Medical Service Cost Estimator

Please note: The ability to price a service using this tool does not indicate that the service is covered. The amount for which you will be responsible may be a simple copayment, a percentage of the service cost, or the entire service cost, depending on the plan you choose. To understand the benefit coverage and share of costs, please refer to the plan Copayment Summary and Combined Evidence of Coverage and Disclosure Forms (EOC/DF).

This Service Cost Estimator presents the estimated cost of each service as allowed by WHA's contractual agreements within the last year. The exact costs for services may vary, depending on the PCP's or specialist's medical group, the number of units rendered, procedure codes billed, whether the service is rendered in-network versus out-of-network, and other factors that are not reflected in this tool (for example, when procedures require anesthesia or other related facility or professional services, these may be billed separately). As such, these costs are simply estimates, and should be used as a guideline only. This tool is intended for member use only. The costs displayed represent the basis for calculating the member share of cost and may not represent the amount WHA actually pays a contracted provider when WHA is responsible for payment.

Individual facilities or health care providers may disagree with the methodology used to define the cost ranges, the cost data, or quality measures. Many factors may influence cost or quality, including, but not limited to, the cost of uninsured and charity care, the type and severity of procedures, the case mix of a facility, special services such as trauma centers, burn units, medical and other educational programs, research, transplant services, technology, payer mix, and other factors affecting individual facilities and health care providers.