Does Tri-City Medical Center have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Tri-City Medical Center. In a medical emergency, call 911.

Where is Tri-City Medical Center?

4002 Vista Way, Oceanside, CA 92056, in San Diego County, California.

What is the phone number of Tri-City Medical Center?

(760) 724-8411, as listed by Medicare (CMS).

What is the Medicare star rating of Tri-City Medical Center?

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

Tri-City Medical Center — Oceanside, CA

Quick answers

Does Tri-City Medical Center have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Tri-City Medical Center. In a medical emergency, call 911.
Where is Tri-City Medical Center?: 4002 Vista Way, Oceanside, CA 92056, in San Diego County, California.
What is the phone number of Tri-City Medical Center?: (760) 724-8411, as listed by Medicare (CMS).
What is the Medicare star rating of Tri-City Medical Center?: 1 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[5][6]

Allergy treatment
Cancer treatment
Emergency services
Endocrinology
Heart and vascular care
Home health care
Intensive care unit
Mental health services
Neuroscience
Nutrition counseling
Orthopedic services
Palliative care
Primary care
Radiology and diagnostic imaging
Rehabilitation services
Spine and back care
Stroke care
Surgical services
Urology
Women's services
Wound care

Programs and centers^[5]

Pulmonary rehabilitation program

Emergency care (hospital website)^[4]

Emergency room	Yes

Visiting and practical information

Parking	Shuttles and golf carts help visitors get to the front of the hospital^[4]
Patient portal	Sharp Tri-City patient portal

Doctors and clinicians (317)

317 doctors and other clinicians list Tri-City Medical Center as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 293 more: the button below opens the full list.

Other emergency rooms nearby

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

Kaiser Foundation Hospital - San Marcos9.0 mi · San Marcos, CA · Acute Care Hospital
Scripps Memorial Hospital - Encinitas11 mi · Encinitas, CA · Acute Care Hospital
Palomar Health Downtown Campus14 mi · Escondido, CA · Acute Care Hospital
NH Camp Pendleton17 mi · Camp Pendleton, CA · Military Hospital (Department of Defense)
Palomar Medical Center Poway20 mi · Poway, CA · Acute Care Hospital

Other hospitals nearby

Palomar Rehabilitation Institute12 mi · Escondido, CA · Inpatient Rehabilitation Hospital
Aurora San Diego19 mi · San Diego, CA · 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

Pacific Villas Post Acute1.0 mi · Oceanside, CA
La Paloma Healthcare Center1.0 mi · Oceanside, CA · 5 of 5 stars
Vista Knoll Specialized Care Facility1.2 mi · Vista, CA · 5 of 5 stars

All nursing homes in the state →

Hospice providers

Dignity Hospice Care Inc2.6 mi · Carlsbad, CA
Shores Hospice LLC3.5 mi · Oceanside, CA
Stand by U Hospice Care Inc3.5 mi · Oceanside, CA

All hospice providers in the state →

Home health agencies

Archer Health Inc4.0 mi · Carlsbad, CA · 5 of 5 stars
Dependable Nursing LLC4.0 mi · Carlsbad, CA · 2 of 5 stars
San Diego Home Health Care Services Inc4.0 mi · Carlsbad, CA · 3 of 5 stars

All home health agencies in the state →

Dialysis facilities

DaVita Oceanside Dialysis0.0 mi · Oceanside, CA · 4 of 5 stars
Fresenius Medical Care North Coast Kidney Center0.0 mi · Oceanside, CA · 4 of 5 stars
USRC Oceanside Dialysis3.5 mi · Oceanside, CA · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

Center for Endoscopy LLC0.0 mi · Oceanside, CA
North Coast Surgery Center0.0 mi · Oceanside, CA
Pacific Surgery Center0.0 mi · Oceanside, CA

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

TrueCare Pacific View Charter School1.1 mi · Oceanside, CA · Community health center
TrueCare Vista Way Health Center Ste 2001.1 mi · Oceanside, CA · Community health center
TrueCare Vista Way Health Center Ste 2021.1 mi · Oceanside, CA · Community health center

Clinics and urgent care

Behzad Baniadam MD Apc0.0 mi · Oceanside, CA · Urgent care center
Access Medical Centers, a Professional Medical Corporation4.0 mi · Carlsbad, CA · Urgent care center
Anaheim Urgent Care, Inc6.4 mi · Carlsbad, CA · Urgent care center

Pharmacies

Albertsons LLC0.0 mi · Oceanside, CA · Community/retail pharmacy
Alpida Pharmaceutical Inc0.0 mi · Oceanside, CA · Community/retail pharmacy
Kaiser Foundation Health Plan Inc0.0 mi · Oceanside, CA · Community/retail pharmacy

Assisted living nearby

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

Aging Gracefully Care of Tri-City0.0 mi · Oceanside, CA
Ana's Elder Care 20.0 mi · Oceanside, CA
Brookdale Oceanside0.0 mi · Oceanside, CA
Everest at Oceanside0.0 mi · Oceanside, CA

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

What patients said (patient survey)

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

Summary star rating (all survey topics)	2 of 5 stars
Overall rating of the hospital	2 of 5 stars
Would recommend the hospital	2 of 5 stars
Nurses communicated well	2 of 5 stars
Doctors communicated well	2 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	2 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Quiet at night	2 of 5 stars
Rated the hospital 9 or 10 out of 10	53%National average: 72%
Would definitely recommend the hospital	52%National average: 71%
Nurses “always” communicated well	71%National average: 80%
Doctors “always” communicated well	72%National average: 80%
Staff “always” explained medicines before giving them	59%National average: 62%
Were given information about recovery at home	83%National average: 86%
Room and bathroom “always” clean	64%National average: 74%
Area around the room “always” quiet at night	39%National average: 60%
Completed surveys	403Response rate: 23%

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)	0.974No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	1.052No different from the national benchmark
Surgical site infections after colon surgery	1.522No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	1.103No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.39Better than 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	13%
Deaths within 30 days: heart failure patients	10.8%
Deaths within 30 days: pneumonia patients	17.1%
Deaths within 30 days: COPD patients	10.1%
Deaths within 30 days: stroke patients	15.6%
Deaths within 30 days: coronary bypass surgery (CABG)	Too few cases to report
Serious complications (patient safety indicator PSI-90)	0.93No different from the national rate
Complications after hip or knee replacement	4.9%

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	15.1%
Readmitted within 30 days: heart failure	21.7%
Readmitted within 30 days: pneumonia	18%
Readmitted within 30 days: COPD	20%
Readmitted within 30 days: coronary bypass surgery	11.9%
Readmitted within 30 days: hip or knee replacement	6.8%

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)	High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	248 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	2%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	86%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 California Best hospitals in California

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 70 common services exactly as Tri-City Medical Center lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99203 OBCH EVAL LVL 3 NEW PATIENT CHARGE	$357.08	$214.25	$71.42 – $281.74
New patient office visit (about 30–44 minutes): 10 of 22 insurance plan rates Aetna — Commercial: $249.96 Aetna — Medicare Advantage: $71.42 Blue Shield of California — Commercial: $212.11 Central Health Plan — Medicare Advantage: $107.12 Cigna — HMO: $264.24 Cigna — PPO: $281.74 Health Net — Blue and Gold: $107.12 Health Net — Bronze Network (SmartCare): $107.12 Health Net — Commercial/Covered California PPO: $208.53 Health Net — Medi-Cal, Healthy Families Healthy Kids: $102.28
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 9920325 LEVEL 3 NEW PT W/TX PROFEE	$357.08	$214.25	$71.42 – $249.96
New patient office visit (about 30–44 minutes): 10 of 20 insurance plan rates Aetna — Commercial: $249.96 Aetna — Medicare Advantage: $71.42 Blue Shield of California — Commercial: $212.11 Central Health Plan — Medicare Advantage: $107.12 Health Net — Blue and Gold: $107.12 Health Net — Bronze Network (SmartCare): $107.12 Health Net — Commercial/Covered California PPO: $208.53 Health Net — Medi-Cal, Healthy Families Healthy Kids: $102.28 Kaiser Permanente — HMO: $124.98 Magellan Health — Commercial/Medicare Advantage: $214.25
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99203 CVHI E&M NEW PT INTERM CHARGE	$357.08	$214.25	$71.42 – $249.96
New patient office visit (about 30–44 minutes): 10 of 20 insurance plan rates Aetna — Commercial: $249.96 Aetna — Medicare Advantage: $71.42 Blue Shield of California — Commercial: $212.11 Central Health Plan — Medicare Advantage: $107.12 Health Net — Blue and Gold: $107.12 Health Net — Bronze Network (SmartCare): $107.12 Health Net — Commercial/Covered California PPO: $208.53 Health Net — Medi-Cal, Healthy Families Healthy Kids: $102.28 Kaiser Permanente — HMO: $124.98 Magellan Health — Commercial/Medicare Advantage: $214.25
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99204 OBCH EVAL LVL 4 NEW PT CHARGE	$412.97	$247.78	$69.59 – $325.83
New patient office visit (about 45–59 minutes): 10 of 22 insurance plan rates Aetna — Commercial: $289.08 Aetna — Medicare Advantage: $82.59 Blue Shield of California — Commercial: $245.30 Central Health Plan — Medicare Advantage: $123.89 Cigna — HMO: $305.60 Cigna — PPO: $325.83 Health Net — Blue and Gold: $123.89 Health Net — Bronze Network (SmartCare): $123.89 Health Net — Commercial/Covered California PPO: $241.17 Health Net — Medi-Cal, Healthy Families Healthy Kids: $69.59
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 9920425 LEVEL 4 NEW PT W/TX PROFEE	$412.97	$247.78	$69.59 – $289.08
New patient office visit (about 45–59 minutes): 10 of 20 insurance plan rates Aetna — Commercial: $289.08 Aetna — Medicare Advantage: $82.59 Blue Shield of California — Commercial: $245.30 Central Health Plan — Medicare Advantage: $123.89 Health Net — Blue and Gold: $123.89 Health Net — Bronze Network (SmartCare): $123.89 Health Net — Commercial/Covered California PPO: $241.17 Health Net — Medi-Cal, Healthy Families Healthy Kids: $69.59 Kaiser Permanente — HMO: $144.54 Magellan Health — Commercial/Medicare Advantage: $247.78
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99204 NEW PATIENT EXTENDED CHARGE	$412.97	$247.78	$69.59 – $289.08
New patient office visit (about 45–59 minutes): 10 of 20 insurance plan rates Aetna — Commercial: $289.08 Aetna — Medicare Advantage: $82.59 Blue Shield of California — Commercial: $245.30 Central Health Plan — Medicare Advantage: $123.89 Health Net — Blue and Gold: $123.89 Health Net — Bronze Network (SmartCare): $123.89 Health Net — Commercial/Covered California PPO: $241.17 Health Net — Medi-Cal, Healthy Families Healthy Kids: $69.59 Kaiser Permanente — HMO: $144.54 Magellan Health — Commercial/Medicare Advantage: $247.78
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99205 OBCH EVAL LVL 5 NEW PT CHARGE	$433.67	$260.20	$86.73 – $342.17
New patient office visit (about 60–74 minutes): 10 of 22 insurance plan rates Aetna — Commercial: $303.57 Aetna — Medicare Advantage: $86.73 Blue Shield of California — Commercial: $257.60 Central Health Plan — Medicare Advantage: $130.10 Cigna — HMO: $320.92 Cigna — PPO: $342.17 Health Net — Blue and Gold: $130.10 Health Net — Bronze Network (SmartCare): $130.10 Health Net — Commercial/Covered California PPO: $253.26 Health Net — Medi-Cal, Healthy Families Healthy Kids: $199.96
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 9920525 LEVEL 5 NEW PT W/TX PROFEE	$433.67	$260.20	$86.73 – $303.57
New patient office visit (about 60–74 minutes): 10 of 20 insurance plan rates Aetna — Commercial: $303.57 Aetna — Medicare Advantage: $86.73 Blue Shield of California — Commercial: $257.60 Central Health Plan — Medicare Advantage: $130.10 Health Net — Blue and Gold: $130.10 Health Net — Bronze Network (SmartCare): $130.10 Health Net — Commercial/Covered California PPO: $253.26 Health Net — Medi-Cal, Healthy Families Healthy Kids: $199.96 Kaiser Permanente — HMO: $151.78 Magellan Health — Commercial/Medicare Advantage: $260.20
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 9920525 LEVEL 5 NEW PT W/TX PROFEE	$433.67	$260.20	$303.57 – $337.83
New patient office visit (about 60–74 minutes): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $337.83 Multiplan — PPO: $303.57
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99213 OBCH EVAL LVL 3 ESTAB PT CHARGE	$357.08	$214.25	$24.24 – $281.74
Established patient office visit (about 20–29 minutes): 10 of 22 insurance plan rates Aetna — Commercial: $249.96 Aetna — Medicare Advantage: $71.42 Blue Shield of California — Commercial: $212.11 Central Health Plan — Medicare Advantage: $107.12 Cigna — HMO: $264.24 Cigna — PPO: $281.74 Health Net — Blue and Gold: $107.12 Health Net — Bronze Network (SmartCare): $107.12 Health Net — Commercial/Covered California PPO: $208.53 Health Net — Medi-Cal, Healthy Families Healthy Kids: $24.24
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99213 NON COPD INITIAL EVAL CHARGE	$65.21	$39.13	$13.04 – $51.45
Established patient office visit (about 20–29 minutes): 10 of 22 insurance plan rates Aetna — Commercial: $45.65 Aetna — Medicare Advantage: $13.04 Blue Shield of California — Commercial: $38.73 Central Health Plan — Medicare Advantage: $19.56 Cigna — HMO: $48.26 Cigna — PPO: $51.45 Health Net — Blue and Gold: $19.56 Health Net — Bronze Network (SmartCare): $19.56 Health Net — Commercial/Covered California PPO: $38.08 Health Net — Medi-Cal, Healthy Families Healthy Kids: $24.24
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99213 CVHI E&M ESTAB PT INTERM CHARGE	$357.08	$214.25	$24.24 – $249.96
Established patient office visit (about 20–29 minutes): 10 of 20 insurance plan rates Aetna — Commercial: $249.96 Aetna — Medicare Advantage: $71.42 Blue Shield of California — Commercial: $212.11 Central Health Plan — Medicare Advantage: $107.12 Health Net — Blue and Gold: $107.12 Health Net — Bronze Network (SmartCare): $107.12 Health Net — Commercial/Covered California PPO: $208.53 Health Net — Medi-Cal, Healthy Families Healthy Kids: $24.24 Kaiser Permanente — HMO: $124.98 Magellan Health — Commercial/Medicare Advantage: $214.25
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99214 OBCH EVAL LVL 4 ESTAB PT CHARGE	$412.97	$247.78	$37.88 – $325.83
Established patient office visit (about 30–39 minutes): 10 of 22 insurance plan rates Aetna — Commercial: $289.08 Aetna — Medicare Advantage: $82.59 Blue Shield of California — Commercial: $245.30 Central Health Plan — Medicare Advantage: $123.89 Cigna — HMO: $305.60 Cigna — PPO: $325.83 Health Net — Blue and Gold: $123.89 Health Net — Bronze Network (SmartCare): $123.89 Health Net — Commercial/Covered California PPO: $241.17 Health Net — Medi-Cal, Healthy Families Healthy Kids: $37.88
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CITY IR E&M ESTABLISHED PT EXTENDED	$412.97	$247.78	$37.88 – $289.08
Established patient office visit (about 30–39 minutes): 10 of 20 insurance plan rates Aetna — Commercial: $289.08 Aetna — Medicare Advantage: $82.59 Blue Shield of California — Commercial: $245.30 Central Health Plan — Medicare Advantage: $123.89 Health Net — Blue and Gold: $123.89 Health Net — Bronze Network (SmartCare): $123.89 Health Net — Commercial/Covered California PPO: $241.17 Health Net — Medi-Cal, Healthy Families Healthy Kids: $37.88 Kaiser Permanente — HMO: $144.54 Magellan Health — Commercial/Medicare Advantage: $247.78
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99214 OBCH EVAL LVL 4 ESTAB PT CHARGE	$412.97	$247.78	$289.08 – $321.70
Established patient office visit (about 30–39 minutes): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $321.70 Multiplan — PPO: $289.08
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99386 Initial Comp Preventive Med 40 to 64 years New	$450.23	$270.14	$90.05 – $355.23
Preventive checkup, new patient, age 40–64: 10 of 23 insurance plan rates Aetna — Commercial: $315.16 Aetna — Medicare Advantage: $90.05 Blue Shield of California — Commercial: $267.44 Blue Shield of California — Covered California: $143.62 Central Health Plan — Medicare Advantage: $135.07 Cigna — HMO: $333.17 Cigna — PPO: $355.23 Health Net — Blue and Gold: $135.07 Health Net — Bronze Network (SmartCare): $135.07 Health Net — Commercial/Covered California PPO: $262.93
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99386 Initial Comp Preventive Med 40 to 64 years New	$450.23	$270.14	$315.16 – $350.73
Preventive checkup, new patient, age 40–64: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $350.73 Multiplan — PPO: $315.16
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99283 - Level 3	$2,380.50	$1,428.30	$72.25 – $3,004
Emergency room visit (moderate): 10 of 38 insurance plan rates Aetna — Commercial: $3,004 Aetna — Medicare Advantage: $351.09 Anthem — Medicare Advantage: $351.09 Blue Shield of California — Commercial: $1,414.02 Blue Shield of California — Covered California: $249.53 Blue Shield of California — Medicare Advantage: $351.09 Central Health Plan — Medicare Advantage: $351.09 Cigna — HMO: $1,761.57 Cigna — PPO: $1,878.21 Clever Care of California — Medicare Advantage: $1,190.25
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99283 ER LEVEL 3 VISIT TechFee	$2,300	$1,380	$72.25 – $3,004
Emergency room visit (moderate): 10 of 38 insurance plan rates Aetna — Commercial: $3,004 Aetna — Medicare Advantage: $351.09 Anthem — Medicare Advantage: $351.09 Blue Shield of California — Commercial: $1,366.20 Blue Shield of California — Covered California: $249.53 Blue Shield of California — Medicare Advantage: $351.09 Central Health Plan — Medicare Advantage: $351.09 Cigna — HMO: $1,702 Cigna — PPO: $1,814.70 Clever Care of California — Medicare Advantage: $1,150
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99283 - Level 3	$2,380.50	$1,428.30	$1,666.35 – $1,854.41
Emergency room visit (moderate): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $1,854.41 Multiplan — PPO: $1,666.35
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99284 - Level 4	$4,140	$2,484	$87.20 – $3,266.46
Emergency room visit (moderately high): 10 of 38 insurance plan rates Aetna — Commercial: $3,004 Aetna — Medicare Advantage: $536.67 Anthem — Medicare Advantage: $536.67 Blue Shield of California — Commercial: $2,459.16 Blue Shield of California — Covered California: $401.32 Blue Shield of California — Medicare Advantage: $536.67 Central Health Plan — Medicare Advantage: $536.67 Cigna — HMO: $3,063.60 Cigna — PPO: $3,266.46 Clever Care of California — Medicare Advantage: $2,070
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99284 ER LEVEL 4 VISIT TechFee	$4,000	$2,400	$87.20 – $3,156
Emergency room visit (moderately high): 10 of 38 insurance plan rates Aetna — Commercial: $3,004 Aetna — Medicare Advantage: $536.67 Anthem — Medicare Advantage: $536.67 Blue Shield of California — Commercial: $2,376 Blue Shield of California — Covered California: $401.32 Blue Shield of California — Medicare Advantage: $536.67 Central Health Plan — Medicare Advantage: $536.67 Cigna — HMO: $2,960 Cigna — PPO: $3,156 Clever Care of California — Medicare Advantage: $2,000
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99284 - Level 4	$4,140	$2,484	$2,898 – $3,225.06
Emergency room visit (moderately high): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $3,225.06 Multiplan — PPO: $2,898
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99285 - Level 5	$5,951.25	$3,570.75	$175.09 – $4,695.54
Emergency room visit (high): 10 of 38 insurance plan rates Aetna — Commercial: $3,004 Aetna — Medicare Advantage: $765.95 Anthem — Medicare Advantage: $765.95 Blue Shield of California — Commercial: $3,535.04 Blue Shield of California — Covered California: $592.94 Blue Shield of California — Medicare Advantage: $765.95 Central Health Plan — Medicare Advantage: $765.95 Cigna — HMO: $4,403.93 Cigna — PPO: $4,695.54 Clever Care of California — Medicare Advantage: $2,975.62
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99285 ER VISIT LEVEL 5 TechFee	$5,750	$3,450	$175.09 – $4,536.75
Emergency room visit (high): 10 of 38 insurance plan rates Aetna — Commercial: $3,004 Aetna — Medicare Advantage: $765.95 Anthem — Medicare Advantage: $765.95 Blue Shield of California — Commercial: $3,415.50 Blue Shield of California — Covered California: $592.94 Blue Shield of California — Medicare Advantage: $765.95 Central Health Plan — Medicare Advantage: $765.95 Cigna — HMO: $4,255 Cigna — PPO: $4,536.75 Clever Care of California — Medicare Advantage: $2,875
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99285 - Level 5	$5,951.25	$3,570.75	$4,165.88 – $4,636.02
Emergency room visit (high): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $4,636.02 Multiplan — PPO: $4,165.88

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic Metabolic Panel (8) LC	$4.14	$2.48	$2.42 – $19.67
Basic metabolic panel (blood test): 10 of 37 insurance plan rates Aetna — Commercial: $2.90 Aetna — Medicare Advantage: $8.46 Anthem — Medicare Advantage: $8.46 Astiva Health — Medicare Advantage: $9.31 Blue Shield of California — Commercial: $2.46 Blue Shield of California — Covered California: $19.67 Blue Shield of California — Medicare Advantage: $8.46 Bright Health — Commercial/Covered California: $13.54 Central Health Plan — Medicare Advantage: $8.46 Cigna — HMO: $3.06
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BMP7+Anion Gap LC	$4.14	$2.48	$2.42 – $19.67
Basic metabolic panel (blood test): 10 of 37 insurance plan rates Aetna — Commercial: $2.90 Aetna — Medicare Advantage: $8.46 Anthem — Medicare Advantage: $8.46 Astiva Health — Medicare Advantage: $9.31 Blue Shield of California — Commercial: $2.46 Blue Shield of California — Covered California: $19.67 Blue Shield of California — Medicare Advantage: $8.46 Bright Health — Commercial/Covered California: $13.54 Central Health Plan — Medicare Advantage: $8.46 Cigna — HMO: $3.06
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic Metabolic Panel	$397.44	$238.46	$7.34 – $313.58
Basic metabolic panel (blood test): 10 of 37 insurance plan rates Aetna — Commercial: $278.21 Aetna — Medicare Advantage: $8.46 Anthem — Medicare Advantage: $8.46 Astiva Health — Medicare Advantage: $9.31 Blue Shield of California — Commercial: $236.08 Blue Shield of California — Covered California: $19.67 Blue Shield of California — Medicare Advantage: $8.46 Bright Health — Commercial/Covered California: $13.54 Central Health Plan — Medicare Advantage: $8.46 Cigna — HMO: $294.11
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comp. Metabolic Panel (14) LC	$4.14	$2.48	$2.42 – $24.58
Comprehensive metabolic panel (blood test): 10 of 37 insurance plan rates Aetna — Commercial: $2.90 Aetna — Medicare Advantage: $10.56 Anthem — Medicare Advantage: $10.56 Astiva Health — Medicare Advantage: $11.62 Blue Shield of California — Commercial: $2.46 Blue Shield of California — Covered California: $24.58 Blue Shield of California — Medicare Advantage: $10.56 Bright Health — Commercial/Covered California: $16.90 Central Health Plan — Medicare Advantage: $10.56 Cigna — HMO: $3.06
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$397.44	$238.46	$9.24 – $313.58
Comprehensive metabolic panel (blood test): 10 of 37 insurance plan rates Aetna — Commercial: $278.21 Aetna — Medicare Advantage: $10.56 Anthem — Medicare Advantage: $10.56 Astiva Health — Medicare Advantage: $11.62 Blue Shield of California — Commercial: $236.08 Blue Shield of California — Covered California: $24.58 Blue Shield of California — Medicare Advantage: $10.56 Bright Health — Commercial/Covered California: $16.90 Central Health Plan — Medicare Advantage: $10.56 Cigna — HMO: $294.11
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Comp. Metabolic Panel (14) LC	$4.14	$2.48	$2.90 – $3.23
Comprehensive metabolic panel (blood test): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $3.23 Multiplan — PPO: $2.90
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel LC	$4.14	$2.48	$2.42 – $31.15
Cholesterol panel (lipid panel): 10 of 37 insurance plan rates Aetna — Commercial: $2.90 Aetna — Medicare Advantage: $13.39 Anthem — Medicare Advantage: $13.39 Astiva Health — Medicare Advantage: $14.73 Blue Shield of California — Commercial: $2.46 Blue Shield of California — Covered California: $31.15 Blue Shield of California — Medicare Advantage: $13.39 Bright Health — Commercial/Covered California: $21.42 Central Health Plan — Medicare Advantage: $13.39 Cigna — HMO: $3.06
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Pnl	$311.54	$186.92	$11.66 – $245.81
Cholesterol panel (lipid panel): 10 of 37 insurance plan rates Aetna — Commercial: $218.08 Aetna — Medicare Advantage: $13.39 Anthem — Medicare Advantage: $13.39 Astiva Health — Medicare Advantage: $14.73 Blue Shield of California — Commercial: $185.05 Blue Shield of California — Covered California: $31.15 Blue Shield of California — Medicare Advantage: $13.39 Bright Health — Commercial/Covered California: $21.42 Central Health Plan — Medicare Advantage: $13.39 Cigna — HMO: $230.54
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel with Direct LDL	$311.54	$186.92	$11.66 – $245.81
Cholesterol panel (lipid panel): 10 of 37 insurance plan rates Aetna — Commercial: $218.08 Aetna — Medicare Advantage: $13.39 Anthem — Medicare Advantage: $13.39 Astiva Health — Medicare Advantage: $14.73 Blue Shield of California — Commercial: $185.05 Blue Shield of California — Covered California: $31.15 Blue Shield of California — Medicare Advantage: $13.39 Bright Health — Commercial/Covered California: $21.42 Central Health Plan — Medicare Advantage: $13.39 Cigna — HMO: $230.54
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Panel (10) LC	$4.14	$2.48	$2.42 – $20.20
Kidney function panel: 10 of 37 insurance plan rates Aetna — Commercial: $2.90 Aetna — Medicare Advantage: $8.68 Anthem — Medicare Advantage: $8.68 Astiva Health — Medicare Advantage: $9.55 Blue Shield of California — Commercial: $2.46 Blue Shield of California — Covered California: $20.20 Blue Shield of California — Medicare Advantage: $8.68 Bright Health — Commercial/Covered California: $13.89 Central Health Plan — Medicare Advantage: $8.68 Cigna — HMO: $3.06
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel	$397.44	$238.46	$7.59 – $313.58
Kidney function panel: 10 of 37 insurance plan rates Aetna — Commercial: $278.21 Aetna — Medicare Advantage: $8.68 Anthem — Medicare Advantage: $8.68 Astiva Health — Medicare Advantage: $9.55 Blue Shield of California — Commercial: $236.08 Blue Shield of California — Covered California: $20.20 Blue Shield of California — Medicare Advantage: $8.68 Bright Health — Commercial/Covered California: $13.89 Central Health Plan — Medicare Advantage: $8.68 Cigna — HMO: $294.11
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Renal Panel (10) LC	$4.14	$2.48	$2.90 – $3.23
Kidney function panel: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $3.23 Multiplan — PPO: $2.90
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel (7) LC	$4.14	$2.48	$2.42 – $19
Liver function panel: 10 of 37 insurance plan rates Aetna — Commercial: $2.90 Aetna — Medicare Advantage: $8.17 Anthem — Medicare Advantage: $8.17 Astiva Health — Medicare Advantage: $8.99 Blue Shield of California — Commercial: $2.46 Blue Shield of California — Covered California: $19 Blue Shield of California — Medicare Advantage: $8.17 Bright Health — Commercial/Covered California: $13.07 Central Health Plan — Medicare Advantage: $8.17 Cigna — HMO: $3.06
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$397.44	$238.46	$6.44 – $313.58
Liver function panel: 10 of 37 insurance plan rates Aetna — Commercial: $278.21 Aetna — Medicare Advantage: $8.17 Anthem — Medicare Advantage: $8.17 Astiva Health — Medicare Advantage: $8.99 Blue Shield of California — Commercial: $236.08 Blue Shield of California — Covered California: $19 Blue Shield of California — Medicare Advantage: $8.17 Bright Health — Commercial/Covered California: $13.07 Central Health Plan — Medicare Advantage: $8.17 Cigna — HMO: $294.11
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Hepatic Function Panel (7) LC	$4.14	$2.48	$2.90 – $3.23
Liver function panel: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $3.23 Multiplan — PPO: $2.90
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 81001	$100.40	$60.24	$2.77 – $79.22
Urine test (automated, with microscope): 10 of 37 insurance plan rates Aetna — Commercial: $70.28 Aetna — Medicare Advantage: $3.17 Anthem — Medicare Advantage: $3.17 Astiva Health — Medicare Advantage: $3.49 Blue Shield of California — Commercial: $59.64 Blue Shield of California — Covered California: $7.36 Blue Shield of California — Medicare Advantage: $3.17 Bright Health — Commercial/Covered California: $5.07 Central Health Plan — Medicare Advantage: $3.17 Cigna — HMO: $74.30
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 81001	$100.40	$60.24	$70.28 – $78.21
Urine test (automated, with microscope): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $78.21 Multiplan — PPO: $70.28
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis (POCT)	$161.46	$96.88	$1.97 – $127.39
Urine test (automated, without microscope): 10 of 37 insurance plan rates Aetna — Commercial: $113.02 Aetna — Medicare Advantage: $2.25 Anthem — Medicare Advantage: $2.25 Astiva Health — Medicare Advantage: $2.48 Blue Shield of California — Commercial: $95.91 Blue Shield of California — Covered California: $5.22 Blue Shield of California — Medicare Advantage: $2.25 Bright Health — Commercial/Covered California: $3.60 Central Health Plan — Medicare Advantage: $2.25 Cigna — HMO: $119.48
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Clinitek Status POC Testing	$178.02	$106.81	$1.97 – $140.46
Urine test (automated, without microscope): 10 of 37 insurance plan rates Aetna — Commercial: $124.61 Aetna — Medicare Advantage: $2.25 Anthem — Medicare Advantage: $2.25 Astiva Health — Medicare Advantage: $2.48 Blue Shield of California — Commercial: $105.74 Blue Shield of California — Covered California: $5.22 Blue Shield of California — Medicare Advantage: $2.25 Bright Health — Commercial/Covered California: $3.60 Central Health Plan — Medicare Advantage: $2.25 Cigna — HMO: $131.73
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Urinalysis (POCT)	$161.46	$96.88	$113.02 – $125.78
Urine test (automated, without microscope): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $125.78 Multiplan — PPO: $113.02
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prostate-Specific Ag LC	$7.25	$4.35	$4.23 – $42.79
PSA (prostate specific antigen) blood test: 10 of 37 insurance plan rates Aetna — Commercial: $5.08 Aetna — Medicare Advantage: $18.39 Anthem — Medicare Advantage: $18.39 Astiva Health — Medicare Advantage: $20.23 Blue Shield of California — Commercial: $4.31 Blue Shield of California — Covered California: $42.79 Blue Shield of California — Medicare Advantage: $18.39 Bright Health — Commercial/Covered California: $29.42 Central Health Plan — Medicare Advantage: $18.39 Cigna — HMO: $5.37
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prostate Specific Antigen Total	$317.75	$190.65	$16.09 – $250.70
PSA (prostate specific antigen) blood test: 10 of 37 insurance plan rates Aetna — Commercial: $222.43 Aetna — Medicare Advantage: $18.39 Anthem — Medicare Advantage: $18.39 Astiva Health — Medicare Advantage: $20.23 Blue Shield of California — Commercial: $188.74 Blue Shield of California — Covered California: $42.79 Blue Shield of California — Medicare Advantage: $18.39 Bright Health — Commercial/Covered California: $29.42 Central Health Plan — Medicare Advantage: $18.39 Cigna — HMO: $235.13
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Prostate-Specific Ag LC	$7.25	$4.35	$5.08 – $5.65
PSA (prostate specific antigen) blood test: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $5.65 Multiplan — PPO: $5.08
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH LC	$5.18	$3.11	$3.03 – $39.08
Thyroid stimulating hormone (TSH) test: 10 of 37 insurance plan rates Aetna — Commercial: $3.63 Aetna — Medicare Advantage: $16.80 Anthem — Medicare Advantage: $16.80 Astiva Health — Medicare Advantage: $18.48 Blue Shield of California — Commercial: $3.08 Blue Shield of California — Covered California: $39.08 Blue Shield of California — Medicare Advantage: $16.80 Bright Health — Commercial/Covered California: $26.88 Central Health Plan — Medicare Advantage: $16.80 Cigna — HMO: $3.83
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thyroid Stimulating Hormone	$41.40	$24.84	$14.70 – $39.08
Thyroid stimulating hormone (TSH) test: 10 of 37 insurance plan rates Aetna — Commercial: $28.98 Aetna — Medicare Advantage: $16.80 Anthem — Medicare Advantage: $16.80 Astiva Health — Medicare Advantage: $18.48 Blue Shield of California — Commercial: $24.59 Blue Shield of California — Covered California: $39.08 Blue Shield of California — Medicare Advantage: $16.80 Bright Health — Commercial/Covered California: $26.88 Central Health Plan — Medicare Advantage: $16.80 Cigna — HMO: $30.64
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: TSH LC	$5.18	$3.11	$3.63 – $4.04
Thyroid stimulating hormone (TSH) test: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $4.04 Multiplan — PPO: $3.63
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC w/ Differential/Platelet LC	$4.14	$2.48	$2.42 – $18.09
Complete blood count (CBC) with differential: 10 of 37 insurance plan rates Aetna — Commercial: $2.90 Aetna — Medicare Advantage: $7.77 Anthem — Medicare Advantage: $7.77 Astiva Health — Medicare Advantage: $8.55 Blue Shield of California — Commercial: $2.46 Blue Shield of California — Covered California: $18.09 Blue Shield of California — Medicare Advantage: $7.77 Bright Health — Commercial/Covered California: $12.43 Central Health Plan — Medicare Advantage: $7.77 Cigna — HMO: $3.06
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC w/ Differential	$192.51	$115.51	$6.80 – $151.89
Complete blood count (CBC) with differential: 10 of 37 insurance plan rates Aetna — Commercial: $134.76 Aetna — Medicare Advantage: $7.77 Anthem — Medicare Advantage: $7.77 Astiva Health — Medicare Advantage: $8.55 Blue Shield of California — Commercial: $114.35 Blue Shield of California — Covered California: $18.09 Blue Shield of California — Medicare Advantage: $7.77 Bright Health — Commercial/Covered California: $12.43 Central Health Plan — Medicare Advantage: $7.77 Cigna — HMO: $142.46
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC w/ Differential/Platelet LC	$4.14	$2.48	$2.90 – $3.23
Complete blood count (CBC) with differential: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $3.23 Multiplan — PPO: $2.90
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC, Platelet; No Differential LC	$4.14	$2.48	$2.42 – $15.06
Complete blood count (CBC), automated: 10 of 37 insurance plan rates Aetna — Commercial: $2.90 Aetna — Medicare Advantage: $6.47 Anthem — Medicare Advantage: $6.47 Astiva Health — Medicare Advantage: $7.12 Blue Shield of California — Commercial: $2.46 Blue Shield of California — Covered California: $15.06 Blue Shield of California — Medicare Advantage: $6.47 Bright Health — Commercial/Covered California: $10.35 Central Health Plan — Medicare Advantage: $6.47 Cigna — HMO: $3.06
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC without Differential	$154.22	$92.53	$5.66 – $121.68
Complete blood count (CBC), automated: 10 of 37 insurance plan rates Aetna — Commercial: $107.95 Aetna — Medicare Advantage: $6.47 Anthem — Medicare Advantage: $6.47 Astiva Health — Medicare Advantage: $7.12 Blue Shield of California — Commercial: $91.61 Blue Shield of California — Covered California: $15.06 Blue Shield of California — Medicare Advantage: $6.47 Bright Health — Commercial/Covered California: $10.35 Central Health Plan — Medicare Advantage: $6.47 Cigna — HMO: $114.12
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC, Platelet; No Differential LC	$4.14	$2.48	$2.90 – $3.23
Complete blood count (CBC), automated: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $3.23 Multiplan — PPO: $2.90
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time (PT) LC	$3.11	$1.87	$1.82 – $9.13
Blood clotting time test (prothrombin time, PT): 10 of 37 insurance plan rates Aetna — Commercial: $2.18 Aetna — Medicare Advantage: $4.29 Anthem — Medicare Advantage: $4.29 Astiva Health — Medicare Advantage: $4.72 Blue Shield of California — Commercial: $1.85 Blue Shield of California — Covered California: $9.13 Blue Shield of California — Medicare Advantage: $4.29 Bright Health — Commercial/Covered California: $6.86 Central Health Plan — Medicare Advantage: $4.29 Cigna — HMO: $2.30
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time and INR	$165.60	$99.36	$3.52 – $130.66
Blood clotting time test (prothrombin time, PT): 10 of 37 insurance plan rates Aetna — Commercial: $115.92 Aetna — Medicare Advantage: $4.29 Anthem — Medicare Advantage: $4.29 Astiva Health — Medicare Advantage: $4.72 Blue Shield of California — Commercial: $98.37 Blue Shield of California — Covered California: $9.13 Blue Shield of California — Medicare Advantage: $4.29 Bright Health — Commercial/Covered California: $6.86 Central Health Plan — Medicare Advantage: $4.29 Cigna — HMO: $122.54
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Prothrombin Time (PT) LC	$3.11	$1.87	$2.18 – $2.42
Blood clotting time test (prothrombin time, PT): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $2.42 Multiplan — PPO: $2.18
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PTT LC	$4.14	$2.48	$2.42 – $13.96
Blood clotting test (partial thromboplastin time, PTT): 10 of 37 insurance plan rates Aetna — Commercial: $2.90 Aetna — Medicare Advantage: $6.01 Anthem — Medicare Advantage: $6.01 Astiva Health — Medicare Advantage: $6.61 Blue Shield of California — Commercial: $2.46 Blue Shield of California — Covered California: $13.96 Blue Shield of California — Medicare Advantage: $6.01 Bright Health — Commercial/Covered California: $9.62 Central Health Plan — Medicare Advantage: $6.01 Cigna — HMO: $3.06
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Partial Thromboplastin Time	$211.14	$126.68	$5.26 – $166.59
Blood clotting test (partial thromboplastin time, PTT): 10 of 37 insurance plan rates Aetna — Commercial: $147.80 Aetna — Medicare Advantage: $6.01 Anthem — Medicare Advantage: $6.01 Astiva Health — Medicare Advantage: $6.61 Blue Shield of California — Commercial: $125.42 Blue Shield of California — Covered California: $13.96 Blue Shield of California — Medicare Advantage: $6.01 Bright Health — Commercial/Covered California: $9.62 Central Health Plan — Medicare Advantage: $6.01 Cigna — HMO: $156.24
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Activated PTT	$211.14	$126.68	$5.26 – $166.59
Blood clotting test (partial thromboplastin time, PTT): 10 of 37 insurance plan rates Aetna — Commercial: $147.80 Aetna — Medicare Advantage: $6.01 Anthem — Medicare Advantage: $6.01 Astiva Health — Medicare Advantage: $6.61 Blue Shield of California — Commercial: $125.42 Blue Shield of California — Covered California: $13.96 Blue Shield of California — Medicare Advantage: $6.01 Bright Health — Commercial/Covered California: $9.62 Central Health Plan — Medicare Advantage: $6.01 Cigna — HMO: $156.24

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 · modifier TC In the file: CT Brain/Head w/o Contrast	$3,436.20	$2,061.72	$102.28 – $2,711.16
CT scan of the head or brain, without contrast: 10 of 25 insurance plan rates Aetna — Commercial: $2,303 Aetna — Medicare Advantage: $687.24 Blue Shield of California — Commercial: $2,041.10 Blue Shield of California — Covered California: $351.95 Central Health Plan — Medicare Advantage: $1,030.86 Cigna — HMO: $2,542.79 Cigna — PPO: $2,711.16 Health Net — Blue and Gold: $1,030.86 Health Net — Bronze Network (SmartCare): $1,030.86 Health Net — Commercial/Covered California PPO: $2,006.74
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT Brain/Head Stroke Alert	$3,436.20	$2,061.72	$102.28 – $2,711.16
CT scan of the head or brain, without contrast: 10 of 25 insurance plan rates Aetna — Commercial: $2,303 Aetna — Medicare Advantage: $687.24 Blue Shield of California — Commercial: $2,041.10 Blue Shield of California — Covered California: $351.95 Central Health Plan — Medicare Advantage: $1,030.86 Cigna — HMO: $2,542.79 Cigna — PPO: $2,711.16 Health Net — Blue and Gold: $1,030.86 Health Net — Bronze Network (SmartCare): $1,030.86 Health Net — Commercial/Covered California PPO: $2,006.74
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: CT Brain/Head w/o Contrast	$3,436.20	$2,061.72	$2,405.34 – $2,676.80
CT scan of the head or brain, without contrast: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $2,676.80 Multiplan — PPO: $2,405.34
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI Brain w/ + w/o Contrast	$4,014.77	$2,408.86	$314.17 – $3,167.65
MRI of the brain, before and after contrast: 10 of 25 insurance plan rates Aetna — Commercial: $2,478 Aetna — Medicare Advantage: $802.95 Blue Shield of California — Commercial: $2,384.77 Blue Shield of California — Covered California: $979.47 Central Health Plan — Medicare Advantage: $1,204.43 Cigna — HMO: $2,970.93 Cigna — PPO: $3,167.65 Health Net — Blue and Gold: $1,204.43 Health Net — Bronze Network (SmartCare): $1,204.43 Health Net — Commercial/Covered California PPO: $2,344.63
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: MRI Brain w/ + w/o Contrast	$4,014.77	$2,408.86	$2,810.34 – $3,127.51
MRI of the brain, before and after contrast: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $3,127.51 Multiplan — PPO: $2,810.34
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: XR Chest 2 Views	$645.84	$387.50	$27.74 – $509.57
Chest X-ray, 2 views: 10 of 25 insurance plan rates Aetna — Commercial: $452.09 Aetna — Medicare Advantage: $129.17 Blue Shield of California — Commercial: $383.63 Blue Shield of California — Covered California: $113.94 Central Health Plan — Medicare Advantage: $193.75 Cigna — HMO: $477.92 Cigna — PPO: $509.57 Health Net — Blue and Gold: $193.75 Health Net — Bronze Network (SmartCare): $193.75 Health Net — Commercial/Covered California PPO: $377.17
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: XR Chest Decubitus	$562.01	$337.21	$27.74 – $443.43
Chest X-ray, 2 views: 10 of 25 insurance plan rates Aetna — Commercial: $393.41 Aetna — Medicare Advantage: $112.40 Blue Shield of California — Commercial: $333.83 Blue Shield of California — Covered California: $113.94 Central Health Plan — Medicare Advantage: $168.60 Cigna — HMO: $415.89 Cigna — PPO: $443.43 Health Net — Blue and Gold: $168.60 Health Net — Bronze Network (SmartCare): $168.60 Health Net — Commercial/Covered California PPO: $328.21
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: XR Chest 2 Views	$645.84	$387.50	$452.09 – $503.11
Chest X-ray, 2 views: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $503.11 Multiplan — PPO: $452.09
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: XR Spine Lumbosacral 4 Plus Views	$1,145.75	$687.45	$44.29 – $904
X-ray of the lower spine, at least 4 views: 10 of 25 insurance plan rates Aetna — Commercial: $802.02 Aetna — Medicare Advantage: $229.15 Blue Shield of California — Commercial: $680.58 Blue Shield of California — Covered California: $138.44 Central Health Plan — Medicare Advantage: $343.73 Cigna — HMO: $847.86 Cigna — PPO: $904 Health Net — Blue and Gold: $343.73 Health Net — Bronze Network (SmartCare): $343.73 Health Net — Commercial/Covered California PPO: $669.12
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: XR Spine Lumbosacral Bending 4 + Views	$1,145.75	$687.45	$44.29 – $904
X-ray of the lower spine, at least 4 views: 10 of 25 insurance plan rates Aetna — Commercial: $802.02 Aetna — Medicare Advantage: $229.15 Blue Shield of California — Commercial: $680.58 Blue Shield of California — Covered California: $138.44 Central Health Plan — Medicare Advantage: $343.73 Cigna — HMO: $847.86 Cigna — PPO: $904 Health Net — Blue and Gold: $343.73 Health Net — Bronze Network (SmartCare): $343.73 Health Net — Commercial/Covered California PPO: $669.12
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: XR Spine Lumbosacral 4 Plus Views	$1,145.75	$687.45	$802.02 – $892.54
X-ray of the lower spine, at least 4 views: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $892.54 Multiplan — PPO: $802.02
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI Spine Lumbar w/o Contrast	$3,615.26	$2,169.16	$187.86 – $2,852.44
MRI of the lower back (lumbar spine), without contrast: 10 of 25 insurance plan rates Aetna — Commercial: $2,478 Aetna — Medicare Advantage: $723.05 Blue Shield of California — Commercial: $2,147.46 Blue Shield of California — Covered California: $620.68 Central Health Plan — Medicare Advantage: $1,084.58 Cigna — HMO: $2,675.29 Cigna — PPO: $2,852.44 Health Net — Blue and Gold: $1,084.58 Health Net — Bronze Network (SmartCare): $1,084.58 Health Net — Commercial/Covered California PPO: $2,111.31
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI Spine Survey w/o Contrast	$3,615.26	$2,169.16	$187.86 – $2,852.44
MRI of the lower back (lumbar spine), without contrast: 10 of 25 insurance plan rates Aetna — Commercial: $2,478 Aetna — Medicare Advantage: $723.05 Blue Shield of California — Commercial: $2,147.46 Blue Shield of California — Covered California: $620.68 Central Health Plan — Medicare Advantage: $1,084.58 Cigna — HMO: $2,675.29 Cigna — PPO: $2,852.44 Health Net — Blue and Gold: $1,084.58 Health Net — Bronze Network (SmartCare): $1,084.58 Health Net — Commercial/Covered California PPO: $2,111.31
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: MRI Spine Lumbar w/o Contrast	$3,615.26	$2,169.16	$2,530.68 – $2,816.29
MRI of the lower back (lumbar spine), without contrast: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $2,816.29 Multiplan — PPO: $2,530.68
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT Pelvis w/ Contrast	$3,411.36	$2,046.82	$206.49 – $2,691.56
CT scan of the pelvis, with contrast: 10 of 25 insurance plan rates Aetna — Commercial: $2,303 Aetna — Medicare Advantage: $682.27 Blue Shield of California — Commercial: $2,026.35 Blue Shield of California — Covered California: $551.14 Central Health Plan — Medicare Advantage: $1,023.41 Cigna — HMO: $2,524.41 Cigna — PPO: $2,691.56 Health Net — Blue and Gold: $1,023.41 Health Net — Bronze Network (SmartCare): $1,023.41 Health Net — Commercial/Covered California PPO: $1,992.23
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: CT Pelvis w/ Contrast	$3,411.36	$2,046.82	$2,387.95 – $2,657.45
CT scan of the pelvis, with contrast: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $2,657.45 Multiplan — PPO: $2,387.95
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC, LT In the file: MRI Ankle w/o Contrast Left	$3,615.26	$2,169.16	$198.89 – $2,852.44
MRI of a leg joint (such as the knee), without contrast: 10 of 24 insurance plan rates Aetna — Commercial: $2,478 Aetna — Medicare Advantage: $723.05 Blue Shield of California — Commercial: $2,147.46 Blue Shield of California — Covered California: $620.68 Central Health Plan — Medicare Advantage: $1,084.58 Cigna — HMO: $2,675.29 Cigna — PPO: $2,852.44 Health Net — Blue and Gold: $1,084.58 Health Net — Bronze Network (SmartCare): $1,084.58 Health Net — Commercial/Covered California PPO: $2,111.31
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC, RT In the file: MRI Ankle w/o Contrast Right	$3,615.26	$2,169.16	$198.89 – $2,852.44
MRI of a leg joint (such as the knee), without contrast: 10 of 24 insurance plan rates Aetna — Commercial: $2,478 Aetna — Medicare Advantage: $723.05 Blue Shield of California — Commercial: $2,147.46 Blue Shield of California — Covered California: $620.68 Central Health Plan — Medicare Advantage: $1,084.58 Cigna — HMO: $2,675.29 Cigna — PPO: $2,852.44 Health Net — Blue and Gold: $1,084.58 Health Net — Bronze Network (SmartCare): $1,084.58 Health Net — Commercial/Covered California PPO: $2,111.31
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC, LT In the file: MRI Hip w/o Contrast Left	$3,615.26	$2,169.16	$198.89 – $2,852.44
MRI of a leg joint (such as the knee), without contrast: 10 of 24 insurance plan rates Aetna — Commercial: $2,478 Aetna — Medicare Advantage: $723.05 Blue Shield of California — Commercial: $2,147.46 Blue Shield of California — Covered California: $620.68 Central Health Plan — Medicare Advantage: $1,084.58 Cigna — HMO: $2,675.29 Cigna — PPO: $2,852.44 Health Net — Blue and Gold: $1,084.58 Health Net — Bronze Network (SmartCare): $1,084.58 Health Net — Commercial/Covered California PPO: $2,111.31
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT Enterography w/ Contrast	$6,973.83	$4,184.30	$284.62 – $5,502.35
CT scan of the abdomen and pelvis, with contrast: 10 of 25 insurance plan rates Aetna — Commercial: $2,303 Aetna — Medicare Advantage: $1,394.77 Blue Shield of California — Commercial: $4,142.46 Blue Shield of California — Covered California: $1,064.77 Central Health Plan — Medicare Advantage: $2,092.15 Cigna — HMO: $5,160.63 Cigna — PPO: $5,502.35 Health Net — Blue and Gold: $2,092.15 Health Net — Bronze Network (SmartCare): $2,092.15 Health Net — Commercial/Covered California PPO: $4,072.72
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT Abd/Pelvis w Contrast	$6,404.58	$3,842.75	$284.62 – $5,053.21
CT scan of the abdomen and pelvis, with contrast: 10 of 25 insurance plan rates Aetna — Commercial: $2,303 Aetna — Medicare Advantage: $1,280.92 Blue Shield of California — Commercial: $3,804.32 Blue Shield of California — Covered California: $1,064.77 Central Health Plan — Medicare Advantage: $1,921.37 Cigna — HMO: $4,739.39 Cigna — PPO: $5,053.21 Health Net — Blue and Gold: $1,921.37 Health Net — Bronze Network (SmartCare): $1,921.37 Health Net — Commercial/Covered California PPO: $3,740.27
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT Abdomen and Pelvis w/ Contrast	$6,404.58	$3,842.75	$284.62 – $5,053.21
CT scan of the abdomen and pelvis, with contrast: 10 of 25 insurance plan rates Aetna — Commercial: $2,303 Aetna — Medicare Advantage: $1,280.92 Blue Shield of California — Commercial: $3,804.32 Blue Shield of California — Covered California: $1,064.77 Central Health Plan — Medicare Advantage: $1,921.37 Cigna — HMO: $4,739.39 Cigna — PPO: $5,053.21 Health Net — Blue and Gold: $1,921.37 Health Net — Bronze Network (SmartCare): $1,921.37 Health Net — Commercial/Covered California PPO: $3,740.27
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US Abdomen Complete	$681.03	$408.62	$84.03 – $537.33
Ultrasound of the abdomen, complete: 10 of 25 insurance plan rates Aetna — Commercial: $476.72 Aetna — Medicare Advantage: $136.21 Blue Shield of California — Commercial: $404.53 Blue Shield of California — Covered California: $176.65 Central Health Plan — Medicare Advantage: $204.31 Cigna — HMO: $503.96 Cigna — PPO: $537.33 Health Net — Blue and Gold: $204.31 Health Net — Bronze Network (SmartCare): $204.31 Health Net — Commercial/Covered California PPO: $397.72
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: US Abdomen Complete	$681.03	$408.62	$476.72 – $530.52
Ultrasound of the abdomen, complete: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $530.52 Multiplan — PPO: $476.72
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US OB Greater Than 14 Weeks	$765.90	$459.54	$129.22 – $604.30
Pregnancy ultrasound (after the first trimester): 10 of 25 insurance plan rates Aetna — Commercial: $536.13 Aetna — Medicare Advantage: $153.18 Blue Shield of California — Commercial: $454.94 Blue Shield of California — Covered California: $176.65 Central Health Plan — Medicare Advantage: $229.77 Cigna — HMO: $566.77 Cigna — PPO: $604.30 Health Net — Blue and Gold: $229.77 Health Net — Bronze Network (SmartCare): $229.77 Health Net — Commercial/Covered California PPO: $447.29
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: US OB Greater Than 14 Weeks	$765.90	$459.54	$536.13 – $596.64
Pregnancy ultrasound (after the first trimester): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $596.64 Multiplan — PPO: $536.13
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US Transvaginal Non-OB	$1,124.01	$674.41	$68.33 – $886.84
Transvaginal ultrasound: 10 of 25 insurance plan rates Aetna — Commercial: $786.81 Aetna — Medicare Advantage: $224.80 Blue Shield of California — Commercial: $667.66 Blue Shield of California — Covered California: $176.65 Central Health Plan — Medicare Advantage: $337.20 Cigna — HMO: $831.77 Cigna — PPO: $886.84 Health Net — Blue and Gold: $337.20 Health Net — Bronze Network (SmartCare): $337.20 Health Net — Commercial/Covered California PPO: $656.42
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CITY US TRANSVAGINAL NON-OB	$1,124.01	$674.41	$68.33 – $886.84
Transvaginal ultrasound: 10 of 25 insurance plan rates Aetna — Commercial: $786.81 Aetna — Medicare Advantage: $224.80 Blue Shield of California — Commercial: $667.66 Blue Shield of California — Covered California: $176.65 Central Health Plan — Medicare Advantage: $337.20 Cigna — HMO: $831.77 Cigna — PPO: $886.84 Health Net — Blue and Gold: $337.20 Health Net — Bronze Network (SmartCare): $337.20 Health Net — Commercial/Covered California PPO: $656.42
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: US Transvaginal Non-OB	$1,124.01	$674.41	$786.81 – $875.60
Transvaginal ultrasound: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $875.60 Multiplan — PPO: $786.81
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC, LT In the file: MG Mammo Digital Diagnostic Left.	$349.83	$209.90	$69.97 – $276.02
Diagnostic mammogram, one breast: 10 of 23 insurance plan rates Aetna — Commercial: $244.88 Aetna — Medicare Advantage: $69.97 Blue Shield of California — Commercial: $207.80 Blue Shield of California — Covered California: $111.60 Central Health Plan — Medicare Advantage: $104.95 Cigna — HMO: $258.87 Cigna — PPO: $276.02 Health Net — Blue and Gold: $104.95 Health Net — Bronze Network (SmartCare): $104.95 Health Net — Commercial/Covered California PPO: $204.30
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC, RT In the file: MG Mammo Digital Diagnostic Right.	$349.83	$209.90	$69.97 – $276.02
Diagnostic mammogram, one breast: 10 of 23 insurance plan rates Aetna — Commercial: $244.88 Aetna — Medicare Advantage: $69.97 Blue Shield of California — Commercial: $207.80 Blue Shield of California — Covered California: $111.60 Central Health Plan — Medicare Advantage: $104.95 Cigna — HMO: $258.87 Cigna — PPO: $276.02 Health Net — Blue and Gold: $104.95 Health Net — Bronze Network (SmartCare): $104.95 Health Net — Commercial/Covered California PPO: $204.30
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT, TC In the file: MG Mammo Implant Digital Diag Left.	$349.83	$209.90	$69.97 – $276.02
Diagnostic mammogram, one breast: 10 of 23 insurance plan rates Aetna — Commercial: $244.88 Aetna — Medicare Advantage: $69.97 Blue Shield of California — Commercial: $207.80 Blue Shield of California — Covered California: $111.60 Central Health Plan — Medicare Advantage: $104.95 Cigna — HMO: $258.87 Cigna — PPO: $276.02 Health Net — Blue and Gold: $104.95 Health Net — Bronze Network (SmartCare): $104.95 Health Net — Commercial/Covered California PPO: $204.30
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MG Mammo Digital Diagnostic Bilat.	$447.12	$268.27	$89.42 – $352.78
Diagnostic mammogram, both breasts: 10 of 24 insurance plan rates Aetna — Commercial: $312.98 Aetna — Medicare Advantage: $89.42 Blue Shield of California — Commercial: $265.59 Blue Shield of California — Covered California: $142.63 Central Health Plan — Medicare Advantage: $134.14 Cigna — HMO: $330.87 Cigna — PPO: $352.78 Health Net — Blue and Gold: $134.14 Health Net — Bronze Network (SmartCare): $134.14 Health Net — Commercial/Covered California PPO: $261.12
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MG Mammo Diagnostic Bilateral w/ Tomo.	$447.12	$268.27	$89.42 – $352.78
Diagnostic mammogram, both breasts: 10 of 24 insurance plan rates Aetna — Commercial: $312.98 Aetna — Medicare Advantage: $89.42 Blue Shield of California — Commercial: $265.59 Blue Shield of California — Covered California: $142.63 Central Health Plan — Medicare Advantage: $134.14 Cigna — HMO: $330.87 Cigna — PPO: $352.78 Health Net — Blue and Gold: $134.14 Health Net — Bronze Network (SmartCare): $134.14 Health Net — Commercial/Covered California PPO: $261.12
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MG Mammo Implant Diag Bilateral w/ Tomo.	$447.12	$268.27	$89.42 – $352.78
Diagnostic mammogram, both breasts: 10 of 24 insurance plan rates Aetna — Commercial: $312.98 Aetna — Medicare Advantage: $89.42 Blue Shield of California — Commercial: $265.59 Blue Shield of California — Covered California: $142.63 Central Health Plan — Medicare Advantage: $134.14 Cigna — HMO: $330.87 Cigna — PPO: $352.78 Health Net — Blue and Gold: $134.14 Health Net — Bronze Network (SmartCare): $134.14 Health Net — Commercial/Covered California PPO: $261.12
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MG Mammo Digital Screening Bilateral.	$370.53	$222.32	$74.11 – $292.35
Screening mammogram, both breasts: 10 of 24 insurance plan rates Aetna — Commercial: $259.37 Aetna — Medicare Advantage: $74.11 Blue Shield of California — Commercial: $220.09 Blue Shield of California — Covered California: $118.20 Central Health Plan — Medicare Advantage: $111.16 Cigna — HMO: $274.19 Cigna — PPO: $292.35 Health Net — Blue and Gold: $111.16 Health Net — Bronze Network (SmartCare): $111.16 Health Net — Commercial/Covered California PPO: $216.39
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MG Mammo Digital Screening Left.	$370.53	$222.32	$74.11 – $292.35
Screening mammogram, both breasts: 10 of 24 insurance plan rates Aetna — Commercial: $259.37 Aetna — Medicare Advantage: $74.11 Blue Shield of California — Commercial: $220.09 Blue Shield of California — Covered California: $118.20 Central Health Plan — Medicare Advantage: $111.16 Cigna — HMO: $274.19 Cigna — PPO: $292.35 Health Net — Blue and Gold: $111.16 Health Net — Bronze Network (SmartCare): $111.16 Health Net — Commercial/Covered California PPO: $216.39
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MG Mammo Digital Screening Right.	$370.53	$222.32	$74.11 – $292.35
Screening mammogram, both breasts: 10 of 24 insurance plan rates Aetna — Commercial: $259.37 Aetna — Medicare Advantage: $74.11 Blue Shield of California — Commercial: $220.09 Blue Shield of California — Covered California: $118.20 Central Health Plan — Medicare Advantage: $111.16 Cigna — HMO: $274.19 Cigna — PPO: $292.35 Health Net — Blue and Gold: $111.16 Health Net — Bronze Network (SmartCare): $111.16 Health Net — Commercial/Covered California PPO: $216.39

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: 93452 LEFT HRT CATH W/VENTRICLGRPHY	$7,305.03	$4,383.02	$770.49 – $9,256
Left heart catheterization (diagnostic): 10 of 25 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $1,461.01 Blue Shield of California — Commercial: $3,206.91 Blue Shield of California — Covered California: $4,985.90 Central Health Plan — Medicare Advantage: $2,191.51 Cigna — HMO: $7,493 Cigna — PPO: $5,763.67 Health Net — Blue and Gold: $2,191.51 Health Net — Bronze Network (SmartCare): $2,191.51 Health Net — Commercial/Covered California PPO: $9,256
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: 93452 LEFT HRT CATH W/VENTRICLGRPHY	$7,305.03	$4,383.02	$5,113.52 – $5,690.62
Left heart catheterization (diagnostic): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $5,690.62 Multiplan — PPO: $5,113.52
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH RIGHT ATRIAL PACING AND RECORDING, RIGHT VENTRICULAR PACING AND RECORDING, HIS BUNDLE RECOR	Not listed in the file	Not listed in the file	$602.42 – $16,213.07
Heart rhythm study (electrophysiology evaluation): 10 of 31 insurance plan rates Aetna — Medicare Advantage: $10,031.67 Anthem — Medicare Advantage: $10,031.67 Astiva Health — Medicare Advantage: $11,034.84 Blue Shield of California — Covered California: $6,894.36 Blue Shield of California — Medicare Advantage: $10,031.67 Bright Health — Commercial/Covered California: $16,050.67 Central Health Plan — Medicare Advantage: $10,031.67 Cigna — HMO: $7,493 Clever Care of California — Medicare Advantage: $11,034.84 Community Health Group — Medicare Advantage: $10,031.67
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: 93619 EPS COMP W/O INDUCTION	$10,459.71	$6,275.83	$602.42 – $16,213.07
Heart rhythm study (electrophysiology evaluation): 10 of 24 insurance plan rates Aetna — Commercial: $7,321.80 Aetna — Medicare Advantage: $2,091.94 Blue Shield of California — Commercial: $6,213.07 Blue Shield of California — Covered California: $6,894.36 Central Health Plan — Medicare Advantage: $3,137.91 Cigna — HMO: $7,740.19 Cigna — PPO: $8,252.71 Health Net — Blue and Gold: $3,137.91 Health Net — Bronze Network (SmartCare): $3,137.91 Health Net — Commercial/Covered California PPO: $6,108.47
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: 93619 EPS COMP W/O INDUCTION	$10,459.71	$6,275.83	$7,321.80 – $8,148.11
Heart rhythm study (electrophysiology evaluation): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $8,148.11 Multiplan — PPO: $7,321.80
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PERQ STENT/ANGIO SINGLE VESSEL --LC	$29,197.35	$17,518.41	$889.27 – $54,332.46
Heart rhythm study with ablation for atrial fibrillation: 10 of 38 insurance plan rates Aetna — Commercial: $20,438.15 Aetna — Medicare Advantage: $33,617.65 Anthem — Medicare Advantage: $33,617.65 Astiva Health — Medicare Advantage: $36,979.42 Blue Shield of California — Commercial: $12,817.64 Blue Shield of California — Covered California: $23,582.80 Blue Shield of California — Medicare Advantage: $33,617.65 Bright Health — Commercial/Covered California: $53,788.24 Central Health Plan — Medicare Advantage: $33,617.65 Cigna — HMO: $7,493
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PERQ STENT/ANGIO SINGLE VESSEL --LC	$29,197.35	$17,518.41	$20,438.15 – $22,744.74
Heart rhythm study with ablation for atrial fibrillation: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $22,744.74 Multiplan — PPO: $20,438.15

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT Therapeutic Exercise Units	$137.66	$82.60	$6.43 – $259
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 23 insurance plan rates Aetna — Commercial: $96.36 Aetna — Medicare Advantage: $27.53 Blue Shield of California — Commercial: $81.77 Blue Shield of California — Covered California: $60.69 Central Health Plan — Medicare Advantage: $41.30 Cigna — HMO: $101.87 Cigna — PPO: $108.61 Health Net — Blue and Gold: $41.30 Health Net — Bronze Network (SmartCare): $41.30 Health Net — Commercial/Covered California PPO: $80.39
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT Therapeutic Exercise Charge	$137.66	$82.60	$6.43 – $259
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 23 insurance plan rates Aetna — Commercial: $96.36 Aetna — Medicare Advantage: $27.53 Blue Shield of California — Commercial: $81.77 Blue Shield of California — Covered California: $60.69 Central Health Plan — Medicare Advantage: $41.30 Cigna — HMO: $101.87 Cigna — PPO: $108.61 Health Net — Blue and Gold: $41.30 Health Net — Bronze Network (SmartCare): $41.30 Health Net — Commercial/Covered California PPO: $80.39
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: Therapeutic Exercise Charges	$137.66	$82.60	$6.43 – $259
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 23 insurance plan rates Aetna — Commercial: $96.36 Aetna — Medicare Advantage: $27.53 Blue Shield of California — Commercial: $81.77 Blue Shield of California — Covered California: $60.69 Central Health Plan — Medicare Advantage: $41.30 Cigna — HMO: $101.87 Cigna — PPO: $108.61 Health Net — Blue and Gold: $41.30 Health Net — Bronze Network (SmartCare): $41.30 Health Net — Commercial/Covered California PPO: $80.39
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT Evaluation Low Complexity Units	$313.61	$188.17	$47.04 – $259
Physical therapy evaluation (low complexity): 10 of 23 insurance plan rates Aetna — Commercial: $219.53 Aetna — Medicare Advantage: $62.72 Blue Shield of California — Commercial: $186.28 Blue Shield of California — Covered California: $157.39 Central Health Plan — Medicare Advantage: $94.08 Cigna — HMO: $232.07 Cigna — PPO: $247.44 Health Net — Blue and Gold: $94.08 Health Net — Bronze Network (SmartCare): $94.08 Health Net — Commercial/Covered California PPO: $183.15
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT Low Complex Units	$313.61	$188.17	$47.04 – $259
Physical therapy evaluation (low complexity): 10 of 23 insurance plan rates Aetna — Commercial: $219.53 Aetna — Medicare Advantage: $62.72 Blue Shield of California — Commercial: $186.28 Blue Shield of California — Covered California: $157.39 Central Health Plan — Medicare Advantage: $94.08 Cigna — HMO: $232.07 Cigna — PPO: $247.44 Health Net — Blue and Gold: $94.08 Health Net — Bronze Network (SmartCare): $94.08 Health Net — Commercial/Covered California PPO: $183.15
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT Evaluation Low Complexity Units	$313.61	$188.17	$219.53 – $244.30
Physical therapy evaluation (low complexity): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $244.30 Multiplan — PPO: $219.53
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT Evaluation Moderate Complexity Units	$527.85	$316.71	$79.18 – $416.47
Physical therapy evaluation (moderate complexity): 10 of 23 insurance plan rates Aetna — Commercial: $369.50 Aetna — Medicare Advantage: $105.57 Blue Shield of California — Commercial: $313.54 Blue Shield of California — Covered California: $157.39 Central Health Plan — Medicare Advantage: $158.35 Cigna — HMO: $390.61 Cigna — PPO: $416.47 Health Net — Blue and Gold: $158.35 Health Net — Bronze Network (SmartCare): $158.35 Health Net — Commercial/Covered California PPO: $308.26
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT Moderate Complex Units	$527.85	$316.71	$79.18 – $416.47
Physical therapy evaluation (moderate complexity): 10 of 23 insurance plan rates Aetna — Commercial: $369.50 Aetna — Medicare Advantage: $105.57 Blue Shield of California — Commercial: $313.54 Blue Shield of California — Covered California: $157.39 Central Health Plan — Medicare Advantage: $158.35 Cigna — HMO: $390.61 Cigna — PPO: $416.47 Health Net — Blue and Gold: $158.35 Health Net — Bronze Network (SmartCare): $158.35 Health Net — Commercial/Covered California PPO: $308.26
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT Evaluation Moderate Complexity Units	$527.85	$316.71	$369.50 – $411.20
Physical therapy evaluation (moderate complexity): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $411.20 Multiplan — PPO: $369.50
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT Evaluation High Complexity Units	$527.85	$316.71	$105.57 – $416.47
Physical therapy evaluation (high complexity): 10 of 23 insurance plan rates Aetna — Commercial: $369.50 Aetna — Medicare Advantage: $105.57 Blue Shield of California — Commercial: $313.54 Blue Shield of California — Covered California: $157.39 Central Health Plan — Medicare Advantage: $158.35 Cigna — HMO: $390.61 Cigna — PPO: $416.47 Health Net — Blue and Gold: $158.35 Health Net — Bronze Network (SmartCare): $158.35 Health Net — Commercial/Covered California PPO: $308.26
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT High Complex Units	$527.85	$316.71	$105.57 – $416.47
Physical therapy evaluation (high complexity): 10 of 23 insurance plan rates Aetna — Commercial: $369.50 Aetna — Medicare Advantage: $105.57 Blue Shield of California — Commercial: $313.54 Blue Shield of California — Covered California: $157.39 Central Health Plan — Medicare Advantage: $158.35 Cigna — HMO: $390.61 Cigna — PPO: $416.47 Health Net — Blue and Gold: $158.35 Health Net — Bronze Network (SmartCare): $158.35 Health Net — Commercial/Covered California PPO: $308.26
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT Evaluation High Complexity Units	$527.85	$316.71	$369.50 – $411.20
Physical therapy evaluation (high complexity): rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $411.20 Multiplan — PPO: $369.50
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO, 59 In the file: 9083259 OP INDIV THERAPY 30MIN	$286.70	$172.02	$57.34 – $627
Psychotherapy, 30 minutes: 10 of 25 insurance plan rates Aetna — Commercial: $627 Aetna — Medicare Advantage: $57.34 Blue Shield of California — Commercial: $170.30 Blue Shield of California — Covered California: $164.13 Central Health Plan — Medicare Advantage: $86.01 Cigna — HMO: $212.16 Cigna — PPO: $226.21 Health Net — Blue and Gold: $86.01 Health Net — Bronze Network (SmartCare): $86.01 Health Net — Commercial/Covered California PPO: $300
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: 90832 PHP INDIV THERAPY 30MIN	$286.70	$172.02	$57.34 – $627
Psychotherapy, 30 minutes: 10 of 25 insurance plan rates Aetna — Commercial: $627 Aetna — Medicare Advantage: $57.34 Blue Shield of California — Commercial: $170.30 Blue Shield of California — Covered California: $164.13 Central Health Plan — Medicare Advantage: $86.01 Cigna — HMO: $212.16 Cigna — PPO: $226.21 Health Net — Blue and Gold: $86.01 Health Net — Bronze Network (SmartCare): $86.01 Health Net — Commercial/Covered California PPO: $300
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO, 59 In the file: 9083259 PHP INDIV THERAPY 30MIN	$286.70	$172.02	$57.34 – $627
Psychotherapy, 30 minutes: 10 of 25 insurance plan rates Aetna — Commercial: $627 Aetna — Medicare Advantage: $57.34 Blue Shield of California — Commercial: $170.30 Blue Shield of California — Covered California: $164.13 Central Health Plan — Medicare Advantage: $86.01 Cigna — HMO: $212.16 Cigna — PPO: $226.21 Health Net — Blue and Gold: $86.01 Health Net — Bronze Network (SmartCare): $86.01 Health Net — Commercial/Covered California PPO: $300
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO, 59 In the file: 9083459 OP INDIV THERAPY 45MIN	$381.92	$229.15	$76.38 – $627
Psychotherapy, 45 minutes: 10 of 25 insurance plan rates Aetna — Commercial: $627 Aetna — Medicare Advantage: $76.38 Blue Shield of California — Commercial: $226.86 Blue Shield of California — Covered California: $211.88 Central Health Plan — Medicare Advantage: $114.58 Cigna — HMO: $282.62 Cigna — PPO: $301.33 Health Net — Blue and Gold: $114.58 Health Net — Bronze Network (SmartCare): $114.58 Health Net — Commercial/Covered California PPO: $300
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: 90834 PHP INDIV THERAPY 45MIN	$381.92	$229.15	$76.38 – $627
Psychotherapy, 45 minutes: 10 of 25 insurance plan rates Aetna — Commercial: $627 Aetna — Medicare Advantage: $76.38 Blue Shield of California — Commercial: $226.86 Blue Shield of California — Covered California: $211.88 Central Health Plan — Medicare Advantage: $114.58 Cigna — HMO: $282.62 Cigna — PPO: $301.33 Health Net — Blue and Gold: $114.58 Health Net — Bronze Network (SmartCare): $114.58 Health Net — Commercial/Covered California PPO: $300
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO, 59 In the file: 9083459 PHP INDIV THER 45MIN	$381.92	$229.15	$76.38 – $627
Psychotherapy, 45 minutes: 10 of 25 insurance plan rates Aetna — Commercial: $627 Aetna — Medicare Advantage: $76.38 Blue Shield of California — Commercial: $226.86 Blue Shield of California — Covered California: $211.88 Central Health Plan — Medicare Advantage: $114.58 Cigna — HMO: $282.62 Cigna — PPO: $301.33 Health Net — Blue and Gold: $114.58 Health Net — Bronze Network (SmartCare): $114.58 Health Net — Commercial/Covered California PPO: $300
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO, 59 In the file: 9083759 OP INDIV THERAPY 60MIN	$381.92	$229.15	$51.51 – $627
Psychotherapy, 60 minutes: 10 of 25 insurance plan rates Aetna — Commercial: $627 Aetna — Medicare Advantage: $76.38 Blue Shield of California — Commercial: $226.86 Blue Shield of California — Covered California: $211.88 Central Health Plan — Medicare Advantage: $114.58 Cigna — HMO: $282.62 Cigna — PPO: $301.33 Health Net — Blue and Gold: $114.58 Health Net — Bronze Network (SmartCare): $114.58 Health Net — Commercial/Covered California PPO: $300
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: 90837 OP INDIV THERAPY 60MIN	$381.92	$229.15	$51.51 – $627
Psychotherapy, 60 minutes: 10 of 25 insurance plan rates Aetna — Commercial: $627 Aetna — Medicare Advantage: $76.38 Blue Shield of California — Commercial: $226.86 Blue Shield of California — Covered California: $211.88 Central Health Plan — Medicare Advantage: $114.58 Cigna — HMO: $282.62 Cigna — PPO: $301.33 Health Net — Blue and Gold: $114.58 Health Net — Bronze Network (SmartCare): $114.58 Health Net — Commercial/Covered California PPO: $300
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: 90837 PHP INDIV THERAPY 60MIN	$381.92	$229.15	$51.51 – $627
Psychotherapy, 60 minutes: 10 of 25 insurance plan rates Aetna — Commercial: $627 Aetna — Medicare Advantage: $76.38 Blue Shield of California — Commercial: $226.86 Blue Shield of California — Covered California: $211.88 Central Health Plan — Medicare Advantage: $114.58 Cigna — HMO: $282.62 Cigna — PPO: $301.33 Health Net — Blue and Gold: $114.58 Health Net — Bronze Network (SmartCare): $114.58 Health Net — Commercial/Covered California PPO: $300
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: 90847 PHP FAMILY THERAPY CONJOINT	$444.02	$266.41	$88.80 – $368.96
Family psychotherapy, with the patient: 10 of 25 insurance plan rates Aetna — Commercial: $310.81 Aetna — Medicare Advantage: $88.80 Blue Shield of California — Commercial: $263.75 Blue Shield of California — Covered California: $233.36 Central Health Plan — Medicare Advantage: $133.21 Cigna — HMO: $328.57 Cigna — PPO: $350.33 Health Net — Blue and Gold: $133.21 Health Net — Bronze Network (SmartCare): $133.21 Health Net — Commercial/Covered California PPO: $300
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: 90847 OP FAMILY THERAPY CONJOINT	$444.02	$266.41	$88.80 – $368.96
Family psychotherapy, with the patient: 10 of 25 insurance plan rates Aetna — Commercial: $310.81 Aetna — Medicare Advantage: $88.80 Blue Shield of California — Commercial: $263.75 Blue Shield of California — Covered California: $233.36 Central Health Plan — Medicare Advantage: $133.21 Cigna — HMO: $328.57 Cigna — PPO: $350.33 Health Net — Blue and Gold: $133.21 Health Net — Bronze Network (SmartCare): $133.21 Health Net — Commercial/Covered California PPO: $300
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Hospital (facility) fee · modifier PO In the file: 90847 PHP FAMILY THERAPY CONJOINT	$444.02	$266.41	$310.81 – $345.89
Family psychotherapy, with the patient: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $345.89 Multiplan — PPO: $310.81
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: 90853 OP GROUP THERAPY	$211.14	$126.68	$24.20 – $627
Group psychotherapy: 10 of 25 insurance plan rates Aetna — Commercial: $627 Aetna — Medicare Advantage: $42.23 Blue Shield of California — Commercial: $125.42 Blue Shield of California — Covered California: $103.81 Central Health Plan — Medicare Advantage: $63.34 Cigna — HMO: $156.24 Cigna — PPO: $166.59 Health Net — Blue and Gold: $63.34 Health Net — Bronze Network (SmartCare): $63.34 Health Net — Commercial/Covered California PPO: $300
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Hospital (facility) fee · modifier PO In the file: 90853 OP GROUP THERAPY	$211.14	$126.68	$147.80 – $164.48
Group psychotherapy: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $164.48 Multiplan — PPO: $147.80

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19	Not listed in the file	Not listed in the file	$212.83 – $8,138.96
Removal of breast growth (open surgery): 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $5,035.90 Anthem — Medicare Advantage: $5,035.90 Astiva Health — Medicare Advantage: $5,539.49 Blue Shield of California — Covered California: $3,272.44 Blue Shield of California — Medicare Advantage: $5,035.90 Bright Health — Commercial/Covered California: $8,057.44 Central Health Plan — Medicare Advantage: $5,035.90 Clever Care of California — Medicare Advantage: $5,539.49 Community Health Group — Medicare Advantage: $5,035.90
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT	Not listed in the file	Not listed in the file	$1,504.09 – $26,687.63
Total hip replacement: 10 of 31 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $16,512.69 Anthem — Medicare Advantage: $16,512.69 Astiva Health — Medicare Advantage: $18,163.96 Blue Shield of California — Medicare Advantage: $16,512.69 Bright Health — Commercial/Covered California: $26,420.30 Central Health Plan — Medicare Advantage: $16,512.69 Clever Care of California — Medicare Advantage: $18,163.96 Community Health Group — Medicare Advantage: $16,512.69 Health Net — Blue and Gold: $26,090.05
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY)	Not listed in the file	Not listed in the file	$1,504.09 – $26,687.63
Total knee replacement: 10 of 31 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $16,512.69 Anthem — Medicare Advantage: $16,512.69 Astiva Health — Medicare Advantage: $18,163.96 Blue Shield of California — Medicare Advantage: $16,512.69 Bright Health — Commercial/Covered California: $26,420.30 Central Health Plan — Medicare Advantage: $16,512.69 Clever Care of California — Medicare Advantage: $18,163.96 Community Health Group — Medicare Advantage: $16,512.69 Health Net — Blue and Gold: $26,090.05
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLASTY, WITH CORACOACROMIAL LIGAMENT (IE, ARCH) RELE	Not listed in the file	Not listed in the file	$426.04 – $6,640
Shoulder arthroscopy: shaving of shoulder bone: rates for 7 insurance plans Aetna — Commercial: $6,640 Blue Shield of California — Covered California: $3,805.09 Health Net — Medi-Cal, Healthy Families Healthy Kids: $426.04 Anthem — Commercial/Covered California: 89.57% (a percentage in the contract, not a dollar amount) Anthem — MCS Commercial/Covered California: 89.57% (a percentage in the contract, not a dollar amount) Cigna — HMO: 74% (a percentage in the contract, not a dollar amount) Health Net — Commercial/Covered California PPO: 38.9% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULA	Not listed in the file	Not listed in the file	$556.51 – $6,801.48
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $4,208.34 Anthem — Medicare Advantage: $4,208.34 Astiva Health — Medicare Advantage: $4,629.17 Blue Shield of California — Covered California: $3,805.09 Blue Shield of California — Medicare Advantage: $4,208.34 Bright Health — Commercial/Covered California: $6,733.34 Central Health Plan — Medicare Advantage: $4,208.34 Clever Care of California — Medicare Advantage: $4,629.17 Community Health Group — Medicare Advantage: $4,208.34
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEP	Not listed in the file	Not listed in the file	$226.36 – $6,640
Upper GI endoscopy (diagnostic): 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $1,166.53 Anthem — Medicare Advantage: $1,166.53 Astiva Health — Medicare Advantage: $1,283.18 Blue Shield of California — Covered California: $1,084.34 Blue Shield of California — Medicare Advantage: $1,166.53 Bright Health — Commercial/Covered California: $1,866.45 Central Health Plan — Medicare Advantage: $1,166.53 Clever Care of California — Medicare Advantage: $1,283.18 Community Health Group — Medicare Advantage: $1,166.53
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE	Not listed in the file	Not listed in the file	$236.52 – $6,640
Upper GI endoscopy with biopsy: 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $1,166.53 Anthem — Medicare Advantage: $1,166.53 Astiva Health — Medicare Advantage: $1,283.18 Blue Shield of California — Covered California: $1,084.34 Blue Shield of California — Medicare Advantage: $1,166.53 Bright Health — Commercial/Covered California: $1,866.45 Central Health Plan — Medicare Advantage: $1,166.53 Clever Care of California — Medicare Advantage: $1,283.18 Community Health Group — Medicare Advantage: $1,166.53
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)	Not listed in the file	Not listed in the file	$298.18 – $6,640
Colonoscopy (diagnostic): 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $1,196.08 Anthem — Medicare Advantage: $1,196.08 Astiva Health — Medicare Advantage: $1,315.69 Blue Shield of California — Covered California: $1,201.91 Blue Shield of California — Medicare Advantage: $1,196.08 Bright Health — Commercial/Covered California: $1,913.73 Central Health Plan — Medicare Advantage: $1,196.08 Clever Care of California — Medicare Advantage: $1,315.69 Community Health Group — Medicare Advantage: $1,196.08
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE	Not listed in the file	Not listed in the file	$333.53 – $6,640
Colonoscopy with biopsy: 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $1,539.08 Anthem — Medicare Advantage: $1,539.08 Astiva Health — Medicare Advantage: $1,692.99 Blue Shield of California — Covered California: $1,201.91 Blue Shield of California — Medicare Advantage: $1,539.08 Bright Health — Commercial/Covered California: $2,462.53 Central Health Plan — Medicare Advantage: $1,539.08 Clever Care of California — Medicare Advantage: $1,692.99 Community Health Group — Medicare Advantage: $1,539.08
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE	Not listed in the file	Not listed in the file	$404.22 – $6,640
Colonoscopy with removal of polyps (snare): 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $1,539.08 Anthem — Medicare Advantage: $1,539.08 Astiva Health — Medicare Advantage: $1,692.99 Blue Shield of California — Covered California: $1,201.91 Blue Shield of California — Medicare Advantage: $1,539.08 Bright Health — Commercial/Covered California: $2,462.53 Central Health Plan — Medicare Advantage: $1,539.08 Clever Care of California — Medicare Advantage: $1,692.99 Community Health Group — Medicare Advantage: $1,539.08
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$470.78 – $12,566.78
Gallbladder removal by laparoscope: 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $7,775.56 Anthem — Medicare Advantage: $7,775.56 Astiva Health — Medicare Advantage: $8,553.12 Blue Shield of California — Covered California: $6,159.60 Blue Shield of California — Medicare Advantage: $7,775.56 Bright Health — Commercial/Covered California: $12,440.90 Central Health Plan — Medicare Advantage: $7,775.56 Clever Care of California — Medicare Advantage: $8,553.12 Community Health Group — Medicare Advantage: $7,775.56
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE	Not listed in the file	Not listed in the file	$347.45 – $7,442.54
Groin (inguinal) hernia repair, age 5 or older: 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $4,604.99 Anthem — Medicare Advantage: $4,604.99 Astiva Health — Medicare Advantage: $5,065.49 Blue Shield of California — Covered California: $4,225.01 Blue Shield of California — Medicare Advantage: $4,604.99 Bright Health — Commercial/Covered California: $7,367.98 Central Health Plan — Medicare Advantage: $4,604.99 Clever Care of California — Medicare Advantage: $5,065.49 Community Health Group — Medicare Advantage: $4,604.99
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CITY BIOPSY PROSTATE	$3,281.99	$1,969.19	$492.30 – $6,640
Prostate biopsy: 10 of 23 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $656.40 Blue Shield of California — Commercial: $1,440.79 Blue Shield of California — Covered California: $1,775.74 Central Health Plan — Medicare Advantage: $984.60 Cigna — PPO: $2,589.49 Health Net — Blue and Gold: $984.60 Health Net — Bronze Network (SmartCare): $984.60 Health Net — Medi-Cal, Healthy Families Healthy Kids: $492.30 Kaiser Permanente — HMO: $1,148.70
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CITY BIOPSY PROSTATE	$3,281.99	$1,969.19	$2,297.39 – $2,556.67
Prostate biopsy: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $2,556.67 Multiplan — PPO: $2,297.39
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH	Not listed in the file	Not listed in the file	$1,775.74 – $6,640
Prostate biopsy: rates for 6 insurance plans Aetna — Commercial: $6,640 Blue Shield of California — Covered California: $1,775.74 Anthem — Commercial/Covered California: 89.57% (a percentage in the contract, not a dollar amount) Anthem — MCS Commercial/Covered California: 89.57% (a percentage in the contract, not a dollar amount) Cigna — HMO: 74% (a percentage in the contract, not a dollar amount) Health Net — Commercial/Covered California PPO: 38.9% (a percentage in the contract, not a dollar amount)
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED;	Not listed in the file	Not listed in the file	$962.62 – $22,096.13
Prostate removal by laparoscope (radical prostatectomy): 10 of 31 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $13,671.74 Anthem — Medicare Advantage: $13,671.74 Astiva Health — Medicare Advantage: $15,038.91 Blue Shield of California — Medicare Advantage: $13,671.74 Bright Health — Commercial/Covered California: $21,874.78 Central Health Plan — Medicare Advantage: $13,671.74 Clever Care of California — Medicare Advantage: $15,038.91 Community Health Group — Medicare Advantage: $13,671.74 Health Net — Blue and Gold: $21,601.35
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C	Not listed in the file	Not listed in the file	$177.07 – $6,728.98
Hysteroscopy with biopsy of the uterus lining: 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $4,163.48 Anthem — Medicare Advantage: $4,163.48 Astiva Health — Medicare Advantage: $4,579.83 Blue Shield of California — Covered California: $2,951.71 Blue Shield of California — Medicare Advantage: $4,163.48 Bright Health — Commercial/Covered California: $6,661.57 Central Health Plan — Medicare Advantage: $4,163.48 Clever Care of California — Medicare Advantage: $4,579.83 Community Health Group — Medicare Advantage: $4,163.48
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CITY IR INJ LUMBAR/SACRAL W/IMAG GUID	$1,349.64	$809.78	$222.23 – $6,640
Spinal injection, lower back (epidural), with imaging guidance: 10 of 38 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $907.88 Anthem — Medicare Advantage: $907.88 Astiva Health — Medicare Advantage: $998.67 Blue Shield of California — Commercial: $592.49 Blue Shield of California — Covered California: $930.24 Blue Shield of California — Medicare Advantage: $907.88 Bright Health — Commercial/Covered California: $1,452.61 Central Health Plan — Medicare Advantage: $907.88 Cigna — PPO: $1,064.87
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CITY IR INJ LUMBAR/SACRAL W/IMAG GUID	$1,349.64	$809.78	$944.75 – $1,051.37
Spinal injection, lower back (epidural), with imaging guidance: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $1,051.37 Multiplan — PPO: $944.75
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CITY IR INJ ANES AGENT/STEROID; L/S	$1,765.71	$1,059.43	$144.77 – $6,640
Nerve root injection, lower back, with imaging guidance: 10 of 38 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $1,137.58 Anthem — Medicare Advantage: $1,137.58 Astiva Health — Medicare Advantage: $1,251.34 Blue Shield of California — Commercial: $775.15 Blue Shield of California — Covered California: $959.01 Blue Shield of California — Medicare Advantage: $1,137.58 Bright Health — Commercial/Covered California: $1,820.13 Central Health Plan — Medicare Advantage: $1,137.58 Cigna — PPO: $1,393.15
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CITY IR INJ ANES AGENT/STEROID; L/S	$1,765.71	$1,059.43	$1,236 – $1,375.49
Nerve root injection, lower back, with imaging guidance: rates for 2 insurance plans Health Net — Commercial/Covered California PPO: $1,375.49 Multiplan — PPO: $1,236
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL	Not listed in the file	Not listed in the file	$63.92 – $6,640
Carpal tunnel release: 10 of 32 insurance plan rates Aetna — Commercial: $6,640 Aetna — Medicare Advantage: $2,511.53 Anthem — Medicare Advantage: $2,511.53 Astiva Health — Medicare Advantage: $2,762.68 Blue Shield of California — Covered California: $2,422.90 Blue Shield of California — Medicare Advantage: $2,511.53 Bright Health — Commercial/Covered California: $4,018.45 Central Health Plan — Medicare Advantage: $2,511.53 Clever Care of California — Medicare Advantage: $2,762.68 Community Health Group — Medicare Advantage: $2,511.53

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	$58,408 – $157,712.26
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 29 insurance plan rates Aetna — Commercial: $63,854 Aetna — Medicare Advantage: $92,771.92 Anthem — Medicare Advantage: $92,771.92 Astiva Health — Medicare Advantage: $92,771.92 Blue Shield of California — Medicare Advantage: $92,771.92 Central Health Plan — Medicare Advantage: $92,771.92 Cigna — HMO: $58,408 Cigna — PPO: $58,763 Clever Care of California — Medicare Advantage: $92,771.92 Community Health Group — Medicare Advantage: $92,771.92
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 HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$16,569.38 – $32,191.93
Hip or knee replacement (major joint of the leg), without major complications: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $18,936.43 Anthem — Medicare Advantage: $18,936.43 Astiva Health — Medicare Advantage: $18,936.43 Blue Shield of California — Medicare Advantage: $18,936.43 Central Health Plan — Medicare Advantage: $18,936.43 Clever Care of California — Medicare Advantage: $18,936.43 Community Health Group — Medicare Advantage: $18,936.43 Health Net — Blue and Gold: $28,972.74 Health Net — Bronze Network (SmartCare): $27,079.09 Health Net — Medicare Advantage: $18,936.43
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	$20,784.37 – $40,381.07
Neck (cervical) spinal fusion, without complications: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $23,753.57 Anthem — Medicare Advantage: $23,753.57 Astiva Health — Medicare Advantage: $23,753.57 Blue Shield of California — Medicare Advantage: $23,753.57 Central Health Plan — Medicare Advantage: $23,753.57 Clever Care of California — Medicare Advantage: $23,753.57 Community Health Group — Medicare Advantage: $23,753.57 Health Net — Blue and Gold: $36,342.96 Health Net — Bronze Network (SmartCare): $33,967.61 Health Net — Medicare Advantage: $23,753.57
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	$10,908.26 – $21,193.19
Uterus and ovary surgery (not for cancer), without complications: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $12,466.58 Anthem — Medicare Advantage: $12,466.58 Astiva Health — Medicare Advantage: $12,466.58 Blue Shield of California — Medicare Advantage: $12,466.58 Central Health Plan — Medicare Advantage: $12,466.58 Clever Care of California — Medicare Advantage: $12,466.58 Community Health Group — Medicare Advantage: $12,466.58 Health Net — Blue and Gold: $19,073.87 Health Net — Bronze Network (SmartCare): $17,827.21 Health Net — Medicare Advantage: $12,466.58

Source: Tri-City Medical Center’s standard charges file (downloads.ctfassets.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on May 29, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	4002 Vista Way, Oceanside, CA 92056
County	San Diego County
State	California
Phone	(760) 724‑8411
Emergency services	Yes
Ownership	Government - Hospital District or Authority
Medicare overall rating	1 of 5 stars
CMS Certification Number	050128
Name in Medicare records	TRI-CITY MEDICAL CENTER
Profile level	Medicare data + hospital website
Name on the hospital’s website	Sharp Tri-City Medical Center
Official website	sharp.com
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 ZIP code areas (Gazetteer) — approximate position (center of the ZIP code area) used for distances

From the hospital’s website

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

Tri-City and Sharp HealthCare partnership — sharp.com
Sharp Tri-City Medical Center | Sharp HealthCare — sharp.com
Sharp Tri-City Medical Center Emergency Room | Sharp HealthCare — sharp.com

Tri-City Medical Center

Summary

Profile from official sources

At a glance