Does Carle Health Pekin Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Carle Health Pekin Hospital. In a medical emergency, call 911.

Where is Carle Health Pekin Hospital?

600 South 13th Street, Pekin, IL 61554, in Tazewell County, Illinois.

What is the phone number of Carle Health Pekin Hospital?

(309) 347-1151, as listed by Medicare (CMS).

What is the Medicare star rating of Carle Health Pekin Hospital?

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

Carle Health Pekin Hospital — Pekin, IL

Quick answers

Does Carle Health Pekin Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Carle Health Pekin Hospital. In a medical emergency, call 911.
Where is Carle Health Pekin Hospital?: 600 South 13th Street, Pekin, IL 61554, in Tazewell County, Illinois.
What is the phone number of Carle Health Pekin Hospital?: (309) 347-1151, as listed by Medicare (CMS).
What is the Medicare star rating of Carle Health Pekin Hospital?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Visiting and practical information

Visiting	Normal visiting hours are 8 a.m. to 8 p.m., seven days a week; check in at the front lobby desk after 8 p.m^[5]
Patient portal	MyCarle

Doctors and clinicians (338)

338 doctors and other clinicians list Carle Health Pekin 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 314 more: the button below opens the full list.

Other emergency rooms nearby

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

Carle Health Methodist Hospital9.7 mi · Peoria, IL · Acute Care Hospital
Saint Francis Medical Center9.9 mi · Peoria, IL · Acute Care Hospital
Carle Health Proctor Hospital13 mi · Peoria, IL · Acute Care Hospital
Hopedale Hospital15 mi · Hopedale, IL · Critical Access Hospital
Graham Hospital Association21 mi · Canton, IL · Acute Care Hospital

Other hospitals nearby

OSF Healthcare Divine Mercy Continuing Care Hosp9.2 mi · Peoria, IL · Long-Term 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

Timbercreek Rehab and Health Care Center0.9 mi · Pekin, IL · 1 of 5 stars
Hallmark Healthcare of Pekin1.3 mi · Pekin, IL · 1 of 5 stars
Pekin Manor1.5 mi · Pekin, IL · 4 of 5 stars

All nursing homes in the state →

Hospice providers

Elysian Hospice, Inc.11 mi · Morton, IL
OSF Hospice13 mi · Peoria, IL · 4 of 5 stars
Comfort Plus Hospice Inc14 mi · Peoria, IL

All hospice providers in the state →

Home health agencies

Helping Hands Home Healthcare and Staffing, LLC11 mi · Morton, IL
St. Francis Medical Center13 mi · Peoria, IL
Iris Home Health Services, LLC14 mi · Peoria, IL · 2 of 5 stars

All home health agencies in the state →

Dialysis facilities

FMC - Central Illinois Pekin1.4 mi · Pekin, IL · 3 of 5 stars
FMC - Peoria Downtown7.9 mi · Peoria, IL · 1 of 5 stars
FKC - East Peoria Home12 mi · East Peoria, IL · 5 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.

Central Illinois Endoscopy Center, LLC9.6 mi · Peoria, IL
Renal Intervention Center LLC11 mi · Morton, IL
Center for Health Ambulatory Surgery Center, LLC13 mi · Peoria, IL

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

Heartland Community Health Clinic DBA: Heartland Health Services - Mobile Health Center 11.7 mi · Pekin, IL · Community health center
Heartland Community Health Clinic DBA: Heartland Health Services - Olt1.7 mi · Pekin, IL · Community health center
Heartland Community Health Clinic DBA: Heartland Health Services - Vandever2.0 mi · Pekin, IL · Community health center

Clinics and urgent care

Graham Medical Group-Glasford11 mi · Glasford, IL · Rural health clinic
Manito Medical Associates12 mi · Manito, IL · Rural health clinic
GMG Convenient Care21 mi · Canton, IL · Rural health clinic

Pharmacies

Walgreen Co1.4 mi · Pekin, IL · Pharmacy
Walgreen Co1.4 mi · Pekin, IL · Pharmacy
Walmart Inc.1.4 mi · Pekin, IL · Community/retail pharmacy

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 Carle Health Pekin 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)	3 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	2 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Quiet at night	3 of 5 stars
Rated the hospital 9 or 10 out of 10	58%National average: 72%
Would definitely recommend the hospital	57%National average: 71%
Nurses “always” communicated well	72%National average: 80%
Doctors “always” communicated well	76%National average: 80%
Staff “always” explained medicines before giving them	54%National average: 62%
Were given information about recovery at home	88%National average: 86%
Room and bathroom “always” clean	65%National average: 74%
Area around the room “always” quiet at night	53%National average: 60%
Completed surveys	273Response rate: 21%

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)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
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	1.232No different from 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	11.5%
Deaths within 30 days: heart failure patients	15.1%
Deaths within 30 days: pneumonia patients	15.4%
Deaths within 30 days: COPD patients	6.9%
Deaths within 30 days: stroke patients	12.1%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.93No different from the national rate
Complications after hip or knee replacement	Not reported to Medicare

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	22.4%
Readmitted within 30 days: pneumonia	16.9%
Readmitted within 30 days: COPD	20%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Not reported to Medicare

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)	115 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	72%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 Illinois Best hospitals in Illinois

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 86 common services exactly as Carle Health Pekin 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) · Hospital (facility) fee In the file: OFFICE O/P NEW LOW 30 MIN	Not listed in the file	Not listed in the file	$58.66 – $133.94
New patient office visit (about 30–44 minutes): rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $60.42 Blue Cross Blue Shield — Medicare Advantage: $115.47 Humana — Medicare Advantage: $115.47 Humana — Medicare-Medicaid (D-SNP): $58.66 Meridian — Medicare-Medicaid (MMAI/Dual): $133.94 Molina — Medicare-Medicaid (MMAI/Dual): $115.47 United Healthcare (UHC) — Medicare Advantage: $115.47 United Healthcare (UHC) — VA CCN: $115.47 Wellcare — Medicare Advantage HMO: $115.47
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE O/P NEW LOW 30 MIN	Not listed in the file	Not listed in the file	$58.66 – $60.42
New patient office visit (about 30–44 minutes): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $60.42 Humana — Medicare-Medicaid (D-SNP): $58.66
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW MOD 45 MIN	Not listed in the file	Not listed in the file	$94.01 – $202.65
New patient office visit (about 45–59 minutes): rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $96.83 Blue Cross Blue Shield — Medicare Advantage: $174.69 Humana — Medicare Advantage: $174.69 Humana — Medicare-Medicaid (D-SNP): $94.01 Meridian — Medicare-Medicaid (MMAI/Dual): $202.65 Molina — Medicare-Medicaid (MMAI/Dual): $174.69 United Healthcare (UHC) — Medicare Advantage: $174.69 United Healthcare (UHC) — VA CCN: $174.69 Wellcare — Medicare Advantage HMO: $174.69
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE O/P NEW MOD 45 MIN	Not listed in the file	Not listed in the file	$94.01 – $96.83
New patient office visit (about 45–59 minutes): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $96.83 Humana — Medicare-Medicaid (D-SNP): $94.01
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW HI 60 MIN	Not listed in the file	Not listed in the file	$127.56 – $271.67
New patient office visit (about 60–74 minutes): rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $131.39 Blue Cross Blue Shield — Medicare Advantage: $234.20 Humana — Medicare Advantage: $234.20 Humana — Medicare-Medicaid (D-SNP): $127.56 Meridian — Medicare-Medicaid (MMAI/Dual): $271.67 Molina — Medicare-Medicaid (MMAI/Dual): $234.20 United Healthcare (UHC) — Medicare Advantage: $234.20 United Healthcare (UHC) — VA CCN: $234.20 Wellcare — Medicare Advantage HMO: $234.20
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE O/P NEW HI 60 MIN	Not listed in the file	Not listed in the file	$127.56 – $131.39
New patient office visit (about 60–74 minutes): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $131.39 Humana — Medicare-Medicaid (D-SNP): $127.56
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P EST LOW 20 MIN	Not listed in the file	Not listed in the file	$46.43 – $107.47
Established patient office visit (about 20–29 minutes): rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $47.82 Blue Cross Blue Shield — Medicare Advantage: $92.64 Humana — Medicare Advantage: $92.64 Humana — Medicare-Medicaid (D-SNP): $46.43 Meridian — Medicare-Medicaid (MMAI/Dual): $107.47 Molina — Medicare-Medicaid (MMAI/Dual): $92.64 United Healthcare (UHC) — Medicare Advantage: $92.64 United Healthcare (UHC) — VA CCN: $92.64 Wellcare — Medicare Advantage HMO: $92.64
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE O/P EST LOW 20 MIN	Not listed in the file	Not listed in the file	$46.43 – $68.34
Established patient office visit (about 20–29 minutes): rates for 3 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $47.82 Humana — Medicare-Medicaid (D-SNP): $46.43 United Healthcare (UHC) — VA CCN: $68.34
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P EST MOD 30 MIN	Not listed in the file	Not listed in the file	$68.51 – $153.62
Established patient office visit (about 30–39 minutes): rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $70.57 Blue Cross Blue Shield — Medicare Advantage: $132.43 Humana — Medicare Advantage: $132.43 Humana — Medicare-Medicaid (D-SNP): $68.51 Meridian — Medicare-Medicaid (MMAI/Dual): $153.62 Molina — Medicare-Medicaid (MMAI/Dual): $132.43 United Healthcare (UHC) — Medicare Advantage: $132.43 United Healthcare (UHC) — VA CCN: $132.43 Wellcare — Medicare Advantage HMO: $132.43
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE O/P EST MOD 30 MIN	Not listed in the file	Not listed in the file	$68.51 – $100.83
Established patient office visit (about 30–39 minutes): rates for 3 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $70.57 Humana — Medicare-Medicaid (D-SNP): $68.51 United Healthcare (UHC) — VA CCN: $100.83
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$91.23 – $128.05
Office consultation with a specialist (moderate): rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $93.97 Blue Cross Blue Shield — Medicare Advantage: $110.39 Humana — Medicare Advantage: $110.39 Humana — Medicare-Medicaid (D-SNP): $91.23 Meridian — Medicare-Medicaid (MMAI/Dual): $128.05 Molina — Medicare-Medicaid (MMAI/Dual): $110.39 United Healthcare (UHC) — Medicare Advantage: $110.39 United Healthcare (UHC) — VA CCN: $110.39 Wellcare — Medicare Advantage HMO: $110.39
Office consultation with a specialist (moderate) CPT 99243 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$91.23 – $93.97
Office consultation with a specialist (moderate): rates for 3 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $93.97 Humana — Medicare-Medicaid (D-SNP): $91.23 United Healthcare (UHC) — VA CCN: $91.67
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$139.12 – $183.85
Office consultation with a specialist (moderate to high): rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $143.29 Blue Cross Blue Shield — Medicare Advantage: $158.49 Humana — Medicare Advantage: $158.49 Humana — Medicare-Medicaid (D-SNP): $139.12 Meridian — Medicare-Medicaid (MMAI/Dual): $183.85 Molina — Medicare-Medicaid (MMAI/Dual): $158.49 United Healthcare (UHC) — Medicare Advantage: $158.49 United Healthcare (UHC) — VA CCN: $158.49 Wellcare — Medicare Advantage HMO: $158.49
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$139.12 – $143.29
Office consultation with a specialist (moderate to high): rates for 3 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $143.29 Humana — Medicare-Medicaid (D-SNP): $139.12 United Healthcare (UHC) — VA CCN: $139.79
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	$76.38 – $152.05
Preventive checkup, new patient, age 18–39: rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $78.67 Blue Cross Blue Shield — Medicare Advantage: $131.08 Humana — Medicare Advantage: $131.08 Humana — Medicare-Medicaid (D-SNP): $76.38 Meridian — Medicare-Medicaid (MMAI/Dual): $152.05 Molina — Medicare-Medicaid (MMAI/Dual): $131.08 United Healthcare (UHC) — Medicare Advantage: $131.08 United Healthcare (UHC) — VA CCN: $131.08 Wellcare — Medicare Advantage HMO: $131.08
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$76.38 – $97.34
Preventive checkup, new patient, age 18–39: rates for 3 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $78.67 Humana — Medicare-Medicaid (D-SNP): $76.38 United Healthcare (UHC) — VA CCN: $97.34
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	$92.54 – $176.48
Preventive checkup, new patient, age 40–64: rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $95.32 Blue Cross Blue Shield — Medicare Advantage: $152.13 Humana — Medicare Advantage: $152.13 Humana — Medicare-Medicaid (D-SNP): $92.54 Meridian — Medicare-Medicaid (MMAI/Dual): $176.48 Molina — Medicare-Medicaid (MMAI/Dual): $152.13 United Healthcare (UHC) — Medicare Advantage: $152.13 United Healthcare (UHC) — VA CCN: $152.13 Wellcare — Medicare Advantage HMO: $152.13
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 40-64	Not listed in the file	Not listed in the file	$92.54 – $117.93
Preventive checkup, new patient, age 40–64: rates for 3 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $95.32 Humana — Medicare-Medicaid (D-SNP): $92.54 United Healthcare (UHC) — VA CCN: $117.93
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency Room Level 3 Np/Pa	$857	$857	$51.73 – $877.58
Emergency room visit (moderate): 10 of 23 insurance plan rates Aetna — Commercial: $659.32 Aetna — Medicare Advantage: $428.50 Aetna Better Health — Managed Medicaid: $214.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $53.28 Blue Cross Blue Shield — Blue Choice: $334.23 Blue Cross Blue Shield — Blue Choice Options: $334.23 Blue Cross Blue Shield — HMO: $317.09 Blue Cross Blue Shield — Managed Medicaid: $214.25 Blue Cross Blue Shield — Medicare Advantage: $292.53 Blue Cross Blue Shield — PPO: $338.52
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency Room Level 3	$1,512	$1,512	$51.73 – $1,043.28
Emergency room visit (moderate): 10 of 23 insurance plan rates Aetna — Commercial: $659.32 Aetna — Medicare Advantage: $756 Aetna Better Health — Managed Medicaid: $378 Aetna Better Health — Medicare-Medicaid (D-SNP): $53.28 Blue Cross Blue Shield — Blue Choice: $589.68 Blue Cross Blue Shield — Blue Choice Options: $589.68 Blue Cross Blue Shield — HMO: $559.44 Blue Cross Blue Shield — Managed Medicaid: $378 Blue Cross Blue Shield — Medicare Advantage: $292.53 Blue Cross Blue Shield — PPO: $597.24
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Emergency Room Level 3 Np/Pa	$857	$857	$51.73 – $428.50
Emergency room visit (moderate): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $214.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $53.28 Blue Cross Blue Shield — HMO: $317.09 Blue Cross Blue Shield — Managed Medicaid: $214.25 Humana — Medicare-Medicaid (D-SNP): $51.73 Molina — Managed Medicaid: $257.10 Molina — Medicare-Medicaid (MMAI/Dual): $257.10 Multiplan/PHCS — PPO: $428.50
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency Room Level 4	$2,373	$2,373	$86.76 – $2,107
Emergency room visit (moderately high): 10 of 23 insurance plan rates Aetna — Commercial: $1,013.36 Aetna — Medicare Advantage: $1,186.50 Aetna Better Health — Managed Medicaid: $593.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $89.36 Blue Cross Blue Shield — Blue Choice: $925.47 Blue Cross Blue Shield — Blue Choice Options: $925.47 Blue Cross Blue Shield — HMO: $878.01 Blue Cross Blue Shield — Managed Medicaid: $593.25 Blue Cross Blue Shield — Medicare Advantage: $447.15 Blue Cross Blue Shield — PPO: $937.34
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Emergency Room Level 4	$2,373	$2,373	$86.76 – $1,186.50
Emergency room visit (moderately high): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $593.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $89.36 Blue Cross Blue Shield — HMO: $878.01 Blue Cross Blue Shield — Managed Medicaid: $593.25 Humana — Medicare-Medicaid (D-SNP): $86.76 Molina — Managed Medicaid: $711.90 Molina — Medicare-Medicaid (MMAI/Dual): $711.90 Multiplan/PHCS — PPO: $1,186.50
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency Room Level 5	$3,402	$3,402	$126.53 – $4,259
Emergency room visit (high): 10 of 23 insurance plan rates Aetna — Commercial: $1,458.56 Aetna — Medicare Advantage: $1,701 Aetna Better Health — Managed Medicaid: $850.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $130.33 Blue Cross Blue Shield — Blue Choice: $1,326.78 Blue Cross Blue Shield — Blue Choice Options: $1,326.78 Blue Cross Blue Shield — HMO: $1,258.74 Blue Cross Blue Shield — Managed Medicaid: $850.50 Blue Cross Blue Shield — Medicare Advantage: $638.18 Blue Cross Blue Shield — PPO: $1,343.79
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Emergency Room Level 5	$3,402	$3,402	$126.53 – $1,701
Emergency room visit (high): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $850.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $130.33 Blue Cross Blue Shield — HMO: $1,258.74 Blue Cross Blue Shield — Managed Medicaid: $850.50 Humana — Medicare-Medicaid (D-SNP): $126.53 Molina — Managed Medicaid: $1,020.60 Molina — Medicare-Medicaid (MMAI/Dual): $1,020.60 Multiplan/PHCS — PPO: $1,701

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: Bmp Ref	$251	$251	$7.28 – $168.17
Basic metabolic panel (blood test): 10 of 23 insurance plan rates Aetna — Commercial: $122.99 Aetna — Medicare Advantage: $125.50 Aetna Better Health — Managed Medicaid: $62.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $7.50 Blue Cross Blue Shield — Blue Choice: $97.89 Blue Cross Blue Shield — Blue Choice Options: $97.89 Blue Cross Blue Shield — HMO: $92.87 Blue Cross Blue Shield — Managed Medicaid: $62.75 Blue Cross Blue Shield — Medicare Advantage: $8.46 Blue Cross Blue Shield — PPO: $99.15
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic Metabolic Panel	$252	$252	$7.28 – $168.84
Basic metabolic panel (blood test): 10 of 23 insurance plan rates Aetna — Commercial: $123.48 Aetna — Medicare Advantage: $126 Aetna Better Health — Managed Medicaid: $63 Aetna Better Health — Medicare-Medicaid (D-SNP): $7.50 Blue Cross Blue Shield — Blue Choice: $98.28 Blue Cross Blue Shield — Blue Choice Options: $98.28 Blue Cross Blue Shield — HMO: $93.24 Blue Cross Blue Shield — Managed Medicaid: $63 Blue Cross Blue Shield — Medicare Advantage: $8.46 Blue Cross Blue Shield — PPO: $99.54
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Bmp Ref	$251	$251	$7.28 – $125.50
Basic metabolic panel (blood test): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $62.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $7.50 Blue Cross Blue Shield — HMO: $92.87 Blue Cross Blue Shield — Managed Medicaid: $62.75 Humana — Medicare-Medicaid (D-SNP): $7.28 Molina — Managed Medicaid: $75.30 Molina — Medicare-Medicaid (MMAI/Dual): $75.30 Multiplan/PHCS — PPO: $125.50
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cmp Panel	$357	$357	$9.08 – $239.19
Comprehensive metabolic panel (blood test): 10 of 23 insurance plan rates Aetna — Commercial: $174.93 Aetna — Medicare Advantage: $178.50 Aetna Better Health — Managed Medicaid: $89.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $9.35 Blue Cross Blue Shield — Blue Choice: $139.23 Blue Cross Blue Shield — Blue Choice Options: $139.23 Blue Cross Blue Shield — HMO: $132.09 Blue Cross Blue Shield — Managed Medicaid: $89.25 Blue Cross Blue Shield — Medicare Advantage: $10.56 Blue Cross Blue Shield — PPO: $141.02
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$341	$341	$9.08 – $228.47
Comprehensive metabolic panel (blood test): 10 of 23 insurance plan rates Aetna — Commercial: $167.09 Aetna — Medicare Advantage: $170.50 Aetna Better Health — Managed Medicaid: $85.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $9.35 Blue Cross Blue Shield — Blue Choice: $132.99 Blue Cross Blue Shield — Blue Choice Options: $132.99 Blue Cross Blue Shield — HMO: $126.17 Blue Cross Blue Shield — Managed Medicaid: $85.25 Blue Cross Blue Shield — Medicare Advantage: $10.56 Blue Cross Blue Shield — PPO: $134.70
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cmp Panel	$357	$357	$9.08 – $178.50
Comprehensive metabolic panel (blood test): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $89.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $9.35 Blue Cross Blue Shield — HMO: $132.09 Blue Cross Blue Shield — Managed Medicaid: $89.25 Humana — Medicare-Medicaid (D-SNP): $9.08 Molina — Managed Medicaid: $107.10 Molina — Medicare-Medicaid (MMAI/Dual): $107.10 Multiplan/PHCS — PPO: $178.50
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	$41.12 – $71.13
Obstetric blood test panel: 10 of 11 insurance plan rates Aetna Better Health — Medicare-Medicaid (D-SNP): $42.35 Blue Cross Blue Shield — Medicare Advantage: $47.81 HealthLink — HMO: $71.13 HealthLink — PPO: $71.13 Humana — Medicare Advantage: $47.81 Humana — Medicare-Medicaid (D-SNP): $41.12 Meridian — Medicare-Medicaid (MMAI/Dual): $55.46 Molina — Medicare-Medicaid (MMAI/Dual): $47.81 United Healthcare (UHC) — Medicare Advantage: $47.81 United Healthcare (UHC) — VA CCN: $47.81
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$41.12 – $42.35
Obstetric blood test panel: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $42.35 Humana — Medicare-Medicaid (D-SNP): $41.12
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Profile	$289	$289	$11.52 – $193.63
Cholesterol panel (lipid panel): 10 of 23 insurance plan rates Aetna — Commercial: $141.61 Aetna — Medicare Advantage: $144.50 Aetna Better Health — Managed Medicaid: $72.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $11.87 Blue Cross Blue Shield — Blue Choice: $112.71 Blue Cross Blue Shield — Blue Choice Options: $112.71 Blue Cross Blue Shield — HMO: $106.93 Blue Cross Blue Shield — Managed Medicaid: $72.25 Blue Cross Blue Shield — Medicare Advantage: $13.39 Blue Cross Blue Shield — PPO: $114.16
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Arup Lipid Panel, Extended	$291	$291	$11.52 – $194.97
Cholesterol panel (lipid panel): 10 of 23 insurance plan rates Aetna — Commercial: $142.59 Aetna — Medicare Advantage: $145.50 Aetna Better Health — Managed Medicaid: $72.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $11.87 Blue Cross Blue Shield — Blue Choice: $113.49 Blue Cross Blue Shield — Blue Choice Options: $113.49 Blue Cross Blue Shield — HMO: $107.67 Blue Cross Blue Shield — Managed Medicaid: $72.75 Blue Cross Blue Shield — Medicare Advantage: $13.39 Blue Cross Blue Shield — PPO: $114.95
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Lipid Profile	$289	$289	$11.52 – $144.50
Cholesterol panel (lipid panel): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $72.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $11.87 Blue Cross Blue Shield — HMO: $106.93 Blue Cross Blue Shield — Managed Medicaid: $72.25 Humana — Medicare-Medicaid (D-SNP): $11.52 Molina — Managed Medicaid: $86.70 Molina — Medicare-Medicaid (MMAI/Dual): $86.70 Multiplan/PHCS — PPO: $144.50
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel	$310	$310	$7.46 – $207.70
Kidney function panel: 10 of 23 insurance plan rates Aetna — Commercial: $151.90 Aetna — Medicare Advantage: $155 Aetna Better Health — Managed Medicaid: $77.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $7.68 Blue Cross Blue Shield — Blue Choice: $120.90 Blue Cross Blue Shield — Blue Choice Options: $120.90 Blue Cross Blue Shield — HMO: $114.70 Blue Cross Blue Shield — Managed Medicaid: $77.50 Blue Cross Blue Shield — Medicare Advantage: $8.68 Blue Cross Blue Shield — PPO: $122.45
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Renal Function Panel	$310	$310	$7.46 – $155
Kidney function panel: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $77.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $7.68 Blue Cross Blue Shield — HMO: $114.70 Blue Cross Blue Shield — Managed Medicaid: $77.50 Humana — Medicare-Medicaid (D-SNP): $7.46 Molina — Managed Medicaid: $93 Molina — Medicare-Medicaid (MMAI/Dual): $93 Multiplan/PHCS — PPO: $155
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$236	$236	$7.03 – $158.12
Liver function panel: 10 of 23 insurance plan rates Aetna — Commercial: $115.64 Aetna — Medicare Advantage: $118 Aetna Better Health — Managed Medicaid: $59 Aetna Better Health — Medicare-Medicaid (D-SNP): $7.24 Blue Cross Blue Shield — Blue Choice: $92.04 Blue Cross Blue Shield — Blue Choice Options: $92.04 Blue Cross Blue Shield — HMO: $87.32 Blue Cross Blue Shield — Managed Medicaid: $59 Blue Cross Blue Shield — Medicare Advantage: $8.17 Blue Cross Blue Shield — PPO: $93.22
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$236	$236	$7.03 – $118
Liver function panel: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $59 Aetna Better Health — Medicare-Medicaid (D-SNP): $7.24 Blue Cross Blue Shield — HMO: $87.32 Blue Cross Blue Shield — Managed Medicaid: $59 Humana — Medicare-Medicaid (D-SNP): $7.03 Molina — Managed Medicaid: $70.80 Molina — Medicare-Medicaid (MMAI/Dual): $70.80 Multiplan/PHCS — PPO: $118
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Auto W/Microscopy	$88	$88	$2.73 – $58.96
Urine test (automated, with microscope): 10 of 23 insurance plan rates Aetna — Commercial: $43.12 Aetna — Medicare Advantage: $44 Aetna Better Health — Managed Medicaid: $22 Aetna Better Health — Medicare-Medicaid (D-SNP): $2.81 Blue Cross Blue Shield — Blue Choice: $34.32 Blue Cross Blue Shield — Blue Choice Options: $34.32 Blue Cross Blue Shield — HMO: $32.56 Blue Cross Blue Shield — Managed Medicaid: $22 Blue Cross Blue Shield — Medicare Advantage: $3.17 Blue Cross Blue Shield — PPO: $34.76
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Urinalysis Auto W/Microscopy	$88	$88	$2.73 – $44
Urine test (automated, with microscope): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $22 Aetna Better Health — Medicare-Medicaid (D-SNP): $2.81 Blue Cross Blue Shield — HMO: $32.56 Blue Cross Blue Shield — Managed Medicaid: $22 Humana — Medicare-Medicaid (D-SNP): $2.73 Molina — Managed Medicaid: $26.40 Molina — Medicare-Medicaid (MMAI/Dual): $26.40 Multiplan/PHCS — PPO: $44
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	$2.99 – $4.66
Urine test (manual, without microscope): 10 of 11 insurance plan rates Aetna Better Health — Medicare-Medicaid (D-SNP): $3.08 Blue Cross Blue Shield — Medicare Advantage: $3.48 HealthLink — HMO: $4.66 HealthLink — PPO: $4.66 Humana — Medicare Advantage: $3.48 Humana — Medicare-Medicaid (D-SNP): $2.99 Meridian — Medicare-Medicaid (MMAI/Dual): $4.04 Molina — Medicare-Medicaid (MMAI/Dual): $3.48 United Healthcare (UHC) — Medicare Advantage: $3.48 United Healthcare (UHC) — VA CCN: $3.48
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE	Not listed in the file	Not listed in the file	$2.99 – $3.08
Urine test (manual, without microscope): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $3.08 Humana — Medicare-Medicaid (D-SNP): $2.99
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis, Auto, W/O Scope	$83	$83	$1.94 – $55.61
Urine test (automated, without microscope): 10 of 23 insurance plan rates Aetna — Commercial: $40.67 Aetna — Medicare Advantage: $41.50 Aetna Better Health — Managed Medicaid: $20.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $2 Blue Cross Blue Shield — Blue Choice: $32.37 Blue Cross Blue Shield — Blue Choice Options: $32.37 Blue Cross Blue Shield — HMO: $30.71 Blue Cross Blue Shield — Managed Medicaid: $20.75 Blue Cross Blue Shield — Medicare Advantage: $2.25 Blue Cross Blue Shield — PPO: $32.79
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Auto W/O Microscopy	$64	$64	$1.94 – $42.88
Urine test (automated, without microscope): 10 of 23 insurance plan rates Aetna — Commercial: $31.36 Aetna — Medicare Advantage: $32 Aetna Better Health — Managed Medicaid: $16 Aetna Better Health — Medicare-Medicaid (D-SNP): $2 Blue Cross Blue Shield — Blue Choice: $24.96 Blue Cross Blue Shield — Blue Choice Options: $24.96 Blue Cross Blue Shield — HMO: $23.68 Blue Cross Blue Shield — Managed Medicaid: $16 Blue Cross Blue Shield — Medicare Advantage: $2.25 Blue Cross Blue Shield — PPO: $25.28
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Urinalysis, Auto, W/O Scope	$83	$83	$1.94 – $41.50
Urine test (automated, without microscope): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $20.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $2 Blue Cross Blue Shield — HMO: $30.71 Blue Cross Blue Shield — Managed Medicaid: $20.75 Humana — Medicare-Medicaid (D-SNP): $1.94 Molina — Managed Medicaid: $24.90 Molina — Medicare-Medicaid (MMAI/Dual): $24.90 Multiplan/PHCS — PPO: $41.50
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psa, Diagnostic (Vista)	$265	$265	$15.82 – $177.55
PSA (prostate specific antigen) blood test: 10 of 23 insurance plan rates Aetna — Commercial: $129.85 Aetna — Medicare Advantage: $132.50 Aetna Better Health — Managed Medicaid: $66.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $16.29 Blue Cross Blue Shield — Blue Choice: $103.35 Blue Cross Blue Shield — Blue Choice Options: $103.35 Blue Cross Blue Shield — HMO: $98.05 Blue Cross Blue Shield — Managed Medicaid: $66.25 Blue Cross Blue Shield — Medicare Advantage: $18.39 Blue Cross Blue Shield — PPO: $104.68
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay of psa total	$268	$268	$15.82 – $179.56
PSA (prostate specific antigen) blood test: 10 of 23 insurance plan rates Aetna — Commercial: $131.32 Aetna — Medicare Advantage: $134 Aetna Better Health — Managed Medicaid: $67 Aetna Better Health — Medicare-Medicaid (D-SNP): $16.29 Blue Cross Blue Shield — Blue Choice: $104.52 Blue Cross Blue Shield — Blue Choice Options: $104.52 Blue Cross Blue Shield — HMO: $99.16 Blue Cross Blue Shield — Managed Medicaid: $67 Blue Cross Blue Shield — Medicare Advantage: $18.39 Blue Cross Blue Shield — PPO: $105.86
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Psa, Diagnostic (Vista)	$265	$265	$15.82 – $132.50
PSA (prostate specific antigen) blood test: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $66.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $16.29 Blue Cross Blue Shield — HMO: $98.05 Blue Cross Blue Shield — Managed Medicaid: $66.25 Humana — Medicare-Medicaid (D-SNP): $15.82 Molina — Managed Medicaid: $79.50 Molina — Medicare-Medicaid (MMAI/Dual): $79.50 Multiplan/PHCS — PPO: $132.50
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH	$252	$252	$14.45 – $168.84
Thyroid stimulating hormone (TSH) test: 10 of 23 insurance plan rates Aetna — Commercial: $123.48 Aetna — Medicare Advantage: $126 Aetna Better Health — Managed Medicaid: $63 Aetna Better Health — Medicare-Medicaid (D-SNP): $14.88 Blue Cross Blue Shield — Blue Choice: $98.28 Blue Cross Blue Shield — Blue Choice Options: $98.28 Blue Cross Blue Shield — HMO: $93.24 Blue Cross Blue Shield — Managed Medicaid: $63 Blue Cross Blue Shield — Medicare Advantage: $16.80 Blue Cross Blue Shield — PPO: $99.54
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay thyroid stim hormone	$71	$71	$14.45 – $50.40
Thyroid stimulating hormone (TSH) test: 10 of 23 insurance plan rates Aetna — Commercial: $34.79 Aetna — Medicare Advantage: $35.50 Aetna Better Health — Managed Medicaid: $17.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $14.88 Blue Cross Blue Shield — Blue Choice: $27.69 Blue Cross Blue Shield — Blue Choice Options: $27.69 Blue Cross Blue Shield — HMO: $26.27 Blue Cross Blue Shield — Managed Medicaid: $17.75 Blue Cross Blue Shield — Medicare Advantage: $16.80 Blue Cross Blue Shield — PPO: $28.05
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: TSH	$252	$252	$14.45 – $126
Thyroid stimulating hormone (TSH) test: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $63 Aetna Better Health — Medicare-Medicaid (D-SNP): $14.88 Blue Cross Blue Shield — HMO: $93.24 Blue Cross Blue Shield — Managed Medicaid: $63 Humana — Medicare-Medicaid (D-SNP): $14.45 Molina — Managed Medicaid: $75.60 Molina — Medicare-Medicaid (MMAI/Dual): $75.60 Multiplan/PHCS — PPO: $126
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc W/Automated Differential	$152	$152	$6.68 – $101.84
Complete blood count (CBC) with differential: 10 of 23 insurance plan rates Aetna — Commercial: $74.48 Aetna — Medicare Advantage: $76 Aetna Better Health — Managed Medicaid: $38 Aetna Better Health — Medicare-Medicaid (D-SNP): $6.88 Blue Cross Blue Shield — Blue Choice: $59.28 Blue Cross Blue Shield — Blue Choice Options: $59.28 Blue Cross Blue Shield — HMO: $56.24 Blue Cross Blue Shield — Managed Medicaid: $38 Blue Cross Blue Shield — Medicare Advantage: $7.77 Blue Cross Blue Shield — PPO: $60.04
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc W/Auto Diff	$163	$163	$6.68 – $109.21
Complete blood count (CBC) with differential: 10 of 23 insurance plan rates Aetna — Commercial: $79.87 Aetna — Medicare Advantage: $81.50 Aetna Better Health — Managed Medicaid: $40.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $6.88 Blue Cross Blue Shield — Blue Choice: $63.57 Blue Cross Blue Shield — Blue Choice Options: $63.57 Blue Cross Blue Shield — HMO: $60.31 Blue Cross Blue Shield — Managed Medicaid: $40.75 Blue Cross Blue Shield — Medicare Advantage: $7.77 Blue Cross Blue Shield — PPO: $64.39
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cbc W/Automated Differential	$152	$152	$6.68 – $76
Complete blood count (CBC) with differential: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $38 Aetna Better Health — Medicare-Medicaid (D-SNP): $6.88 Blue Cross Blue Shield — HMO: $56.24 Blue Cross Blue Shield — Managed Medicaid: $38 Humana — Medicare-Medicaid (D-SNP): $6.68 Molina — Managed Medicaid: $45.60 Molina — Medicare-Medicaid (MMAI/Dual): $45.60 Multiplan/PHCS — PPO: $76
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc W/O Differential	$139	$139	$5.56 – $93.13
Complete blood count (CBC), automated: 10 of 23 insurance plan rates Aetna — Commercial: $68.11 Aetna — Medicare Advantage: $69.50 Aetna Better Health — Managed Medicaid: $34.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $5.73 Blue Cross Blue Shield — Blue Choice: $54.21 Blue Cross Blue Shield — Blue Choice Options: $54.21 Blue Cross Blue Shield — HMO: $51.43 Blue Cross Blue Shield — Managed Medicaid: $34.75 Blue Cross Blue Shield — Medicare Advantage: $6.47 Blue Cross Blue Shield — PPO: $54.91
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc (Itc Lab)	$137	$137	$5.56 – $91.79
Complete blood count (CBC), automated: 10 of 23 insurance plan rates Aetna — Commercial: $67.13 Aetna — Medicare Advantage: $68.50 Aetna Better Health — Managed Medicaid: $34.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $5.73 Blue Cross Blue Shield — Blue Choice: $53.43 Blue Cross Blue Shield — Blue Choice Options: $53.43 Blue Cross Blue Shield — HMO: $50.69 Blue Cross Blue Shield — Managed Medicaid: $34.25 Blue Cross Blue Shield — Medicare Advantage: $6.47 Blue Cross Blue Shield — PPO: $54.12
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cbc W/O Differential	$139	$139	$5.56 – $69.50
Complete blood count (CBC), automated: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $34.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $5.73 Blue Cross Blue Shield — HMO: $51.43 Blue Cross Blue Shield — Managed Medicaid: $34.75 Humana — Medicare-Medicaid (D-SNP): $5.56 Molina — Managed Medicaid: $41.70 Molina — Medicare-Medicaid (MMAI/Dual): $41.70 Multiplan/PHCS — PPO: $69.50
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time	$116	$116	$3.69 – $77.72
Blood clotting time test (prothrombin time, PT): 10 of 23 insurance plan rates Aetna — Commercial: $56.84 Aetna — Medicare Advantage: $58 Aetna Better Health — Managed Medicaid: $29 Aetna Better Health — Medicare-Medicaid (D-SNP): $3.80 Blue Cross Blue Shield — Blue Choice: $45.24 Blue Cross Blue Shield — Blue Choice Options: $45.24 Blue Cross Blue Shield — HMO: $42.92 Blue Cross Blue Shield — Managed Medicaid: $29 Blue Cross Blue Shield — Medicare Advantage: $4.29 Blue Cross Blue Shield — PPO: $45.82
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT	$116	$116	$3.69 – $77.72
Blood clotting time test (prothrombin time, PT): 10 of 23 insurance plan rates Aetna — Commercial: $56.84 Aetna — Medicare Advantage: $58 Aetna Better Health — Managed Medicaid: $29 Aetna Better Health — Medicare-Medicaid (D-SNP): $3.80 Blue Cross Blue Shield — Blue Choice: $45.24 Blue Cross Blue Shield — Blue Choice Options: $45.24 Blue Cross Blue Shield — HMO: $42.92 Blue Cross Blue Shield — Managed Medicaid: $29 Blue Cross Blue Shield — Medicare Advantage: $4.29 Blue Cross Blue Shield — PPO: $45.82
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin time	$116	$116	$3.69 – $77.72
Blood clotting time test (prothrombin time, PT): 10 of 23 insurance plan rates Aetna — Commercial: $56.84 Aetna — Medicare Advantage: $58 Aetna Better Health — Managed Medicaid: $29 Aetna Better Health — Medicare-Medicaid (D-SNP): $3.80 Blue Cross Blue Shield — Blue Choice: $45.24 Blue Cross Blue Shield — Blue Choice Options: $45.24 Blue Cross Blue Shield — HMO: $42.92 Blue Cross Blue Shield — Managed Medicaid: $29 Blue Cross Blue Shield — Medicare Advantage: $4.29 Blue Cross Blue Shield — PPO: $45.82
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin Time, Ptl (Ptt)	$169	$169	$5.17 – $113.23
Blood clotting test (partial thromboplastin time, PTT): 10 of 23 insurance plan rates Aetna — Commercial: $82.81 Aetna — Medicare Advantage: $84.50 Aetna Better Health — Managed Medicaid: $42.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $5.33 Blue Cross Blue Shield — Blue Choice: $65.91 Blue Cross Blue Shield — Blue Choice Options: $65.91 Blue Cross Blue Shield — HMO: $62.53 Blue Cross Blue Shield — Managed Medicaid: $42.25 Blue Cross Blue Shield — Medicare Advantage: $6.01 Blue Cross Blue Shield — PPO: $66.76
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin Time, Ptl (Ptt)-Incubated	$168	$168	$5.17 – $112.56
Blood clotting test (partial thromboplastin time, PTT): 10 of 23 insurance plan rates Aetna — Commercial: $82.32 Aetna — Medicare Advantage: $84 Aetna Better Health — Managed Medicaid: $42 Aetna Better Health — Medicare-Medicaid (D-SNP): $5.33 Blue Cross Blue Shield — Blue Choice: $65.52 Blue Cross Blue Shield — Blue Choice Options: $65.52 Blue Cross Blue Shield — HMO: $62.16 Blue Cross Blue Shield — Managed Medicaid: $42 Blue Cross Blue Shield — Medicare Advantage: $6.01 Blue Cross Blue Shield — PPO: $66.36
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin time partial	$169	$169	$5.17 – $113.23
Blood clotting test (partial thromboplastin time, PTT): 10 of 23 insurance plan rates Aetna — Commercial: $82.81 Aetna — Medicare Advantage: $84.50 Aetna Better Health — Managed Medicaid: $42.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $5.33 Blue Cross Blue Shield — Blue Choice: $65.91 Blue Cross Blue Shield — Blue Choice Options: $65.91 Blue Cross Blue Shield — HMO: $62.53 Blue Cross Blue Shield — Managed Medicaid: $42.25 Blue Cross Blue Shield — Medicare Advantage: $6.01 Blue Cross Blue Shield — PPO: $66.76

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 Contrast	$4,557	$4,557	$42.41 – $2,657
CT scan of the head or brain, without contrast: 10 of 23 insurance plan rates Aetna — Commercial: $252.28 Aetna — Medicare Advantage: $42.41 Aetna Better Health — Managed Medicaid: $1,139.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $115.55 Blue Cross Blue Shield — Blue Choice: $1,777.23 Blue Cross Blue Shield — Blue Choice Options: $1,777.23 Blue Cross Blue Shield — HMO: $1,686.09 Blue Cross Blue Shield — Managed Medicaid: $1,139.25 Blue Cross Blue Shield — Medicare Advantage: $112.03 Blue Cross Blue Shield — PPO: $1,800.02
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Head/Brain W/O Contrast	$4,557	$4,557	$112.18 – $2,278.50
CT scan of the head or brain, without contrast: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $1,139.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $115.55 Blue Cross Blue Shield — HMO: $1,686.09 Blue Cross Blue Shield — Managed Medicaid: $1,139.25 Humana — Medicare-Medicaid (D-SNP): $112.18 Molina — Managed Medicaid: $1,367.10 Molina — Medicare-Medicaid (MMAI/Dual): $1,367.10 Multiplan/PHCS — PPO: $2,278.50
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	$105.06
CT scan of the head or brain, without contrast: rates for 2 insurance plans HealthLink — HMO: $105.06 HealthLink — PPO: $105.06
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Brain W/O & W/Contrast	$8,516	$8,516	$129.70 – $4,258
MRI of the brain, before and after contrast: 10 of 23 insurance plan rates Aetna — Commercial: $850.12 Aetna — Medicare Advantage: $129.70 Aetna Better Health — Managed Medicaid: $2,129 Aetna Better Health — Medicare-Medicaid (D-SNP): $404.43 Blue Cross Blue Shield — Blue Choice: $3,321.24 Blue Cross Blue Shield — Blue Choice Options: $3,321.24 Blue Cross Blue Shield — HMO: $3,150.92 Blue Cross Blue Shield — Managed Medicaid: $2,129 Blue Cross Blue Shield — Medicare Advantage: $373.86 Blue Cross Blue Shield — PPO: $3,363.82
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI Brain W/O & W/Contrast	$8,516	$8,516	$392.65 – $4,258
MRI of the brain, before and after contrast: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $2,129 Aetna Better Health — Medicare-Medicaid (D-SNP): $404.43 Blue Cross Blue Shield — HMO: $3,150.92 Blue Cross Blue Shield — Managed Medicaid: $2,129 Humana — Medicare-Medicaid (D-SNP): $392.65 Molina — Managed Medicaid: $2,554.80 Molina — Medicare-Medicaid (MMAI/Dual): $2,554.80 Multiplan/PHCS — PPO: $4,258
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Radiologic Exam Chest 2 Views	$546	$546	$9.46 – $365.82
Chest X-ray, 2 views: 10 of 23 insurance plan rates Aetna — Commercial: $209.88 Aetna — Medicare Advantage: $9.46 Aetna Better Health — Managed Medicaid: $136.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $29.45 Blue Cross Blue Shield — Blue Choice: $212.94 Blue Cross Blue Shield — Blue Choice Options: $212.94 Blue Cross Blue Shield — HMO: $202.02 Blue Cross Blue Shield — Managed Medicaid: $136.50 Blue Cross Blue Shield — Medicare Advantage: $93.26 Blue Cross Blue Shield — PPO: $215.67
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Radiologic Exam Chest 2 Views	$546	$546	$28.59 – $273
Chest X-ray, 2 views: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $136.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $29.45 Blue Cross Blue Shield — HMO: $202.02 Blue Cross Blue Shield — Managed Medicaid: $136.50 Humana — Medicare-Medicaid (D-SNP): $28.59 Molina — Managed Medicaid: $163.80 Molina — Medicare-Medicaid (MMAI/Dual): $163.80 Multiplan/PHCS — PPO: $273
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lumbosacral Xrays 4/> Views	$1,082	$1,082	$11.27 – $724.94
X-ray of the lower spine, at least 4 views: 10 of 23 insurance plan rates Aetna — Commercial: $252.28 Aetna — Medicare Advantage: $11.27 Aetna Better Health — Managed Medicaid: $270.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $44.57 Blue Cross Blue Shield — Blue Choice: $421.98 Blue Cross Blue Shield — Blue Choice Options: $421.98 Blue Cross Blue Shield — HMO: $400.34 Blue Cross Blue Shield — Managed Medicaid: $270.50 Blue Cross Blue Shield — Medicare Advantage: $112.03 Blue Cross Blue Shield — PPO: $427.39
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Lumbosacral Xrays 4/> Views	$1,082	$1,082	$43.27 – $541
X-ray of the lower spine, at least 4 views: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $270.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $44.57 Blue Cross Blue Shield — HMO: $400.34 Blue Cross Blue Shield — Managed Medicaid: $270.50 Humana — Medicare-Medicaid (D-SNP): $43.27 Molina — Managed Medicaid: $324.60 Molina — Medicare-Medicaid (MMAI/Dual): $324.60 Multiplan/PHCS — PPO: $541
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI L Spine W/O Contrast	$7,151	$7,151	$83.42 – $3,575.50
MRI of the lower back (lumbar spine), without contrast: 10 of 23 insurance plan rates Aetna — Commercial: $574.52 Aetna — Medicare Advantage: $83.42 Aetna Better Health — Managed Medicaid: $1,787.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $242.49 Blue Cross Blue Shield — Blue Choice: $2,788.89 Blue Cross Blue Shield — Blue Choice Options: $2,788.89 Blue Cross Blue Shield — HMO: $2,645.87 Blue Cross Blue Shield — Managed Medicaid: $1,787.75 Blue Cross Blue Shield — Medicare Advantage: $255.69 Blue Cross Blue Shield — PPO: $2,824.65
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI L Spine W/O Contrast	$7,151	$7,151	$235.43 – $3,575.50
MRI of the lower back (lumbar spine), without contrast: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $1,787.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $242.49 Blue Cross Blue Shield — HMO: $2,645.87 Blue Cross Blue Shield — Managed Medicaid: $1,787.75 Humana — Medicare-Medicaid (D-SNP): $235.43 Molina — Managed Medicaid: $2,145.30 Molina — Medicare-Medicaid (MMAI/Dual): $2,145.30 Multiplan/PHCS — PPO: $3,575.50
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Pelvis W/Contrast	$5,555	$5,555	$57.58 – $2,777.50
CT scan of the pelvis, with contrast: 10 of 23 insurance plan rates Aetna — Commercial: $424 Aetna — Medicare Advantage: $57.58 Aetna Better Health — Managed Medicaid: $1,388.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $241.98 Blue Cross Blue Shield — Blue Choice: $2,166.45 Blue Cross Blue Shield — Blue Choice Options: $2,166.45 Blue Cross Blue Shield — HMO: $2,055.35 Blue Cross Blue Shield — Managed Medicaid: $1,388.75 Blue Cross Blue Shield — Medicare Advantage: $187.96 Blue Cross Blue Shield — PPO: $2,194.23
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Pelvis W/Contrast	$5,555	$5,555	$234.93 – $2,777.50
CT scan of the pelvis, with contrast: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $1,388.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $241.98 Blue Cross Blue Shield — HMO: $2,055.35 Blue Cross Blue Shield — Managed Medicaid: $1,388.75 Humana — Medicare-Medicaid (D-SNP): $234.93 Molina — Managed Medicaid: $1,666.50 Molina — Medicare-Medicaid (MMAI/Dual): $1,666.50 Multiplan/PHCS — PPO: $2,777.50
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Lwr Ext Joint W/O Contrast	$7,151	$7,151	$76.63 – $3,575.50
MRI of a leg joint (such as the knee), without contrast: 10 of 23 insurance plan rates Aetna — Commercial: $574.52 Aetna — Medicare Advantage: $76.63 Aetna Better Health — Managed Medicaid: $1,787.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $255.66 Blue Cross Blue Shield — Blue Choice: $2,788.89 Blue Cross Blue Shield — Blue Choice Options: $2,788.89 Blue Cross Blue Shield — HMO: $2,645.87 Blue Cross Blue Shield — Managed Medicaid: $1,787.75 Blue Cross Blue Shield — Medicare Advantage: $255.69 Blue Cross Blue Shield — PPO: $2,824.65
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI Lwr Ext Joint W/O Contrast	$7,151	$7,151	$248.21 – $3,575.50
MRI of a leg joint (such as the knee), without contrast: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $1,787.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $255.66 Blue Cross Blue Shield — HMO: $2,645.87 Blue Cross Blue Shield — Managed Medicaid: $1,787.75 Humana — Medicare-Medicaid (D-SNP): $248.21 Molina — Managed Medicaid: $2,145.30 Molina — Medicare-Medicaid (MMAI/Dual): $2,145.30 Multiplan/PHCS — PPO: $3,575.50
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Abd & Pelvis W/ Contrast	$8,285	$8,285	$90.87 – $4,142.50
CT scan of the abdomen and pelvis, with contrast: 10 of 23 insurance plan rates Aetna — Commercial: $850.12 Aetna — Medicare Advantage: $90.87 Aetna Better Health — Managed Medicaid: $2,071.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $331.90 Blue Cross Blue Shield — Blue Choice: $3,231.15 Blue Cross Blue Shield — Blue Choice Options: $3,231.15 Blue Cross Blue Shield — HMO: $3,065.45 Blue Cross Blue Shield — Managed Medicaid: $2,071.25 Blue Cross Blue Shield — Medicare Advantage: $373.86 Blue Cross Blue Shield — PPO: $3,272.58
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Abd & Pelvis W/ Contrast	$8,285	$8,285	$322.23 – $4,142.50
CT scan of the abdomen and pelvis, with contrast: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $2,071.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $331.90 Blue Cross Blue Shield — HMO: $3,065.45 Blue Cross Blue Shield — Managed Medicaid: $2,071.25 Humana — Medicare-Medicaid (D-SNP): $322.23 Molina — Managed Medicaid: $2,485.50 Molina — Medicare-Medicaid (MMAI/Dual): $2,485.50 Multiplan/PHCS — PPO: $4,142.50
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Abdomen Complete	$2,289	$2,289	$34.84 – $1,533.63
Ultrasound of the abdomen, complete: 10 of 23 insurance plan rates Aetna — Commercial: $252.28 Aetna — Medicare Advantage: $34.84 Aetna Better Health — Managed Medicaid: $572.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $102.23 Blue Cross Blue Shield — Blue Choice: $892.71 Blue Cross Blue Shield — Blue Choice Options: $892.71 Blue Cross Blue Shield — HMO: $846.93 Blue Cross Blue Shield — Managed Medicaid: $572.25 Blue Cross Blue Shield — Medicare Advantage: $112.03 Blue Cross Blue Shield — PPO: $904.16
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ultrasound Abdmnl Complete W/O Contrast	$2,174	$2,174	$34.84 – $1,456.58
Ultrasound of the abdomen, complete: 10 of 23 insurance plan rates Aetna — Commercial: $252.28 Aetna — Medicare Advantage: $34.84 Aetna Better Health — Managed Medicaid: $543.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $102.23 Blue Cross Blue Shield — Blue Choice: $847.86 Blue Cross Blue Shield — Blue Choice Options: $847.86 Blue Cross Blue Shield — HMO: $804.38 Blue Cross Blue Shield — Managed Medicaid: $543.50 Blue Cross Blue Shield — Medicare Advantage: $112.03 Blue Cross Blue Shield — PPO: $858.73
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Abdomen Complete	$2,289	$2,289	$99.25 – $1,144.50
Ultrasound of the abdomen, complete: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $572.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $102.23 Blue Cross Blue Shield — HMO: $846.93 Blue Cross Blue Shield — Managed Medicaid: $572.25 Humana — Medicare-Medicaid (D-SNP): $99.25 Molina — Managed Medicaid: $686.70 Molina — Medicare-Medicaid (MMAI/Dual): $686.70 Multiplan/PHCS — PPO: $1,144.50
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Routine Scrn OB Sono > 14 Wks	$1,617	$1,617	$42.69 – $1,083.39
Pregnancy ultrasound (after the first trimester): 10 of 23 insurance plan rates Aetna — Commercial: $252.28 Aetna — Medicare Advantage: $42.69 Aetna Better Health — Managed Medicaid: $404.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $118.99 Blue Cross Blue Shield — Blue Choice: $630.63 Blue Cross Blue Shield — Blue Choice Options: $630.63 Blue Cross Blue Shield — HMO: $598.29 Blue Cross Blue Shield — Managed Medicaid: $404.25 Blue Cross Blue Shield — Medicare Advantage: $112.03 Blue Cross Blue Shield — PPO: $638.72
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Routine Scrn OB Sono > 14 Wks	$1,617	$1,617	$115.52 – $808.50
Pregnancy ultrasound (after the first trimester): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $404.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $118.99 Blue Cross Blue Shield — HMO: $598.29 Blue Cross Blue Shield — Managed Medicaid: $404.25 Humana — Medicare-Medicaid (D-SNP): $115.52 Molina — Managed Medicaid: $485.10 Molina — Medicare-Medicaid (MMAI/Dual): $485.10 Multiplan/PHCS — PPO: $808.50
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ultrasound Transvaginal	$1,155	$1,155	$29.98 – $773.85
Transvaginal ultrasound: 10 of 23 insurance plan rates Aetna — Commercial: $252.28 Aetna — Medicare Advantage: $29.98 Aetna Better Health — Managed Medicaid: $288.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $104.73 Blue Cross Blue Shield — Blue Choice: $450.45 Blue Cross Blue Shield — Blue Choice Options: $450.45 Blue Cross Blue Shield — HMO: $427.35 Blue Cross Blue Shield — Managed Medicaid: $288.75 Blue Cross Blue Shield — Medicare Advantage: $112.03 Blue Cross Blue Shield — PPO: $456.23
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Ultrasound Transvaginal	$1,155	$1,155	$101.68 – $577.50
Transvaginal ultrasound: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $288.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $104.73 Blue Cross Blue Shield — HMO: $427.35 Blue Cross Blue Shield — Managed Medicaid: $288.75 Humana — Medicare-Medicaid (D-SNP): $101.68 Molina — Managed Medicaid: $346.50 Molina — Medicare-Medicaid (MMAI/Dual): $346.50 Multiplan/PHCS — PPO: $577.50
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Diagnostic Mammography Unilat W/Cad	$567	$567	$34.84 – $379.89
Diagnostic mammogram, one breast: 10 of 23 insurance plan rates Aetna — Commercial: $94.07 Aetna — Medicare Advantage: $34.84 Aetna Better Health — Managed Medicaid: $141.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $109.31 Blue Cross Blue Shield — Blue Choice: $221.13 Blue Cross Blue Shield — Blue Choice Options: $221.13 Blue Cross Blue Shield — HMO: $209.79 Blue Cross Blue Shield — Managed Medicaid: $141.75 Blue Cross Blue Shield — Medicare Advantage: $116.73 Blue Cross Blue Shield — PPO: $223.97
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Diagnostic Mammography Unilat W/Cad	$567	$567	$106.13 – $283.50
Diagnostic mammogram, one breast: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $141.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $109.31 Blue Cross Blue Shield — HMO: $209.79 Blue Cross Blue Shield — Managed Medicaid: $141.75 Humana — Medicare-Medicaid (D-SNP): $106.13 Molina — Managed Medicaid: $170.10 Molina — Medicare-Medicaid (MMAI/Dual): $170.10 Multiplan/PHCS — PPO: $283.50
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Diagnostic Mammography Bilat W/Cad	$872	$872	$43.09 – $584.24
Diagnostic mammogram, both breasts: 10 of 23 insurance plan rates Aetna — Commercial: $120.78 Aetna — Medicare Advantage: $43.09 Aetna Better Health — Managed Medicaid: $218 Aetna Better Health — Medicare-Medicaid (D-SNP): $137.60 Blue Cross Blue Shield — Blue Choice: $340.08 Blue Cross Blue Shield — Blue Choice Options: $340.08 Blue Cross Blue Shield — HMO: $322.64 Blue Cross Blue Shield — Managed Medicaid: $218 Blue Cross Blue Shield — Medicare Advantage: $147.91 Blue Cross Blue Shield — PPO: $344.44
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Diagnostic Mammography Bilat W/Cad	$872	$872	$133.59 – $436
Diagnostic mammogram, both breasts: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $218 Aetna Better Health — Medicare-Medicaid (D-SNP): $137.60 Blue Cross Blue Shield — HMO: $322.64 Blue Cross Blue Shield — Managed Medicaid: $218 Humana — Medicare-Medicaid (D-SNP): $133.59 Molina — Managed Medicaid: $261.60 Molina — Medicare-Medicaid (MMAI/Dual): $261.60 Multiplan/PHCS — PPO: $436
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Screening Mammography Bilat W/Cad	$557	$557	$33 – $373.19
Screening mammogram, both breasts: 10 of 23 insurance plan rates Aetna — Commercial: $99.44 Aetna — Medicare Advantage: $33 Aetna Better Health — Managed Medicaid: $139.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $111.72 Blue Cross Blue Shield — Blue Choice: $217.23 Blue Cross Blue Shield — Blue Choice Options: $217.23 Blue Cross Blue Shield — HMO: $206.09 Blue Cross Blue Shield — Managed Medicaid: $139.25 Blue Cross Blue Shield — Medicare Advantage: $118.51 Blue Cross Blue Shield — PPO: $220.02
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Screening Mammography Bilat W/Cad	$557	$557	$108.47 – $278.50
Screening mammogram, both breasts: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $139.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $111.72 Blue Cross Blue Shield — HMO: $206.09 Blue Cross Blue Shield — Managed Medicaid: $139.25 Humana — Medicare-Medicaid (D-SNP): $108.47 Molina — Managed Medicaid: $167.10 Molina — Medicare-Medicaid (MMAI/Dual): $167.10 Multiplan/PHCS — PPO: $278.50

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	$14.96 – $17.35
Electrocardiogram (ECG/EKG) with reading: rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $15.63 Blue Cross Blue Shield — Medicare Advantage: $14.96 Humana — Medicare Advantage: $14.96 Humana — Medicare-Medicaid (D-SNP): $15.17 Meridian — Medicare-Medicaid (MMAI/Dual): $17.35 Molina — Medicare-Medicaid (MMAI/Dual): $14.96 United Healthcare (UHC) — Medicare Advantage: $14.96 United Healthcare (UHC) — VA CCN: $14.96 Wellcare — Medicare Advantage HMO: $14.96
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ELECTROCARDIOGRAM COMPLETE	Not listed in the file	Not listed in the file	$15.17 – $15.63
Electrocardiogram (ECG/EKG) with reading: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $15.63 Humana — Medicare-Medicaid (D-SNP): $15.17
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Left Heart Catheterization	$11,319	$11,319	$249.91 – $10,422.34
Left heart catheterization (diagnostic): 10 of 23 insurance plan rates Aetna — Commercial: $7,646.84 Aetna — Medicare Advantage: $249.91 Aetna Better Health — Managed Medicaid: $2,829.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $954.87 Blue Cross Blue Shield — Blue Choice: $4,414.41 Blue Cross Blue Shield — Blue Choice Options: $4,414.41 Blue Cross Blue Shield — HMO: $4,188.03 Blue Cross Blue Shield — Managed Medicaid: $2,829.75 Blue Cross Blue Shield — Medicare Advantage: $3,474.11 Blue Cross Blue Shield — PPO: $4,471.01
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Left Heart Catheterization	$11,319	$11,319	$927.06 – $5,659.50
Left heart catheterization (diagnostic): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $2,829.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $954.87 Blue Cross Blue Shield — HMO: $4,188.03 Blue Cross Blue Shield — Managed Medicaid: $2,829.75 Humana — Medicare-Medicaid (D-SNP): $927.06 Molina — Managed Medicaid: $3,395.70 Molina — Medicare-Medicaid (MMAI/Dual): $3,395.70 Multiplan/PHCS — PPO: $5,659.50
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Ep Eval	$12,779	$12,779	$413.96 – $25,074.79
Heart rhythm study (electrophysiology evaluation): 10 of 23 insurance plan rates Aetna — Commercial: $18,041.20 Aetna — Medicare Advantage: $413.96 Aetna Better Health — Managed Medicaid: $3,194.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $728.31 Blue Cross Blue Shield — Blue Choice: $4,983.81 Blue Cross Blue Shield — Blue Choice Options: $4,983.81 Blue Cross Blue Shield — HMO: $4,728.23 Blue Cross Blue Shield — Managed Medicaid: $3,194.75 Blue Cross Blue Shield — Medicare Advantage: $8,358.26 Blue Cross Blue Shield — PPO: $5,047.71
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Comprehensive Ep Eval	$12,779	$12,779	$707.10 – $6,389.50
Heart rhythm study (electrophysiology evaluation): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $3,194.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $728.31 Blue Cross Blue Shield — HMO: $4,728.23 Blue Cross Blue Shield — Managed Medicaid: $3,194.75 Humana — Medicare-Medicaid (D-SNP): $707.10 Molina — Managed Medicaid: $3,833.70 Molina — Medicare-Medicaid (MMAI/Dual): $3,833.70 Multiplan/PHCS — PPO: $6,389.50
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comp Ep Eval W/Ablation for a-Fib	$55,041	$55,041	$1,040.84 – $84,029.45
Heart rhythm study with ablation for atrial fibrillation: 10 of 23 insurance plan rates Aetna — Commercial: $58,325.44 Aetna — Medicare Advantage: $27,520.50 Aetna Better Health — Managed Medicaid: $13,760.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $1,072.07 Blue Cross Blue Shield — Blue Choice: $21,465.99 Blue Cross Blue Shield — Blue Choice Options: $21,465.99 Blue Cross Blue Shield — HMO: $20,365.17 Blue Cross Blue Shield — Managed Medicaid: $13,760.25 Blue Cross Blue Shield — Medicare Advantage: $28,009.82 Blue Cross Blue Shield — PPO: $21,741.20
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Comp Ep Eval W/Ablation for a-Fib	$55,041	$55,041	$1,040.84 – $27,520.50
Heart rhythm study with ablation for atrial fibrillation: rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $13,760.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $1,072.07 Blue Cross Blue Shield — HMO: $20,365.17 Blue Cross Blue Shield — Managed Medicaid: $13,760.25 Humana — Medicare-Medicaid (D-SNP): $1,040.84 Molina — Managed Medicaid: $16,512.30 Molina — Medicare-Medicaid (MMAI/Dual): $16,512.30 Multiplan/PHCS — PPO: $27,520.50
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: All Night Polysomnography	$8,757	$8,757	$110.32 – $5,867.19
Sleep study (overnight, in a sleep lab): 10 of 23 insurance plan rates Aetna — Commercial: $2,418.92 Aetna — Medicare Advantage: $110.32 Aetna Better Health — Managed Medicaid: $2,189.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $582.65 Blue Cross Blue Shield — Blue Choice: $3,415.23 Blue Cross Blue Shield — Blue Choice Options: $3,415.23 Blue Cross Blue Shield — HMO: $3,240.09 Blue Cross Blue Shield — Managed Medicaid: $2,189.25 Blue Cross Blue Shield — Medicare Advantage: $920.24 Blue Cross Blue Shield — PPO: $3,459.02
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: All Night Polysomnography	$8,757	$8,757	$565.68 – $4,378.50
Sleep study (overnight, in a sleep lab): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $2,189.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $582.65 Blue Cross Blue Shield — HMO: $3,240.09 Blue Cross Blue Shield — Managed Medicaid: $2,189.25 Humana — Medicare-Medicaid (D-SNP): $565.68 Molina — Managed Medicaid: $2,627.10 Molina — Medicare-Medicaid (MMAI/Dual): $2,627.10 Multiplan/PHCS — PPO: $4,378.50

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: 15' Therapeutic Exercise	$184	$184	$21.50 – $123.28
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 23 insurance plan rates Aetna — Commercial: $90.16 Aetna — Medicare Advantage: $92 Aetna Better Health — Managed Medicaid: $46 Aetna Better Health — Medicare-Medicaid (D-SNP): $22.15 Blue Cross Blue Shield — Blue Choice: $71.76 Blue Cross Blue Shield — Blue Choice Options: $71.76 Blue Cross Blue Shield — HMO: $68.08 Blue Cross Blue Shield — Managed Medicaid: $46 Blue Cross Blue Shield — Medicare Advantage: $28.06 Blue Cross Blue Shield — PPO: $72.68
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 15' Individual Therapy-Onsite	$194	$194	$21.50 – $129.98
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 23 insurance plan rates Aetna — Commercial: $95.06 Aetna — Medicare Advantage: $97 Aetna Better Health — Managed Medicaid: $48.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $22.15 Blue Cross Blue Shield — Blue Choice: $75.66 Blue Cross Blue Shield — Blue Choice Options: $75.66 Blue Cross Blue Shield — HMO: $71.78 Blue Cross Blue Shield — Managed Medicaid: $48.50 Blue Cross Blue Shield — Medicare Advantage: $28.06 Blue Cross Blue Shield — PPO: $76.63
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 15' Therapeutic Exercise	$184	$184	$21.50 – $92
Physical therapy: therapeutic exercise (each 15 minutes): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $46 Aetna Better Health — Medicare-Medicaid (D-SNP): $22.15 Blue Cross Blue Shield — HMO: $68.08 Blue Cross Blue Shield — Managed Medicaid: $46 Humana — Medicare-Medicaid (D-SNP): $21.50 Molina — Managed Medicaid: $55.20 Molina — Medicare-Medicaid (MMAI/Dual): $55.20 Multiplan/PHCS — PPO: $92
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Low Complexity	$410	$410	$73.36 – $274.70
Physical therapy evaluation (low complexity): 10 of 23 insurance plan rates Aetna — Commercial: $200.90 Aetna — Medicare Advantage: $205 Aetna Better Health — Managed Medicaid: $102.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $75.56 Blue Cross Blue Shield — Blue Choice: $159.90 Blue Cross Blue Shield — Blue Choice Options: $159.90 Blue Cross Blue Shield — HMO: $151.70 Blue Cross Blue Shield — Managed Medicaid: $102.50 Blue Cross Blue Shield — Medicare Advantage: $94.04 Blue Cross Blue Shield — PPO: $161.95
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Low Complexity Curtis	$152	$152	$38 – $109.09
Physical therapy evaluation (low complexity): 10 of 23 insurance plan rates Aetna — Commercial: $74.48 Aetna — Medicare Advantage: $76 Aetna Better Health — Managed Medicaid: $38 Aetna Better Health — Medicare-Medicaid (D-SNP): $75.56 Blue Cross Blue Shield — Blue Choice: $59.28 Blue Cross Blue Shield — Blue Choice Options: $59.28 Blue Cross Blue Shield — HMO: $56.24 Blue Cross Blue Shield — Managed Medicaid: $38 Blue Cross Blue Shield — Medicare Advantage: $94.04 Blue Cross Blue Shield — PPO: $60.04
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Pt Eval Low Complexity	$410	$410	$73.36 – $205
Physical therapy evaluation (low complexity): rates for 8 insurance plans Aetna Better Health — Managed Medicaid: $102.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $75.56 Blue Cross Blue Shield — HMO: $151.70 Blue Cross Blue Shield — Managed Medicaid: $102.50 Humana — Medicare-Medicaid (D-SNP): $73.36 Molina — Managed Medicaid: $123 Molina — Medicare-Medicaid (MMAI/Dual): $123 Multiplan/PHCS — PPO: $205
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Moderate Complexity (0-30 Minutes)	$483	$483	$73.36 – $323.61
Physical therapy evaluation (moderate complexity): 10 of 23 insurance plan rates Aetna — Commercial: $236.67 Aetna — Medicare Advantage: $241.50 Aetna Better Health — Managed Medicaid: $120.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $75.56 Blue Cross Blue Shield — Blue Choice: $188.37 Blue Cross Blue Shield — Blue Choice Options: $188.37 Blue Cross Blue Shield — HMO: $178.71 Blue Cross Blue Shield — Managed Medicaid: $120.75 Blue Cross Blue Shield — Medicare Advantage: $94.04 Blue Cross Blue Shield — PPO: $190.79
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Moderate Complexity (31-60 Minutes)	$483	$483	$73.36 – $323.61
Physical therapy evaluation (moderate complexity): 10 of 23 insurance plan rates Aetna — Commercial: $236.67 Aetna — Medicare Advantage: $241.50 Aetna Better Health — Managed Medicaid: $120.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $75.56 Blue Cross Blue Shield — Blue Choice: $188.37 Blue Cross Blue Shield — Blue Choice Options: $188.37 Blue Cross Blue Shield — HMO: $178.71 Blue Cross Blue Shield — Managed Medicaid: $120.75 Blue Cross Blue Shield — Medicare Advantage: $94.04 Blue Cross Blue Shield — PPO: $190.79
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Moderate Complexity (61-90 Minutes)	$483	$483	$73.36 – $323.61
Physical therapy evaluation (moderate complexity): 10 of 23 insurance plan rates Aetna — Commercial: $236.67 Aetna — Medicare Advantage: $241.50 Aetna Better Health — Managed Medicaid: $120.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $75.56 Blue Cross Blue Shield — Blue Choice: $188.37 Blue Cross Blue Shield — Blue Choice Options: $188.37 Blue Cross Blue Shield — HMO: $178.71 Blue Cross Blue Shield — Managed Medicaid: $120.75 Blue Cross Blue Shield — Medicare Advantage: $94.04 Blue Cross Blue Shield — PPO: $190.79
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval High Complexity (0-30 Minutes)	$546	$546	$73.36 – $365.82
Physical therapy evaluation (high complexity): 10 of 23 insurance plan rates Aetna — Commercial: $267.54 Aetna — Medicare Advantage: $273 Aetna Better Health — Managed Medicaid: $136.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $75.56 Blue Cross Blue Shield — Blue Choice: $212.94 Blue Cross Blue Shield — Blue Choice Options: $212.94 Blue Cross Blue Shield — HMO: $202.02 Blue Cross Blue Shield — Managed Medicaid: $136.50 Blue Cross Blue Shield — Medicare Advantage: $94.04 Blue Cross Blue Shield — PPO: $215.67
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval High Complexity (31-60 Minutes)	$546	$546	$73.36 – $365.82
Physical therapy evaluation (high complexity): 10 of 23 insurance plan rates Aetna — Commercial: $267.54 Aetna — Medicare Advantage: $273 Aetna Better Health — Managed Medicaid: $136.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $75.56 Blue Cross Blue Shield — Blue Choice: $212.94 Blue Cross Blue Shield — Blue Choice Options: $212.94 Blue Cross Blue Shield — HMO: $202.02 Blue Cross Blue Shield — Managed Medicaid: $136.50 Blue Cross Blue Shield — Medicare Advantage: $94.04 Blue Cross Blue Shield — PPO: $215.67
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval High Complexity (61-90 Minutes)	$546	$546	$73.36 – $365.82
Physical therapy evaluation (high complexity): 10 of 23 insurance plan rates Aetna — Commercial: $267.54 Aetna — Medicare Advantage: $273 Aetna Better Health — Managed Medicaid: $136.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $75.56 Blue Cross Blue Shield — Blue Choice: $212.94 Blue Cross Blue Shield — Blue Choice Options: $212.94 Blue Cross Blue Shield — HMO: $202.02 Blue Cross Blue Shield — Managed Medicaid: $136.50 Blue Cross Blue Shield — Medicare Advantage: $94.04 Blue Cross Blue Shield — PPO: $215.67
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Medical Service	$331	$331	$66.15 – $570.62
Psychotherapy, 30 minutes: 10 of 23 insurance plan rates Aetna — Commercial: $381.60 Aetna — Medicare Advantage: $165.50 Aetna Better Health — Managed Medicaid: $82.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $68.13 Blue Cross Blue Shield — Blue Choice: $129.09 Blue Cross Blue Shield — Blue Choice Options: $129.09 Blue Cross Blue Shield — HMO: $122.47 Blue Cross Blue Shield — Managed Medicaid: $82.75 Blue Cross Blue Shield — Medicare Advantage: $190.21 Blue Cross Blue Shield — PPO: $130.75
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Medical Service	$331	$331	$66.15 – $165.50
Psychotherapy, 30 minutes: 10 of 11 insurance plan rates Aetna Better Health — Managed Medicaid: $82.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $68.13 Blue Cross Blue Shield — HMO: $122.47 Blue Cross Blue Shield — Managed Medicaid: $82.75 HealthLink — HMO: $165.50 HealthLink — PPO: $165.50 Humana — Medicare-Medicaid (D-SNP): $66.15 Molina — Managed Medicaid: $99.30 Molina — Medicare-Medicaid (MMAI/Dual): $99.30 Multiplan/PHCS — PPO: $165.50
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	$87.79 – $381.60
Psychotherapy, 45 minutes: rates for 10 insurance plans Aetna — Commercial: $381.60 Aetna Better Health — Medicare-Medicaid (D-SNP): $90.42 Blue Cross Blue Shield — Medicare Advantage: $190.21 Humana — Medicare Advantage: $190.21 Humana — Medicare-Medicaid (D-SNP): $87.79 Meridian — Medicare-Medicaid (MMAI/Dual): $220.64 Molina — Medicare-Medicaid (MMAI/Dual): $190.21 United Healthcare (UHC) — Medicare Advantage: $190.21 United Healthcare (UHC) — VA CCN: $190.21 Wellcare — Medicare Advantage HMO: $190.21
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSYTX W PT 45 MINUTES	Not listed in the file	Not listed in the file	$87.79 – $91.74
Psychotherapy, 45 minutes: rates for 3 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $90.42 Humana — Medicare-Medicaid (D-SNP): $87.79 United Healthcare (UHC) — VA CCN: $91.74
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Medical Service	$557	$557	$128.93 – $570.62
Psychotherapy, 60 minutes: 10 of 23 insurance plan rates Aetna — Commercial: $381.60 Aetna — Medicare Advantage: $278.50 Aetna Better Health — Managed Medicaid: $139.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $132.80 Blue Cross Blue Shield — Blue Choice: $217.23 Blue Cross Blue Shield — Blue Choice Options: $217.23 Blue Cross Blue Shield — HMO: $206.09 Blue Cross Blue Shield — Managed Medicaid: $139.25 Blue Cross Blue Shield — Medicare Advantage: $190.21 Blue Cross Blue Shield — PPO: $220.02
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Medical Service	$557	$557	$128.93 – $278.50
Psychotherapy, 60 minutes: 10 of 11 insurance plan rates Aetna Better Health — Managed Medicaid: $139.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $132.80 Blue Cross Blue Shield — HMO: $206.09 Blue Cross Blue Shield — Managed Medicaid: $139.25 HealthLink — HMO: $278.50 HealthLink — PPO: $278.50 Humana — Medicare-Medicaid (D-SNP): $128.93 Molina — Managed Medicaid: $167.10 Molina — Medicare-Medicaid (MMAI/Dual): $167.10 Multiplan/PHCS — PPO: $278.50
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family Psytx W/O Patient	$599	$599	$94.88 – $570.62
Family psychotherapy, without the patient: 10 of 23 insurance plan rates Aetna — Commercial: $381.60 Aetna — Medicare Advantage: $299.50 Aetna Better Health — Managed Medicaid: $149.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $97.73 Blue Cross Blue Shield — Blue Choice: $233.61 Blue Cross Blue Shield — Blue Choice Options: $233.61 Blue Cross Blue Shield — HMO: $221.63 Blue Cross Blue Shield — Managed Medicaid: $149.75 Blue Cross Blue Shield — Medicare Advantage: $190.21 Blue Cross Blue Shield — PPO: $236.61
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Family Psytx W/O Patient	$599	$599	$94.88 – $299.50
Family psychotherapy, without the patient: rates for 9 insurance plans Aetna Better Health — Managed Medicaid: $149.75 Aetna Better Health — Medicare-Medicaid (D-SNP): $97.73 Blue Cross Blue Shield — HMO: $221.63 Blue Cross Blue Shield — Managed Medicaid: $149.75 Humana — Medicare-Medicaid (D-SNP): $94.88 Molina — Managed Medicaid: $179.70 Molina — Medicare-Medicaid (MMAI/Dual): $179.70 Multiplan/PHCS — PPO: $299.50 United Healthcare (UHC) — VA CCN: $99.15
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Fam Ther W Pt 50 Min MCR	$305	$305	$76.25 – $570.62
Family psychotherapy, with the patient: 10 of 23 insurance plan rates Aetna — Commercial: $381.60 Aetna — Medicare Advantage: $152.50 Aetna Better Health — Managed Medicaid: $76.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $101.85 Blue Cross Blue Shield — Blue Choice: $118.95 Blue Cross Blue Shield — Blue Choice Options: $118.95 Blue Cross Blue Shield — HMO: $112.85 Blue Cross Blue Shield — Managed Medicaid: $76.25 Blue Cross Blue Shield — Medicare Advantage: $190.21 Blue Cross Blue Shield — PPO: $120.48
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Fam Ther W Pt 50 Min MCR	$305	$305	$76.25 – $152.50
Family psychotherapy, with the patient: rates for 9 insurance plans Aetna Better Health — Managed Medicaid: $76.25 Aetna Better Health — Medicare-Medicaid (D-SNP): $101.85 Blue Cross Blue Shield — HMO: $112.85 Blue Cross Blue Shield — Managed Medicaid: $76.25 Humana — Medicare-Medicaid (D-SNP): $98.88 Molina — Managed Medicaid: $91.50 Molina — Medicare-Medicaid (MMAI/Dual): $91.50 Multiplan/PHCS — PPO: $152.50 United Healthcare (UHC) — VA CCN: $103.33
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Telemed Group Psychotherapy (90853)	$252	$252	$23.33 – $326.60
Group psychotherapy: 10 of 23 insurance plan rates Aetna — Commercial: $220.48 Aetna — Medicare Advantage: $126 Aetna Better Health — Managed Medicaid: $63 Aetna Better Health — Medicare-Medicaid (D-SNP): $24.03 Blue Cross Blue Shield — Blue Choice: $98.28 Blue Cross Blue Shield — Blue Choice Options: $98.28 Blue Cross Blue Shield — HMO: $93.24 Blue Cross Blue Shield — Managed Medicaid: $63 Blue Cross Blue Shield — Medicare Advantage: $108.87 Blue Cross Blue Shield — PPO: $99.54
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Group Therapy per Unit	$252	$252	$23.33 – $326.60
Group psychotherapy: 10 of 23 insurance plan rates Aetna — Commercial: $220.48 Aetna — Medicare Advantage: $126 Aetna Better Health — Managed Medicaid: $63 Aetna Better Health — Medicare-Medicaid (D-SNP): $24.03 Blue Cross Blue Shield — Blue Choice: $98.28 Blue Cross Blue Shield — Blue Choice Options: $98.28 Blue Cross Blue Shield — HMO: $93.24 Blue Cross Blue Shield — Managed Medicaid: $63 Blue Cross Blue Shield — Medicare Advantage: $108.87 Blue Cross Blue Shield — PPO: $99.54
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Tx Prog per Diem Moderate	$2,762	$2,762	$23.33 – $1,850.54
Group psychotherapy: 10 of 23 insurance plan rates Aetna — Commercial: $220.48 Aetna — Medicare Advantage: $1,381 Aetna Better Health — Managed Medicaid: $690.50 Aetna Better Health — Medicare-Medicaid (D-SNP): $24.03 Blue Cross Blue Shield — Blue Choice: $1,077.18 Blue Cross Blue Shield — Blue Choice Options: $1,077.18 Blue Cross Blue Shield — HMO: $1,021.94 Blue Cross Blue Shield — Managed Medicaid: $690.50 Blue Cross Blue Shield — Medicare Advantage: $108.87 Blue Cross Blue Shield — PPO: $1,090.99

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	$359.77 – $9,103.28
Removal of breast growth (open surgery): rates for 10 insurance plans Aetna — Commercial: $9,103.28 Aetna Better Health — Medicare-Medicaid (D-SNP): $370.56 Blue Cross Blue Shield — Medicare Advantage: $4,195.85 Humana — Medicare Advantage: $4,195.85 Humana — Medicare-Medicaid (D-SNP): $359.77 Meridian — Medicare-Medicaid (MMAI/Dual): $4,867.19 Molina — Medicare-Medicaid (MMAI/Dual): $4,195.85 United Healthcare (UHC) — Medicare Advantage: $4,195.85 United Healthcare (UHC) — VA CCN: $4,195.85 Wellcare — Medicare Advantage HMO: $4,195.85
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Hospital (facility) fee In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$359.77 – $370.56
Removal of breast growth (open surgery): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $370.56 Humana — Medicare-Medicaid (D-SNP): $359.77
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	$1,203.70 – $30,591.60
Total hip replacement: rates for 10 insurance plans Aetna — Commercial: $30,591.60 Aetna Better Health — Medicare-Medicaid (D-SNP): $1,239.81 Blue Cross Blue Shield — Medicare Advantage: $13,758.17 Humana — Medicare Advantage: $13,758.17 Humana — Medicare-Medicaid (D-SNP): $1,203.70 Meridian — Medicare-Medicaid (MMAI/Dual): $15,959.48 Molina — Medicare-Medicaid (MMAI/Dual): $13,758.17 United Healthcare (UHC) — Medicare Advantage: $13,758.17 United Healthcare (UHC) — VA CCN: $13,758.17 Wellcare — Medicare Advantage HMO: $13,758.17
Total hip replacement CPT 27130 · Inpatient (hospital stay) · Hospital (facility) fee In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$1,203.70 – $1,239.81
Total hip replacement: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $1,239.81 Humana — Medicare-Medicaid (D-SNP): $1,203.70
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	$1,202.43 – $30,591.60
Total knee replacement: rates for 10 insurance plans Aetna — Commercial: $30,591.60 Aetna Better Health — Medicare-Medicaid (D-SNP): $1,238.50 Blue Cross Blue Shield — Medicare Advantage: $13,758.17 Humana — Medicare Advantage: $13,758.17 Humana — Medicare-Medicaid (D-SNP): $1,202.43 Meridian — Medicare-Medicaid (MMAI/Dual): $15,959.48 Molina — Medicare-Medicaid (MMAI/Dual): $13,758.17 United Healthcare (UHC) — Medicare Advantage: $13,758.17 United Healthcare (UHC) — VA CCN: $13,758.17 Wellcare — Medicare Advantage HMO: $13,758.17
Total knee replacement CPT 27447 · Inpatient (hospital stay) · Hospital (facility) fee In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$1,202.43 – $1,238.50
Total knee replacement: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $1,238.50 Humana — Medicare-Medicaid (D-SNP): $1,202.43
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$155.89 – $180.84
Shoulder arthroscopy: shaving of shoulder bone: rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $166.81 Blue Cross Blue Shield — Medicare Advantage: $155.89 Humana — Medicare Advantage: $155.89 Humana — Medicare-Medicaid (D-SNP): $161.95 Meridian — Medicare-Medicaid (MMAI/Dual): $180.84 Molina — Medicare-Medicaid (MMAI/Dual): $155.89 United Healthcare (UHC) — Medicare Advantage: $155.89 United Healthcare (UHC) — VA CCN: $155.89 Wellcare — Medicare Advantage HMO: $155.89
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient (hospital stay) · Hospital (facility) fee In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$161.95 – $166.81
Shoulder arthroscopy: shaving of shoulder bone: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $166.81 Humana — Medicare-Medicaid (D-SNP): $161.95
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$504.71 – $7,714.68
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 10 insurance plans Aetna — Commercial: $7,714.68 Aetna Better Health — Medicare-Medicaid (D-SNP): $519.85 Blue Cross Blue Shield — Medicare Advantage: $3,506.34 Humana — Medicare Advantage: $3,506.34 Humana — Medicare-Medicaid (D-SNP): $504.71 Meridian — Medicare-Medicaid (MMAI/Dual): $4,067.35 Molina — Medicare-Medicaid (MMAI/Dual): $3,506.34 United Healthcare (UHC) — Medicare Advantage: $3,506.34 United Healthcare (UHC) — VA CCN: $3,506.34 Wellcare — Medicare Advantage HMO: $3,506.34
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$504.71 – $519.85
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $519.85 Humana — Medicare-Medicaid (D-SNP): $504.71
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	$284.90 – $14,064.08
Removal of tonsils and adenoids (under age 12): rates for 10 insurance plans Aetna — Commercial: $14,064.08 Aetna Better Health — Medicare-Medicaid (D-SNP): $293.45 Blue Cross Blue Shield — Medicare Advantage: $6,343.80 Humana — Medicare Advantage: $6,343.80 Humana — Medicare-Medicaid (D-SNP): $284.90 Meridian — Medicare-Medicaid (MMAI/Dual): $7,358.81 Molina — Medicare-Medicaid (MMAI/Dual): $6,343.80 United Healthcare (UHC) — Medicare Advantage: $6,343.80 United Healthcare (UHC) — VA CCN: $6,343.80 Wellcare — Medicare Advantage HMO: $6,343.80
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient (hospital stay) · Hospital (facility) fee In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$284.90 – $293.45
Removal of tonsils and adenoids (under age 12): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $293.45 Humana — Medicare-Medicaid (D-SNP): $284.90
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	$118.34 – $2,228.12
Upper GI endoscopy (diagnostic): rates for 10 insurance plans Aetna — Commercial: $2,228.12 Aetna Better Health — Medicare-Medicaid (D-SNP): $121.89 Blue Cross Blue Shield — Medicare Advantage: $971.94 Humana — Medicare Advantage: $971.94 Humana — Medicare-Medicaid (D-SNP): $118.34 Meridian — Medicare-Medicaid (MMAI/Dual): $1,127.45 Molina — Medicare-Medicaid (MMAI/Dual): $971.94 United Healthcare (UHC) — Medicare Advantage: $971.94 United Healthcare (UHC) — VA CCN: $971.94 Wellcare — Medicare Advantage HMO: $971.94
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$118.34 – $121.89
Upper GI endoscopy (diagnostic): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $121.89 Humana — Medicare-Medicaid (D-SNP): $118.34
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	$133.51 – $2,228.12
Upper GI endoscopy with biopsy: rates for 10 insurance plans Aetna — Commercial: $2,228.12 Aetna Better Health — Medicare-Medicaid (D-SNP): $137.52 Blue Cross Blue Shield — Medicare Advantage: $971.94 Humana — Medicare Advantage: $971.94 Humana — Medicare-Medicaid (D-SNP): $133.51 Meridian — Medicare-Medicaid (MMAI/Dual): $1,127.45 Molina — Medicare-Medicaid (MMAI/Dual): $971.94 United Healthcare (UHC) — Medicare Advantage: $971.94 United Healthcare (UHC) — VA CCN: $971.94 Wellcare — Medicare Advantage HMO: $971.94
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$133.51 – $137.52
Upper GI endoscopy with biopsy: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $137.52 Humana — Medicare-Medicaid (D-SNP): $133.51
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	$178.84 – $2,166.64
Colonoscopy (diagnostic): rates for 10 insurance plans Aetna — Commercial: $2,166.64 Aetna Better Health — Medicare-Medicaid (D-SNP): $184.21 Blue Cross Blue Shield — Medicare Advantage: $996.56 Humana — Medicare Advantage: $996.56 Humana — Medicare-Medicaid (D-SNP): $178.84 Meridian — Medicare-Medicaid (MMAI/Dual): $1,156.01 Molina — Medicare-Medicaid (MMAI/Dual): $996.56 United Healthcare (UHC) — Medicare Advantage: $996.56 United Healthcare (UHC) — VA CCN: $996.56 Wellcare — Medicare Advantage HMO: $996.56
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Hospital (facility) fee In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$178.84 – $184.21
Colonoscopy (diagnostic): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $184.21 Humana — Medicare-Medicaid (D-SNP): $178.84
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	$194.20 – $2,802.64
Colonoscopy with biopsy: rates for 10 insurance plans Aetna — Commercial: $2,802.64 Aetna Better Health — Medicare-Medicaid (D-SNP): $200.03 Blue Cross Blue Shield — Medicare Advantage: $1,282.34 Humana — Medicare Advantage: $1,282.34 Humana — Medicare-Medicaid (D-SNP): $194.20 Meridian — Medicare-Medicaid (MMAI/Dual): $1,487.52 Molina — Medicare-Medicaid (MMAI/Dual): $1,282.34 United Healthcare (UHC) — Medicare Advantage: $1,282.34 United Healthcare (UHC) — VA CCN: $1,282.34 Wellcare — Medicare Advantage HMO: $1,282.34
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$194.20 – $200.03
Colonoscopy with biopsy: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $200.03 Humana — Medicare-Medicaid (D-SNP): $194.20
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	$245.75 – $2,802.64
Colonoscopy with removal of polyps (snare): rates for 10 insurance plans Aetna — Commercial: $2,802.64 Aetna Better Health — Medicare-Medicaid (D-SNP): $253.12 Blue Cross Blue Shield — Medicare Advantage: $1,282.34 Humana — Medicare Advantage: $1,282.34 Humana — Medicare-Medicaid (D-SNP): $245.75 Meridian — Medicare-Medicaid (MMAI/Dual): $1,487.52 Molina — Medicare-Medicaid (MMAI/Dual): $1,282.34 United Healthcare (UHC) — Medicare Advantage: $1,282.34 United Healthcare (UHC) — VA CCN: $1,282.34 Wellcare — Medicare Advantage HMO: $1,282.34
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$245.75 – $253.12
Colonoscopy with removal of polyps (snare): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $253.12 Humana — Medicare-Medicaid (D-SNP): $245.75
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	$249.17 – $2,802.64
Ultrasound of the lower bowel by endoscope: rates for 10 insurance plans Aetna — Commercial: $2,802.64 Aetna Better Health — Medicare-Medicaid (D-SNP): $256.65 Blue Cross Blue Shield — Medicare Advantage: $1,282.34 Humana — Medicare Advantage: $1,282.34 Humana — Medicare-Medicaid (D-SNP): $249.17 Meridian — Medicare-Medicaid (MMAI/Dual): $1,487.52 Molina — Medicare-Medicaid (MMAI/Dual): $1,282.34 United Healthcare (UHC) — Medicare Advantage: $1,282.34 United Healthcare (UHC) — VA CCN: $1,282.34 Wellcare — Medicare Advantage HMO: $1,282.34
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$249.17 – $256.65
Ultrasound of the lower bowel by endoscope: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $256.65 Humana — Medicare-Medicaid (D-SNP): $249.17
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	$182.93 – $2,166.64
Screening colonoscopy (not high risk): rates for 10 insurance plans Aetna — Commercial: $2,166.64 Aetna Better Health — Medicare-Medicaid (D-SNP): $188.42 Blue Cross Blue Shield — Medicare Advantage: $996.56 Humana — Medicare Advantage: $996.56 Humana — Medicare-Medicaid (D-SNP): $182.93 Meridian — Medicare-Medicaid (MMAI/Dual): $1,156.01 Molina — Medicare-Medicaid (MMAI/Dual): $996.56 United Healthcare (UHC) — Medicare Advantage: $996.56 United Healthcare (UHC) — VA CCN: $996.56 Wellcare — Medicare Advantage HMO: $996.56
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$182.93 – $188.42
Screening colonoscopy (not high risk): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $188.42 Humana — Medicare-Medicaid (D-SNP): $182.93
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	$660.53 – $13,871.16
Gallbladder removal by laparoscope: rates for 10 insurance plans Aetna — Commercial: $13,871.16 Aetna Better Health — Medicare-Medicaid (D-SNP): $680.35 Blue Cross Blue Shield — Medicare Advantage: $6,478.50 Humana — Medicare Advantage: $6,478.50 Humana — Medicare-Medicaid (D-SNP): $660.53 Meridian — Medicare-Medicaid (MMAI/Dual): $7,515.06 Molina — Medicare-Medicaid (MMAI/Dual): $6,478.50 United Healthcare (UHC) — Medicare Advantage: $6,478.50 United Healthcare (UHC) — VA CCN: $6,478.50 Wellcare — Medicare Advantage HMO: $6,478.50
Gallbladder removal by laparoscope CPT 47562 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$660.53 – $680.35
Gallbladder removal by laparoscope: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $680.35 Humana — Medicare-Medicaid (D-SNP): $660.53
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	$523.28 – $8,390.96
Groin (inguinal) hernia repair, age 5 or older: rates for 10 insurance plans Aetna — Commercial: $8,390.96 Aetna Better Health — Medicare-Medicaid (D-SNP): $538.98 Blue Cross Blue Shield — Medicare Advantage: $3,836.82 Humana — Medicare Advantage: $3,836.82 Humana — Medicare-Medicaid (D-SNP): $523.28 Meridian — Medicare-Medicaid (MMAI/Dual): $4,450.72 Molina — Medicare-Medicaid (MMAI/Dual): $3,836.82 United Healthcare (UHC) — Medicare Advantage: $3,836.82 United Healthcare (UHC) — VA CCN: $3,836.82 Wellcare — Medicare Advantage HMO: $3,836.82
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$523.28 – $538.98
Groin (inguinal) hernia repair, age 5 or older: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $538.98 Humana — Medicare-Medicaid (D-SNP): $523.28
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Inpatient Services	Not listed in the file	Not listed in the file	$128.97 – $132.84
Prostate biopsy: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $132.84 Humana — Medicare-Medicaid (D-SNP): $128.97
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Outpatient Services	Not listed in the file	Not listed in the file	$128.97 – $4,869.64
Prostate biopsy: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $132.84 Humana — Medicare-Medicaid (D-SNP): $128.97
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Other Outpatient Services	Not listed in the file	Not listed in the file	$128.97 – $4,869.64
Prostate biopsy: rates for 1 insurance plan Aetna — Commercial: $4,869.64
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$1,187.82 – $24,753.12
Prostate removal by laparoscope (radical prostatectomy): rates for 10 insurance plans Aetna — Commercial: $24,753.12 Aetna Better Health — Medicare-Medicaid (D-SNP): $1,223.45 Blue Cross Blue Shield — Medicare Advantage: $11,391.13 Humana — Medicare Advantage: $11,391.13 Humana — Medicare-Medicaid (D-SNP): $1,187.82 Meridian — Medicare-Medicaid (MMAI/Dual): $13,213.71 Molina — Medicare-Medicaid (MMAI/Dual): $11,391.13 United Healthcare (UHC) — Medicare Advantage: $11,391.13 United Healthcare (UHC) — VA CCN: $11,391.13 Wellcare — Medicare Advantage HMO: $11,391.13
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$1,187.82 – $1,223.45
Prostate removal by laparoscope (radical prostatectomy): rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $1,223.45 Humana — Medicare-Medicaid (D-SNP): $1,187.82
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	$201.26 – $7,559.92
Hysteroscopy with biopsy of the uterus lining: rates for 10 insurance plans Aetna — Commercial: $7,559.92 Aetna Better Health — Medicare-Medicaid (D-SNP): $207.30 Blue Cross Blue Shield — Medicare Advantage: $3,468.96 Humana — Medicare Advantage: $3,468.96 Humana — Medicare-Medicaid (D-SNP): $201.26 Meridian — Medicare-Medicaid (MMAI/Dual): $4,024 Molina — Medicare-Medicaid (MMAI/Dual): $3,468.96 United Healthcare (UHC) — Medicare Advantage: $3,468.96 United Healthcare (UHC) — VA CCN: $3,468.96 Wellcare — Medicare Advantage HMO: $3,468.96
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$201.26 – $207.30
Hysteroscopy with biopsy of the uterus lining: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $207.30 Humana — Medicare-Medicaid (D-SNP): $201.26
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	$84.17 – $1,647.24
Spinal injection, lower back (epidural), with imaging guidance: rates for 10 insurance plans Aetna — Commercial: $1,647.24 Aetna Better Health — Medicare-Medicaid (D-SNP): $86.70 Blue Cross Blue Shield — Medicare Advantage: $756.44 Humana — Medicare Advantage: $756.44 Humana — Medicare-Medicaid (D-SNP): $84.17 Meridian — Medicare-Medicaid (MMAI/Dual): $877.46 Molina — Medicare-Medicaid (MMAI/Dual): $756.44 United Healthcare (UHC) — Medicare Advantage: $756.44 United Healthcare (UHC) — VA CCN: $756.44 Wellcare — Medicare Advantage HMO: $756.44
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$84.17 – $86.70
Spinal injection, lower back (epidural), with imaging guidance: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $86.70 Humana — Medicare-Medicaid (D-SNP): $84.17
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$93.73 – $2,115.76
Nerve root injection, lower back, with imaging guidance: rates for 10 insurance plans Aetna — Commercial: $2,115.76 Aetna Better Health — Medicare-Medicaid (D-SNP): $96.54 Blue Cross Blue Shield — Medicare Advantage: $947.82 Humana — Medicare Advantage: $947.82 Humana — Medicare-Medicaid (D-SNP): $93.73 Meridian — Medicare-Medicaid (MMAI/Dual): $1,099.47 Molina — Medicare-Medicaid (MMAI/Dual): $947.82 United Healthcare (UHC) — Medicare Advantage: $947.82 United Healthcare (UHC) — VA CCN: $947.82 Wellcare — Medicare Advantage HMO: $947.82
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$93.73 – $96.54
Nerve root injection, lower back, with imaging guidance: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $96.54 Humana — Medicare-Medicaid (D-SNP): $93.73
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	$374.04 – $4,642.80
Carpal tunnel release: rates for 10 insurance plans Aetna — Commercial: $4,642.80 Aetna Better Health — Medicare-Medicaid (D-SNP): $385.26 Blue Cross Blue Shield — Medicare Advantage: $2,092.58 Humana — Medicare Advantage: $2,092.58 Humana — Medicare-Medicaid (D-SNP): $374.04 Meridian — Medicare-Medicaid (MMAI/Dual): $2,427.39 Molina — Medicare-Medicaid (MMAI/Dual): $2,092.58 United Healthcare (UHC) — Medicare Advantage: $2,092.58 United Healthcare (UHC) — VA CCN: $2,092.58 Wellcare — Medicare Advantage HMO: $2,092.58
Carpal tunnel release CPT 64721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$374.04 – $385.26
Carpal tunnel release: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $385.26 Humana — Medicare-Medicaid (D-SNP): $374.04
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	$306.27 – $1,303.80
Laser treatment of clouding after cataract surgery: rates for 10 insurance plans Aetna — Commercial: $1,303.80 Aetna Better Health — Medicare-Medicaid (D-SNP): $315.46 Blue Cross Blue Shield — Medicare Advantage: $589.39 Humana — Medicare Advantage: $589.39 Humana — Medicare-Medicaid (D-SNP): $306.27 Meridian — Medicare-Medicaid (MMAI/Dual): $683.69 Molina — Medicare-Medicaid (MMAI/Dual): $589.39 United Healthcare (UHC) — Medicare Advantage: $589.39 United Healthcare (UHC) — VA CCN: $589.39 Wellcare — Medicare Advantage HMO: $589.39
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) · Hospital (facility) fee In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$306.27 – $315.46
Laser treatment of clouding after cataract surgery: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $315.46 Humana — Medicare-Medicaid (D-SNP): $306.27
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$538.68 – $5,422.96
Cataract removal with lens implant: rates for 10 insurance plans Aetna — Commercial: $5,422.96 Aetna Better Health — Medicare-Medicaid (D-SNP): $554.84 Blue Cross Blue Shield — Medicare Advantage: $2,473.11 Humana — Medicare Advantage: $2,473.11 Humana — Medicare-Medicaid (D-SNP): $538.68 Meridian — Medicare-Medicaid (MMAI/Dual): $2,868.80 Molina — Medicare-Medicaid (MMAI/Dual): $2,473.11 United Healthcare (UHC) — Medicare Advantage: $2,473.11 United Healthcare (UHC) — VA CCN: $2,473.11 Wellcare — Medicare Advantage HMO: $2,473.11
Cataract removal with lens implant CPT 66984 · Inpatient (hospital stay) · Hospital (facility) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$538.68 – $554.84
Cataract removal with lens implant: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $554.84 Humana — Medicare-Medicaid (D-SNP): $538.68

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$1,791.18 – $2,735.47
Vaginal delivery, with care before and after: rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $1,844.92 Blue Cross Blue Shield — Medicare Advantage: $2,358.17 Humana — Medicare Advantage: $2,358.17 Humana — Medicare-Medicaid (D-SNP): $1,791.18 Meridian — Medicare-Medicaid (MMAI/Dual): $2,735.47 Molina — Medicare-Medicaid (MMAI/Dual): $2,358.17 United Healthcare (UHC) — Medicare Advantage: $2,358.17 United Healthcare (UHC) — VA CCN: $2,358.17 Wellcare — Medicare Advantage HMO: $2,358.17
Vaginal delivery, with care before and after CPT 59400 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$1,791.18 – $1,844.92
Vaginal delivery, with care before and after: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $1,844.92 Humana — Medicare-Medicaid (D-SNP): $1,791.18
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$1,991.74 – $3,085.23
Cesarean delivery (C-section), with care before and after: rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $2,051.49 Blue Cross Blue Shield — Medicare Advantage: $2,659.68 Humana — Medicare Advantage: $2,659.68 Humana — Medicare-Medicaid (D-SNP): $1,991.74 Meridian — Medicare-Medicaid (MMAI/Dual): $3,085.23 Molina — Medicare-Medicaid (MMAI/Dual): $2,659.68 United Healthcare (UHC) — Medicare Advantage: $2,659.68 United Healthcare (UHC) — VA CCN: $2,659.68 Wellcare — Medicare Advantage HMO: $2,659.68
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$1,991.74 – $2,051.49
Cesarean delivery (C-section), with care before and after: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $2,051.49 Humana — Medicare-Medicaid (D-SNP): $1,991.74
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$1,886.48 – $2,912.19
Vaginal delivery after a previous C-section, with care before and after: rates for 9 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $1,943.07 Blue Cross Blue Shield — Medicare Advantage: $2,510.51 Humana — Medicare Advantage: $2,510.51 Humana — Medicare-Medicaid (D-SNP): $1,886.48 Meridian — Medicare-Medicaid (MMAI/Dual): $2,912.19 Molina — Medicare-Medicaid (MMAI/Dual): $2,510.51 United Healthcare (UHC) — Medicare Advantage: $2,510.51 United Healthcare (UHC) — VA CCN: $2,510.51 Wellcare — Medicare Advantage HMO: $2,510.51
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$1,886.48 – $1,943.07
Vaginal delivery after a previous C-section, with care before and after: rates for 2 insurance plans Aetna Better Health — Medicare-Medicaid (D-SNP): $1,943.07 Humana — Medicare-Medicaid (D-SNP): $1,886.48

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	$74,127.19 – $131,480.83
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 16 insurance plan rates Aetna — Commercial: $106,202.08 Aetna — Medicare Advantage: $74,127.19 Blue Cross Blue Shield — Blue Choice: $125,141.58 Blue Cross Blue Shield — Blue Choice Options: $125,141.58 Blue Cross Blue Shield — Medicare Advantage: $74,127.19 Blue Cross Blue Shield — PPO: $131,480.83 Cigna — PPO: $86,313.64 HealthLink — HMO: $107,747.76 HealthLink — PPO: $120,680.62 Humana — Medicare Advantage: $74,127.19
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Outpatient (no overnight 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	$74,127.19
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 1 insurance plan Aetna — Medicare Advantage: $74,127.19
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	$14,615.85 – $25,924.42
Hip or knee replacement (major joint of the leg), without major complications: 10 of 16 insurance plan rates Aetna — Commercial: $20,940.14 Aetna — Medicare Advantage: $14,615.85 Blue Cross Blue Shield — Blue Choice: $24,674.49 Blue Cross Blue Shield — Blue Choice Options: $24,674.49 Blue Cross Blue Shield — Medicare Advantage: $14,615.85 Blue Cross Blue Shield — PPO: $25,924.42 Cigna — PPO: $17,018.68 HealthLink — HMO: $21,244.90 HealthLink — PPO: $23,794.91 Humana — Medicare Advantage: $14,615.85
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Outpatient (no overnight 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	$14,615.85
Hip or knee replacement (major joint of the leg), without major complications: rates for 1 insurance plan Aetna — Medicare Advantage: $14,615.85
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	$18,498.46 – $32,811.07
Neck (cervical) spinal fusion, without complications: 10 of 16 insurance plan rates Aetna — Commercial: $26,502.75 Aetna — Medicare Advantage: $18,498.46 Blue Cross Blue Shield — Blue Choice: $31,229.11 Blue Cross Blue Shield — Blue Choice Options: $31,229.11 Blue Cross Blue Shield — Medicare Advantage: $18,498.46 Blue Cross Blue Shield — PPO: $32,811.07 Cigna — PPO: $21,539.59 HealthLink — HMO: $26,888.48 HealthLink — PPO: $30,115.88 Humana — Medicare Advantage: $18,498.46
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$18,498.46
Neck (cervical) spinal fusion, without complications: rates for 1 insurance plan Aetna — Medicare Advantage: $18,498.46
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	$9,401.14 – $16,675.01
Uterus and ovary surgery (not for cancer), without complications: 10 of 16 insurance plan rates Aetna — Commercial: $13,469.04 Aetna — Medicare Advantage: $9,401.14 Blue Cross Blue Shield — Blue Choice: $15,871.03 Blue Cross Blue Shield — Blue Choice Options: $15,871.03 Blue Cross Blue Shield — Medicare Advantage: $9,401.14 Blue Cross Blue Shield — PPO: $16,675.01 Cigna — PPO: $10,946.70 HealthLink — HMO: $13,665.07 HealthLink — PPO: $15,305.28 Humana — Medicare Advantage: $9,401.14
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Outpatient (no overnight 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	$9,401.14
Uterus and ovary surgery (not for cancer), without complications: rates for 1 insurance plan Aetna — Medicare Advantage: $9,401.14

Source: Carle Health Pekin Hospital’s standard charges file (sthpiprd.blob.core.windows.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 15, 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	600 South 13th Street, Pekin, IL 61554
County	Tazewell County
State	Illinois
Phone	(309) 347‑1151
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	3 of 5 stars
CMS Certification Number	140120
Name in Medicare records	CARLE HEALTH PEKIN HOSPITAL
Profile level	Medicare data + hospital website
Official website	carle.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.

Visiting Hours - Carle Health Pekin Hospital — carle.org

Carle Health Pekin Hospital

Summary

Profile from official sources

At a glance