Does Bayhealth Hospital, Sussex Campus have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Bayhealth Hospital, Sussex Campus. In a medical emergency, call 911.

Where is Bayhealth Hospital, Sussex Campus?

100 Wellness Way, Milford, DE 19963, in Sussex County, Delaware.

What is the phone number of Bayhealth Hospital, Sussex Campus?

(302) 422-3311, as listed by Medicare (CMS).

What is the Medicare star rating of Bayhealth Hospital, Sussex Campus?

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

Bayhealth Hospital, Sussex Campus

Quick answers

Does Bayhealth Hospital, Sussex Campus have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Bayhealth Hospital, Sussex Campus. In a medical emergency, call 911.
Where is Bayhealth Hospital, Sussex Campus?: 100 Wellness Way, Milford, DE 19963, in Sussex County, Delaware.
What is the phone number of Bayhealth Hospital, Sussex Campus?: (302) 422-3311, as listed by Medicare (CMS).
What is the Medicare star rating of Bayhealth Hospital, Sussex Campus?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4][6][7]

Cancer care
Heart & Vascular
Surgical Weight Loss
Orthopedics
Surgical Services
Outpatient Therapies
Women's & Children's Health
Emergency medicine
Obstetrics

Programs and centers^[4][7][8]

Bariatric Program
Center for Women and Infants
Cardiac, pulmonary and vascular rehabilitation
Obstetrical Emergency Department (OBED)
Level I newborn care

Emergency care (hospital website)^[4][6][9]

Emergency room	Yes
Open 24/7	Yes
Stroke designation	Certified Primary Stroke Center

Visiting and practical information

Visiting	Inpatient visiting hours are 8 a.m. to 8 p.m^[5]
Parking	Free parking and free valet; valet at hospital entrance 6 a.m. to 9 p.m. daily^[4]

Recognition^[9]

Primary Stroke Center (certified)

Doctors and clinicians (966)

966 doctors and other clinicians list Bayhealth Hospital, Sussex Campus 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 942 more: the button below opens the full list.

Other emergency rooms nearby

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

Bayhealth Medical Center, Kent Campus17 mi · Dover, DE · Acute Care Hospital
Beebe Medical Center17 mi · Lewes, DE · Acute Care Hospital
Tidalhealth Nanticoke, Inc.25 mi · Seaford, DE · Acute Care Hospital
Cape Regional Medical Center Inc31 mi · Cape May Court House, NJ · Acute Care Hospital
Inspira Medical Center Vineland39 mi · Vineland, NJ · Acute Care Hospital

Other hospitals nearby

Dover Behavioral Health System16 mi · Dover, DE · Psychiatric Hospital
Sun Behavioral Delaware LLC17 mi · Georgetown, DE · Psychiatric Hospital
PAM Health Rehabilitation Hospital of Georgetown L…18 mi · Georgetown, DE · Inpatient Rehabilitation Hospital
PAM Rehabilitation Hospital of Dover19 mi · Dover, DE · Inpatient Rehabilitation 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

Polaris Healthcare and Rehabilitation Center4.6 mi · Milford, DE · 2 of 5 stars
Milford Center4.9 mi · Milford, DE · 3 of 5 stars
Delaware Veterans Home4.9 mi · Milford, DE · 3 of 5 stars

All nursing homes in the state →

Hospice providers

Compassionate Care Hospice of the Delmar Peninsula0.0 mi · Milford, DE · 3 of 5 stars
Delaware Hospice, Inc Southern Division0.0 mi · Milford, DE · 4 of 5 stars
Delaware Hospice Central Div18 mi · Dover, DE · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Aveanna Healthcare0.0 mi · Milford, DE
Aveanna Home Healthcare0.0 mi · Milford, DE
Affinity Home Care Services, LLC.14 mi · Felton, DE

All home health agencies in the state →

Dialysis facilities

FKC Milford0.0 mi · Milford, DE · 2 of 5 stars
DaVita Harrington14 mi · Harrington, DE · 2 of 5 stars
FKC Central Delaware18 mi · Dover, DE · 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.

Lewes Surgery Center18 mi · Lewes, DE
Seaside Endoscopy Pavilion18 mi · Lewes, DE
Advance Endoscopy Center, LLC20 mi · Dover, DE

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

Northern Sussex Community Health Center4.5 mi · Milford, DE · Community health center
La Red Health Center Main Campus17 mi · Georgetown, DE · Community health center
LRHC Mobile Health Unit17 mi · Georgetown, DE · Community health center

Clinics and urgent care

Ambient Care Express Milford0.0 mi · Milford, DE · Urgent care center
Delaware Walk-In Medical, LLC17 mi · Camden, DE · Urgent care center
Christiana Care Quality Partners18 mi · Dover, DE · Urgent care center

Pharmacies

Aerenson Pharmacy0.0 mi · Milford, DE · Community/retail pharmacy
Bayhealth Medical Center Inc0.0 mi · Milford, DE · Clinic pharmacy
Ekantik LLC0.0 mi · Milford, DE · Community/retail pharmacy

Assisted living nearby

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

Milford Place Enlivant Assisted Living0.0 mi · Milford, DE

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 Bayhealth Hospital, Sussex Campus 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)	4 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	3 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	75%National average: 72%
Would definitely recommend the hospital	73%National average: 71%
Nurses “always” communicated well	81%National average: 80%
Doctors “always” communicated well	77%National average: 80%
Staff “always” explained medicines before giving them	61%National average: 62%
Were given information about recovery at home	87%National average: 86%
Room and bathroom “always” clean	74%National average: 74%
Area around the room “always” quiet at night	62%National average: 60%
Completed surveys	1,315Response rate: 22%

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	0.925No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.235Better 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	12.9%
Deaths within 30 days: heart failure patients	12.5%
Deaths within 30 days: pneumonia patients	15.3%
Deaths within 30 days: COPD patients	8.5%
Deaths within 30 days: stroke patients	10.6%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	1.26No different from the national rate
Complications after hip or knee replacement	Too few cases to report

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	14%
Readmitted within 30 days: heart failure	21.8%
Readmitted within 30 days: pneumonia	17.3%
Readmitted within 30 days: COPD	21.4%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Too few cases to report

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)	High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	252 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)	43%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 Delaware

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 82 common services exactly as Bayhealth Hospital, Sussex Campus 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) · Hospital (facility) fee In the file: Office/outpatient visit new	Not listed in the file	Not listed in the file	$133.96
New patient office visit (about 30–44 minutes): rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $133.96
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Office O/P New Sf 30-44 Min (Telemed)	$276	$231.84	Not listed in the file
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office/outpatient visit new	Not listed in the file	Not listed in the file	$218.24
New patient office visit (about 45–59 minutes): rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $218.24
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Office O/P New Sf 45-59 Min (Telemed)	$323	$271.32	Not listed in the file
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office/outpatient visit new	Not listed in the file	Not listed in the file	$296.92
New patient office visit (about 60–74 minutes): rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $296.92
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Office O/P New Sf 60-74 Min (Telemed)	$370	$310.80	Not listed in the file
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office/outpatient visit est	Not listed in the file	Not listed in the file	$107.80
Established patient office visit (about 20–29 minutes): rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $107.80
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Office O/P Est Low 20-29 Min (Telemed)	$276	$231.84	Not listed in the file
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office/outpatient visit est	Not listed in the file	Not listed in the file	$158.69
Established patient office visit (about 30–39 minutes): rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $158.69
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Office O/P Est Mod 30-39 Min (Telemed)	$323	$271.32	Not listed in the file
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prev visit new age 18-39	Not listed in the file	Not listed in the file	$153.33
Preventive checkup, new patient, age 18–39: rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $153.33
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prev visit new age 40-64	Not listed in the file	Not listed in the file	$185.64
Preventive checkup, new patient, age 40–64: rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $185.64
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$115.52 – $1,379.80
Emergency room visit (moderate): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $294.99 Ambetter Health — Exchange: $442.48 Amerihealth Caritas — Medicaid Managed Care Plan: $115.52 Amerihealth Caritas — Medicare Managed Care Plan: $300.89 Bcbs — Highmark Aca Exchange: $1,228.36 Bcbs — Highmark Non-Aca All Commercial Plans: $1,379.80
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Emergency Dept Visit Level 3	$1,140	$957.60	Not listed in the file
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$197.09 – $2,109.11
Emergency room visit (moderately high): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $450.91 Ambetter Health — Exchange: $676.36 Amerihealth Caritas — Medicaid Managed Care Plan: $197.09 Amerihealth Caritas — Medicare Managed Care Plan: $459.92 Bcbs — Highmark Aca Exchange: $1,877.62 Bcbs — Highmark Non-Aca All Commercial Plans: $2,109.11
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Emergency Dept Visit Level 4	$1,703	$1,430.52	Not listed in the file
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$285.78 – $3,010.20
Emergency room visit (high): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $643.55 Ambetter Health — Exchange: $965.32 Amerihealth Caritas — Medicaid Managed Care Plan: $285.78 Amerihealth Caritas — Medicare Managed Care Plan: $656.42 Bcbs — Highmark Aca Exchange: $2,679.80 Bcbs — Highmark Non-Aca All Commercial Plans: $3,010.20
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Emergency Dept Visit Level 5	$2,524	$2,120.16	Not listed in the file

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Metabolic panel total ca	Not listed in the file	Not listed in the file	$8.46 – $39.57
Basic metabolic panel (blood test): rates for 5 insurance plans Ambetter Health — Exchange: $12.69 Amerihealth Caritas — Medicare Managed Care Plan: $8.63 Amerihealth Caritas — Next Exchange: $8.46 Bcbs — Highmark Aca Exchange: $35.23 Bcbs — Highmark Non-Aca All Commercial Plans: $39.57
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Basic Metabolic Panel Total Ca	$89	$74.76	Not listed in the file
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehen metabolic panel	Not listed in the file	Not listed in the file	$10.56 – $49.39
Comprehensive metabolic panel (blood test): rates for 5 insurance plans Ambetter Health — Exchange: $15.84 Amerihealth Caritas — Medicare Managed Care Plan: $10.77 Amerihealth Caritas — Next Exchange: $10.56 Bcbs — Highmark Aca Exchange: $43.97 Bcbs — Highmark Non-Aca All Commercial Plans: $49.39
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Comprehensive Metabolic Panel	$101	$84.84	Not listed in the file
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric panel	Not listed in the file	Not listed in the file	$47.81 – $223.63
Obstetric blood test panel: rates for 5 insurance plans Ambetter Health — Exchange: $71.72 Amerihealth Caritas — Medicare Managed Care Plan: $48.77 Amerihealth Caritas — Next Exchange: $47.81 Bcbs — Highmark Aca Exchange: $199.09 Bcbs — Highmark Non-Aca All Commercial Plans: $223.63
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid panel	Not listed in the file	Not listed in the file	$13.39 – $62.63
Cholesterol panel (lipid panel): rates for 5 insurance plans Ambetter Health — Exchange: $20.08 Amerihealth Caritas — Medicare Managed Care Plan: $13.66 Amerihealth Caritas — Next Exchange: $13.39 Bcbs — Highmark Aca Exchange: $55.76 Bcbs — Highmark Non-Aca All Commercial Plans: $62.63
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Lipid Panel	$86	$72.24	Not listed in the file
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal function panel	Not listed in the file	Not listed in the file	$8.68 – $40.60
Kidney function panel: rates for 5 insurance plans Ambetter Health — Exchange: $13.02 Amerihealth Caritas — Medicare Managed Care Plan: $8.85 Amerihealth Caritas — Next Exchange: $8.68 Bcbs — Highmark Aca Exchange: $36.14 Bcbs — Highmark Non-Aca All Commercial Plans: $40.60
Kidney function panel CPT 80069 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Renal Function Panel	$96	$80.64	Not listed in the file
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic function panel	Not listed in the file	Not listed in the file	$8.17 – $38.22
Liver function panel: rates for 5 insurance plans Ambetter Health — Exchange: $12.26 Amerihealth Caritas — Medicare Managed Care Plan: $8.33 Amerihealth Caritas — Next Exchange: $8.17 Bcbs — Highmark Aca Exchange: $34.02 Bcbs — Highmark Non-Aca All Commercial Plans: $38.22
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Hepatic Function Panel	$96	$80.64	Not listed in the file
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$3.17 – $14.83
Urine test (automated, with microscope): rates for 5 insurance plans Ambetter Health — Exchange: $4.76 Amerihealth Caritas — Medicare Managed Care Plan: $3.23 Amerihealth Caritas — Next Exchange: $3.17 Bcbs — Highmark Aca Exchange: $13.20 Bcbs — Highmark Non-Aca All Commercial Plans: $14.83
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Urinalysis Auto W/Scope	$95	$79.80	Not listed in the file
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis nonauto w/o scope	Not listed in the file	Not listed in the file	$3.48 – $16.28
Urine test (manual, without microscope): rates for 5 insurance plans Ambetter Health — Exchange: $5.22 Amerihealth Caritas — Medicare Managed Care Plan: $3.55 Amerihealth Caritas — Next Exchange: $3.48 Bcbs — Highmark Aca Exchange: $14.49 Bcbs — Highmark Non-Aca All Commercial Plans: $16.28
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Urinalysis Nonauto W/O Scope	$65	$54.60	Not listed in the file
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/o scope	Not listed in the file	Not listed in the file	$2.25 – $10.52
Urine test (automated, without microscope): rates for 5 insurance plans Ambetter Health — Exchange: $3.38 Amerihealth Caritas — Medicare Managed Care Plan: $2.30 Amerihealth Caritas — Next Exchange: $2.25 Bcbs — Highmark Aca Exchange: $9.37 Bcbs — Highmark Non-Aca All Commercial Plans: $10.52
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Urinalysis Auto W/O Scope	$71	$59.64	Not listed in the file
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay of psa total	Not listed in the file	Not listed in the file	$18.39 – $86.02
PSA (prostate specific antigen) blood test: rates for 5 insurance plans Ambetter Health — Exchange: $27.58 Amerihealth Caritas — Medicare Managed Care Plan: $18.76 Amerihealth Caritas — Next Exchange: $18.39 Bcbs — Highmark Aca Exchange: $76.58 Bcbs — Highmark Non-Aca All Commercial Plans: $86.02
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Assay Of Psa Total	$137	$115.08	Not listed in the file
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay thyroid stim hormone	Not listed in the file	Not listed in the file	$16.80 – $78.58
Thyroid stimulating hormone (TSH) test: rates for 5 insurance plans Ambetter Health — Exchange: $25.20 Amerihealth Caritas — Medicare Managed Care Plan: $17.14 Amerihealth Caritas — Next Exchange: $16.80 Bcbs — Highmark Aca Exchange: $69.96 Bcbs — Highmark Non-Aca All Commercial Plans: $78.58
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Assay Thyroid Stim Hormone	$228	$191.52	Not listed in the file
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc w/auto diff wbc	Not listed in the file	Not listed in the file	$7.77 – $36.34
Complete blood count (CBC) with differential: rates for 5 insurance plans Ambetter Health — Exchange: $11.66 Amerihealth Caritas — Medicare Managed Care Plan: $7.93 Amerihealth Caritas — Next Exchange: $7.77 Bcbs — Highmark Aca Exchange: $32.36 Bcbs — Highmark Non-Aca All Commercial Plans: $36.34
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Complete Cbc With Diff	$160	$134.40	Not listed in the file
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc automated	Not listed in the file	Not listed in the file	$6.47 – $30.26
Complete blood count (CBC), automated: rates for 5 insurance plans Ambetter Health — Exchange: $9.70 Amerihealth Caritas — Medicare Managed Care Plan: $6.60 Amerihealth Caritas — Next Exchange: $6.47 Bcbs — Highmark Aca Exchange: $26.94 Bcbs — Highmark Non-Aca All Commercial Plans: $30.26
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Complete Cbc Without Diff	$74	$62.16	Not listed in the file
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin time	Not listed in the file	Not listed in the file	$4.29 – $20.07
Blood clotting time test (prothrombin time, PT): rates for 5 insurance plans Ambetter Health — Exchange: $6.44 Amerihealth Caritas — Medicare Managed Care Plan: $4.38 Amerihealth Caritas — Next Exchange: $4.29 Bcbs — Highmark Aca Exchange: $17.86 Bcbs — Highmark Non-Aca All Commercial Plans: $20.07
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Prothrombin Time	$40	$33.60	Not listed in the file
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin time partial	Not listed in the file	Not listed in the file	$6.01 – $28.11
Blood clotting test (partial thromboplastin time, PTT): rates for 5 insurance plans Ambetter Health — Exchange: $9.02 Amerihealth Caritas — Medicare Managed Care Plan: $6.13 Amerihealth Caritas — Next Exchange: $6.01 Bcbs — Highmark Aca Exchange: $25.03 Bcbs — Highmark Non-Aca All Commercial Plans: $28.11
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Thromboplastin Time Partial	$97	$81.48	Not listed in the file

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) · Hospital (facility) fee In the file: Ct head/brain w/o dye	Not listed in the file	Not listed in the file	$111.14 – $528.44
CT scan of the head or brain, without contrast: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $112.98 Ambetter Health — Exchange: $169.46 Amerihealth Caritas — Medicaid Managed Care Plan: $111.14 Amerihealth Caritas — Medicare Managed Care Plan: $115.23 Bcbs — Highmark Aca Exchange: $470.44 Bcbs — Highmark Non-Aca All Commercial Plans: $528.44
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ct Head W/O Contrast	$2,136	$1,794.24	Not listed in the file
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri brain stem w/o & w/dye	Not listed in the file	Not listed in the file	$350.80 – $1,763.43
MRI of the brain, before and after contrast: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $377 Ambetter Health — Exchange: $565.50 Amerihealth Caritas — Medicaid Managed Care Plan: $350.80 Amerihealth Caritas — Medicare Managed Care Plan: $384.54 Bcbs — Highmark Aca Exchange: $1,569.88 Bcbs — Highmark Non-Aca All Commercial Plans: $1,763.43
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mri Brain Stem W/O & W Contrast	$6,186	$5,196.24	Not listed in the file
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam chest 2 views	Not listed in the file	Not listed in the file	$37.94 – $439.88
Chest X-ray, 2 views: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $94.04 Ambetter Health — Exchange: $141.06 Amerihealth Caritas — Medicaid Managed Care Plan: $37.94 Amerihealth Caritas — Medicare Managed Care Plan: $95.92 Bcbs — Highmark Aca Exchange: $391.60 Bcbs — Highmark Non-Aca All Commercial Plans: $439.88
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc X-Ray Exam Chest 2 Views	$410	$344.40	Not listed in the file
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam l-2 spine 4/>vws	Not listed in the file	Not listed in the file	$63.96 – $528.44
X-ray of the lower spine, at least 4 views: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $112.98 Ambetter Health — Exchange: $169.46 Amerihealth Caritas — Medicaid Managed Care Plan: $63.96 Amerihealth Caritas — Medicare Managed Care Plan: $115.23 Bcbs — Highmark Aca Exchange: $470.44 Bcbs — Highmark Non-Aca All Commercial Plans: $528.44
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Spine Lumbar 4-5 Views	$685	$575.40	Not listed in the file
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri lumbar spine w/o dye	Not listed in the file	Not listed in the file	$202.23 – $1,206.05
MRI of the lower back (lumbar spine), without contrast: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $257.84 Ambetter Health — Exchange: $386.76 Amerihealth Caritas — Medicaid Managed Care Plan: $202.23 Amerihealth Caritas — Medicare Managed Care Plan: $263 Bcbs — Highmark Aca Exchange: $1,073.67 Bcbs — Highmark Non-Aca All Commercial Plans: $1,206.05
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mri Lumbar Spine W/O Contrast	$4,013	$3,370.92	Not listed in the file
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct pelvis w/dye	Not listed in the file	Not listed in the file	$189.54 – $886.59
CT scan of the pelvis, with contrast: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $189.54 Ambetter Health — Exchange: $284.32 Amerihealth Caritas — Medicaid Managed Care Plan: $285.73 Amerihealth Caritas — Medicare Managed Care Plan: $193.33 Bcbs — Highmark Aca Exchange: $789.28 Bcbs — Highmark Non-Aca All Commercial Plans: $886.59
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ct Pelvis W/Contrast	$3,177	$2,668.68	Not listed in the file
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	Not listed in the file	$232.01 – $1,206.05
MRI of a leg joint (such as the knee), without contrast: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $257.84 Ambetter Health — Exchange: $386.76 Amerihealth Caritas — Medicaid Managed Care Plan: $232.01 Amerihealth Caritas — Medicare Managed Care Plan: $263 Bcbs — Highmark Aca Exchange: $1,073.67 Bcbs — Highmark Non-Aca All Commercial Plans: $1,206.05
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mri Joint Of Lower Extremity W/O Cont	$5,301	$4,452.84	Not listed in the file
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct abd & pelv w/contrast	Not listed in the file	Not listed in the file	$358.40 – $1,763.43
CT scan of the abdomen and pelvis, with contrast: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $377 Ambetter Health — Exchange: $565.50 Amerihealth Caritas — Medicaid Managed Care Plan: $358.40 Amerihealth Caritas — Medicare Managed Care Plan: $384.54 Bcbs — Highmark Aca Exchange: $1,569.88 Bcbs — Highmark Non-Aca All Commercial Plans: $1,763.43
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Abd/Pel W Contrast	$6,000	$5,040	Not listed in the file
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Us exam abdom complete	Not listed in the file	Not listed in the file	$112.98 – $528.44
Ultrasound of the abdomen, complete: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $112.98 Ambetter Health — Exchange: $169.46 Amerihealth Caritas — Medicaid Managed Care Plan: $125.77 Amerihealth Caritas — Medicare Managed Care Plan: $115.23 Bcbs — Highmark Aca Exchange: $470.44 Bcbs — Highmark Non-Aca All Commercial Plans: $528.44
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Abdominal Complete	$1,301	$1,092.84	Not listed in the file
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ob us >/= 14 wks sngl fetus	Not listed in the file	Not listed in the file	$112.98 – $528.44
Pregnancy ultrasound (after the first trimester): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $112.98 Ambetter Health — Exchange: $169.46 Amerihealth Caritas — Medicaid Managed Care Plan: $141.50 Amerihealth Caritas — Medicare Managed Care Plan: $115.23 Bcbs — Highmark Aca Exchange: $470.44 Bcbs — Highmark Non-Aca All Commercial Plans: $528.44
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ob Fetal >= 14 Wks Single	$1,116	$937.44	Not listed in the file
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Transvaginal us non-ob	Not listed in the file	Not listed in the file	$112.98 – $528.44
Transvaginal ultrasound: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $112.98 Ambetter Health — Exchange: $169.46 Amerihealth Caritas — Medicaid Managed Care Plan: $138.24 Amerihealth Caritas — Medicare Managed Care Plan: $115.23 Bcbs — Highmark Aca Exchange: $470.44 Bcbs — Highmark Non-Aca All Commercial Plans: $528.44
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Us Transvaginal	$1,301	$1,092.84	Not listed in the file
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$142.56
Diagnostic mammogram, one breast: rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $142.56
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mammo Diagnostic Unilateral	$783	$657.72	Not listed in the file
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$85.11 – $398.10
Diagnostic mammogram, one breast: rates for 5 insurance plans Aetna — Medicare Managed Care Plan: $85.11 Ambetter Health — Exchange: $127.66 Amerihealth Caritas — Medicare Managed Care Plan: $86.81 Bcbs — Highmark Aca Exchange: $354.41 Bcbs — Highmark Non-Aca All Commercial Plans: $398.10
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad bi	Not listed in the file	Not listed in the file	$181.62
Diagnostic mammogram, both breasts: rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $181.62
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mammo Diagnostic Bilateral	$966	$811.44	Not listed in the file
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: Dx mammo incl cad bi	Not listed in the file	Not listed in the file	$109.17 – $510.64
Diagnostic mammogram, both breasts: rates for 5 insurance plans Aetna — Medicare Managed Care Plan: $109.17 Ambetter Health — Exchange: $163.76 Amerihealth Caritas — Medicare Managed Care Plan: $111.35 Bcbs — Highmark Aca Exchange: $454.59 Bcbs — Highmark Non-Aca All Commercial Plans: $510.64
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Scr mammo bi incl cad	Not listed in the file	Not listed in the file	$150.19
Screening mammogram, both breasts: rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $150.19
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mammo Screening Bilateral	$734	$616.56	Not listed in the file
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: Scr mammo bi incl cad	Not listed in the file	Not listed in the file	$90.06 – $421.26
Screening mammogram, both breasts: rates for 5 insurance plans Aetna — Medicare Managed Care Plan: $90.06 Ambetter Health — Exchange: $135.09 Amerihealth Caritas — Medicare Managed Care Plan: $91.86 Bcbs — Highmark Aca Exchange: $375.02 Bcbs — Highmark Non-Aca All Commercial Plans: $421.26

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) · Hospital (facility) fee In the file: Electrocardiogram complete	Not listed in the file	Not listed in the file	$23.42
Electrocardiogram (ECG/EKG) with reading: rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $23.42
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$1,017.78 – $16,386.81
Left heart catheterization (diagnostic): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $3,503.33 Ambetter Health — Exchange: $5,254.99 Amerihealth Caritas — Medicaid Managed Care Plan: $1,017.78 Amerihealth Caritas — Medicare Managed Care Plan: $3,573.39 Bcbs — Highmark Aca Exchange: $14,588.21 Bcbs — Highmark Non-Aca All Commercial Plans: $16,386.81
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Left Heart Catheterization W/Ventrclgrphy	$12,827	$10,774.68	Not listed in the file
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Comprehensive Electrophysiology Eval W/O Induction	$17,484	$14,686.56	Not listed in the file
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tx atrial fib pulm vein isol	Not listed in the file	Not listed in the file	$1,510.06 – $132,117.60
Heart rhythm study with ablation for atrial fibrillation: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $28,245.34 Ambetter Health — Exchange: $42,368.02 Amerihealth Caritas — Medicaid Managed Care Plan: $1,510.06 Amerihealth Caritas — Medicare Managed Care Plan: $28,810.25 Bcbs — Highmark Aca Exchange: $117,616.44 Bcbs — Highmark Non-Aca All Commercial Plans: $132,117.60
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ephys Evl Trnsptl Tx Atrial Fib Isolat Pulm Vein	$42,604	$35,787.36	Not listed in the file
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom 6/> yrs 4/> param	Not listed in the file	Not listed in the file	$831.48 – $4,340.63
Sleep study (overnight, in a sleep lab): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $927.98 Ambetter Health — Exchange: $1,391.97 Amerihealth Caritas — Medicaid Managed Care Plan: $831.48 Amerihealth Caritas — Medicare Managed Care Plan: $946.54 Bcbs — Highmark Aca Exchange: $3,864.20 Bcbs — Highmark Non-Aca All Commercial Plans: $4,340.63
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Sleep Apnea Over Night	$6,976	$5,859.84	Not listed in the file

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) · Hospital (facility) fee In the file: Therapeutic exercises	Not listed in the file	Not listed in the file	$28.94 – $135.37
Physical therapy: therapeutic exercise (each 15 minutes): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $28.94 Ambetter Health — Exchange: $43.41 Amerihealth Caritas — Medicaid Managed Care Plan: $48.65 Amerihealth Caritas — Medicare Managed Care Plan: $29.52 Bcbs — Highmark Aca Exchange: $120.51 Bcbs — Highmark Non-Aca All Commercial Plans: $135.37
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Therapeutic Exercises	$124	$104.16	Not listed in the file
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Telemedicine Therapeutic Px 1/> Areas Each 15 Min Exercises	$124	$104.16	Not listed in the file
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$97.53 – $456.20
Physical therapy evaluation (low complexity): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $97.53 Ambetter Health — Exchange: $146.30 Amerihealth Caritas — Medicaid Managed Care Plan: $165.66 Amerihealth Caritas — Medicare Managed Care Plan: $99.48 Bcbs — Highmark Aca Exchange: $406.12 Bcbs — Highmark Non-Aca All Commercial Plans: $456.20
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Pt Eval Low Complex 20 Min	$328	$275.52	Not listed in the file
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Telemedicine Pt Eval Low Complex 20 Min	$328	$275.52	Not listed in the file
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval mod complex 30 min	Not listed in the file	Not listed in the file	$97.53 – $456.20
Physical therapy evaluation (moderate complexity): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $97.53 Ambetter Health — Exchange: $146.30 Amerihealth Caritas — Medicaid Managed Care Plan: $165.66 Amerihealth Caritas — Medicare Managed Care Plan: $99.48 Bcbs — Highmark Aca Exchange: $406.12 Bcbs — Highmark Non-Aca All Commercial Plans: $456.20
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Pt Eval Mod Complex 30 Min	$328	$275.52	Not listed in the file
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Telemedicine Pt Eval Mod Complex 30 Min	$328	$275.52	Not listed in the file
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$97.53 – $456.20
Physical therapy evaluation (high complexity): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $97.53 Ambetter Health — Exchange: $146.30 Amerihealth Caritas — Medicaid Managed Care Plan: $165.66 Amerihealth Caritas — Medicare Managed Care Plan: $99.48 Bcbs — Highmark Aca Exchange: $406.12 Bcbs — Highmark Non-Aca All Commercial Plans: $456.20
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Pt Eval High Complex 45 Min	$328	$275.52	Not listed in the file
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Telemedicine Pt Eval High Complex 45 Min	$328	$275.52	Not listed in the file
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 30 minutes	Not listed in the file	Not listed in the file	$117.13 – $897.18
Psychotherapy, 30 minutes: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $191.81 Ambetter Health — Exchange: $287.71 Amerihealth Caritas — Medicaid Managed Care Plan: $117.13 Amerihealth Caritas — Medicare Managed Care Plan: $195.64 Bcbs — Highmark Aca Exchange: $798.70 Bcbs — Highmark Non-Aca All Commercial Plans: $897.18
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 45 minutes	Not listed in the file	Not listed in the file	$154.53 – $897.18
Psychotherapy, 45 minutes: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $191.81 Ambetter Health — Exchange: $287.71 Amerihealth Caritas — Medicaid Managed Care Plan: $154.53 Amerihealth Caritas — Medicare Managed Care Plan: $195.64 Bcbs — Highmark Aca Exchange: $798.70 Bcbs — Highmark Non-Aca All Commercial Plans: $897.18
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 60 minutes	Not listed in the file	Not listed in the file	$191.81 – $897.18
Psychotherapy, 60 minutes: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $191.81 Ambetter Health — Exchange: $287.71 Amerihealth Caritas — Medicaid Managed Care Plan: $228.77 Amerihealth Caritas — Medicare Managed Care Plan: $195.64 Bcbs — Highmark Aca Exchange: $798.70 Bcbs — Highmark Non-Aca All Commercial Plans: $897.18
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$167.16 – $897.18
Family psychotherapy, without the patient: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $191.81 Ambetter Health — Exchange: $287.71 Amerihealth Caritas — Medicaid Managed Care Plan: $167.16 Amerihealth Caritas — Medicare Managed Care Plan: $195.64 Bcbs — Highmark Aca Exchange: $798.70 Bcbs — Highmark Non-Aca All Commercial Plans: $897.18
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/pt 50 min	Not listed in the file	Not listed in the file	$174.31 – $897.18
Family psychotherapy, with the patient: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $191.81 Ambetter Health — Exchange: $287.71 Amerihealth Caritas — Medicaid Managed Care Plan: $174.31 Amerihealth Caritas — Medicare Managed Care Plan: $195.64 Bcbs — Highmark Aca Exchange: $798.70 Bcbs — Highmark Non-Aca All Commercial Plans: $897.18
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Group psychotherapy	Not listed in the file	Not listed in the file	$41.23 – $513.50
Group psychotherapy: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $109.78 Ambetter Health — Exchange: $164.67 Amerihealth Caritas — Medicaid Managed Care Plan: $41.23 Amerihealth Caritas — Medicare Managed Care Plan: $111.98 Bcbs — Highmark Aca Exchange: $457.14 Bcbs — Highmark Non-Aca All Commercial Plans: $513.50

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$694.03 – $19,791.13
Removal of breast growth (open surgery): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $4,231.13 Ambetter Health — Exchange: $6,346.70 Amerihealth Caritas — Medicaid Managed Care Plan: $694.03 Amerihealth Caritas — Medicare Managed Care Plan: $4,315.76 Bcbs — Highmark Aca Exchange: $17,618.86 Bcbs — Highmark Non-Aca All Commercial Plans: $19,791.13
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Removal Of Breast Lesion	$8,186	$6,876.24	Not listed in the file
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$2,119.95 – $64,894.98
Total hip replacement: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $13,873.86 Ambetter Health — Exchange: $20,810.79 Amerihealth Caritas — Medicaid Managed Care Plan: $2,119.95 Amerihealth Caritas — Medicare Managed Care Plan: $14,151.34 Bcbs — Highmark Aca Exchange: $57,772.14 Bcbs — Highmark Non-Aca All Commercial Plans: $64,894.98
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$2,117.25 – $64,894.98
Total knee replacement: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $13,873.86 Ambetter Health — Exchange: $20,810.79 Amerihealth Caritas — Medicaid Managed Care Plan: $2,117.25 Amerihealth Caritas — Medicare Managed Care Plan: $14,151.34 Bcbs — Highmark Aca Exchange: $57,772.14 Bcbs — Highmark Non-Aca All Commercial Plans: $64,894.98
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Shoulder arthroscopy/surgery	Not listed in the file	Not listed in the file	$280.68
Shoulder arthroscopy: shaving of shoulder bone: rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $280.68
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Knee arthroscopy/surgery	Not listed in the file	Not listed in the file	$905.62 – $16,538.80
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $3,535.82 Ambetter Health — Exchange: $5,303.73 Amerihealth Caritas — Medicaid Managed Care Plan: $905.62 Amerihealth Caritas — Medicare Managed Care Plan: $3,606.54 Bcbs — Highmark Aca Exchange: $14,723.51 Bcbs — Highmark Non-Aca All Commercial Plans: $16,538.80
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$484.58 – $29,922.64
Removal of tonsils and adenoids (under age 12): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $6,397.14 Ambetter Health — Exchange: $9,595.72 Amerihealth Caritas — Medicaid Managed Care Plan: $484.58 Amerihealth Caritas — Medicare Managed Care Plan: $6,525.09 Bcbs — Highmark Aca Exchange: $26,638.35 Bcbs — Highmark Non-Aca All Commercial Plans: $29,922.64
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Egd diagnostic brush wash	Not listed in the file	Not listed in the file	$199.23 – $4,584.49
Upper GI endoscopy (diagnostic): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $980.12 Ambetter Health — Exchange: $1,470.17 Amerihealth Caritas — Medicaid Managed Care Plan: $199.23 Amerihealth Caritas — Medicare Managed Care Plan: $999.72 Bcbs — Highmark Aca Exchange: $4,081.30 Bcbs — Highmark Non-Aca All Commercial Plans: $4,584.49
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Egd Diagnostic Brush Wash	$2,662	$2,236.08	Not listed in the file
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Egd biopsy single/multiple	Not listed in the file	Not listed in the file	$223.87 – $4,584.49
Upper GI endoscopy with biopsy: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $980.12 Ambetter Health — Exchange: $1,470.17 Amerihealth Caritas — Medicaid Managed Care Plan: $223.87 Amerihealth Caritas — Medicare Managed Care Plan: $999.72 Bcbs — Highmark Aca Exchange: $4,081.30 Bcbs — Highmark Non-Aca All Commercial Plans: $4,584.49
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Egd Biopsy Single/Multiple	$2,662	$2,236.08	Not listed in the file
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Diagnostic colonoscopy	Not listed in the file	Not listed in the file	$299.20 – $4,700.61
Colonoscopy (diagnostic): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $1,004.94 Ambetter Health — Exchange: $1,507.41 Amerihealth Caritas — Medicaid Managed Care Plan: $299.20 Amerihealth Caritas — Medicare Managed Care Plan: $1,025.04 Bcbs — Highmark Aca Exchange: $4,184.67 Bcbs — Highmark Non-Aca All Commercial Plans: $4,700.61
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Diagnostic Colonoscopy	$2,825	$2,373	Not listed in the file
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy and biopsy	Not listed in the file	Not listed in the file	$325.41 – $6,048.60
Colonoscopy with biopsy: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $1,293.13 Ambetter Health — Exchange: $1,939.69 Amerihealth Caritas — Medicaid Managed Care Plan: $325.41 Amerihealth Caritas — Medicare Managed Care Plan: $1,318.99 Bcbs — Highmark Aca Exchange: $5,384.71 Bcbs — Highmark Non-Aca All Commercial Plans: $6,048.60
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Colonoscopy And Biopsy	$2,825	$2,373	Not listed in the file
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/lesion removal	Not listed in the file	Not listed in the file	$410.19 – $6,048.60
Colonoscopy with removal of polyps (snare): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $1,293.13 Ambetter Health — Exchange: $1,939.69 Amerihealth Caritas — Medicaid Managed Care Plan: $410.19 Amerihealth Caritas — Medicare Managed Care Plan: $1,318.99 Bcbs — Highmark Aca Exchange: $5,384.71 Bcbs — Highmark Non-Aca All Commercial Plans: $6,048.60
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Colonoscopy W/Lesion Removal By Snare	$2,825	$2,373	Not listed in the file
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/endoscope us	Not listed in the file	Not listed in the file	$415.73 – $6,048.60
Ultrasound of the lower bowel by endoscope: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $1,293.13 Ambetter Health — Exchange: $1,939.69 Amerihealth Caritas — Medicaid Managed Care Plan: $415.73 Amerihealth Caritas — Medicare Managed Care Plan: $1,318.99 Bcbs — Highmark Aca Exchange: $5,384.71 Bcbs — Highmark Non-Aca All Commercial Plans: $6,048.60
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Colsc Flx W/Ndsc Us Xm Rctm Et Al Lmtd&Adj Strux	$4,793	$4,026.12	Not listed in the file
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$299.70 – $4,700.61
Screening colonoscopy (not high risk): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $1,004.94 Ambetter Health — Exchange: $1,507.41 Amerihealth Caritas — Medicaid Managed Care Plan: $299.70 Amerihealth Caritas — Medicare Managed Care Plan: $1,025.04 Bcbs — Highmark Aca Exchange: $4,184.67 Bcbs — Highmark Non-Aca All Commercial Plans: $4,700.61
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Colon Ca Scrn Not Hi Rsk Ind	$3,246	$2,726.64	Not listed in the file
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$1,091.38 – $30,557.99
Gallbladder removal by laparoscope: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $6,532.98 Ambetter Health — Exchange: $9,799.46 Amerihealth Caritas — Medicaid Managed Care Plan: $1,091.38 Amerihealth Caritas — Medicare Managed Care Plan: $6,663.64 Bcbs — Highmark Aca Exchange: $27,203.96 Bcbs — Highmark Non-Aca All Commercial Plans: $30,557.99
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$867.13 – $18,097.65
Groin (inguinal) hernia repair, age 5 or older: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $3,869.09 Ambetter Health — Exchange: $5,803.63 Amerihealth Caritas — Medicaid Managed Care Plan: $867.13 Amerihealth Caritas — Medicare Managed Care Plan: $3,946.47 Bcbs — Highmark Aca Exchange: $16,111.26 Bcbs — Highmark Non-Aca All Commercial Plans: $18,097.65
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Biopsy of prostate	Not listed in the file	Not listed in the file	$210.96
Prostate biopsy: rates for 1 insurance plan Amerihealth Caritas — Medicaid Managed Care Plan: $210.96
Prostate biopsy CPT 55700 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Biopsy Of Prostate	$6,093	$5,118.12	Not listed in the file
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laparo radical prostatectomy	Not listed in the file	Not listed in the file	$1,953.65 – $53,730.04
Prostate removal by laparoscope (radical prostatectomy): rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $11,486.91 Ambetter Health — Exchange: $17,230.37 Amerihealth Caritas — Medicaid Managed Care Plan: $1,953.65 Amerihealth Caritas — Medicare Managed Care Plan: $11,716.65 Bcbs — Highmark Aca Exchange: $47,832.66 Bcbs — Highmark Non-Aca All Commercial Plans: $53,730.04
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$378.54 – $16,362.52
Hysteroscopy with biopsy of the uterus lining: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $3,498.13 Ambetter Health — Exchange: $5,247.20 Amerihealth Caritas — Medicaid Managed Care Plan: $378.54 Amerihealth Caritas — Medicare Managed Care Plan: $3,568.10 Bcbs — Highmark Aca Exchange: $14,566.58 Bcbs — Highmark Non-Aca All Commercial Plans: $16,362.52
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx interlaminar lmbr/sac	Not listed in the file	Not listed in the file	$162.33 – $3,567.98
Spinal injection, lower back (epidural), with imaging guidance: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $762.80 Ambetter Health — Exchange: $1,144.19 Amerihealth Caritas — Medicaid Managed Care Plan: $162.33 Amerihealth Caritas — Medicare Managed Care Plan: $778.05 Bcbs — Highmark Aca Exchange: $3,176.36 Bcbs — Highmark Non-Aca All Commercial Plans: $3,567.98
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Inject Spine Lumbar/Sacral	$3,524	$2,960.16	Not listed in the file
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Inj foramen epidural l/s	Not listed in the file	Not listed in the file	$181.97 – $4,470.70
Nerve root injection, lower back, with imaging guidance: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $955.79 Ambetter Health — Exchange: $1,433.68 Amerihealth Caritas — Medicaid Managed Care Plan: $181.97 Amerihealth Caritas — Medicare Managed Care Plan: $974.90 Bcbs — Highmark Aca Exchange: $3,979.99 Bcbs — Highmark Non-Aca All Commercial Plans: $4,470.70
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Inj Foramen Epidural L/S	$4,595	$3,859.80	Not listed in the file
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc N Block Inj Foramen / Lumbar Plexus Epidural L/S	$4,595	$3,859.80	Not listed in the file
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Carpal tunnel surgery	Not listed in the file	Not listed in the file	$733.84 – $9,870.33
Carpal tunnel release: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $2,110.17 Ambetter Health — Exchange: $3,165.26 Amerihealth Caritas — Medicaid Managed Care Plan: $733.84 Amerihealth Caritas — Medicare Managed Care Plan: $2,152.38 Bcbs — Highmark Aca Exchange: $8,786.97 Bcbs — Highmark Non-Aca All Commercial Plans: $9,870.33
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: After cataract laser surgery	Not listed in the file	Not listed in the file	$503.66 – $2,780.04
Laser treatment of clouding after cataract surgery: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $594.34 Ambetter Health — Exchange: $891.52 Amerihealth Caritas — Medicaid Managed Care Plan: $503.66 Amerihealth Caritas — Medicare Managed Care Plan: $606.23 Bcbs — Highmark Aca Exchange: $2,474.91 Bcbs — Highmark Non-Aca All Commercial Plans: $2,780.04
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cataract surg w/iol 1 stage	Not listed in the file	Not listed in the file	$880.24 – $11,665.23
Cataract removal with lens implant: rates for 6 insurance plans Aetna — Medicare Managed Care Plan: $2,493.90 Ambetter Health — Exchange: $3,740.85 Amerihealth Caritas — Medicaid Managed Care Plan: $880.24 Amerihealth Caritas — Medicare Managed Care Plan: $2,543.78 Bcbs — Highmark Aca Exchange: $10,384.86 Bcbs — Highmark Non-Aca All Commercial Plans: $11,665.23

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc	Not listed in the file	Not listed in the file	$83,200.03 – $224,929.02
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 15 insurance plan rates Aetna — Medicare Managed Care Plan: $83,200.03 Amerihealth Caritas — Medicare Managed Care Plan: $84,864.03 Bcbs — Highmark Aca Exchange: $224,929.02 Bcbs — Highmark Medicare Managed Care Plan: $83,200.03 Bcbs — Highmark Non-Aca All Commercial Plans: $224,929.02 Health Options — Medicare/Medicaid Managed Care Plan: $83,200.03 Pace Your Life — Medicare/Medicaid Managed Care Plan: $83,200.03 Unitedhealthcare — Medicare Managed Care Plan: $84,864.03 Wellcare — Medicare/Medicaid Managed Care Plan: $83,200.03 Aetna — All Commercial Plans: 92% (a percentage in the contract, not a dollar amount)
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Spinal Fusion Except Cervical Without Mcc	Not listed in the file	Not listed in the file	$71,615.07
Spinal fusion (not neck), without major complications: rates for 8 insurance plans Bcbs — Highmark Aca Exchange: $71,615.07 Bcbs — Highmark Non-Aca All Commercial Plans: $71,615.07 Aetna — All Commercial Plans: 92% (a percentage in the contract, not a dollar amount) Ambetter Health — Exchange: 90% (a percentage in the contract, not a dollar amount) Amerihealth Caritas — Next Exchange: 89% (a percentage in the contract, not a dollar amount) Cigna — All Commercial Plans: 82.4% (a percentage in the contract, not a dollar amount) Vitalcore — All Commercial Plans: 73% (a percentage in the contract, not a dollar amount) Welsh & Associates — All Commercial Plans: 78% (a percentage in the contract, not a dollar amount)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	Not listed in the file	Not listed in the file	$17,064.42 – $39,705.06
Hip or knee replacement (major joint of the leg), without major complications: 10 of 15 insurance plan rates Aetna — Medicare Managed Care Plan: $17,064.42 Amerihealth Caritas — Medicare Managed Care Plan: $17,405.71 Bcbs — Highmark Aca Exchange: $39,705.06 Bcbs — Highmark Medicare Managed Care Plan: $17,064.42 Bcbs — Highmark Non-Aca All Commercial Plans: $39,705.06 Health Options — Medicare/Medicaid Managed Care Plan: $17,064.42 Pace Your Life — Medicare/Medicaid Managed Care Plan: $17,064.42 Unitedhealthcare — Medicare Managed Care Plan: $17,405.71 Wellcare — Medicare/Medicaid Managed Care Plan: $17,064.42 Aetna — All Commercial Plans: 92% (a percentage in the contract, not a dollar amount)
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cervical Spinal Fusion Without Cc/Mcc	Not listed in the file	Not listed in the file	$21,379.21 – $50,916.69
Neck (cervical) spinal fusion, without complications: 10 of 15 insurance plan rates Aetna — Medicare Managed Care Plan: $21,379.21 Amerihealth Caritas — Medicare Managed Care Plan: $21,806.79 Bcbs — Highmark Aca Exchange: $50,916.69 Bcbs — Highmark Medicare Managed Care Plan: $21,379.21 Bcbs — Highmark Non-Aca All Commercial Plans: $50,916.69 Health Options — Medicare/Medicaid Managed Care Plan: $21,379.21 Pace Your Life — Medicare/Medicaid Managed Care Plan: $21,379.21 Unitedhealthcare — Medicare Managed Care Plan: $21,806.79 Wellcare — Medicare/Medicaid Managed Care Plan: $21,379.21 Aetna — All Commercial Plans: 92% (a percentage in the contract, not a dollar amount)
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	Not listed in the file	Not listed in the file	$11,269.27 – $28,493.44
Uterus and ovary surgery (not for cancer), without complications: 10 of 15 insurance plan rates Aetna — Medicare Managed Care Plan: $11,269.27 Amerihealth Caritas — Medicare Managed Care Plan: $11,494.66 Bcbs — Highmark Aca Exchange: $28,493.44 Bcbs — Highmark Medicare Managed Care Plan: $11,269.27 Bcbs — Highmark Non-Aca All Commercial Plans: $28,493.44 Health Options — Medicare/Medicaid Managed Care Plan: $11,269.27 Pace Your Life — Medicare/Medicaid Managed Care Plan: $11,269.27 Unitedhealthcare — Medicare Managed Care Plan: $11,494.66 Wellcare — Medicare/Medicaid Managed Care Plan: $11,269.27 Aetna — All Commercial Plans: 92% (a percentage in the contract, not a dollar amount)

Source: Bayhealth Hospital, Sussex Campus’s standard charges file (bayhealth.org, JSON, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 1, 2026; 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	100 Wellness Way, Milford, DE 19963
County	Sussex County
State	Delaware
Phone	(302) 422‑3311
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	3 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	080009
Name in Medicare records	BAYHEALTH HOSPITAL, SUSSEX CAMPUS
Profile level	Medicare data + hospital website
Official website	bayhealth.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 ZIP code areas (Gazetteer) — approximate position (center of the ZIP code area) used for distances

From the hospital’s website

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

Bayhealth Hospital, Sussex Campus — bayhealth.org
Visitation Policy — bayhealth.org
Bayhealth Emergency and Trauma Center, Sussex Campus | Bayhealth — bayhealth.org
OB Hospitalists and Obstetrical ED | Bayhealth — bayhealth.org
Maternity & Obstetrics | Bayhealth — bayhealth.org
Stroke Care | Bayhealth — bayhealth.org