Provider Partners Health Plan: disclosed hospital rates

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Based on the published hospital price files, Provider Partners Health Plan appears in disclosed negotiated rates across 5 hospitals and 54 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.

54 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
17-hydroxypregnenolone (hormone) level Outpatient	Jefferson Bucks Hospital	84143 CPT	—	—	$15.97 – $252	—
17-hydroxypregnenolone (hormone) level Outpatient	Jefferson Cherry Hill Hospital	84143 CPT	—	—	$15.97 – $321	—
17-hydroxypregnenolone (hormone) level Outpatient	Jefferson Frankford Hospital	84143 CPT	—	—	$15.97 – $252	—
1ST PSYC COLLAB CARE MGMT Outpatient	CHRISTUS Health - West Beaumont	99492 CPT	—	—	$92.65 – $185	—
2019-NCOV DIAGNOSTIC P Outpatient	CHRISTUS Health - West Beaumont	U0001 HCPCS	—	—	$32.33 – $183	—
2D CEPHAL RADIO IMAGE Outpatient	CHRISTUS Health - West Beaumont	D0702 HCPCS	—	—	$88.19 – $176	—
2D CEPHALOMETRIC IMAGE Outpatient	CHRISTUS Health - West Beaumont	D0340 HCPCS	—	—	$88.19 – $176	—
2D ORAL/FACIAL PHOTO IMAGE Outpatient	CHRISTUS Health - West Beaumont	D0703 HCPCS	—	—	$88.19 – $176	—
2D TTE W OR W/O FOL W/CON,CO Outpatient	CHRISTUS Health - West Beaumont	C8923 HCPCS	—	—	$195 – $3,248	—
3-d radiotherapy plan Outpatient	Jefferson Cherry Hill Hospital	77295 CPT	—	—	$418 – $7,215	—
3-D RADIOTHERAPY PLAN Outpatient	CHRISTUS Health - West Beaumont	77295 CPT	—	—	$685 – $2,741	—
3d anatomical segmentation imaging for preoperative planning, data preparation and transmission, obtained from previous diagnostic computed tomographic or magnetic resonance examination of the same anatomy Outpatient	CHRISTUS Health - West Beaumont	C8001 HCPCS	—	—	$88.19 – $420	—
3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation Outpatient	CHRISTUS Health - West Beaumont	944T CPT	—	—	$242 – $484	—
ABATACEPT INJECTION Outpatient	CHRISTUS Health - West Beaumont	J0129 HCPCS	—	—	$43.38 – $247	—
ABDOMINAL PARACENTESIS W/ IMAGING GUIDANCE-EFOU Outpatient	University of Missouri Health Care	1949083 CDM	$2,313	$1,388	$891 – $2,650	—
ABL1 GENE Outpatient	CHRISTUS Health - West Beaumont	81170 CPT	—	—	$150 – $1,530	—
ABLATE BONE TUMOR(S) PERQ Outpatient	CHRISTUS Health - West Beaumont	20983 CPT	—	—	$1,935 – $15,219	—
ADMINISTRATION OF PNEUMOCOCCAL VACCINE-EAC Outpatient	University of Missouri Health Care	205600009 CDM	$85.00	$51.00	$43.87 – $45.58	—
ADMINISTRATION OF PNEUMOCOCCAL VACCINE-EFOU Outpatient	University of Missouri Health Care	1900009 CDM	$85.00	$51.00	$43.87 – $45.58	—
APPLICATION ON-BODY INJECTOR FOR TIMED SUBQ INJECTION-EFOU Outpatient	University of Missouri Health Care	1996377 CDM	$146	$87.60	$43.87 – $45.58	—
BIOPSY OROPHARYNX-EFOU Outpatient	University of Missouri Health Care	1942800 CDM	$3,721	$2,233	$1,017 – $1,980	—
CHEMO ADMIN CNS REQUIRING AND INCLUDING SPINAL PUNCTURE-EFOU Outpatient	University of Missouri Health Care	1996450 CDM	$1,122	$673	$315 – $328	—
CYSTOURETHROSCOPY W/INSERTION INDWELLING URETERAL STENT-EFOU Outpatient	University of Missouri Health Care	1952332 CDM	$6,405	$3,843	$3,145 – $5,200	—
DIAGNOSTIC BONE MARROW BIOPSY(IES) AND ASPIRATION(S)-EFOU Outpatient	University of Missouri Health Care	1938222 CDM	$3,788	$2,273	$1,017 – $2,827	—
FACILITY LEVEL 1-EFOU Outpatient	University of Missouri Health Care	1999211 CDM	$184	$110	$123 – $127	—