Does Charlevoix Area Hospital have an emergency room?

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

Where is Charlevoix Area Hospital?

14700 Lakeshore Drive, Charlevoix, MI 49720, in Charlevoix County, Michigan.

What is the phone number of Charlevoix Area Hospital?

(231) 547-4024, as listed by Medicare (CMS).

What is the Medicare star rating of Charlevoix Area Hospital?

CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Charlevoix Area Hospital — Charlevoix, MI

Quick answers

Does Charlevoix Area Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Charlevoix Area Hospital. In a medical emergency, call 911.
Where is Charlevoix Area Hospital?: 14700 Lakeshore Drive, Charlevoix, MI 49720, in Charlevoix County, Michigan.
What is the phone number of Charlevoix Area Hospital?: (231) 547-4024, as listed by Medicare (CMS).
What is the Medicare star rating of Charlevoix Area Hospital?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas^[5][8]

Treatments^[5][8][9]

Chemotherapy
Infusion therapy
Cardiac rehabilitation
Joint replacement
Neurosurgical spine procedures

Procedures^[8]

Open MRI
CT scan
Nuclear medicine imaging
Diagnostic ultrasound
X-ray
Digital mammography
Bone density test
General and complex surgery

Programs and centers^[8][9]

School Nurses Program
Wellness Workshop

Emergency care (hospital website)^[4][5][7][8]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Medical/surgical patients: visit any time until 8 pm. Maternity: family any time, other visitors 4-8 pm. Max two visitors at a time^[6]
Interpreters and languages	For language assistance, call 231-935-6632^[7]

Recognition^[8]

The Joint Commission accreditation (Critical Access Hospital and Laboratory Accreditation Program)

Doctors and clinicians (236)

236 doctors and other clinicians list Charlevoix Area 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 212 more: the button below opens the full list.

Other emergency rooms nearby

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

McLaren Northern Michigan15 mi · Petoskey, MI · Acute Care Hospital
Munson Healthcare Otsego Memorial Hospital33 mi · Gaylord, MI · Acute Care Hospital
Kalkaska Memorial Health Center38 mi · Kalkaska, MI · Critical Access Hospital
Munson Medical Center41 mi · Traverse City, MI · Acute Care Hospital
Mackinac Straits Hospital and Health Center49 mi · Saint Ignace, MI · Critical Access Hospital

Other hospitals nearby

Munson Healthcare Grayling Hospital50 mi · Grayling, MI · 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

Boulder Park Terrace2.7 mi · Charlevoix, MI · 1 of 5 stars
Grandvue Medical Care Facility8.2 mi · East Jordan, MI · 3 of 5 stars
The Villa at the Bay14 mi · Petoskey, MI · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Advisacare Solutions of Northern Michigan, LLC0.0 mi · Charlevoix, MI
McLaren Hospice17 mi · Petoskey, MI · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Advisacare Solutions of Northern Michigan, LLC0.0 mi · Charlevoix, MI

All home health agencies in the state →

Dialysis facilities

DaVita Petoskey Dialysis17 mi · Petoskey, MI · 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.

Northern Michigan Surgical Suites, LLC12 mi · Boyne City, MI

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

East Jordan Family Health Center10 mi · East Jordan, MI · Community health center
Alcona Health Center Lincoln Elementary Petoskey15 mi · Petoskey, MI · Community health center
Alcona Health Center Sheridan Elementary Petoskey15 mi · Petoskey, MI · Community health center

Clinics and urgent care

Boyne Area Medical Center12 mi · Boyne City, MI · Rural health clinic
Bay Urgent Care and Family Practice PLLC17 mi · Petoskey, MI · Urgent care center
McLaren Northern Michigan Burns Building17 mi · Petoskey, MI · Rural health clinic

Pharmacies

Charlevoix Commons Apothecary, Ltd0.0 mi · Charlevoix, MI · Community/retail pharmacy
Munson Healthcare Charlevoix Hospital0.0 mi · Charlevoix, MI · Community/retail pharmacy
Walgreen Co0.0 mi · Charlevoix, MI · Pharmacy

Assisted living nearby

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

Autumnvue Clf12 mi · East Jordan, MI
Springridge Home12 mi · Boyne City, MI
Winterlake Clf12 mi · Boyne City, MI
Eastport Village Care Home14 mi · Central Lake, MI

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 Charlevoix Area 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)	4 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	5 of 5 stars
Nurses communicated well	5 of 5 stars
Doctors communicated well	4 of 5 stars
Staff explained medicines	4 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	78%National average: 72%
Would definitely recommend the hospital	79%National average: 71%
Nurses “always” communicated well	86%National average: 80%
Doctors “always” communicated well	85%National average: 80%
Staff “always” explained medicines before giving them	70%National average: 62%
Were given information about recovery at home	85%National average: 86%
Room and bathroom “always” clean	72%National average: 74%
Area around the room “always” quiet at night	63%National average: 60%
Completed surveys	308Response rate: 29%

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	Not reported to Medicare

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	Too few cases to report
Deaths within 30 days: heart failure patients	Too few cases to report
Deaths within 30 days: pneumonia patients	16.2%
Deaths within 30 days: COPD patients	Too few cases to report
Deaths within 30 days: stroke patients	Too few cases to report
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	Not reported to Medicare
Complications after hip or knee replacement	Too few cases to report

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	Not reported to Medicare
Readmitted within 30 days: heart failure	Too few cases to report
Readmitted within 30 days: pneumonia	17%
Readmitted within 30 days: COPD	Too few cases to report
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Too few cases to report

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; data from July 2023 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	133 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)	Too few cases to report

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 Michigan Best hospitals in Michigan

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 83 common services exactly as Charlevoix Area 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 Visit Level 3 New 99203	$136	$115.60	$63.92 – $136
New patient office visit (about 30–44 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $122.81 Aetna — Medicare Advantage: $65.20 ASR Physicians Care Network — Commercial: $108.80 Blue Care Network — Medicare Advantage: $63.92 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $125.62 Blue Cross Complete — Managed Medicaid: $79.77 Cigna — Commercial: $136 Cofinity — Commercial: $126.48 Employee Benefits Logistics — Commercial: $108.66 Enterprise Group Planning Employee Benefit Plan — Commercial: $108.80
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Office Visit Level 3 New 99203	$136	$115.60	$108.80 – $136
New patient office visit (about 30–44 minutes): 10 of 16 insurance plan rates Aetna — Commercial: $122.81 ASR Physicians Care Network — Commercial: $108.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $125.62 Cigna — Commercial: $136 Cofinity — Commercial: $126.48 Enterprise Group Planning Employee Benefit Plan — Commercial: $108.80 HAP (Health Alliance Plan) — Commercial: $108.80 IBA Health and Life Assurance Company — Commercial: $125.12 McLaren Health Plan — Commercial: $126.62 Medical Cost Savings Solution — Commercial: $108.80
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE O/P NEW LOW 30 MIN	Not listed in the file	Not listed in the file	$52.19 – $169.72
New patient office visit (about 30–44 minutes): 10 of 24 insurance plan rates Aetna — Medicare Advantage: $71.06 ASR Physicians Care Network — Commercial: $106.59 Blue Care Network — Medicare Advantage: $71.06 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $117.35 Blue Cross Complete — Managed Medicaid: $53.23 Cigna — Commercial: $92.88 Employee Benefits Logistics — Commercial: $120.80 HAP (Health Alliance Plan) — Commercial: $169.72 HAP (Health Alliance Plan) — Medicare Advantage: $71.06 McLaren Health Plan — Managed Medicaid: $52.19
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Visit Level 4 New 99204	$136	$115.60	$63.92 – $136
New patient office visit (about 45–59 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $122.81 Aetna — Medicare Advantage: $65.20 ASR Physicians Care Network — Commercial: $108.80 Blue Care Network — Medicare Advantage: $63.92 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $125.62 Blue Cross Complete — Managed Medicaid: $120.71 Cigna — Commercial: $136 Cofinity — Commercial: $126.48 Employee Benefits Logistics — Commercial: $108.66 Enterprise Group Planning Employee Benefit Plan — Commercial: $108.80
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Office Visit Level 4 New 99204	$136	$115.60	$108.80 – $136
New patient office visit (about 45–59 minutes): 10 of 16 insurance plan rates Aetna — Commercial: $122.81 ASR Physicians Care Network — Commercial: $108.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $125.62 Cigna — Commercial: $136 Cofinity — Commercial: $126.48 Enterprise Group Planning Employee Benefit Plan — Commercial: $108.80 HAP (Health Alliance Plan) — Commercial: $108.80 IBA Health and Life Assurance Company — Commercial: $125.12 McLaren Health Plan — Commercial: $126.62 Medical Cost Savings Solution — Commercial: $108.80
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE O/P NEW MOD 45 MIN	Not listed in the file	Not listed in the file	$84.99 – $256.82
New patient office visit (about 45–59 minutes): 10 of 24 insurance plan rates Aetna — Medicare Advantage: $116.02 ASR Physicians Care Network — Commercial: $174.03 Blue Care Network — Medicare Advantage: $116.02 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $179.33 Blue Cross Complete — Managed Medicaid: $86.69 Cigna — Commercial: $151.25 Employee Benefits Logistics — Commercial: $197.23 HAP (Health Alliance Plan) — Commercial: $256.82 HAP (Health Alliance Plan) — Medicare Advantage: $116.02 McLaren Health Plan — Managed Medicaid: $84.99
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Visit Level 5 New 99205	$136	$115.60	$63.92 – $161.43
New patient office visit (about 60–74 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $122.81 Aetna — Medicare Advantage: $65.20 ASR Physicians Care Network — Commercial: $108.80 Blue Care Network — Medicare Advantage: $63.92 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $125.62 Blue Cross Complete — Managed Medicaid: $161.43 Cigna — Commercial: $136 Cofinity — Commercial: $126.48 Employee Benefits Logistics — Commercial: $108.66 Enterprise Group Planning Employee Benefit Plan — Commercial: $108.80
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Office Visit Level 5 New 99205	$136	$115.60	$108.80 – $136
New patient office visit (about 60–74 minutes): 10 of 16 insurance plan rates Aetna — Commercial: $122.81 ASR Physicians Care Network — Commercial: $108.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $125.62 Cigna — Commercial: $136 Cofinity — Commercial: $126.48 Enterprise Group Planning Employee Benefit Plan — Commercial: $108.80 HAP (Health Alliance Plan) — Commercial: $108.80 IBA Health and Life Assurance Company — Commercial: $125.12 McLaren Health Plan — Commercial: $126.62 Medical Cost Savings Solution — Commercial: $108.80
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE O/P NEW HI 60 MIN	Not listed in the file	Not listed in the file	$115.66 – $343.47
New patient office visit (about 60–74 minutes): 10 of 24 insurance plan rates Aetna — Medicare Advantage: $159.14 ASR Physicians Care Network — Commercial: $238.71 Blue Care Network — Medicare Advantage: $159.14 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $226.59 Blue Cross Complete — Managed Medicaid: $117.97 Cigna — Commercial: $205.84 Employee Benefits Logistics — Commercial: $270.54 HAP (Health Alliance Plan) — Commercial: $343.47 HAP (Health Alliance Plan) — Medicare Advantage: $159.14 McLaren Health Plan — Managed Medicaid: $115.66
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office/Outpatient Visit Est Lv3	$148	$125.80	$64.39 – $148
Established patient office visit (about 20–29 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $133.64 Aetna — Medicare Advantage: $70.95 ASR Physicians Care Network — Commercial: $118.40 Blue Care Network — Medicare Advantage: $69.56 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $136.71 Blue Cross Complete — Managed Medicaid: $64.39 Cigna — Commercial: $148 Cofinity — Commercial: $137.64 Employee Benefits Logistics — Commercial: $118.25 Enterprise Group Planning Employee Benefit Plan — Commercial: $118.40
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: E&M FAC 15 MIN W/SERVICE BCE	$148	$125.80	$64.39 – $148
Established patient office visit (about 20–29 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $133.64 Aetna — Medicare Advantage: $70.95 ASR Physicians Care Network — Commercial: $118.40 Blue Care Network — Medicare Advantage: $69.56 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $136.71 Blue Cross Complete — Managed Medicaid: $64.39 Cigna — Commercial: $148 Cofinity — Commercial: $137.64 Employee Benefits Logistics — Commercial: $118.25 Enterprise Group Planning Employee Benefit Plan — Commercial: $118.40
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EST PT E&M FACIL 15 MIN BCE	$148	$125.80	$64.39 – $148
Established patient office visit (about 20–29 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $133.64 Aetna — Medicare Advantage: $70.95 ASR Physicians Care Network — Commercial: $118.40 Blue Care Network — Medicare Advantage: $69.56 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $136.71 Blue Cross Complete — Managed Medicaid: $64.39 Cigna — Commercial: $148 Cofinity — Commercial: $137.64 Employee Benefits Logistics — Commercial: $118.25 Enterprise Group Planning Employee Benefit Plan — Commercial: $118.40
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office/Outpatient Visit Est Lv4	$83	$70.55	$39.01 – $91.93
Established patient office visit (about 30–39 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $74.95 Aetna — Medicare Advantage: $39.79 ASR Physicians Care Network — Commercial: $66.40 Blue Care Network — Medicare Advantage: $39.01 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $76.67 Blue Cross Complete — Managed Medicaid: $91.93 Cigna — Commercial: $83 Cofinity — Commercial: $77.19 Employee Benefits Logistics — Commercial: $66.32 Enterprise Group Planning Employee Benefit Plan — Commercial: $66.40
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: E&M FAC 25 MIN W/SERVICE BCE	$83	$70.55	$39.01 – $91.93
Established patient office visit (about 30–39 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $74.95 Aetna — Medicare Advantage: $39.79 ASR Physicians Care Network — Commercial: $66.40 Blue Care Network — Medicare Advantage: $39.01 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $76.67 Blue Cross Complete — Managed Medicaid: $91.93 Cigna — Commercial: $83 Cofinity — Commercial: $77.19 Employee Benefits Logistics — Commercial: $66.32 Enterprise Group Planning Employee Benefit Plan — Commercial: $66.40
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EST PT E&M FACIL 25 MIN BCE	$83	$70.55	$39.01 – $91.93
Established patient office visit (about 30–39 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $74.95 Aetna — Medicare Advantage: $39.79 ASR Physicians Care Network — Commercial: $66.40 Blue Care Network — Medicare Advantage: $39.01 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $76.67 Blue Cross Complete — Managed Medicaid: $91.93 Cigna — Commercial: $83 Cofinity — Commercial: $77.19 Employee Benefits Logistics — Commercial: $66.32 Enterprise Group Planning Employee Benefit Plan — Commercial: $66.40
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Doctor (professional) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$56.02 – $163.19
Office consultation with a specialist (moderate): 10 of 12 insurance plan rates Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $140.07 Blue Cross Complete — Managed Medicaid: $57.14 Cigna — Commercial: $117.81 HAP (Health Alliance Plan) — Commercial: $163.19 McLaren Health Plan — Managed Medicaid: $56.02 Meridian — Managed Medicaid: $56.02 Priority Health — Commercial: $117.81 Priority Health — Managed Medicaid: $56.02 Provider Network of America/HMA Group Health — Commercial: $152.31 United Healthcare — Managed Medicaid: $56.02
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	$76.70
Office consultation with a specialist (moderate): rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $76.70 McLaren Health Plan — Managed Medicaid: $76.70 Meridian — Managed Medicaid: $76.70 Priority Health — Managed Medicaid: $76.70 United Healthcare — Managed Medicaid: $76.70
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$84.99 – $234.04
Office consultation with a specialist (moderate to high): 10 of 12 insurance plan rates Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $212.51 Blue Cross Complete — Managed Medicaid: $86.69 Cigna — Commercial: $178.72 HAP (Health Alliance Plan) — Commercial: $234.04 McLaren Health Plan — Managed Medicaid: $84.99 Meridian — Managed Medicaid: $84.99 Priority Health — Commercial: $178.72 Priority Health — Managed Medicaid: $84.99 Provider Network of America/HMA Group Health — Commercial: $218.44 United Healthcare — Managed Medicaid: $84.99
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	$110
Office consultation with a specialist (moderate to high): rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $110 McLaren Health Plan — Managed Medicaid: $110 Meridian — Managed Medicaid: $110 Priority Health — Managed Medicaid: $110 United Healthcare — Managed Medicaid: $110
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee · modifier KX In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$1,873.94
Office consultation with a specialist (moderate to high): rates for 2 insurance plans Cigna — Commercial: $1,873.94 Priority Health — Commercial: $1,873.94
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient · Doctor (professional) fee In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$69 – $194.01
Preventive checkup, new patient, age 18–39: 10 of 12 insurance plan rates Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $151.52 Blue Cross Complete — Managed Medicaid: $70.38 Cigna — Commercial: $121.95 HAP (Health Alliance Plan) — Commercial: $194.01 McLaren Health Plan — Managed Medicaid: $69 Meridian — Managed Medicaid: $69 Priority Health — Commercial: $121.95 Priority Health — Managed Medicaid: $69 Provider Network of America/HMA Group Health — Commercial: $181.08 United Healthcare — Managed Medicaid: $69
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	$91.18
Preventive checkup, new patient, age 18–39: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $91.18 McLaren Health Plan — Managed Medicaid: $91.18 Meridian — Managed Medicaid: $91.18 Priority Health — Managed Medicaid: $91.18 United Healthcare — Managed Medicaid: $91.18
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Doctor (professional) fee In the file: PREV VISIT NEW AGE 40-64	Not listed in the file	Not listed in the file	$84.51 – $224.94
Preventive checkup, new patient, age 40–64: 10 of 12 insurance plan rates Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $174.44 Blue Cross Complete — Managed Medicaid: $86.20 Cigna — Commercial: $147.64 HAP (Health Alliance Plan) — Commercial: $224.94 McLaren Health Plan — Managed Medicaid: $84.51 Meridian — Managed Medicaid: $84.51 Priority Health — Commercial: $147.64 Priority Health — Managed Medicaid: $84.51 Provider Network of America/HMA Group Health — Commercial: $209.94 United Healthcare — Managed Medicaid: $84.51
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	$105.72
Preventive checkup, new patient, age 40–64: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $105.72 McLaren Health Plan — Managed Medicaid: $105.72 Meridian — Managed Medicaid: $105.72 Priority Health — Managed Medicaid: $105.72 United Healthcare — Managed Medicaid: $105.72
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED visit for the EM expanded problem focused examination	$372	$316.20	$174.84 – $372
Emergency room visit (moderate): 10 of 34 insurance plan rates Aetna — Commercial: $335.92 Aetna — Medicare Advantage: $178.34 ASR Physicians Care Network — Commercial: $297.60 Blue Care Network — Medicare Advantage: $174.84 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $343.62 Blue Cross Complete — Managed Medicaid: $192.64 Cigna — Commercial: $372 Cofinity — Commercial: $345.96 Employee Benefits Logistics — Commercial: $297.23 Enterprise Group Planning Employee Benefit Plan — Commercial: $297.60
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV3	$372	$316.20	$174.84 – $372
Emergency room visit (moderate): 10 of 34 insurance plan rates Aetna — Commercial: $335.92 Aetna — Medicare Advantage: $178.34 ASR Physicians Care Network — Commercial: $297.60 Blue Care Network — Medicare Advantage: $174.84 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $343.62 Blue Cross Complete — Managed Medicaid: $192.64 Cigna — Commercial: $372 Cofinity — Commercial: $345.96 Employee Benefits Logistics — Commercial: $297.23 Enterprise Group Planning Employee Benefit Plan — Commercial: $297.60
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV3	$372	$316.20	$174.84 – $372
Emergency room visit (moderate): 10 of 34 insurance plan rates Aetna — Commercial: $335.92 Aetna — Medicare Advantage: $178.34 ASR Physicians Care Network — Commercial: $297.60 Blue Care Network — Medicare Advantage: $174.84 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $343.62 Blue Cross Complete — Managed Medicaid: $192.64 Cigna — Commercial: $372 Cofinity — Commercial: $345.96 Employee Benefits Logistics — Commercial: $297.23 Enterprise Group Planning Employee Benefit Plan — Commercial: $297.60
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED visit for the EM of a patient which requires these three key components	$638	$542.30	$294.46 – $638
Emergency room visit (moderately high): 10 of 34 insurance plan rates Aetna — Commercial: $576.11 Aetna — Medicare Advantage: $305.86 ASR Physicians Care Network — Commercial: $510.40 Blue Care Network — Medicare Advantage: $299.86 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $589.32 Blue Cross Complete — Managed Medicaid: $294.46 Cigna — Commercial: $638 Cofinity — Commercial: $593.34 Employee Benefits Logistics — Commercial: $509.76 Enterprise Group Planning Employee Benefit Plan — Commercial: $510.40
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV4	$638	$542.30	$294.46 – $638
Emergency room visit (moderately high): 10 of 34 insurance plan rates Aetna — Commercial: $576.11 Aetna — Medicare Advantage: $305.86 ASR Physicians Care Network — Commercial: $510.40 Blue Care Network — Medicare Advantage: $299.86 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $589.32 Blue Cross Complete — Managed Medicaid: $294.46 Cigna — Commercial: $638 Cofinity — Commercial: $593.34 Employee Benefits Logistics — Commercial: $509.76 Enterprise Group Planning Employee Benefit Plan — Commercial: $510.40
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV4	$638	$542.30	$294.46 – $638
Emergency room visit (moderately high): 10 of 34 insurance plan rates Aetna — Commercial: $576.11 Aetna — Medicare Advantage: $305.86 ASR Physicians Care Network — Commercial: $510.40 Blue Care Network — Medicare Advantage: $299.86 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $589.32 Blue Cross Complete — Managed Medicaid: $294.46 Cigna — Commercial: $638 Cofinity — Commercial: $593.34 Employee Benefits Logistics — Commercial: $509.76 Enterprise Group Planning Employee Benefit Plan — Commercial: $510.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED visit for the EM of a patient which requires these three key components win the constraints impo	$733	$623.05	$344.51 – $733
Emergency room visit (high): 10 of 34 insurance plan rates Aetna — Commercial: $661.90 Aetna — Medicare Advantage: $351.40 ASR Physicians Care Network — Commercial: $586.40 Blue Care Network — Medicare Advantage: $344.51 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $677.07 Blue Cross Complete — Managed Medicaid: $420.27 Cigna — Commercial: $733 Cofinity — Commercial: $681.69 Employee Benefits Logistics — Commercial: $585.67 Enterprise Group Planning Employee Benefit Plan — Commercial: $586.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV5	$733	$623.05	$344.51 – $733
Emergency room visit (high): 10 of 34 insurance plan rates Aetna — Commercial: $661.90 Aetna — Medicare Advantage: $351.40 ASR Physicians Care Network — Commercial: $586.40 Blue Care Network — Medicare Advantage: $344.51 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $677.07 Blue Cross Complete — Managed Medicaid: $420.27 Cigna — Commercial: $733 Cofinity — Commercial: $681.69 Employee Benefits Logistics — Commercial: $585.67 Enterprise Group Planning Employee Benefit Plan — Commercial: $586.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV5	$733	$623.05	$344.51 – $733
Emergency room visit (high): 10 of 34 insurance plan rates Aetna — Commercial: $661.90 Aetna — Medicare Advantage: $351.40 ASR Physicians Care Network — Commercial: $586.40 Blue Care Network — Medicare Advantage: $344.51 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $677.07 Blue Cross Complete — Managed Medicaid: $420.27 Cigna — Commercial: $733 Cofinity — Commercial: $681.69 Employee Benefits Logistics — Commercial: $585.67 Enterprise Group Planning Employee Benefit Plan — Commercial: $586.40

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: Basic Metabolic Panel	$73	$62.05	$5.96 – $73
Basic metabolic panel (blood test): 10 of 34 insurance plan rates Aetna — Commercial: $65.92 Aetna — Medicare Advantage: $35 ASR Physicians Care Network — Commercial: $58.40 Blue Care Network — Medicare Advantage: $34.31 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $67.43 Blue Cross Complete — Managed Medicaid: $5.96 Cigna — Commercial: $73 Cofinity — Commercial: $67.89 Employee Benefits Logistics — Commercial: $58.33 Enterprise Group Planning Employee Benefit Plan — Commercial: $58.40
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Basic Metabolic Panel	$73	$62.05	$58.40 – $73
Basic metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Commercial: $65.92 ASR Physicians Care Network — Commercial: $58.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $67.43 Cigna — Commercial: $73 Cofinity — Commercial: $67.89 Enterprise Group Planning Employee Benefit Plan — Commercial: $58.40 HAP (Health Alliance Plan) — Commercial: $58.40 IBA Health and Life Assurance Company — Commercial: $67.16 McLaren Health Plan — Commercial: $67.96 Medical Cost Savings Solution — Commercial: $58.40
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Doctor (professional) fee In the file: BASIC METABOLIC PNL TOTAL CA	Not listed in the file	Not listed in the file	$7.27 – $12.69
Basic metabolic panel (blood test): rates for 7 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $9.98 Cigna — Commercial: $8.74 HAP (Health Alliance Plan) — Commercial: $12.69 Priority Health — Commercial: $8.74 Provider Network of America/HMA Group Health — Commercial: $11.84 United Healthcare — Medicare Advantage: $8.46 United Healthcare Definity — Commercial: $7.27
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$122	$103.70	$7.44 – $122
Comprehensive metabolic panel (blood test): 10 of 34 insurance plan rates Aetna — Commercial: $110.17 Aetna — Medicare Advantage: $58.49 ASR Physicians Care Network — Commercial: $97.60 Blue Care Network — Medicare Advantage: $57.34 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $112.69 Blue Cross Complete — Managed Medicaid: $7.44 Cigna — Commercial: $122 Cofinity — Commercial: $113.46 Employee Benefits Logistics — Commercial: $97.48 Enterprise Group Planning Employee Benefit Plan — Commercial: $97.60
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$122	$103.70	$97.60 – $122
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Commercial: $110.17 ASR Physicians Care Network — Commercial: $97.60 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $112.69 Cigna — Commercial: $122 Cofinity — Commercial: $113.46 Enterprise Group Planning Employee Benefit Plan — Commercial: $97.60 HAP (Health Alliance Plan) — Commercial: $97.60 IBA Health and Life Assurance Company — Commercial: $112.24 McLaren Health Plan — Commercial: $113.58 Medical Cost Savings Solution — Commercial: $97.60
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPREHEN METABOLIC PANEL	Not listed in the file	Not listed in the file	$8.95 – $15.84
Comprehensive metabolic panel (blood test): rates for 7 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $15.19 Cigna — Commercial: $11.09 HAP (Health Alliance Plan) — Commercial: $15.84 Priority Health — Commercial: $11.09 Provider Network of America/HMA Group Health — Commercial: $14.78 United Healthcare — Medicare Advantage: $10.56 United Healthcare Definity — Commercial: $8.95
Obstetric blood test panel CPT 80055 · Inpatient or outpatient · Doctor (professional) fee In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$35.12 – $71.72
Obstetric blood test panel: rates for 7 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $49.77 Cigna — Commercial: $49.76 HAP (Health Alliance Plan) — Commercial: $71.72 Priority Health — Commercial: $49.76 Provider Network of America/HMA Group Health — Commercial: $66.93 United Healthcare — Medicare Advantage: $47.81 United Healthcare Definity — Commercial: $35.12
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	$33.71
Obstetric blood test panel: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $33.71 McLaren Health Plan — Managed Medicaid: $33.71 Meridian — Managed Medicaid: $33.71 Priority Health — Managed Medicaid: $33.71 United Healthcare — Managed Medicaid: $33.71
Obstetric blood test panel CPT 80055 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$43.28
Obstetric blood test panel: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $43.28
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel	$87	$73.95	$9.44 – $87
Cholesterol panel (lipid panel): 10 of 34 insurance plan rates Aetna — Commercial: $78.56 Aetna — Medicare Advantage: $41.71 ASR Physicians Care Network — Commercial: $69.60 Blue Care Network — Medicare Advantage: $40.89 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $80.36 Blue Cross Complete — Managed Medicaid: $9.44 Cigna — Commercial: $87 Cofinity — Commercial: $80.91 Employee Benefits Logistics — Commercial: $69.51 Enterprise Group Planning Employee Benefit Plan — Commercial: $69.60
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Lipid Panel	$87	$73.95	$69.60 – $87
Cholesterol panel (lipid panel): 10 of 16 insurance plan rates Aetna — Commercial: $78.56 ASR Physicians Care Network — Commercial: $69.60 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $80.36 Cigna — Commercial: $87 Cofinity — Commercial: $80.91 Enterprise Group Planning Employee Benefit Plan — Commercial: $69.60 HAP (Health Alliance Plan) — Commercial: $69.60 IBA Health and Life Assurance Company — Commercial: $80.04 McLaren Health Plan — Commercial: $81 Medical Cost Savings Solution — Commercial: $69.60
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Doctor (professional) fee In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$10.98 – $20.09
Cholesterol panel (lipid panel): rates for 7 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $19.07 Cigna — Commercial: $13.78 HAP (Health Alliance Plan) — Commercial: $20.09 Priority Health — Commercial: $13.78 Provider Network of America/HMA Group Health — Commercial: $18.75 United Healthcare — Medicare Advantage: $13.39 United Healthcare Definity — Commercial: $10.98
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel	$95	$80.75	$6.12 – $95
Kidney function panel: 10 of 34 insurance plan rates Aetna — Commercial: $85.79 Aetna — Medicare Advantage: $45.54 ASR Physicians Care Network — Commercial: $76 Blue Care Network — Medicare Advantage: $44.65 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $87.75 Blue Cross Complete — Managed Medicaid: $6.12 Cigna — Commercial: $95 Cofinity — Commercial: $88.35 Employee Benefits Logistics — Commercial: $75.91 Enterprise Group Planning Employee Benefit Plan — Commercial: $76
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Renal Function Panel	$95	$80.75	$76 – $95
Kidney function panel: 10 of 16 insurance plan rates Aetna — Commercial: $85.79 ASR Physicians Care Network — Commercial: $76 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $87.75 Cigna — Commercial: $95 Cofinity — Commercial: $88.35 Enterprise Group Planning Employee Benefit Plan — Commercial: $76 HAP (Health Alliance Plan) — Commercial: $76 IBA Health and Life Assurance Company — Commercial: $87.40 McLaren Health Plan — Commercial: $88.45 Medical Cost Savings Solution — Commercial: $76
Kidney function panel CPT 80069 · Inpatient or outpatient · Doctor (professional) fee In the file: RENAL FUNCTION PANEL	Not listed in the file	Not listed in the file	$7.46 – $13.02
Kidney function panel: rates for 7 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $10.84 Cigna — Commercial: $9.07 HAP (Health Alliance Plan) — Commercial: $13.02 Priority Health — Commercial: $9.07 Provider Network of America/HMA Group Health — Commercial: $12.15 United Healthcare — Medicare Advantage: $8.68 United Healthcare Definity — Commercial: $7.46
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$48	$40.80	$5.76 – $48
Liver function panel: 10 of 34 insurance plan rates Aetna — Commercial: $43.34 Aetna — Medicare Advantage: $23.01 ASR Physicians Care Network — Commercial: $38.40 Blue Care Network — Medicare Advantage: $22.56 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $44.34 Blue Cross Complete — Managed Medicaid: $5.76 Cigna — Commercial: $48 Cofinity — Commercial: $44.64 Employee Benefits Logistics — Commercial: $38.35 Enterprise Group Planning Employee Benefit Plan — Commercial: $38.40
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$48	$40.80	$38.40 – $48
Liver function panel: 10 of 16 insurance plan rates Aetna — Commercial: $43.34 ASR Physicians Care Network — Commercial: $38.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $44.34 Cigna — Commercial: $48 Cofinity — Commercial: $44.64 Enterprise Group Planning Employee Benefit Plan — Commercial: $38.40 HAP (Health Alliance Plan) — Commercial: $38.40 IBA Health and Life Assurance Company — Commercial: $44.16 McLaren Health Plan — Commercial: $44.69 Medical Cost Savings Solution — Commercial: $38.40
Liver function panel CPT 80076 · Inpatient or outpatient · Doctor (professional) fee In the file: HEPATIC FUNCTION PANEL	Not listed in the file	Not listed in the file	$3.94 – $12.26
Liver function panel: rates for 7 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $7.59 Cigna — Commercial: $8.41 HAP (Health Alliance Plan) — Commercial: $12.26 Priority Health — Commercial: $8.41 Provider Network of America/HMA Group Health — Commercial: $11.44 United Healthcare — Medicare Advantage: $8.17 United Healthcare Definity — Commercial: $3.94
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Dipstick auto w/ Micro POC	$48	$40.80	$2.23 – $48
Urine test (automated, with microscope): 10 of 34 insurance plan rates Aetna — Commercial: $43.34 Aetna — Medicare Advantage: $23.01 ASR Physicians Care Network — Commercial: $38.40 Blue Care Network — Medicare Advantage: $22.56 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $44.34 Blue Cross Complete — Managed Medicaid: $2.23 Cigna — Commercial: $48 Cofinity — Commercial: $44.64 Employee Benefits Logistics — Commercial: $38.35 Enterprise Group Planning Employee Benefit Plan — Commercial: $38.40
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis with Culture if Indicated	$27	$22.95	$2.23 – $27
Urine test (automated, with microscope): 10 of 34 insurance plan rates Aetna — Commercial: $24.38 Aetna — Medicare Advantage: $12.94 ASR Physicians Care Network — Commercial: $21.60 Blue Care Network — Medicare Advantage: $12.69 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $24.94 Blue Cross Complete — Managed Medicaid: $2.23 Cigna — Commercial: $27 Cofinity — Commercial: $25.11 Employee Benefits Logistics — Commercial: $21.57 Enterprise Group Planning Employee Benefit Plan — Commercial: $21.60
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis with Microscopic	$20	$17	$2.23 – $20
Urine test (automated, with microscope): 10 of 34 insurance plan rates Aetna — Commercial: $18.06 Aetna — Medicare Advantage: $9.59 ASR Physicians Care Network — Commercial: $16 Blue Care Network — Medicare Advantage: $9.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $18.47 Blue Cross Complete — Managed Medicaid: $2.23 Cigna — Commercial: $20 Cofinity — Commercial: $18.60 Employee Benefits Logistics — Commercial: $15.98 Enterprise Group Planning Employee Benefit Plan — Commercial: $16
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Dipstick non-auto POC	$36	$30.60	$2.45 – $36
Urine test (manual, without microscope): 10 of 34 insurance plan rates Aetna — Commercial: $32.51 Aetna — Medicare Advantage: $17.26 ASR Physicians Care Network — Commercial: $28.80 Blue Care Network — Medicare Advantage: $16.92 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $33.25 Blue Cross Complete — Managed Medicaid: $2.45 Cigna — Commercial: $36 Cofinity — Commercial: $33.48 Employee Benefits Logistics — Commercial: $28.76 Enterprise Group Planning Employee Benefit Plan — Commercial: $28.80
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Dipstick non-auto POC - UC	$36	$30.60	$2.45 – $36
Urine test (manual, without microscope): 10 of 34 insurance plan rates Aetna — Commercial: $32.51 Aetna — Medicare Advantage: $17.26 ASR Physicians Care Network — Commercial: $28.80 Blue Care Network — Medicare Advantage: $16.92 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $33.25 Blue Cross Complete — Managed Medicaid: $2.45 Cigna — Commercial: $36 Cofinity — Commercial: $33.48 Employee Benefits Logistics — Commercial: $28.76 Enterprise Group Planning Employee Benefit Plan — Commercial: $28.80
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIPSTICK URINE BCE	$36	$30.60	$2.45 – $36
Urine test (manual, without microscope): 10 of 34 insurance plan rates Aetna — Commercial: $32.51 Aetna — Medicare Advantage: $17.26 ASR Physicians Care Network — Commercial: $28.80 Blue Care Network — Medicare Advantage: $16.92 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $33.25 Blue Cross Complete — Managed Medicaid: $2.45 Cigna — Commercial: $36 Cofinity — Commercial: $33.48 Employee Benefits Logistics — Commercial: $28.76 Enterprise Group Planning Employee Benefit Plan — Commercial: $28.80
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Urinalysis Dipstick auto - UC	$47	$39.95	$1.59 – $47
Urine test (automated, without microscope): 10 of 34 insurance plan rates Aetna — Commercial: $42.44 Aetna — Medicare Advantage: $22.53 ASR Physicians Care Network — Commercial: $37.60 Blue Care Network — Medicare Advantage: $22.09 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $43.41 Blue Cross Complete — Managed Medicaid: $1.59 Cigna — Commercial: $47 Cofinity — Commercial: $43.71 Employee Benefits Logistics — Commercial: $37.55 Enterprise Group Planning Employee Benefit Plan — Commercial: $37.60
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Dipstick auto POC	$47	$39.95	$1.59 – $47
Urine test (automated, without microscope): 10 of 34 insurance plan rates Aetna — Commercial: $42.44 Aetna — Medicare Advantage: $22.53 ASR Physicians Care Network — Commercial: $37.60 Blue Care Network — Medicare Advantage: $22.09 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $43.41 Blue Cross Complete — Managed Medicaid: $1.59 Cigna — Commercial: $47 Cofinity — Commercial: $43.71 Employee Benefits Logistics — Commercial: $37.55 Enterprise Group Planning Employee Benefit Plan — Commercial: $37.60
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Dipstick auto POC - UC	$47	$39.95	$1.59 – $47
Urine test (automated, without microscope): 10 of 34 insurance plan rates Aetna — Commercial: $42.44 Aetna — Medicare Advantage: $22.53 ASR Physicians Care Network — Commercial: $37.60 Blue Care Network — Medicare Advantage: $22.09 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $43.41 Blue Cross Complete — Managed Medicaid: $1.59 Cigna — Commercial: $47 Cofinity — Commercial: $43.71 Employee Benefits Logistics — Commercial: $37.55 Enterprise Group Planning Employee Benefit Plan — Commercial: $37.60
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 84153 4140	$141	$119.85	$12.96 – $141
PSA (prostate specific antigen) blood test: 10 of 34 insurance plan rates Aetna — Commercial: $127.32 Aetna — Medicare Advantage: $67.60 ASR Physicians Care Network — Commercial: $112.80 Blue Care Network — Medicare Advantage: $66.27 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $130.24 Blue Cross Complete — Managed Medicaid: $12.96 Cigna — Commercial: $141 Cofinity — Commercial: $131.13 Employee Benefits Logistics — Commercial: $112.66 Enterprise Group Planning Employee Benefit Plan — Commercial: $112.80
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 84153 4727	$141	$119.85	$12.96 – $141
PSA (prostate specific antigen) blood test: 10 of 34 insurance plan rates Aetna — Commercial: $127.32 Aetna — Medicare Advantage: $67.60 ASR Physicians Care Network — Commercial: $112.80 Blue Care Network — Medicare Advantage: $66.27 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $130.24 Blue Cross Complete — Managed Medicaid: $12.96 Cigna — Commercial: $141 Cofinity — Commercial: $131.13 Employee Benefits Logistics — Commercial: $112.66 Enterprise Group Planning Employee Benefit Plan — Commercial: $112.80
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA Diagnostic	$141	$119.85	$12.96 – $141
PSA (prostate specific antigen) blood test: 10 of 34 insurance plan rates Aetna — Commercial: $127.32 Aetna — Medicare Advantage: $67.60 ASR Physicians Care Network — Commercial: $112.80 Blue Care Network — Medicare Advantage: $66.27 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $130.24 Blue Cross Complete — Managed Medicaid: $12.96 Cigna — Commercial: $141 Cofinity — Commercial: $131.13 Employee Benefits Logistics — Commercial: $112.66 Enterprise Group Planning Employee Benefit Plan — Commercial: $112.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH with Reflex to FT4	$132	$112.20	$11.84 – $132
Thyroid stimulating hormone (TSH) test: 10 of 34 insurance plan rates Aetna — Commercial: $119.20 Aetna — Medicare Advantage: $63.28 ASR Physicians Care Network — Commercial: $105.60 Blue Care Network — Medicare Advantage: $62.04 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $121.93 Blue Cross Complete — Managed Medicaid: $11.84 Cigna — Commercial: $132 Cofinity — Commercial: $122.76 Employee Benefits Logistics — Commercial: $105.47 Enterprise Group Planning Employee Benefit Plan — Commercial: $105.60
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thyroid Function Cascade	$132	$112.20	$11.84 – $132
Thyroid stimulating hormone (TSH) test: 10 of 34 insurance plan rates Aetna — Commercial: $119.20 Aetna — Medicare Advantage: $63.28 ASR Physicians Care Network — Commercial: $105.60 Blue Care Network — Medicare Advantage: $62.04 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $121.93 Blue Cross Complete — Managed Medicaid: $11.84 Cigna — Commercial: $132 Cofinity — Commercial: $122.76 Employee Benefits Logistics — Commercial: $105.47 Enterprise Group Planning Employee Benefit Plan — Commercial: $105.60
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thyroid Stimulating Hormone	$132	$112.20	$11.84 – $132
Thyroid stimulating hormone (TSH) test: 10 of 34 insurance plan rates Aetna — Commercial: $119.20 Aetna — Medicare Advantage: $63.28 ASR Physicians Care Network — Commercial: $105.60 Blue Care Network — Medicare Advantage: $62.04 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $121.93 Blue Cross Complete — Managed Medicaid: $11.84 Cigna — Commercial: $132 Cofinity — Commercial: $122.76 Employee Benefits Logistics — Commercial: $105.47 Enterprise Group Planning Employee Benefit Plan — Commercial: $105.60
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC w/ Differential	$66	$56.10	$5.48 – $66
Complete blood count (CBC) with differential: 10 of 34 insurance plan rates Aetna — Commercial: $59.60 Aetna — Medicare Advantage: $31.64 ASR Physicians Care Network — Commercial: $52.80 Blue Care Network — Medicare Advantage: $31.02 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $60.96 Blue Cross Complete — Managed Medicaid: $5.48 Cigna — Commercial: $66 Cofinity — Commercial: $61.38 Employee Benefits Logistics — Commercial: $52.73 Enterprise Group Planning Employee Benefit Plan — Commercial: $52.80
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC w/ Differential	$66	$56.10	$52.80 – $66
Complete blood count (CBC) with differential: 10 of 16 insurance plan rates Aetna — Commercial: $59.60 ASR Physicians Care Network — Commercial: $52.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $60.96 Cigna — Commercial: $66 Cofinity — Commercial: $61.38 Enterprise Group Planning Employee Benefit Plan — Commercial: $52.80 HAP (Health Alliance Plan) — Commercial: $52.80 IBA Health and Life Assurance Company — Commercial: $60.72 McLaren Health Plan — Commercial: $61.45 Medical Cost Savings Solution — Commercial: $52.80
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPLETE CBC W/AUTO DIFF WBC	Not listed in the file	Not listed in the file	$6.67 – $11.66
Complete blood count (CBC) with differential: rates for 7 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $8.94 Cigna — Commercial: $8.07 HAP (Health Alliance Plan) — Commercial: $11.66 Priority Health — Commercial: $8.07 Provider Network of America/HMA Group Health — Commercial: $10.88 United Healthcare — Medicare Advantage: $7.77 United Healthcare Definity — Commercial: $6.67
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC without Differential	$53	$45.05	$4.56 – $53
Complete blood count (CBC), automated: 10 of 34 insurance plan rates Aetna — Commercial: $47.86 Aetna — Medicare Advantage: $25.41 ASR Physicians Care Network — Commercial: $42.40 Blue Care Network — Medicare Advantage: $24.91 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $48.96 Blue Cross Complete — Managed Medicaid: $4.56 Cigna — Commercial: $53 Cofinity — Commercial: $49.29 Employee Benefits Logistics — Commercial: $42.35 Enterprise Group Planning Employee Benefit Plan — Commercial: $42.40
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC without Differential	$53	$45.05	$42.40 – $53
Complete blood count (CBC), automated: 10 of 16 insurance plan rates Aetna — Commercial: $47.86 ASR Physicians Care Network — Commercial: $42.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $48.96 Cigna — Commercial: $53 Cofinity — Commercial: $49.29 Enterprise Group Planning Employee Benefit Plan — Commercial: $42.40 HAP (Health Alliance Plan) — Commercial: $42.40 IBA Health and Life Assurance Company — Commercial: $48.76 McLaren Health Plan — Commercial: $49.34 Medical Cost Savings Solution — Commercial: $42.40
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPLETE CBC AUTOMATED	Not listed in the file	Not listed in the file	$4 – $9.71
Complete blood count (CBC), automated: rates for 7 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $7.44 Cigna — Commercial: $6.73 HAP (Health Alliance Plan) — Commercial: $9.71 Priority Health — Commercial: $6.73 Provider Network of America/HMA Group Health — Commercial: $9.06 United Healthcare — Medicare Advantage: $6.47 United Healthcare Definity — Commercial: $4
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 85610 4832	$9.72	$8.27	$3.02 – $9.72
Blood clotting time test (prothrombin time, PT): 10 of 34 insurance plan rates Aetna — Commercial: $8.78 Aetna — Medicare Advantage: $4.66 ASR Physicians Care Network — Commercial: $7.78 Blue Care Network — Medicare Advantage: $4.57 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $8.98 Blue Cross Complete — Managed Medicaid: $3.02 Cigna — Commercial: $9.72 Cofinity — Commercial: $9.04 Employee Benefits Logistics — Commercial: $7.77 Enterprise Group Planning Employee Benefit Plan — Commercial: $7.78
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INR POC	$52	$44.20	$3.02 – $52
Blood clotting time test (prothrombin time, PT): 10 of 34 insurance plan rates Aetna — Commercial: $46.96 Aetna — Medicare Advantage: $24.93 ASR Physicians Care Network — Commercial: $41.60 Blue Care Network — Medicare Advantage: $24.44 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $48.03 Blue Cross Complete — Managed Medicaid: $3.02 Cigna — Commercial: $52 Cofinity — Commercial: $48.36 Employee Benefits Logistics — Commercial: $41.55 Enterprise Group Planning Employee Benefit Plan — Commercial: $41.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME BCE	$52	$44.20	$3.02 – $52
Blood clotting time test (prothrombin time, PT): 10 of 34 insurance plan rates Aetna — Commercial: $46.96 Aetna — Medicare Advantage: $24.93 ASR Physicians Care Network — Commercial: $41.60 Blue Care Network — Medicare Advantage: $24.44 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $48.03 Blue Cross Complete — Managed Medicaid: $3.02 Cigna — Commercial: $52 Cofinity — Commercial: $48.36 Employee Benefits Logistics — Commercial: $41.55 Enterprise Group Planning Employee Benefit Plan — Commercial: $41.60
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 85730 6787	$46.16	$39.24	$4.24 – $46.16
Blood clotting test (partial thromboplastin time, PTT): 10 of 34 insurance plan rates Aetna — Commercial: $41.68 Aetna — Medicare Advantage: $22.13 ASR Physicians Care Network — Commercial: $36.93 Blue Care Network — Medicare Advantage: $21.70 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $42.64 Blue Cross Complete — Managed Medicaid: $4.24 Cigna — Commercial: $46.16 Cofinity — Commercial: $42.93 Employee Benefits Logistics — Commercial: $36.88 Enterprise Group Planning Employee Benefit Plan — Commercial: $36.93
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Partial Thromboplastin Time	$63	$53.55	$4.24 – $63
Blood clotting test (partial thromboplastin time, PTT): 10 of 34 insurance plan rates Aetna — Commercial: $56.89 Aetna — Medicare Advantage: $30.20 ASR Physicians Care Network — Commercial: $50.40 Blue Care Network — Medicare Advantage: $29.61 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $58.19 Blue Cross Complete — Managed Medicaid: $4.24 Cigna — Commercial: $63 Cofinity — Commercial: $58.59 Employee Benefits Logistics — Commercial: $50.34 Enterprise Group Planning Employee Benefit Plan — Commercial: $50.40
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Partial Thromboplastin Time Heparin Protocol	$63	$53.55	$4.24 – $63
Blood clotting test (partial thromboplastin time, PTT): 10 of 34 insurance plan rates Aetna — Commercial: $56.89 Aetna — Medicare Advantage: $30.20 ASR Physicians Care Network — Commercial: $50.40 Blue Care Network — Medicare Advantage: $29.61 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $58.19 Blue Cross Complete — Managed Medicaid: $4.24 Cigna — Commercial: $63 Cofinity — Commercial: $58.59 Employee Benefits Logistics — Commercial: $50.34 Enterprise Group Planning Employee Benefit Plan — Commercial: $50.40

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 Exams	$1,024	$870.40	$73.78 – $1,024
CT scan of the head or brain, without contrast: 10 of 34 insurance plan rates Aetna — Commercial: $924.67 Aetna — Medicare Advantage: $490.91 ASR Physicians Care Network — Commercial: $819.20 Blue Care Network — Medicare Advantage: $481.28 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $945.87 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $1,024 Cofinity — Commercial: $952.32 Employee Benefits Logistics — Commercial: $818.18 Enterprise Group Planning Employee Benefit Plan — Commercial: $819.20
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT HEAD W/O CONTRAST	$1,024	$870.40	$73.78 – $1,024
CT scan of the head or brain, without contrast: 10 of 34 insurance plan rates Aetna — Commercial: $924.67 Aetna — Medicare Advantage: $490.91 ASR Physicians Care Network — Commercial: $819.20 Blue Care Network — Medicare Advantage: $481.28 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $945.87 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $1,024 Cofinity — Commercial: $952.32 Employee Benefits Logistics — Commercial: $818.18 Enterprise Group Planning Employee Benefit Plan — Commercial: $819.20
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Exams	$1,024	$870.40	$819.20 – $1,024
CT scan of the head or brain, without contrast: 10 of 16 insurance plan rates Aetna — Commercial: $924.67 ASR Physicians Care Network — Commercial: $819.20 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $945.87 Cigna — Commercial: $1,024 Cofinity — Commercial: $952.32 Enterprise Group Planning Employee Benefit Plan — Commercial: $819.20 HAP (Health Alliance Plan) — Commercial: $819.20 IBA Health and Life Assurance Company — Commercial: $942.08 McLaren Health Plan — Commercial: $953.34 Medical Cost Savings Solution — Commercial: $819.20
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Exams	$5,808	$4,936.80	$246.20 – $5,808
MRI of the brain, before and after contrast: 10 of 34 insurance plan rates Aetna — Commercial: $5,244.62 Aetna — Medicare Advantage: $2,784.36 ASR Physicians Care Network — Commercial: $4,646.40 Blue Care Network — Medicare Advantage: $2,729.76 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $5,364.85 Blue Cross Complete — Managed Medicaid: $246.20 Cigna — Commercial: $5,808 Cofinity — Commercial: $5,401.44 Employee Benefits Logistics — Commercial: $4,640.59 Enterprise Group Planning Employee Benefit Plan — Commercial: $4,646.40
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI BRAIN W/ + W/O CONTRAST	$5,808	$4,936.80	$246.20 – $5,808
MRI of the brain, before and after contrast: 10 of 34 insurance plan rates Aetna — Commercial: $5,244.62 Aetna — Medicare Advantage: $2,784.36 ASR Physicians Care Network — Commercial: $4,646.40 Blue Care Network — Medicare Advantage: $2,729.76 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $5,364.85 Blue Cross Complete — Managed Medicaid: $246.20 Cigna — Commercial: $5,808 Cofinity — Commercial: $5,401.44 Employee Benefits Logistics — Commercial: $4,640.59 Enterprise Group Planning Employee Benefit Plan — Commercial: $4,646.40
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MR Exams	$5,808	$4,936.80	$4,646.40 – $5,808
MRI of the brain, before and after contrast: 10 of 16 insurance plan rates Aetna — Commercial: $5,244.62 ASR Physicians Care Network — Commercial: $4,646.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $5,364.85 Cigna — Commercial: $5,808 Cofinity — Commercial: $5,401.44 Enterprise Group Planning Employee Benefit Plan — Commercial: $4,646.40 HAP (Health Alliance Plan) — Commercial: $4,646.40 IBA Health and Life Assurance Company — Commercial: $5,343.36 McLaren Health Plan — Commercial: $5,407.25 Medical Cost Savings Solution — Commercial: $4,646.40
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CHEST 2 V	$163	$138.55	$61.41 – $163
Chest X-ray, 2 views: 10 of 34 insurance plan rates Aetna — Commercial: $147.19 Aetna — Medicare Advantage: $78.14 ASR Physicians Care Network — Commercial: $130.40 Blue Care Network — Medicare Advantage: $76.61 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $150.56 Blue Cross Complete — Managed Medicaid: $61.41 Cigna — Commercial: $163 Cofinity — Commercial: $151.59 Employee Benefits Logistics — Commercial: $130.24 Enterprise Group Planning Employee Benefit Plan — Commercial: $130.40
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GD Exams	$163	$138.55	$61.41 – $163
Chest X-ray, 2 views: 10 of 34 insurance plan rates Aetna — Commercial: $147.19 Aetna — Medicare Advantage: $78.14 ASR Physicians Care Network — Commercial: $130.40 Blue Care Network — Medicare Advantage: $76.61 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $150.56 Blue Cross Complete — Managed Medicaid: $61.41 Cigna — Commercial: $163 Cofinity — Commercial: $151.59 Employee Benefits Logistics — Commercial: $130.24 Enterprise Group Planning Employee Benefit Plan — Commercial: $130.40
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SNIFF TEST	$163	$138.55	$61.41 – $163
Chest X-ray, 2 views: 10 of 34 insurance plan rates Aetna — Commercial: $147.19 Aetna — Medicare Advantage: $78.14 ASR Physicians Care Network — Commercial: $130.40 Blue Care Network — Medicare Advantage: $76.61 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $150.56 Blue Cross Complete — Managed Medicaid: $61.41 Cigna — Commercial: $163 Cofinity — Commercial: $151.59 Employee Benefits Logistics — Commercial: $130.24 Enterprise Group Planning Employee Benefit Plan — Commercial: $130.40
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GD Exams	$244	$207.40	$73.78 – $244
X-ray of the lower spine, at least 4 views: 10 of 34 insurance plan rates Aetna — Commercial: $220.33 Aetna — Medicare Advantage: $116.97 ASR Physicians Care Network — Commercial: $195.20 Blue Care Network — Medicare Advantage: $114.68 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $225.38 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $244 Cofinity — Commercial: $226.92 Employee Benefits Logistics — Commercial: $194.96 Enterprise Group Planning Employee Benefit Plan — Commercial: $195.20
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SPINE LUMBAR AP + LAT W/ FLEX + EXT	$244	$207.40	$73.78 – $244
X-ray of the lower spine, at least 4 views: 10 of 34 insurance plan rates Aetna — Commercial: $220.33 Aetna — Medicare Advantage: $116.97 ASR Physicians Care Network — Commercial: $195.20 Blue Care Network — Medicare Advantage: $114.68 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $225.38 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $244 Cofinity — Commercial: $226.92 Employee Benefits Logistics — Commercial: $194.96 Enterprise Group Planning Employee Benefit Plan — Commercial: $195.20
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SPINE LUMBAR MIN 4 V	$244	$207.40	$73.78 – $244
X-ray of the lower spine, at least 4 views: 10 of 34 insurance plan rates Aetna — Commercial: $220.33 Aetna — Medicare Advantage: $116.97 ASR Physicians Care Network — Commercial: $195.20 Blue Care Network — Medicare Advantage: $114.68 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $225.38 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $244 Cofinity — Commercial: $226.92 Employee Benefits Logistics — Commercial: $194.96 Enterprise Group Planning Employee Benefit Plan — Commercial: $195.20
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Exams	$2,401	$2,040.85	$168.38 – $2,401
MRI of the lower back (lumbar spine), without contrast: 10 of 34 insurance plan rates Aetna — Commercial: $2,168.10 Aetna — Medicare Advantage: $1,151.04 ASR Physicians Care Network — Commercial: $1,920.80 Blue Care Network — Medicare Advantage: $1,128.47 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,217.80 Blue Cross Complete — Managed Medicaid: $168.38 Cigna — Commercial: $2,401 Cofinity — Commercial: $2,232.93 Employee Benefits Logistics — Commercial: $1,918.40 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,920.80
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI INCOMPLETE LUMBAR SPINE	$2,401	$2,040.85	$168.38 – $2,401
MRI of the lower back (lumbar spine), without contrast: 10 of 34 insurance plan rates Aetna — Commercial: $2,168.10 Aetna — Medicare Advantage: $1,151.04 ASR Physicians Care Network — Commercial: $1,920.80 Blue Care Network — Medicare Advantage: $1,128.47 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,217.80 Blue Cross Complete — Managed Medicaid: $168.38 Cigna — Commercial: $2,401 Cofinity — Commercial: $2,232.93 Employee Benefits Logistics — Commercial: $1,918.40 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,920.80
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LUMBAR SPINE W/O CONTRAST	$2,401	$2,040.85	$168.38 – $2,401
MRI of the lower back (lumbar spine), without contrast: 10 of 34 insurance plan rates Aetna — Commercial: $2,168.10 Aetna — Medicare Advantage: $1,151.04 ASR Physicians Care Network — Commercial: $1,920.80 Blue Care Network — Medicare Advantage: $1,128.47 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,217.80 Blue Cross Complete — Managed Medicaid: $168.38 Cigna — Commercial: $2,401 Cofinity — Commercial: $2,232.93 Employee Benefits Logistics — Commercial: $1,918.40 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,920.80
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Exams	$1,298	$1,103.30	$123.78 – $1,298
CT scan of the pelvis, with contrast: 10 of 34 insurance plan rates Aetna — Commercial: $1,172.09 Aetna — Medicare Advantage: $622.26 ASR Physicians Care Network — Commercial: $1,038.40 Blue Care Network — Medicare Advantage: $610.06 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,198.96 Blue Cross Complete — Managed Medicaid: $123.78 Cigna — Commercial: $1,298 Cofinity — Commercial: $1,207.14 Employee Benefits Logistics — Commercial: $1,037.10 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,038.40
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT PELVIS W/ CONTRAST (ORAL + IV)	$1,298	$1,103.30	$123.78 – $1,298
CT scan of the pelvis, with contrast: 10 of 34 insurance plan rates Aetna — Commercial: $1,172.09 Aetna — Medicare Advantage: $622.26 ASR Physicians Care Network — Commercial: $1,038.40 Blue Care Network — Medicare Advantage: $610.06 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,198.96 Blue Cross Complete — Managed Medicaid: $123.78 Cigna — Commercial: $1,298 Cofinity — Commercial: $1,207.14 Employee Benefits Logistics — Commercial: $1,037.10 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,038.40
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT PELVIS W/ IV CONTRAST (NO ORAL CONT)	$1,298	$1,103.30	$123.78 – $1,298
CT scan of the pelvis, with contrast: 10 of 34 insurance plan rates Aetna — Commercial: $1,172.09 Aetna — Medicare Advantage: $622.26 ASR Physicians Care Network — Commercial: $1,038.40 Blue Care Network — Medicare Advantage: $610.06 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,198.96 Blue Cross Complete — Managed Medicaid: $123.78 Cigna — Commercial: $1,298 Cofinity — Commercial: $1,207.14 Employee Benefits Logistics — Commercial: $1,037.10 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,038.40
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Exams	$2,434	$2,068.90	$168.38 – $2,434
MRI of a leg joint (such as the knee), without contrast: 10 of 34 insurance plan rates Aetna — Commercial: $2,197.90 Aetna — Medicare Advantage: $1,166.86 ASR Physicians Care Network — Commercial: $1,947.20 Blue Care Network — Medicare Advantage: $1,143.98 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,248.29 Blue Cross Complete — Managed Medicaid: $168.38 Cigna — Commercial: $2,434 Cofinity — Commercial: $2,263.62 Employee Benefits Logistics — Commercial: $1,944.77 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,947.20
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI ANKLE W/O CONTRAST LT	$2,434	$2,068.90	$168.38 – $2,434
MRI of a leg joint (such as the knee), without contrast: 10 of 34 insurance plan rates Aetna — Commercial: $2,197.90 Aetna — Medicare Advantage: $1,166.86 ASR Physicians Care Network — Commercial: $1,947.20 Blue Care Network — Medicare Advantage: $1,143.98 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,248.29 Blue Cross Complete — Managed Medicaid: $168.38 Cigna — Commercial: $2,434 Cofinity — Commercial: $2,263.62 Employee Benefits Logistics — Commercial: $1,944.77 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,947.20
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI ANKLE W/O CONTRAST RT	$2,434	$2,068.90	$168.38 – $2,434
MRI of a leg joint (such as the knee), without contrast: 10 of 34 insurance plan rates Aetna — Commercial: $2,197.90 Aetna — Medicare Advantage: $1,166.86 ASR Physicians Care Network — Commercial: $1,947.20 Blue Care Network — Medicare Advantage: $1,143.98 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,248.29 Blue Cross Complete — Managed Medicaid: $168.38 Cigna — Commercial: $2,434 Cofinity — Commercial: $2,263.62 Employee Benefits Logistics — Commercial: $1,944.77 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,947.20
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 93077 CT ABD PELV W/ IV CONT	$2,594	$2,204.90	$246.20 – $2,594
CT scan of the abdomen and pelvis, with contrast: 10 of 34 insurance plan rates Aetna — Commercial: $2,342.38 Aetna — Medicare Advantage: $1,243.56 ASR Physicians Care Network — Commercial: $2,075.20 Blue Care Network — Medicare Advantage: $1,219.18 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,396.08 Blue Cross Complete — Managed Medicaid: $246.20 Cigna — Commercial: $2,594 Cofinity — Commercial: $2,412.42 Employee Benefits Logistics — Commercial: $2,072.61 Enterprise Group Planning Employee Benefit Plan — Commercial: $2,075.20
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 93079 CT ABD PELV W/ IV+ORAL CONT	$2,594	$2,204.90	$246.20 – $2,594
CT scan of the abdomen and pelvis, with contrast: 10 of 34 insurance plan rates Aetna — Commercial: $2,342.38 Aetna — Medicare Advantage: $1,243.56 ASR Physicians Care Network — Commercial: $2,075.20 Blue Care Network — Medicare Advantage: $1,219.18 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,396.08 Blue Cross Complete — Managed Medicaid: $246.20 Cigna — Commercial: $2,594 Cofinity — Commercial: $2,412.42 Employee Benefits Logistics — Commercial: $2,072.61 Enterprise Group Planning Employee Benefit Plan — Commercial: $2,075.20
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/IV CONT (NO ORAL)	$2,594	$2,204.90	$246.20 – $2,594
CT scan of the abdomen and pelvis, with contrast: 10 of 34 insurance plan rates Aetna — Commercial: $2,342.38 Aetna — Medicare Advantage: $1,243.56 ASR Physicians Care Network — Commercial: $2,075.20 Blue Care Network — Medicare Advantage: $1,219.18 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,396.08 Blue Cross Complete — Managed Medicaid: $246.20 Cigna — Commercial: $2,594 Cofinity — Commercial: $2,412.42 Employee Benefits Logistics — Commercial: $2,072.61 Enterprise Group Planning Employee Benefit Plan — Commercial: $2,075.20
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US ABDOMEN COMPLETE	$664	$564.40	$73.78 – $664
Ultrasound of the abdomen, complete: 10 of 34 insurance plan rates Aetna — Commercial: $599.59 Aetna — Medicare Advantage: $318.32 ASR Physicians Care Network — Commercial: $531.20 Blue Care Network — Medicare Advantage: $312.08 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $613.34 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $664 Cofinity — Commercial: $617.52 Employee Benefits Logistics — Commercial: $530.54 Enterprise Group Planning Employee Benefit Plan — Commercial: $531.20
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Exams	$664	$564.40	$73.78 – $664
Ultrasound of the abdomen, complete: 10 of 34 insurance plan rates Aetna — Commercial: $599.59 Aetna — Medicare Advantage: $318.32 ASR Physicians Care Network — Commercial: $531.20 Blue Care Network — Medicare Advantage: $312.08 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $613.34 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $664 Cofinity — Commercial: $617.52 Employee Benefits Logistics — Commercial: $530.54 Enterprise Group Planning Employee Benefit Plan — Commercial: $531.20
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US ABDOMEN COMPLETE	$664	$564.40	$531.20 – $664
Ultrasound of the abdomen, complete: 10 of 16 insurance plan rates Aetna — Commercial: $599.59 ASR Physicians Care Network — Commercial: $531.20 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $613.34 Cigna — Commercial: $664 Cofinity — Commercial: $617.52 Enterprise Group Planning Employee Benefit Plan — Commercial: $531.20 HAP (Health Alliance Plan) — Commercial: $531.20 IBA Health and Life Assurance Company — Commercial: $610.88 McLaren Health Plan — Commercial: $618.18 Medical Cost Savings Solution — Commercial: $531.20
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Exams	$664	$564.40	$73.78 – $664
Pregnancy ultrasound (after the first trimester): 10 of 34 insurance plan rates Aetna — Commercial: $599.59 Aetna — Medicare Advantage: $318.32 ASR Physicians Care Network — Commercial: $531.20 Blue Care Network — Medicare Advantage: $312.08 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $613.34 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $664 Cofinity — Commercial: $617.52 Employee Benefits Logistics — Commercial: $530.54 Enterprise Group Planning Employee Benefit Plan — Commercial: $531.20
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US OB COMPLETE	$664	$564.40	$73.78 – $664
Pregnancy ultrasound (after the first trimester): 10 of 34 insurance plan rates Aetna — Commercial: $599.59 Aetna — Medicare Advantage: $318.32 ASR Physicians Care Network — Commercial: $531.20 Blue Care Network — Medicare Advantage: $312.08 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $613.34 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $664 Cofinity — Commercial: $617.52 Employee Benefits Logistics — Commercial: $530.54 Enterprise Group Planning Employee Benefit Plan — Commercial: $531.20
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US OB COMPLETE-	$664	$564.40	$73.78 – $664
Pregnancy ultrasound (after the first trimester): 10 of 34 insurance plan rates Aetna — Commercial: $599.59 Aetna — Medicare Advantage: $318.32 ASR Physicians Care Network — Commercial: $531.20 Blue Care Network — Medicare Advantage: $312.08 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $613.34 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $664 Cofinity — Commercial: $617.52 Employee Benefits Logistics — Commercial: $530.54 Enterprise Group Planning Employee Benefit Plan — Commercial: $531.20
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 4611 US TRANSVAGINAL NON OB	$332	$282.20	$73.78 – $332
Transvaginal ultrasound: 10 of 34 insurance plan rates Aetna — Commercial: $299.80 Aetna — Medicare Advantage: $159.16 ASR Physicians Care Network — Commercial: $265.60 Blue Care Network — Medicare Advantage: $156.04 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $306.67 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $332 Cofinity — Commercial: $308.76 Employee Benefits Logistics — Commercial: $265.27 Enterprise Group Planning Employee Benefit Plan — Commercial: $265.60
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Pelvis Non-OB 76830	$332	$282.20	$73.78 – $332
Transvaginal ultrasound: 10 of 34 insurance plan rates Aetna — Commercial: $299.80 Aetna — Medicare Advantage: $159.16 ASR Physicians Care Network — Commercial: $265.60 Blue Care Network — Medicare Advantage: $156.04 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $306.67 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $332 Cofinity — Commercial: $308.76 Employee Benefits Logistics — Commercial: $265.27 Enterprise Group Planning Employee Benefit Plan — Commercial: $265.60
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Pelvis Complete 76856 READ	$332	$282.20	$73.78 – $332
Transvaginal ultrasound: 10 of 34 insurance plan rates Aetna — Commercial: $299.80 Aetna — Medicare Advantage: $159.16 ASR Physicians Care Network — Commercial: $265.60 Blue Care Network — Medicare Advantage: $156.04 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $306.67 Blue Cross Complete — Managed Medicaid: $73.78 Cigna — Commercial: $332 Cofinity — Commercial: $308.76 Employee Benefits Logistics — Commercial: $265.27 Enterprise Group Planning Employee Benefit Plan — Commercial: $265.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Exams	$295	$250.75	$81.68 – $295
Diagnostic mammogram, one breast: 10 of 34 insurance plan rates Aetna — Commercial: $266.39 Aetna — Medicare Advantage: $141.42 ASR Physicians Care Network — Commercial: $236 Blue Care Network — Medicare Advantage: $138.65 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $272.49 Blue Cross Complete — Managed Medicaid: $81.68 Cigna — Commercial: $295 Cofinity — Commercial: $274.35 Employee Benefits Logistics — Commercial: $235.71 Enterprise Group Planning Employee Benefit Plan — Commercial: $236
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD DX FOLLOW PROCEDURE LT	$295	$250.75	$81.68 – $295
Diagnostic mammogram, one breast: 10 of 34 insurance plan rates Aetna — Commercial: $266.39 Aetna — Medicare Advantage: $141.42 ASR Physicians Care Network — Commercial: $236 Blue Care Network — Medicare Advantage: $138.65 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $272.49 Blue Cross Complete — Managed Medicaid: $81.68 Cigna — Commercial: $295 Cofinity — Commercial: $274.35 Employee Benefits Logistics — Commercial: $235.71 Enterprise Group Planning Employee Benefit Plan — Commercial: $236
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD DX FOLLOW PROCEDURE RT	$295	$250.75	$81.68 – $295
Diagnostic mammogram, one breast: 10 of 34 insurance plan rates Aetna — Commercial: $266.39 Aetna — Medicare Advantage: $141.42 ASR Physicians Care Network — Commercial: $236 Blue Care Network — Medicare Advantage: $138.65 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $272.49 Blue Cross Complete — Managed Medicaid: $81.68 Cigna — Commercial: $295 Cofinity — Commercial: $274.35 Employee Benefits Logistics — Commercial: $235.71 Enterprise Group Planning Employee Benefit Plan — Commercial: $236
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Exams	$352	$299.20	$103.46 – $352
Diagnostic mammogram, both breasts: 10 of 34 insurance plan rates Aetna — Commercial: $317.86 Aetna — Medicare Advantage: $168.75 ASR Physicians Care Network — Commercial: $281.60 Blue Care Network — Medicare Advantage: $165.44 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $325.14 Blue Cross Complete — Managed Medicaid: $103.46 Cigna — Commercial: $352 Cofinity — Commercial: $327.36 Employee Benefits Logistics — Commercial: $281.25 Enterprise Group Planning Employee Benefit Plan — Commercial: $281.60
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD MAMM DIAGNOSTIC BILAT	$352	$299.20	$103.46 – $352
Diagnostic mammogram, both breasts: 10 of 34 insurance plan rates Aetna — Commercial: $317.86 Aetna — Medicare Advantage: $168.75 ASR Physicians Care Network — Commercial: $281.60 Blue Care Network — Medicare Advantage: $165.44 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $325.14 Blue Cross Complete — Managed Medicaid: $103.46 Cigna — Commercial: $352 Cofinity — Commercial: $327.36 Employee Benefits Logistics — Commercial: $281.25 Enterprise Group Planning Employee Benefit Plan — Commercial: $281.60
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD MAMM DIAGNOSTIC W/ CONT BIL	$342	$290.70	$103.46 – $342
Diagnostic mammogram, both breasts: 10 of 34 insurance plan rates Aetna — Commercial: $308.83 Aetna — Medicare Advantage: $163.95 ASR Physicians Care Network — Commercial: $273.60 Blue Care Network — Medicare Advantage: $160.74 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $315.91 Blue Cross Complete — Managed Medicaid: $103.46 Cigna — Commercial: $342 Cofinity — Commercial: $318.06 Employee Benefits Logistics — Commercial: $273.26 Enterprise Group Planning Employee Benefit Plan — Commercial: $273.60
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Exams	$341	$289.85	$83.04 – $341
Screening mammogram, both breasts: 10 of 34 insurance plan rates Aetna — Commercial: $307.92 Aetna — Medicare Advantage: $163.48 ASR Physicians Care Network — Commercial: $272.80 Blue Care Network — Medicare Advantage: $160.27 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $314.98 Blue Cross Complete — Managed Medicaid: $83.04 Cigna — Commercial: $341 Cofinity — Commercial: $317.13 Employee Benefits Logistics — Commercial: $272.46 Enterprise Group Planning Employee Benefit Plan — Commercial: $272.80
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD MAMM SCREEN BILATERAL	$341	$289.85	$83.04 – $341
Screening mammogram, both breasts: 10 of 34 insurance plan rates Aetna — Commercial: $307.92 Aetna — Medicare Advantage: $163.48 ASR Physicians Care Network — Commercial: $272.80 Blue Care Network — Medicare Advantage: $160.27 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $314.98 Blue Cross Complete — Managed Medicaid: $83.04 Cigna — Commercial: $341 Cofinity — Commercial: $317.13 Employee Benefits Logistics — Commercial: $272.46 Enterprise Group Planning Employee Benefit Plan — Commercial: $272.80
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD MAMM SCREEN LT UNI	$341	$289.85	$83.04 – $341
Screening mammogram, both breasts: 10 of 34 insurance plan rates Aetna — Commercial: $307.92 Aetna — Medicare Advantage: $163.48 ASR Physicians Care Network — Commercial: $272.80 Blue Care Network — Medicare Advantage: $160.27 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $314.98 Blue Cross Complete — Managed Medicaid: $83.04 Cigna — Commercial: $341 Cofinity — Commercial: $317.13 Employee Benefits Logistics — Commercial: $272.46 Enterprise Group Planning Employee Benefit Plan — Commercial: $272.80

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: EKG - UC 93000	$101	$85.85	$10.34 – $101
Electrocardiogram (ECG/EKG) with reading: 10 of 34 insurance plan rates Aetna — Commercial: $91.20 Aetna — Medicare Advantage: $48.42 ASR Physicians Care Network — Commercial: $80.80 Blue Care Network — Medicare Advantage: $47.47 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $93.29 Blue Cross Complete — Managed Medicaid: $10.34 Cigna — Commercial: $101 Cofinity — Commercial: $93.93 Employee Benefits Logistics — Commercial: $80.70 Enterprise Group Planning Employee Benefit Plan — Commercial: $80.80
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000	$101	$85.85	$10.34 – $101
Electrocardiogram (ECG/EKG) with reading: 10 of 34 insurance plan rates Aetna — Commercial: $91.20 Aetna — Medicare Advantage: $48.42 ASR Physicians Care Network — Commercial: $80.80 Blue Care Network — Medicare Advantage: $47.47 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $93.29 Blue Cross Complete — Managed Medicaid: $10.34 Cigna — Commercial: $101 Cofinity — Commercial: $93.93 Employee Benefits Logistics — Commercial: $80.70 Enterprise Group Planning Employee Benefit Plan — Commercial: $80.80
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ELECTROCARDIOGRAM COMPLETE	$155	$131.75	$10.34 – $155
Electrocardiogram (ECG/EKG) with reading: 10 of 34 insurance plan rates Aetna — Commercial: $139.97 Aetna — Medicare Advantage: $74.31 ASR Physicians Care Network — Commercial: $124 Blue Care Network — Medicare Advantage: $72.85 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $143.17 Blue Cross Complete — Managed Medicaid: $10.34 Cigna — Commercial: $155 Cofinity — Commercial: $144.15 Employee Benefits Logistics — Commercial: $123.85 Enterprise Group Planning Employee Benefit Plan — Commercial: $124
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$776.47 – $4,867.77
Left heart catheterization (diagnostic): 10 of 19 insurance plan rates Aetna — Medicare Advantage: $819.74 ASR Physicians Care Network — Commercial: $1,229.61 Blue Care Network — Medicare Advantage: $819.74 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,366.65 Cigna — Commercial: $1,214.50 Employee Benefits Logistics — Commercial: $1,393.56 HAP (Health Alliance Plan) — Commercial: $4,867.77 HAP (Health Alliance Plan) — Medicare Advantage: $819.74 McLaren Health Plan — Medicare Advantage: $819.74 Medicare Plus Blue — Medicare Advantage: $819.74
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$2,287.85
Left heart catheterization (diagnostic): rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $2,287.85 McLaren Health Plan — Managed Medicaid: $2,287.85 Meridian — Managed Medicaid: $2,287.85 Priority Health — Managed Medicaid: $2,287.85 United Healthcare — Managed Medicaid: $2,287.85
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$146.76 – $390.85
Left heart catheterization (diagnostic): 10 of 22 insurance plan rates Aetna — Medicare Advantage: $229.91 ASR Physicians Care Network — Commercial: $344.87 Blue Care Network — Medicare Advantage: $229.91 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $366.96 Blue Cross Complete — Managed Medicaid: $149.70 Cigna — Commercial: $326.11 Employee Benefits Logistics — Commercial: $390.85 HAP (Health Alliance Plan) — Medicare Advantage: $229.91 McLaren Health Plan — Managed Medicaid: $146.76 McLaren Health Plan — Medicare Advantage: $229.91
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$595.46 – $11,711.21
Heart rhythm study (electrophysiology evaluation): 10 of 19 insurance plan rates Aetna — Medicare Advantage: $790.07 ASR Physicians Care Network — Commercial: $1,185.11 Blue Care Network — Medicare Advantage: $790.07 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $595.46 Cigna — Commercial: $928.15 Employee Benefits Logistics — Commercial: $1,343.12 HAP (Health Alliance Plan) — Commercial: $11,711.21 HAP (Health Alliance Plan) — Medicare Advantage: $790.07 McLaren Health Plan — Medicare Advantage: $790.07 Medicare Plus Blue — Medicare Advantage: $790.07
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$5,504.27
Heart rhythm study (electrophysiology evaluation): rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $5,504.27 McLaren Health Plan — Managed Medicaid: $5,504.27 Meridian — Managed Medicaid: $5,504.27 Priority Health — Managed Medicaid: $5,504.27 United Healthcare — Managed Medicaid: $5,504.27
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$238.13 – $633.52
Heart rhythm study (electrophysiology evaluation): 10 of 22 insurance plan rates Aetna — Medicare Advantage: $372.66 ASR Physicians Care Network — Commercial: $558.99 Blue Care Network — Medicare Advantage: $372.66 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $595.45 Blue Cross Complete — Managed Medicaid: $242.89 Cigna — Commercial: $529.15 Employee Benefits Logistics — Commercial: $633.52 HAP (Health Alliance Plan) — Medicare Advantage: $372.66 McLaren Health Plan — Managed Medicaid: $238.13 McLaren Health Plan — Medicare Advantage: $372.66
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$590.44 – $39,246.05
Heart rhythm study with ablation for atrial fibrillation: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $812.84 ASR Physicians Care Network — Commercial: $1,219.26 Blue Care Network — Medicare Advantage: $812.84 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,476.37 Blue Cross Complete — Managed Medicaid: $602.25 Cigna — Commercial: $1,312 Employee Benefits Logistics — Commercial: $1,381.83 HAP (Health Alliance Plan) — Commercial: $39,246.05 HAP (Health Alliance Plan) — Medicare Advantage: $812.84 McLaren Health Plan — Managed Medicaid: $590.44
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$18,445.64
Heart rhythm study with ablation for atrial fibrillation: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $18,445.64 McLaren Health Plan — Managed Medicaid: $18,445.64 Meridian — Managed Medicaid: $18,445.64 Priority Health — Managed Medicaid: $18,445.64 United Healthcare — Managed Medicaid: $18,445.64
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POLYSOM 6/> YRS 4/> PARAM 95810	$3,364	$2,859.40	$606.02 – $3,364
Sleep study (overnight, in a sleep lab): 10 of 34 insurance plan rates Aetna — Commercial: $3,037.69 Aetna — Medicare Advantage: $1,612.70 ASR Physicians Care Network — Commercial: $2,691.20 Blue Care Network — Medicare Advantage: $1,581.08 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,107.33 Blue Cross Complete — Managed Medicaid: $606.02 Cigna — Commercial: $3,364 Cofinity — Commercial: $3,128.52 Employee Benefits Logistics — Commercial: $2,687.84 Enterprise Group Planning Employee Benefit Plan — Commercial: $2,691.20
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom 6/> Yrs 4/> par RDC 95810	$3,364	$2,859.40	$606.02 – $3,364
Sleep study (overnight, in a sleep lab): 10 of 34 insurance plan rates Aetna — Commercial: $3,037.69 Aetna — Medicare Advantage: $1,612.70 ASR Physicians Care Network — Commercial: $2,691.20 Blue Care Network — Medicare Advantage: $1,581.08 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,107.33 Blue Cross Complete — Managed Medicaid: $606.02 Cigna — Commercial: $3,364 Cofinity — Commercial: $3,128.52 Employee Benefits Logistics — Commercial: $2,687.84 Enterprise Group Planning Employee Benefit Plan — Commercial: $2,691.20
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSG Study (C)	$3,364	$2,859.40	$606.02 – $3,364
Sleep study (overnight, in a sleep lab): 10 of 34 insurance plan rates Aetna — Commercial: $3,037.69 Aetna — Medicare Advantage: $1,612.70 ASR Physicians Care Network — Commercial: $2,691.20 Blue Care Network — Medicare Advantage: $1,581.08 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,107.33 Blue Cross Complete — Managed Medicaid: $606.02 Cigna — Commercial: $3,364 Cofinity — Commercial: $3,128.52 Employee Benefits Logistics — Commercial: $2,687.84 Enterprise Group Planning Employee Benefit Plan — Commercial: $2,691.20

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: 97110 THERAPEUTIC EXERCISES EA 15 OT IP	$81	$68.85	$19.68 – $81
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $73.14 Aetna — Medicare Advantage: $38.83 ASR Physicians Care Network — Commercial: $64.80 Blue Care Network — Medicare Advantage: $38.07 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $74.82 Blue Cross Complete — Managed Medicaid: $19.68 Cigna — Commercial: $81 Cofinity — Commercial: $75.33 Employee Benefits Logistics — Commercial: $64.72 Enterprise Group Planning Employee Benefit Plan — Commercial: $64.80
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COTA Therapeutic Exercise 15min	$81	$68.85	$19.68 – $81
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $73.14 Aetna — Medicare Advantage: $38.83 ASR Physicians Care Network — Commercial: $64.80 Blue Care Network — Medicare Advantage: $38.07 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $74.82 Blue Cross Complete — Managed Medicaid: $19.68 Cigna — Commercial: $81 Cofinity — Commercial: $75.33 Employee Benefits Logistics — Commercial: $64.72 Enterprise Group Planning Employee Benefit Plan — Commercial: $64.80
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OT Therapeutic Exercise 15min	$81	$68.85	$19.68 – $81
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 34 insurance plan rates Aetna — Commercial: $73.14 Aetna — Medicare Advantage: $38.83 ASR Physicians Care Network — Commercial: $64.80 Blue Care Network — Medicare Advantage: $38.07 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $74.82 Blue Cross Complete — Managed Medicaid: $19.68 Cigna — Commercial: $81 Cofinity — Commercial: $75.33 Employee Benefits Logistics — Commercial: $64.72 Enterprise Group Planning Employee Benefit Plan — Commercial: $64.80
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Low Complexity Evaluation - PT Untimed Charges	$194	$164.90	$66.20 – $194
Physical therapy evaluation (low complexity): 10 of 34 insurance plan rates Aetna — Commercial: $175.18 Aetna — Medicare Advantage: $93 ASR Physicians Care Network — Commercial: $155.20 Blue Care Network — Medicare Advantage: $91.18 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $179.20 Blue Cross Complete — Managed Medicaid: $66.20 Cigna — Commercial: $194 Cofinity — Commercial: $180.42 Employee Benefits Logistics — Commercial: $155.01 Enterprise Group Planning Employee Benefit Plan — Commercial: $155.20
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Eval 20 Min - PT MMC	$194	$164.90	$66.20 – $194
Physical therapy evaluation (low complexity): 10 of 34 insurance plan rates Aetna — Commercial: $175.18 Aetna — Medicare Advantage: $93 ASR Physicians Care Network — Commercial: $155.20 Blue Care Network — Medicare Advantage: $91.18 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $179.20 Blue Cross Complete — Managed Medicaid: $66.20 Cigna — Commercial: $194 Cofinity — Commercial: $180.42 Employee Benefits Logistics — Commercial: $155.01 Enterprise Group Planning Employee Benefit Plan — Commercial: $155.20
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT 97161 PT EVAL LOW COMPLEX 20M OP	$194	$164.90	$66.20 – $194
Physical therapy evaluation (low complexity): 10 of 34 insurance plan rates Aetna — Commercial: $175.18 Aetna — Medicare Advantage: $93 ASR Physicians Care Network — Commercial: $155.20 Blue Care Network — Medicare Advantage: $91.18 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $179.20 Blue Cross Complete — Managed Medicaid: $66.20 Cigna — Commercial: $194 Cofinity — Commercial: $180.42 Employee Benefits Logistics — Commercial: $155.01 Enterprise Group Planning Employee Benefit Plan — Commercial: $155.20
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 97162 PT EVAL 30 MIN PT IP	$293	$249.05	$66.20 – $293
Physical therapy evaluation (moderate complexity): 10 of 34 insurance plan rates Aetna — Commercial: $264.58 Aetna — Medicare Advantage: $140.46 ASR Physicians Care Network — Commercial: $234.40 Blue Care Network — Medicare Advantage: $137.71 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $270.64 Blue Cross Complete — Managed Medicaid: $66.20 Cigna — Commercial: $293 Cofinity — Commercial: $272.49 Employee Benefits Logistics — Commercial: $234.11 Enterprise Group Planning Employee Benefit Plan — Commercial: $234.40
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Moderate Complexity Evaluation - PT Untimed Charges	$293	$249.05	$66.20 – $293
Physical therapy evaluation (moderate complexity): 10 of 34 insurance plan rates Aetna — Commercial: $264.58 Aetna — Medicare Advantage: $140.46 ASR Physicians Care Network — Commercial: $234.40 Blue Care Network — Medicare Advantage: $137.71 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $270.64 Blue Cross Complete — Managed Medicaid: $66.20 Cigna — Commercial: $293 Cofinity — Commercial: $272.49 Employee Benefits Logistics — Commercial: $234.11 Enterprise Group Planning Employee Benefit Plan — Commercial: $234.40
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Eval 30 Min - PT MMC	$293	$249.05	$66.20 – $293
Physical therapy evaluation (moderate complexity): 10 of 34 insurance plan rates Aetna — Commercial: $264.58 Aetna — Medicare Advantage: $140.46 ASR Physicians Care Network — Commercial: $234.40 Blue Care Network — Medicare Advantage: $137.71 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $270.64 Blue Cross Complete — Managed Medicaid: $66.20 Cigna — Commercial: $293 Cofinity — Commercial: $272.49 Employee Benefits Logistics — Commercial: $234.11 Enterprise Group Planning Employee Benefit Plan — Commercial: $234.40
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 97163 PT EVAL 45 MIN PT IP	$432	$367.20	$66.20 – $432
Physical therapy evaluation (high complexity): 10 of 34 insurance plan rates Aetna — Commercial: $390.10 Aetna — Medicare Advantage: $207.10 ASR Physicians Care Network — Commercial: $345.60 Blue Care Network — Medicare Advantage: $203.04 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $399.04 Blue Cross Complete — Managed Medicaid: $66.20 Cigna — Commercial: $432 Cofinity — Commercial: $401.76 Employee Benefits Logistics — Commercial: $345.17 Enterprise Group Planning Employee Benefit Plan — Commercial: $345.60
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: High Complexity Evaluation - PT Untimed Charges	$431	$366.35	$66.20 – $431
Physical therapy evaluation (high complexity): 10 of 34 insurance plan rates Aetna — Commercial: $389.19 Aetna — Medicare Advantage: $206.62 ASR Physicians Care Network — Commercial: $344.80 Blue Care Network — Medicare Advantage: $202.57 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $398.11 Blue Cross Complete — Managed Medicaid: $66.20 Cigna — Commercial: $431 Cofinity — Commercial: $400.83 Employee Benefits Logistics — Commercial: $344.37 Enterprise Group Planning Employee Benefit Plan — Commercial: $344.80
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Eval 45 Min - PT MMC	$432	$367.20	$66.20 – $432
Physical therapy evaluation (high complexity): 10 of 34 insurance plan rates Aetna — Commercial: $390.10 Aetna — Medicare Advantage: $207.10 ASR Physicians Care Network — Commercial: $345.60 Blue Care Network — Medicare Advantage: $203.04 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $399.04 Blue Cross Complete — Managed Medicaid: $66.20 Cigna — Commercial: $432 Cofinity — Commercial: $401.76 Employee Benefits Logistics — Commercial: $345.17 Enterprise Group Planning Employee Benefit Plan — Commercial: $345.60
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psychotherapy 30 Mins 90832	$226	$192.10	$106.22 – $226
Psychotherapy, 30 minutes: 10 of 34 insurance plan rates Aetna — Commercial: $204.08 Aetna — Medicare Advantage: $108.34 ASR Physicians Care Network — Commercial: $180.80 Blue Care Network — Medicare Advantage: $106.22 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $208.76 Blue Cross Complete — Managed Medicaid: $125.26 Cigna — Commercial: $226 Cofinity — Commercial: $210.18 Employee Benefits Logistics — Commercial: $180.57 Enterprise Group Planning Employee Benefit Plan — Commercial: $180.80
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Psychotherapy 30 Mins 90832	$226	$192.10	$180.80 – $226
Psychotherapy, 30 minutes: 10 of 16 insurance plan rates Aetna — Commercial: $204.08 ASR Physicians Care Network — Commercial: $180.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $208.76 Cigna — Commercial: $226 Cofinity — Commercial: $210.18 Enterprise Group Planning Employee Benefit Plan — Commercial: $180.80 HAP (Health Alliance Plan) — Commercial: $180.80 IBA Health and Life Assurance Company — Commercial: $207.92 McLaren Health Plan — Commercial: $210.41 Medical Cost Savings Solution — Commercial: $180.80
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Doctor (professional) fee In the file: PSYTX W PT 30 MINUTES	Not listed in the file	Not listed in the file	$45.37 – $266.51
Psychotherapy, 30 minutes: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $69.14 ASR Physicians Care Network — Commercial: $103.71 Blue Care Network — Medicare Advantage: $69.14 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $89.46 Blue Cross Complete — Managed Medicaid: $46.28 Cigna — Commercial: $89.05 Employee Benefits Logistics — Commercial: $117.54 HAP (Health Alliance Plan) — Commercial: $266.51 HAP (Health Alliance Plan) — Medicare Advantage: $69.14 McLaren Health Plan — Managed Medicaid: $45.37
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psychotherapy 45 Mins 90834	$279	$237.15	$125.26 – $279
Psychotherapy, 45 minutes: 10 of 34 insurance plan rates Aetna — Commercial: $251.94 Aetna — Medicare Advantage: $133.75 ASR Physicians Care Network — Commercial: $223.20 Blue Care Network — Medicare Advantage: $131.13 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $257.71 Blue Cross Complete — Managed Medicaid: $125.26 Cigna — Commercial: $279 Cofinity — Commercial: $259.47 Employee Benefits Logistics — Commercial: $222.92 Enterprise Group Planning Employee Benefit Plan — Commercial: $223.20
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psych THPY 45 Min PO 90834	$279	$237.15	$125.26 – $279
Psychotherapy, 45 minutes: 10 of 34 insurance plan rates Aetna — Commercial: $251.94 Aetna — Medicare Advantage: $133.75 ASR Physicians Care Network — Commercial: $223.20 Blue Care Network — Medicare Advantage: $131.13 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $257.71 Blue Cross Complete — Managed Medicaid: $125.26 Cigna — Commercial: $279 Cofinity — Commercial: $259.47 Employee Benefits Logistics — Commercial: $222.92 Enterprise Group Planning Employee Benefit Plan — Commercial: $223.20
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psych Thpy 45 Min 90834	$279	$237.15	$125.26 – $279
Psychotherapy, 45 minutes: 10 of 34 insurance plan rates Aetna — Commercial: $251.94 Aetna — Medicare Advantage: $133.75 ASR Physicians Care Network — Commercial: $223.20 Blue Care Network — Medicare Advantage: $131.13 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $257.71 Blue Cross Complete — Managed Medicaid: $125.26 Cigna — Commercial: $279 Cofinity — Commercial: $259.47 Employee Benefits Logistics — Commercial: $222.92 Enterprise Group Planning Employee Benefit Plan — Commercial: $223.20
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psychotherapy 60 Mins 90837	$263	$223.55	$123.61 – $263
Psychotherapy, 60 minutes: 10 of 34 insurance plan rates Aetna — Commercial: $237.49 Aetna — Medicare Advantage: $126.08 ASR Physicians Care Network — Commercial: $210.40 Blue Care Network — Medicare Advantage: $123.61 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $242.93 Blue Cross Complete — Managed Medicaid: $125.26 Cigna — Commercial: $263 Cofinity — Commercial: $244.59 Employee Benefits Logistics — Commercial: $210.14 Enterprise Group Planning Employee Benefit Plan — Commercial: $210.40
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VIDEO Psychotherapy 60 Mins 90837	$263	$223.55	$123.61 – $263
Psychotherapy, 60 minutes: 10 of 34 insurance plan rates Aetna — Commercial: $237.49 Aetna — Medicare Advantage: $126.08 ASR Physicians Care Network — Commercial: $210.40 Blue Care Network — Medicare Advantage: $123.61 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $242.93 Blue Cross Complete — Managed Medicaid: $125.26 Cigna — Commercial: $263 Cofinity — Commercial: $244.59 Employee Benefits Logistics — Commercial: $210.14 Enterprise Group Planning Employee Benefit Plan — Commercial: $210.40
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Psychotherapy 60 Mins 90837	$263	$223.55	$210.40 – $263
Psychotherapy, 60 minutes: 10 of 16 insurance plan rates Aetna — Commercial: $237.49 ASR Physicians Care Network — Commercial: $210.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $242.93 Cigna — Commercial: $263 Cofinity — Commercial: $244.59 Enterprise Group Planning Employee Benefit Plan — Commercial: $210.40 HAP (Health Alliance Plan) — Commercial: $210.40 IBA Health and Life Assurance Company — Commercial: $241.96 McLaren Health Plan — Commercial: $244.85 Medical Cost Savings Solution — Commercial: $210.40
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Doctor (professional) fee In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$90.08 – $266.51
Family psychotherapy, without the patient: 10 of 19 insurance plan rates Aetna — Medicare Advantage: $98.75 ASR Physicians Care Network — Commercial: $148.13 Blue Care Network — Medicare Advantage: $98.75 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $161.91 Cigna — Commercial: $129.77 Employee Benefits Logistics — Commercial: $167.88 HAP (Health Alliance Plan) — Commercial: $266.51 HAP (Health Alliance Plan) — Medicare Advantage: $98.75 McLaren Health Plan — Medicare Advantage: $98.75 Medicare Plus Blue — Medicare Advantage: $98.75
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$125.26
Family psychotherapy, without the patient: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $125.26 McLaren Health Plan — Managed Medicaid: $125.26 Meridian — Managed Medicaid: $125.26 Priority Health — Managed Medicaid: $125.26 United Healthcare — Managed Medicaid: $125.26
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family Therapy 50 Min 90847	$295	$250.75	$125.26 – $295
Family psychotherapy, with the patient: 10 of 34 insurance plan rates Aetna — Commercial: $266.39 Aetna — Medicare Advantage: $141.42 ASR Physicians Care Network — Commercial: $236 Blue Care Network — Medicare Advantage: $138.65 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $272.49 Blue Cross Complete — Managed Medicaid: $125.26 Cigna — Commercial: $295 Cofinity — Commercial: $274.35 Employee Benefits Logistics — Commercial: $235.71 Enterprise Group Planning Employee Benefit Plan — Commercial: $236
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Family Therapy 50 Min 90847	$295	$250.75	$236 – $295
Family psychotherapy, with the patient: 10 of 16 insurance plan rates Aetna — Commercial: $266.39 ASR Physicians Care Network — Commercial: $236 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $272.49 Cigna — Commercial: $295 Cofinity — Commercial: $274.35 Enterprise Group Planning Employee Benefit Plan — Commercial: $236 HAP (Health Alliance Plan) — Commercial: $236 IBA Health and Life Assurance Company — Commercial: $271.40 McLaren Health Plan — Commercial: $274.65 Medical Cost Savings Solution — Commercial: $236
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Doctor (professional) fee In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$67.52 – $266.51
Family psychotherapy, with the patient: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $102.38 ASR Physicians Care Network — Commercial: $153.57 Blue Care Network — Medicare Advantage: $102.38 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $133.14 Blue Cross Complete — Managed Medicaid: $68.87 Cigna — Commercial: $137.85 Employee Benefits Logistics — Commercial: $174.05 HAP (Health Alliance Plan) — Commercial: $266.51 HAP (Health Alliance Plan) — Medicare Advantage: $102.38 McLaren Health Plan — Managed Medicaid: $67.52
Group psychotherapy CPT 90853 · Inpatient or outpatient · Doctor (professional) fee In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$15.98 – $152.54
Group psychotherapy: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $24.28 ASR Physicians Care Network — Commercial: $36.42 Blue Care Network — Medicare Advantage: $24.28 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $31.50 Blue Cross Complete — Managed Medicaid: $16.30 Cigna — Commercial: $33.48 Employee Benefits Logistics — Commercial: $41.28 HAP (Health Alliance Plan) — Commercial: $152.54 HAP (Health Alliance Plan) — Medicare Advantage: $24.28 McLaren Health Plan — Managed Medicaid: $15.98
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$71.69
Group psychotherapy: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $71.69 McLaren Health Plan — Managed Medicaid: $71.69 Meridian — Managed Medicaid: $71.69 Priority Health — Managed Medicaid: $71.69 United Healthcare — Managed Medicaid: $71.69

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: Biopsy 19120	$6,474	$5,502.90	$2,763.15 – $6,474
Removal of breast growth (open surgery): 10 of 34 insurance plan rates Aetna — Commercial: $5,846.02 Aetna — Medicare Advantage: $3,103.64 ASR Physicians Care Network — Commercial: $5,179.20 Blue Care Network — Medicare Advantage: $3,042.78 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $5,980.03 Blue Cross Complete — Managed Medicaid: $2,763.15 Cigna — Commercial: $6,474 Cofinity — Commercial: $6,020.82 Employee Benefits Logistics — Commercial: $5,172.73 Enterprise Group Planning Employee Benefit Plan — Commercial: $5,179.20
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Biopsy 19120	$6,474	$5,502.90	$5,179.20 – $6,474
Removal of breast growth (open surgery): 10 of 16 insurance plan rates Aetna — Commercial: $5,846.02 ASR Physicians Care Network — Commercial: $5,179.20 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $5,980.03 Cigna — Commercial: $6,474 Cofinity — Commercial: $6,020.82 Enterprise Group Planning Employee Benefit Plan — Commercial: $5,179.20 HAP (Health Alliance Plan) — Commercial: $5,179.20 IBA Health and Life Assurance Company — Commercial: $5,956.08 McLaren Health Plan — Commercial: $6,027.29 Medical Cost Savings Solution — Commercial: $5,179.20
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$271.79 – $5,879.03
Removal of breast growth (open surgery): 10 of 24 insurance plan rates Aetna — Medicare Advantage: $399.57 ASR Physicians Care Network — Commercial: $599.36 Blue Care Network — Medicare Advantage: $399.57 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $730.74 Blue Cross Complete — Managed Medicaid: $277.23 Cigna — Commercial: $581.58 Employee Benefits Logistics — Commercial: $679.27 HAP (Health Alliance Plan) — Commercial: $5,879.03 HAP (Health Alliance Plan) — Medicare Advantage: $399.57 McLaren Health Plan — Managed Medicaid: $271.79
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$829.21 – $19,277.31
Total hip replacement: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $1,145.30 ASR Physicians Care Network — Commercial: $1,717.95 Blue Care Network — Medicare Advantage: $1,145.30 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,449.19 Blue Cross Complete — Managed Medicaid: $845.79 Cigna — Commercial: $2,072.35 Employee Benefits Logistics — Commercial: $1,947.01 HAP (Health Alliance Plan) — Commercial: $19,277.31 HAP (Health Alliance Plan) — Medicare Advantage: $1,145.30 McLaren Health Plan — Managed Medicaid: $829.21
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	$9,060.34
Total hip replacement: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $9,060.34 McLaren Health Plan — Managed Medicaid: $9,060.34 Meridian — Managed Medicaid: $9,060.34 Priority Health — Managed Medicaid: $9,060.34 United Healthcare — Managed Medicaid: $9,060.34
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$2,277.79
Total hip replacement: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,277.79
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$828.14 – $19,277.31
Total knee replacement: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $1,143.32 ASR Physicians Care Network — Commercial: $1,714.98 Blue Care Network — Medicare Advantage: $1,143.32 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,446.05 Blue Cross Complete — Managed Medicaid: $844.70 Cigna — Commercial: $2,069.69 Employee Benefits Logistics — Commercial: $1,943.64 HAP (Health Alliance Plan) — Commercial: $19,277.31 HAP (Health Alliance Plan) — Medicare Advantage: $1,143.32 McLaren Health Plan — Managed Medicaid: $828.14
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	$9,060.34
Total knee replacement: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $9,060.34 McLaren Health Plan — Managed Medicaid: $9,060.34 Meridian — Managed Medicaid: $9,060.34 Priority Health — Managed Medicaid: $9,060.34 United Healthcare — Managed Medicaid: $9,060.34
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$2,274.87
Total knee replacement: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,274.87
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$109.70 – $765.67
Shoulder arthroscopy: shaving of shoulder bone: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $147.49 ASR Physicians Care Network — Commercial: $221.24 Blue Care Network — Medicare Advantage: $147.49 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $232.58 Blue Cross Complete — Managed Medicaid: $111.89 Cigna — Commercial: $274.14 Employee Benefits Logistics — Commercial: $250.73 HAP (Health Alliance Plan) — Commercial: $221.23 HAP (Health Alliance Plan) — Medicare Advantage: $147.49 McLaren Health Plan — Managed Medicaid: $109.70
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	$103.98
Shoulder arthroscopy: shaving of shoulder bone: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $103.98 McLaren Health Plan — Managed Medicaid: $103.98 Meridian — Managed Medicaid: $103.98 Priority Health — Managed Medicaid: $103.98 United Healthcare — Managed Medicaid: $103.98
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$216.30
Shoulder arthroscopy: shaving of shoulder bone: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $216.30
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$354.43 – $4,912.92
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 24 insurance plan rates Aetna — Medicare Advantage: $501.15 ASR Physicians Care Network — Commercial: $751.73 Blue Care Network — Medicare Advantage: $501.15 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,046.88 Blue Cross Complete — Managed Medicaid: $361.52 Cigna — Commercial: $885.80 Employee Benefits Logistics — Commercial: $851.96 HAP (Health Alliance Plan) — Commercial: $4,912.92 HAP (Health Alliance Plan) — Medicare Advantage: $501.15 McLaren Health Plan — Managed Medicaid: $354.43
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	$2,309.07
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $2,309.07 McLaren Health Plan — Managed Medicaid: $2,309.07 Meridian — Managed Medicaid: $2,309.07 Priority Health — Managed Medicaid: $2,309.07 United Healthcare — Managed Medicaid: $2,309.07
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$973.61
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $973.61
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$189.36 – $8,888.64
Removal of tonsils and adenoids (under age 12): 10 of 24 insurance plan rates Aetna — Medicare Advantage: $254.37 ASR Physicians Care Network — Commercial: $381.56 Blue Care Network — Medicare Advantage: $254.37 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $473.48 Blue Cross Complete — Managed Medicaid: $193.15 Cigna — Commercial: $539.41 Employee Benefits Logistics — Commercial: $432.43 HAP (Health Alliance Plan) — Commercial: $8,888.64 HAP (Health Alliance Plan) — Medicare Advantage: $254.37 McLaren Health Plan — Managed Medicaid: $189.36
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	$4,177.66
Removal of tonsils and adenoids (under age 12): rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $4,177.66 McLaren Health Plan — Managed Medicaid: $4,177.66 Meridian — Managed Medicaid: $4,177.66 Priority Health — Managed Medicaid: $4,177.66 United Healthcare — Managed Medicaid: $4,177.66
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$318.19
Removal of tonsils and adenoids (under age 12): rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $318.19
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$77.75 – $1,361.84
Upper GI endoscopy (diagnostic): 10 of 24 insurance plan rates Aetna — Medicare Advantage: $108.60 ASR Physicians Care Network — Commercial: $162.90 Blue Care Network — Medicare Advantage: $108.60 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $194.40 Blue Cross Complete — Managed Medicaid: $79.31 Cigna — Commercial: $221.46 Employee Benefits Logistics — Commercial: $184.62 HAP (Health Alliance Plan) — Commercial: $1,361.84 HAP (Health Alliance Plan) — Medicare Advantage: $108.60 McLaren Health Plan — Managed Medicaid: $77.75
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	$640.06
Upper GI endoscopy (diagnostic): rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $640.06 McLaren Health Plan — Managed Medicaid: $640.06 Meridian — Managed Medicaid: $640.06 Priority Health — Managed Medicaid: $640.06 United Healthcare — Managed Medicaid: $640.06
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$130.64
Upper GI endoscopy (diagnostic): rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $130.64
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$87.33 – $1,361.84
Upper GI endoscopy with biopsy: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $121.55 ASR Physicians Care Network — Commercial: $182.33 Blue Care Network — Medicare Advantage: $121.55 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $218.37 Blue Cross Complete — Managed Medicaid: $89.08 Cigna — Commercial: $248.77 Employee Benefits Logistics — Commercial: $206.64 HAP (Health Alliance Plan) — Commercial: $1,361.84 HAP (Health Alliance Plan) — Medicare Advantage: $121.55 McLaren Health Plan — Managed Medicaid: $87.33
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	$640.06
Upper GI endoscopy with biopsy: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $640.06 McLaren Health Plan — Managed Medicaid: $640.06 Meridian — Managed Medicaid: $640.06 Priority Health — Managed Medicaid: $640.06 United Healthcare — Managed Medicaid: $640.06
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$146.75
Upper GI endoscopy with biopsy: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $146.75
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy High G0105 45378	$747	$634.95	$351.09 – $747
Colonoscopy (diagnostic): 10 of 34 insurance plan rates Aetna — Commercial: $674.54 Aetna — Medicare Advantage: $358.11 ASR Physicians Care Network — Commercial: $597.60 Blue Care Network — Medicare Advantage: $351.09 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $690 Blue Cross Complete — Managed Medicaid: $656.28 Cigna — Commercial: $747 Cofinity — Commercial: $694.71 Employee Benefits Logistics — Commercial: $596.85 Enterprise Group Planning Employee Benefit Plan — Commercial: $597.60
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy Low G0121 45378	$764	$649.40	$359.08 – $764
Colonoscopy (diagnostic): 10 of 34 insurance plan rates Aetna — Commercial: $689.89 Aetna — Medicare Advantage: $366.26 ASR Physicians Care Network — Commercial: $611.20 Blue Care Network — Medicare Advantage: $359.08 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $705.71 Blue Cross Complete — Managed Medicaid: $656.28 Cigna — Commercial: $764 Cofinity — Commercial: $710.52 Employee Benefits Logistics — Commercial: $610.44 Enterprise Group Planning Employee Benefit Plan — Commercial: $611.20
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Colonoscopy High G0105 45378	$747	$634.95	$597.60 – $747
Colonoscopy (diagnostic): 10 of 16 insurance plan rates Aetna — Commercial: $674.54 ASR Physicians Care Network — Commercial: $597.60 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $690 Cigna — Commercial: $747 Cofinity — Commercial: $694.71 Enterprise Group Planning Employee Benefit Plan — Commercial: $597.60 HAP (Health Alliance Plan) — Commercial: $597.60 IBA Health and Life Assurance Company — Commercial: $687.24 McLaren Health Plan — Commercial: $695.46 Medical Cost Savings Solution — Commercial: $597.60
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$126.95 – $1,796.76
Colonoscopy with biopsy: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $175.35 ASR Physicians Care Network — Commercial: $263.03 Blue Care Network — Medicare Advantage: $175.35 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $317.43 Blue Cross Complete — Managed Medicaid: $129.49 Cigna — Commercial: $361.64 Employee Benefits Logistics — Commercial: $298.10 HAP (Health Alliance Plan) — Commercial: $1,796.76 HAP (Health Alliance Plan) — Medicare Advantage: $175.35 McLaren Health Plan — Managed Medicaid: $126.95
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	$844.48
Colonoscopy with biopsy: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $844.48 McLaren Health Plan — Managed Medicaid: $844.48 Meridian — Managed Medicaid: $844.48 Priority Health — Managed Medicaid: $844.48 United Healthcare — Managed Medicaid: $844.48
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$213.31
Colonoscopy with biopsy: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $213.31
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$159.96 – $1,796.76
Colonoscopy with removal of polyps (snare): 10 of 24 insurance plan rates Aetna — Medicare Advantage: $220.65 ASR Physicians Care Network — Commercial: $330.98 Blue Care Network — Medicare Advantage: $220.65 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $399.98 Blue Cross Complete — Managed Medicaid: $163.16 Cigna — Commercial: $455.67 Employee Benefits Logistics — Commercial: $375.11 HAP (Health Alliance Plan) — Commercial: $1,796.76 HAP (Health Alliance Plan) — Medicare Advantage: $220.65 McLaren Health Plan — Managed Medicaid: $159.96
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	$844.48
Colonoscopy with removal of polyps (snare): rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $844.48 McLaren Health Plan — Managed Medicaid: $844.48 Meridian — Managed Medicaid: $844.48 Priority Health — Managed Medicaid: $844.48 United Healthcare — Managed Medicaid: $844.48
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$268.80
Colonoscopy with removal of polyps (snare): rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $268.80
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$162.09 – $1,796.76
Ultrasound of the lower bowel by endoscope: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $222.82 ASR Physicians Care Network — Commercial: $334.23 Blue Care Network — Medicare Advantage: $222.82 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $405.31 Blue Cross Complete — Managed Medicaid: $165.33 Cigna — Commercial: $461.75 Employee Benefits Logistics — Commercial: $378.79 HAP (Health Alliance Plan) — Commercial: $1,796.76 HAP (Health Alliance Plan) — Medicare Advantage: $222.82 McLaren Health Plan — Managed Medicaid: $162.09
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	$844.48
Ultrasound of the lower bowel by endoscope: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $844.48 McLaren Health Plan — Managed Medicaid: $844.48 Meridian — Managed Medicaid: $844.48 Priority Health — Managed Medicaid: $844.48 United Healthcare — Managed Medicaid: $844.48
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$272.38
Ultrasound of the lower bowel by endoscope: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $272.38
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy Low G0121 45378	$764	$649.40	$359.08 – $764
Screening colonoscopy (not high risk): 10 of 34 insurance plan rates Aetna — Commercial: $689.89 Aetna — Medicare Advantage: $366.26 ASR Physicians Care Network — Commercial: $611.20 Blue Care Network — Medicare Advantage: $359.08 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $705.71 Blue Cross Complete — Managed Medicaid: $656.28 Cigna — Commercial: $764 Cofinity — Commercial: $710.52 Employee Benefits Logistics — Commercial: $610.44 Enterprise Group Planning Employee Benefit Plan — Commercial: $611.20
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Colonoscopy Low G0121 45378	$764	$649.40	$611.20 – $764
Screening colonoscopy (not high risk): 10 of 16 insurance plan rates Aetna — Commercial: $689.89 ASR Physicians Care Network — Commercial: $611.20 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $705.71 Cigna — Commercial: $764 Cofinity — Commercial: $710.52 Enterprise Group Planning Employee Benefit Plan — Commercial: $611.20 HAP (Health Alliance Plan) — Commercial: $611.20 IBA Health and Life Assurance Company — Commercial: $702.88 McLaren Health Plan — Commercial: $711.28 Medical Cost Savings Solution — Commercial: $611.20
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$116.94 – $1,396.33
Screening colonoscopy (not high risk): 10 of 24 insurance plan rates Aetna — Medicare Advantage: $162.92 ASR Physicians Care Network — Commercial: $244.38 Blue Care Network — Medicare Advantage: $162.92 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $292.40 Blue Cross Complete — Managed Medicaid: $119.28 Cigna — Commercial: $333.11 Employee Benefits Logistics — Commercial: $276.96 HAP (Health Alliance Plan) — Commercial: $1,396.33 HAP (Health Alliance Plan) — Medicare Advantage: $162.92 McLaren Health Plan — Managed Medicaid: $116.94
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$427.28 – $9,077.37
Gallbladder removal by laparoscope: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $625.52 ASR Physicians Care Network — Commercial: $938.28 Blue Care Network — Medicare Advantage: $625.52 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,068.40 Blue Cross Complete — Managed Medicaid: $435.83 Cigna — Commercial: $1,217.15 Employee Benefits Logistics — Commercial: $1,063.38 HAP (Health Alliance Plan) — Commercial: $9,077.37 HAP (Health Alliance Plan) — Medicare Advantage: $625.52 McLaren Health Plan — Managed Medicaid: $427.28
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	$4,266.37
Gallbladder removal by laparoscope: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $4,266.37 McLaren Health Plan — Managed Medicaid: $4,266.37 Meridian — Managed Medicaid: $4,266.37 Priority Health — Managed Medicaid: $4,266.37 United Healthcare — Managed Medicaid: $4,266.37
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$718
Gallbladder removal by laparoscope: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $718
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$339.52 – $5,375.98
Groin (inguinal) hernia repair, age 5 or older: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $500.79 ASR Physicians Care Network — Commercial: $751.19 Blue Care Network — Medicare Advantage: $500.79 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $912.85 Blue Cross Complete — Managed Medicaid: $346.31 Cigna — Commercial: $967.17 Employee Benefits Logistics — Commercial: $851.34 HAP (Health Alliance Plan) — Commercial: $5,375.98 HAP (Health Alliance Plan) — Medicare Advantage: $500.79 McLaren Health Plan — Managed Medicaid: $339.52
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	$2,526.71
Groin (inguinal) hernia repair, age 5 or older: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $2,526.71 McLaren Health Plan — Managed Medicaid: $2,526.71 Meridian — Managed Medicaid: $2,526.71 Priority Health — Managed Medicaid: $2,526.71 United Healthcare — Managed Medicaid: $2,526.71
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$848.96
Groin (inguinal) hernia repair, age 5 or older: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $848.96
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prostate Biopsy Needle/Punch-1 or more 55700	$2,220	$1,887	$1,043.40 – $2,220
Prostate biopsy: 10 of 29 insurance plan rates Aetna — Commercial: $2,004.66 Aetna — Medicare Advantage: $1,064.27 ASR Physicians Care Network — Commercial: $1,776 Blue Care Network — Medicare Advantage: $1,043.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,050.61 Cigna — Commercial: $2,220 Cofinity — Commercial: $2,064.60 Employee Benefits Logistics — Commercial: $1,773.78 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,776 First Health/Coventry Health/Community Care Network — Commercial: $1,776
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Prostate Biopsy Needle/Punch-1 or more 55700	$2,220	$1,887	$1,776 – $2,220
Prostate biopsy: 10 of 16 insurance plan rates Aetna — Commercial: $2,004.66 ASR Physicians Care Network — Commercial: $1,776 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,050.61 Cigna — Commercial: $2,220 Cofinity — Commercial: $2,064.60 Enterprise Group Planning Employee Benefit Plan — Commercial: $1,776 HAP (Health Alliance Plan) — Commercial: $1,776 IBA Health and Life Assurance Company — Commercial: $2,042.40 McLaren Health Plan — Commercial: $2,066.82 Medical Cost Savings Solution — Commercial: $1,776
Prostate biopsy CPT 55700 · Inpatient or outpatient · Doctor (professional) fee In the file: Professional Services	Not listed in the file	Not listed in the file	$82.22 – $205.58
Prostate biopsy: rates for 8 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $205.58 Blue Cross Complete — Managed Medicaid: $83.86 McLaren Health Plan — Managed Medicaid: $82.22 Meridian — Managed Medicaid: $82.22 Priority Health — Managed Medicaid: $82.22 United Healthcare — Managed Medicaid: $82.22 United Healthcare — Medicare Advantage: $123.40 United Healthcare Definity — Commercial: $167.08
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$761.69 – $15,960.72
Prostate removal by laparoscope (radical prostatectomy): 10 of 24 insurance plan rates Aetna — Medicare Advantage: $1,071.41 ASR Physicians Care Network — Commercial: $1,607.12 Blue Care Network — Medicare Advantage: $1,071.41 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,904.58 Blue Cross Complete — Managed Medicaid: $776.92 Cigna — Commercial: $1,939.85 Employee Benefits Logistics — Commercial: $1,821.40 HAP (Health Alliance Plan) — Commercial: $15,960.72 HAP (Health Alliance Plan) — Medicare Advantage: $1,071.41 McLaren Health Plan — Managed Medicaid: $761.69
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	$7,501.54
Prostate removal by laparoscope (radical prostatectomy): rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $7,501.54 McLaren Health Plan — Managed Medicaid: $7,501.54 Meridian — Managed Medicaid: $7,501.54 Priority Health — Managed Medicaid: $7,501.54 United Healthcare — Managed Medicaid: $7,501.54
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$1,279.94
Prostate removal by laparoscope (radical prostatectomy): rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,279.94
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$147.82 – $4,860.55
Hysteroscopy with biopsy of the uterus lining: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $203.65 ASR Physicians Care Network — Commercial: $305.48 Blue Care Network — Medicare Advantage: $203.65 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $369.62 Blue Cross Complete — Managed Medicaid: $150.78 Cigna — Commercial: $350.01 Employee Benefits Logistics — Commercial: $346.21 HAP (Health Alliance Plan) — Commercial: $4,860.55 HAP (Health Alliance Plan) — Medicare Advantage: $203.65 McLaren Health Plan — Managed Medicaid: $147.82
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	$2,284.46
Hysteroscopy with biopsy of the uterus lining: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $2,284.46 McLaren Health Plan — Managed Medicaid: $2,284.46 Meridian — Managed Medicaid: $2,284.46 Priority Health — Managed Medicaid: $2,284.46 United Healthcare — Managed Medicaid: $2,284.46
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$248.39
Hysteroscopy with biopsy of the uterus lining: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $248.39
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Epidural Interlaminar Lumbar/Sacral	$948	$805.80	$445.56 – $948
Spinal injection, lower back (epidural), with imaging guidance: 10 of 34 insurance plan rates Aetna — Commercial: $856.04 Aetna — Medicare Advantage: $454.47 ASR Physicians Care Network — Commercial: $758.40 Blue Care Network — Medicare Advantage: $445.56 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $875.67 Blue Cross Complete — Managed Medicaid: $498.14 Cigna — Commercial: $948 Cofinity — Commercial: $881.64 Employee Benefits Logistics — Commercial: $757.45 Enterprise Group Planning Employee Benefit Plan — Commercial: $758.40
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Epidural Interlaminar Lumbar/Sacral	$948	$805.80	$758.40 – $948
Spinal injection, lower back (epidural), with imaging guidance: 10 of 16 insurance plan rates Aetna — Commercial: $856.04 ASR Physicians Care Network — Commercial: $758.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $875.67 Cigna — Commercial: $948 Cofinity — Commercial: $881.64 Enterprise Group Planning Employee Benefit Plan — Commercial: $758.40 HAP (Health Alliance Plan) — Commercial: $758.40 IBA Health and Life Assurance Company — Commercial: $872.16 McLaren Health Plan — Commercial: $882.59 Medical Cost Savings Solution — Commercial: $758.40
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Doctor (professional) fee In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$63.26 – $1,059.88
Spinal injection, lower back (epidural), with imaging guidance: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $87.76 ASR Physicians Care Network — Commercial: $131.64 Blue Care Network — Medicare Advantage: $87.76 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $158.18 Blue Cross Complete — Managed Medicaid: $64.53 Cigna — Commercial: $171.79 Employee Benefits Logistics — Commercial: $149.19 HAP (Health Alliance Plan) — Commercial: $1,059.88 HAP (Health Alliance Plan) — Medicare Advantage: $87.76 McLaren Health Plan — Managed Medicaid: $63.26
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Doctor (professional) fee In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$70.93 – $1,328.04
Nerve root injection, lower back, with imaging guidance: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $97.48 ASR Physicians Care Network — Commercial: $146.22 Blue Care Network — Medicare Advantage: $97.48 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $190.70 Blue Cross Complete — Managed Medicaid: $72.35 Cigna — Commercial: $192.60 Employee Benefits Logistics — Commercial: $165.72 HAP (Health Alliance Plan) — Commercial: $1,328.04 HAP (Health Alliance Plan) — Medicare Advantage: $97.48 McLaren Health Plan — Managed Medicaid: $70.93
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	$624.18
Nerve root injection, lower back, with imaging guidance: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $624.18 McLaren Health Plan — Managed Medicaid: $624.18 Meridian — Managed Medicaid: $624.18 Priority Health — Managed Medicaid: $624.18 United Healthcare — Managed Medicaid: $624.18
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$177.36
Nerve root injection, lower back, with imaging guidance: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $177.36
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$287.34 – $2,932.02
Carpal tunnel release: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $407.61 ASR Physicians Care Network — Commercial: $611.42 Blue Care Network — Medicare Advantage: $407.61 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $772.55 Blue Cross Complete — Managed Medicaid: $293.09 Cigna — Commercial: $780.25 Employee Benefits Logistics — Commercial: $692.94 HAP (Health Alliance Plan) — Commercial: $2,932.02 HAP (Health Alliance Plan) — Medicare Advantage: $407.61 McLaren Health Plan — Managed Medicaid: $287.34
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	$1,378.05
Carpal tunnel release: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $1,378.05 McLaren Health Plan — Managed Medicaid: $1,378.05 Meridian — Managed Medicaid: $1,378.05 Priority Health — Managed Medicaid: $1,378.05 United Healthcare — Managed Medicaid: $1,378.05
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$718.48
Carpal tunnel release: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $718.48
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient · Doctor (professional) fee In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$196.81 – $825.82
Laser treatment of clouding after cataract surgery: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $262.76 ASR Physicians Care Network — Commercial: $394.14 Blue Care Network — Medicare Advantage: $262.76 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $529.15 Blue Cross Complete — Managed Medicaid: $200.75 Cigna — Commercial: $538.97 Employee Benefits Logistics — Commercial: $446.69 HAP (Health Alliance Plan) — Commercial: $825.82 HAP (Health Alliance Plan) — Medicare Advantage: $262.76 McLaren Health Plan — Managed Medicaid: $196.81
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	$388.14
Laser treatment of clouding after cataract surgery: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $388.14 McLaren Health Plan — Managed Medicaid: $388.14 Meridian — Managed Medicaid: $388.14 Priority Health — Managed Medicaid: $388.14 United Healthcare — Managed Medicaid: $388.14
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$492.12
Laser treatment of clouding after cataract surgery: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $492.12
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Doctor (professional) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$343.57 – $3,465.20
Cataract removal with lens implant: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $447.39 ASR Physicians Care Network — Commercial: $671.09 Blue Care Network — Medicare Advantage: $447.39 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $923.73 Blue Cross Complete — Managed Medicaid: $350.44 Cigna — Commercial: $940.87 Employee Benefits Logistics — Commercial: $760.56 HAP (Health Alliance Plan) — Commercial: $3,465.20 HAP (Health Alliance Plan) — Medicare Advantage: $447.39 McLaren Health Plan — Managed Medicaid: $343.57
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	$1,628.65
Cataract removal with lens implant: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $1,628.65 McLaren Health Plan — Managed Medicaid: $1,628.65 Meridian — Managed Medicaid: $1,628.65 Priority Health — Managed Medicaid: $1,628.65 United Healthcare — Managed Medicaid: $1,628.65
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$859.08
Cataract removal with lens implant: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $859.08

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient · Doctor (professional) fee In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$2,140.75 – $3,748.50
Vaginal delivery, with care before and after: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $2,205 ASR Physicians Care Network — Commercial: $3,307.50 Blue Care Network — Medicare Advantage: $2,205 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,504.67 Blue Cross Complete — Managed Medicaid: $2,265.14 Cigna — Commercial: $3,423.23 Employee Benefits Logistics — Commercial: $3,748.50 HAP (Health Alliance Plan) — Commercial: $3,308.07 HAP (Health Alliance Plan) — Medicare Advantage: $2,205 McLaren Health Plan — Managed Medicaid: $2,220.73
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	$1,554.79
Vaginal delivery, with care before and after: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $1,554.79 McLaren Health Plan — Managed Medicaid: $1,554.79 Meridian — Managed Medicaid: $1,554.79 Priority Health — Managed Medicaid: $1,554.79 United Healthcare — Managed Medicaid: $1,554.79
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient · Doctor (professional) fee · modifier 80 In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$736.41
Vaginal delivery, with care before and after: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $736.41
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$2,426.95 – $4,201.62
Cesarean delivery (C-section), with care before and after: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $2,471.54 ASR Physicians Care Network — Commercial: $3,707.31 Blue Care Network — Medicare Advantage: $2,471.54 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,504.67 Blue Cross Complete — Managed Medicaid: $2,525.28 Cigna — Commercial: $3,802.61 Employee Benefits Logistics — Commercial: $4,201.62 HAP (Health Alliance Plan) — Commercial: $3,706.85 HAP (Health Alliance Plan) — Medicare Advantage: $2,471.54 McLaren Health Plan — Managed Medicaid: $2,475.76
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	$1,742.22
Cesarean delivery (C-section), with care before and after: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $1,742.22 McLaren Health Plan — Managed Medicaid: $1,742.22 Meridian — Managed Medicaid: $1,742.22 Priority Health — Managed Medicaid: $1,742.22 United Healthcare — Managed Medicaid: $1,742.22
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee · modifier 80 In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$736.41
Cesarean delivery (C-section), with care before and after: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $736.41
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient · Doctor (professional) fee In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$2,257.16 – $3,961.31
Vaginal delivery after a previous C-section, with care before and after: 10 of 24 insurance plan rates Aetna — Medicare Advantage: $2,330.18 ASR Physicians Care Network — Commercial: $3,495.27 Blue Care Network — Medicare Advantage: $2,330.18 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,679.92 Blue Cross Complete — Managed Medicaid: $2,382.51 Cigna — Commercial: $3,585.89 Employee Benefits Logistics — Commercial: $3,961.31 HAP (Health Alliance Plan) — Commercial: $3,495.27 HAP (Health Alliance Plan) — Medicare Advantage: $2,330.18 McLaren Health Plan — Managed Medicaid: $2,335.79
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	$1,642.78
Vaginal delivery after a previous C-section, with care before and after: rates for 5 insurance plans Blue Cross Complete — Managed Medicaid: $1,642.78 McLaren Health Plan — Managed Medicaid: $1,642.78 Meridian — Managed Medicaid: $1,642.78 Priority Health — Managed Medicaid: $1,642.78 United Healthcare — Managed Medicaid: $1,642.78
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient · Doctor (professional) fee · modifier 80 In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$773.24
Vaginal delivery after a previous C-section, with care before and after: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $773.24

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
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	$20,609.51
Hip or knee replacement (major joint of the leg), without major complications: rates for 2 insurance plans Cigna — Commercial: $20,609.51 Priority Health — Commercial: $20,609.51

Source: Charlevoix Area 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 17, 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	Critical Access Hospital
Address	14700 Lakeshore Drive, Charlevoix, MI 49720
County	Charlevoix County
State	Michigan
Phone	(231) 547‑4024
Emergency services	Yes
Ownership	Voluntary non-profit - Other
Medicare overall rating	Not rated by CMS
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	231322
Name in Medicare records	CHARLEVOIX AREA HOSPITAL
Profile level	Medicare data + hospital website
Name on the hospital’s website	Charlevoix Hospital
Official website	munsonhealthcare.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau ZIP code areas (Gazetteer) — approximate position (center of the ZIP code area) used for distances

From the hospital’s website

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

Charlevoix Hospital — munsonhealthcare.org
Charlevoix Hospital — munsonhealthcare.org
Visitor Information | Charlevoix Hospital | Charlevoix, Michigan — munsonhealthcare.org
Contact Us | Charlevoix Hospital | Charlevoix, Michigan — munsonhealthcare.org
About Us | Charlevoix Hospital | Charlevoix, Michigan — munsonhealthcare.org
Charlevoix Hospital Celebrates a Century of Caring | Charlevoix Hospital | Charlevoix, Michigan — munsonhealthcare.org

Charlevoix Area Hospital

Summary

Profile from official sources

At a glance