Does Auburn Community Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Auburn Community Hospital. In a medical emergency, call 911.

Where is Auburn Community Hospital?

17 Lansing Street, Auburn, NY 13021, in Cayuga County, New York.

What is the phone number of Auburn Community Hospital?

(315) 255-7011, as listed by Medicare (CMS).

What is the Medicare star rating of Auburn Community Hospital?

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

Auburn Community Hospital — Auburn, NY

Quick answers

Does Auburn Community Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Auburn Community Hospital. In a medical emergency, call 911.
Where is Auburn Community Hospital?: 17 Lansing Street, Auburn, NY 13021, in Cayuga County, New York.
What is the phone number of Auburn Community Hospital?: (315) 255-7011, as listed by Medicare (CMS).
What is the Medicare star rating of Auburn Community Hospital?: 2 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^{[4][7][8][9][10][11][12][13][14][15]}

Maternity (Stardust Birthing Center)
Radiology and diagnostic imaging
Stroke care
Emergency medicine
Cardiology
General surgery
Critical care
Psychiatry
Pulmonary and sleep medicine
Clinical laboratory
Anesthesiology
Ophthalmology
Urology

Conditions treated^{[4][11][13][14]}

Stroke
Heart attack
Congestive heart failure
Obstructive sleep apnea
Central sleep apnea

Treatments^[6][11][13]

Chemotherapy
Cardiac rehabilitation
Telemetry monitoring
Ventilator support
Hemodynamic monitoring
Stereotactic breast biopsy
Ultrasound-guided breast biopsy

Procedures^{[6][9][10][14][15]}

Breast surgery
Colorectal surgery
Esophageal surgery
Gallbladder and bile duct surgery
Hernia repair
Skin surgery
Thyroid surgery
CT scan
MRI
PET/CT
Nuclear medicine
Fluoroscopy
Interventional radiology
X-ray
Bone densitometry
3D digital mammography
Echocardiography
Electrocardiography (ECG/EKG)
Holter monitoring
Ankle brachial index
Electroencephalogram (EEG)
Sleep studies
Blood bank services
Cytology

Programs and centers^{[4][6][8][9][12][13][14][15]}

Stroke care with UR Medicine Strong Memorial Hospital
Stardust Birthing Center
Emergency Department (fast track and Emergency Care Unit)
Behavioral health inpatient unit (14 beds)
Cardiac rehabilitation program
Sleep Center
Women's Imaging Suite
Outpatient surgery (one-day surgery) unit
Core laboratory

Emergency care (hospital website)^[4][8]

Emergency room	Yes
Open 24/7	Yes
Stroke designation	A Designated Stroke Center in conjunction with UR Medicine Strong Memorial Hospital

Visiting and practical information

Visiting	Varies by unit; most inpatient units noon to 8 p.m., 2 visitors per patient per day; behavioral health weekdays 6-8 p.m^[5]
Parking	Enter through the main parking garage entrance^[5]
Patient portal	FollowMyHealth

Recognition^{[4][6][14][15]}

Designated Stroke Center (with UR Medicine Strong Memorial Hospital)
Designated Stroke Center (in conjunction with UR Medicine Strong Memorial Hospital)
American Association of Sleep Medicine (AASM) accredited Sleep Center
American College of Radiology accreditation for CT, MRI and mammography
Accredited and inspected laboratory of the New York State Department of Health and The Joint Commission

Doctors and clinicians (336)

336 doctors and other clinicians list Auburn Community Hospital 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 312 more: the button below opens the full list.

Other emergency rooms nearby

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

Geneva General Hospital22 mi · Geneva, NY · Acute Care Hospital
St Joseph's Hospital Health Center22 mi · Syracuse, NY · Acute Care Hospital
Hutchings Psychiatric Ctr22 mi · Syracuse, NY · Psychiatric Hospital
University Hospital S U N y Health Science Center22 mi · Syracuse, NY · Acute Care Hospital
Syracuse VA Medical Center22 mi · Syracuse, NY · Federal/VA Acute Care Hospital

Other hospitals nearby

Crouse Hospital23 mi · Syracuse, NY · Acute Care 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

Finger Lakes Center for Living0.1 mi · Auburn, NY · 1 of 5 stars
The Commons on St Anthony, A S N F & Short T R C1.8 mi · Auburn, NY · 3 of 5 stars
Auburn Rehabilitation & Nursing Center2.0 mi · Auburn, NY · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Hospice of Central New York22 mi · Liverpool, NY · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Nascentia Health at Home21 mi · Syracuse, NY · 4 of 5 stars
Centerwell Home Health22 mi · Liverpool, NY · 5 of 5 stars

All home health agencies in the state →

Dialysis facilities

Univ Dialysis Ctr @ Auburn1.6 mi · Auburn, NY · 2 of 5 stars
FMC St. Joseph's - Camillus15 mi · Camillus, NY · 2 of 5 stars
DaVita Central New York Dialysis Center23 mi · Syracuse, NY · 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.

Camillus Surgery Center15 mi · Camillus, NY
Endoscopic Procedure Center15 mi · Camillus, NY
Intrepid Lane Endoscopy and Surgery Center22 mi · Syracuse, NY

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

EHMC Family and Pediatric Medicine0.5 mi · Auburn, NY · Community health center
EHMC Adult Medicine0.8 mi · Auburn, NY · Community health center
EHMC Dental0.8 mi · Auburn, NY · Community health center

Clinics and urgent care

Soldiers & Sailors Memorial Hospital11 mi · Seneca Falls, NY · Rural health clinic
Soldiers & Sailors Memorial Hospital16 mi · Waterloo, NY · Rural health clinic
Urgent Medical Care of Syracuse P.C.19 mi · Baldwinsville, NY · Urgent care center

Pharmacies

State of New York Office of State Comptroller0.7 mi · Auburn, NY · Pharmacy
Auburn Community Hospital1.6 mi · Auburn, NY · Community/retail pharmacy
Eckerd Corporation1.6 mi · Auburn, NY · Pharmacy

Assisted living nearby

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

Faatz-Crofut Home for the Elderly1.6 mi · Auburn, NY
North Brook Heights Home for Adults1.6 mi · Auburn, NY
Westminster Manor1.6 mi · Auburn, NY
The Athenaeum of Skaneateles9.5 mi · Skaneateles, NY

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 Auburn Community Hospital 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	1 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	1 of 5 stars
Quiet at night	1 of 5 stars
Rated the hospital 9 or 10 out of 10	52%National average: 72%
Would definitely recommend the hospital	50%National average: 71%
Nurses “always” communicated well	70%National average: 80%
Doctors “always” communicated well	69%National average: 80%
Staff “always” explained medicines before giving them	48%National average: 62%
Were given information about recovery at home	88%National average: 86%
Room and bathroom “always” clean	52%National average: 74%
Area around the room “always” quiet at night	36%National average: 60%
Completed surveys	475Response 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)	0No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0No different from the national benchmark
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	0Better 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	Too few cases to report
Deaths within 30 days: heart failure patients	12.9%
Deaths within 30 days: pneumonia patients	16.9%
Deaths within 30 days: COPD patients	7%
Deaths within 30 days: stroke patients	14.1%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	1.05No different from the national rate
Complications after hip or knee replacement	5.2%

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	Too few cases to report
Readmitted within 30 days: heart failure	23.7%
Readmitted within 30 days: pneumonia	19.8%
Readmitted within 30 days: COPD	20.7%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	5.7%

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)	Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	224 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	3%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	44%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 New York Best hospitals in New York

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 66 common services exactly as Auburn Community Hospital 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) In the file: OFFICE OR OTHER OUTPTLEVL 3	$204.75	$69.46	$35.39 – $479.10
New patient office visit (about 30–44 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $159.71 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $128.99 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $51.82 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: HOSPITALIST-OFFICE OR OTHER OUTPTLEVL 3	$204.75	$110.80	$35.39 – $479.10
New patient office visit (about 30–44 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $159.71 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $128.99 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $51.82 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: NEW PATIENT OFFICE	$365.93	$92.14	$35.39 – $479.10
New patient office visit (about 30–44 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $285.43 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $230.54 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $92.62 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: FACILITY NEW VISIT COMPLEX	$255.09	$110.80	$58.81 – $479.10
New patient office visit (about 45–59 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $198.97 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $160.71 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $64.56 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: NEW LEVEL 4 FACILITY	$358.82	$136.44	$58.81 – $479.10
New patient office visit (about 45–59 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $279.88 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $226.06 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $90.82 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: FACILITY NEW LEVEL 4	$255.09	$161.47	$58.81 – $479.10
New patient office visit (about 45–59 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $198.97 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $160.71 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $64.56 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: FACILITY NEW LEVEL 5	$336.79	$186.64	$85.24 – $479.10
New patient office visit (about 60–74 minutes): 10 of 35 insurance plan rates AETNA — AETNA: $262.70 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $212.18 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $85.24 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: VISIT-NEW-LEVEL V	$476.18	$151.56	$85.24 – $479.10
New patient office visit (about 60–74 minutes): 10 of 35 insurance plan rates AETNA — AETNA: $371.42 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $299.99 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $120.52 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: NEW PATIENT OFFICE	$476.18	$214.28	$85.24 – $479.10
New patient office visit (about 60–74 minutes): 10 of 35 insurance plan rates AETNA — AETNA: $371.42 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $299.99 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $120.52 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: OFFICE / OP VISIT LEVEL 3	$98.96	$115.06	$22.62 – $479.10
Established patient office visit (about 20–29 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $77.19 AETNA_MCAREHMO — AETNA MEDICARE HMO: $98.96 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $62.34 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $25.05 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: EST PATIENT LEVEL III	$310.80	$44.53	$22.62 – $479.10
Established patient office visit (about 20–29 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $242.42 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $195.80 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $78.66 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: EST DETAILED FACILITY	$310.80	$139.86	$22.62 – $479.10
Established patient office visit (about 20–29 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $242.42 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $195.80 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $78.66 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: OUTPATIENT VISIT FOR THE E M OF AN ESTAB	$366.45	$111.63	$22.62 – $479.10
Established patient office visit (about 30–39 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $285.83 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $230.86 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $92.75 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: HOSP- OFFICE/OP VISIT EST LEVEL 4	$204.75	$164.90	$22.62 – $479.10
Established patient office visit (about 30–39 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $159.71 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $128.99 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $51.82 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: RADONC- ESTABLISHED PATIENT OFFICE	$365.93	$92.14	$22.62 – $479.10
Established patient office visit (about 30–39 minutes): 10 of 36 insurance plan rates AETNA — AETNA: $285.43 AETNA_MCAREHMO — AETNA MEDICARE HMO: $163.33 CIGNA — CIGNA: $296.13 EXCELLUS-BC — EXCELLUS BLUE CROSS: $230.54 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $163.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $92.62 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: OFFICE/ER CONSULT LEVEL 3	$230.48	$77.37	$119.37 – $479.10
Office consultation with a specialist (moderate): 10 of 17 insurance plan rates AETNA — AETNA: $179.77 CIGNA — CIGNA: $161.34 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92 FIDELIS_1402 — FIDELIS EMERGENCY ROOM: $132.01 LIFETIME_BEN — LIFETIME BENEFITS: $145.20 MVP — MVP HEALTH CARE: $161.34 MVP_EXCHANGE — MVP INSURANCE EXCHANGE: $161.34
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: HOSP/PSYCH ED CONSULT	$229.95	$103.72	$119.37 – $479.10
Office consultation with a specialist (moderate): 10 of 17 insurance plan rates AETNA — AETNA: $179.36 CIGNA — CIGNA: $160.97 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92 FIDELIS_1402 — FIDELIS EMERGENCY ROOM: $132.01 LIFETIME_BEN — LIFETIME BENEFITS: $144.87 MVP — MVP HEALTH CARE: $160.97 MVP_EXCHANGE — MVP INSURANCE EXCHANGE: $160.97
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: HOSPITALIST- OFFICE/ER CONSULT LEVEL 3	$223.91	$103.48	$119.37 – $479.10
Office consultation with a specialist (moderate): 10 of 17 insurance plan rates AETNA — AETNA: $174.65 CIGNA — CIGNA: $156.74 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92 FIDELIS_1402 — FIDELIS EMERGENCY ROOM: $132.01 LIFETIME_BEN — LIFETIME BENEFITS: $141.06 MVP — MVP HEALTH CARE: $156.74 MVP_EXCHANGE — MVP INSURANCE EXCHANGE: $156.74
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: HOSP/PSYCH ED CONSULT	$326.29	$100.76	$119.37 – $479.10
Office consultation with a specialist (moderate to high): 10 of 17 insurance plan rates AETNA — AETNA: $254.51 CIGNA — CIGNA: $228.40 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92 FIDELIS_1402 — FIDELIS EMERGENCY ROOM: $132.01 LIFETIME_BEN — LIFETIME BENEFITS: $205.56 MVP — MVP HEALTH CARE: $228.40 MVP_EXCHANGE — MVP INSURANCE EXCHANGE: $228.40
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: HOSPITALIST- OFFICE/ER CONSULT LEVEL 4	$317.63	$146.83	$119.37 – $479.10
Office consultation with a specialist (moderate to high): 10 of 17 insurance plan rates AETNA — AETNA: $247.75 CIGNA — CIGNA: $222.34 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92 FIDELIS_1402 — FIDELIS EMERGENCY ROOM: $132.01 LIFETIME_BEN — LIFETIME BENEFITS: $200.11 MVP — MVP HEALTH CARE: $222.34 MVP_EXCHANGE — MVP INSURANCE EXCHANGE: $222.34
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: HOSP- PSYCH OFFICE/ER CONSULT LEVEL 4	$326.29	$142.93	$119.37 – $479.10
Office consultation with a specialist (moderate to high): 10 of 17 insurance plan rates AETNA — AETNA: $254.51 CIGNA — CIGNA: $228.40 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92 FIDELIS_1402 — FIDELIS EMERGENCY ROOM: $132.01 LIFETIME_BEN — LIFETIME BENEFITS: $205.56 MVP — MVP HEALTH CARE: $228.40 MVP_EXCHANGE — MVP INSURANCE EXCHANGE: $228.40
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: E M MODERATE COMPLEXITY	$450.71	$83.75	$119.37 – $962.04
Emergency room visit (moderate): 10 of 37 insurance plan rates AETNA — AETNA: $351.55 AETNA_MCAREHMO — AETNA MEDICARE HMO: $350.92 CIGNA — CIGNA: $636.27 EXCELLUS-BC — EXCELLUS BLUE CROSS: $962.04 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $350.92 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $218.19 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: ER LEVEL III	$450.71	$202.82	$119.37 – $962.04
Emergency room visit (moderate): 10 of 37 insurance plan rates AETNA — AETNA: $351.55 AETNA_MCAREHMO — AETNA MEDICARE HMO: $350.92 CIGNA — CIGNA: $636.27 EXCELLUS-BC — EXCELLUS BLUE CROSS: $962.04 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $350.92 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $218.19 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: LEVEL III-TYPE B	$338.36	$55.87	$119.37 – $962.04
Emergency room visit (moderate): 10 of 37 insurance plan rates AETNA — AETNA: $263.92 AETNA_MCAREHMO — AETNA MEDICARE HMO: $338.36 CIGNA — CIGNA: $636.27 EXCELLUS-BC — EXCELLUS BLUE CROSS: $962.04 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $350.92 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $218.19 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: ER LEVEL IV NS ADMIT	$720.04	$162.18	$119.37 – $1,493.40
Emergency room visit (moderately high): 10 of 37 insurance plan rates AETNA — AETNA: $561.63 AETNA_MCAREHMO — AETNA MEDICARE HMO: $539.68 CIGNA — CIGNA: $978.50 EXCELLUS-BC — EXCELLUS BLUE CROSS: $1,493.40 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $539.68 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $335.54 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: LEVEL IV-TYPE B	$539.96	$324.02	$119.37 – $1,493.40
Emergency room visit (moderately high): 10 of 37 insurance plan rates AETNA — AETNA: $421.17 AETNA_MCAREHMO — AETNA MEDICARE HMO: $539.68 CIGNA — CIGNA: $978.50 EXCELLUS-BC — EXCELLUS BLUE CROSS: $1,493.40 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $539.68 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $335.54 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: ER LEVEL IV	$720.04	$148.37	$119.37 – $1,493.40
Emergency room visit (moderately high): 10 of 37 insurance plan rates AETNA — AETNA: $561.63 AETNA_MCAREHMO — AETNA MEDICARE HMO: $539.68 CIGNA — CIGNA: $978.50 EXCELLUS-BC — EXCELLUS BLUE CROSS: $1,493.40 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $539.68 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $335.54 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: E M HIGH COMPLEXITY	$1,061.03	$216.17	$119.37 – $2,165.75
Emergency room visit (high): 10 of 37 insurance plan rates AETNA — AETNA: $827.60 AETNA_MCAREHMO — AETNA MEDICARE HMO: $777.03 CIGNA — CIGNA: $1,408.85 EXCELLUS-BC — EXCELLUS BLUE CROSS: $2,165.75 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $777.03 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $483.12 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: ER LEVEL V	$1,061.03	$183.33	$119.37 – $2,165.75
Emergency room visit (high): 10 of 37 insurance plan rates AETNA — AETNA: $827.60 AETNA_MCAREHMO — AETNA MEDICARE HMO: $777.03 CIGNA — CIGNA: $1,408.85 EXCELLUS-BC — EXCELLUS BLUE CROSS: $2,165.75 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $777.03 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $483.12 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: ER CONSULT LEVEL 5	$309.75	$324.02	$119.37 – $2,165.75
Emergency room visit (high): 10 of 34 insurance plan rates AETNA — AETNA: $241.61 AETNA_MCAREHMO — AETNA MEDICARE HMO: $309.75 CIGNA — CIGNA: $1,408.85 EXCELLUS-BC — EXCELLUS BLUE CROSS: $2,165.75 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $777.03 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $483.12 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $479.10 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $297.01 FIDELIS_1400 — FIDELIS CLINIC: $119.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $212.92

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: BASIC METABOLIC PNL>2000	$141.23	$55.28	$7.19 – $244.08
Basic metabolic panel (blood test): 10 of 40 insurance plan rates AETNA — AETNA: $14.38 AETNA_MCAREHMO — AETNA MEDICARE HMO: $8.46 CIGNA — CIGNA: $16.05 EXCELLUS-BC — EXCELLUS BLUE CROSS: $8.04 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $8.46 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $8.04 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $12.69 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $244.08 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $57.24 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $7.25
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: COMPREHENSIVE METABOLIC PANEL>2000	$50.66	$235.07	$8.98 – $329.10
Comprehensive metabolic panel (blood test): 10 of 40 insurance plan rates AETNA — AETNA: $17.95 AETNA_MCAREHMO — AETNA MEDICARE HMO: $10.56 CIGNA — CIGNA: $20.04 EXCELLUS-BC — EXCELLUS BLUE CROSS: $10.03 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $10.56 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $10.03 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $17.50 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $302.77 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $115.93 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $10
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: OBSTETRICAL PANEL	$154.09	$235.07	$40.64 – $302.77
Obstetric blood test panel: 10 of 35 insurance plan rates AETNA — AETNA: $81.28 AETNA_MCAREHMO — AETNA MEDICARE HMO: $47.81 CIGNA — CIGNA: $90.71 EXCELLUS-BC — EXCELLUS BLUE CROSS: $45.42 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $47.81 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $45.42 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $302.77 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $115.93 FIDELIS_1400 — FIDELIS CLINIC: $48.30 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $134.56
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: LIPID PANEL	$162.49	$69.34	$6.04 – $302.77
Cholesterol panel (lipid panel): 10 of 42 insurance plan rates AETNA — AETNA: $22.76 AETNA_MCAREHMO — AETNA MEDICARE HMO: $13.39 CIGNA — CIGNA: $25.40 EXCELLUS-BC — EXCELLUS BLUE CROSS: $12.72 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $13.39 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $12.72 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $10.57 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $302.77 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $115.93 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $6.04
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL FUNCTION PANEL	$531.30	$82.93	$7.38 – $334.72
Kidney function panel: 10 of 40 insurance plan rates AETNA — AETNA: $14.76 AETNA_MCAREHMO — AETNA MEDICARE HMO: $8.68 CIGNA — CIGNA: $16.47 EXCELLUS-BC — EXCELLUS BLUE CROSS: $8.25 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $8.68 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $8.25 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $15.19 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $302.77 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $115.93 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $8.68
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HEPATIC FUNCTION PANEL	$37.28	$221.49	$6.94 – $302.77
Liver function panel: 10 of 40 insurance plan rates AETNA — AETNA: $13.89 AETNA_MCAREHMO — AETNA MEDICARE HMO: $8.17 CIGNA — CIGNA: $15.50 EXCELLUS-BC — EXCELLUS BLUE CROSS: $7.76 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $8.17 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $7.76 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $12.69 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $302.77 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $115.93 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $7.25
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: URINALYSIS WITH MICRO	$59.06	$36.62	$2.69 – $268.04
Urine test (automated, with microscope): 10 of 40 insurance plan rates AETNA — AETNA: $5.39 AETNA_MCAREHMO — AETNA MEDICARE HMO: $3.17 CIGNA — CIGNA: $6.01 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3.01 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $3.17 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $3.01 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $5.55 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $268.04 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $81.20 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $3.17
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: URINE DIPSTICK	$43.58	$26.58	$2 – $268.04
Urine test (manual, without microscope): 10 of 40 insurance plan rates AETNA — AETNA: $5.92 AETNA_MCAREHMO — AETNA MEDICARE HMO: $3.48 CIGNA — CIGNA: $6.60 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3.31 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $3.48 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $3.31 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $3.50 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $268.04 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $81.20 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $2
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: GLUCOSE URINE DIPSTICK	$30.19	$19.61	$2 – $268.04
Urine test (manual, without microscope): 10 of 40 insurance plan rates AETNA — AETNA: $5.92 AETNA_MCAREHMO — AETNA MEDICARE HMO: $3.48 CIGNA — CIGNA: $6.60 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3.31 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $3.48 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $3.31 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $3.50 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $268.04 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $81.20 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $2
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: GLUCOSE URINE RANDOM	$50.40	$13.59	$2 – $268.04
Urine test (manual, without microscope): 10 of 40 insurance plan rates AETNA — AETNA: $5.92 AETNA_MCAREHMO — AETNA MEDICARE HMO: $3.48 CIGNA — CIGNA: $6.60 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3.31 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $3.48 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $3.31 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $3.50 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $268.04 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $81.20 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $2
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: PH URINE	$30.19	$22.68	$1.91 – $268.04
Urine test (automated, without microscope): 10 of 40 insurance plan rates AETNA — AETNA: $3.83 AETNA_MCAREHMO — AETNA MEDICARE HMO: $2.25 CIGNA — CIGNA: $4.27 EXCELLUS-BC — EXCELLUS BLUE CROSS: $2.14 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $2.25 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $2.14 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $3.50 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $268.04 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $81.20 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $2
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: KETONES URINE	$30.71	$13.59	$1.91 – $268.04
Urine test (automated, without microscope): 10 of 40 insurance plan rates AETNA — AETNA: $3.83 AETNA_MCAREHMO — AETNA MEDICARE HMO: $2.25 CIGNA — CIGNA: $4.27 EXCELLUS-BC — EXCELLUS BLUE CROSS: $2.14 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $2.25 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $2.14 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $3.50 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $268.04 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $81.20 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $2
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: BILE URINE	$25.20	$13.82	$1.91 – $268.04
Urine test (automated, without microscope): 10 of 40 insurance plan rates AETNA — AETNA: $3.83 AETNA_MCAREHMO — AETNA MEDICARE HMO: $2.25 CIGNA — CIGNA: $4.27 EXCELLUS-BC — EXCELLUS BLUE CROSS: $2.14 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $2.25 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $2.14 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $3.50 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $268.04 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $81.20 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $2
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PROSTATIC SPECIFIC ANTIGEN	$106.31	$51.62	$15.63 – $268.51
PSA (prostate specific antigen) blood test: 10 of 40 insurance plan rates AETNA — AETNA: $31.26 AETNA_MCAREHMO — AETNA MEDICARE HMO: $18.39 CIGNA — CIGNA: $34.89 EXCELLUS-BC — EXCELLUS BLUE CROSS: $17.47 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $18.39 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $17.47 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $32.18 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $268.51 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $81.67 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA TOTAL ( REFLEX TO FREE )	$106.31	$47.84	$15.63 – $268.51
PSA (prostate specific antigen) blood test: 10 of 40 insurance plan rates AETNA — AETNA: $31.26 AETNA_MCAREHMO — AETNA MEDICARE HMO: $18.39 CIGNA — CIGNA: $34.89 EXCELLUS-BC — EXCELLUS BLUE CROSS: $17.47 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $18.39 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $17.47 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $32.18 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $268.51 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $81.67 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA ULTRA-SENSITIVE	$106.31	$47.84	$15.63 – $268.51
PSA (prostate specific antigen) blood test: 10 of 40 insurance plan rates AETNA — AETNA: $31.26 AETNA_MCAREHMO — AETNA MEDICARE HMO: $18.39 CIGNA — CIGNA: $34.89 EXCELLUS-BC — EXCELLUS BLUE CROSS: $17.47 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $18.39 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $17.47 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $32.18 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $268.51 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $81.67 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $18.39
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: TSH	$80.33	$28.59	$9 – $301.42
Thyroid stimulating hormone (TSH) test: 10 of 40 insurance plan rates AETNA — AETNA: $28.56 AETNA_MCAREHMO — AETNA MEDICARE HMO: $16.80 CIGNA — CIGNA: $31.87 EXCELLUS-BC — EXCELLUS BLUE CROSS: $15.96 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $16.80 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $15.96 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $15.75 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $301.42 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $114.58 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $9
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: CBC\ DIFF\ AUTO	$35.18	$15.36	$3.17 – $269.20
Complete blood count (CBC) with differential: 10 of 40 insurance plan rates AETNA — AETNA: $13.21 AETNA_MCAREHMO — AETNA MEDICARE HMO: $7.77 CIGNA — CIGNA: $14.74 EXCELLUS-BC — EXCELLUS BLUE CROSS: $7.38 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $7.77 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $7.38 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $5.55 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $269.20 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $82.36 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $3.17
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: CELL PROFILE	$59.06	$15.83	$3.17 – $269.20
Complete blood count (CBC), automated: 10 of 40 insurance plan rates AETNA — AETNA: $11 AETNA_MCAREHMO — AETNA MEDICARE HMO: $6.47 CIGNA — CIGNA: $12.28 EXCELLUS-BC — EXCELLUS BLUE CROSS: $6.15 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $6.47 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $6.15 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $5.55 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $269.20 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $82.36 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $3.17
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PROTIME/INR	$51.71	$34.02	$3.65 – $244.08
Blood clotting time test (prothrombin time, PT): 10 of 40 insurance plan rates AETNA — AETNA: $7.29 AETNA_MCAREHMO — AETNA MEDICARE HMO: $4.29 CIGNA — CIGNA: $8.14 EXCELLUS-BC — EXCELLUS BLUE CROSS: $4.08 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $4.29 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $4.08 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $6.84 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $244.08 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $57.24 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $3.91
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: PTT-HEPARIN	$61.69	$11.22	$5.11 – $274.30
Blood clotting test (partial thromboplastin time, PTT): 10 of 40 insurance plan rates AETNA — AETNA: $10.22 AETNA_MCAREHMO — AETNA MEDICARE HMO: $6.01 CIGNA — CIGNA: $11.40 EXCELLUS-BC — EXCELLUS BLUE CROSS: $5.71 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $6.01 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $5.71 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $10.52 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $274.30 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $87.46 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: PTT	$57.49	$27.76	$5.11 – $274.30
Blood clotting test (partial thromboplastin time, PTT): 10 of 40 insurance plan rates AETNA — AETNA: $10.22 AETNA_MCAREHMO — AETNA MEDICARE HMO: $6.01 CIGNA — CIGNA: $11.40 EXCELLUS-BC — EXCELLUS BLUE CROSS: $5.71 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $6.01 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $5.71 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $10.52 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $274.30 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $87.46 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $6.01

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) In the file: CT HEAD/BRAIN W/O CONTRAST	$1,899.71	$119.07	$83.79 – $1,196.82
CT scan of the head or brain, without contrast: 10 of 42 insurance plan rates AETNA — AETNA: $191.46 AETNA_MCAREHMO — AETNA MEDICARE HMO: $134.77 CIGNA — CIGNA: $244.36 EXCELLUS-BC — EXCELLUS BLUE CROSS: $370.70 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $134.77 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $83.79 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $210 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $951.25 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $764.41 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $120
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN W/O FOLLOWED BY CONTRAST	$2,884.35	$1,297.96	$281.42 – $1,817.14
MRI of the brain, before and after contrast: 10 of 42 insurance plan rates AETNA — AETNA: $643.82 AETNA_MCAREHMO — AETNA MEDICARE HMO: $452.62 CIGNA — CIGNA: $820.65 EXCELLUS-BC — EXCELLUS BLUE CROSS: $1,296.71 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $452.62 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $281.42 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $875 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,550.17 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,363.33 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $500
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: RADIOLOGIC EXAM CHEST TWO VIEWS	$285.60	$96.27	$15 – $313.02
Chest X-ray, 2 views: 10 of 42 insurance plan rates AETNA — AETNA: $60.10 AETNA_MCAREHMO — AETNA MEDICARE HMO: $111.59 CIGNA — CIGNA: $202.33 EXCELLUS-BC — EXCELLUS BLUE CROSS: $306.39 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $111.59 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $69.38 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $26.25 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $313.02 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $126.18 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $15
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: RADIOLOGIC EXAM LUMBOSACRAL 4-5 VIEWS	$481.95	$168.68	$30 – $370.70
X-ray of the lower spine, at least 4 views: 10 of 42 insurance plan rates AETNA — AETNA: $99.68 AETNA_MCAREHMO — AETNA MEDICARE HMO: $134.77 CIGNA — CIGNA: $244.36 EXCELLUS-BC — EXCELLUS BLUE CROSS: $370.70 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $134.77 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $83.79 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $52.50 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $313.02 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $126.18 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $30
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI LUMBAR SPINE W/O CONTRAST	$2,188.46	$1,123.72	$190.47 – $1,378.73
MRI of the lower back (lumbar spine), without contrast: 10 of 42 insurance plan rates AETNA — AETNA: $369.60 AETNA_MCAREHMO — AETNA MEDICARE HMO: $306.35 CIGNA — CIGNA: $555.45 EXCELLUS-BC — EXCELLUS BLUE CROSS: $826.22 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $306.35 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $190.47 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $875 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,110.07 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $923.23 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $500
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · modifier TC In the file: MRI LUMBAR SPINE W/O CONTRAST	$2,188.46	$984.81	$190.47 – $1,378.73
MRI of the lower back (lumbar spine), without contrast: 10 of 42 insurance plan rates AETNA — AETNA: $369.60 AETNA_MCAREHMO — AETNA MEDICARE HMO: $306.35 CIGNA — CIGNA: $555.45 EXCELLUS-BC — EXCELLUS BLUE CROSS: $826.22 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $306.35 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $190.47 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $875 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,110.07 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $923.23 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $500
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W/ CONTRAST	$2,163.26	$136.44	$140.28 – $1,362.85
CT scan of the pelvis, with contrast: 10 of 42 insurance plan rates AETNA — AETNA: $507.25 AETNA_MCAREHMO — AETNA MEDICARE HMO: $225.62 CIGNA — CIGNA: $409.08 EXCELLUS-BC — EXCELLUS BLUE CROSS: $619.51 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $225.62 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $140.28 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $297.50 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $951.25 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $764.41 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $170
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W/ CONTRAST MAKO PROTOCOL	$303.19	$973.47	$140.28 – $1,362.85
CT scan of the pelvis, with contrast: 10 of 42 insurance plan rates AETNA — AETNA: $303.19 AETNA_MCAREHMO — AETNA MEDICARE HMO: $225.62 CIGNA — CIGNA: $409.08 EXCELLUS-BC — EXCELLUS BLUE CROSS: $619.51 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $225.62 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $140.28 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $297.50 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $951.25 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $764.41 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $170
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI LOWER EXTREMITY JOINT W/O CONTRAST	$3,239.25	$1,238.42	$190.47 – $2,040.73
MRI of a leg joint (such as the knee), without contrast: 10 of 42 insurance plan rates AETNA — AETNA: $416.18 AETNA_MCAREHMO — AETNA MEDICARE HMO: $306.35 CIGNA — CIGNA: $555.45 EXCELLUS-BC — EXCELLUS BLUE CROSS: $826.22 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $306.35 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $190.47 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $875 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,110.07 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $923.23 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $500
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABDOMEN PELVIS W/ CONTRAST	$2,155.39	$969.93	$107.93 – $1,357.90
CT scan of the abdomen and pelvis, with contrast: 10 of 42 insurance plan rates AETNA — AETNA: $642.92 AETNA_MCAREHMO — AETNA MEDICARE HMO: $452.62 CIGNA — CIGNA: $820.65 EXCELLUS-BC — EXCELLUS BLUE CROSS: $1,296.71 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $452.62 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $281.42 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $188.88 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $951.25 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $764.41 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $107.93
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: ULTRASOUND ABDOMEN COMPLETE	$1,130.06	$152.86	$60 – $1,520.93
Ultrasound of the abdomen, complete: 10 of 42 insurance plan rates AETNA — AETNA: $218.43 AETNA_MCAREHMO — AETNA MEDICARE HMO: $134.77 CIGNA — CIGNA: $244.36 EXCELLUS-BC — EXCELLUS BLUE CROSS: $370.70 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $134.77 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $83.79 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $105 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,520.93 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,359.93 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $60
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: ULTRASOUND PREGNANT UTERUS 14<WKS	$654.94	$240.15	$55 – $498.44
Pregnancy ultrasound (after the first trimester): 10 of 42 insurance plan rates AETNA — AETNA: $242.73 AETNA_MCAREHMO — AETNA MEDICARE HMO: $134.77 CIGNA — CIGNA: $244.36 EXCELLUS-BC — EXCELLUS BLUE CROSS: $370.70 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $134.77 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $83.79 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $96.25 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $498.44 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $316.75 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $55
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: ULTRASOUND TRANSVAGINAL	$682.50	$239.67	$60 – $538.44
Transvaginal ultrasound: 10 of 42 insurance plan rates AETNA — AETNA: $239.14 AETNA_MCAREHMO — AETNA MEDICARE HMO: $134.77 CIGNA — CIGNA: $244.36 EXCELLUS-BC — EXCELLUS BLUE CROSS: $370.70 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $134.77 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $83.79 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $105 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $538.44 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $357.56 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: DIAGNOSTIC MAMMOGRAPHY INCL CAD UNILAT	$233.89	$105.25	$61.26 – $487.26
Diagnostic mammogram, one breast: 10 of 42 insurance plan rates AETNA — AETNA: $233.89 AETNA_MCAREHMO — AETNA MEDICARE HMO: $80.59 CIGNA — CIGNA: $152.90 EXCELLUS-BC — EXCELLUS BLUE CROSS: $241.61 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $80.59 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $61.26 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $169.75 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $487.26 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $300.42 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $97
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: DIAGNOSTIC MAMMOGRAPHY INCL CAD BILAT	$276.94	$105.25	$78.06 – $487.26
Diagnostic mammogram, both breasts: 10 of 42 insurance plan rates AETNA — AETNA: $276.94 AETNA_MCAREHMO — AETNA MEDICARE HMO: $102.69 CIGNA — CIGNA: $194.83 EXCELLUS-BC — EXCELLUS BLUE CROSS: $309.72 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $102.69 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $78.06 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $169.75 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $487.26 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $300.42 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $97
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: SCREENING MAMMOGRAPHY INCL CAD BILATER	$276.94	$124.62	$64.59 – $487.26
Screening mammogram, both breasts: 10 of 42 insurance plan rates AETNA — AETNA: $249.02 AETNA_MCAREHMO — AETNA MEDICARE HMO: $84.96 CIGNA — CIGNA: $161.19 EXCELLUS-BC — EXCELLUS BLUE CROSS: $255.46 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $84.96 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $64.59 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $169.75 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $487.26 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $300.42 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $97

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) In the file: EKG ROUTINE	$145.95	$603.50	$10.10 – $327.78
Electrocardiogram (ECG/EKG) with reading: 10 of 42 insurance plan rates AETNA — AETNA: $113.84 AETNA_MCAREHMO — AETNA MEDICARE HMO: $13.29 CIGNA — CIGNA: $25.22 EXCELLUS-BC — EXCELLUS BLUE CROSS: $40.12 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $13.29 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $10.10 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $26.25 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $327.78 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $142.64 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $15
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) In the file: EKG- ROUTINE SERVICE	$145.95	$65.68	$10.10 – $327.78
Electrocardiogram (ECG/EKG) with reading: 10 of 42 insurance plan rates AETNA — AETNA: $113.84 AETNA_MCAREHMO — AETNA MEDICARE HMO: $13.29 CIGNA — CIGNA: $25.22 EXCELLUS-BC — EXCELLUS BLUE CROSS: $40.12 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $13.29 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $10.10 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $26.25 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $327.78 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $142.64 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $15
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: SLEEP STAGE/4+ PARAMETERS	$3,793.91	$1,245.98	$729.48 – $3,525.34
Sleep study (overnight, in a sleep lab): 10 of 38 insurance plan rates AETNA — AETNA: $2,959.25 AETNA_MCAREHMO — AETNA MEDICARE HMO: $1,289.42 CIGNA — CIGNA: $1,687 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3,525.34 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $1,289.42 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $801.69 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,955.01 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,802.81 FIDELIS_1400 — FIDELIS CLINIC: $729.48 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $868.80

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) · modifier GP In the file: THERAPUTIC EXERCISE 15MIN	$119.18	$61.54	$20.64 – $327.31
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 42 insurance plan rates AETNA — AETNA: $92.96 AETNA_MCAREHMO — AETNA MEDICARE HMO: $27.86 CIGNA — CIGNA: $52.86 EXCELLUS-BC — EXCELLUS BLUE CROSS: $83.24 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $27.86 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $21.18 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $36.12 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $327.31 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $142.15 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $20.64
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier GO In the file: THERAPUTIC EXER 15 MIN	$119.18	$53.63	$20.64 – $327.31
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 42 insurance plan rates AETNA — AETNA: $92.96 AETNA_MCAREHMO — AETNA MEDICARE HMO: $27.86 CIGNA — CIGNA: $52.86 EXCELLUS-BC — EXCELLUS BLUE CROSS: $83.24 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $27.86 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $21.18 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $36.12 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $327.31 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $142.15 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $20.64
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · modifier GP In the file: PT EVALUATION LOW COMPLEXITY	$234.15	$53.63	$69.29 – $442.53
Physical therapy evaluation (low complexity): 10 of 42 insurance plan rates AETNA — AETNA: $182.64 AETNA_MCAREHMO — AETNA MEDICARE HMO: $94.82 CIGNA — CIGNA: $179.90 EXCELLUS-BC — EXCELLUS BLUE CROSS: $284.62 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $94.82 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $72.08 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $121.26 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $442.53 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $259.71 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $69.29
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · modifier GP In the file: PT EVALUATION MODERATE COMPLEXITY	$284.03	$105.37	$69.29 – $508.68
Physical therapy evaluation (moderate complexity): 10 of 42 insurance plan rates AETNA — AETNA: $221.54 AETNA_MCAREHMO — AETNA MEDICARE HMO: $94.82 CIGNA — CIGNA: $179.90 EXCELLUS-BC — EXCELLUS BLUE CROSS: $284.62 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $94.82 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $72.08 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $121.26 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $508.68 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $327.20 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $69.29
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · modifier GP In the file: PT EVALUATION HIGH COMPLEXITY	$340.73	$127.81	$69.29 – $574.83
Physical therapy evaluation (high complexity): 10 of 42 insurance plan rates AETNA — AETNA: $265.77 AETNA_MCAREHMO — AETNA MEDICARE HMO: $94.82 CIGNA — CIGNA: $179.90 EXCELLUS-BC — EXCELLUS BLUE CROSS: $284.62 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $94.82 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $72.08 FIDELIS-EP_0000 — FIDELIS ESSENTIAL PLAN 1-2 IP AND OP NO RATE CODE: $121.26 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $574.83 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $394.68 FIDELIS_0000 — FIDELIS IP AND OP NO RATE CODE: $69.29
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: PSYCHOTHERAPY 30 MIN	$171.94	$144.59	$108.32 – $537.59
Psychotherapy, 30 minutes: 10 of 31 insurance plan rates AETNA — AETNA: $134.11 AETNA_MCAREHMO — AETNA MEDICARE HMO: $171.94 EXCELLUS-BC — EXCELLUS BLUE CROSS: $537.59 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $203.63 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $126.61 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $471.01 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $288.77 FIDELIS_1400 — FIDELIS CLINIC: $116.03 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $209.33 FIDELIS_1402 — FIDELIS EMERGENCY ROOM: $128.34
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: PSYCHOTHERAPY 45 MIN	$290.85	$77.37	$126.61 – $546.67
Psychotherapy, 45 minutes: 10 of 31 insurance plan rates AETNA — AETNA: $226.86 AETNA_MCAREHMO — AETNA MEDICARE HMO: $203.63 EXCELLUS-BC — EXCELLUS BLUE CROSS: $537.59 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $203.63 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $126.61 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $546.67 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $365.96 FIDELIS_1400 — FIDELIS CLINIC: $147.30 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $242.95 FIDELIS_1402 — FIDELIS EMERGENCY ROOM: $162.65
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: PSYCHOTHERAPY 60 MIN	$355.43	$130.88	$126.61 – $546.67
Psychotherapy, 60 minutes: 10 of 31 insurance plan rates AETNA — AETNA: $277.24 AETNA_MCAREHMO — AETNA MEDICARE HMO: $203.63 EXCELLUS-BC — EXCELLUS BLUE CROSS: $537.59 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $203.63 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $126.61 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $546.67 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $365.96 FIDELIS_1400 — FIDELIS CLINIC: $147.30 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $242.95 FIDELIS_1402 — FIDELIS EMERGENCY ROOM: $162.65

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · modifier AS In the file: EXC CYST/ABERRANT BREAST TISSUE OPEN	$259.09	$666.34	$163.23 – $12,852.40
Removal of breast growth (open surgery): 10 of 34 insurance plan rates AETNA — AETNA: $202.09 AETNA_MCAREHMO — AETNA MEDICARE HMO: $259.09 CIGNA — CIGNA: $8,799.37 EXCELLUS-BC — EXCELLUS BLUE CROSS: $12,852.40 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $4,853.15 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $3,017.44 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $3,378.64 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $3,255.25 FIDELIS_1400 — FIDELIS CLINIC: $1,317.98 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $1,501.45
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · modifier AS In the file: ARTHRO KNEE CONDYLE PLATEAU MED LAT	$651.79	$293.31	$410.63 – $44,376.70
Total knee replacement: 10 of 34 insurance plan rates AETNA — AETNA: $508.40 AETNA_MCAREHMO — AETNA MEDICARE HMO: $651.79 CIGNA — CIGNA: $29,566.88 EXCELLUS-BC — EXCELLUS BLUE CROSS: $44,376.70 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $16,307.13 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $10,138.93 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $7,215.58 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $7,169.87 FIDELIS_1400 — FIDELIS CLINIC: $2,904.09 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $3,206.54
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · modifier AS In the file: ARTHROSCOPY- DECOMPRESSION OF SUBACROMI	$346.24	$125.10	$218.13 – $3,882.83
Shoulder arthroscopy: shaving of shoulder bone: 10 of 14 insurance plan rates AETNA — AETNA: $270.07 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $3,882.83 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $3,769.65 FIDELIS_1400 — FIDELIS CLINIC: $1,526.40 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $1,725.50 FIDELIS_1402 — FIDELIS EMERGENCY ROOM: $1,675.40 LIFETIME_BEN — LIFETIME BENEFITS: $218.13 NYSDOH_1400 — NY MEDICAID CLINIC EPISODE: $1,526.40 NYSDOH_1401 — NY MEDICAID AMBULATORY SURGERY: $1,725.70 NYSDOH_1402 — NY MEDICAID EMERGENCY ROOM: $1,675.40
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · modifier AS In the file: ARTHRO KNEE MENISCECTOMY MED/LAT	$346.24	$184.16	$218.13 – $10,913.96
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 34 insurance plan rates AETNA — AETNA: $270.07 AETNA_MCAREHMO — AETNA MEDICARE HMO: $346.24 CIGNA — CIGNA: $7,455.84 EXCELLUS-BC — EXCELLUS BLUE CROSS: $10,913.96 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $4,112.15 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $2,556.72 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $3,882.83 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $3,769.65 FIDELIS_1400 — FIDELIS CLINIC: $1,526.40 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $1,725.50
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · modifier AS In the file: EGD DIAGNOSTIC COLLECTION OF SPECIMENS	$162.23	$329.69	$102.20 – $3,056.48
Upper GI endoscopy (diagnostic): 10 of 34 insurance plan rates AETNA — AETNA: $126.54 AETNA_MCAREHMO — AETNA MEDICARE HMO: $162.23 CIGNA — CIGNA: $2,154.44 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3,056.48 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $1,188.24 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $738.79 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,851.38 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,697.08 FIDELIS_1400 — FIDELIS CLINIC: $686.64 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $822.75
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · modifier AS In the file: EGD W/BIOPSY	$406.88	$73	$256.33 – $3,056.48
Upper GI endoscopy with biopsy: 10 of 34 insurance plan rates AETNA — AETNA: $317.37 AETNA_MCAREHMO — AETNA MEDICARE HMO: $406.88 CIGNA — CIGNA: $2,154.44 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3,056.48 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $1,188.24 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $738.79 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,851.38 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,697.08 FIDELIS_1400 — FIDELIS CLINIC: $686.64 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $822.75
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · modifier AS In the file: COLONOSCOPY FLEXIBLE DIAGNOSTIC	$238.35	$75.48	$150.16 – $3,081.68
Colonoscopy (diagnostic): 10 of 34 insurance plan rates AETNA — AETNA: $185.91 AETNA_MCAREHMO — AETNA MEDICARE HMO: $238.35 CIGNA — CIGNA: $2,095.03 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3,081.68 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $1,155.48 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $718.42 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,788.09 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,632.50 FIDELIS_1400 — FIDELIS CLINIC: $660.48 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $794.62
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · modifier AS In the file: COLONOSCOPY WITH BIOPSY SINGLE OR MULTIP	$406.88	$107.26	$256.33 – $3,978.96
Colonoscopy with biopsy: 10 of 34 insurance plan rates AETNA — AETNA: $317.37 AETNA_MCAREHMO — AETNA MEDICARE HMO: $406.88 CIGNA — CIGNA: $2,709.43 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3,978.96 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $1,494.34 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $929.10 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,788.09 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,632.50 FIDELIS_1400 — FIDELIS CLINIC: $660.48 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $794.62
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · modifier AS In the file: COLONOSCOPY REMOVE TUMOR/POLYP SNARE	$189.79	$123.09	$119.57 – $3,978.96
Colonoscopy with removal of polyps (snare): 10 of 34 insurance plan rates AETNA — AETNA: $148.04 AETNA_MCAREHMO — AETNA MEDICARE HMO: $189.79 CIGNA — CIGNA: $2,709.43 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3,978.96 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $1,494.34 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $929.10 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,788.09 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,632.50 FIDELIS_1400 — FIDELIS CLINIC: $660.48 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $794.62
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: CA SCREEN COLONOSCOPY	$979.13	$37.44	$616.85 – $3,081.68
Screening colonoscopy (not high risk): 10 of 37 insurance plan rates AETNA — AETNA: $763.72 AETNA_MCAREHMO — AETNA MEDICARE HMO: $979.13 CIGNA — CIGNA: $2,095.03 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3,081.68 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $1,155.48 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $718.42 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,788.09 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,632.50 FIDELIS_1400 — FIDELIS CLINIC: $660.48 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $794.62
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · modifier AS In the file: LAPAROSCOPY SURGICAL CHOLECYSTECTOMY	$429.98	$829.12	$270.89 – $19,455.21
Gallbladder removal by laparoscope: 10 of 34 insurance plan rates AETNA — AETNA: $335.38 AETNA_MCAREHMO — AETNA MEDICARE HMO: $429.98 CIGNA — CIGNA: $13,406.87 EXCELLUS-BC — EXCELLUS BLUE CROSS: $19,455.21 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $7,394.34 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $4,597.42 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $5,623.12 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $5,545.17 FIDELIS_1400 — FIDELIS CLINIC: $2,245.80 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $2,498.87
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · modifier AS In the file: REPAIR INITIAL INGUINAL HERNIA 5YR=< RED	$302.14	$309.60	$190.35 – $11,665.29
Groin (inguinal) hernia repair, age 5 or older: 10 of 34 insurance plan rates AETNA — AETNA: $235.67 AETNA_MCAREHMO — AETNA MEDICARE HMO: $302.14 CIGNA — CIGNA: $8,109.49 EXCELLUS-BC — EXCELLUS BLUE CROSS: $11,665.29 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $4,472.65 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $2,780.87 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $4,401.97 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $4,299.30 FIDELIS_1400 — FIDELIS CLINIC: $1,741 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $1,956.20
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: PROSTATE BIOPSY	$2,827.48	$152.86	$1,614.21 – $6,867.73
Prostate biopsy: 10 of 37 insurance plan rates AETNA — AETNA: $2,205.43 AETNA_MCAREHMO — AETNA MEDICARE HMO: $2,596.24 CIGNA — CIGNA: $4,707.31 EXCELLUS-BC — EXCELLUS BLUE CROSS: $6,867.73 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $2,596.24 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $1,614.21 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $4,217.67 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $4,111.27 FIDELIS_1400 — FIDELIS CLINIC: $1,664.82 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $1,874.30
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · modifier AS In the file: HYSTEROSCOPY W/ BX OF ENDO /POLYPECTOMY	$174.30	$77.96	$109.81 – $10,541.46
Hysteroscopy with biopsy of the uterus lining: 10 of 34 insurance plan rates AETNA — AETNA: $135.95 AETNA_MCAREHMO — AETNA MEDICARE HMO: $174.30 CIGNA — CIGNA: $7,306.30 EXCELLUS-BC — EXCELLUS BLUE CROSS: $10,541.46 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $4,029.67 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $2,505.44 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $3,031.07 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $2,900.65 FIDELIS_1400 — FIDELIS CLINIC: $1,174.30 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $1,346.99
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: INJ DX/THERAPEUTIC SUBSTANCES LUMB W/ G	$1,132.95	$313.98	$479.37 – $2,331.76
Spinal injection, lower back (epidural), with imaging guidance: 10 of 37 insurance plan rates AETNA — AETNA: $883.70 AETNA_MCAREHMO — AETNA MEDICARE HMO: $877.69 CIGNA — CIGNA: $1,591.35 EXCELLUS-BC — EXCELLUS BLUE CROSS: $2,331.76 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $877.69 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $545.70 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,349.98 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,185.52 FIDELIS_1400 — FIDELIS CLINIC: $479.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $599.93
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: ANEST AGNT/TRANSFORAMINAL LUMB SNGL LVL	$460.95	$973.21	$290.40 – $3,073.33
Nerve root injection, lower back, with imaging guidance: 10 of 37 insurance plan rates AETNA — AETNA: $359.54 AETNA_MCAREHMO — AETNA MEDICARE HMO: $460.95 CIGNA — CIGNA: $2,045.81 EXCELLUS-BC — EXCELLUS BLUE CROSS: $3,073.33 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $1,128.33 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $701.54 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $1,349.98 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $1,185.52 FIDELIS_1400 — FIDELIS CLINIC: $479.37 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $599.93
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: CARPEL TUNNEL RELEASE	$5,701.50	$149.90	$1,116.86 – $6,510.20
Carpal tunnel release: 10 of 37 insurance plan rates AETNA — AETNA: $4,447.17 AETNA_MCAREHMO — AETNA MEDICARE HMO: $2,474.90 CIGNA — CIGNA: $4,487.30 EXCELLUS-BC — EXCELLUS BLUE CROSS: $6,510.20 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $2,474.90 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $1,538.76 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $2,892.12 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $2,758.88 FIDELIS_1400 — FIDELIS CLINIC: $1,116.86 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $1,285.24
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · modifier AS In the file: NEUROPLASTY /TRANSPOSITION MEDIAN@CARPAL	$333.11	$2,565.68	$209.86 – $6,510.20
Carpal tunnel release: 10 of 34 insurance plan rates AETNA — AETNA: $259.83 AETNA_MCAREHMO — AETNA MEDICARE HMO: $333.11 CIGNA — CIGNA: $4,487.30 EXCELLUS-BC — EXCELLUS BLUE CROSS: $6,510.20 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $2,474.90 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $1,538.76 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $2,892.12 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $2,758.88 FIDELIS_1400 — FIDELIS CLINIC: $1,116.86 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $1,285.24
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · modifier AS In the file: EXTRACAP CATARACT REMOVAL W/ INS LENS	$376.16	$111.63	$236.98 – $7,857.51
Cataract removal with lens implant: 10 of 34 insurance plan rates AETNA — AETNA: $293.40 AETNA_MCAREHMO — AETNA MEDICARE HMO: $376.16 CIGNA — CIGNA: $5,240.93 EXCELLUS-BC — EXCELLUS BLUE CROSS: $7,857.51 EXCELLUS-BC_MCAREADV — EXCELLUS BLUECROSS MEDICARE ADVANTAGE: $2,890.55 EXCELLUS-BC_MEDICAID — EXCELLUS BLUE CROSS SPECIAL PROGRAMS: $1,797.19 FIDELIS-EP_1401 — FIDELIS ESSENTIAL PLAN 1-2 AMBULATORY SURGERY: $4,310.95 FIDELIS-EP_1402 — FIDELIS ESSENTIAL PLAN 1-2 EMERGENCY ROOM: $4,206.44 FIDELIS_1400 — FIDELIS CLINIC: $1,703.38 FIDELIS_1401 — FIDELIS AMBULATORY SURGERY: $1,915.76

Source: Auburn Community Hospital’s standard charges file (auburnhospital.org, CSV, CMS template 2.0.0; it can be a very large file), last updated by the hospital on January 19, 2025; 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	17 Lansing Street, Auburn, NY 13021
County	Cayuga County
State	New York
Phone	(315) 255‑7011
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	2 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	330235
Name in Medicare records	AUBURN COMMUNITY HOSPITAL
Profile level	Medicare data + hospital website
Official website	auburnhospital.org
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 Geocoder — map position used for distances

From the hospital’s website

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

Auburn Community Hospital — auburnhospital.org
Visiting Hours — auburnhospital.org
Diagnostic Imaging Services | Auburn Community Hospital — auburnhospital.org
Programs & Services | Auburn Community Hospital — auburnhospital.org
Emergency Department | Auburn Community Hospital — auburnhospital.org
Surgical Services | Inpatient & Outpatient Services | Auburn Community Hospital — auburnhospital.org
Cardiovascular Lab Services | Auburn Community Hospital — auburnhospital.org
Inpatient Care Services | Auburn Community Hospital — auburnhospital.org
Behavioral Health | Mental Health Auburn | Auburn Community Hospital — auburnhospital.org
Cardiac & Pulmonary Rehabilitation | Auburn Community Hospital — auburnhospital.org
Sleep Center | Auburn Community Hospital — auburnhospital.org
Laboratory Services | Auburn Community Hospital — auburnhospital.org

Auburn Community Hospital

Summary

Profile from official sources

At a glance