Does Samaritan Lebanon Community Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Samaritan Lebanon Community Hospital. In a medical emergency, call 911.

Where is Samaritan Lebanon Community Hospital?

525 N Santiam Highway, Lebanon, OR 97355, in Linn County, Oregon.

What is the phone number of Samaritan Lebanon Community Hospital?

(541) 258-2101, as listed by Medicare (CMS).

What is the Medicare star rating of Samaritan Lebanon Community Hospital?

3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Samaritan Lebanon Community Hospital

Quick answers

Does Samaritan Lebanon Community Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Samaritan Lebanon Community Hospital. In a medical emergency, call 911.
Where is Samaritan Lebanon Community Hospital?: 525 N Santiam Highway, Lebanon, OR 97355, in Linn County, Oregon.
What is the phone number of Samaritan Lebanon Community Hospital?: (541) 258-2101, as listed by Medicare (CMS).
What is the Medicare star rating of Samaritan Lebanon Community Hospital?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4]

Obstetrics & Gynecology
Emergency Care
Palliative Care
Diabetes
Physical Rehabilitation
Pulmonary care & rehabilitation

Treatments^[4]

Medication management
Nutrition services
Physical rehabilitation

Programs and centers^[4]

Cardiac Rehabilitation
Pulmonary Care & Rehabilitation
Girod Birth Center
Nutrition Services
Medication Management
Diabetes education

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

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	General visiting 8 a.m. to 6 p.m^[4]
Parking	Park in any hospital lot; use main entrance until 8 p.m., then the Emergency Department entrance^[7]

Recognition^[7]

Birthing-Friendly designation (Girod Birth Center)

Doctors and clinicians (432)

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

Main specialties

Doctors with a page on this site (432)

Aaron L. David, DOFamily Practice
Aaron M. Chavira, DOHospitalist
Abdelghaffar Elobeid, MDInternal Medicine
Abdulmetin DursunInternal Medicine
Abigail Kennedy, MDInternal Medicine
Abinet A. Ashine, MDCardiovascular Disease (Cardiology)
Adam C. Brady, MDInternal Medicine
Aditi Madabhushi, MDVascular Surgery
Adrienne ReddickNurse Practitioner
Alanna Didier, DOFamily Practice
Alex J. Russell, CNACertified Registered Nurse Anesthetist (CRNA)
Alexandra Morrow, DOFamily Practice
Alexis A. Robles, DOInternal Medicine
Alice J. Solomon, NPNurse Practitioner
Alicia L. Duyvejonck, NPNurse Practitioner
Alisha Cluff Kingsford, DOGeneral Surgery
Alison Grady, MDEmergency Medicine
Alysia Greco, PAPhysician Assistant
Amanda Eckersley, NPNurse Practitioner
Amber R. Hashizume, NPNurse Practitioner
Amelia Elliott, PAPhysician Assistant
Amie L. Keys, NPNurse Practitioner
Andrea L. Buras, MDGynecological Oncology
Andrei Gasic, MDGastroenterology

And 408 more: the button below opens the full list.

Other emergency rooms nearby

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

Samaritan Albany General Hospital12 mi · Albany, OR · Acute Care Hospital
Good Samaritan Regional Medical Center17 mi · Corvallis, OR · Acute Care Hospital
Santiam Hospital & Clinics19 mi · Stayton, OR · Acute Care Hospital
Salem Hospital27 mi · Salem, OR · Acute Care Hospital
Legacy Silverton Medical Center32 mi · Silverton, OR · Acute Care Hospital

Other hospitals nearby

Oregon State Hospital Distinct Part27 mi · Salem, OR · Psychiatric Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Lebanon Veterans Home0.2 mi · Lebanon, OR · 2 of 5 stars
Avamere Rehabilitation of Lebanon0.8 mi · Lebanon, OR · 2 of 5 stars
Mennonite Home8.9 mi · Albany, OR · 4 of 5 stars

All nursing homes in the state →

Hospice providers

Samaritan Evergreen Hospice7.6 mi · Albany, OR · 4 of 5 stars
Lumina Hospice and Palliative Care20 mi · Corvallis, OR · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Mission Home Health of Salem7.6 mi · Albany, OR · 3 of 5 stars

All home health agencies in the state →

Dialysis facilities

FMC Lebanon Oregon4.5 mi · Lebanon, OR · 1 of 5 stars
Qualicenters - Albany Ltd13 mi · Albany, OR · 2 of 5 stars
DaVita Linn Benton Dialysis19 mi · Corvallis, OR · 2 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

Eye Surgery Center7.6 mi · Albany, OR
Waverly Lake Surgery Center7.6 mi · Albany, OR
BSM Surgery Center, LLC19 mi · Corvallis, OR

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

East Linn Health Center0.1 mi · Lebanon, OR · Community health center
Sweet Home Health Center14 mi · Sweet Home, OR · Community health center
Children's Farm Home16 mi · Corvallis, OR · Community health center

Clinics and urgent care

Samaritan Family Medicine - Main St4.5 mi · Lebanon, OR · Rural health clinic
Samaritan Health Clinic - Lebanon Medical Plaza4.5 mi · Lebanon, OR · Rural health clinic
Samaritan Health Clinic - Park St4.5 mi · Lebanon, OR · Rural health clinic

Pharmacies

Mid Valley Healthcare Inc4.5 mi · Lebanon, OR · Community/retail pharmacy
Pill Box Drugs Inc4.5 mi · Lebanon, OR · Pharmacy
Safeway Inc4.5 mi · Lebanon, OR · Community/retail pharmacy

Assisted living nearby

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

Bridgecreek Memory Care4.5 mi · Lebanon, OR
Meadowlark Senior Living4.5 mi · Lebanon, OR
The Oaks at Lebanon4.5 mi · Lebanon, OR
Willamette Manor4.5 mi · Lebanon, OR

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

What patients said (patient survey)

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

Summary star rating (all survey topics)	4 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	5 of 5 stars
Nurses communicated well	5 of 5 stars
Doctors communicated well	4 of 5 stars
Staff explained medicines	4 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	78%National average: 72%
Would definitely recommend the hospital	75%National average: 71%
Nurses “always” communicated well	85%National average: 80%
Doctors “always” communicated well	82%National average: 80%
Staff “always” explained medicines before giving them	66%National average: 62%
Were given information about recovery at home	91%National average: 86%
Room and bathroom “always” clean	76%National average: 74%
Area around the room “always” quiet at night	61%National average: 60%
Completed surveys	276Response rate: 21%

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	0No different from the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 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 attack patients	Too few cases to report
Deaths within 30 days: heart failure patients	12.3%
Deaths within 30 days: pneumonia patients	16.2%
Deaths within 30 days: COPD patients	9.3%
Deaths within 30 days: stroke patients	11.6%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	Not reported to Medicare
Complications after hip or knee replacement	Not reported to Medicare

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026; 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)	Not reported to Medicare
Readmitted within 30 days: heart attack	Too few cases to report
Readmitted within 30 days: heart failure	21.3%
Readmitted within 30 days: pneumonia	16.4%
Readmitted within 30 days: COPD	19.3%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Not reported to Medicare

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; data from July 2023 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)	179 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	7%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	68%National average: 65%

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in Oregon Best hospitals in Oregon

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 78 common services exactly as Samaritan Lebanon Community Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

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) · Doctor (professional) fee In the file: PC E&M NEW PT LOW LEVEL 30 MINS OR MORE	$296	$236.80	$69.26 – $349.48
New patient office visit (about 30–44 minutes): 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $182.42 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $136.82 AETNA — FAC - MIDLEVEL NP-PA-CNM: $155.06 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $155.06 AETNA — FAC - PSYCHIATRIC NP: $182.42 AETNA — NONFAC - MD-DO: $248.23 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $186.17 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $210.99 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $210.99 AETNA — NONFAC - PSYCHIATRIC NP: $248.23
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC E&M NEW PT LOW LEVEL 30 MINS OR MORE	$68	$54.40	$19.72 – $65.96
New patient office visit (about 30–44 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $64.60 CIGNA — ALL PRODUCTS: $65.96 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $22.68 HEALTHNET — ALL PRODUCTS: $65.96 HEALTHNET — MEDICARE ADV.: $21.69 PACIFICSOURCE — MEDICARE ADV.: $22.09 PROVIDENCE — EPO - NON PEBB/OEBB: $65.96 PROVIDENCE — EPO - PEBB/OEBB: $65.96 PROVIDENCE — INDIVIDUAL-STANDARD: $65.96 PROVIDENCE — MA-BEHAVIORAL HEALTH: $19.72
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: HC E&M NEW PT LOW LEVEL 30 MINS OR MORE W/ PROC	$68	$54.40	$19.72 – $65.96
New patient office visit (about 30–44 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $64.60 CIGNA — ALL PRODUCTS: $65.96 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $22.68 HEALTHNET — ALL PRODUCTS: $65.96 HEALTHNET — MEDICARE ADV.: $21.69 PACIFICSOURCE — MEDICARE ADV.: $22.09 PROVIDENCE — EPO - NON PEBB/OEBB: $65.96 PROVIDENCE — EPO - PEBB/OEBB: $65.96 PROVIDENCE — INDIVIDUAL-STANDARD: $65.96 PROVIDENCE — MA-BEHAVIORAL HEALTH: $19.72
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC E&M NEW PT MODERATE LEVEL 45 MINS OR MORE	$441	$352.80	$112.76 – $518.45
New patient office visit (about 45–59 minutes): 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $294.70 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $221.03 AETNA — FAC - MIDLEVEL NP-PA-CNM: $250.50 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $250.50 AETNA — FAC - PSYCHIATRIC NP: $294.70 AETNA — NONFAC - MD-DO: $369.48 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $277.11 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $314.06 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $314.06 AETNA — NONFAC - PSYCHIATRIC NP: $369.48
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC E&M NEW PT MODERATE LEVEL 45 MINS OR MORE	$102	$81.60	$29.58 – $98.94
New patient office visit (about 45–59 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $96.90 CIGNA — ALL PRODUCTS: $98.94 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $34.02 HEALTHNET — ALL PRODUCTS: $98.94 HEALTHNET — MEDICARE ADV.: $32.54 PACIFICSOURCE — MEDICARE ADV.: $33.13 PROVIDENCE — EPO - NON PEBB/OEBB: $98.94 PROVIDENCE — EPO - PEBB/OEBB: $98.94 PROVIDENCE — INDIVIDUAL-STANDARD: $98.94 PROVIDENCE — MA-BEHAVIORAL HEALTH: $29.58
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: HC E&M NEW PT MODERATE LEVEL 45 MINS OR MORE W/ PROC	$350	$280	$101.50 – $339.50
New patient office visit (about 45–59 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $332.50 CIGNA — ALL PRODUCTS: $339.50 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $116.73 HEALTHNET — ALL PRODUCTS: $339.50 HEALTHNET — MEDICARE ADV.: $111.65 PACIFICSOURCE — MEDICARE ADV.: $113.68 PROVIDENCE — EPO - NON PEBB/OEBB: $339.50 PROVIDENCE — EPO - PEBB/OEBB: $339.50 PROVIDENCE — INDIVIDUAL-STANDARD: $339.50 PROVIDENCE — MA-BEHAVIORAL HEALTH: $101.50
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC E&M NEW PT HIGH LEVEL 60 MINS OR MORE	$583	$466.40	$153.12 – $684.27
New patient office visit (about 60–74 minutes): 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $400.16 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $300.12 AETNA — FAC - MIDLEVEL NP-PA-CNM: $340.13 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $340.13 AETNA — FAC - PSYCHIATRIC NP: $400.16 AETNA — NONFAC - MD-DO: $487.63 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $365.73 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $414.49 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $414.49 AETNA — NONFAC - PSYCHIATRIC NP: $487.63
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC E&M NEW PT HIGH LEVEL 60 MINS OR MORE	$134	$107.20	$38.86 – $129.98
New patient office visit (about 60–74 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $127.30 CIGNA — ALL PRODUCTS: $129.98 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $44.69 HEALTHNET — ALL PRODUCTS: $129.98 HEALTHNET — MEDICARE ADV.: $42.75 PACIFICSOURCE — MEDICARE ADV.: $43.52 PROVIDENCE — EPO - NON PEBB/OEBB: $129.98 PROVIDENCE — EPO - PEBB/OEBB: $129.98 PROVIDENCE — INDIVIDUAL-STANDARD: $129.98 PROVIDENCE — MA-BEHAVIORAL HEALTH: $38.86
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: HC E&M NEW PT HIGH LEVEL 60 MINS OR MORE W/ PROC	$420	$336	$121.80 – $407.40
New patient office visit (about 60–74 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $399 CIGNA — ALL PRODUCTS: $407.40 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $140.07 HEALTHNET — ALL PRODUCTS: $407.40 HEALTHNET — MEDICARE ADV.: $133.98 PACIFICSOURCE — MEDICARE ADV.: $136.42 PROVIDENCE — EPO - NON PEBB/OEBB: $407.40 PROVIDENCE — EPO - PEBB/OEBB: $407.40 PROVIDENCE — INDIVIDUAL-STANDARD: $407.40 PROVIDENCE — MA-BEHAVIORAL HEALTH: $121.80
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC E&M EST PT LOW LEVEL 20 MINS OR MORE	$240	$192	$55.81 – $281.27
Established patient office visit (about 20–29 minutes): 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $146.29 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $109.72 AETNA — FAC - MIDLEVEL NP-PA-CNM: $124.35 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $124.35 AETNA — FAC - PSYCHIATRIC NP: $146.29 AETNA — NONFAC - MD-DO: $200.88 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $150.66 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $170.75 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $170.75 AETNA — NONFAC - PSYCHIATRIC NP: $200.88
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC E&M EST PT LOW LEVEL 20 MINS OR MORE	$56	$44.80	$16.24 – $54.32
Established patient office visit (about 20–29 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $53.20 CIGNA — ALL PRODUCTS: $54.32 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $18.68 HEALTHNET — ALL PRODUCTS: $54.32 HEALTHNET — MEDICARE ADV.: $17.86 PACIFICSOURCE — MEDICARE ADV.: $18.19 PROVIDENCE — EPO - NON PEBB/OEBB: $54.32 PROVIDENCE — EPO - PEBB/OEBB: $54.32 PROVIDENCE — INDIVIDUAL-STANDARD: $54.32 PROVIDENCE — MA-BEHAVIORAL HEALTH: $16.24
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: HC E&M EST PT LOW LEVEL 20 MINS OR MORE W/ PROC	$56	$44.80	$16.24 – $54.32
Established patient office visit (about 20–29 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $53.20 CIGNA — ALL PRODUCTS: $54.32 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $18.68 HEALTHNET — ALL PRODUCTS: $54.32 HEALTHNET — MEDICARE ADV.: $17.86 PACIFICSOURCE — MEDICARE ADV.: $18.19 PROVIDENCE — EPO - NON PEBB/OEBB: $54.32 PROVIDENCE — EPO - PEBB/OEBB: $54.32 PROVIDENCE — INDIVIDUAL-STANDARD: $54.32 PROVIDENCE — MA-BEHAVIORAL HEALTH: $16.24
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC E&M EST PT MODERATE LEVEL 30 MINS OR MORE	$350	$280	$82.42 – $397.76
Established patient office visit (about 30–39 minutes): 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $216.29 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $162.22 AETNA — FAC - MIDLEVEL NP-PA-CNM: $183.85 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $183.85 AETNA — FAC - PSYCHIATRIC NP: $216.29 AETNA — NONFAC - MD-DO: $284.34 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $213.25 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $241.68 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $241.68 AETNA — NONFAC - PSYCHIATRIC NP: $284.34
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC E&M EST PT MODERATE LEVEL 30 MINS OR MORE	$78	$62.40	$22.62 – $75.66
Established patient office visit (about 30–39 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $74.10 CIGNA — ALL PRODUCTS: $75.66 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $26.01 HEALTHNET — ALL PRODUCTS: $75.66 HEALTHNET — MEDICARE ADV.: $24.88 PACIFICSOURCE — MEDICARE ADV.: $25.33 PROVIDENCE — EPO - NON PEBB/OEBB: $75.66 PROVIDENCE — EPO - PEBB/OEBB: $75.66 PROVIDENCE — INDIVIDUAL-STANDARD: $75.66 PROVIDENCE — MA-BEHAVIORAL HEALTH: $22.62
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: HC E&M EST PT MODERATE LEVEL 30 MINS OR MORE W/ PROC	$78	$62.40	$22.62 – $75.66
Established patient office visit (about 30–39 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $74.10 CIGNA — ALL PRODUCTS: $75.66 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $26.01 HEALTHNET — ALL PRODUCTS: $75.66 HEALTHNET — MEDICARE ADV.: $24.88 PACIFICSOURCE — MEDICARE ADV.: $25.33 PROVIDENCE — EPO - NON PEBB/OEBB: $75.66 PROVIDENCE — EPO - PEBB/OEBB: $75.66 PROVIDENCE — INDIVIDUAL-STANDARD: $75.66 PROVIDENCE — MA-BEHAVIORAL HEALTH: $22.62
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC N/P PREVENTATIVE MEDICINE 18-39	$376	$300.80	$80.42 – $401.96
Preventive checkup, new patient, age 18–39: 10 of 104 insurance plan rates CIGNA — FACILITY: $91.35 CIGNA — NONFACILITY: $125.67 DEVOTED HEALTH — MEDICARE ADVANTAGE - MIDLEVEL - FAC: $88.53 DEVOTED HEALTH — MEDICARE ADVANTAGE - MIDLEVEL - NONFAC: $123.31 DEVOTED HEALTH — Medicare Advantage-FAC: $102.04 DEVOTED HEALTH — Medicare Advantage-NONFAC: $142.38 FIRST CHOICE — FACILITY: $209.89 FIRST CHOICE — NONFACILITY: $289.17 HEALTHNET — FACILITY: $207.14 HEALTHNET — MEDICARE ADVANTAGE - FAC: $104.16
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC N/P PREVENTATIVE MED 18-39 YRS	$76	$60.80	$22.04 – $73.72
Preventive checkup, new patient, age 18–39: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $72.20 CIGNA — ALL PRODUCTS: $73.72 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $25.35 HEALTHNET — ALL PRODUCTS: $73.72 HEALTHNET — MEDICARE ADV.: $24.24 PACIFICSOURCE — MEDICARE ADV.: $24.68 PROVIDENCE — EPO - NON PEBB/OEBB: $73.72 PROVIDENCE — EPO - PEBB/OEBB: $73.72 PROVIDENCE — INDIVIDUAL-STANDARD: $73.72 PROVIDENCE — MA-BEHAVIORAL HEALTH: $22.04
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC N/P PREVENTATIVE MEDICINE 40-64	$433	$346.40	$97.88 – $462.83
Preventive checkup, new patient, age 40–64: 10 of 104 insurance plan rates CIGNA — FACILITY: $111.06 CIGNA — NONFACILITY: $145.04 DEVOTED HEALTH — MEDICARE ADVANTAGE - MIDLEVEL - FAC: $107.19 DEVOTED HEALTH — MEDICARE ADVANTAGE - MIDLEVEL - NONFAC: $141.97 DEVOTED HEALTH — Medicare Advantage-FAC: $123.64 DEVOTED HEALTH — Medicare Advantage-NONFAC: $163.98 FIRST CHOICE — FACILITY: $254.44 FIRST CHOICE — NONFACILITY: $332.96 HEALTHNET — FACILITY: $252.03 HEALTHNET — MEDICARE ADVANTAGE - FAC: $126.10
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC N/P PREVENTATIVE MED 40-64 YRS	$86	$68.80	$24.94 – $83.42
Preventive checkup, new patient, age 40–64: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $81.70 CIGNA — ALL PRODUCTS: $83.42 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $28.68 HEALTHNET — ALL PRODUCTS: $83.42 HEALTHNET — MEDICARE ADV.: $27.43 PACIFICSOURCE — MEDICARE ADV.: $27.93 PROVIDENCE — EPO - NON PEBB/OEBB: $83.42 PROVIDENCE — EPO - PEBB/OEBB: $83.42 PROVIDENCE — INDIVIDUAL-STANDARD: $83.42 PROVIDENCE — MA-BEHAVIORAL HEALTH: $24.94
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC E / M ER DEPT MOD COMPLEXITY	$270	$216	$59.82 – $223.54
Emergency room visit (moderate): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $158.21 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $118.66 AETNA — FAC - MIDLEVEL NP-PA-CNM: $134.48 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $134.48 AETNA — FAC - PSYCHIATRIC NP: $158.21 AETNA — NONFAC - MD-DO: $158.21 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $118.66 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $134.48 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $134.48 AETNA — NONFAC - PSYCHIATRIC NP: $158.21
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY RM III W/O PROCEDURE	$1,200	$960	$348 – $1,164
Emergency room visit (moderate): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $1,140 CIGNA — ALL PRODUCTS: $1,164 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $400.20 HEALTHNET — ALL PRODUCTS: $1,164 HEALTHNET — MEDICARE ADV.: $382.80 PACIFICSOURCE — MEDICARE ADV.: $389.76 PROVIDENCE — EPO - NON PEBB/OEBB: $1,164 PROVIDENCE — EPO - PEBB/OEBB: $1,164 PROVIDENCE — INDIVIDUAL-STANDARD: $1,164 PROVIDENCE — MA-BEHAVIORAL HEALTH: $348
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: HC EMERGENCY RM III W/PROCEDURE	$1,200	$960	$348 – $1,164
Emergency room visit (moderate): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $1,140 CIGNA — ALL PRODUCTS: $1,164 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $400.20 HEALTHNET — ALL PRODUCTS: $1,164 HEALTHNET — MEDICARE ADV.: $382.80 PACIFICSOURCE — MEDICARE ADV.: $389.76 PROVIDENCE — EPO - NON PEBB/OEBB: $1,164 PROVIDENCE — EPO - PEBB/OEBB: $1,164 PROVIDENCE — INDIVIDUAL-STANDARD: $1,164 PROVIDENCE — MA-BEHAVIORAL HEALTH: $348
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC E / M ER DEPT DETAILED - MOD COMPL	$456	$364.80	$101.60 – $375.72
Emergency room visit (moderately high): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $267 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $200.25 AETNA — FAC - MIDLEVEL NP-PA-CNM: $226.95 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $226.95 AETNA — FAC - PSYCHIATRIC NP: $267 AETNA — NONFAC - MD-DO: $267 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $200.25 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $226.95 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $226.95 AETNA — NONFAC - PSYCHIATRIC NP: $267
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY RM IV W/O PROCEDURE	$2,000	$1,600	$580 – $1,940
Emergency room visit (moderately high): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $1,900 CIGNA — ALL PRODUCTS: $1,940 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $667 HEALTHNET — ALL PRODUCTS: $1,940 HEALTHNET — MEDICARE ADV.: $638 PACIFICSOURCE — MEDICARE ADV.: $649.60 PROVIDENCE — EPO - NON PEBB/OEBB: $1,940 PROVIDENCE — EPO - PEBB/OEBB: $1,940 PROVIDENCE — INDIVIDUAL-STANDARD: $1,940 PROVIDENCE — MA-BEHAVIORAL HEALTH: $580
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: HC EMERGENCY RM IV W/PROCEDURE	$2,000	$1,600	$580 – $1,940
Emergency room visit (moderately high): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $1,900 CIGNA — ALL PRODUCTS: $1,940 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $667 HEALTHNET — ALL PRODUCTS: $1,940 HEALTHNET — MEDICARE ADV.: $638 PACIFICSOURCE — MEDICARE ADV.: $649.60 PROVIDENCE — EPO - NON PEBB/OEBB: $1,940 PROVIDENCE — EPO - PEBB/OEBB: $1,940 PROVIDENCE — INDIVIDUAL-STANDARD: $1,940 PROVIDENCE — MA-BEHAVIORAL HEALTH: $580
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC E / M ER DEPT HIGH COMPLEXITY	$663	$530.40	$148.25 – $546.79
Emergency room visit (high): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $387.80 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $290.85 AETNA — FAC - MIDLEVEL NP-PA-CNM: $329.63 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $329.63 AETNA — FAC - PSYCHIATRIC NP: $387.80 AETNA — NONFAC - MD-DO: $387.80 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $290.85 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $329.63 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $329.63 AETNA — NONFAC - PSYCHIATRIC NP: $387.80
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY RM V W/O PROCEDURE	$2,700	$2,160	$783 – $2,619
Emergency room visit (high): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $2,565 CIGNA — ALL PRODUCTS: $2,619 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $900.45 HEALTHNET — ALL PRODUCTS: $2,619 HEALTHNET — MEDICARE ADV.: $861.30 PACIFICSOURCE — MEDICARE ADV.: $876.96 PROVIDENCE — EPO - NON PEBB/OEBB: $2,619 PROVIDENCE — EPO - PEBB/OEBB: $2,619 PROVIDENCE — INDIVIDUAL-STANDARD: $2,619 PROVIDENCE — MA-BEHAVIORAL HEALTH: $783
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: HC EMERGENCY RM V W/PROCEDURE	$2,700	$2,160	$783 – $2,619
Emergency room visit (high): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $2,565 CIGNA — ALL PRODUCTS: $2,619 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $900.45 HEALTHNET — ALL PRODUCTS: $2,619 HEALTHNET — MEDICARE ADV.: $861.30 PACIFICSOURCE — MEDICARE ADV.: $876.96 PROVIDENCE — EPO - NON PEBB/OEBB: $2,619 PROVIDENCE — EPO - PEBB/OEBB: $2,619 PROVIDENCE — INDIVIDUAL-STANDARD: $2,619 PROVIDENCE — MA-BEHAVIORAL HEALTH: $783

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL PL	$60	$48	$17.40 – $58.20
Basic metabolic panel (blood test): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $57 CIGNA — ALL PRODUCTS: $58.20 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $9.73 HEALTHNET — ALL PRODUCTS: $58.20 HEALTHNET — MEDICARE ADV.: $19.14 PACIFICSOURCE — MEDICARE ADV.: $19.49 PROVIDENCE — EPO - NON PEBB/OEBB: $58.20 PROVIDENCE — EPO - PEBB/OEBB: $58.20 PROVIDENCE — INDIVIDUAL-STANDARD: $58.20 PROVIDENCE — MA-BEHAVIORAL HEALTH: $17.40
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$60	$48	$17.40 – $58.20
Basic metabolic panel (blood test): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $57 CIGNA — ALL PRODUCTS: $58.20 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $9.73 HEALTHNET — ALL PRODUCTS: $58.20 HEALTHNET — MEDICARE ADV.: $19.14 PACIFICSOURCE — MEDICARE ADV.: $19.49 PROVIDENCE — EPO - NON PEBB/OEBB: $58.20 PROVIDENCE — EPO - PEBB/OEBB: $58.20 PROVIDENCE — INDIVIDUAL-STANDARD: $58.20 PROVIDENCE — MA-BEHAVIORAL HEALTH: $17.40
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$110	$88	$31.90 – $106.70
Comprehensive metabolic panel (blood test): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $104.50 CIGNA — ALL PRODUCTS: $106.70 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $12.14 HEALTHNET — ALL PRODUCTS: $106.70 HEALTHNET — MEDICARE ADV.: $35.09 PACIFICSOURCE — MEDICARE ADV.: $35.73 PROVIDENCE — EPO - NON PEBB/OEBB: $106.70 PROVIDENCE — EPO - PEBB/OEBB: $106.70 PROVIDENCE — INDIVIDUAL-STANDARD: $106.70 PROVIDENCE — MA-BEHAVIORAL HEALTH: $31.90
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL PL	$110	$88	$31.90 – $106.70
Comprehensive metabolic panel (blood test): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $104.50 CIGNA — ALL PRODUCTS: $106.70 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $12.14 HEALTHNET — ALL PRODUCTS: $106.70 HEALTHNET — MEDICARE ADV.: $35.09 PACIFICSOURCE — MEDICARE ADV.: $35.73 PROVIDENCE — EPO - NON PEBB/OEBB: $106.70 PROVIDENCE — EPO - PEBB/OEBB: $106.70 PROVIDENCE — INDIVIDUAL-STANDARD: $106.70 PROVIDENCE — MA-BEHAVIORAL HEALTH: $31.90
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PRENATAL PANEL OBSTETRIC PANEL	$200	$160	$58 – $194
Obstetric blood test panel: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $190 CIGNA — ALL PRODUCTS: $194 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $54.98 HEALTHNET — ALL PRODUCTS: $194 HEALTHNET — MEDICARE ADV.: $63.80 PACIFICSOURCE — MEDICARE ADV.: $64.96 PROVIDENCE — EPO - NON PEBB/OEBB: $194 PROVIDENCE — EPO - PEBB/OEBB: $194 PROVIDENCE — INDIVIDUAL-STANDARD: $194 PROVIDENCE — MA-BEHAVIORAL HEALTH: $58
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC LIPID PANEL	$32	$25.60	$13.39 – $20.09
Cholesterol panel (lipid panel): 10 of 113 insurance plan rates AETNA — FAC - MD-DO: $20.09 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $20.09 AETNA — FAC - MIDLEVEL NP-PA-CNM: $20.09 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $20.09 AETNA — FAC - PSYCHIATRIC NP: $20.09 AETNA — NONFAC - MD-DO: $20.09 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $20.09 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $20.09 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $20.09 AETNA — NONFAC - PSYCHIATRIC NP: $20.09
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$100	$80	$29 – $97
Cholesterol panel (lipid panel): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $95 CIGNA — ALL PRODUCTS: $97 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $15.40 HEALTHNET — ALL PRODUCTS: $97 HEALTHNET — MEDICARE ADV.: $31.90 PACIFICSOURCE — MEDICARE ADV.: $32.48 PROVIDENCE — EPO - NON PEBB/OEBB: $97 PROVIDENCE — EPO - PEBB/OEBB: $97 PROVIDENCE — INDIVIDUAL-STANDARD: $97 PROVIDENCE — MA-BEHAVIORAL HEALTH: $29
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID CASCADE	$100	$80	$29 – $97
Cholesterol panel (lipid panel): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $95 CIGNA — ALL PRODUCTS: $97 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $15.40 HEALTHNET — ALL PRODUCTS: $97 HEALTHNET — MEDICARE ADV.: $31.90 PACIFICSOURCE — MEDICARE ADV.: $32.48 PROVIDENCE — EPO - NON PEBB/OEBB: $97 PROVIDENCE — EPO - PEBB/OEBB: $97 PROVIDENCE — INDIVIDUAL-STANDARD: $97 PROVIDENCE — MA-BEHAVIORAL HEALTH: $29
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$73	$58.40	$21.17 – $70.81
Kidney function panel: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $69.35 CIGNA — ALL PRODUCTS: $70.81 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $9.98 HEALTHNET — ALL PRODUCTS: $70.81 HEALTHNET — MEDICARE ADV.: $23.29 PACIFICSOURCE — MEDICARE ADV.: $23.71 PROVIDENCE — EPO - NON PEBB/OEBB: $70.81 PROVIDENCE — EPO - PEBB/OEBB: $70.81 PROVIDENCE — INDIVIDUAL-STANDARD: $70.81 PROVIDENCE — MA-BEHAVIORAL HEALTH: $21.17
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$52	$41.60	$15.08 – $50.44
Liver function panel: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $49.40 CIGNA — ALL PRODUCTS: $50.44 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $9.40 HEALTHNET — ALL PRODUCTS: $50.44 HEALTHNET — MEDICARE ADV.: $16.59 PACIFICSOURCE — MEDICARE ADV.: $16.89 PROVIDENCE — EPO - NON PEBB/OEBB: $50.44 PROVIDENCE — EPO - PEBB/OEBB: $50.44 PROVIDENCE — INDIVIDUAL-STANDARD: $50.44 PROVIDENCE — MA-BEHAVIORAL HEALTH: $15.08
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC URINALYSIS AUTOMATED W MICROSCOPY	$8	$6.40	$3.17 – $4.76
Urine test (automated, with microscope): 10 of 113 insurance plan rates AETNA — FAC - MD-DO: $4.76 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $4.76 AETNA — FAC - MIDLEVEL NP-PA-CNM: $4.76 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $4.76 AETNA — FAC - PSYCHIATRIC NP: $4.76 AETNA — NONFAC - MD-DO: $4.76 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $4.76 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $4.76 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $4.76 AETNA — NONFAC - PSYCHIATRIC NP: $4.76
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS WITH MICROSCOPIC	$62	$49.60	$17.98 – $60.14
Urine test (automated, with microscope): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $58.90 CIGNA — ALL PRODUCTS: $60.14 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $3.65 HEALTHNET — ALL PRODUCTS: $60.14 HEALTHNET — MEDICARE ADV.: $19.78 PACIFICSOURCE — MEDICARE ADV.: $20.14 PROVIDENCE — EPO - NON PEBB/OEBB: $60.14 PROVIDENCE — EPO - PEBB/OEBB: $60.14 PROVIDENCE — INDIVIDUAL-STANDARD: $60.14 PROVIDENCE — MA-BEHAVIORAL HEALTH: $17.98
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS WITH MICROSCOPIC PL	$21	$16.80	$6.09 – $20.37
Urine test (automated, with microscope): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $19.95 CIGNA — ALL PRODUCTS: $20.37 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $3.65 HEALTHNET — ALL PRODUCTS: $20.37 HEALTHNET — MEDICARE ADV.: $6.70 PACIFICSOURCE — MEDICARE ADV.: $6.82 PROVIDENCE — EPO - NON PEBB/OEBB: $20.37 PROVIDENCE — EPO - PEBB/OEBB: $20.37 PROVIDENCE — INDIVIDUAL-STANDARD: $20.37 PROVIDENCE — MA-BEHAVIORAL HEALTH: $6.09
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC URINALYSIS DIPSTICK NON-AUTOMATED W/O MICROSCOPY	$8	$6.40	$3.48 – $5.22
Urine test (manual, without microscope): 10 of 113 insurance plan rates AETNA — FAC - MD-DO: $5.22 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $5.22 AETNA — FAC - MIDLEVEL NP-PA-CNM: $5.22 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $5.22 AETNA — FAC - PSYCHIATRIC NP: $5.22 AETNA — NONFAC - MD-DO: $5.22 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $5.22 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $5.22 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $5.22 AETNA — NONFAC - PSYCHIATRIC NP: $5.22
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC UA DIP	$30	$24	$8.70 – $29.10
Urine test (manual, without microscope): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $28.50 CIGNA — ALL PRODUCTS: $29.10 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $4 HEALTHNET — ALL PRODUCTS: $29.10 HEALTHNET — MEDICARE ADV.: $9.57 PACIFICSOURCE — MEDICARE ADV.: $9.74 PROVIDENCE — EPO - NON PEBB/OEBB: $29.10 PROVIDENCE — EPO - PEBB/OEBB: $29.10 PROVIDENCE — INDIVIDUAL-STANDARD: $29.10 PROVIDENCE — MA-BEHAVIORAL HEALTH: $8.70
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS ROUTINE-NO MICRO	$94	$75.20	$27.26 – $91.18
Urine test (automated, without microscope): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $89.30 CIGNA — ALL PRODUCTS: $91.18 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $2.59 HEALTHNET — ALL PRODUCTS: $91.18 HEALTHNET — MEDICARE ADV.: $29.99 PACIFICSOURCE — MEDICARE ADV.: $30.53 PROVIDENCE — EPO - NON PEBB/OEBB: $91.18 PROVIDENCE — EPO - PEBB/OEBB: $91.18 PROVIDENCE — INDIVIDUAL-STANDARD: $91.18 PROVIDENCE — MA-BEHAVIORAL HEALTH: $27.26
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ROUTINE URINALYSIS	$49	$39.20	$14.21 – $47.53
Urine test (automated, without microscope): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $46.55 CIGNA — ALL PRODUCTS: $47.53 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $2.59 HEALTHNET — ALL PRODUCTS: $47.53 HEALTHNET — MEDICARE ADV.: $15.63 PACIFICSOURCE — MEDICARE ADV.: $15.92 PROVIDENCE — EPO - NON PEBB/OEBB: $47.53 PROVIDENCE — EPO - PEBB/OEBB: $47.53 PROVIDENCE — INDIVIDUAL-STANDARD: $47.53 PROVIDENCE — MA-BEHAVIORAL HEALTH: $14.21
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SPECIFIC GRAVITY, URINE	$22	$17.60	$6.38 – $21.34
Urine test (automated, without microscope): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $20.90 CIGNA — ALL PRODUCTS: $21.34 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $2.59 HEALTHNET — ALL PRODUCTS: $21.34 HEALTHNET — MEDICARE ADV.: $7.02 PACIFICSOURCE — MEDICARE ADV.: $7.15 PROVIDENCE — EPO - NON PEBB/OEBB: $21.34 PROVIDENCE — EPO - PEBB/OEBB: $21.34 PROVIDENCE — INDIVIDUAL-STANDARD: $21.34 PROVIDENCE — MA-BEHAVIORAL HEALTH: $6.38
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE SPECIFIC ANTIGEN-DIAG	$110	$88	$31.90 – $106.70
PSA (prostate specific antigen) blood test: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $104.50 CIGNA — ALL PRODUCTS: $106.70 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $21.15 HEALTHNET — ALL PRODUCTS: $106.70 HEALTHNET — MEDICARE ADV.: $35.09 PACIFICSOURCE — MEDICARE ADV.: $35.73 PROVIDENCE — EPO - NON PEBB/OEBB: $106.70 PROVIDENCE — EPO - PEBB/OEBB: $106.70 PROVIDENCE — INDIVIDUAL-STANDARD: $106.70 PROVIDENCE — MA-BEHAVIORAL HEALTH: $31.90
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSA DIAGNOSTIC	$94	$75.20	$27.26 – $91.18
PSA (prostate specific antigen) blood test: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $89.30 CIGNA — ALL PRODUCTS: $91.18 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $21.15 HEALTHNET — ALL PRODUCTS: $91.18 HEALTHNET — MEDICARE ADV.: $29.99 PACIFICSOURCE — MEDICARE ADV.: $30.53 PROVIDENCE — EPO - NON PEBB/OEBB: $91.18 PROVIDENCE — EPO - PEBB/OEBB: $91.18 PROVIDENCE — INDIVIDUAL-STANDARD: $91.18 PROVIDENCE — MA-BEHAVIORAL HEALTH: $27.26
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSA TOTAL-PL	$73	$58.40	$21.17 – $70.81
PSA (prostate specific antigen) blood test: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $69.35 CIGNA — ALL PRODUCTS: $70.81 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $21.15 HEALTHNET — ALL PRODUCTS: $70.81 HEALTHNET — MEDICARE ADV.: $23.29 PACIFICSOURCE — MEDICARE ADV.: $23.71 PROVIDENCE — EPO - NON PEBB/OEBB: $70.81 PROVIDENCE — EPO - PEBB/OEBB: $70.81 PROVIDENCE — INDIVIDUAL-STANDARD: $70.81 PROVIDENCE — MA-BEHAVIORAL HEALTH: $21.17
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TSH	$110	$88	$31.90 – $106.70
Thyroid stimulating hormone (TSH) test: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $104.50 CIGNA — ALL PRODUCTS: $106.70 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $19.32 HEALTHNET — ALL PRODUCTS: $106.70 HEALTHNET — MEDICARE ADV.: $35.09 PACIFICSOURCE — MEDICARE ADV.: $35.73 PROVIDENCE — EPO - NON PEBB/OEBB: $106.70 PROVIDENCE — EPO - PEBB/OEBB: $106.70 PROVIDENCE — INDIVIDUAL-STANDARD: $106.70 PROVIDENCE — MA-BEHAVIORAL HEALTH: $31.90
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TSH PL	$83	$66.40	$24.07 – $80.51
Thyroid stimulating hormone (TSH) test: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $78.85 CIGNA — ALL PRODUCTS: $80.51 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $19.32 HEALTHNET — ALL PRODUCTS: $80.51 HEALTHNET — MEDICARE ADV.: $26.48 PACIFICSOURCE — MEDICARE ADV.: $26.96 PROVIDENCE — EPO - NON PEBB/OEBB: $80.51 PROVIDENCE — EPO - PEBB/OEBB: $80.51 PROVIDENCE — INDIVIDUAL-STANDARD: $80.51 PROVIDENCE — MA-BEHAVIORAL HEALTH: $24.07
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ASSAY THYROID STIMULATING HORMNE CHRONIC URTICARIA	$120	$96	$34.80 – $116.40
Thyroid stimulating hormone (TSH) test: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $114 CIGNA — ALL PRODUCTS: $116.40 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $19.32 HEALTHNET — ALL PRODUCTS: $116.40 HEALTHNET — MEDICARE ADV.: $38.28 PACIFICSOURCE — MEDICARE ADV.: $38.98 PROVIDENCE — EPO - NON PEBB/OEBB: $116.40 PROVIDENCE — EPO - PEBB/OEBB: $116.40 PROVIDENCE — INDIVIDUAL-STANDARD: $116.40 PROVIDENCE — MA-BEHAVIORAL HEALTH: $34.80
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC CBC WITH PLATELET CT WITH AUTO DIF	$19	$15.20	$7.77 – $11.66
Complete blood count (CBC) with differential: 10 of 113 insurance plan rates AETNA — FAC - MD-DO: $11.66 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $11.66 AETNA — FAC - MIDLEVEL NP-PA-CNM: $11.66 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $11.66 AETNA — FAC - PSYCHIATRIC NP: $11.66 AETNA — NONFAC - MD-DO: $11.66 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $11.66 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $11.66 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $11.66 AETNA — NONFAC - PSYCHIATRIC NP: $11.66
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC W/AUTO DIFFERENTIAL	$73	$58.40	$21.17 – $70.81
Complete blood count (CBC) with differential: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $69.35 CIGNA — ALL PRODUCTS: $70.81 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $8.94 HEALTHNET — ALL PRODUCTS: $70.81 HEALTHNET — MEDICARE ADV.: $23.29 PACIFICSOURCE — MEDICARE ADV.: $23.71 PROVIDENCE — EPO - NON PEBB/OEBB: $70.81 PROVIDENCE — EPO - PEBB/OEBB: $70.81 PROVIDENCE — INDIVIDUAL-STANDARD: $70.81 PROVIDENCE — MA-BEHAVIORAL HEALTH: $21.17
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC W/AUTO DIFFERENTIAL PL	$100	$80	$29 – $97
Complete blood count (CBC) with differential: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $95 CIGNA — ALL PRODUCTS: $97 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $8.94 HEALTHNET — ALL PRODUCTS: $97 HEALTHNET — MEDICARE ADV.: $31.90 PACIFICSOURCE — MEDICARE ADV.: $32.48 PROVIDENCE — EPO - NON PEBB/OEBB: $97 PROVIDENCE — EPO - PEBB/OEBB: $97 PROVIDENCE — INDIVIDUAL-STANDARD: $97 PROVIDENCE — MA-BEHAVIORAL HEALTH: $29
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC HEMOGRAM AND PLATELET CT AUTO	$16	$12.80	$6.47 – $9.71
Complete blood count (CBC), automated: 10 of 113 insurance plan rates AETNA — FAC - MD-DO: $9.71 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $9.71 AETNA — FAC - MIDLEVEL NP-PA-CNM: $9.71 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $9.71 AETNA — FAC - PSYCHIATRIC NP: $9.71 AETNA — NONFAC - MD-DO: $9.71 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $9.71 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $9.71 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $9.71 AETNA — NONFAC - PSYCHIATRIC NP: $9.71
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC NO DIFF	$41	$32.80	$11.89 – $39.77
Complete blood count (CBC), automated: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $38.95 CIGNA — ALL PRODUCTS: $39.77 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $7.44 HEALTHNET — ALL PRODUCTS: $39.77 HEALTHNET — MEDICARE ADV.: $13.08 PACIFICSOURCE — MEDICARE ADV.: $13.32 PROVIDENCE — EPO - NON PEBB/OEBB: $39.77 PROVIDENCE — EPO - PEBB/OEBB: $39.77 PROVIDENCE — INDIVIDUAL-STANDARD: $39.77 PROVIDENCE — MA-BEHAVIORAL HEALTH: $11.89
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC NO DIFF(PNL)	$33	$26.40	$9.57 – $32.01
Complete blood count (CBC), automated: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $31.35 CIGNA — ALL PRODUCTS: $32.01 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $7.44 HEALTHNET — ALL PRODUCTS: $32.01 HEALTHNET — MEDICARE ADV.: $10.53 PACIFICSOURCE — MEDICARE ADV.: $10.72 PROVIDENCE — EPO - NON PEBB/OEBB: $32.01 PROVIDENCE — EPO - PEBB/OEBB: $32.01 PROVIDENCE — INDIVIDUAL-STANDARD: $32.01 PROVIDENCE — MA-BEHAVIORAL HEALTH: $9.57
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC PROTIME	$10	$8	$4.29 – $6.44
Blood clotting time test (prothrombin time, PT): 10 of 113 insurance plan rates AETNA — FAC - MD-DO: $6.44 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $6.44 AETNA — FAC - MIDLEVEL NP-PA-CNM: $6.44 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $6.44 AETNA — FAC - PSYCHIATRIC NP: $6.44 AETNA — NONFAC - MD-DO: $6.44 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $6.44 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $6.44 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $6.44 AETNA — NONFAC - PSYCHIATRIC NP: $6.44
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME	$52	$41.60	$15.08 – $50.44
Blood clotting time test (prothrombin time, PT): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $49.40 CIGNA — ALL PRODUCTS: $50.44 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $4.93 HEALTHNET — ALL PRODUCTS: $50.44 HEALTHNET — MEDICARE ADV.: $16.59 PACIFICSOURCE — MEDICARE ADV.: $16.89 PROVIDENCE — EPO - NON PEBB/OEBB: $50.44 PROVIDENCE — EPO - PEBB/OEBB: $50.44 PROVIDENCE — INDIVIDUAL-STANDARD: $50.44 PROVIDENCE — MA-BEHAVIORAL HEALTH: $15.08
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME-JUP PNL	$15	$12	$4.35 – $14.55
Blood clotting time test (prothrombin time, PT): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $14.25 CIGNA — ALL PRODUCTS: $14.55 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $4.93 HEALTHNET — ALL PRODUCTS: $14.55 HEALTHNET — MEDICARE ADV.: $4.79 PACIFICSOURCE — MEDICARE ADV.: $4.87 PROVIDENCE — EPO - NON PEBB/OEBB: $14.55 PROVIDENCE — EPO - PEBB/OEBB: $14.55 PROVIDENCE — INDIVIDUAL-STANDARD: $14.55 PROVIDENCE — MA-BEHAVIORAL HEALTH: $4.35
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PTT	$83	$66.40	$24.07 – $80.51
Blood clotting test (partial thromboplastin time, PTT): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $78.85 CIGNA — ALL PRODUCTS: $80.51 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $6.91 HEALTHNET — ALL PRODUCTS: $80.51 HEALTHNET — MEDICARE ADV.: $26.48 PACIFICSOURCE — MEDICARE ADV.: $26.96 PROVIDENCE — EPO - NON PEBB/OEBB: $80.51 PROVIDENCE — EPO - PEBB/OEBB: $80.51 PROVIDENCE — INDIVIDUAL-STANDARD: $80.51 PROVIDENCE — MA-BEHAVIORAL HEALTH: $24.07
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC APTT	$27	$21.60	$7.83 – $26.19
Blood clotting test (partial thromboplastin time, PTT): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $25.65 CIGNA — ALL PRODUCTS: $26.19 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $6.91 HEALTHNET — ALL PRODUCTS: $26.19 HEALTHNET — MEDICARE ADV.: $8.61 PACIFICSOURCE — MEDICARE ADV.: $8.77 PROVIDENCE — EPO - NON PEBB/OEBB: $26.19 PROVIDENCE — EPO - PEBB/OEBB: $26.19 PROVIDENCE — INDIVIDUAL-STANDARD: $26.19 PROVIDENCE — MA-BEHAVIORAL HEALTH: $7.83
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC APTT (TRAP)	$21	$16.80	$6.09 – $20.37
Blood clotting test (partial thromboplastin time, PTT): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $19.95 CIGNA — ALL PRODUCTS: $20.37 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $6.91 HEALTHNET — ALL PRODUCTS: $20.37 HEALTHNET — MEDICARE ADV.: $6.70 PACIFICSOURCE — MEDICARE ADV.: $6.82 PROVIDENCE — EPO - NON PEBB/OEBB: $20.37 PROVIDENCE — EPO - PEBB/OEBB: $20.37 PROVIDENCE — INDIVIDUAL-STANDARD: $20.37 PROVIDENCE — MA-BEHAVIORAL HEALTH: $6.09

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CRANIAL UNENHANCED	$1,150	$920	$333.50 – $1,115.50
CT scan of the head or brain, without contrast: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $1,092.50 CIGNA — ALL PRODUCTS: $1,115.50 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $383.53 HEALTHNET — ALL PRODUCTS: $1,115.50 HEALTHNET — MEDICARE ADV.: $366.85 PACIFICSOURCE — MEDICARE ADV.: $373.52 PROVIDENCE — EPO - NON PEBB/OEBB: $1,115.50 PROVIDENCE — EPO - PEBB/OEBB: $1,115.50 PROVIDENCE — INDIVIDUAL-STANDARD: $1,115.50 PROVIDENCE — MA-BEHAVIORAL HEALTH: $333.50
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC CT HEAD/BRAIN W/O DYE	$140	$112	$34.34 – $125.94
CT scan of the head or brain, without contrast: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $90.79 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $68.09 AETNA — FAC - MIDLEVEL NP-PA-CNM: $77.17 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $77.17 AETNA — FAC - PSYCHIATRIC NP: $90.79 AETNA — NONFAC - MD-DO: $90.79 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $68.09 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $77.17 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $77.17 AETNA — NONFAC - PSYCHIATRIC NP: $90.79
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI BRAIN W&WO	$3,340	$2,672	$968.60 – $3,239.80
MRI of the brain, before and after contrast: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $3,173 CIGNA — ALL PRODUCTS: $3,239.80 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $1,113.89 HEALTHNET — ALL PRODUCTS: $3,239.80 HEALTHNET — MEDICARE ADV.: $1,065.46 PACIFICSOURCE — MEDICARE ADV.: $1,084.83 PROVIDENCE — EPO - NON PEBB/OEBB: $3,239.80 PROVIDENCE — EPO - PEBB/OEBB: $3,239.80 PROVIDENCE — INDIVIDUAL-STANDARD: $3,239.80 PROVIDENCE — MA-BEHAVIORAL HEALTH: $968.60
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC MRI BRAIN W & W/O CONTRAST	$811	$648.80	$92.44 – $340.04
MRI of the brain, before and after contrast: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $244.78 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $183.58 AETNA — FAC - MIDLEVEL NP-PA-CNM: $208.06 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $208.06 AETNA — FAC - PSYCHIATRIC NP: $244.78 AETNA — NONFAC - MD-DO: $244.78 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $183.58 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $208.06 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $208.06 AETNA — NONFAC - PSYCHIATRIC NP: $244.78
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier TC In the file: PC MRI BRAIN W & W/O CONTRAST	$3,240	$2,592	$204.57 – $705.26
MRI of the brain, before and after contrast: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $501.27 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $375.95 AETNA — FAC - MIDLEVEL NP-PA-CNM: $426.08 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $426.08 AETNA — FAC - PSYCHIATRIC NP: $501.27 AETNA — NONFAC - MD-DO: $501.27 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $375.95 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $426.08 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $426.08 AETNA — NONFAC - PSYCHIATRIC NP: $501.27
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC CHEST 2 VIEWS	$103	$82.40	$28.05 – $106
Chest X-ray, 2 views: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $75.51 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $56.63 AETNA — FAC - MIDLEVEL NP-PA-CNM: $64.18 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $64.18 AETNA — FAC - PSYCHIATRIC NP: $75.51 AETNA — NONFAC - MD-DO: $75.51 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $56.63 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $64.18 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $64.18 AETNA — NONFAC - PSYCHIATRIC NP: $75.51
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CHEST XRAY 2 VIEWS	$370	$296	$107.30 – $358.90
Chest X-ray, 2 views: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $351.50 CIGNA — ALL PRODUCTS: $358.90 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $123.40 HEALTHNET — ALL PRODUCTS: $358.90 HEALTHNET — MEDICARE ADV.: $118.03 PACIFICSOURCE — MEDICARE ADV.: $120.18 PROVIDENCE — EPO - NON PEBB/OEBB: $358.90 PROVIDENCE — EPO - PEBB/OEBB: $358.90 PROVIDENCE — INDIVIDUAL-STANDARD: $358.90 PROVIDENCE — MA-BEHAVIORAL HEALTH: $107.30
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC CHEST 2 VIEWS	$30	$24	$8.87 – $32.53
Chest X-ray, 2 views: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $23.46 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $17.59 AETNA — FAC - MIDLEVEL NP-PA-CNM: $19.94 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $19.94 AETNA — FAC - PSYCHIATRIC NP: $23.46 AETNA — NONFAC - MD-DO: $23.46 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $17.59 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $19.94 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $19.94 AETNA — NONFAC - PSYCHIATRIC NP: $23.46
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC X-RAY EXAM OF LOWER SPINE	$159	$127.20	$42.36 – $161.62
X-ray of the lower spine, at least 4 views: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $115.25 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $86.44 AETNA — FAC - MIDLEVEL NP-PA-CNM: $97.96 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $97.96 AETNA — FAC - PSYCHIATRIC NP: $115.25 AETNA — NONFAC - MD-DO: $115.25 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $86.44 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $97.96 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $97.96 AETNA — NONFAC - PSYCHIATRIC NP: $115.25
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC XRAY LUMBOSACRAL MINIMUM 4 VIEWS	$450	$360	$130.50 – $436.50
X-ray of the lower spine, at least 4 views: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $427.50 CIGNA — ALL PRODUCTS: $436.50 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $150.08 HEALTHNET — ALL PRODUCTS: $436.50 HEALTHNET — MEDICARE ADV.: $143.55 PACIFICSOURCE — MEDICARE ADV.: $146.16 PROVIDENCE — EPO - NON PEBB/OEBB: $436.50 PROVIDENCE — EPO - PEBB/OEBB: $436.50 PROVIDENCE — INDIVIDUAL-STANDARD: $436.50 PROVIDENCE — MA-BEHAVIORAL HEALTH: $130.50
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC X-RAY EXAM OF LOWER SPINE	$36	$28.80	$10.59 – $38.83
X-ray of the lower spine, at least 4 views: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $28.05 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $21.04 AETNA — FAC - MIDLEVEL NP-PA-CNM: $23.84 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $23.84 AETNA — FAC - PSYCHIATRIC NP: $28.05 AETNA — NONFAC - MD-DO: $28.05 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $21.04 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $23.84 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $23.84 AETNA — NONFAC - PSYCHIATRIC NP: $28.05
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI LUMBAR WO	$2,220	$1,776	$643.80 – $2,153.40
MRI of the lower back (lumbar spine), without contrast: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $2,109 CIGNA — ALL PRODUCTS: $2,153.40 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $740.37 HEALTHNET — ALL PRODUCTS: $2,153.40 HEALTHNET — MEDICARE ADV.: $708.18 PACIFICSOURCE — MEDICARE ADV.: $721.06 PROVIDENCE — EPO - NON PEBB/OEBB: $2,153.40 PROVIDENCE — EPO - PEBB/OEBB: $2,153.40 PROVIDENCE — INDIVIDUAL-STANDARD: $2,153.40 PROVIDENCE — MA-BEHAVIORAL HEALTH: $643.80
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC MRI LUMBAR SPINE W/O DYE	$528	$422.40	$59.53 – $220.40
MRI of the lower back (lumbar spine), without contrast: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $158.58 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $118.93 AETNA — FAC - MIDLEVEL NP-PA-CNM: $134.79 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $134.79 AETNA — FAC - PSYCHIATRIC NP: $158.58 AETNA — NONFAC - MD-DO: $158.58 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $118.93 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $134.79 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $134.79 AETNA — NONFAC - PSYCHIATRIC NP: $158.58
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier TC In the file: PC MRI LUMBAR SPINE W/O DYE	$2,160	$1,728	$117.63 – $405.11
MRI of the lower back (lumbar spine), without contrast: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $288.01 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $216.01 AETNA — FAC - MIDLEVEL NP-PA-CNM: $244.81 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $244.81 AETNA — FAC - PSYCHIATRIC NP: $288.01 AETNA — NONFAC - MD-DO: $288.01 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $216.01 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $244.81 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $244.81 AETNA — NONFAC - PSYCHIATRIC NP: $288.01
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PELVIS ENHANCED	$1,440	$1,152	$417.60 – $1,396.80
CT scan of the pelvis, with contrast: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $1,368 CIGNA — ALL PRODUCTS: $1,396.80 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $480.24 HEALTHNET — ALL PRODUCTS: $1,396.80 HEALTHNET — MEDICARE ADV.: $459.36 PACIFICSOURCE — MEDICARE ADV.: $467.71 PROVIDENCE — EPO - NON PEBB/OEBB: $1,396.80 PROVIDENCE — EPO - PEBB/OEBB: $1,396.80 PROVIDENCE — INDIVIDUAL-STANDARD: $1,396.80 PROVIDENCE — MA-BEHAVIORAL HEALTH: $417.60
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC CT PELVIS W/DYE	$192	$153.60	$46.65 – $172.12
CT scan of the pelvis, with contrast: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $123.93 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $92.95 AETNA — FAC - MIDLEVEL NP-PA-CNM: $105.34 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $105.34 AETNA — FAC - PSYCHIATRIC NP: $123.93 AETNA — NONFAC - MD-DO: $123.93 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $92.95 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $105.34 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $105.34 AETNA — NONFAC - PSYCHIATRIC NP: $123.93
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC MRI LOWER EXTREMITY JOINT	$484	$387.20	$54.66 – $201.50
MRI of a leg joint (such as the knee), without contrast: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $145.06 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $108.79 AETNA — FAC - MIDLEVEL NP-PA-CNM: $123.30 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $123.30 AETNA — FAC - PSYCHIATRIC NP: $145.06 AETNA — NONFAC - MD-DO: $145.06 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $108.79 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $123.30 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $123.30 AETNA — NONFAC - PSYCHIATRIC NP: $145.06
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier TC In the file: PC MRI LOWER EXTREMITY JOINT	$2,160	$1,728	$132.51 – $460.73
MRI of a leg joint (such as the knee), without contrast: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $327.64 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $245.73 AETNA — FAC - MIDLEVEL NP-PA-CNM: $278.49 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $278.49 AETNA — FAC - PSYCHIATRIC NP: $327.64 AETNA — NONFAC - MD-DO: $327.64 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $245.73 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $278.49 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $278.49 AETNA — NONFAC - PSYCHIATRIC NP: $327.64
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: HC MRI EXT LOWER JOINT WO LT	$2,220	$1,776	$643.80 – $2,153.40
MRI of a leg joint (such as the knee), without contrast: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $2,109 CIGNA — ALL PRODUCTS: $2,153.40 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $740.37 HEALTHNET — ALL PRODUCTS: $2,153.40 HEALTHNET — MEDICARE ADV.: $708.18 PACIFICSOURCE — MEDICARE ADV.: $721.06 PROVIDENCE — EPO - NON PEBB/OEBB: $2,153.40 PROVIDENCE — EPO - PEBB/OEBB: $2,153.40 PROVIDENCE — INDIVIDUAL-STANDARD: $2,153.40 PROVIDENCE — MA-BEHAVIORAL HEALTH: $643.80
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT ABD AND PELVIS W/CONTRAST	$2,400	$1,920	$696 – $2,328
CT scan of the abdomen and pelvis, with contrast: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $2,280 CIGNA — ALL PRODUCTS: $2,328 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $800.40 HEALTHNET — ALL PRODUCTS: $2,328 HEALTHNET — MEDICARE ADV.: $765.60 PACIFICSOURCE — MEDICARE ADV.: $779.52 PROVIDENCE — EPO - NON PEBB/OEBB: $2,328 PROVIDENCE — EPO - PEBB/OEBB: $2,328 PROVIDENCE — INDIVIDUAL-STANDARD: $2,328 PROVIDENCE — MA-BEHAVIORAL HEALTH: $696
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC CT ABD & PELV W/CONTRAST	$302	$241.60	$73.55 – $270.77
CT scan of the abdomen and pelvis, with contrast: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $194.78 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $146.08 AETNA — FAC - MIDLEVEL NP-PA-CNM: $165.56 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $165.56 AETNA — FAC - PSYCHIATRIC NP: $194.78 AETNA — NONFAC - MD-DO: $194.78 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $146.08 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $165.56 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $165.56 AETNA — NONFAC - PSYCHIATRIC NP: $194.78
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC US EXAM ABDOM COMPLETE	$155	$124	$102.17 – $368.37
Ultrasound of the abdomen, complete: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $155 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $197.32 AETNA — FAC - MIDLEVEL NP-PA-CNM: $155 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $155 AETNA — FAC - PSYCHIATRIC NP: $155 AETNA — NONFAC - MD-DO: $155 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $155 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $223.63 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $223.63 AETNA — NONFAC - PSYCHIATRIC NP: $155
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ABDOMEN COMPLETE	$930	$744	$269.70 – $902.10
Ultrasound of the abdomen, complete: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $883.50 CIGNA — ALL PRODUCTS: $902.10 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $310.16 HEALTHNET — ALL PRODUCTS: $902.10 HEALTHNET — MEDICARE ADV.: $296.67 PACIFICSOURCE — MEDICARE ADV.: $302.06 PROVIDENCE — EPO - NON PEBB/OEBB: $902.10 PROVIDENCE — EPO - PEBB/OEBB: $902.10 PROVIDENCE — INDIVIDUAL-STANDARD: $902.10 PROVIDENCE — MA-BEHAVIORAL HEALTH: $269.70
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC US EXAM ABDOM COMPLETE	$142	$113.60	$32.63 – $119.64
Ultrasound of the abdomen, complete: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $86.20 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $64.65 AETNA — FAC - MIDLEVEL NP-PA-CNM: $73.27 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $73.27 AETNA — FAC - PSYCHIATRIC NP: $86.20 AETNA — NONFAC - MD-DO: $86.20 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $64.65 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $73.27 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $73.27 AETNA — NONFAC - PSYCHIATRIC NP: $86.20
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC OB US >/= 14 WKS SNGL FETUS	$531	$424.80	$117.34 – $428.20
Pregnancy ultrasound (after the first trimester): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $305.90 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $229.42 AETNA — FAC - MIDLEVEL NP-PA-CNM: $260.01 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $260.01 AETNA — FAC - PSYCHIATRIC NP: $305.90 AETNA — NONFAC - MD-DO: $305.90 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $229.42 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $260.01 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $260.01 AETNA — NONFAC - PSYCHIATRIC NP: $305.90
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OB US >/=14 WKS SINGLE FETUS	$1,150	$920	$333.50 – $1,115.50
Pregnancy ultrasound (after the first trimester): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $1,092.50 CIGNA — ALL PRODUCTS: $1,115.50 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $383.53 HEALTHNET — ALL PRODUCTS: $1,115.50 HEALTHNET — MEDICARE ADV.: $366.85 PACIFICSOURCE — MEDICARE ADV.: $373.52 PROVIDENCE — EPO - NON PEBB/OEBB: $1,115.50 PROVIDENCE — EPO - PEBB/OEBB: $1,115.50 PROVIDENCE — INDIVIDUAL-STANDARD: $1,115.50 PROVIDENCE — MA-BEHAVIORAL HEALTH: $333.50
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC OB US >/= 14 WKS SNGL FETUS	$174	$139.20	$40.07 – $147.98
Pregnancy ultrasound (after the first trimester): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $106.87 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $80.15 AETNA — FAC - MIDLEVEL NP-PA-CNM: $90.84 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $90.84 AETNA — FAC - PSYCHIATRIC NP: $106.87 AETNA — NONFAC - MD-DO: $106.87 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $80.15 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $90.84 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $90.84 AETNA — NONFAC - PSYCHIATRIC NP: $106.87
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC TRANSVAGINAL US NON-OB	$472	$377.60	$104.18 – $378.87
Transvaginal ultrasound: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $270.27 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $202.70 AETNA — FAC - MIDLEVEL NP-PA-CNM: $229.73 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $229.73 AETNA — FAC - PSYCHIATRIC NP: $270.27 AETNA — NONFAC - MD-DO: $270.27 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $202.70 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $229.73 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $229.73 AETNA — NONFAC - PSYCHIATRIC NP: $270.27
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NON OB US TRANSVAGINAL	$630	$504	$182.70 – $611.10
Transvaginal ultrasound: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $598.50 CIGNA — ALL PRODUCTS: $611.10 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $210.11 HEALTHNET — ALL PRODUCTS: $611.10 HEALTHNET — MEDICARE ADV.: $200.97 PACIFICSOURCE — MEDICARE ADV.: $204.62 PROVIDENCE — EPO - NON PEBB/OEBB: $611.10 PROVIDENCE — EPO - PEBB/OEBB: $611.10 PROVIDENCE — INDIVIDUAL-STANDARD: $611.10 PROVIDENCE — MA-BEHAVIORAL HEALTH: $182.70
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC TRANSVAGINAL US NON-OB	$121	$96.80	$28.05 – $103.90
Transvaginal ultrasound: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $74.66 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $56 AETNA — FAC - MIDLEVEL NP-PA-CNM: $63.46 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $63.46 AETNA — FAC - PSYCHIATRIC NP: $74.66 AETNA — NONFAC - MD-DO: $74.66 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $56 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $63.46 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $63.46 AETNA — NONFAC - PSYCHIATRIC NP: $74.66
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC DIAGNOSTIC MAMMOGRAPHY UNILATERAL	$115	$92	$32.63 – $119.64
Diagnostic mammogram, one breast: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $86.20 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $64.65 AETNA — FAC - MIDLEVEL NP-PA-CNM: $73.27 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $73.27 AETNA — FAC - PSYCHIATRIC NP: $86.20 AETNA — NONFAC - MD-DO: $86.20 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $64.65 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $73.27 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $73.27 AETNA — NONFAC - PSYCHIATRIC NP: $86.20
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: HC DIGITAL MAMMO DIAG UNILAT W OR W/O CAD LT	$390	$312	$113.10 – $378.30
Diagnostic mammogram, one breast: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $370.50 CIGNA — ALL PRODUCTS: $378.30 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $130.07 HEALTHNET — ALL PRODUCTS: $378.30 HEALTHNET — MEDICARE ADV.: $124.41 PACIFICSOURCE — MEDICARE ADV.: $126.67 PROVIDENCE — EPO - NON PEBB/OEBB: $378.30 PROVIDENCE — EPO - PEBB/OEBB: $378.30 PROVIDENCE — INDIVIDUAL-STANDARD: $378.30 PROVIDENCE — MA-BEHAVIORAL HEALTH: $113.10
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: HC DIGITAL MAMMO DIAG UNILAT W OR W/O CAD RT	$390	$312	$113.10 – $378.30
Diagnostic mammogram, one breast: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $370.50 CIGNA — ALL PRODUCTS: $378.30 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $130.07 HEALTHNET — ALL PRODUCTS: $378.30 HEALTHNET — MEDICARE ADV.: $124.41 PACIFICSOURCE — MEDICARE ADV.: $126.67 PROVIDENCE — EPO - NON PEBB/OEBB: $378.30 PROVIDENCE — EPO - PEBB/OEBB: $378.30 PROVIDENCE — INDIVIDUAL-STANDARD: $378.30 PROVIDENCE — MA-BEHAVIORAL HEALTH: $113.10
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIGITAL MAMMOGRAPHY DIAG BILAT W OR W/O CAD	$530	$424	$153.70 – $514.10
Diagnostic mammogram, both breasts: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $503.50 CIGNA — ALL PRODUCTS: $514.10 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $176.76 HEALTHNET — ALL PRODUCTS: $514.10 HEALTHNET — MEDICARE ADV.: $169.07 PACIFICSOURCE — MEDICARE ADV.: $172.14 PROVIDENCE — EPO - NON PEBB/OEBB: $514.10 PROVIDENCE — EPO - PEBB/OEBB: $514.10 PROVIDENCE — INDIVIDUAL-STANDARD: $514.10 PROVIDENCE — MA-BEHAVIORAL HEALTH: $153.70
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC DIAGNSTIC MAMMOGRAPHY BILATERAL	$142	$113.60	$40.36 – $146.93
Diagnostic mammogram, both breasts: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $106.14 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $79.60 AETNA — FAC - MIDLEVEL NP-PA-CNM: $90.22 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $90.22 AETNA — FAC - PSYCHIATRIC NP: $106.14 AETNA — NONFAC - MD-DO: $106.14 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $79.60 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $90.22 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $90.22 AETNA — NONFAC - PSYCHIATRIC NP: $106.14
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIGITAL MAMMOGRAPHY SCREENING W OR W/O CAD	$500	$400	$145 – $485
Screening mammogram, both breasts: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $475 CIGNA — ALL PRODUCTS: $485 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $166.75 HEALTHNET — ALL PRODUCTS: $485 HEALTHNET — MEDICARE ADV.: $159.50 PACIFICSOURCE — MEDICARE ADV.: $162.40 PROVIDENCE — EPO - NON PEBB/OEBB: $485 PROVIDENCE — EPO - PEBB/OEBB: $485 PROVIDENCE — INDIVIDUAL-STANDARD: $485 PROVIDENCE — MA-BEHAVIORAL HEALTH: $145
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC SCREENING MAMMOGRAPHY BILATERAL	$108	$86.40	$30.91 – $113.35
Screening mammogram, both breasts: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $81.58 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $61.19 AETNA — FAC - MIDLEVEL NP-PA-CNM: $69.35 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $69.35 AETNA — FAC - PSYCHIATRIC NP: $81.58 AETNA — NONFAC - MD-DO: $81.58 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $61.19 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $69.35 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $69.35 AETNA — NONFAC - PSYCHIATRIC NP: $81.58
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 52 In the file: HC DIGITAL MAMMO REDUC SCREENING W OR W/O CAD	$500	$400	$145 – $485
Screening mammogram, both breasts: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $475 CIGNA — ALL PRODUCTS: $485 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $166.75 HEALTHNET — ALL PRODUCTS: $485 HEALTHNET — MEDICARE ADV.: $159.50 PACIFICSOURCE — MEDICARE ADV.: $162.40 PROVIDENCE — EPO - NON PEBB/OEBB: $485 PROVIDENCE — EPO - PEBB/OEBB: $485 PROVIDENCE — INDIVIDUAL-STANDARD: $485 PROVIDENCE — MA-BEHAVIORAL HEALTH: $145

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) · Doctor (professional) fee In the file: PC EKG WITH REPORT (ECG)	$52	$41.60	$12.31 – $45.13
Electrocardiogram (ECG/EKG) with reading: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $32.02 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $24.02 AETNA — FAC - MIDLEVEL NP-PA-CNM: $27.22 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $27.22 AETNA — FAC - PSYCHIATRIC NP: $32.02 AETNA — NONFAC - MD-DO: $32.02 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $24.02 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $27.22 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $27.22 AETNA — NONFAC - PSYCHIATRIC NP: $32.02
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC LT HEART CATHETERIZATION	$814	$651.20	$805.37 – $2,833.65
Left heart catheterization (diagnostic): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $814 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $1,504.53 AETNA — FAC - MIDLEVEL NP-PA-CNM: $814 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $814 AETNA — FAC - PSYCHIATRIC NP: $814 AETNA — NONFAC - MD-DO: $814 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $814 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $1,705.13 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $1,705.13 AETNA — NONFAC - PSYCHIATRIC NP: $814
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LEFT HRT CATH INCL INJ LT VENT	$10,250	$8,200	$2,972.50 – $9,942.50
Left heart catheterization (diagnostic): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $9,737.50 CIGNA — ALL PRODUCTS: $9,942.50 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $3,418.38 HEALTHNET — ALL PRODUCTS: $9,942.50 HEALTHNET — MEDICARE ADV.: $3,269.75 PACIFICSOURCE — MEDICARE ADV.: $3,329.20 PROVIDENCE — EPO - NON PEBB/OEBB: $9,942.50 PROVIDENCE — EPO - PEBB/OEBB: $9,942.50 PROVIDENCE — INDIVIDUAL-STANDARD: $9,942.50 PROVIDENCE — MA-BEHAVIORAL HEALTH: $2,972.50
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC LT HEART CATHETERIZATION	$781	$624.80	$196.90 – $719.96
Left heart catheterization (diagnostic): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $501.41 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $376.05 AETNA — FAC - MIDLEVEL NP-PA-CNM: $426.20 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $426.20 AETNA — FAC - PSYCHIATRIC NP: $501.41 AETNA — NONFAC - MD-DO: $501.41 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $376.05 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $426.20 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $426.20 AETNA — NONFAC - PSYCHIATRIC NP: $501.41
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE EP EVAL W/O INDU	$8,960	$7,168	$2,598.40 – $8,691.20
Heart rhythm study (electrophysiology evaluation): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $8,512 CIGNA — ALL PRODUCTS: $8,691.20 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $2,988.16 HEALTHNET — ALL PRODUCTS: $8,691.20 HEALTHNET — MEDICARE ADV.: $2,858.24 PACIFICSOURCE — MEDICARE ADV.: $2,910.21 PROVIDENCE — EPO - NON PEBB/OEBB: $8,691.20 PROVIDENCE — EPO - PEBB/OEBB: $8,691.20 PROVIDENCE — INDIVIDUAL-STANDARD: $8,691.20 PROVIDENCE — MA-BEHAVIORAL HEALTH: $2,598.40
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC COMPREHENSIVE EP EVAL W/O INDUCTIN	$1,285	$1,028	$327.13 – $1,184.89
Heart rhythm study (electrophysiology evaluation): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $825.35 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $619.01 AETNA — FAC - MIDLEVEL NP-PA-CNM: $701.54 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $701.54 AETNA — FAC - PSYCHIATRIC NP: $825.35 AETNA — NONFAC - MD-DO: $825.35 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $619.01 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $701.54 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $701.54 AETNA — NONFAC - PSYCHIATRIC NP: $825.35
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC TX ATRIAL FIB PULM VEIN ISOL	$3,293	$2,634.40	$830.68 – $2,939.65
Heart rhythm study with ablation for atrial fibrillation: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $2,028.65 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $1,521.49 AETNA — FAC - MIDLEVEL NP-PA-CNM: $1,724.35 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $1,724.35 AETNA — FAC - PSYCHIATRIC NP: $2,028.65 AETNA — NONFAC - MD-DO: $2,028.65 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $1,521.49 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $1,724.35 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $1,724.35 AETNA — NONFAC - PSYCHIATRIC NP: $2,028.65
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EP TX ATRIAL FIB PULM VEIN ISOL	$50,000	$40,000	$14,500 – $48,500
Heart rhythm study with ablation for atrial fibrillation: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $47,500 CIGNA — ALL PRODUCTS: $48,500 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $16,675 HEALTHNET — ALL PRODUCTS: $48,500 HEALTHNET — MEDICARE ADV.: $15,950 PACIFICSOURCE — MEDICARE ADV.: $16,240 PROVIDENCE — EPO - NON PEBB/OEBB: $48,500 PROVIDENCE — EPO - PEBB/OEBB: $48,500 PROVIDENCE — INDIVIDUAL-STANDARD: $48,500 PROVIDENCE — MA-BEHAVIORAL HEALTH: $14,500
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC POLYSOMINOGRAPHY SLEEP STUDY	$5,360	$4,288	$1,554.40 – $5,199.20
Sleep study (overnight, in a sleep lab): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $5,092 CIGNA — ALL PRODUCTS: $5,199.20 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $1,787.56 HEALTHNET — ALL PRODUCTS: $5,199.20 HEALTHNET — MEDICARE ADV.: $1,709.84 PACIFICSOURCE — MEDICARE ADV.: $1,740.93 PROVIDENCE — EPO - NON PEBB/OEBB: $5,199.20 PROVIDENCE — EPO - PEBB/OEBB: $5,199.20 PROVIDENCE — INDIVIDUAL-STANDARD: $5,199.20 PROVIDENCE — MA-BEHAVIORAL HEALTH: $1,554.40
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PC POLYSOMNOGRAPHY SLEEP STUDY	$382	$305.60	$99.60 – $364.18
Sleep study (overnight, in a sleep lab): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $263.09 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $197.32 AETNA — FAC - MIDLEVEL NP-PA-CNM: $223.63 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $223.63 AETNA — FAC - PSYCHIATRIC NP: $263.09 AETNA — NONFAC - MD-DO: $263.09 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $197.32 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $223.63 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $223.63 AETNA — NONFAC - PSYCHIATRIC NP: $263.09
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier TC In the file: PC POLYSOMNOGRAPHY SLEEP STUDY	$1,397	$1,117.60	$416.14 – $1,540.67
Sleep study (overnight, in a sleep lab): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $1,093.49 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $820.12 AETNA — FAC - MIDLEVEL NP-PA-CNM: $929.46 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $929.46 AETNA — FAC - PSYCHIATRIC NP: $1,093.49 AETNA — NONFAC - MD-DO: $1,093.49 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $820.12 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $929.46 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $929.46 AETNA — NONFAC - PSYCHIATRIC NP: $1,093.49

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) · Doctor (professional) fee In the file: PC THERAPEUTIC EXERCISE	$85	$68	$24.90 – $92.36
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $66.69 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $50.02 AETNA — FAC - MIDLEVEL NP-PA-CNM: $56.69 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $56.69 AETNA — FAC - PSYCHIATRIC NP: $66.69 AETNA — NONFAC - MD-DO: $66.69 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $50.02 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $56.69 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $56.69 AETNA — NONFAC - PSYCHIATRIC NP: $66.69
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC EXERCISE THERAPEUTIC PT	$92	$73.60	$26.68 – $89.24
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $87.40 CIGNA — ALL PRODUCTS: $89.24 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $30.68 HEALTHNET — ALL PRODUCTS: $89.24 HEALTHNET — MEDICARE ADV.: $29.35 PACIFICSOURCE — MEDICARE ADV.: $29.88 PROVIDENCE — EPO - NON PEBB/OEBB: $89.24 PROVIDENCE — EPO - PEBB/OEBB: $89.24 PROVIDENCE — INDIVIDUAL-STANDARD: $89.24 PROVIDENCE — MA-BEHAVIORAL HEALTH: $26.68
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GO In the file: HC EXERCISE THERAPEUTIC OT	$92	$73.60	$26.68 – $89.24
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $87.40 CIGNA — ALL PRODUCTS: $89.24 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $30.68 HEALTHNET — ALL PRODUCTS: $89.24 HEALTHNET — MEDICARE ADV.: $29.35 PACIFICSOURCE — MEDICARE ADV.: $29.88 PROVIDENCE — EPO - NON PEBB/OEBB: $89.24 PROVIDENCE — EPO - PEBB/OEBB: $89.24 PROVIDENCE — INDIVIDUAL-STANDARD: $89.24 PROVIDENCE — MA-BEHAVIORAL HEALTH: $26.68
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC PT EVALUATION LOW COMPLEXITY	$291	$232.80	$83.57 – $314.85
Physical therapy evaluation (low complexity): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $227.19 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $170.39 AETNA — FAC - MIDLEVEL NP-PA-CNM: $193.11 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $193.11 AETNA — FAC - PSYCHIATRIC NP: $227.19 AETNA — NONFAC - MD-DO: $227.19 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $170.39 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $193.11 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $193.11 AETNA — NONFAC - PSYCHIATRIC NP: $227.19
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC PHYSICAL THERAPY EVAL LOW COMPLEXITY	$310	$248	$89.90 – $300.70
Physical therapy evaluation (low complexity): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $294.50 CIGNA — ALL PRODUCTS: $300.70 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $103.39 HEALTHNET — ALL PRODUCTS: $300.70 HEALTHNET — MEDICARE ADV.: $98.89 PACIFICSOURCE — MEDICARE ADV.: $100.69 PROVIDENCE — EPO - NON PEBB/OEBB: $300.70 PROVIDENCE — EPO - PEBB/OEBB: $300.70 PROVIDENCE — INDIVIDUAL-STANDARD: $300.70 PROVIDENCE — MA-BEHAVIORAL HEALTH: $89.90
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC PT EVALUATION MODERATE COMPLEXITY	$291	$232.80	$83.57 – $314.85
Physical therapy evaluation (moderate complexity): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $227.19 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $170.39 AETNA — FAC - MIDLEVEL NP-PA-CNM: $193.11 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $193.11 AETNA — FAC - PSYCHIATRIC NP: $227.19 AETNA — NONFAC - MD-DO: $227.19 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $170.39 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $193.11 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $193.11 AETNA — NONFAC - PSYCHIATRIC NP: $227.19
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC PHYSICAL THERAPY EVAL MODERATE COMPLEXITY	$310	$248	$89.90 – $300.70
Physical therapy evaluation (moderate complexity): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $294.50 CIGNA — ALL PRODUCTS: $300.70 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $103.39 HEALTHNET — ALL PRODUCTS: $300.70 HEALTHNET — MEDICARE ADV.: $98.89 PACIFICSOURCE — MEDICARE ADV.: $100.69 PROVIDENCE — EPO - NON PEBB/OEBB: $300.70 PROVIDENCE — EPO - PEBB/OEBB: $300.70 PROVIDENCE — INDIVIDUAL-STANDARD: $300.70 PROVIDENCE — MA-BEHAVIORAL HEALTH: $89.90
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC PT EVALUATION HIGH COMPLEXITY	$291	$232.80	$83.57 – $314.85
Physical therapy evaluation (high complexity): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $227.19 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $170.39 AETNA — FAC - MIDLEVEL NP-PA-CNM: $193.11 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $193.11 AETNA — FAC - PSYCHIATRIC NP: $227.19 AETNA — NONFAC - MD-DO: $227.19 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $170.39 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $193.11 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $193.11 AETNA — NONFAC - PSYCHIATRIC NP: $227.19
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC PHYSICAL THERAPY EVAL HIGH COMPLEXITY	$310	$248	$89.90 – $300.70
Physical therapy evaluation (high complexity): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $294.50 CIGNA — ALL PRODUCTS: $300.70 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $103.39 HEALTHNET — ALL PRODUCTS: $300.70 HEALTHNET — MEDICARE ADV.: $98.89 PACIFICSOURCE — MEDICARE ADV.: $100.69 PROVIDENCE — EPO - NON PEBB/OEBB: $300.70 PROVIDENCE — EPO - PEBB/OEBB: $300.70 PROVIDENCE — INDIVIDUAL-STANDARD: $300.70 PROVIDENCE — MA-BEHAVIORAL HEALTH: $89.90
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC PSYCHOTHERAPY W PT 30 MINS	$243	$194.40	$56.38 – $234.04
Psychotherapy, 30 minutes: 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $149.85 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $112.39 AETNA — FAC - MIDLEVEL NP-PA-CNM: $127.38 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $127.38 AETNA — FAC - PSYCHIATRIC NP: $149.85 AETNA — NONFAC - MD-DO: $170.04 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $127.53 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $144.54 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $144.54 AETNA — NONFAC - PSYCHIATRIC NP: $170.04
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYCH 30 MIN W PT/FAMILY	$48	$38.40	$13.92 – $46.56
Psychotherapy, 30 minutes: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $45.60 CIGNA — ALL PRODUCTS: $46.56 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $16.01 HEALTHNET — ALL PRODUCTS: $46.56 HEALTHNET — MEDICARE ADV.: $15.31 PACIFICSOURCE — MEDICARE ADV.: $15.59 PROVIDENCE — EPO - NON PEBB/OEBB: $46.56 PROVIDENCE — EPO - PEBB/OEBB: $46.56 PROVIDENCE — INDIVIDUAL-STANDARD: $46.56 PROVIDENCE — MA-BEHAVIORAL HEALTH: $13.92
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX W PT 30 MINS	$200	$160	$58 – $194
Psychotherapy, 30 minutes: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $190 CIGNA — ALL PRODUCTS: $194 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $66.70 HEALTHNET — ALL PRODUCTS: $194 HEALTHNET — MEDICARE ADV.: $63.80 PACIFICSOURCE — MEDICARE ADV.: $64.96 PROVIDENCE — EPO - NON PEBB/OEBB: $194 PROVIDENCE — EPO - PEBB/OEBB: $194 PROVIDENCE — INDIVIDUAL-STANDARD: $194 PROVIDENCE — MA-BEHAVIORAL HEALTH: $58
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC PSYCHOTHERAPY W PT 45 MINS	$321	$256.80	$74.70 – $309.60
Psychotherapy, 45 minutes: 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $198.55 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $148.91 AETNA — FAC - MIDLEVEL NP-PA-CNM: $168.77 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $168.77 AETNA — FAC - PSYCHIATRIC NP: $198.55 AETNA — NONFAC - MD-DO: $224.70 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $168.52 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $190.99 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $190.99 AETNA — NONFAC - PSYCHIATRIC NP: $224.70
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYCH 45 MIN W PT/FAMILY	$64	$51.20	$18.56 – $62.08
Psychotherapy, 45 minutes: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $60.80 CIGNA — ALL PRODUCTS: $62.08 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $21.34 HEALTHNET — ALL PRODUCTS: $62.08 HEALTHNET — MEDICARE ADV.: $20.42 PACIFICSOURCE — MEDICARE ADV.: $20.79 PROVIDENCE — EPO - NON PEBB/OEBB: $62.08 PROVIDENCE — EPO - PEBB/OEBB: $62.08 PROVIDENCE — INDIVIDUAL-STANDARD: $62.08 PROVIDENCE — MA-BEHAVIORAL HEALTH: $18.56
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX W PT 45 MINS	$270	$216	$78.30 – $261.90
Psychotherapy, 45 minutes: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $256.50 CIGNA — ALL PRODUCTS: $261.90 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $90.05 HEALTHNET — ALL PRODUCTS: $261.90 HEALTHNET — MEDICARE ADV.: $86.13 PACIFICSOURCE — MEDICARE ADV.: $87.70 PROVIDENCE — EPO - NON PEBB/OEBB: $261.90 PROVIDENCE — EPO - PEBB/OEBB: $261.90 PROVIDENCE — INDIVIDUAL-STANDARD: $261.90 PROVIDENCE — MA-BEHAVIORAL HEALTH: $78.30
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC PSYCHOTHERAPY W PT 60 MINS	$471	$376.80	$89.97 – $455.48
Psychotherapy, 60 minutes: 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $291.99 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $218.99 AETNA — FAC - MIDLEVEL NP-PA-CNM: $248.19 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $248.19 AETNA — FAC - PSYCHIATRIC NP: $291.99 AETNA — NONFAC - MD-DO: $330.86 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $248.15 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $281.23 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $281.23 AETNA — NONFAC - PSYCHIATRIC NP: $330.86
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYCH 60 MIN W PT/FAMILY	$94	$75.20	$27.26 – $91.18
Psychotherapy, 60 minutes: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $89.30 CIGNA — ALL PRODUCTS: $91.18 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $31.35 HEALTHNET — ALL PRODUCTS: $91.18 HEALTHNET — MEDICARE ADV.: $29.99 PACIFICSOURCE — MEDICARE ADV.: $30.53 PROVIDENCE — EPO - NON PEBB/OEBB: $91.18 PROVIDENCE — EPO - PEBB/OEBB: $91.18 PROVIDENCE — INDIVIDUAL-STANDARD: $91.18 PROVIDENCE — MA-BEHAVIORAL HEALTH: $27.26
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX W PT 60 MINS	$330	$264	$95.70 – $320.10
Psychotherapy, 60 minutes: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $313.50 CIGNA — ALL PRODUCTS: $320.10 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $110.06 HEALTHNET — ALL PRODUCTS: $320.10 HEALTHNET — MEDICARE ADV.: $105.27 PACIFICSOURCE — MEDICARE ADV.: $107.18 PROVIDENCE — EPO - NON PEBB/OEBB: $320.10 PROVIDENCE — EPO - PEBB/OEBB: $320.10 PROVIDENCE — INDIVIDUAL-STANDARD: $320.10 PROVIDENCE — MA-BEHAVIORAL HEALTH: $95.70
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC FAMILY PSYCHOTHERAPY W/O PT 50 MIN	$318	$254.40	$74.24 – $295.96
Family psychotherapy, without the patient: 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $214.38 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $160.78 AETNA — FAC - MIDLEVEL NP-PA-CNM: $182.22 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $182.22 AETNA — FAC - PSYCHIATRIC NP: $214.38 AETNA — NONFAC - MD-DO: $215.11 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $161.33 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $182.84 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $182.84 AETNA — NONFAC - PSYCHIATRIC NP: $215.11
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FAMILY PSYCHOTX / NO PT 15 MIN	$64	$51.20	$18.56 – $62.08
Family psychotherapy, without the patient: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $60.80 CIGNA — ALL PRODUCTS: $62.08 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $21.34 HEALTHNET — ALL PRODUCTS: $62.08 HEALTHNET — MEDICARE ADV.: $20.42 PACIFICSOURCE — MEDICARE ADV.: $20.79 PROVIDENCE — EPO - NON PEBB/OEBB: $62.08 PROVIDENCE — EPO - PEBB/OEBB: $62.08 PROVIDENCE — INDIVIDUAL-STANDARD: $62.08 PROVIDENCE — MA-BEHAVIORAL HEALTH: $18.56
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FAMILY PSYTX WO /PT 50 MIN	$270	$216	$78.30 – $261.90
Family psychotherapy, without the patient: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $256.50 CIGNA — ALL PRODUCTS: $261.90 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $90.05 HEALTHNET — ALL PRODUCTS: $261.90 HEALTHNET — MEDICARE ADV.: $86.13 PACIFICSOURCE — MEDICARE ADV.: $87.70 PROVIDENCE — EPO - NON PEBB/OEBB: $261.90 PROVIDENCE — EPO - PEBB/OEBB: $261.90 PROVIDENCE — INDIVIDUAL-STANDARD: $261.90 PROVIDENCE — MA-BEHAVIORAL HEALTH: $78.30
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC FAMILY PSYCHOTHERAPY W PT 50 MIN	$329	$263.20	$83.57 – $308.55
Family psychotherapy, with the patient: 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $223.60 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $167.70 AETNA — FAC - MIDLEVEL NP-PA-CNM: $190.06 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $190.06 AETNA — FAC - PSYCHIATRIC NP: $223.60 AETNA — NONFAC - MD-DO: $224.36 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $168.27 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $190.70 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $190.70 AETNA — NONFAC - PSYCHIATRIC NP: $224.36
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FAMILY PSYCHOTX W/ PT 15 MIN	$66	$52.80	$19.14 – $64.02
Family psychotherapy, with the patient: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $62.70 CIGNA — ALL PRODUCTS: $64.02 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $22.01 HEALTHNET — ALL PRODUCTS: $64.02 HEALTHNET — MEDICARE ADV.: $21.05 PACIFICSOURCE — MEDICARE ADV.: $21.44 PROVIDENCE — EPO - NON PEBB/OEBB: $64.02 PROVIDENCE — EPO - PEBB/OEBB: $64.02 PROVIDENCE — INDIVIDUAL-STANDARD: $64.02 PROVIDENCE — MA-BEHAVIORAL HEALTH: $19.14
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FAMILY PSYTX W/PT 50 MIN	$270	$216	$78.30 – $261.90
Family psychotherapy, with the patient: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $256.50 CIGNA — ALL PRODUCTS: $261.90 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $90.05 HEALTHNET — ALL PRODUCTS: $261.90 HEALTHNET — MEDICARE ADV.: $86.13 PACIFICSOURCE — MEDICARE ADV.: $87.70 PROVIDENCE — EPO - NON PEBB/OEBB: $261.90 PROVIDENCE — EPO - PEBB/OEBB: $261.90 PROVIDENCE — INDIVIDUAL-STANDARD: $261.90 PROVIDENCE — MA-BEHAVIORAL HEALTH: $78.30
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC GROUP PSYCHOTHERAPY	$86	$68.80	$19.75 – $82.91
Group psychotherapy: 10 of 115 insurance plan rates AETNA — FAC - MD-DO: $52.55 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $39.42 AETNA — FAC - MIDLEVEL NP-PA-CNM: $44.67 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $44.67 AETNA — FAC - PSYCHIATRIC NP: $52.55 AETNA — NONFAC - MD-DO: $60.02 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $45.02 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $51.02 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $51.02 AETNA — NONFAC - PSYCHIATRIC NP: $60.02
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC GROUP PSYCHOTHERAPY	$17	$13.60	$4.93 – $16.49
Group psychotherapy: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $16.15 CIGNA — ALL PRODUCTS: $16.49 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $5.67 HEALTHNET — ALL PRODUCTS: $16.49 HEALTHNET — MEDICARE ADV.: $5.42 PACIFICSOURCE — MEDICARE ADV.: $5.52 PROVIDENCE — EPO - NON PEBB/OEBB: $16.49 PROVIDENCE — EPO - PEBB/OEBB: $16.49 PROVIDENCE — INDIVIDUAL-STANDARD: $16.49 PROVIDENCE — MA-BEHAVIORAL HEALTH: $4.93

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC EXCISE OF CYST BREAST MALE/FEMALE	$1,559	$1,247.20	$352.03 – $1,638.27
Removal of breast growth (open surgery): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $911.13 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $683.35 AETNA — FAC - MIDLEVEL NP-PA-CNM: $774.46 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $774.46 AETNA — FAC - PSYCHIATRIC NP: $911.13 AETNA — NONFAC - MD-DO: $1,140.68 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $855.51 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $969.57 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $969.57 AETNA — NONFAC - PSYCHIATRIC NP: $1,140.68
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EXCISE OF CYST BREAST MALE/FEM	$312	$249.60	$90.48 – $302.64
Removal of breast growth (open surgery): 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $296.40 CIGNA — ALL PRODUCTS: $302.64 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $104.05 HEALTHNET — ALL PRODUCTS: $302.64 HEALTHNET — MEDICARE ADV.: $99.53 PACIFICSOURCE — MEDICARE ADV.: $101.34 PROVIDENCE — EPO - NON PEBB/OEBB: $302.64 PROVIDENCE — EPO - PEBB/OEBB: $302.64 PROVIDENCE — INDIVIDUAL-STANDARD: $302.64 PROVIDENCE — MA-BEHAVIORAL HEALTH: $90.48
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC HIP REPLACEMENT TOTAL	$5,275	$4,220	$1,084.70 – $4,029.03
Total hip replacement: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $2,806.92 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $2,105.19 AETNA — FAC - MIDLEVEL NP-PA-CNM: $2,385.88 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $2,385.88 AETNA — FAC - PSYCHIATRIC NP: $2,806.92 AETNA — NONFAC - MD-DO: $2,806.92 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $2,105.19 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $2,385.88 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $2,385.88 AETNA — NONFAC - PSYCHIATRIC NP: $2,806.92
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC ARTHROPLASTY KNEE CONDYL MED & LAT	$5,270	$4,216	$1,083.27 – $4,024.83
Total knee replacement: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $2,804.20 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $2,103.15 AETNA — FAC - MIDLEVEL NP-PA-CNM: $2,383.57 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $2,383.57 AETNA — FAC - PSYCHIATRIC NP: $2,804.20 AETNA — NONFAC - MD-DO: $2,804.20 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $2,103.15 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $2,383.57 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $2,383.57 AETNA — NONFAC - PSYCHIATRIC NP: $2,804.20
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC ARTHROSCOPY SHLDER DECOMP SUBACRI	$701	$560.80	$146.25 – $536.29
Shoulder arthroscopy: shaving of shoulder bone: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $373.02 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $279.77 AETNA — FAC - MIDLEVEL NP-PA-CNM: $317.07 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $317.07 AETNA — FAC - PSYCHIATRIC NP: $373.02 AETNA — NONFAC - MD-DO: $373.02 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $279.77 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $317.07 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $317.07 AETNA — NONFAC - PSYCHIATRIC NP: $373.02
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC ARTHROSCOPY KNEE W/MENISECT MED OR	$2,255	$1,804	$459.06 – $1,713.83
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $1,199.76 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $899.82 AETNA — FAC - MIDLEVEL NP-PA-CNM: $1,019.80 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $1,019.80 AETNA — FAC - PSYCHIATRIC NP: $1,199.76 AETNA — NONFAC - MD-DO: $1,199.76 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $899.82 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $1,019.80 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $1,019.80 AETNA — NONFAC - PSYCHIATRIC NP: $1,199.76
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC TONSILECTOMY/ADENOID < 12	$1,025	$820	$241.55 – $919.36
Removal of tonsils and adenoids (under age 12): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $648.84 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $486.63 AETNA — FAC - MIDLEVEL NP-PA-CNM: $551.51 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $551.51 AETNA — FAC - PSYCHIATRIC NP: $648.84 AETNA — NONFAC - MD-DO: $648.84 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $486.63 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $551.51 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $551.51 AETNA — NONFAC - PSYCHIATRIC NP: $648.84
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC ESOPHAGOGASTRODUODENOSCOPY DIAGNOSTIC	$1,003	$802.40	$102.17 – $908.87
Upper GI endoscopy (diagnostic): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $267.07 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $200.30 AETNA — FAC - MIDLEVEL NP-PA-CNM: $227.01 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $227.01 AETNA — FAC - PSYCHIATRIC NP: $267.07 AETNA — NONFAC - MD-DO: $645.39 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $484.04 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $548.58 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $548.58 AETNA — NONFAC - PSYCHIATRIC NP: $645.39
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC UPPER GI ENDO W/BIOPSY 1 OR MORE	$1,445	$1,156	$115.05 – $1,190.13
Upper GI endoscopy with biopsy: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $301.37 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $226.03 AETNA — FAC - MIDLEVEL NP-PA-CNM: $256.17 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $256.17 AETNA — FAC - PSYCHIATRIC NP: $301.37 AETNA — NONFAC - MD-DO: $845.67 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $634.26 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $718.82 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $718.82 AETNA — NONFAC - PSYCHIATRIC NP: $845.67
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC UPPER GI ENDO W/BIOPSY 1OR MOR	$290	$232	$84.10 – $281.30
Upper GI endoscopy with biopsy: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $275.50 CIGNA — ALL PRODUCTS: $281.30 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $96.72 HEALTHNET — ALL PRODUCTS: $281.30 HEALTHNET — MEDICARE ADV.: $92.51 PACIFICSOURCE — MEDICARE ADV.: $94.19 PROVIDENCE — EPO - NON PEBB/OEBB: $281.30 PROVIDENCE — EPO - PEBB/OEBB: $281.30 PROVIDENCE — INDIVIDUAL-STANDARD: $281.30 PROVIDENCE — MA-BEHAVIORAL HEALTH: $84.10
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC COLONOSCOPY FIBEROPTIC	$1,445	$1,156	$154.55 – $1,069.44
Colonoscopy (diagnostic): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $401.55 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $301.16 AETNA — FAC - MIDLEVEL NP-PA-CNM: $341.32 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $341.32 AETNA — FAC - PSYCHIATRIC NP: $401.55 AETNA — NONFAC - MD-DO: $758.20 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $568.65 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $644.47 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $644.47 AETNA — NONFAC - PSYCHIATRIC NP: $758.20
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC COLONOSCOPY W/REM TUMORS BY FORCEP	$1,603	$1,282.40	$167.43 – $1,368.55
Colonoscopy with biopsy: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $436.91 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $327.68 AETNA — FAC - MIDLEVEL NP-PA-CNM: $371.37 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $371.37 AETNA — FAC - PSYCHIATRIC NP: $436.91 AETNA — NONFAC - MD-DO: $971.50 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $728.62 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $825.77 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $825.77 AETNA — NONFAC - PSYCHIATRIC NP: $971.50
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC COLONOSCOPY POLYP REMOVAL	$1,603	$1,282.40	$211.50 – $1,428.37
Colonoscopy with removal of polyps (snare): 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $552.98 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $414.73 AETNA — FAC - MIDLEVEL NP-PA-CNM: $470.03 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $470.03 AETNA — FAC - PSYCHIATRIC NP: $552.98 AETNA — NONFAC - MD-DO: $1,013.55 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $760.16 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $861.52 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $861.52 AETNA — NONFAC - PSYCHIATRIC NP: $1,013.55
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC LAPAROSCOPY CHOLECYSTECTOMY	$2,260	$1,808	$559.24 – $2,073.81
Gallbladder removal by laparoscope: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $1,430.24 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $1,072.68 AETNA — FAC - MIDLEVEL NP-PA-CNM: $1,215.70 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $1,215.70 AETNA — FAC - PSYCHIATRIC NP: $1,430.24 AETNA — NONFAC - MD-DO: $1,430.24 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $1,072.68 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $1,215.70 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $1,215.70 AETNA — NONFAC - PSYCHIATRIC NP: $1,430.24
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BIOPSY, PROSTATE, SNGL/MULTI A	$146	$116.80	$42.34 – $141.62
Prostate biopsy: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $138.70 CIGNA — ALL PRODUCTS: $141.62 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $48.69 HEALTHNET — ALL PRODUCTS: $141.62 HEALTHNET — MEDICARE ADV.: $46.57 PACIFICSOURCE — MEDICARE ADV.: $47.42 PROVIDENCE — EPO - NON PEBB/OEBB: $141.62 PROVIDENCE — EPO - PEBB/OEBB: $141.62 PROVIDENCE — INDIVIDUAL-STANDARD: $141.62 PROVIDENCE — MA-BEHAVIORAL HEALTH: $42.34
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC HYSTEROSCOPY W/BIOPSY W OR W/O D&C	$3,224	$2,579.20	$194.04 – $4,250.48
Hysteroscopy with biopsy of the uterus lining: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $505.97 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $379.48 AETNA — FAC - MIDLEVEL NP-PA-CNM: $430.08 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $430.08 AETNA — FAC - PSYCHIATRIC NP: $505.97 AETNA — NONFAC - MD-DO: $3,018.90 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $2,264.17 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $2,566.06 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $2,566.06 AETNA — NONFAC - PSYCHIATRIC NP: $3,018.90
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HB HYSTEROSCOPY BIOPSY W/WO D&C	$763	$610.40	$221.27 – $740.11
Hysteroscopy with biopsy of the uterus lining: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $724.85 CIGNA — ALL PRODUCTS: $740.11 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $254.46 HEALTHNET — ALL PRODUCTS: $740.11 HEALTHNET — MEDICARE ADV.: $243.40 PACIFICSOURCE — MEDICARE ADV.: $247.82 PROVIDENCE — EPO - NON PEBB/OEBB: $740.11 PROVIDENCE — EPO - PEBB/OEBB: $740.11 PROVIDENCE — INDIVIDUAL-STANDARD: $740.11 PROVIDENCE — MA-BEHAVIORAL HEALTH: $221.27
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC NJX INTERLAMINAR LMBR/SAC W GUDIE	$1,154	$923.20	$82.71 – $812.31
Spinal injection, lower back (epidural), with imaging guidance: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $217.80 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $163.35 AETNA — FAC - MIDLEVEL NP-PA-CNM: $185.13 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $185.13 AETNA — FAC - PSYCHIATRIC NP: $217.80 AETNA — NONFAC - MD-DO: $578.17 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $433.63 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $491.45 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $491.45 AETNA — NONFAC - PSYCHIATRIC NP: $578.17
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: HC INJ TRANSFOR EPI L/S BIL SNGL REDUCD	$1,920	$1,536	$556.80 – $1,862.40
Nerve root injection, lower back, with imaging guidance: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $1,824 CIGNA — ALL PRODUCTS: $1,862.40 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $640.32 HEALTHNET — ALL PRODUCTS: $1,862.40 HEALTHNET — MEDICARE ADV.: $612.48 PACIFICSOURCE — MEDICARE ADV.: $623.62 PROVIDENCE — EPO - NON PEBB/OEBB: $1,862.40 PROVIDENCE — EPO - PEBB/OEBB: $1,862.40 PROVIDENCE — INDIVIDUAL-STANDARD: $1,862.40 PROVIDENCE — MA-BEHAVIORAL HEALTH: $556.80
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: HC INJ TRANSFOR EPI L/S SNGL LT	$1,920	$1,536	$556.80 – $1,862.40
Nerve root injection, lower back, with imaging guidance: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $1,824 CIGNA — ALL PRODUCTS: $1,862.40 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $640.32 HEALTHNET — ALL PRODUCTS: $1,862.40 HEALTHNET — MEDICARE ADV.: $612.48 PACIFICSOURCE — MEDICARE ADV.: $623.62 PROVIDENCE — EPO - NON PEBB/OEBB: $1,862.40 PROVIDENCE — EPO - PEBB/OEBB: $1,862.40 PROVIDENCE — INDIVIDUAL-STANDARD: $1,862.40 PROVIDENCE — MA-BEHAVIORAL HEALTH: $556.80
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: HC INJ TRANSFOR EPI L/S SNGLE RT	$1,920	$1,536	$556.80 – $1,862.40
Nerve root injection, lower back, with imaging guidance: 10 of 17 insurance plan rates AETNA — ALL PRODUCTS: $1,824 CIGNA — ALL PRODUCTS: $1,862.40 DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $640.32 HEALTHNET — ALL PRODUCTS: $1,862.40 HEALTHNET — MEDICARE ADV.: $612.48 PACIFICSOURCE — MEDICARE ADV.: $623.62 PROVIDENCE — EPO - NON PEBB/OEBB: $1,862.40 PROVIDENCE — EPO - PEBB/OEBB: $1,862.40 PROVIDENCE — INDIVIDUAL-STANDARD: $1,862.40 PROVIDENCE — MA-BEHAVIORAL HEALTH: $556.80
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC NEUROPLASTY MEDIAL @ CARPAL TUNNEL	$1,860	$1,488	$367.20 – $1,410.53
Carpal tunnel release: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $971.70 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $728.78 AETNA — FAC - MIDLEVEL NP-PA-CNM: $825.95 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $825.95 AETNA — FAC - PSYCHIATRIC NP: $971.70 AETNA — NONFAC - MD-DO: $989.63 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $742.23 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $841.19 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $841.19 AETNA — NONFAC - PSYCHIATRIC NP: $989.63

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC OB NORMAL CARE	$7,086	$5,668.80	$2,010.84 – $7,543.81
Vaginal delivery, with care before and after: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $5,183.97 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $3,887.98 AETNA — FAC - MIDLEVEL NP-PA-CNM: $4,406.38 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $4,406.38 AETNA — FAC - PSYCHIATRIC NP: $5,183.97 AETNA — NONFAC - MD-DO: $5,183.97 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $3,887.98 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $4,406.38 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $4,406.38 AETNA — NONFAC - PSYCHIATRIC NP: $5,183.97
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC OB CARE CESAREAN DELIVERY	$7,797	$6,237.60	$2,220.91 – $8,346.67
Cesarean delivery (C-section), with care before and after: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $5,703.22 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $4,277.41 AETNA — FAC - MIDLEVEL NP-PA-CNM: $4,847.73 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $4,847.73 AETNA — FAC - PSYCHIATRIC NP: $5,703.22 AETNA — NONFAC - MD-DO: $5,703.22 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $4,277.41 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $4,847.73 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $4,847.73 AETNA — NONFAC - PSYCHIATRIC NP: $5,703.22
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PC VBAC W/TOTAL OB CARE	$7,377	$5,901.60	$2,102.14 – $7,901.69
Vaginal delivery after a previous C-section, with care before and after: 10 of 114 insurance plan rates AETNA — FAC - MD-DO: $5,396.73 AETNA — FAC - MIDLEVEL LCSW/LPC/RDN: $4,047.54 AETNA — FAC - MIDLEVEL NP-PA-CNM: $4,587.22 AETNA — FAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $4,587.22 AETNA — FAC - PSYCHIATRIC NP: $5,396.73 AETNA — NONFAC - MD-DO: $5,396.73 AETNA — NONFAC - MIDLEVEL LCSW/LPC/RDN: $4,047.54 AETNA — NONFAC - MIDLEVEL NP-PA-CNM: $4,587.22 AETNA — NONFAC - OPTOMETRISTS - PYSCHOLOGISTS- PT-ST-OT: $4,587.22 AETNA — NONFAC - PSYCHIATRIC NP: $5,396.73

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$4,620
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 9 insurance plans DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $4,620 HEALTHNET — ALL PRODUCTS: $100,181 AETNA — ALL PRODUCTS: 95% (a percentage in the contract, not a dollar amount) CIGNA — ALL PRODUCTS: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — EPO - NON PEBB/OEBB: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — EPO - PEBB/OEBB: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — INDIVIDUAL-STANDARD: 97% (a percentage in the contract, not a dollar amount) REGENCE — ALL PRODUCTS: 96.55% (a percentage in the contract, not a dollar amount) SAMARITAN — SAMARITAN CHOICE: 80% (a percentage in the contract, not a dollar amount)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Major joint replacement or reattachment of lower extremity w/o MCC	Not listed in the file	Not listed in the file	$4,620
Hip or knee replacement (major joint of the leg), without major complications: rates for 9 insurance plans DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $4,620 AETNA — ALL PRODUCTS: 95% (a percentage in the contract, not a dollar amount) CIGNA — ALL PRODUCTS: 97% (a percentage in the contract, not a dollar amount) HEALTHNET — ALL PRODUCTS: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — EPO - NON PEBB/OEBB: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — EPO - PEBB/OEBB: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — INDIVIDUAL-STANDARD: 97% (a percentage in the contract, not a dollar amount) REGENCE — ALL PRODUCTS: 96.55% (a percentage in the contract, not a dollar amount) SAMARITAN — SAMARITAN CHOICE: 80% (a percentage in the contract, not a dollar amount)
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$4,620
Neck (cervical) spinal fusion, without complications: rates for 9 insurance plans DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $4,620 AETNA — ALL PRODUCTS: 95% (a percentage in the contract, not a dollar amount) CIGNA — ALL PRODUCTS: 97% (a percentage in the contract, not a dollar amount) HEALTHNET — ALL PRODUCTS: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — EPO - NON PEBB/OEBB: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — EPO - PEBB/OEBB: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — INDIVIDUAL-STANDARD: 97% (a percentage in the contract, not a dollar amount) REGENCE — ALL PRODUCTS: 96.55% (a percentage in the contract, not a dollar amount) SAMARITAN — SAMARITAN CHOICE: 80% (a percentage in the contract, not a dollar amount)
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$4,620
Uterus and ovary surgery (not for cancer), without complications: rates for 9 insurance plans DEVOTED HEALTH — DEVOTED HEALTH MCR ADVANTAGE: $4,620 AETNA — ALL PRODUCTS: 95% (a percentage in the contract, not a dollar amount) CIGNA — ALL PRODUCTS: 97% (a percentage in the contract, not a dollar amount) HEALTHNET — ALL PRODUCTS: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — EPO - NON PEBB/OEBB: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — EPO - PEBB/OEBB: 97% (a percentage in the contract, not a dollar amount) PROVIDENCE — INDIVIDUAL-STANDARD: 97% (a percentage in the contract, not a dollar amount) REGENCE — ALL PRODUCTS: 96.55% (a percentage in the contract, not a dollar amount) SAMARITAN — SAMARITAN CHOICE: 80% (a percentage in the contract, not a dollar amount)

Source: Samaritan Lebanon Community Hospital’s standard charges file (samaritanhealth.pt.panaceainc.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on January 31, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Critical Access Hospital
Address	525 N Santiam Highway, Lebanon, OR 97355
County	Linn County
State	Oregon
Phone	(541) 258‑2101
Emergency services	Yes
Ownership	Voluntary non-profit - Church
Medicare overall rating	3 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	381323
Name in Medicare records	SAMARITAN LEBANON COMMUNITY HOSPITAL
Profile level	Medicare data + hospital website
Official website	samhealth.org
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

Samaritan Lebanon Community Hospital — samhealth.org
Emergency Care - Samaritan Health Services — samhealth.org
Girod Birth Center (SLCH) - Samaritan Health Services — samhealth.org