Does Duke University Hospital have an emergency room?

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

Where is Duke University Hospital?

2301 Erwin Rd, Durham, NC 27705, in Durham County, North Carolina.

What is the phone number of Duke University Hospital?

(919) 684-8111, as listed by Medicare (CMS).

What is the Medicare star rating of Duke University Hospital?

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

Duke University Hospital — Durham, NC

Quick answers

Does Duke University Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Duke University Hospital. In a medical emergency, call 911.
Where is Duke University Hospital?: 2301 Erwin Rd, Durham, NC 27705, in Durham County, North Carolina.
What is the phone number of Duke University Hospital?: (919) 684-8111, as listed by Medicare (CMS).
What is the Medicare star rating of Duke University Hospital?: 5 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4][6]

Conditions treated^[4][6]

Kidney disease
GI disorders
Lung disease
Brain tumors
Acoustic neuromas
Movement disorders
Chronic pain
Spine and back conditions

Treatments^[6]

Cardiac rehabilitation

Programs and centers^[5][10]

Arts & Health
Patient resource management
LGBTQ+ patient services

Emergency care (hospital website)^[11]

Emergency room	Yes
Open 24/7	Yes
Stroke designation	Comprehensive Stroke Center

Visiting and practical information

Visiting	Visitation 6:00 am to 9:00 pm daily; visitor restrictions are in effect^[7]
Parking	Hospital garage across Erwin Rd, $2/hour or $16/day max; valet $17 per 24 hours^[8]
Interpreters and languages	Free interpreter services available for patients who prefer a language other than English^[11]

Doctors and clinicians (3,740)

3,740 doctors and other clinicians list Duke University 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

Nurse Practitioner577
Physician Assistant474
Internal Medicine315
Certified Registered Nurse Anesthetist (CRNA)228
Family Practice222
Anesthesiology147
Diagnostic Radiology144
Ophthalmology102
Neurology96
Cardiovascular Disease (Cardiology)95
Orthopedic Surgery92
Obstetrics/Gynecology88

Doctors with a page on this site (3,740)

Aaditya Khatri, MDPulmonary Disease
Aakash K. Babaria, DODiagnostic Radiology
Aaron C. Lentz, MDUrology
Aaron J. Marks, MDDiagnostic Radiology
Aatif M. Husain, MDNeurology
Abby C. Niedermann, CNACertified Registered Nurse Anesthetist (CRNA)
Abhay K. Komandur, PAPhysician Assistant
Abhijit B. Power, MDHospitalist
Abhiram S. Harohalli, CNACertified Registered Nurse Anesthetist (CRNA)
Abigail C. Milchuck, NPNurse Practitioner
Abigail H. Melnick, MDAnesthesiology
Abigail I. Tepper, NPNurse Practitioner
Abigail J. Lancaster, MDFamily Practice
Abigail N. Hulbert, NPNurse Practitioner
Abirami Natarajan, MDMedical Oncology
Adam B. Stern, MDNephrology
Adam Brekke, MDOrthopedic Surgery
Adam C. Wenzlik, MDFamily Practice
Adam D. Devore, MDAdvanced Heart Failure and Transplant Cardiology
Adam J. Hobbs, CNACertified Registered Nurse Anesthetist (CRNA)
Adam J. Tosh, MDHospitalist
Adam M. Flowe, CNACertified Registered Nurse Anesthetist (CRNA)
Adam M. Tulp, PAPhysician Assistant
Adam P. Johnson, MDGeneral Surgery

And 3,716 more: the button below opens the full list.

Other emergency rooms nearby

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

Durham VA Medical Center0.1 mi · Durham, NC · Federal/VA Acute Care Hospital
Duke Regional Hospital3.0 mi · Durham, NC · Acute Care Hospital
UNC Hospitals9.6 mi · Chapel Hill, NC · Acute Care Hospital
Central Regional Hospital12 mi · Butner, NC · Psychiatric Hospital
Rex Hospital19 mi · Raleigh, NC · Acute Care Hospital

Other hospitals nearby

Select Specialty Hospital Durham Inc3.0 mi · Durham, NC · Long-Term Acute Care Hospital
North Carolina Specialty Hospital3.3 mi · Durham, NC · Acute Care Hospital
Triangle Springs11 mi · Raleigh, NC · Psychiatric 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

University Health and Rehabilitation Center0.7 mi · Durham, NC · 1 of 5 stars
PruittHealth-Durham0.8 mi · Durham, NC · 1 of 5 stars
Pettigrew Rehabilitation Center1.0 mi · Durham, NC · 4 of 5 stars

All nursing homes in the state →

Hospice providers

Duke Hospice8.6 mi · Durham, NC · 4 of 5 stars
UNC Hospice13 mi · Chapel Hill, NC · 3 of 5 stars
Transitions Lifecare18 mi · Raleigh, NC · 5 of 5 stars

All hospice providers in the state →

Home health agencies

Liberty Home Care, LLC2.8 mi · Durham, NC
Duke Home Health6.5 mi · Durham, NC
UNC Home Health7.0 mi · Chapel Hill, NC · 3 of 5 stars

All home health agencies in the state →

Dialysis facilities

DaVita Durham Dialysis2.3 mi · Durham, NC · 4 of 5 stars
DaVita Durham West Dialysis2.8 mi · Durham, NC · 3 of 5 stars
FMC West Pettigrew Dialysis Center2.8 mi · Durham, NC · 1 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.

James E Davis Ambulatory Surg6.5 mi · Durham, NC
Triangle Vascular Surgery Center6.5 mi · Durham, NC
Southpoint Surgery Center8.6 mi · Durham, NC

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

Walltown Clinic1.0 mi · Durham, NC · Community health center
Lakewood1.4 mi · Durham, NC · Community health center
Lyon Park Clinic1.6 mi · Durham, NC · Community health center

Clinics and urgent care

Battleground Urgent Care3.8 mi · Durham, NC · Urgent care center
Doctors Urgent Care PLLC7.0 mi · Chapel Hill, NC · Urgent care center
Premise Health of North Carolina Medical PC7.2 mi · Durham, NC · Urgent care center

Pharmacies

Duke University Health System Inc0.6 mi · Durham, NC · Community/retail pharmacy
Gurleys Pharmacy Inc2.3 mi · Durham, NC · Pharmacy
Main Street Pharmacy LLC2.3 mi · Durham, NC · Community/retail pharmacy

Assisted living nearby

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

Croasdaile Village2.8 mi · Durham, NC
Carolina Reserve of Durham3.8 mi · Durham, NC
TerraBella Durham3.8 mi · Durham, NC
Calyx Living of Durham6.3 mi · Durham, NC

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 Duke University 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	4 of 5 stars
Doctors communicated well	4 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Quiet at night	3 of 5 stars
Rated the hospital 9 or 10 out of 10	78%National average: 72%
Would definitely recommend the hospital	80%National average: 71%
Nurses “always” communicated well	81%National average: 80%
Doctors “always” communicated well	82%National average: 80%
Staff “always” explained medicines before giving them	63%National average: 62%
Were given information about recovery at home	90%National average: 86%
Room and bathroom “always” clean	65%National average: 74%
Area around the room “always” quiet at night	58%National average: 60%
Completed surveys	1,341Response rate: 22%

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	0.727Better than the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.374Better than the national benchmark
Surgical site infections after colon surgery	1.048No different from the national benchmark
Surgical site infections after abdominal hysterectomy	1.373No different from the national benchmark
MRSA bloodstream infections	0.592Better than the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.398Better than the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

Complications and deaths

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

Deaths within 30 days: heart attack patients	10.4%
Deaths within 30 days: heart failure patients	9.1%
Deaths within 30 days: pneumonia patients	9.6%
Deaths within 30 days: COPD patients	6.4%
Deaths within 30 days: stroke patients	11.4%
Deaths within 30 days: coronary bypass surgery (CABG)	1.6%
Serious complications (patient safety indicator PSI-90)	1.1No different from the national rate
Complications after hip or knee replacement	4.9%

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	12.7%
Readmitted within 30 days: heart failure	20.6%
Readmitted within 30 days: pneumonia	15.9%
Readmitted within 30 days: COPD	20.1%
Readmitted within 30 days: coronary bypass surgery	9.7%
Readmitted within 30 days: hip or knee replacement	5.9%

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)	Very high (60,000 or more)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	317 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	5%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	49%National average: 65%

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Durham Best hospitals in Durham

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 76 common services exactly as Duke University 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 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Office/Outpatient New Low Mdm 30 Minutes	$330	$165	$58.40 – $309.10
New patient office visit (about 30–44 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $222.97 Aetna — Medicare Advantage HMO: $99.90 Aetna — Medicare Advantage PPO: $99.76 Alliance Health — Managed Medicaid: $60.58 AmeriHealth — Managed Medicaid: $88.81 BCBS — Commercial/HMO/PPO/Select: $250.45 BCBS — HPN: $190.96 BCBS — Managed Medicaid: $88.81 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $99.95 Carolina Complete Health — Managed Medicaid: $88.81
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office/Outpatient New Low Mdm 30 Minutes	$330	$165	$57.88 – $287.10
New patient office visit (about 30–44 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $222.97 Aetna — Medicare Advantage HMO: $77.06 Aetna — Medicare Advantage PPO: $79.32 Alliance Health — Managed Medicaid: $60.58 AmeriHealth — Managed Medicaid: $88.81 BCBS — Commercial/HMO/PPO/Select: $238.44 BCBS — HPN: $190.96 BCBS — Managed Medicaid: $88.81 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $80.48 Carolina Complete Health — Managed Medicaid: $88.81
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Outpatient New Low Mdm 30 Minutes	$330	$165	$60.58 – $287.10
New patient office visit (about 30–44 minutes): 10 of 14 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $222.97 Aetna — Medicare Advantage HMO: $75.12 Aetna — Medicare Advantage PPO: $79.32 AmeriHealth — Managed Medicaid: $80.86 BCBS — Commercial/HMO/PPO/Select: $237.45 BCBS — Managed Medicaid: $80.86 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $80.48 Carolina Complete Health — Managed Medicaid: $80.86 Cigna — Commercial/HMO/PPO: $258.17 Humana — Medicare Advantage: $77.76
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Office/Outpatient New Moderate Mdm 45 Minutes	$527	$263.50	$95.65 – $474.30
New patient office visit (about 45–59 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $385.03 Aetna — Medicare Advantage HMO: $318.42 Aetna — Medicare Advantage PPO: $182.64 Alliance Health — Managed Medicaid: $101.72 AmeriHealth — Managed Medicaid: $160.01 BCBS — Commercial/HMO/PPO/Select: $385.03 BCBS — HPN: $296.67 BCBS — Managed Medicaid: $160.01 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $95.65 Carolina Complete Health — Managed Medicaid: $160.01
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office/Outpatient New Moderate Mdm 45 Minutes	$527	$263.50	$95.65 – $474.30
New patient office visit (about 45–59 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $353.60 Aetna — Medicare Advantage HMO: $266.75 Aetna — Medicare Advantage PPO: $162.24 Alliance Health — Managed Medicaid: $101.72 AmeriHealth — Managed Medicaid: $160.01 BCBS — Commercial/HMO/PPO/Select: $365.65 BCBS — HPN: $296.67 BCBS — Managed Medicaid: $160.01 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $95.65 Carolina Complete Health — Managed Medicaid: $160.01
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Outpatient New Moderate Mdm 45 Minutes	$527	$263.50	$101.72 – $430.65
New patient office visit (about 45–59 minutes): 10 of 14 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $339.95 Aetna — Medicare Advantage HMO: $153.65 Aetna — Medicare Advantage PPO: $162.24 AmeriHealth — Managed Medicaid: $160.01 BCBS — Commercial/HMO/PPO/Select: $365.65 BCBS — Managed Medicaid: $160.01 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $164.63 Carolina Complete Health — Managed Medicaid: $160.01 Cigna — Commercial/HMO/PPO: $394.57 Humana — Medicare Advantage: $420.75
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Office/Outpatient New High Mdm 60 Minutes	$686	$343	$129.73 – $596.82
New patient office visit (about 60–74 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $494.55 Aetna — Medicare Advantage HMO: $430.03 Aetna — Medicare Advantage PPO: $214.01 Alliance Health — Managed Medicaid: $132.38 AmeriHealth — Managed Medicaid: $201.48 BCBS — Commercial/HMO/PPO/Select: $494.55 BCBS — HPN: $373.38 BCBS — Managed Medicaid: $201.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $457.36 Carolina Complete Health — Managed Medicaid: $201.48
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office/Outpatient New High Mdm 60 Minutes	$681	$340.50	$130.80 – $612.90
New patient office visit (about 60–74 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $455.36 Aetna — Medicare Advantage HMO: $361.67 Aetna — Medicare Advantage PPO: $214.01 Alliance Health — Managed Medicaid: $132.38 AmeriHealth — Managed Medicaid: $201.48 BCBS — Commercial/HMO/PPO/Select: $455.94 BCBS — HPN: $373.38 BCBS — Managed Medicaid: $201.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $455.94 Carolina Complete Health — Managed Medicaid: $201.48
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Outpatient New High Mdm 60 Minutes	$681	$340.50	$132.38 – $565.50
New patient office visit (about 60–74 minutes): 10 of 14 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $427.83 Aetna — Medicare Advantage HMO: $202.68 Aetna — Medicare Advantage PPO: $214.01 AmeriHealth — Managed Medicaid: $201.48 BCBS — Commercial/HMO/PPO/Select: $455.94 BCBS — Managed Medicaid: $201.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $217.15 Carolina Complete Health — Managed Medicaid: $201.48 Cigna — Commercial/HMO/PPO: $496.27 Humana — Medicare Advantage: $552.50
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Office/Outpatient Established Low Mdm 20 Min	$223	$111.50	$39.32 – $203.96
Established patient office visit (about 20–29 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $97.08 Aetna — Medicare Advantage HMO: $86.68 Aetna — Medicare Advantage PPO: $88.21 Alliance Health — Managed Medicaid: $40.13 AmeriHealth — Managed Medicaid: $70.86 BCBS — Commercial/HMO/PPO/Select: $166.65 BCBS — HPN: $128.69 BCBS — Managed Medicaid: $70.86 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $89.51 Carolina Complete Health — Managed Medicaid: $70.86
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office/Outpatient Established Low Mdm 20 Min	$223	$111.50	$40.13 – $194.01
Established patient office visit (about 20–29 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $97.08 Aetna — Medicare Advantage HMO: $83.54 Aetna — Medicare Advantage PPO: $88.21 Alliance Health — Managed Medicaid: $40.13 AmeriHealth — Managed Medicaid: $70.86 BCBS — Commercial/HMO/PPO/Select: $159.72 BCBS — HPN: $128.69 BCBS — Managed Medicaid: $70.86 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $89.51 Carolina Complete Health — Managed Medicaid: $70.86
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Outpatient Established Low Mdm 20 Min	$223	$111.50	$40.13 – $194.01
Established patient office visit (about 20–29 minutes): 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $97.08 Aetna — Medicare Advantage HMO: $83.54 Aetna — Medicare Advantage PPO: $88.21 AmeriHealth — Managed Medicaid: $70.86 BCBS — Commercial/HMO/PPO/Select: $159.72 BCBS — Managed Medicaid: $70.86 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $89.51 Carolina Complete Health — Managed Medicaid: $70.86 Cigna — Commercial/HMO/PPO: $162 Cigna — Medicare Advantage: $88.21
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Office/Outpatient Established Mod Mdm 30 Min	$446	$223	$60.84 – $388.02
Established patient office visit (about 30–39 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $224.82 Aetna — Medicare Advantage HMO: $89.45 Aetna — Medicare Advantage PPO: $94.45 Alliance Health — Managed Medicaid: $62.08 AmeriHealth — Managed Medicaid: $89.05 BCBS — Commercial/HMO/PPO/Select: $238.60 BCBS — HPN: $193.09 BCBS — Managed Medicaid: $89.05 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $95.84 Carolina Complete Health — Managed Medicaid: $89.05
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office/Outpatient Established Mod Mdm 30 Min	$318	$159	$62.08 – $286.30
Established patient office visit (about 30–39 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $224.82 Aetna — Medicare Advantage HMO: $89.45 Aetna — Medicare Advantage PPO: $94.45 Alliance Health — Managed Medicaid: $62.08 AmeriHealth — Managed Medicaid: $89.05 BCBS — Commercial/HMO/PPO/Select: $237.79 BCBS — HPN: $193.09 BCBS — Managed Medicaid: $89.05 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $95.84 Carolina Complete Health — Managed Medicaid: $89.05
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Outpatient Established Mod Mdm 30 Min	$318	$159	$62.08 – $286.20
Established patient office visit (about 30–39 minutes): 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $224.82 Aetna — Medicare Advantage HMO: $89.45 Aetna — Medicare Advantage PPO: $94.45 AmeriHealth — Managed Medicaid: $81.76 BCBS — Commercial/HMO/PPO/Select: $237.11 BCBS — Managed Medicaid: $81.76 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $95.84 Carolina Complete Health — Managed Medicaid: $81.76 Cigna — Commercial/HMO/PPO: $238.43 Cigna — Medicare Advantage: $124.63
Office consultation with a specialist (moderate) CPT 99243 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Office/OP Consltj New/Est Pt Low Mdm 30 Minutes	$375	$187.50	$33.69 – $339.95
Office consultation with a specialist (moderate): 10 of 20 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $339.95 Aetna — Medicare Advantage HMO: $80.05 Aetna — Medicare Advantage PPO: $83.71 Alliance Health — Managed Medicaid: $78.66 AmeriHealth — Managed Medicaid: $99.91 BCBS — Commercial/HMO/PPO/Select: $271.77 BCBS — HPN: $244.71 BCBS — Managed Medicaid: $99.91 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $85.76 Carolina Complete Health — Managed Medicaid: $99.91
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office/OP Consltj New/Est Pt Low Mdm 30 Minutes	$375	$187.50	$77.76 – $339.95
Office consultation with a specialist (moderate): 10 of 19 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $339.95 Aetna — Medicare Advantage HMO: $79.28 Aetna — Medicare Advantage PPO: $83.71 Alliance Health — Managed Medicaid: $78.66 AmeriHealth — Managed Medicaid: $99.91 BCBS — Commercial/HMO/PPO/Select: $271.77 BCBS — HPN: $244.71 BCBS — Managed Medicaid: $99.91 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $109.51 Carolina Complete Health — Managed Medicaid: $99.91
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/OP Consltj New/Est Pt Low Mdm 30 Minutes	$375	$187.50	$99.91 – $177.65
Office consultation with a specialist (moderate): rates for 5 insurance plans AmeriHealth — Managed Medicaid: $99.91 BCBS — Managed Medicaid: $99.91 Carolina Complete Health — Managed Medicaid: $99.91 Humana — Medicare Advantage: $105.81 United Healthcare — Managed Medicaid: $99.91
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes	$557	$278.50	$110.82 – $484.59
Office consultation with a specialist (moderate to high): 10 of 20 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $427.83 Aetna — Medicare Advantage HMO: $386.88 Aetna — Medicare Advantage PPO: $162.24 Alliance Health — Managed Medicaid: $124.91 AmeriHealth — Managed Medicaid: $176.20 BCBS — Commercial/HMO/PPO/Select: $404.27 BCBS — HPN: $364.02 BCBS — Managed Medicaid: $176.20 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $164.63 Carolina Complete Health — Managed Medicaid: $176.20
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes	$557	$278.50	$107.21 – $484.59
Office consultation with a specialist (moderate to high): 10 of 19 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $427.83 Aetna — Medicare Advantage HMO: $412.65 Aetna — Medicare Advantage PPO: $162.24 Alliance Health — Managed Medicaid: $124.91 AmeriHealth — Managed Medicaid: $148.71 BCBS — Commercial/HMO/PPO/Select: $404.27 BCBS — HPN: $364.02 BCBS — Managed Medicaid: $148.71 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $164.63 Carolina Complete Health — Managed Medicaid: $148.71
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes	$557	$278.50	$121.84 – $484.59
Office consultation with a specialist (moderate to high): 10 of 13 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $326.26 Aetna — Medicare Advantage HMO: $153.65 Aetna — Medicare Advantage PPO: $162.24 AmeriHealth — Managed Medicaid: $148.40 BCBS — Commercial/HMO/PPO/Select: $366.08 BCBS — Managed Medicaid: $148.40 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $156.28 Carolina Complete Health — Managed Medicaid: $148.40 Cigna — Commercial/HMO/PPO: $443.72 Humana — Medicare Advantage: $473.45
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Level 3	$1,261	$340.47	$154.83 – $1,594.73
Emergency room visit (moderate): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $697.33 Aetna — Medicare Advantage HMO: $266.39 Aetna — Medicare Advantage PPO: $266.39 Aetna — Whole Health: $471.61 Alliance Health — Managed Medicaid: $316.76 AmeriHealth — Managed Medicaid: $316.76 BCBS — Commercial/HMO/PPO/Select: $636.81 BCBS — Managed Medicaid: $316.76 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $266.39 Carolina Complete Health — Managed Medicaid: $316.76
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Emergency Department Visit Low Mdm	$251	$125.50	$49.81 – $197.49
Emergency room visit (moderate): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $129.99 Aetna — Medicare Advantage HMO: $65.21 Aetna — Medicare Advantage PPO: $68.85 Alliance Health — Managed Medicaid: $49.81 AmeriHealth — Managed Medicaid: $54.86 BCBS — Commercial/HMO/PPO/Select: $142.28 BCBS — HPN: $121.70 BCBS — Managed Medicaid: $54.86 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $69.86 Carolina Complete Health — Managed Medicaid: $54.86
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency Department Visit Low Mdm	$251	$125.50	$49.81 – $199.76
Emergency room visit (moderate): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $129.99 Aetna — Medicare Advantage HMO: $65.21 Aetna — Medicare Advantage PPO: $68.85 Alliance Health — Managed Medicaid: $49.81 AmeriHealth — Managed Medicaid: $51.25 BCBS — Commercial/HMO/PPO/Select: $142.28 BCBS — HPN: $121.70 BCBS — Managed Medicaid: $50.96 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $69.86 Carolina Complete Health — Managed Medicaid: $54.18
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Level 4	$2,065	$557.55	$387.83 – $5,214.72
Emergency room visit (moderately high): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,141.95 Aetna — Medicare Advantage HMO: $409.67 Aetna — Medicare Advantage PPO: $409.67 Aetna — Whole Health: $772.31 Alliance Health — Managed Medicaid: $518.73 AmeriHealth — Managed Medicaid: $518.73 BCBS — Commercial/HMO/PPO/Select: $1,042.83 BCBS — Managed Medicaid: $518.73 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $5,214.72 Carolina Complete Health — Managed Medicaid: $518.73
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Emergency Department Visit Moderate Mdm	$477	$238.50	$93.26 – $333.21
Emergency room visit (moderately high): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $246.65 Aetna — Medicare Advantage HMO: $110.98 Aetna — Medicare Advantage PPO: $117.19 Alliance Health — Managed Medicaid: $93.26 AmeriHealth — Managed Medicaid: $93.26 BCBS — Commercial/HMO/PPO/Select: $268.09 BCBS — HPN: $228.61 BCBS — Managed Medicaid: $93.26 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $96.06 Carolina Complete Health — Managed Medicaid: $93.26
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency Department Visit Moderate Mdm	$477	$238.50	$93.26 – $333.21
Emergency room visit (moderately high): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $284.68 Aetna — Medicare Advantage HMO: $174.68 Aetna — Medicare Advantage PPO: $117.19 Alliance Health — Managed Medicaid: $93.26 AmeriHealth — Managed Medicaid: $97.50 BCBS — Commercial/HMO/PPO/Select: $284.68 BCBS — HPN: $228.61 BCBS — Managed Medicaid: $96.62 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $96.06 Carolina Complete Health — Managed Medicaid: $93.26
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Level 5	$3,556	$960.12	$319.36 – $5,621.95
Emergency room visit (high): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,973.64 Aetna — Medicare Advantage HMO: $589.85 Aetna — Medicare Advantage PPO: $589.85 Aetna — Whole Health: $1,329.94 Alliance Health — Managed Medicaid: $930.81 AmeriHealth — Managed Medicaid: $930.81 BCBS — Commercial/HMO/PPO/Select: $1,927.38 BCBS — Managed Medicaid: $930.81 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $589.85 Carolina Complete Health — Managed Medicaid: $930.81
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Emergency Department Visit High Mdm	$702	$351	$132.83 – $484.59
Emergency room visit (high): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $363.25 Aetna — Medicare Advantage HMO: $160.83 Aetna — Medicare Advantage PPO: $169.82 Alliance Health — Managed Medicaid: $138.64 AmeriHealth — Managed Medicaid: $153.40 BCBS — Commercial/HMO/PPO/Select: $393.35 BCBS — HPN: $337.69 BCBS — Managed Medicaid: $153.40 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $172.32 Carolina Complete Health — Managed Medicaid: $153.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency Department Visit High Mdm	$702	$351	$132.83 – $519
Emergency room visit (high): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $363.25 Aetna — Medicare Advantage HMO: $310.19 Aetna — Medicare Advantage PPO: $165.55 Alliance Health — Managed Medicaid: $138.64 AmeriHealth — Managed Medicaid: $142.67 BCBS — Commercial/HMO/PPO/Select: $394.38 BCBS — HPN: $337.69 BCBS — Managed Medicaid: $141.06 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $394.38 Carolina Complete Health — Managed Medicaid: $153.40

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Basic Metabolic Panel Total Ca	$275	$74.25	$19.15 – $284.75
Basic metabolic panel (blood test): 10 of 15 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $152.08 Aetna — Medicare Advantage HMO: $63.25 Aetna — Medicare Advantage PPO: $63.25 AmeriHealth — Managed Medicaid: $69.08 BCBS — Commercial/HMO/PPO/Select: $138.88 BCBS — Managed Medicaid: $69.08 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $68.75 Carolina Complete Health — Managed Medicaid: $69.08 Cigna — Commercial/HMO/PPO: $275 Cigna — Connect: $137.50
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic Metabolic Panel Total Ca	$275	$74.25	$18.61 – $247.50
Basic metabolic panel (blood test): rates for 8 insurance plans Aetna — Commercial/HMO/PPO/POS: $163.16 Aetna — Whole Health: $102.85 BCBS — Commercial/HMO/PPO/Select: $138.88 Cigna — Commercial/HMO/PPO: $22.24 Cigna — Connect: $103.95 Humana — ChoiceCare: $233.75 MedCost — Ultra: $117.15 Sentara — Optima: $171.32
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee In the file: Basic Metabolic Panel Total Ca	$275	$74.25	$18.61 – $178.75
Basic metabolic panel (blood test): rates for 5 insurance plans Aetna — Commercial/HMO/PPO/POS: $152.08 Aetna — Whole Health: $102.85 BCBS — Commercial/HMO/PPO/Select: $138.88 Cigna — Connect: $101.48 MedCost — Ultra: $117.15
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$400	$108	$62.91 – $412.98
Comprehensive metabolic panel (blood test): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $221.20 Aetna — Medicare Advantage HMO: $92 Aetna — Medicare Advantage PPO: $92 Alliance Health — Managed Medicaid: $62.91 AmeriHealth — Managed Medicaid: $62.91 BCBS — Commercial/HMO/PPO/Select: $202 BCBS — Managed Medicaid: $62.91 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $98 Carolina Complete Health — Managed Medicaid: $62.91 Cigna — Commercial/HMO/PPO: $400
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$400	$108	$23.23 – $360
Comprehensive metabolic panel (blood test): rates for 8 insurance plans Aetna — Commercial/HMO/PPO/POS: $223.57 Aetna — Whole Health: $151.66 BCBS — Commercial/HMO/PPO/Select: $202 Cigna — Commercial/HMO/PPO: $27.58 Cigna — Connect: $151.20 Humana — ChoiceCare: $340 MedCost — Ultra: $170.40 Sentara — Optima: $249.20
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$400	$108	$23.23 – $260
Comprehensive metabolic panel (blood test): rates for 5 insurance plans Aetna — Commercial/HMO/PPO/POS: $221.20 Aetna — Whole Health: $149.60 BCBS — Commercial/HMO/PPO/Select: $202 Cigna — Connect: $147.60 MedCost — Ultra: $170.40
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel	$222	$59.94	$12.93 – $199.80
Cholesterol panel (lipid panel): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $122.98 Aetna — Medicare Advantage HMO: $13.39 Aetna — Medicare Advantage PPO: $13.40 Aetna — Whole Health: $83.03 Alliance Health — Managed Medicaid: $16.70 AmeriHealth — Managed Medicaid: $16.70 BCBS — Commercial/HMO/PPO/Select: $79.38 BCBS — Managed Medicaid: $16.70 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $13.39 Carolina Complete Health — Managed Medicaid: $16.70
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Lipid Panel	$222	$59.94	$13.12 – $222
Cholesterol panel (lipid panel): 10 of 18 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $122.77 Aetna — Medicare Advantage HMO: $51.06 Aetna — Medicare Advantage PPO: $51.06 Alliance Health — Managed Medicaid: $22.82 AmeriHealth — Managed Medicaid: $55.77 BCBS — Commercial/HMO/PPO/Select: $112.11 BCBS — Managed Medicaid: $55.77 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $55.50 Carolina Complete Health — Managed Medicaid: $55.77 Cigna — Commercial/HMO/PPO: $222
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Hospital (facility) fee In the file: Lipid Panel	$222	$59.94	$12.68 – $144.30
Cholesterol panel (lipid panel): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $122.77 Aetna — Medicare Advantage HMO: $12.68 Aetna — Medicare Advantage PPO: $13.38 Aetna — Whole Health: $83.03 Alliance Health — Managed Medicaid: $16.70 AmeriHealth — Managed Medicaid: $16.70 BCBS — Commercial/HMO/PPO/Select: $57.05 BCBS — Managed Medicaid: $16.70 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $13.14 Carolina Complete Health — Managed Medicaid: $16.70
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Renal Function Panel	$347	$93.69	$79.46 – $768.67
Kidney function panel: 10 of 15 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $191.89 Aetna — Medicare Advantage HMO: $79.81 Aetna — Medicare Advantage PPO: $79.81 AmeriHealth — Managed Medicaid: $87.17 BCBS — Commercial/HMO/PPO/Select: $175.24 BCBS — Managed Medicaid: $87.17 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $86.75 Carolina Complete Health — Managed Medicaid: $87.17 Cigna — Commercial/HMO/PPO: $347 Cigna — Connect: $173.50
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel	$347	$93.69	$19.10 – $312.30
Kidney function panel: rates for 8 insurance plans Aetna — Commercial/HMO/PPO/POS: $198.88 Aetna — Whole Health: $129.78 BCBS — Commercial/HMO/PPO/Select: $89.18 Cigna — Commercial/HMO/PPO: $23.14 Cigna — Connect: $131.17 Humana — ChoiceCare: $294.95 MedCost — Ultra: $147.82 Sentara — Optima: $216.18
Kidney function panel CPT 80069 · Inpatient or outpatient · Hospital (facility) fee In the file: Renal Function Panel	$347	$93.69	$19.10 – $225.55
Kidney function panel: rates for 5 insurance plans Aetna — Commercial/HMO/PPO/POS: $191.89 Aetna — Whole Health: $129.78 BCBS — Commercial/HMO/PPO/Select: $89.18 Cigna — Connect: $128.04 MedCost — Ultra: $147.82
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$262	$70.74	$14.62 – $262
Liver function panel: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $144.89 Aetna — Medicare Advantage HMO: $60.26 Aetna — Medicare Advantage PPO: $60.26 Alliance Health — Managed Medicaid: $14.62 AmeriHealth — Managed Medicaid: $65.81 BCBS — Commercial/HMO/PPO/Select: $132.31 BCBS — Managed Medicaid: $65.81 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $65.50 Carolina Complete Health — Managed Medicaid: $65.81 Cigna — Commercial/HMO/PPO: $262
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$262	$70.74	$17.97 – $235.80
Liver function panel: rates for 8 insurance plans Aetna — Commercial/HMO/PPO/POS: $145.13 Aetna — Whole Health: $97.99 BCBS — Commercial/HMO/PPO/Select: $91.68 Cigna — Commercial/HMO/PPO: $21.35 Cigna — Connect: $99.04 Humana — ChoiceCare: $222.70 MedCost — Ultra: $111.61 Sentara — Optima: $163.23
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee In the file: Hepatic Function Panel	$262	$70.74	$17.97 – $170.30
Liver function panel: rates for 5 insurance plans Aetna — Commercial/HMO/PPO/POS: $144.89 Aetna — Whole Health: $97.99 BCBS — Commercial/HMO/PPO/Select: $67.33 Cigna — Connect: $96.68 MedCost — Ultra: $111.61
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Urinalysis Auto W Micro	$88	$23.76	$5.53 – $88
Urine test (automated, with microscope): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $48.66 Aetna — Medicare Advantage HMO: $20.24 Aetna — Medicare Advantage PPO: $20.24 Alliance Health — Managed Medicaid: $5.53 AmeriHealth — Managed Medicaid: $5.53 BCBS — Commercial/HMO/PPO/Select: $44.44 BCBS — Managed Medicaid: $5.53 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $22 Carolina Complete Health — Managed Medicaid: $5.53 Cigna — Commercial/HMO/PPO: $88
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Auto W Micro	$88	$23.76	$4.98 – $109.39
Urine test (automated, with microscope): rates for 8 insurance plans Aetna — Commercial/HMO/PPO/POS: $49.01 Aetna — Whole Health: $32.91 BCBS — Commercial/HMO/PPO/Select: $36.96 Cigna — Commercial/HMO/PPO: $8.01 Cigna — Connect: $33.26 Humana — ChoiceCare: $74.80 MedCost — Ultra: $37.49 Sentara — Optima: $54.82
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Hospital (facility) fee In the file: Urinalysis Auto W Micro	$88	$23.76	$6.97 – $57.20
Urine test (automated, with microscope): rates for 5 insurance plans Aetna — Commercial/HMO/PPO/POS: $48.66 Aetna — Whole Health: $32.91 BCBS — Commercial/HMO/PPO/Select: $22.62 Cigna — Connect: $32.47 MedCost — Ultra: $37.49
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Non-Auto WO Micro	$52	$14.04	$3.19 – $52
Urine test (manual, without microscope): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $28.76 Aetna — Medicare Advantage HMO: $3.48 Aetna — Medicare Advantage PPO: $3.48 Aetna — Whole Health: $19.45 Alliance Health — Managed Medicaid: $3.19 AmeriHealth — Managed Medicaid: $3.19 BCBS — Commercial/HMO/PPO/Select: $19.81 BCBS — Managed Medicaid: $3.19 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $3.48 Carolina Complete Health — Managed Medicaid: $3.19
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ph Urine by Dipstick	$52	$14.04	$3.19 – $52
Urine test (manual, without microscope): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $28.76 Aetna — Medicare Advantage HMO: $3.48 Aetna — Medicare Advantage PPO: $3.48 Aetna — Whole Health: $19.45 Alliance Health — Managed Medicaid: $3.19 AmeriHealth — Managed Medicaid: $3.19 BCBS — Commercial/HMO/PPO/Select: $19.81 BCBS — Managed Medicaid: $3.19 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $3.48 Carolina Complete Health — Managed Medicaid: $3.19
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urnls Dip Stick/Tablet Rgnt Non-Auto W/O Micrscp	$52	$14.04	$3.19 – $52
Urine test (manual, without microscope): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $28.76 Aetna — Medicare Advantage HMO: $3.48 Aetna — Medicare Advantage PPO: $3.48 Aetna — Whole Health: $19.45 Alliance Health — Managed Medicaid: $3.19 AmeriHealth — Managed Medicaid: $3.19 BCBS — Commercial/HMO/PPO/Select: $19.81 BCBS — Managed Medicaid: $3.19 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $3.48 Carolina Complete Health — Managed Medicaid: $3.19
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Urinalysis Auto WO Micro	$69	$18.63	$3.83 – $69
Urine test (automated, without microscope): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $38.16 Aetna — Medicare Advantage HMO: $15.87 Aetna — Medicare Advantage PPO: $15.87 Alliance Health — Managed Medicaid: $3.83 AmeriHealth — Managed Medicaid: $3.83 BCBS — Commercial/HMO/PPO/Select: $34.85 BCBS — Managed Medicaid: $3.83 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $17.25 Carolina Complete Health — Managed Medicaid: $3.83 Cigna — Commercial/HMO/PPO: $69
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Auto WO Micro	$69	$18.63	$3.55 – $69
Urine test (automated, without microscope): rates for 8 insurance plans Aetna — Commercial/HMO/PPO/POS: $38.18 Aetna — Whole Health: $25.81 BCBS — Commercial/HMO/PPO/Select: $34.85 Cigna — Commercial/HMO/PPO: $6.23 Cigna — Connect: $26.08 Humana — ChoiceCare: $58.65 MedCost — Ultra: $29.39 Sentara — Optima: $42.99
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Hospital (facility) fee In the file: Urinalysis Auto WO Micro	$69	$18.63	$4.95 – $44.85
Urine test (automated, without microscope): rates for 5 insurance plans Aetna — Commercial/HMO/PPO/POS: $38.16 Aetna — Whole Health: $25.81 BCBS — Commercial/HMO/PPO/Select: $34.85 Cigna — Connect: $25.46 MedCost — Ultra: $29.39
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psa Total	$235	$63.45	$17.47 – $211.50
PSA (prostate specific antigen) blood test: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $130.37 Aetna — Medicare Advantage HMO: $18.39 Aetna — Medicare Advantage PPO: $18.41 Aetna — Whole Health: $87.89 Alliance Health — Managed Medicaid: $22.92 AmeriHealth — Managed Medicaid: $22.92 BCBS — Commercial/HMO/PPO/Select: $118.68 BCBS — Managed Medicaid: $22.92 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $18.39 Carolina Complete Health — Managed Medicaid: $22.92
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee In the file: Psa Total	$235	$63.45	$17.41 – $152.75
PSA (prostate specific antigen) blood test: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $129.96 Aetna — Medicare Advantage HMO: $17.41 Aetna — Medicare Advantage PPO: $18.38 Aetna — Whole Health: $87.89 Alliance Health — Managed Medicaid: $22.92 AmeriHealth — Managed Medicaid: $22.92 BCBS — Commercial/HMO/PPO/Select: $118.68 BCBS — Managed Medicaid: $22.92 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $18.04 Carolina Complete Health — Managed Medicaid: $22.92
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Psa Total	$235	$63.45	$53.82 – $235
PSA (prostate specific antigen) blood test: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $129.96 Aetna — Medicare Advantage HMO: $54.05 Aetna — Medicare Advantage PPO: $54.05 Alliance Health — Managed Medicaid: $59.03 AmeriHealth — Managed Medicaid: $59.03 BCBS — Commercial/HMO/PPO/Select: $118.68 BCBS — Managed Medicaid: $59.03 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $58.75 Carolina Complete Health — Managed Medicaid: $59.03 Cigna — Commercial/HMO/PPO: $235
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH	$202	$54.54	$10.44 – $181.80
Thyroid stimulating hormone (TSH) test: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $111.72 Aetna — Medicare Advantage HMO: $16.80 Aetna — Medicare Advantage PPO: $16.82 Aetna — Whole Health: $75.55 Alliance Health — Managed Medicaid: $20.31 AmeriHealth — Managed Medicaid: $20.31 BCBS — Commercial/HMO/PPO/Select: $67.57 BCBS — Managed Medicaid: $20.31 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $16.80 Carolina Complete Health — Managed Medicaid: $20.31
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: TSH	$202	$54.54	$16.46 – $202
Thyroid stimulating hormone (TSH) test: 10 of 18 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $111.71 Aetna — Medicare Advantage HMO: $46.46 Aetna — Medicare Advantage PPO: $46.46 Alliance Health — Managed Medicaid: $57.45 AmeriHealth — Managed Medicaid: $57.45 BCBS — Commercial/HMO/PPO/Select: $102.01 BCBS — Managed Medicaid: $57.45 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $50.50 Carolina Complete Health — Managed Medicaid: $57.45 Cigna — Commercial/HMO/PPO: $202
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Hospital (facility) fee In the file: TSH	$202	$54.54	$15.90 – $131.30
Thyroid stimulating hormone (TSH) test: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $111.71 Aetna — Medicare Advantage HMO: $15.90 Aetna — Medicare Advantage PPO: $16.79 Aetna — Whole Health: $75.55 Alliance Health — Managed Medicaid: $20.31 AmeriHealth — Managed Medicaid: $20.31 BCBS — Commercial/HMO/PPO/Select: $102.01 BCBS — Managed Medicaid: $20.31 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $16.48 Carolina Complete Health — Managed Medicaid: $20.31
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc W Auto Diff	$126	$34.02	$7.51 – $113.40
Complete blood count (CBC) with differential: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $71.10 Aetna — Medicare Advantage HMO: $7.77 Aetna — Medicare Advantage PPO: $7.78 Aetna — Whole Health: $47.41 Alliance Health — Managed Medicaid: $9.68 AmeriHealth — Managed Medicaid: $9.68 BCBS — Commercial/HMO/PPO/Select: $63.63 BCBS — Managed Medicaid: $9.68 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $7.77 Carolina Complete Health — Managed Medicaid: $9.68
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cbc W Auto Diff	$126	$34.02	$7.61 – $126
Complete blood count (CBC) with differential: 10 of 18 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $69.68 Aetna — Medicare Advantage HMO: $28.98 Aetna — Medicare Advantage PPO: $28.98 Alliance Health — Managed Medicaid: $26.07 AmeriHealth — Managed Medicaid: $31.65 BCBS — Commercial/HMO/PPO/Select: $63.63 BCBS — Managed Medicaid: $31.65 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $31.50 Carolina Complete Health — Managed Medicaid: $31.65 Cigna — Commercial/HMO/PPO: $63
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Hospital (facility) fee In the file: Cbc W Auto Diff	$126	$34.02	$7.36 – $81.90
Complete blood count (CBC) with differential: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $69.68 Aetna — Medicare Advantage HMO: $7.36 Aetna — Medicare Advantage PPO: $7.77 Aetna — Whole Health: $47.12 Alliance Health — Managed Medicaid: $9.68 AmeriHealth — Managed Medicaid: $9.68 BCBS — Commercial/HMO/PPO/Select: $63.63 BCBS — Managed Medicaid: $9.68 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $7.62 Carolina Complete Health — Managed Medicaid: $9.68
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc Auto WO Diff	$103	$27.81	$6.25 – $92.70
Complete blood count (CBC), automated: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $57.34 Aetna — Medicare Advantage HMO: $6.47 Aetna — Medicare Advantage PPO: $6.48 Aetna — Whole Health: $38.52 Alliance Health — Managed Medicaid: $8.07 AmeriHealth — Managed Medicaid: $8.07 BCBS — Commercial/HMO/PPO/Select: $43.07 BCBS — Managed Medicaid: $8.07 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $6.47 Carolina Complete Health — Managed Medicaid: $8.07
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cbc Auto WO Diff	$103	$27.81	$6.34 – $106.43
Complete blood count (CBC), automated: 10 of 18 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $56.96 Aetna — Medicare Advantage HMO: $23.69 Aetna — Medicare Advantage PPO: $23.69 Alliance Health — Managed Medicaid: $13.90 AmeriHealth — Managed Medicaid: $25.87 BCBS — Commercial/HMO/PPO/Select: $52.02 BCBS — Managed Medicaid: $25.87 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $25.75 Carolina Complete Health — Managed Medicaid: $25.87 Cigna — Commercial/HMO/PPO: $51.50
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Hospital (facility) fee In the file: Cbc Auto WO Diff	$103	$27.81	$6.13 – $66.95
Complete blood count (CBC), automated: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $56.96 Aetna — Medicare Advantage HMO: $6.13 Aetna — Medicare Advantage PPO: $6.47 Aetna — Whole Health: $38.52 Alliance Health — Managed Medicaid: $8.07 AmeriHealth — Managed Medicaid: $8.07 BCBS — Commercial/HMO/PPO/Select: $26.47 BCBS — Managed Medicaid: $8.07 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $6.35 Carolina Complete Health — Managed Medicaid: $8.07
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Othrombin Time	$29.75	$14.88	$2.81 – $132.83
Blood clotting time test (prothrombin time, PT): 10 of 24 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $9.49 Aetna — Medicare Advantage HMO: $5 Aetna — Medicare Advantage PPO: $4.38 Alliance Health — Managed Medicaid: $4.85 AmeriHealth — Managed Medicaid: $4.90 BCBS — Commercial/HMO/PPO/Select: $9.10 BCBS — HPN: $8.24 BCBS — Managed Medicaid: $4.90 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $8.24 Carolina Complete Health — Managed Medicaid: $4.90
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Othrombin Time	$29.75	$14.88	$2.17 – $132.83
Blood clotting time test (prothrombin time, PT): 10 of 24 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $4.63 Aetna — Medicare Advantage HMO: $4.14 Aetna — Medicare Advantage PPO: $4.38 Alliance Health — Managed Medicaid: $4.85 AmeriHealth — Managed Medicaid: $4.90 BCBS — Commercial/HMO/PPO/Select: $8.24 BCBS — HPN: $8.24 BCBS — Managed Medicaid: $4.90 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $4.44 Carolina Complete Health — Managed Medicaid: $4.90
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time	$86	$23.22	$4.31 – $77.40
Blood clotting time test (prothrombin time, PT): 10 of 19 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $49.51 Aetna — Whole Health: $34.28 Alliance Health — Managed Medicaid: $4.90 AmeriHealth — Managed Medicaid: $4.90 BCBS — Commercial/HMO/PPO/Select: $40.67 BCBS — Managed Medicaid: $4.90 Carolina Complete Health — Managed Medicaid: $4.90 Cigna — Commercial/HMO/PPO: $11.57 Cigna — Connect: $32.51 Cigna — Medicare Advantage: $4.38
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin Time (Aptt)	$97	$26.19	$5.81 – $174.38
Blood clotting test (partial thromboplastin time, PTT): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $56.78 Aetna — Medicare Advantage HMO: $6.01 Aetna — Medicare Advantage PPO: $6.02 Aetna — Whole Health: $42.35 Alliance Health — Managed Medicaid: $7.48 AmeriHealth — Managed Medicaid: $7.48 BCBS — Commercial/HMO/PPO/Select: $48.99 BCBS — Managed Medicaid: $7.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $6.01 Carolina Complete Health — Managed Medicaid: $7.48
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: Thromboplastin Time (Aptt)	$97	$26.19	$5.69 – $63.05
Blood clotting test (partial thromboplastin time, PTT): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $53.64 Aetna — Medicare Advantage HMO: $5.69 Aetna — Medicare Advantage PPO: $6.01 Aetna — Whole Health: $36.28 Alliance Health — Managed Medicaid: $7.48 AmeriHealth — Managed Medicaid: $7.48 BCBS — Commercial/HMO/PPO/Select: $48.99 BCBS — Managed Medicaid: $7.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $5.90 Carolina Complete Health — Managed Medicaid: $7.48
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Thromboplastin Time (Aptt)	$97	$26.19	$5.89 – $100.65
Blood clotting test (partial thromboplastin time, PTT): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $53.64 Aetna — Medicare Advantage HMO: $22.31 Aetna — Medicare Advantage PPO: $22.31 Alliance Health — Managed Medicaid: $10.36 AmeriHealth — Managed Medicaid: $24.37 BCBS — Commercial/HMO/PPO/Select: $48.99 BCBS — Managed Medicaid: $24.37 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $24.25 Carolina Complete Health — Managed Medicaid: $24.37 Cigna — Commercial/HMO/PPO: $97

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Head/Brain WO Cntrst	$1,675	$452.25	$95.60 – $1,675
CT scan of the head or brain, without contrast: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $926.28 Aetna — Medicare Advantage HMO: $98.96 Aetna — Medicare Advantage PPO: $99.06 Aetna — Whole Health: $429 Alliance Health — Managed Medicaid: $451.39 AmeriHealth — Managed Medicaid: $451.39 BCBS — Commercial/HMO/PPO/Select: $778.87 BCBS — Managed Medicaid: $451.39 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $98.96 Carolina Complete Health — Managed Medicaid: $451.39
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Head/Brain WO Cntrst	$1,675	$452.25	$163.44 – $1,675
CT scan of the head or brain, without contrast: 10 of 18 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $926.28 Aetna — Medicare Advantage HMO: $385.25 Aetna — Medicare Advantage PPO: $385.25 Alliance Health — Managed Medicaid: $914.05 AmeriHealth — Managed Medicaid: $914.05 BCBS — Commercial/HMO/PPO/Select: $845.88 BCBS — Managed Medicaid: $914.05 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $418.75 Carolina Complete Health — Managed Medicaid: $914.05 Cigna — Commercial/HMO/PPO: $837.50
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Hospital (facility) fee In the file: CT Head/Brain WO Cntrst	$1,675	$452.25	$93.68 – $1,675
CT scan of the head or brain, without contrast: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $926.28 Aetna — Medicare Advantage HMO: $98.83 Aetna — Medicare Advantage PPO: $98.92 Aetna — Whole Health: $429 Alliance Health — Managed Medicaid: $378.72 AmeriHealth — Managed Medicaid: $378.72 BCBS — Commercial/HMO/PPO/Select: $1,675 BCBS — Managed Medicaid: $378.72 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $97.08 Carolina Complete Health — Managed Medicaid: $378.72
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Brain Wow Cntrst	$5,192	$1,401.84	$284.94 – $5,192
MRI of the brain, before and after contrast: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,871.18 Aetna — Medicare Advantage HMO: $374.23 Aetna — Medicare Advantage PPO: $385.13 Aetna — Whole Health: $746.07 Alliance Health — Managed Medicaid: $1,382.63 AmeriHealth — Managed Medicaid: $1,382.63 BCBS — Commercial/HMO/PPO/Select: $5,192 BCBS — Managed Medicaid: $1,382.63 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $413.31 Carolina Complete Health — Managed Medicaid: $1,382.63
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI Brain Wow Cntrst	$5,192	$1,401.84	$348.21 – $5,192
MRI of the brain, before and after contrast: 10 of 18 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,871.18 Aetna — Medicare Advantage HMO: $1,194.16 Aetna — Medicare Advantage PPO: $1,194.16 Alliance Health — Managed Medicaid: $2,600.15 AmeriHealth — Managed Medicaid: $2,600.15 BCBS — Commercial/HMO/PPO/Select: $2,621.96 BCBS — Managed Medicaid: $2,600.15 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,298 Carolina Complete Health — Managed Medicaid: $2,600.15 Cigna — Commercial/HMO/PPO: $5,192
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Hospital (facility) fee In the file: MRI Brain Wow Cntrst	$5,192	$1,401.84	$279.24 – $5,192
MRI of the brain, before and after contrast: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,871.18 Aetna — Medicare Advantage HMO: $331.91 Aetna — Medicare Advantage PPO: $350.46 Aetna — Whole Health: $672 Alliance Health — Managed Medicaid: $1,173.91 AmeriHealth — Managed Medicaid: $1,173.91 BCBS — Commercial/HMO/PPO/Select: $5,192 BCBS — Managed Medicaid: $1,173.91 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $343.59 Carolina Complete Health — Managed Medicaid: $1,173.91
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xr Chest 2 View	$345	$93.15	$26.24 – $345
Chest X-ray, 2 views: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $192.55 Aetna — Medicare Advantage HMO: $84.71 Aetna — Medicare Advantage PPO: $86.19 Aetna — Whole Health: $26.24 Alliance Health — Managed Medicaid: $86.66 AmeriHealth — Managed Medicaid: $86.66 BCBS — Commercial/HMO/PPO/Select: $177.07 BCBS — Managed Medicaid: $86.66 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $91.91 Carolina Complete Health — Managed Medicaid: $86.66
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Radiologic Exam Chest 2 Views	$127	$63.50	$20.27 – $1,458.31
Chest X-ray, 2 views: 10 of 24 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $76.20 Aetna — Medicare Advantage HMO: $63.41 Aetna — Medicare Advantage PPO: $32.13 Alliance Health — Managed Medicaid: $24.94 AmeriHealth — Managed Medicaid: $24.94 BCBS — Commercial/HMO/PPO/Select: $91.38 BCBS — HPN: $60.32 BCBS — Managed Medicaid: $24.94 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $69.54 Carolina Complete Health — Managed Medicaid: $24.94
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Radiologic Exam Chest 2 Views	$127	$63.50	$20.73 – $1,458.31
Chest X-ray, 2 views: 10 of 24 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $76.20 Aetna — Medicare Advantage HMO: $31.60 Aetna — Medicare Advantage PPO: $32.13 Alliance Health — Managed Medicaid: $24.94 AmeriHealth — Managed Medicaid: $24.94 BCBS — Commercial/HMO/PPO/Select: $66.99 BCBS — HPN: $60.32 BCBS — Managed Medicaid: $24.94 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $49.41 Carolina Complete Health — Managed Medicaid: $24.94
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xr Spine Lumbosacral Min 4v	$513	$138.51	$45.58 – $513
X-ray of the lower spine, at least 4 views: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $283.69 Aetna — Medicare Advantage HMO: $96.85 Aetna — Medicare Advantage PPO: $47.23 Aetna — Whole Health: $191.86 Alliance Health — Managed Medicaid: $128.87 AmeriHealth — Managed Medicaid: $128.87 BCBS — Commercial/HMO/PPO/Select: $259.07 BCBS — Managed Medicaid: $128.87 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $47.18 Carolina Complete Health — Managed Medicaid: $128.87
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Hospital (facility) fee In the file: Xr Spine Lumbosacral Min 4v	$513	$138.51	$44.66 – $513
X-ray of the lower spine, at least 4 views: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $283.69 Aetna — Medicare Advantage HMO: $98.83 Aetna — Medicare Advantage PPO: $47.16 Aetna — Whole Health: $191.86 Alliance Health — Managed Medicaid: $115.99 AmeriHealth — Managed Medicaid: $115.99 BCBS — Commercial/HMO/PPO/Select: $259.07 BCBS — Managed Medicaid: $115.99 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $46.28 Carolina Complete Health — Managed Medicaid: $115.99
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Xr Spine Lumbosacral Min 4v	$513	$138.51	$117.99 – $513
X-ray of the lower spine, at least 4 views: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $283.69 Aetna — Medicare Advantage HMO: $117.99 Aetna — Medicare Advantage PPO: $117.99 Alliance Health — Managed Medicaid: $128.87 AmeriHealth — Managed Medicaid: $128.87 BCBS — Commercial/HMO/PPO/Select: $259.07 BCBS — Managed Medicaid: $128.87 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $128.25 Carolina Complete Health — Managed Medicaid: $128.87 Cigna — Commercial/HMO/PPO: $513
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Lumb Spine WO Cntrst	$3,245	$876.15	$171.09 – $3,245
MRI of the lower back (lumbar spine), without contrast: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,794.49 Aetna — Medicare Advantage HMO: $232.55 Aetna — Medicare Advantage PPO: $252.99 Aetna — Whole Health: $672 Alliance Health — Managed Medicaid: $847.04 AmeriHealth — Managed Medicaid: $847.04 BCBS — Commercial/HMO/PPO/Select: $3,245 BCBS — Managed Medicaid: $847.04 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $232.55 Carolina Complete Health — Managed Medicaid: $847.04
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Hospital (facility) fee In the file: MRI Lumb Spine WO Cntrst	$3,245	$876.15	$167.67 – $3,245
MRI of the lower back (lumbar spine), without contrast: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,794.49 Aetna — Medicare Advantage HMO: $224.65 Aetna — Medicare Advantage PPO: $237.21 Aetna — Whole Health: $672 Alliance Health — Managed Medicaid: $733.69 AmeriHealth — Managed Medicaid: $733.69 BCBS — Commercial/HMO/PPO/Select: $3,245 BCBS — Managed Medicaid: $733.69 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $232.55 Carolina Complete Health — Managed Medicaid: $733.69
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI Lumb Spine WO Cntrst	$3,245	$876.15	$746.35 – $3,245
MRI of the lower back (lumbar spine), without contrast: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,794.49 Aetna — Medicare Advantage HMO: $746.35 Aetna — Medicare Advantage PPO: $746.35 Alliance Health — Managed Medicaid: $815.14 AmeriHealth — Managed Medicaid: $815.14 BCBS — Commercial/HMO/PPO/Select: $1,638.73 BCBS — Managed Medicaid: $815.14 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $811.25 Carolina Complete Health — Managed Medicaid: $815.14 Cigna — Commercial/HMO/PPO: $3,245
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Pelvis W Cntrst	$2,778	$750.06	$162.14 – $2,778
CT scan of the pelvis, with contrast: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,536.23 Aetna — Medicare Advantage HMO: $208.86 Aetna — Medicare Advantage PPO: $209.07 Aetna — Whole Health: $429 Alliance Health — Managed Medicaid: $697.83 AmeriHealth — Managed Medicaid: $697.83 BCBS — Commercial/HMO/PPO/Select: $935.26 BCBS — Managed Medicaid: $697.83 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $411.98 Carolina Complete Health — Managed Medicaid: $697.83
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Hospital (facility) fee In the file: CT Pelvis W Cntrst	$2,778	$750.06	$165.45 – $2,778
CT scan of the pelvis, with contrast: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,536.23 Aetna — Medicare Advantage HMO: $197.72 Aetna — Medicare Advantage PPO: $208.78 Aetna — Whole Health: $429 Alliance Health — Managed Medicaid: $628.11 AmeriHealth — Managed Medicaid: $628.11 BCBS — Commercial/HMO/PPO/Select: $2,778 BCBS — Managed Medicaid: $628.11 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $204.89 Carolina Complete Health — Managed Medicaid: $628.11
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Pelvis W Cntrst	$2,778	$750.06	$638.94 – $2,778
CT scan of the pelvis, with contrast: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,536.23 Aetna — Medicare Advantage HMO: $638.94 Aetna — Medicare Advantage PPO: $638.94 Alliance Health — Managed Medicaid: $697.83 AmeriHealth — Managed Medicaid: $697.83 BCBS — Commercial/HMO/PPO/Select: $1,402.89 BCBS — Managed Medicaid: $697.83 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $694.50 Carolina Complete Health — Managed Medicaid: $697.83 Cigna — Commercial/HMO/PPO: $2,778
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Lwr Ext Joint WO Cntrst	$4,867.50	$1,314.23	$220.15 – $4,867.50
MRI of a leg joint (such as the knee), without contrast: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,691.73 Aetna — Medicare Advantage HMO: $519.78 Aetna — Medicare Advantage PPO: $519.78 Aetna — Whole Health: $672 Alliance Health — Managed Medicaid: $815.14 AmeriHealth — Managed Medicaid: $815.14 BCBS — Commercial/HMO/PPO/Select: $4,867.50 BCBS — Managed Medicaid: $815.14 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $519.78 Carolina Complete Health — Managed Medicaid: $815.14
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Hospital (facility) fee In the file: MRI Lwr Ext Joint WO Cntrst	$3,245	$876.15	$224.65 – $4,867.50
MRI of a leg joint (such as the knee), without contrast: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,691.73 Aetna — Medicare Advantage HMO: $266.79 Aetna — Medicare Advantage PPO: $281.71 Aetna — Whole Health: $672 Alliance Health — Managed Medicaid: $733.69 AmeriHealth — Managed Medicaid: $733.69 BCBS — Commercial/HMO/PPO/Select: $4,867.50 BCBS — Managed Medicaid: $733.69 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $276.47 Carolina Complete Health — Managed Medicaid: $733.69
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI Lwr Ext Joint WO Cntrst	$4,867.50	$1,314.23	$746.35 – $4,867.50
MRI of a leg joint (such as the knee), without contrast: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,691.73 Aetna — Medicare Advantage HMO: $746.35 Aetna — Medicare Advantage PPO: $746.35 Alliance Health — Managed Medicaid: $815.14 AmeriHealth — Managed Medicaid: $815.14 BCBS — Commercial/HMO/PPO/Select: $2,458.09 BCBS — Managed Medicaid: $815.14 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $811.25 Carolina Complete Health — Managed Medicaid: $815.14 Cigna — Commercial/HMO/PPO: $4,867.50
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Abd&Pelvis W Cntrst	$5,727	$1,546.29	$343.59 – $5,727
CT scan of the abdomen and pelvis, with contrast: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $3,167.03 Aetna — Medicare Advantage HMO: $534.07 Aetna — Medicare Advantage PPO: $351.49 Aetna — Whole Health: $429 Alliance Health — Managed Medicaid: $1,604.13 AmeriHealth — Managed Medicaid: $1,604.13 BCBS — Commercial/HMO/PPO/Select: $5,727 BCBS — Managed Medicaid: $1,604.13 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $343.59 Carolina Complete Health — Managed Medicaid: $1,604.13
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Abd&Pelvis W Cntrst	$5,727	$1,546.29	$322.61 – $5,727
CT scan of the abdomen and pelvis, with contrast: 10 of 18 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $3,167.03 Aetna — Medicare Advantage HMO: $1,317.21 Aetna — Medicare Advantage PPO: $1,317.21 Alliance Health — Managed Medicaid: $1,342.79 AmeriHealth — Managed Medicaid: $1,438.62 BCBS — Commercial/HMO/PPO/Select: $2,892.14 BCBS — Managed Medicaid: $1,438.62 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,431.75 Carolina Complete Health — Managed Medicaid: $1,438.62 Cigna — Commercial/HMO/PPO: $5,727
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Hospital (facility) fee In the file: CT Abd&Pelvis W Cntrst	$5,727	$1,546.29	$331.91 – $5,727
CT scan of the abdomen and pelvis, with contrast: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $3,167.03 Aetna — Medicare Advantage HMO: $331.91 Aetna — Medicare Advantage PPO: $350.46 Aetna — Whole Health: $429 Alliance Health — Managed Medicaid: $1,294.87 AmeriHealth — Managed Medicaid: $1,294.87 BCBS — Commercial/HMO/PPO/Select: $5,727 BCBS — Managed Medicaid: $1,294.87 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $343.59 Carolina Complete Health — Managed Medicaid: $1,294.87
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Abd Complete	$819	$221.13	$97.58 – $819
Ultrasound of the abdomen, complete: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $452.91 Aetna — Medicare Advantage HMO: $97.58 Aetna — Medicare Advantage PPO: $105.18 Aetna — Whole Health: $306.31 Alliance Health — Managed Medicaid: $252.39 AmeriHealth — Managed Medicaid: $252.39 BCBS — Commercial/HMO/PPO/Select: $819 BCBS — Managed Medicaid: $252.39 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $105.07 Carolina Complete Health — Managed Medicaid: $252.39
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Hospital (facility) fee In the file: US Abd Complete	$819	$221.13	$98.83 – $819
Ultrasound of the abdomen, complete: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $452.91 Aetna — Medicare Advantage HMO: $99.47 Aetna — Medicare Advantage PPO: $105.03 Aetna — Whole Health: $306.31 Alliance Health — Managed Medicaid: $185.18 AmeriHealth — Managed Medicaid: $185.18 BCBS — Commercial/HMO/PPO/Select: $819 BCBS — Managed Medicaid: $185.18 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $103.07 Carolina Complete Health — Managed Medicaid: $185.18
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Abd Complete	$819	$221.13	$188.37 – $819
Ultrasound of the abdomen, complete: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $452.91 Aetna — Medicare Advantage HMO: $188.37 Aetna — Medicare Advantage PPO: $188.37 Alliance Health — Managed Medicaid: $205.73 AmeriHealth — Managed Medicaid: $205.73 BCBS — Commercial/HMO/PPO/Select: $413.60 BCBS — Managed Medicaid: $205.73 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $204.75 Carolina Complete Health — Managed Medicaid: $205.73 Cigna — Commercial/HMO/PPO: $819
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US OB Over 14wks Sngl	$819	$221.13	$96.85 – $819
Pregnancy ultrasound (after the first trimester): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $454.47 Aetna — Medicare Advantage HMO: $96.85 Aetna — Medicare Advantage PPO: $102.31 Aetna — Whole Health: $306.31 Alliance Health — Managed Medicaid: $205.73 AmeriHealth — Managed Medicaid: $205.73 BCBS — Commercial/HMO/PPO/Select: $423.27 BCBS — Managed Medicaid: $205.73 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $102.31 Carolina Complete Health — Managed Medicaid: $205.73
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Hospital (facility) fee In the file: US OB Over 14wks Sngl	$819	$221.13	$98.83 – $561.83
Pregnancy ultrasound (after the first trimester): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $452.91 Aetna — Medicare Advantage HMO: $98.83 Aetna — Medicare Advantage PPO: $104.35 Aetna — Whole Health: $306.31 Alliance Health — Managed Medicaid: $185.18 AmeriHealth — Managed Medicaid: $185.18 BCBS — Commercial/HMO/PPO/Select: $413.60 BCBS — Managed Medicaid: $185.18 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $102.31 Carolina Complete Health — Managed Medicaid: $185.18
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US OB Over 14wks Sngl	$819	$221.13	$188.37 – $819
Pregnancy ultrasound (after the first trimester): 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $452.91 Aetna — Medicare Advantage HMO: $188.37 Aetna — Medicare Advantage PPO: $188.37 Alliance Health — Managed Medicaid: $205.73 AmeriHealth — Managed Medicaid: $205.73 BCBS — Commercial/HMO/PPO/Select: $413.60 BCBS — Managed Medicaid: $205.73 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $204.75 Carolina Complete Health — Managed Medicaid: $205.73 Cigna — Commercial/HMO/PPO: $819
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Transvaginal	$819	$221.13	$81.65 – $819
Transvaginal ultrasound: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $452.91 Aetna — Medicare Advantage HMO: $97.46 Aetna — Medicare Advantage PPO: $107.07 Aetna — Whole Health: $306.31 Alliance Health — Managed Medicaid: $206.43 AmeriHealth — Managed Medicaid: $206.43 BCBS — Commercial/HMO/PPO/Select: $413.60 BCBS — Managed Medicaid: $206.43 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $106.96 Carolina Complete Health — Managed Medicaid: $206.43
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Hospital (facility) fee In the file: US Transvaginal	$819	$221.13	$98.83 – $819
Transvaginal ultrasound: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $452.91 Aetna — Medicare Advantage HMO: $98.83 Aetna — Medicare Advantage PPO: $106.92 Aetna — Whole Health: $306.31 Alliance Health — Managed Medicaid: $185.18 AmeriHealth — Managed Medicaid: $185.18 BCBS — Commercial/HMO/PPO/Select: $413.60 BCBS — Managed Medicaid: $185.18 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $104.93 Carolina Complete Health — Managed Medicaid: $185.18
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Transvaginal	$819	$221.13	$100.99 – $819
Transvaginal ultrasound: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $452.91 Aetna — Medicare Advantage HMO: $188.37 Aetna — Medicare Advantage PPO: $188.37 Alliance Health — Managed Medicaid: $205.73 AmeriHealth — Managed Medicaid: $205.73 BCBS — Commercial/HMO/PPO/Select: $413.60 BCBS — Managed Medicaid: $205.73 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $204.75 Carolina Complete Health — Managed Medicaid: $205.73 Cigna — Commercial/HMO/PPO: $819
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx Mammo Incl Cad Uni	$568.50	$153.50	$76.91 – $568.50
Diagnostic mammogram, one breast: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $314.38 Aetna — Medicare Advantage HMO: $171.53 Aetna — Medicare Advantage PPO: $171.70 Aetna — Whole Health: $212.62 Alliance Health — Managed Medicaid: $95.20 AmeriHealth — Managed Medicaid: $95.20 BCBS — Commercial/HMO/PPO/Select: $287.09 BCBS — Managed Medicaid: $95.20 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $171.53 Carolina Complete Health — Managed Medicaid: $95.20
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Hospital (facility) fee In the file: Dx Mammo Incl Cad Uni	$379	$102.33	$74.42 – $389.99
Diagnostic mammogram, one breast: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $314.38 Aetna — Medicare Advantage HMO: $74.42 Aetna — Medicare Advantage PPO: $78.58 Aetna — Whole Health: $212.62 Alliance Health — Managed Medicaid: $85.69 AmeriHealth — Managed Medicaid: $85.69 BCBS — Commercial/HMO/PPO/Select: $287.09 BCBS — Managed Medicaid: $85.69 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $77.12 Carolina Complete Health — Managed Medicaid: $85.69
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Dx Mammo Incl Cad Uni	$568.50	$153.50	$87.17 – $568.50
Diagnostic mammogram, one breast: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $314.38 Aetna — Medicare Advantage HMO: $87.17 Aetna — Medicare Advantage PPO: $87.17 Alliance Health — Managed Medicaid: $95.20 AmeriHealth — Managed Medicaid: $95.20 BCBS — Commercial/HMO/PPO/Select: $287.09 BCBS — Managed Medicaid: $95.20 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $94.75 Carolina Complete Health — Managed Medicaid: $95.20 Cigna — Commercial/HMO/PPO: $568.50
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx Mammo Incl Cad Bi	$482	$130.14	$97.76 – $482
Diagnostic mammogram, both breasts: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $266.59 Aetna — Medicare Advantage HMO: $144.16 Aetna — Medicare Advantage PPO: $144.30 Aetna — Whole Health: $180.27 Alliance Health — Managed Medicaid: $140.79 AmeriHealth — Managed Medicaid: $140.79 BCBS — Commercial/HMO/PPO/Select: $244.15 BCBS — Managed Medicaid: $140.79 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $144.16 Carolina Complete Health — Managed Medicaid: $140.79
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Hospital (facility) fee In the file: Dx Mammo Incl Cad Bi	$482	$130.14	$94.83 – $330.65
Diagnostic mammogram, both breasts: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $266.55 Aetna — Medicare Advantage HMO: $94.83 Aetna — Medicare Advantage PPO: $100.13 Aetna — Whole Health: $180.27 Alliance Health — Managed Medicaid: $108.98 AmeriHealth — Managed Medicaid: $108.98 BCBS — Commercial/HMO/PPO/Select: $243.41 BCBS — Managed Medicaid: $108.98 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $98.27 Carolina Complete Health — Managed Medicaid: $108.98
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Dx Mammo Incl Cad Bi	$482	$130.14	$110.86 – $482
Diagnostic mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $266.55 Aetna — Medicare Advantage HMO: $110.86 Aetna — Medicare Advantage PPO: $110.86 Alliance Health — Managed Medicaid: $121.08 AmeriHealth — Managed Medicaid: $121.08 BCBS — Commercial/HMO/PPO/Select: $243.41 BCBS — Managed Medicaid: $121.08 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $120.50 Carolina Complete Health — Managed Medicaid: $121.08 Cigna — Commercial/HMO/PPO: $482
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Scr Mammo Bi Incl Cad	$399	$107.73	$80.71 – $399
Screening mammogram, both breasts: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $220.65 Aetna — Medicare Advantage HMO: $116.72 Aetna — Medicare Advantage PPO: $116.84 Aetna — Whole Health: $149.23 Alliance Health — Managed Medicaid: $96.73 AmeriHealth — Managed Medicaid: $96.73 BCBS — Commercial/HMO/PPO/Select: $201.70 BCBS — Managed Medicaid: $96.73 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $116.72 Carolina Complete Health — Managed Medicaid: $96.73
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Hospital (facility) fee In the file: Scr Mammo Bi Incl Cad	$399	$107.73	$78.46 – $399
Screening mammogram, both breasts: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $220.65 Aetna — Medicare Advantage HMO: $78.46 Aetna — Medicare Advantage PPO: $82.85 Aetna — Whole Health: $149.23 Alliance Health — Managed Medicaid: $90.21 AmeriHealth — Managed Medicaid: $90.21 BCBS — Commercial/HMO/PPO/Select: $201.50 BCBS — Managed Medicaid: $90.21 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $81.31 Carolina Complete Health — Managed Medicaid: $90.21
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Scr Mammo Bi Incl Cad	$399	$107.73	$81.22 – $399
Screening mammogram, both breasts: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $220.65 Aetna — Medicare Advantage HMO: $91.77 Aetna — Medicare Advantage PPO: $91.77 Aetna — Whole Health: $149.23 Alliance Health — Managed Medicaid: $100.23 AmeriHealth — Managed Medicaid: $100.23 BCBS — Commercial/HMO/PPO/Select: $201.50 BCBS — Managed Medicaid: $100.23 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $97.76 Carolina Complete Health — Managed Medicaid: $100.23

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PR Ekg 12 Lead W I&R	$145	$72.50	$11.48 – $132.83
Electrocardiogram (ECG/EKG) with reading: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $39.24 Aetna — Medicare Advantage HMO: $35.15 Aetna — Medicare Advantage PPO: $18.79 Alliance Health — Managed Medicaid: $16.34 AmeriHealth — Managed Medicaid: $16.34 BCBS — Commercial/HMO/PPO/Select: $52.24 BCBS — HPN: $38.36 BCBS — Managed Medicaid: $16.34 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $45.59 Carolina Complete Health — Managed Medicaid: $16.34
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR Ekg 12 Lead W I&R	$145	$72.50	$11.96 – $132.83
Electrocardiogram (ECG/EKG) with reading: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $39.24 Aetna — Medicare Advantage HMO: $31.80 Aetna — Medicare Advantage PPO: $13.77 Alliance Health — Managed Medicaid: $16.34 AmeriHealth — Managed Medicaid: $16.34 BCBS — Commercial/HMO/PPO/Select: $45.40 BCBS — HPN: $38.36 BCBS — Managed Medicaid: $16.34 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $45.40 Carolina Complete Health — Managed Medicaid: $16.34
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient · Doctor (professional) fee In the file: Ecg Routine Ecg W/Least 12 Lds W/I&R	$145	$72.50	$13.50 – $51
Electrocardiogram (ECG/EKG) with reading: rates for 5 insurance plans AmeriHealth — Managed Medicaid: $16.34 BCBS — Managed Medicaid: $16.34 Carolina Complete Health — Managed Medicaid: $16.34 Humana — Medicare Advantage: $13.50 United Healthcare — Managed Medicaid: $16.34
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lt Hrt Cath S&I	$11,953	$3,227.31	$2,929.45 – $11,953
Left heart catheterization (diagnostic): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $6,610.01 Aetna — Medicare Advantage HMO: $3,094.44 Aetna — Medicare Advantage PPO: $3,094.44 Aetna — Whole Health: $4,470.42 Alliance Health — Managed Medicaid: $3,002.59 AmeriHealth — Managed Medicaid: $3,002.59 BCBS — Commercial/HMO/PPO/Select: $6,036.27 BCBS — Managed Medicaid: $3,002.59 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $3,094.44 Carolina Complete Health — Managed Medicaid: $3,002.59
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Hospital (facility) fee In the file: Lt Hrt Cath S&I	$11,953	$3,227.31	$2,702.57 – $10,327.39
Left heart catheterization (diagnostic): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $6,610.01 Aetna — Medicare Advantage HMO: $2,989.23 Aetna — Medicare Advantage PPO: $3,156.33 Aetna — Whole Health: $4,470.42 Alliance Health — Managed Medicaid: $2,702.57 AmeriHealth — Managed Medicaid: $2,702.57 BCBS — Commercial/HMO/PPO/Select: $6,036.27 BCBS — Managed Medicaid: $2,702.57 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $3,094.44 Carolina Complete Health — Managed Medicaid: $2,702.57
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Lt Hrt Cath S&I	$11,953	$3,227.31	$2,749.19 – $11,953
Left heart catheterization (diagnostic): 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $6,610.01 Aetna — Medicare Advantage HMO: $2,749.19 Aetna — Medicare Advantage PPO: $2,749.19 Alliance Health — Managed Medicaid: $3,002.59 AmeriHealth — Managed Medicaid: $3,002.59 BCBS — Commercial/HMO/PPO/Select: $6,036.27 BCBS — Managed Medicaid: $3,002.59 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $2,988.25 Carolina Complete Health — Managed Medicaid: $3,002.59 Cigna — Commercial/HMO/PPO: $5,976.50
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Eps WO Arryth	$12,474	$3,367.98	$3,133.47 – $12,474
Heart rhythm study (electrophysiology evaluation): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $6,898.12 Aetna — Medicare Advantage HMO: $7,300.36 Aetna — Medicare Advantage PPO: $7,300.36 Aetna — Whole Health: $4,665.28 Alliance Health — Managed Medicaid: $3,133.47 AmeriHealth — Managed Medicaid: $3,133.47 BCBS — Commercial/HMO/PPO/Select: $6,299.37 BCBS — Managed Medicaid: $3,133.47 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $7,300.36 Carolina Complete Health — Managed Medicaid: $3,133.47
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Hospital (facility) fee In the file: Eps WO Arryth	$12,474	$3,367.98	$2,820.37 – $10,777.54
Heart rhythm study (electrophysiology evaluation): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $6,898.12 Aetna — Medicare Advantage HMO: $7,052.15 Aetna — Medicare Advantage PPO: $7,446.37 Aetna — Whole Health: $4,665.28 Alliance Health — Managed Medicaid: $2,820.37 AmeriHealth — Managed Medicaid: $2,820.37 BCBS — Commercial/HMO/PPO/Select: $6,299.37 BCBS — Managed Medicaid: $2,820.37 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $7,300.36 Carolina Complete Health — Managed Medicaid: $2,820.37
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Eps WO Arryth	$12,474	$3,367.98	$2,307.69 – $10,602.90
Heart rhythm study (electrophysiology evaluation): 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $6,898.12 Aetna — Medicare Advantage HMO: $2,869.02 Aetna — Medicare Advantage PPO: $2,869.02 Alliance Health — Managed Medicaid: $3,133.47 AmeriHealth — Managed Medicaid: $3,133.47 BCBS — Commercial/HMO/PPO/Select: $6,299.37 BCBS — Managed Medicaid: $3,133.47 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $3,118.50 Carolina Complete Health — Managed Medicaid: $3,133.47 Cigna — Commercial/HMO/PPO: $6,237
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tx Atrial Fib Pulm Vein Isol	$40,572	$10,954.44	$9,682.51 – $52,089.62
Heart rhythm study with ablation for atrial fibrillation: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $22,539.10 Aetna — Medicare Advantage HMO: $23,602.04 Aetna — Medicare Advantage PPO: $23,677.50 Aetna — Whole Health: $15,173.93 Alliance Health — Managed Medicaid: $9,682.51 AmeriHealth — Managed Medicaid: $9,682.51 BCBS — Commercial/HMO/PPO/Select: $20,488.86 BCBS — Managed Medicaid: $9,682.51 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $23,602.04 Carolina Complete Health — Managed Medicaid: $9,682.51
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Hospital (facility) fee In the file: Tx Atrial Fib Pulm Vein Isol	$40,572	$10,954.44	$9,173.33 – $35,054.21
Heart rhythm study with ablation for atrial fibrillation: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $22,436.32 Aetna — Medicare Advantage HMO: $22,799.57 Aetna — Medicare Advantage PPO: $24,074.08 Aetna — Whole Health: $15,173.93 Alliance Health — Managed Medicaid: $9,173.33 AmeriHealth — Managed Medicaid: $9,173.33 BCBS — Commercial/HMO/PPO/Select: $20,488.86 BCBS — Managed Medicaid: $9,173.33 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $23,602.04 Carolina Complete Health — Managed Medicaid: $9,173.33
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Tx Atrial Fib Pulm Vein Isol	$40,572	$10,954.44	$9,331.56 – $40,572
Heart rhythm study with ablation for atrial fibrillation: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $22,436.32 Aetna — Medicare Advantage HMO: $9,331.56 Aetna — Medicare Advantage PPO: $9,331.56 Alliance Health — Managed Medicaid: $10,191.69 AmeriHealth — Managed Medicaid: $10,191.69 BCBS — Commercial/HMO/PPO/Select: $20,488.86 BCBS — Managed Medicaid: $10,191.69 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $9,940.14 Carolina Complete Health — Managed Medicaid: $10,191.69 Cigna — Commercial/HMO/PPO: $40,572
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysomnography >=4	$4,613	$1,245.51	$931.90 – $4,613
Sleep study (overnight, in a sleep lab): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,554.80 Aetna — Medicare Advantage HMO: $978.81 Aetna — Medicare Advantage PPO: $983.40 Aetna — Whole Health: $1,725.26 Alliance Health — Managed Medicaid: $1,158.79 AmeriHealth — Managed Medicaid: $1,158.79 BCBS — Commercial/HMO/PPO/Select: $2,365.25 BCBS — Managed Medicaid: $1,158.79 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $978.81 Carolina Complete Health — Managed Medicaid: $1,158.79
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Polysom 6/>Yrs Sleep 4/> Addl Param Attnd	$2,019	$1,009.50	$132.83 – $1,824.90
Sleep study (overnight, in a sleep lab): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,488.38 Aetna — Medicare Advantage HMO: $561.34 Aetna — Medicare Advantage PPO: $592.72 Alliance Health — Managed Medicaid: $598.12 AmeriHealth — Managed Medicaid: $598.12 BCBS — Commercial/HMO/PPO/Select: $1,617.32 BCBS — HPN: $1,456.29 BCBS — Managed Medicaid: $598.12 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $631.47 Carolina Complete Health — Managed Medicaid: $598.12
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Polysom 6/>Yrs Sleep 4/> Addl Param Attnd	$2,019	$1,009.50	$132.83 – $1,824.90
Sleep study (overnight, in a sleep lab): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,488.38 Aetna — Medicare Advantage HMO: $561.34 Aetna — Medicare Advantage PPO: $592.72 Alliance Health — Managed Medicaid: $598.12 AmeriHealth — Managed Medicaid: $598.12 BCBS — Commercial/HMO/PPO/Select: $1,617.32 BCBS — HPN: $1,456.29 BCBS — Managed Medicaid: $598.12 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $631.47 Carolina Complete Health — Managed Medicaid: $598.12

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: Thrpy Exer Proc Dirct Ea 15min	$162	$43.74	$23.06 – $430.03
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $89.59 Aetna — Medicare Advantage HMO: $26.47 Aetna — Medicare Advantage PPO: $27.95 Aetna — Whole Health: $60.59 Alliance Health — Managed Medicaid: $40.69 AmeriHealth — Managed Medicaid: $40.69 BCBS — Commercial/HMO/PPO/Select: $41.63 BCBS — Managed Medicaid: $40.69 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $26.88 Carolina Complete Health — Managed Medicaid: $40.69
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Hospital (facility) fee In the file: Thrpy Exer Proc Dirct Ea 15min	$162	$43.74	$26.47 – $139.97
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $89.59 Aetna — Medicare Advantage HMO: $26.47 Aetna — Medicare Advantage PPO: $27.40 Aetna — Whole Health: $60.59 Alliance Health — Managed Medicaid: $36.63 AmeriHealth — Managed Medicaid: $36.63 BCBS — Commercial/HMO/PPO/Select: $41.63 BCBS — Managed Medicaid: $36.63 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $26.88 Carolina Complete Health — Managed Medicaid: $36.63
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Thrpy Exer Proc Dirct Ea 15min	$162	$43.74	$21.92 – $162
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $89.59 Aetna — Medicare Advantage HMO: $37.26 Aetna — Medicare Advantage PPO: $37.26 Alliance Health — Managed Medicaid: $40.69 AmeriHealth — Managed Medicaid: $40.69 BCBS — Commercial/HMO/PPO/Select: $81.81 BCBS — Managed Medicaid: $40.69 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $40.50 Carolina Complete Health — Managed Medicaid: $40.69 Cigna — Commercial/HMO/PPO: $81
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Low Complex	$221	$59.67	$50.61 – $238
Physical therapy evaluation (low complexity): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $122.21 Aetna — Medicare Advantage HMO: $90.09 Aetna — Medicare Advantage PPO: $95.13 Aetna — Whole Health: $82.65 Alliance Health — Managed Medicaid: $55.52 AmeriHealth — Managed Medicaid: $55.52 BCBS — Commercial/HMO/PPO/Select: $56.80 BCBS — Managed Medicaid: $55.52 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $91.49 Carolina Complete Health — Managed Medicaid: $55.52
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Hospital (facility) fee In the file: Pt Eval Low Complex	$221	$59.67	$49.97 – $190.94
Physical therapy evaluation (low complexity): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $122.21 Aetna — Medicare Advantage HMO: $90.09 Aetna — Medicare Advantage PPO: $93.26 Aetna — Whole Health: $82.65 Alliance Health — Managed Medicaid: $49.97 AmeriHealth — Managed Medicaid: $49.97 BCBS — Commercial/HMO/PPO/Select: $56.80 BCBS — Managed Medicaid: $49.97 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $91.49 Carolina Complete Health — Managed Medicaid: $49.97
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Pt Eval Low Complex	$221	$59.67	$50.61 – $221
Physical therapy evaluation (low complexity): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $122.21 Aetna — Medicare Advantage HMO: $50.83 Aetna — Medicare Advantage PPO: $50.83 Alliance Health — Managed Medicaid: $55.52 AmeriHealth — Managed Medicaid: $55.52 BCBS — Commercial/HMO/PPO/Select: $111.61 BCBS — Managed Medicaid: $55.52 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $55.25 Carolina Complete Health — Managed Medicaid: $55.52 Cigna — Commercial/HMO/PPO: $221
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Mod Complex	$373	$100.71	$30 – $373
Physical therapy evaluation (moderate complexity): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $206.27 Aetna — Medicare Advantage HMO: $90.09 Aetna — Medicare Advantage PPO: $95.13 Aetna — Whole Health: $139.50 Alliance Health — Managed Medicaid: $93.70 AmeriHealth — Managed Medicaid: $93.70 BCBS — Commercial/HMO/PPO/Select: $95.86 BCBS — Managed Medicaid: $93.70 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $91.49 Carolina Complete Health — Managed Medicaid: $93.70
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Hospital (facility) fee In the file: Pt Eval Mod Complex	$373	$100.71	$84.34 – $322.27
Physical therapy evaluation (moderate complexity): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $206.27 Aetna — Medicare Advantage HMO: $90.09 Aetna — Medicare Advantage PPO: $93.26 Aetna — Whole Health: $139.50 Alliance Health — Managed Medicaid: $84.34 AmeriHealth — Managed Medicaid: $84.34 BCBS — Commercial/HMO/PPO/Select: $95.86 BCBS — Managed Medicaid: $84.34 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $91.49 Carolina Complete Health — Managed Medicaid: $84.34
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Pt Eval Mod Complex	$373	$100.71	$75.28 – $373
Physical therapy evaluation (moderate complexity): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $206.27 Aetna — Medicare Advantage HMO: $85.79 Aetna — Medicare Advantage PPO: $85.79 Alliance Health — Managed Medicaid: $93.70 AmeriHealth — Managed Medicaid: $93.70 BCBS — Commercial/HMO/PPO/Select: $188.37 BCBS — Managed Medicaid: $93.70 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $93.25 Carolina Complete Health — Managed Medicaid: $93.70 Cigna — Commercial/HMO/PPO: $373
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval High Complex	$596	$160.92	$87.69 – $596
Physical therapy evaluation (high complexity): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $329.59 Aetna — Medicare Advantage HMO: $90.09 Aetna — Medicare Advantage PPO: $95.13 Aetna — Whole Health: $222.90 Alliance Health — Managed Medicaid: $149.72 AmeriHealth — Managed Medicaid: $149.72 BCBS — Commercial/HMO/PPO/Select: $300.98 BCBS — Managed Medicaid: $149.72 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $91.49 Carolina Complete Health — Managed Medicaid: $149.72
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Hospital (facility) fee In the file: Pt Eval High Complex	$596	$160.92	$90.09 – $514.94
Physical therapy evaluation (high complexity): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $329.59 Aetna — Medicare Advantage HMO: $90.09 Aetna — Medicare Advantage PPO: $93.26 Aetna — Whole Health: $222.90 Alliance Health — Managed Medicaid: $134.76 AmeriHealth — Managed Medicaid: $134.76 BCBS — Commercial/HMO/PPO/Select: $300.98 BCBS — Managed Medicaid: $134.76 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $91.49 Carolina Complete Health — Managed Medicaid: $134.76
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Pt Eval High Complex	$596	$160.92	$75.56 – $596
Physical therapy evaluation (high complexity): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $329.59 Aetna — Medicare Advantage HMO: $137.08 Aetna — Medicare Advantage PPO: $137.08 Alliance Health — Managed Medicaid: $149.72 AmeriHealth — Managed Medicaid: $149.72 BCBS — Commercial/HMO/PPO/Select: $300.98 BCBS — Managed Medicaid: $149.72 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $149 Carolina Complete Health — Managed Medicaid: $149.72 Cigna — Commercial/HMO/PPO: $596
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Psychotherapy W/Patient 30 Minutes	$260	$130	$40.15 – $226.20
Psychotherapy, 30 minutes: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $93 Aetna — Medicare Advantage HMO: $84.47 Aetna — Medicare Advantage PPO: $78.60 Alliance Health — Managed Medicaid: $40.15 AmeriHealth — Managed Medicaid: $50.67 BCBS — Commercial/HMO/PPO/Select: $145.37 BCBS — HPN: $126.34 BCBS — Managed Medicaid: $50.67 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $79.06 Carolina Complete Health — Managed Medicaid: $50.67
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psychotherapy W/Patient 30 Minutes	$260	$130	$40.15 – $226.20
Psychotherapy, 30 minutes: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $93 Aetna — Medicare Advantage HMO: $73.79 Aetna — Medicare Advantage PPO: $77.92 Alliance Health — Managed Medicaid: $40.15 AmeriHealth — Managed Medicaid: $63.57 BCBS — Commercial/HMO/PPO/Select: $145.68 BCBS — HPN: $126.34 BCBS — Managed Medicaid: $65.52 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $79.06 Carolina Complete Health — Managed Medicaid: $50.67
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx Pt&/Family 30 Minutes	$191	$51.57	$47.98 – $171.90
Psychotherapy, 30 minutes: 10 of 23 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $105.62 Aetna — Medicare Advantage HMO: $154.58 Aetna — Medicare Advantage PPO: $154.58 Aetna — Whole Health: $71.43 Alliance Health — Managed Medicaid: $47.98 AmeriHealth — Managed Medicaid: $47.98 BCBS — Commercial/HMO/PPO/Select: $96.46 BCBS — Managed Medicaid: $47.98 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $154.58 Carolina Complete Health — Managed Medicaid: $47.98
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Psychotherapy W/Patient 45 Minutes	$344	$172	$60.29 – $299.28
Psychotherapy, 45 minutes: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $206.40 Aetna — Medicare Advantage HMO: $98.41 Aetna — Medicare Advantage PPO: $91.40 Alliance Health — Managed Medicaid: $60.29 AmeriHealth — Managed Medicaid: $65.81 BCBS — Commercial/HMO/PPO/Select: $188.55 BCBS — HPN: $164.09 BCBS — Managed Medicaid: $65.81 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $98.84 Carolina Complete Health — Managed Medicaid: $65.81
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psychotherapy W/Patient 45 Minutes	$344	$172	$60.29 – $299.28
Psychotherapy, 45 minutes: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $206.40 Aetna — Medicare Advantage HMO: $98.16 Aetna — Medicare Advantage PPO: $98.16 Alliance Health — Managed Medicaid: $60.29 AmeriHealth — Managed Medicaid: $76.22 BCBS — Commercial/HMO/PPO/Select: $194.73 BCBS — HPN: $164.09 BCBS — Managed Medicaid: $86.84 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $98 Carolina Complete Health — Managed Medicaid: $86.84
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx Patient 45 Minutes	$271	$73.17	$68.08 – $243.90
Psychotherapy, 45 minutes: 10 of 23 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $149.86 Aetna — Medicare Advantage HMO: $154.58 Aetna — Medicare Advantage PPO: $154.58 Aetna — Whole Health: $101.35 Alliance Health — Managed Medicaid: $68.08 AmeriHealth — Managed Medicaid: $68.08 BCBS — Commercial/HMO/PPO/Select: $136.86 BCBS — Managed Medicaid: $68.08 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $154.58 Carolina Complete Health — Managed Medicaid: $68.08
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Psychotherapy W/Patient 60 Minutes	$506	$253	$90.91 – $440.22
Psychotherapy, 60 minutes: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $303.60 Aetna — Medicare Advantage HMO: $178.73 Aetna — Medicare Advantage PPO: $153.67 Alliance Health — Managed Medicaid: $90.91 AmeriHealth — Managed Medicaid: $96.44 BCBS — Commercial/HMO/PPO/Select: $276.28 BCBS — HPN: $240.45 BCBS — Managed Medicaid: $96.44 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $273.20 Carolina Complete Health — Managed Medicaid: $96.44
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psychotherapy W/Patient 60 Minutes	$506	$253	$90.91 – $440.22
Psychotherapy, 60 minutes: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $303.60 Aetna — Medicare Advantage HMO: $218.35 Aetna — Medicare Advantage PPO: $151.60 Alliance Health — Managed Medicaid: $90.91 AmeriHealth — Managed Medicaid: $96.44 BCBS — Commercial/HMO/PPO/Select: $276.28 BCBS — HPN: $240.45 BCBS — Managed Medicaid: $96.44 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $276.06 Carolina Complete Health — Managed Medicaid: $96.44
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx Patient 60 Minutes	$516	$139.32	$129.62 – $464.40
Psychotherapy, 60 minutes: 10 of 23 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $285.35 Aetna — Medicare Advantage HMO: $154.58 Aetna — Medicare Advantage PPO: $154.58 Aetna — Whole Health: $192.98 Alliance Health — Managed Medicaid: $129.62 AmeriHealth — Managed Medicaid: $129.62 BCBS — Commercial/HMO/PPO/Select: $260.58 BCBS — Managed Medicaid: $129.62 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $154.58 Carolina Complete Health — Managed Medicaid: $129.62
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Family Psychotherapy W/O Patient Present 50 Mins	$331	$165.50	$69.82 – $289
Family psychotherapy, without the patient: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $229.76 Aetna — Medicare Advantage HMO: $93.56 Aetna — Medicare Advantage PPO: $98.79 Alliance Health — Managed Medicaid: $69.82 AmeriHealth — Managed Medicaid: $71.50 BCBS — Commercial/HMO/PPO/Select: $197.58 BCBS — HPN: $172 BCBS — Managed Medicaid: $71.50 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $99.25 Carolina Complete Health — Managed Medicaid: $71.50
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Family Psychotherapy W/O Patient Present 50 Mins	$331	$165.50	$69.82 – $297.90
Family psychotherapy, without the patient: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $229.76 Aetna — Medicare Advantage HMO: $93.56 Aetna — Medicare Advantage PPO: $98.79 Alliance Health — Managed Medicaid: $69.82 AmeriHealth — Managed Medicaid: $71.50 BCBS — Commercial/HMO/PPO/Select: $197.99 BCBS — HPN: $172 BCBS — Managed Medicaid: $82.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $99.25 Carolina Complete Health — Managed Medicaid: $71.50
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Doctor (professional) fee In the file: Family Psychotherapy W/O Patient Present 50 Mins	$331	$165.50	$69.82 – $297.90
Family psychotherapy, without the patient: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $229.76 Aetna — Medicare Advantage HMO: $92.63 Aetna — Medicare Advantage PPO: $97.81 AmeriHealth — Managed Medicaid: $71.50 BCBS — Commercial/HMO/PPO/Select: $197.58 BCBS — Managed Medicaid: $71.50 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $99.25 Carolina Complete Health — Managed Medicaid: $71.50 Cigna — Commercial/HMO/PPO: $250.55 Cigna — Medicare Advantage: $97.81
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Family Psychotherapy W/Patient Present 50 Mins	$345	$172.50	$74.90 – $306.90
Family psychotherapy, with the patient: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $238.88 Aetna — Medicare Advantage HMO: $97.57 Aetna — Medicare Advantage PPO: $103.02 Alliance Health — Managed Medicaid: $83.74 AmeriHealth — Managed Medicaid: $88.78 BCBS — Commercial/HMO/PPO/Select: $248.21 BCBS — HPN: $214.07 BCBS — Managed Medicaid: $88.78 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $99.86 Carolina Complete Health — Managed Medicaid: $88.78
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Family Psychotherapy W/Patient Present 50 Mins	$345	$172.50	$73.58 – $306.90
Family psychotherapy, with the patient: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $238.88 Aetna — Medicare Advantage HMO: $97.57 Aetna — Medicare Advantage PPO: $103.02 Alliance Health — Managed Medicaid: $83.74 AmeriHealth — Managed Medicaid: $88.78 BCBS — Commercial/HMO/PPO/Select: $246.71 BCBS — HPN: $214.07 BCBS — Managed Medicaid: $95.57 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $86.86 Carolina Complete Health — Managed Medicaid: $88.78
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Doctor (professional) fee In the file: Family Psychotherapy W/Patient Present 50 Mins	$345	$172.50	$83.74 – $157.85
Family psychotherapy, with the patient: rates for 5 insurance plans AmeriHealth — Managed Medicaid: $88.78 BCBS — Managed Medicaid: $88.78 Carolina Complete Health — Managed Medicaid: $88.78 Humana — Medicare Advantage: $99.86 United Healthcare — Managed Medicaid: $88.78
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PR Group Psychothrapy	$93	$46.50	$20.21 – $132.83
Group psychotherapy: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $59.66 Aetna — Medicare Advantage HMO: $26.02 Aetna — Medicare Advantage PPO: $27.48 Alliance Health — Managed Medicaid: $23.91 AmeriHealth — Managed Medicaid: $25.31 BCBS — Commercial/HMO/PPO/Select: $74.47 BCBS — HPN: $62.73 BCBS — Managed Medicaid: $25.31 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $27.88 Carolina Complete Health — Managed Medicaid: $25.31
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR Group Psychothrapy	$93	$46.50	$15.90 – $132.83
Group psychotherapy: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $59.66 Aetna — Medicare Advantage HMO: $49 Aetna — Medicare Advantage PPO: $27.48 Alliance Health — Managed Medicaid: $23.91 AmeriHealth — Managed Medicaid: $25.31 BCBS — Commercial/HMO/PPO/Select: $74.74 BCBS — HPN: $62.73 BCBS — Managed Medicaid: $25.31 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $74.74 Carolina Complete Health — Managed Medicaid: $25.31
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Group Therapy	$208	$56.16	$52.25 – $187.20
Group psychotherapy: 10 of 23 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $115.02 Aetna — Medicare Advantage HMO: $88.99 Aetna — Medicare Advantage PPO: $88.99 Aetna — Whole Health: $77.79 Alliance Health — Managed Medicaid: $52.25 AmeriHealth — Managed Medicaid: $52.25 BCBS — Commercial/HMO/PPO/Select: $105.04 BCBS — Managed Medicaid: $52.25 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $88.99 Carolina Complete Health — Managed Medicaid: $52.25

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: Excisn Breast Lesn 1 or More	$3,684	$994.68	$370.98 – $3,804.16
Removal of breast growth (open surgery): 10 of 24 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,037.25 Aetna — Medicare Advantage HMO: $576.06 Aetna — Medicare Advantage PPO: $576.64 Alliance Health — Managed Medicaid: $925.42 AmeriHealth — Managed Medicaid: $925.42 BCBS — Commercial/HMO/PPO/Select: $1,860.42 BCBS — Managed Medicaid: $925.42 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $576.06 Carolina Complete Health — Managed Medicaid: $925.42 Cigna — Commercial/HMO/PPO: $3,684
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Hospital (facility) fee In the file: Excisn Breast Lesn 1 or More	$2,456	$663.12	$363.56 – $3,684.07
Removal of breast growth (open surgery): 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,037.25 Aetna — Medicare Advantage HMO: $545.34 Aetna — Medicare Advantage PPO: $575.83 Alliance Health — Managed Medicaid: $832.95 AmeriHealth — Managed Medicaid: $832.95 BCBS — Commercial/HMO/PPO/Select: $1,860.42 BCBS — Managed Medicaid: $832.95 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $565.11 Carolina Complete Health — Managed Medicaid: $832.95 Cigna — Connect: $906.26
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Excisn Breast Lesn 1 or More	$3,684	$994.68	$454.36 – $3,131.40
Removal of breast growth (open surgery): 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,037.25 Aetna — Medicare Advantage HMO: $847.32 Aetna — Medicare Advantage PPO: $847.32 Alliance Health — Managed Medicaid: $925.42 AmeriHealth — Managed Medicaid: $925.42 BCBS — Commercial/HMO/PPO/Select: $1,860.42 BCBS — Managed Medicaid: $925.42 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $921 Carolina Complete Health — Managed Medicaid: $925.42 Cigna — Commercial/HMO/PPO: $1,842
Total hip replacement CPT 27130 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Total Hip Arthroplasty	$6,782	$3,391	$924.09 – $4,227.33
Total hip replacement: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,830.37 Aetna — Medicare Advantage HMO: $1,163.07 Aetna — Medicare Advantage PPO: $1,228.09 Alliance Health — Managed Medicaid: $1,072.82 AmeriHealth — Managed Medicaid: $1,072.82 BCBS — Commercial/HMO/PPO/Select: $3,272.20 BCBS — HPN: $2,655.41 BCBS — Managed Medicaid: $1,072.82 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $924.09 Carolina Complete Health — Managed Medicaid: $1,072.82
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Total Hip Arthroplasty	$6,782	$3,391	$924.09 – $3,873.71
Total hip replacement: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,830.37 Aetna — Medicare Advantage HMO: $984.71 Aetna — Medicare Advantage PPO: $984.71 Alliance Health — Managed Medicaid: $1,072.82 AmeriHealth — Managed Medicaid: $1,072.82 BCBS — Commercial/HMO/PPO/Select: $3,343.34 BCBS — HPN: $2,655.41 BCBS — Managed Medicaid: $1,072.82 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $984.71 Carolina Complete Health — Managed Medicaid: $1,072.82
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee In the file: Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft	$6,782	$3,391	$536.41 – $953.76
Total hip replacement: rates for 5 insurance plans AmeriHealth — Managed Medicaid: $536.41 BCBS — Managed Medicaid: $536.41 Carolina Complete Health — Managed Medicaid: $536.41 Humana — Medicare Advantage: $602.01 United Healthcare — Managed Medicaid: $536.41
Total knee replacement CPT 27447 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Total Knee Arthroplasty	$6,540	$3,270	$922.22 – $3,816.69
Total knee replacement: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,896.67 Aetna — Medicare Advantage HMO: $1,161.45 Aetna — Medicare Advantage PPO: $1,226.38 Alliance Health — Managed Medicaid: $1,148.49 AmeriHealth — Managed Medicaid: $1,148.49 BCBS — Commercial/HMO/PPO/Select: $3,497.84 BCBS — HPN: $2,840.18 BCBS — Managed Medicaid: $1,148.49 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $922.22 Carolina Complete Health — Managed Medicaid: $1,148.49
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Total Knee Arthroplasty	$6,540	$3,270	$677.95 – $3,504.20
Total knee replacement: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,896.67 Aetna — Medicare Advantage HMO: $990.05 Aetna — Medicare Advantage PPO: $978.28 Alliance Health — Managed Medicaid: $1,148.49 AmeriHealth — Managed Medicaid: $1,173.10 BCBS — Commercial/HMO/PPO/Select: $3,504.20 BCBS — HPN: $2,840.18 BCBS — Managed Medicaid: $1,148.49 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $922.22 Carolina Complete Health — Managed Medicaid: $1,173.10
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee In the file: Arthrp Kne Condyle&Platu Medial&Lat Compartments	$6,540	$3,270	$574.25 – $1,021.02
Total knee replacement: rates for 5 insurance plans AmeriHealth — Managed Medicaid: $574.25 BCBS — Managed Medicaid: $574.25 Carolina Complete Health — Managed Medicaid: $574.25 Humana — Medicare Advantage: $601.17 United Healthcare — Managed Medicaid: $574.25
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Esophagogastroduodenoscopy Transoral Diagnostic	$1,106	$553	$55.44 – $1,100.86
Upper GI endoscopy (diagnostic): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $549.86 Aetna — Medicare Advantage HMO: $55.44 Aetna — Medicare Advantage PPO: $95.32 Alliance Health — Managed Medicaid: $112.30 AmeriHealth — Managed Medicaid: $56.15 BCBS — Commercial/HMO/PPO/Select: $626.58 BCBS — HPN: $543.11 BCBS — Managed Medicaid: $56.15 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $89.56 Carolina Complete Health — Managed Medicaid: $56.15
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Esophagogastroduodenoscopy Transoral Diagnostic	$1,106	$553	$57.50 – $1,100.86
Upper GI endoscopy (diagnostic): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $549.86 Aetna — Medicare Advantage HMO: $94.71 Aetna — Medicare Advantage PPO: $95.10 Alliance Health — Managed Medicaid: $112.30 AmeriHealth — Managed Medicaid: $220.29 BCBS — Commercial/HMO/PPO/Select: $676.47 BCBS — HPN: $543.11 BCBS — Managed Medicaid: $220.29 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $95.93 Carolina Complete Health — Managed Medicaid: $220.29
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Endo Ugi Dx	$3,010	$812.70	$745.93 – $8,549.98
Upper GI endoscopy (diagnostic): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,783.13 Aetna — Medicare Advantage HMO: $902.01 Aetna — Medicare Advantage PPO: $910.52 Aetna — Whole Health: $1,125.74 Alliance Health — Managed Medicaid: $756.11 AmeriHealth — Managed Medicaid: $756.11 BCBS — Commercial/HMO/PPO/Select: $1,666.49 BCBS — Managed Medicaid: $756.11 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $902.01 Carolina Complete Health — Managed Medicaid: $756.11
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Egd Transoral Biopsy Single/Multiple	$1,446	$723	$90.89 – $1,374.10
Upper GI endoscopy with biopsy: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $735.11 Aetna — Medicare Advantage HMO: $93.57 Aetna — Medicare Advantage PPO: $132.25 Alliance Health — Managed Medicaid: $132.99 AmeriHealth — Managed Medicaid: $255.25 BCBS — Commercial/HMO/PPO/Select: $743.78 BCBS — HPN: $631.45 BCBS — Managed Medicaid: $255.25 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $717.08 Carolina Complete Health — Managed Medicaid: $255.25
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Egd Transoral Biopsy Single/Multiple	$1,446	$723	$81.35 – $1,374.10
Upper GI endoscopy with biopsy: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $802.50 Aetna — Medicare Advantage HMO: $93.74 Aetna — Medicare Advantage PPO: $98.87 Alliance Health — Managed Medicaid: $132.99 AmeriHealth — Managed Medicaid: $255.25 BCBS — Commercial/HMO/PPO/Select: $743.78 BCBS — HPN: $631.45 BCBS — Managed Medicaid: $255.25 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $98.66 Carolina Complete Health — Managed Medicaid: $255.25
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Endo Ugi W Biopsy	$3,010	$812.70	$709.13 – $4,878.54
Upper GI endoscopy with biopsy: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,664.53 Aetna — Medicare Advantage HMO: $902.01 Aetna — Medicare Advantage PPO: $902.01 Aetna — Whole Health: $1,777.05 Alliance Health — Managed Medicaid: $756.11 AmeriHealth — Managed Medicaid: $756.11 BCBS — Commercial/HMO/PPO/Select: $1,550.84 BCBS — Managed Medicaid: $756.11 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $902.01 Carolina Complete Health — Managed Medicaid: $756.11
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$1,474	$737	$83.26 – $1,473.80
Colonoscopy (diagnostic): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $665.01 Aetna — Medicare Advantage HMO: $83.26 Aetna — Medicare Advantage PPO: $87.91 Alliance Health — Managed Medicaid: $167.15 AmeriHealth — Managed Medicaid: $83.58 BCBS — Commercial/HMO/PPO/Select: $803.83 BCBS — HPN: $723.80 BCBS — Managed Medicaid: $83.58 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $89.20 Carolina Complete Health — Managed Medicaid: $83.58
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$1,474	$737	$132.83 – $943.74
Colonoscopy (diagnostic): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $665.01 Aetna — Medicare Advantage HMO: $659.65 Aetna — Medicare Advantage PPO: $457.58 Alliance Health — Managed Medicaid: $167.15 AmeriHealth — Managed Medicaid: $291.93 BCBS — Commercial/HMO/PPO/Select: $910.72 BCBS — HPN: $723.80 BCBS — Managed Medicaid: $291.93 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $910.72 Carolina Complete Health — Managed Medicaid: $291.93
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy Diagnostic	$3,107	$838.89	$612.70 – $5,002.81
Colonoscopy (diagnostic): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,766.06 Aetna — Medicare Advantage HMO: $877.14 Aetna — Medicare Advantage PPO: $879.58 Aetna — Whole Health: $2,431.92 Alliance Health — Managed Medicaid: $780.48 AmeriHealth — Managed Medicaid: $780.48 BCBS — Commercial/HMO/PPO/Select: $1,569.04 BCBS — Managed Medicaid: $780.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $877.14 Carolina Complete Health — Managed Medicaid: $780.48
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Colonoscopy W/Biopsy Single/Multiple	$1,668	$834	$90.53 – $1,610.78
Colonoscopy with biopsy: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $852.94 Aetna — Medicare Advantage HMO: $98.30 Aetna — Medicare Advantage PPO: $95.59 Alliance Health — Managed Medicaid: $201.40 AmeriHealth — Managed Medicaid: $350.51 BCBS — Commercial/HMO/PPO/Select: $962.58 BCBS — HPN: $866.74 BCBS — Managed Medicaid: $350.51 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $97 Carolina Complete Health — Managed Medicaid: $350.51
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy W/Biopsy Single/Multiple	$1,668	$834	$86.56 – $1,610.78
Colonoscopy with biopsy: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $852.94 Aetna — Medicare Advantage HMO: $86.56 Aetna — Medicare Advantage PPO: $413.46 Alliance Health — Managed Medicaid: $201.40 AmeriHealth — Managed Medicaid: $350.51 BCBS — Commercial/HMO/PPO/Select: $962.58 BCBS — HPN: $866.74 BCBS — Managed Medicaid: $350.51 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $870.73 Carolina Complete Health — Managed Medicaid: $350.51
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy W Biopsy	$4,011	$1,082.97	$919.77 – $7,754.61
Colonoscopy with biopsy: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,218.08 Aetna — Medicare Advantage HMO: $1,134.37 Aetna — Medicare Advantage PPO: $1,134.37 Aetna — Whole Health: $3,151.90 Alliance Health — Managed Medicaid: $919.77 AmeriHealth — Managed Medicaid: $919.77 BCBS — Commercial/HMO/PPO/Select: $2,079.22 BCBS — Managed Medicaid: $919.77 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,134.37 Carolina Complete Health — Managed Medicaid: $919.77
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy W Rmvl Snare	$4,011	$1,082.97	$867.30 – $4,968.70
Colonoscopy with removal of polyps (snare): 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,228.24 Aetna — Medicare Advantage HMO: $1,134.37 Aetna — Medicare Advantage PPO: $1,134.37 Aetna — Whole Health: $2,872.92 Alliance Health — Managed Medicaid: $1,010.75 AmeriHealth — Managed Medicaid: $1,010.75 BCBS — Commercial/HMO/PPO/Select: $2,025.56 BCBS — Managed Medicaid: $1,010.75 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,134.37 Carolina Complete Health — Managed Medicaid: $1,010.75
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Hospital (facility) fee In the file: Colonoscopy W Rmvl Snare	$4,011	$1,082.97	$906.89 – $3,465.50
Colonoscopy with removal of polyps (snare): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,218.08 Aetna — Medicare Advantage HMO: $1,095.80 Aetna — Medicare Advantage PPO: $1,157.06 Aetna — Whole Health: $1,500.11 Alliance Health — Managed Medicaid: $906.89 AmeriHealth — Managed Medicaid: $906.89 BCBS — Commercial/HMO/PPO/Select: $2,025.56 BCBS — Managed Medicaid: $906.89 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,134.37 Carolina Complete Health — Managed Medicaid: $906.89
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Colonoscopy W Rmvl Snare	$4,011	$1,082.97	$922.53 – $4,011
Colonoscopy with removal of polyps (snare): 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,218.08 Aetna — Medicare Advantage HMO: $922.53 Aetna — Medicare Advantage PPO: $922.53 Alliance Health — Managed Medicaid: $1,007.56 AmeriHealth — Managed Medicaid: $1,007.56 BCBS — Commercial/HMO/PPO/Select: $2,025.56 BCBS — Managed Medicaid: $1,007.56 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $982.70 Carolina Complete Health — Managed Medicaid: $1,007.56 Cigna — Commercial/HMO/PPO: $4,011
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy W Eus Exam	$4,011	$1,082.97	$559.89 – $4,011
Ultrasound of the lower bowel by endoscope: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,218.08 Aetna — Medicare Advantage HMO: $1,134.37 Aetna — Medicare Advantage PPO: $1,134.37 Aetna — Whole Health: $1,500.11 Alliance Health — Managed Medicaid: $1,007.56 AmeriHealth — Managed Medicaid: $1,007.56 BCBS — Commercial/HMO/PPO/Select: $2,025.56 BCBS — Managed Medicaid: $1,007.56 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,134.37 Carolina Complete Health — Managed Medicaid: $1,007.56
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Hospital (facility) fee In the file: Colonoscopy W Eus Exam	$4,011	$1,082.97	$906.89 – $3,465.50
Ultrasound of the lower bowel by endoscope: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,218.08 Aetna — Medicare Advantage HMO: $1,095.80 Aetna — Medicare Advantage PPO: $1,157.06 Aetna — Whole Health: $1,500.11 Alliance Health — Managed Medicaid: $906.89 AmeriHealth — Managed Medicaid: $906.89 BCBS — Commercial/HMO/PPO/Select: $2,025.56 BCBS — Managed Medicaid: $906.89 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,134.37 Carolina Complete Health — Managed Medicaid: $906.89
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Colonoscopy W Eus Exam	$4,011	$1,082.97	$742.04 – $3,409.35
Ultrasound of the lower bowel by endoscope: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,218.08 Aetna — Medicare Advantage HMO: $922.53 Aetna — Medicare Advantage PPO: $922.53 Alliance Health — Managed Medicaid: $1,007.56 AmeriHealth — Managed Medicaid: $1,007.56 BCBS — Commercial/HMO/PPO/Select: $2,025.56 BCBS — Managed Medicaid: $1,007.56 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $982.70 Carolina Complete Health — Managed Medicaid: $1,007.56 Cigna — Commercial/HMO/PPO: $2,005.50
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colorectal Ca Scrn Not High Risk	$3,107	$838.89	$780.48 – $3,107
Screening colonoscopy (not high risk): 10 of 24 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,718.17 Aetna — Medicare Advantage HMO: $877.14 Aetna — Medicare Advantage PPO: $877.14 Aetna — Whole Health: $1,162.02 Alliance Health — Managed Medicaid: $780.48 AmeriHealth — Managed Medicaid: $780.48 BCBS — Commercial/HMO/PPO/Select: $1,569.04 BCBS — Managed Medicaid: $780.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $877.14 Carolina Complete Health — Managed Medicaid: $780.48
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Hospital (facility) fee In the file: Colorectal Ca Scrn Not High Risk	$3,107	$838.89	$702.49 – $2,684.45
Screening colonoscopy (not high risk): 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,718.17 Aetna — Medicare Advantage HMO: $847.32 Aetna — Medicare Advantage PPO: $894.68 Aetna — Whole Health: $1,162.02 Alliance Health — Managed Medicaid: $702.49 AmeriHealth — Managed Medicaid: $702.49 BCBS — Commercial/HMO/PPO/Select: $1,569.04 BCBS — Managed Medicaid: $702.49 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $877.14 Carolina Complete Health — Managed Medicaid: $702.49
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Colorectal Ca Scrn Not High Risk	$3,107	$838.89	$714.61 – $3,107
Screening colonoscopy (not high risk): 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,718.17 Aetna — Medicare Advantage HMO: $714.61 Aetna — Medicare Advantage PPO: $714.61 Alliance Health — Managed Medicaid: $780.48 AmeriHealth — Managed Medicaid: $780.48 BCBS — Commercial/HMO/PPO/Select: $1,569.04 BCBS — Managed Medicaid: $780.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $776.75 Carolina Complete Health — Managed Medicaid: $780.48 Cigna — Commercial/HMO/PPO: $3,107
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee In the file: Laparoscopy Surg Cholecystectomy	$3,300	$1,650	$264.29 – $469.91
Gallbladder removal by laparoscope: rates for 5 insurance plans AmeriHealth — Managed Medicaid: $264.29 BCBS — Managed Medicaid: $264.29 Carolina Complete Health — Managed Medicaid: $264.29 Humana — Medicare Advantage: $308.44 United Healthcare — Managed Medicaid: $264.29
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Rpr Inguinl Hernia Age5+ Reduc	$8,502	$2,295.54	$463.39 – $8,502
Groin (inguinal) hernia repair, age 5 or older: 10 of 24 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $4,701.61 Aetna — Medicare Advantage HMO: $719.55 Aetna — Medicare Advantage PPO: $720.27 Alliance Health — Managed Medicaid: $2,135.70 AmeriHealth — Managed Medicaid: $2,135.70 BCBS — Commercial/HMO/PPO/Select: $4,293.51 BCBS — Managed Medicaid: $2,135.70 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $719.55 Carolina Complete Health — Managed Medicaid: $2,135.70 Cigna — Commercial/HMO/PPO: $8,502
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Hospital (facility) fee In the file: Rpr Inguinl Hernia Age5+ Reduc	$5,668	$1,530.36	$454.12 – $7,345.73
Groin (inguinal) hernia repair, age 5 or older: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $4,701.61 Aetna — Medicare Advantage HMO: $681.18 Aetna — Medicare Advantage PPO: $719.26 Alliance Health — Managed Medicaid: $1,922.30 AmeriHealth — Managed Medicaid: $1,922.30 BCBS — Commercial/HMO/PPO/Select: $4,293.51 BCBS — Managed Medicaid: $1,922.30 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $705.88 Carolina Complete Health — Managed Medicaid: $1,922.30 Cigna — Connect: $3,137.24
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Rpr Inguinl Hernia Age5+ Reduc	$8,502	$2,295.54	$1,048.58 – $7,226.70
Groin (inguinal) hernia repair, age 5 or older: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $4,701.61 Aetna — Medicare Advantage HMO: $1,955.46 Aetna — Medicare Advantage PPO: $1,955.46 Alliance Health — Managed Medicaid: $2,135.70 AmeriHealth — Managed Medicaid: $2,135.70 BCBS — Commercial/HMO/PPO/Select: $4,293.51 BCBS — Managed Medicaid: $2,135.70 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $2,125.50 Carolina Complete Health — Managed Medicaid: $2,135.70 Cigna — Commercial/HMO/PPO: $4,251
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Bx Prostate Ndl/Punch	$4,291.20	$1,158.62	$898.29 – $3,862.08
Prostate biopsy: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,373.03 Aetna — Medicare Advantage HMO: $1,970.83 Aetna — Medicare Advantage PPO: $1,970.83 Aetna — Whole Health: $1,604.91 Alliance Health — Managed Medicaid: $898.29 AmeriHealth — Managed Medicaid: $898.29 BCBS — Commercial/HMO/PPO/Select: $2,167.06 BCBS — Managed Medicaid: $898.29 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,970.83 Carolina Complete Health — Managed Medicaid: $898.29
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Bx Prostate Ndl/Punch	$4,291.20	$1,158.62	$822.48 – $3,647.52
Prostate biopsy: 10 of 13 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,373.03 Aetna — Medicare Advantage HMO: $986.98 Aetna — Medicare Advantage PPO: $986.98 AmeriHealth — Managed Medicaid: $898.29 BCBS — Commercial/HMO/PPO/Select: $2,167.06 BCBS — Managed Medicaid: $898.29 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $894 Carolina Complete Health — Managed Medicaid: $898.29 Cigna — Commercial/HMO/PPO: $2,145.60 Cigna — Connect: $2,145.60
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 22 In the file: Bx Prostate Ndl/Punch\|UNUSUAL PROCEDURAL SERVICES	$4,291.20	$1,158.62	$898.29 – $3,862.08
Prostate biopsy: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,373.03 Aetna — Medicare Advantage HMO: $1,970.83 Aetna — Medicare Advantage PPO: $1,970.83 Aetna — Whole Health: $1,604.91 Alliance Health — Managed Medicaid: $898.29 AmeriHealth — Managed Medicaid: $898.29 BCBS — Commercial/HMO/PPO/Select: $2,167.06 BCBS — Managed Medicaid: $898.29 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,970.83 Carolina Complete Health — Managed Medicaid: $898.29
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy W Bx Endometrium	$5,327	$1,438.29	$1,338.14 – $15,741.34
Hysteroscopy with biopsy of the uterus lining: 10 of 19 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $3,769.72 Alliance Health — Managed Medicaid: $1,829.59 AmeriHealth — Managed Medicaid: $1,829.59 BCBS — Commercial/HMO/PPO/Select: $3,635.08 BCBS — Managed Medicaid: $1,829.59 Carolina Complete Health — Managed Medicaid: $1,829.59 Cigna — Commercial/HMO/PPO: $5,327 Cigna — Connect: $2,013.61 Cigna — Medicare Advantage: $3,158.67 Humana — ChoiceCare: $4,527.95
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Hysteroscopy W Bx Endometrium	$5,327	$1,438.29	$985.50 – $4,527.95
Hysteroscopy with biopsy of the uterus lining: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,945.83 Aetna — Medicare Advantage HMO: $1,225.21 Aetna — Medicare Advantage PPO: $1,225.21 Alliance Health — Managed Medicaid: $1,338.14 AmeriHealth — Managed Medicaid: $1,338.14 BCBS — Commercial/HMO/PPO/Select: $2,690.14 BCBS — Managed Medicaid: $1,338.14 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,331.75 Carolina Complete Health — Managed Medicaid: $1,338.14 Cigna — Commercial/HMO/PPO: $2,663.50
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Hospital (facility) fee In the file: Hysteroscopy W Bx Endometrium	$5,327	$1,438.29	$1,204.43 – $4,602.53
Hysteroscopy with biopsy of the uterus lining: 10 of 11 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,945.83 Alliance Health — Managed Medicaid: $1,204.43 AmeriHealth — Managed Medicaid: $1,204.43 BCBS — Commercial/HMO/PPO/Select: $2,690.14 BCBS — Managed Medicaid: $1,204.43 Carolina Complete Health — Managed Medicaid: $1,204.43 Cigna — Connect: $1,965.66 MedCost — Ultra: $2,269.30 Trillium — Managed Medicaid: $1,204.43 United Healthcare — Commercial/EPO/PPO: $4,602.53
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx Interlaminar Lmbr/Sac W/ Img	$5,868	$1,584.36	$602.02 – $5,868
Spinal injection, lower back (epidural), with imaging guidance: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $3,245 Aetna — Medicare Advantage HMO: $666.26 Aetna — Medicare Advantage PPO: $669.74 Aetna — Whole Health: $2,194.63 Alliance Health — Managed Medicaid: $982.69 AmeriHealth — Managed Medicaid: $982.69 BCBS — Commercial/HMO/PPO/Select: $2,963.34 BCBS — Managed Medicaid: $982.69 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $666.26 Carolina Complete Health — Managed Medicaid: $982.69
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Hospital (facility) fee In the file: Njx Interlaminar Lmbr/Sac W/ Img	$3,912	$1,056.24	$643.61 – $5,069.95
Spinal injection, lower back (epidural), with imaging guidance: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $3,245 Aetna — Medicare Advantage HMO: $643.61 Aetna — Medicare Advantage PPO: $679.58 Aetna — Whole Health: $2,194.63 Alliance Health — Managed Medicaid: $884.50 AmeriHealth — Managed Medicaid: $884.50 BCBS — Commercial/HMO/PPO/Select: $2,963.34 BCBS — Managed Medicaid: $884.50 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $666.26 Carolina Complete Health — Managed Medicaid: $884.50
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Njx Interlaminar Lmbr/Sac W/ Img	$5,868	$1,584.36	$899.76 – $5,868
Spinal injection, lower back (epidural), with imaging guidance: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $3,245 Aetna — Medicare Advantage HMO: $899.76 Aetna — Medicare Advantage PPO: $899.76 Alliance Health — Managed Medicaid: $982.69 AmeriHealth — Managed Medicaid: $982.69 BCBS — Commercial/HMO/PPO/Select: $2,963.34 BCBS — Managed Medicaid: $982.69 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $978 Carolina Complete Health — Managed Medicaid: $982.69 Cigna — Commercial/HMO/PPO: $5,868
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Inj Anes Foramen Epi Lumb Sngl	$5,071.50	$1,369.31	$766.09 – $5,071.50
Nerve root injection, lower back, with imaging guidance: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,804.54 Aetna — Medicare Advantage HMO: $856.53 Aetna — Medicare Advantage PPO: $859.21 Aetna — Whole Health: $1,896.74 Alliance Health — Managed Medicaid: $849.31 AmeriHealth — Managed Medicaid: $849.31 BCBS — Commercial/HMO/PPO/Select: $2,561.11 BCBS — Managed Medicaid: $849.31 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $856.53 Carolina Complete Health — Managed Medicaid: $849.31
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Hospital (facility) fee In the file: Inj Anes Foramen Epi Lumb Sngl	$3,381	$912.87	$764.44 – $4,381.78
Nerve root injection, lower back, with imaging guidance: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,804.54 Aetna — Medicare Advantage HMO: $827.41 Aetna — Medicare Advantage PPO: $873.66 Aetna — Whole Health: $1,896.74 Alliance Health — Managed Medicaid: $764.44 AmeriHealth — Managed Medicaid: $764.44 BCBS — Commercial/HMO/PPO/Select: $2,561.11 BCBS — Managed Medicaid: $764.44 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $856.53 Carolina Complete Health — Managed Medicaid: $764.44
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Inj Anes Foramen Epi Lumb Sngl	$5,071.50	$1,369.31	$777.63 – $5,071.50
Nerve root injection, lower back, with imaging guidance: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,804.54 Aetna — Medicare Advantage HMO: $777.63 Aetna — Medicare Advantage PPO: $777.63 Alliance Health — Managed Medicaid: $849.31 AmeriHealth — Managed Medicaid: $849.31 BCBS — Commercial/HMO/PPO/Select: $2,561.11 BCBS — Managed Medicaid: $849.31 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $845.25 Carolina Complete Health — Managed Medicaid: $849.31 Cigna — Commercial/HMO/PPO: $5,071.50
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Neuroplasty Median Nerve	$3,042	$821.34	$509.43 – $3,042
Carpal tunnel release: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,682.23 Aetna — Medicare Advantage HMO: $1,878.72 Aetna — Medicare Advantage PPO: $1,878.72 Aetna — Whole Health: $758.47 Alliance Health — Managed Medicaid: $764.15 AmeriHealth — Managed Medicaid: $764.15 BCBS — Commercial/HMO/PPO/Select: $1,536.21 BCBS — Managed Medicaid: $764.15 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,878.72 Carolina Complete Health — Managed Medicaid: $764.15
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Hospital (facility) fee In the file: Neuroplasty Median Nerve	$2,028	$547.56	$458.53 – $2,628.29
Carpal tunnel release: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,682.23 Aetna — Medicare Advantage HMO: $1,814.84 Aetna — Medicare Advantage PPO: $1,916.30 Aetna — Whole Health: $758.47 Alliance Health — Managed Medicaid: $687.80 AmeriHealth — Managed Medicaid: $687.80 BCBS — Commercial/HMO/PPO/Select: $1,536.21 BCBS — Managed Medicaid: $687.80 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $1,878.72 Carolina Complete Health — Managed Medicaid: $687.80
Carpal tunnel release CPT 64721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Neuroplasty Median Nerve	$3,042	$821.34	$375.18 – $2,585.70
Carpal tunnel release: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $1,682.23 Aetna — Medicare Advantage HMO: $699.66 Aetna — Medicare Advantage PPO: $699.66 Alliance Health — Managed Medicaid: $764.15 AmeriHealth — Managed Medicaid: $764.15 BCBS — Commercial/HMO/PPO/Select: $1,536.21 BCBS — Managed Medicaid: $764.15 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $760.50 Carolina Complete Health — Managed Medicaid: $764.15 Cigna — Commercial/HMO/PPO: $1,521
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Disc Secndry Membran Cataract Laser	$1,338	$361.26	$336.11 – $1,338
Laser treatment of clouding after cataract surgery: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $739.91 Aetna — Medicare Advantage HMO: $527.80 Aetna — Medicare Advantage PPO: $527.80 Aetna — Whole Health: $500.41 Alliance Health — Managed Medicaid: $336.11 AmeriHealth — Managed Medicaid: $336.11 BCBS — Commercial/HMO/PPO/Select: $675.69 BCBS — Managed Medicaid: $336.11 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $527.80 Carolina Complete Health — Managed Medicaid: $336.11
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient · Hospital (facility) fee In the file: Disc Secndry Membran Cataract Laser	$1,338	$361.26	$302.52 – $1,156.03
Laser treatment of clouding after cataract surgery: 10 of 18 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $739.91 Aetna — Medicare Advantage HMO: $509.85 Aetna — Medicare Advantage PPO: $538.35 Aetna — Whole Health: $500.41 Alliance Health — Managed Medicaid: $302.52 AmeriHealth — Managed Medicaid: $302.52 BCBS — Commercial/HMO/PPO/Select: $675.69 BCBS — Managed Medicaid: $302.52 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $527.80 Carolina Complete Health — Managed Medicaid: $302.52
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Disc Secndry Membran Cataract Laser	$1,338	$361.26	$247.53 – $1,137.30
Laser treatment of clouding after cataract surgery: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $739.91 Aetna — Medicare Advantage HMO: $307.74 Aetna — Medicare Advantage PPO: $307.74 Alliance Health — Managed Medicaid: $336.11 AmeriHealth — Managed Medicaid: $336.11 BCBS — Commercial/HMO/PPO/Select: $675.69 BCBS — Managed Medicaid: $336.11 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $334.50 Carolina Complete Health — Managed Medicaid: $336.11 Cigna — Commercial/HMO/PPO: $669
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Rmvl Catarc W Iol Extrcp WO Ndsc Cyclophotocoagulation	$4,350	$1,174.50	$718.83 – $4,350
Cataract removal with lens implant: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,405.55 Aetna — Medicare Advantage HMO: $744.14 Aetna — Medicare Advantage PPO: $744.88 Aetna — Whole Health: $1,084.60 Alliance Health — Managed Medicaid: $728.48 AmeriHealth — Managed Medicaid: $728.48 BCBS — Commercial/HMO/PPO/Select: $2,196.75 BCBS — Managed Medicaid: $728.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $744.14 Carolina Complete Health — Managed Medicaid: $728.48
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Hospital (facility) fee In the file: Rmvl Catarc W Iol Extrcp WO Ndsc Cyclophotocoagulation	$2,900	$783	$655.69 – $3,758.40
Cataract removal with lens implant: 10 of 17 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,405.55 Aetna — Medicare Advantage HMO: $704.46 Aetna — Medicare Advantage PPO: $743.84 Aetna — Whole Health: $1,084.60 Alliance Health — Managed Medicaid: $983.54 AmeriHealth — Managed Medicaid: $983.54 BCBS — Commercial/HMO/PPO/Select: $2,196.75 BCBS — Managed Medicaid: $983.54 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $730 Carolina Complete Health — Managed Medicaid: $983.54
Cataract removal with lens implant CPT 66984 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Rmvl Catarc W Iol Extrcp WO Ndsc Cyclophotocoagulation	$4,350	$1,174.50	$536.50 – $3,697.50
Cataract removal with lens implant: 10 of 16 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $2,405.55 Aetna — Medicare Advantage HMO: $667 Aetna — Medicare Advantage PPO: $667 Alliance Health — Managed Medicaid: $728.48 AmeriHealth — Managed Medicaid: $728.48 BCBS — Commercial/HMO/PPO/Select: $2,196.75 BCBS — Managed Medicaid: $728.48 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $725 Carolina Complete Health — Managed Medicaid: $728.48 Cigna — Commercial/HMO/PPO: $2,175

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC	$284,450.62	$76,801.67	$32,315.08 – $499,824.82
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $146,385.90 Aetna — Medicare Advantage HMO: $72,542.83 Aetna — Medicare Advantage PPO: $76,447.54 Aetna — Whole Health: $106,101.42 Alliance Health — Managed Medicaid: $126,397.79 AmeriHealth — Managed Medicaid: $126,397.79 BCBS — Commercial/HMO/PPO/Select: $133,691.74 BCBS — Managed Medicaid: $126,397.79 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $75,025.05 Carolina Complete Health — Managed Medicaid: $126,397.79
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	$50,891.50	$13,740.71	$6,371.65 – $43,967.12
Hip or knee replacement (major joint of the leg), without major complications: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $26,092.36 Aetna — Medicare Advantage HMO: $16,228.18 Aetna — Medicare Advantage PPO: $17,118.13 Aetna — Whole Health: $19,138.46 Alliance Health — Managed Medicaid: $21,437.81 AmeriHealth — Managed Medicaid: $21,437.81 BCBS — Commercial/HMO/PPO/Select: $28,001 BCBS — Managed Medicaid: $21,437.81 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $16,799.61 Carolina Complete Health — Managed Medicaid: $21,437.81
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cervical Spinal Fusion Without Cc/McC	$73,721.98	$19,904.93	$8,064.24 – $55,278.79
Neck (cervical) spinal fusion, without complications: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $38,040.54 Aetna — Medicare Advantage HMO: $19,878.12 Aetna — Medicare Advantage PPO: $21,017.65 Aetna — Whole Health: $15,265.55 Alliance Health — Managed Medicaid: $24,349.82 AmeriHealth — Managed Medicaid: $24,349.82 BCBS — Commercial/HMO/PPO/Select: $33,362.81 BCBS — Managed Medicaid: $24,349.82 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $20,598.32 Carolina Complete Health — Managed Medicaid: $24,349.82
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC	$32,781.70	$8,851.06	$4,098.35 – $22,938.06
Uterus and ovary surgery (not for cancer), without complications: 10 of 25 insurance plan rates Aetna — Commercial/HMO/PPO/POS: $11,458.88 Aetna — Medicare Advantage HMO: $11,321.27 Aetna — Medicare Advantage PPO: $11,919.37 Aetna — Whole Health: $6,047 Alliance Health — Managed Medicaid: $10,949.92 AmeriHealth — Managed Medicaid: $10,949.92 BCBS — Commercial/HMO/PPO/Select: $16,955.41 BCBS — Managed Medicaid: $10,949.92 BCBS — Medicare Advantage/Medicare Advantage HMO/Medicare Advantage: $8,130.10 Carolina Complete Health — Managed Medicaid: $10,949.92

Source: Duke University Hospital’s standard charges file (rca.elevatepfs.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 1, 2026; retrieved November 5, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Acute Care Hospital
Address	2301 Erwin Rd, Durham, NC 27705
County	Durham County
State	North Carolina
Phone	(919) 684‑8111
Emergency services	Yes
Ownership	Proprietary
Medicare overall rating	5 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	340030
Name in Medicare records	DUKE UNIVERSITY HOSPITAL
Profile level	Medicare data + hospital website
Official website	dukehealth.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

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

Duke University Hospital | Durham, NC | Duke Health — dukehealth.org
Support Services | Duke University Hospital | Duke Health — dukehealth.org
Specialties | Duke University Hospital | Duke Health — dukehealth.org
Visitor Information | Duke University Hospital | Duke Health — dukehealth.org
Parking and Directions | Duke University Hospital | Duke Health — dukehealth.org
About Duke University Hospital | Duke University Hospital | Duke Health — dukehealth.org
Arts & Health | Duke Health — dukehealth.org
Duke University Hospital: Emergency Room | Durham, NC | Duke Health — dukehealth.org

Duke University Hospital

Summary

Profile from official sources

At a glance