plans: $18,157.34 Humana — Medicare\|All Plans: $19,112.98
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	Not listed in the file	Not listed in the file	$8,600.55 – $20,118.22
Uterus and ovary surgery (not for cancer), without complications: 10 of 19 insurance plan rates Aetna — Medicaid\|Better Health: $8,600.55 Aetna — Medicare\|All Plans: $10,360.89 BCBS - Anthem — Commercial\|HMO PPO: $13,030 BCBS - Anthem — Commercial\|Pathway: $11,653 BCBS - Anthem — Medicaid\|All Plans: $10,033.97 BCBS - Anthem — Medicare\|All Plans: $10,109.41 CareSource — Commercial\|All Plans: $20,118.22 Humana — Commercial\|All Plans: $11,772 Humana — Medicaid\|All Plans: $9,556.16 Humana — Medicare\|All Plans: $10,059.11

Source: Saint Joseph Mount Sterling’s standard charges file (commonspirit.org, JSON, CMS template 3.0.0; it can be a very large file), last updated by the hospital on February 28, 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	225 Falcon Drive, Mount Sterling, KY 40353
County	Montgomery County
State	Kentucky
Phone	(859) 497‑5018
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	180064
Name in Medicare records	SAINT JOSEPH MOUNT STERLING
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(859) 497‑5000^[4]
Name on the hospital’s website	CommonSpirit - Saint Joseph Hospital - Mount Sterling
Official website	commonspirit.org
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

CommonSpirit - Saint Joseph Hospital - Mount Sterling — commonspirit.org

Saint Joseph Mount Sterling

Summary

Profile from official sources

At a glance