Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
C OT EVAL LOW COMPLEXITY
Puyallup, WA
See all hospitals reporting CPT 97165 →Price type
Good Samaritan Hospital’s median price of $120 is 23% below the median hospital's median price ($155), higher than 35% of the 2,514 hospitals reporting CPT 97165. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 11 payers, 24 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Molina apple health fee schedule · outpatient | $59.12 | $59.12 | $59.12 – $59.12 |
| 2 | UnitedHealthcare apple health fee schedule · outpatient | $63.85 | $63.85 | $63.85 – $63.85 |
| 3 | UnitedHealthcare all commercial plans fee schedule · outpatient | $91.58 | $91.58 | $91.58 – $91.58 |
| 4 | Aetna medadvantage fee schedule · outpatient | $104.68 | $104.68 | $104.68 – $104.68 |
| 5 | Regence medadvantage fee schedule · outpatient | $104.68 | $104.68 | $104.68 – $104.68 |
| 6 | UnitedHealthcare medadvantage fee schedule · outpatient | $105.70 | $105.70 | $105.70 – $105.70 |
| 7 | Molina medadvantage fee schedule · outpatient | $106.72 | $106.72 | $106.72 – $106.72 |
| 8 | WellCare medadvantage fee schedule · outpatient | $106.72 | $106.72 | $106.72 – $106.72 |
| 9 | Regence blue high performance fee schedule · outpatient | $110.68 | $110.68 | $110.68 – $110.68 |
| 10 | Regence mcc/ahn fee schedule · outpatient | $110.68 | $110.68 | $110.68 – $110.68 |
| 11 | Regence realvalue fee schedule · outpatient | $113.84 | $113.84 | $113.84 – $113.84 |
| 12 | Regence commercial fee schedule · outpatient | $126.49 | $126.49 | $126.49 – $126.49 |
| 13 | Cigna all commercial plans fee schedule · outpatient | $158.82 | $158.82 | $158.82 – $158.82 |
| 14 | Premera hmo fee schedule · outpatient | $164.50 | $164.50 | $164.50 – $164.50 |
| 15 | Aetna all commercial plans percent of total billed charges · outpatientfrom % of charges | $181.73 | $181.73 | $181.73 – $181.73 |
| 16 | Premera prime fee schedule · outpatient | $182.79 | $182.79 | $182.79 – $182.79 |
| 17 | Premera signature fee schedule · outpatient | $182.79 | $182.79 | $182.79 – $182.79 |
| 18 | Ambetter coordinated care exchange fee schedule · outpatient | $203.27 | $203.27 | $203.27 – $203.27 |
| 19 | Premera other commercial plans fee schedule · outpatient | $223.41 | $223.41 | $223.41 – $223.41 |
| 20 | First Health all commercial plans percent of total billed charges · inpatientfrom % of charges | $262.80 | $262.80 | $262.80 – $262.80 |
| 21 | First Health all commercial plans percent of total billed charges · outpatientfrom % of charges | $262.80 | $262.80 | $262.80 – $262.80 |
| 22 | MultiPlan all commercial plans percent of total billed charges · inpatientfrom % of charges | $262.80 | $262.80 | $262.80 – $262.80 |
| 23 | MultiPlan all commercial plans percent of total billed charges · outpatientfrom % of charges | $262.80 | $262.80 | $262.80 – $262.80 |
| 24 | Kaiser ppo fee schedule · outpatient | $470.73 | $470.73 | $470.73 – $470.73 |
Last updated: Aug 27, 2026
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