Ambetter: disclosed hospital rates

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Based on the published hospital price files, Ambetter appears in disclosed negotiated rates across 6 hospitals and 4624 services. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

4,624 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
""Y SET"" TUBING Outpatient	CHRISTUS St. Vincent Regional Medical Center	A4719 HCPCS	—	—	—	—
""Y SET"" TUBING Outpatient	Novant Health Brunswick Medical Center	A4719 HCPCS	—	—	—	—
& CHLAMYDIA AG DFA Outpatient	Novant Health Brunswick Medical Center	87270 CPT	$225	$113	$12.83 – $218	—
<50% TOTAL PT OUTPT RA ENCTS Outpatient	CHRISTUS St. Vincent Regional Medical Center	M1008 HCPCS	—	—	—	—
<50% TOTAL PT OUTPT RA ENCTS Outpatient	Novant Health Brunswick Medical Center	M1008 HCPCS	—	—	—	—
<6YR NEW ONSET HD ACHE Outpatient	CHRISTUS St. Vincent Regional Medical Center	G2193 HCPCS	—	—	—	—
<6YR NEW ONSET HD ACHE Outpatient	Novant Health Brunswick Medical Center	G2193 HCPCS	—	—	—	—
>= 2 SAME HI-RSK MED NOT ORD Outpatient	CHRISTUS St. Vincent Regional Medical Center	G9368 HCPCS	—	—	—	—
>= 2 SAME HI-RSK MED NOT ORD Outpatient	Novant Health Brunswick Medical Center	G9368 HCPCS	—	—	—	—
>= 2 SAME HI-RSK MED ORD Outpatient	CHRISTUS St. Vincent Regional Medical Center	G9367 HCPCS	—	—	—	—
>= 2 SAME HI-RSK MED ORD Outpatient	Novant Health Brunswick Medical Center	G9367 HCPCS	—	—	—	—
>=2 SAME HI-RSK MED W/O DIAG Outpatient	CHRISTUS St. Vincent Regional Medical Center	M1209 HCPCS	—	—	—	—
>=2 SAME HI-RSK MED W/O DIAG Outpatient	Novant Health Brunswick Medical Center	M1209 HCPCS	—	—	—	—
>=2 SAME MEDS TBL4 NOT ORD Outpatient	CHRISTUS St. Vincent Regional Medical Center	M1210 HCPCS	—	—	—	—
>=2 SAME MEDS TBL4 NOT ORD Outpatient	Novant Health Brunswick Medical Center	M1210 HCPCS	—	—	—	—
>=50% TOTAL PT OUTPT RA ENCT Outpatient	CHRISTUS St. Vincent Regional Medical Center	M1007 HCPCS	—	—	—	—
>=50% TOTAL PT OUTPT RA ENCT Outpatient	Novant Health Brunswick Medical Center	M1007 HCPCS	—	—	—	—
>=86Y NO HX COLO CA/RSN SCOP Outpatient	CHRISTUS St. Vincent Regional Medical Center	G9659 HCPCS	—	—	—	—
>=86Y NO HX COLO CA/RSN SCOP Outpatient	Novant Health Brunswick Medical Center	G9659 HCPCS	—	—	—	—
>55 YRS TEMP HD ACHE Outpatient	CHRISTUS St. Vincent Regional Medical Center	G2192 HCPCS	—	—	—	—
>55 YRS TEMP HD ACHE Outpatient	Novant Health Brunswick Medical Center	G2192 HCPCS	—	—	—	—
0.45% NaCl + KCl 20 mEq/L infusion Outpatient	CHRISTUS St. Vincent Regional Medical Center	J3480 HCPCS	$118	$70.67	$17.66 – $106	—
0.9% NaCl + KCl 20 mEq/L infusion Outpatient	CHRISTUS St. Vincent Regional Medical Center	J3480 HCPCS	$1.00	$0.60	$0.15 – $0.90	—
0.9% NaCl + KCl 40 mEq/L infusion Outpatient	CHRISTUS St. Vincent Regional Medical Center	J3480 HCPCS	$4.00	$2.40	$0.60 – $3.60	—
1 ADMN RSV MONOC ANTB IM NJX Outpatient	CHRISTUS St. Vincent Regional Medical Center	96381 CPT	—	—	—	—