Does Ellis Hospital have an emergency room?

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

Where is Ellis Hospital?

1101 Nott Street, Schenectady, NY 12308, in Schenectady County, New York.

What is the phone number of Ellis Hospital?

(518) 243-4196, as listed by Medicare (CMS).

What is the Medicare star rating of Ellis Hospital?

3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).

Does Medicare reduce its payments to Ellis Hospital for hospital-acquired conditions?

No. For fiscal year 2026, CMS lists no Medicare payment reduction for Ellis Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.0688; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Ellis Hospital — Phone, Address, ER & Ratings

Quick answers

Does Ellis Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Ellis Hospital. In a medical emergency, call 911.
Where is Ellis Hospital?: 1101 Nott Street, Schenectady, NY 12308, in Schenectady County, New York.
What is the phone number of Ellis Hospital?: (518) 243-4196, as listed by Medicare (CMS).
What is the Medicare star rating of Ellis Hospital?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to Ellis Hospital for hospital-acquired conditions?: No. For fiscal year 2026, CMS lists no Medicare payment reduction for Ellis Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.0688; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas^[4][7][8]

Emergency medicine
Heart care (Heart Center)
Cardiothoracic surgery
Orthopedic surgery
Neurological surgery
Vascular surgery
Inpatient medical/surgical care
Psychiatric care
Critical care (Intensive Care Unit)
Neurology / stroke care
Diagnostic imaging

Conditions treated^[8]

Stroke

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

Stroke Center (NYS designated Primary Stroke Center)
Stroke Alert System and 24/7 Stroke Team
Neuro Intensive Care Unit
Stroke survivor and caregiver support group
Sexual Assault Forensic Examiners (S.A.F.E.) program
Certified Autism Center emergency room
36-bed Intensive Care Unit

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

Emergency room	Yes
Stroke designation	New York State designated Stroke Center

Visiting and practical information

Visiting	Inpatient units 8 a.m.-9 p.m., ICU 10 a.m.-9 p.m., daily; two visitors at a time; ED two visitors 24/7^[6]
Parking	Complimentary valet at Nott Street entrance Mon-Fri 6 a.m.-5 p.m.; Rosa Road garage with entry via ED main entrance^[6]

Recognition^[4][7][8]

New York State designated Stroke Center
New York State designated Primary Stroke Center
Certified Autism Center (IBCCES) - Emergency Room

Doctors and clinicians (798)

798 doctors and other clinicians list Ellis Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 774 more: the button below opens the full list.

Other emergency rooms nearby

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

St Peter's Hospital12 mi · Albany, NY · Acute Care Hospital
Albany Medical Center Hospital14 mi · Albany, NY · Acute Care Hospital
Samaritan Hospital14 mi · Troy, NY · Acute Care Hospital
Albany VA Medical Center14 mi · Albany, NY · Federal/VA Acute Care Hospital
St Mary's Healthcare18 mi · Amsterdam, NY · Acute Care Hospital

Find the closest emergency room to where you are → · Compare ER wait times

Other hospitals near Schenectady

Sunnyview Hospital and Rehabilitation Center0.3 mi · Schenectady, NY · Acute Care Hospital
Capital District Psychiatric Center13 mi · Albany, NY · Psychiatric Hospital

All hospitals in Schenectady · Hospitals in Schenectady County · Hospitals near me

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

Pathways Nursing and Rehabilitation Center1.2 mi · Niskayuna, NY · 4 of 5 stars
Schenectady Center for Rehabilitation and Nursing2.0 mi · Schenectady, NY · 2 of 5 stars
Baptist Health Nursing and Rehabilitation Center2.1 mi · Scotia, NY · 1 of 5 stars

All nursing homes in the state →

Hospice providers

The Community Hospice, Inc8.5 mi · Albany, NY · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Centerwell Home Health8.1 mi · Ballston Lake, NY · 5 of 5 stars
Marquis Certified Home Care, LLC8.5 mi · Albany, NY · 4 of 5 stars
VNA Home Health12 mi · Albany, NY · 4 of 5 stars

All home health agencies in the state →

Dialysis facilities

Fms-Niskayuna Dialysis Center3.1 mi · Schenectady, NY · 2 of 5 stars
Fms-Capital District Dialysis Center3.3 mi · Schenectady, NY · 1 of 5 stars
Rotterdam-Schenectady Dialysis Center3.3 mi · Schenectady, NY · 2 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.

Saratoga-Schenectady Endoscopy Center7.0 mi · Burnt Hills, NY
Orthony Surgical Suites7.1 mi · Clifton Park, NY
The Northway Surgery and Pain Center7.1 mi · Clifton Park, NY

All outpatient surgery centers in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

Hometown Health Centers at Schenectady High School0.6 mi · Schenectady, NY · Community health center
Hometown Health Centers1.4 mi · Schenectady, NY · Community health center
Hometown Health Centers Dental at State Street1.4 mi · Schenectady, NY · Community health center

Clinics and urgent care

Ellis Hospital1.7 mi · Schenectady, NY · Urgent care center
TPB Medical Services PC4.9 mi · Schenectady, NY · Urgent care center
Albany Medical College7.1 mi · Clifton Park, NY · Urgent care center

Pharmacies

Ellis Nott Street Pharmacy LLC0.1 mi · Schenectady, NY · Community/retail pharmacy
Golub Corporation0.1 mi · Schenectady, NY · Pharmacy
Walgreen Co0.1 mi · Schenectady, NY · Pharmacy

Assisted living nearby

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

Brookdale East Niskayuna3.1 mi · Niskayuna, NY
Brookdale Niskayuna3.1 mi · Niskayuna, NY
Heritage Home for Women3.1 mi · Schenectady, NY
The Terrace at Glen Eddy3.1 mi · Niskayuna, NY

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Ellis Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	2 of 5 stars
Overall rating of the hospital	2 of 5 stars
Would recommend the hospital	3 of 5 stars
Nurses communicated well	3 of 5 stars
Doctors communicated well	3 of 5 stars
Patients got help quickly from staff	2 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Restfulness of Environment	1 of 5 stars
Care Coordination	2 of 5 stars
Symptoms After Stay	3 of 5 stars
Rated the hospital 9 or 10 out of 10	61%National average: 72%
Would definitely recommend the hospital	62%National average: 71%
Nurses “always” communicated well	76%National average: 80%
Doctors “always” communicated well	77%National average: 80%
“Always” got help as soon as they wanted	52%National average: 64%
Staff “always” explained medicines before giving them	58%National average: 62%
Were given information about recovery at home	85%National average: 86%
Room and bathroom “always” clean	67%National average: 73%
Completed surveys	1,494Response rate: 21%

Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged January 2025 to December 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)	0.259Better than the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.355No different from the national benchmark
Surgical site infections after colon surgery	0No different from the national benchmark
MRSA bloodstream infections	0.968No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.593No different from the national benchmark
Not reported to Medicare	Surgical site infections after abdominal hysterectomy

Source: Healthcare Associated Infections - Hospital — CMS, released October 19, 2026; data from January 2025 to December 2025.

Complications and deaths

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

Deaths within 30 days: heart attack patients	12.4%
Deaths within 30 days: heart failure patients	10.1%
Deaths within 30 days: pneumonia patients	17.2%
Deaths within 30 days: COPD patients	8.6%
Deaths within 30 days: stroke patients	12.4%
Deaths within 30 days: coronary bypass surgery (CABG)	2.5%
Serious complications (patient safety indicator PSI-90)	1.12No different from the national rate
Complications after hip or knee replacement	7.5%

Source: Complications and Deaths - Hospital — CMS, released October 20, 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)	16.3%
Readmitted within 30 days: heart attack	14.2%
Readmitted within 30 days: heart failure	19.4%
Readmitted within 30 days: pneumonia	17.1%
Readmitted within 30 days: COPD	20.3%
Readmitted within 30 days: coronary bypass surgery	12.3%
Readmitted within 30 days: hip or knee replacement	6.5%

Source: Unplanned Hospital Visits - Hospital — CMS, released October 20, 2026; data from July 2024 to June 2025.

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	217 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	2%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	78%National average: 66%

Source: Timely and Effective Care - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

Medicare payment programs

Medicare (CMS) uses these federal programs to adjust what it pays hospitals, based on quality, safety and cost results. This is a payment to the hospital for Medicare patients, not a price you pay, and not a prediction for any one person. Results for Ellis Hospital, fiscal year 2026 (October 2025 to September 2026).

Show the Medicare payment program results

Hospital-Acquired Condition Reduction Program

What this means: Medicare gives each hospital a Total HAC Score built from patient-safety complications and from infections caught in the hospital. The quarter of hospitals with the highest (worst) scores gets a reduction in its Medicare payments. A lower score is better.

CMS says: Hospitals with a Total HAC Score above the 75th percentile of the Total HAC Score distribution will be subject to a 1-percent payment reduction.

Medicare payment reduction, fiscal year 2026	NoCMS lists no payment reduction for this hospital.
Total HAC Score	-0.0688Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

Source: Hospital-Acquired Condition (HAC) Reduction Program — CMS, released January 26, 2026; patient-safety data from July 2022 to June 2024 and infection data from January 2023 to December 2024.

Hospital Readmissions Reduction Program

What this means: For six conditions, Medicare compares how often this hospital’s patients had to go back into a hospital within 30 days with how often that happens at an average hospital with similar patients. The ratio is that comparison: 1 means as many readmissions as expected, above 1 means more than expected (CMS calls these “excess readmissions”), below 1 means fewer.

CMS says: In October 2012, CMS began reducing Medicare payments for subsection(d) hospitals with excess readmissions under the Hospital Readmissions Reduction Program (HRRP).

Heart attack	0.9560Fewer readmissions than expected
Heart failure	1.0388More readmissions than expected
Pneumonia	0.9969Fewer readmissions than expected
COPD (chronic lung disease)	1.0539More readmissions than expected
Coronary bypass surgery (CABG)	0.9424Fewer readmissions than expected
No result published	Hip or knee replacement (not reported, or too few cases)

Source: Hospital Readmissions Reduction Program — CMS, released January 26, 2026; patients discharged July 2021 to June 2024.

Hospital Value-Based Purchasing Program

What this means: Medicare scores hospitals in four areas, each from 0 to 100, and combines them into a Total Performance Score from 0 to 100. A higher score means better results on these measures. Medicare uses the score to adjust what it pays the hospital.

CMS says: This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver.

Total Performance Score	30.17 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)	42.00 out of 100
Person and community engagement (patient survey)	12.00 out of 100
Safety (infections and sepsis care)	36.67 out of 100
Efficiency and cost reduction (Medicare spending)	30.00 out of 100

Source: Hospital Value-Based Purchasing (HVBP) - Total Performance Score — CMS, released January 26, 2026, fiscal year 2026. Program description: The Hospital Value-Based Purchasing (VBP) Program — CMS, page last modified September 10, 2024.

Medicare spending per patient (MSPB)

What this means: This compares what Medicare spent on a hospital stay, counting the 3 days before it and the 30 days after, with the national median hospital, after adjusting for the patient’s age and health and for local prices. A ratio of 1.00 is the national median hospital; below 1.00 means Medicare spent less, above 1.00 means more. It measures the cost to Medicare, not the quality of care.

CMS says: The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (episode) at a specific hospital compared to all hospitals nationally.

Medicare spending per patient, ratio	0.93Below the national median hospital (1.00): Medicare spent less

Source: Medicare Spending Per Beneficiary - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

ER wait times and Medicare ratings nearby

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

ER wait times in New York Best hospitals in New York

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 86 common services exactly as Ellis 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 →

Show the prices of 86 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00068P OFFICE/OUTPATIENT VISIT NEW	$239	$119.50	$119.50 – $617
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $198.37 CDPHP — CDPHP: $124.25 Coventry — Coventry: $198.37 Empire BC — Empire BC: $617 MVP Commercial/Select — MVP Commercial/Select: $273.62 Non-Contracted — Non-Contracted: $215.10 POMCO — POMCO: $186.42 RMSCO — RMSCO: $203.15 Self-Pay — Self-Pay: $119.50 Tricare — Tricare: $239
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00301P OFFICE/OUTPATIENT VISIT NEW	$252	$126	$124.25 – $617
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $209.16 CDPHP — CDPHP: $124.25 Coventry — Coventry: $209.16 Empire BC — Empire BC: $617 MVP Commercial/Select — MVP Commercial/Select: $273.62 Non-Contracted — Non-Contracted: $226.80 POMCO — POMCO: $196.56 RMSCO — RMSCO: $214.20 Self-Pay — Self-Pay: $126 Tricare — Tricare: $252
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99203 P- OFFICE VISIT NEW LVL 3 (00310)	$252	$126	$124.25 – $617
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $209.16 CDPHP — CDPHP: $124.25 Coventry — Coventry: $209.16 Empire BC — Empire BC: $617 MVP Commercial/Select — MVP Commercial/Select: $273.62 Non-Contracted — Non-Contracted: $226.80 POMCO — POMCO: $196.56 RMSCO — RMSCO: $214.20 Self-Pay — Self-Pay: $126 Tricare — Tricare: $252
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00069P OFFICE/OUTPATIENT VISIT NEW	$405	$202.50	$202.50 – $1,392
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $336.15 CDPHP — CDPHP: $202.57 Coventry — Coventry: $336.15 Empire BC — Empire BC: $1,392 MVP Commercial/Select — MVP Commercial/Select: $445.20 Non-Contracted — Non-Contracted: $364.50 POMCO — POMCO: $315.90 RMSCO — RMSCO: $344.25 Self-Pay — Self-Pay: $202.50 Tricare — Tricare: $405
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00302P OFFICE/OUTPATIENT VISIT NEW	$427	$213.50	$202.57 – $1,392
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $354.41 CDPHP — CDPHP: $202.57 Coventry — Coventry: $354.41 Empire BC — Empire BC: $1,392 MVP Commercial/Select — MVP Commercial/Select: $445.20 Non-Contracted — Non-Contracted: $384.30 POMCO — POMCO: $333.06 RMSCO — RMSCO: $362.95 Self-Pay — Self-Pay: $213.50 Tricare — Tricare: $427
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99204 P- OFFICE VISIT NEW LVL 4 (00311)	$427	$213.50	$202.57 – $1,392
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $354.41 CDPHP — CDPHP: $202.57 Coventry — Coventry: $354.41 Empire BC — Empire BC: $1,392 MVP Commercial/Select — MVP Commercial/Select: $445.20 Non-Contracted — Non-Contracted: $384.30 POMCO — POMCO: $333.06 RMSCO — RMSCO: $362.95 Self-Pay — Self-Pay: $213.50 Tricare — Tricare: $427
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00070P OFFICE/OUTPATIENT VISIT NEW	$554	$277	$275.43 – $1,479
New patient office visit (about 60–74 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $459.82 CDPHP — CDPHP: $275.43 Coventry — Coventry: $459.82 Empire BC — Empire BC: $1,479 MVP Commercial/Select — MVP Commercial/Select: $605.56 Non-Contracted — Non-Contracted: $498.60 POMCO — POMCO: $432.12 RMSCO — RMSCO: $470.90 Self-Pay — Self-Pay: $277 Tricare — Tricare: $554
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00303P OFFICE/OUTPATIENT VISIT NEW	$554	$277	$275.43 – $1,479
New patient office visit (about 60–74 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $459.82 CDPHP — CDPHP: $275.43 Coventry — Coventry: $459.82 Empire BC — Empire BC: $1,479 MVP Commercial/Select — MVP Commercial/Select: $605.56 Non-Contracted — Non-Contracted: $498.60 POMCO — POMCO: $432.12 RMSCO — RMSCO: $470.90 Self-Pay — Self-Pay: $277 Tricare — Tricare: $554
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99205 P- OFFICE VISIT NEW LVL 5 (00312)	$554	$277	$275.43 – $1,479
New patient office visit (about 60–74 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $459.82 CDPHP — CDPHP: $275.43 Coventry — Coventry: $459.82 Empire BC — Empire BC: $1,479 MVP Commercial/Select — MVP Commercial/Select: $605.56 Non-Contracted — Non-Contracted: $498.60 POMCO — POMCO: $432.12 RMSCO — RMSCO: $470.90 Self-Pay — Self-Pay: $277 Tricare — Tricare: $554
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00072P OFFICE/OUTPATIENT VISIT EST	$239	$119.50	$100.27 – $617
Established patient office visit (about 20–29 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $198.37 CDPHP — CDPHP: $100.27 Coventry — Coventry: $198.37 Empire BC — Empire BC: $617 MVP Commercial/Select — MVP Commercial/Select: $219.79 Non-Contracted — Non-Contracted: $215.10 POMCO — POMCO: $186.42 RMSCO — RMSCO: $203.15 Self-Pay — Self-Pay: $119.50 Tricare — Tricare: $239
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00305P OFFICE/OUTPATIENT VISIT EST	$170	$85	$85 – $617
Established patient office visit (about 20–29 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $141.10 CDPHP — CDPHP: $100.27 Coventry — Coventry: $141.10 Empire BC — Empire BC: $617 MVP Commercial/Select — MVP Commercial/Select: $219.79 Non-Contracted — Non-Contracted: $153 POMCO — POMCO: $132.60 RMSCO — RMSCO: $144.50 Self-Pay — Self-Pay: $85 Tricare — Tricare: $170
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99213 P- OFFICE VISIT EST LVL 3 (00314)	$170	$85	$85 – $617
Established patient office visit (about 20–29 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $141.10 CDPHP — CDPHP: $100.27 Coventry — Coventry: $141.10 Empire BC — Empire BC: $617 MVP Commercial/Select — MVP Commercial/Select: $219.79 Non-Contracted — Non-Contracted: $153 POMCO — POMCO: $132.60 RMSCO — RMSCO: $144.50 Self-Pay — Self-Pay: $85 Tricare — Tricare: $170
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00073P OFFICE/OUTPATIENT VISIT EST	$405	$202.50	$147.58 – $1,392
Established patient office visit (about 30–39 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $336.15 CDPHP — CDPHP: $147.58 Coventry — Coventry: $336.15 Empire BC — Empire BC: $1,392 MVP Commercial/Select — MVP Commercial/Select: $324.08 Non-Contracted — Non-Contracted: $364.50 POMCO — POMCO: $315.90 RMSCO — RMSCO: $344.25 Self-Pay — Self-Pay: $202.50 Tricare — Tricare: $405
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00306P OFFICE/OUTPATIENT VISIT EST	$259	$129.50	$129.50 – $1,392
Established patient office visit (about 30–39 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $214.97 CDPHP — CDPHP: $147.58 Coventry — Coventry: $214.97 Empire BC — Empire BC: $1,392 MVP Commercial/Select — MVP Commercial/Select: $324.08 Non-Contracted — Non-Contracted: $233.10 POMCO — POMCO: $202.02 RMSCO — RMSCO: $220.15 Self-Pay — Self-Pay: $129.50 Tricare — Tricare: $259
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99214 P- OFFICE VISIT EST LVL 4 (00315)	$259	$129.50	$129.50 – $1,392
Established patient office visit (about 30–39 minutes): 10 of 11 insurance plan rates Aetna — Aetna: $214.97 CDPHP — CDPHP: $147.58 Coventry — Coventry: $214.97 Empire BC — Empire BC: $1,392 MVP Commercial/Select — MVP Commercial/Select: $324.08 Non-Contracted — Non-Contracted: $233.10 POMCO — POMCO: $202.02 RMSCO — RMSCO: $220.15 Self-Pay — Self-Pay: $129.50 Tricare — Tricare: $259
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99243P OFFICE CONSULTATION	$160	$80	$80 – $160
Office consultation with a specialist (moderate): rates for 10 insurance plans Aetna — Aetna: $132.80 Coventry — Coventry: $132.80 Empire BC — Empire BC: $80 MVP Commercial/Select — MVP Commercial/Select: $80 Non-Contracted — Non-Contracted: $144 POMCO — POMCO: $124.80 RMSCO — RMSCO: $136 Self-Pay — Self-Pay: $80 Tricare — Tricare: $160 United Healthcare — United Healthcare: $128
Office consultation with a specialist (moderate) CPT 99243 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99243P OFFICE CONSULTATION	$160	$80	$80 – $144
Office consultation with a specialist (moderate): rates for 7 insurance plans Aetna — Aetna: $136 Coventry — Coventry: $132.80 Non-Contracted — Non-Contracted: $144 POMCO — POMCO: $124.80 RMSCO — RMSCO: $144 Self-Pay — Self-Pay: $80 United Healthcare — United Healthcare: $128
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: 00983T OFFICE CONSULTATION (99243)	$132	$66	$66 – $132
Office consultation with a specialist (moderate): rates for 10 insurance plans Aetna — Aetna: $109.56 Coventry — Coventry: $109.56 Empire BC — Empire BC: $66 MVP Commercial/Select — MVP Commercial/Select: $66 Non-Contracted — Non-Contracted: $118.80 POMCO — POMCO: $102.96 RMSCO — RMSCO: $112.20 Self-Pay — Self-Pay: $66 Tricare — Tricare: $132 United Healthcare — United Healthcare: $105.60
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99244P OFFICE CONSULTATION	$263	$131.50	$131.50 – $263
Office consultation with a specialist (moderate to high): rates for 10 insurance plans Aetna — Aetna: $218.29 Coventry — Coventry: $218.29 Empire BC — Empire BC: $131.50 MVP Commercial/Select — MVP Commercial/Select: $131.50 Non-Contracted — Non-Contracted: $236.70 POMCO — POMCO: $205.14 RMSCO — RMSCO: $223.55 Self-Pay — Self-Pay: $131.50 Tricare — Tricare: $263 United Healthcare — United Healthcare: $210.40
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99244P OFFICE CONSULTATION	$263	$131.50	$131.50 – $236.70
Office consultation with a specialist (moderate to high): rates for 7 insurance plans Aetna — Aetna: $223.55 Coventry — Coventry: $218.29 Non-Contracted — Non-Contracted: $236.70 POMCO — POMCO: $205.14 RMSCO — RMSCO: $236.70 Self-Pay — Self-Pay: $131.50 United Healthcare — United Healthcare: $210.40
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: 99244T OFFICE CONSULTATION	$139	$69.50	$69.50 – $139
Office consultation with a specialist (moderate to high): rates for 10 insurance plans Aetna — Aetna: $115.37 Coventry — Coventry: $115.37 Empire BC — Empire BC: $69.50 MVP Commercial/Select — MVP Commercial/Select: $69.50 Non-Contracted — Non-Contracted: $125.10 POMCO — POMCO: $108.42 RMSCO — RMSCO: $118.15 Self-Pay — Self-Pay: $69.50 Tricare — Tricare: $139 United Healthcare — United Healthcare: $111.20
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99385P PREV VISIT NEW AGE 18-39	$130	$65	$65 – $311.75
Preventive checkup, new patient, age 18–39: rates for 10 insurance plans Aetna — Aetna: $107.90 Coventry — Coventry: $107.90 Empire BC — Empire BC: $65 MVP Commercial/Select — MVP Commercial/Select: $311.75 Non-Contracted — Non-Contracted: $117 POMCO — POMCO: $101.40 RMSCO — RMSCO: $110.50 Self-Pay — Self-Pay: $65 Tricare — Tricare: $130 United Healthcare — United Healthcare: $104
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99385P PREV VISIT NEW AGE 18-39 CM	$130	$65	$65 – $311.75
Preventive checkup, new patient, age 18–39: rates for 10 insurance plans Aetna — Aetna: $107.90 Coventry — Coventry: $107.90 Empire BC — Empire BC: $65 MVP Commercial/Select — MVP Commercial/Select: $311.75 Non-Contracted — Non-Contracted: $117 POMCO — POMCO: $101.40 RMSCO — RMSCO: $110.50 Self-Pay — Self-Pay: $65 Tricare — Tricare: $130 United Healthcare — United Healthcare: $104
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99385P PREV VISIT NEW AGE 18-39	$130	$65	$65 – $117
Preventive checkup, new patient, age 18–39: rates for 7 insurance plans Aetna — Aetna: $110.50 Coventry — Coventry: $107.90 Non-Contracted — Non-Contracted: $117 POMCO — POMCO: $101.40 RMSCO — RMSCO: $117 Self-Pay — Self-Pay: $65 United Healthcare — United Healthcare: $104
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99386P PREV VISIT NEW AGE 40-64	$172	$86	$86 – $377.91
Preventive checkup, new patient, age 40–64: rates for 10 insurance plans Aetna — Aetna: $142.76 Coventry — Coventry: $142.76 Empire BC — Empire BC: $86 MVP Commercial/Select — MVP Commercial/Select: $377.91 Non-Contracted — Non-Contracted: $154.80 POMCO — POMCO: $134.16 RMSCO — RMSCO: $146.20 Self-Pay — Self-Pay: $86 Tricare — Tricare: $172 United Healthcare — United Healthcare: $137.60
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99386P PREV VISIT NEW AGE 40-64 CM	$172	$86	$86 – $377.91
Preventive checkup, new patient, age 40–64: rates for 10 insurance plans Aetna — Aetna: $142.76 Coventry — Coventry: $142.76 Empire BC — Empire BC: $86 MVP Commercial/Select — MVP Commercial/Select: $377.91 Non-Contracted — Non-Contracted: $154.80 POMCO — POMCO: $134.16 RMSCO — RMSCO: $146.20 Self-Pay — Self-Pay: $86 Tricare — Tricare: $172 United Healthcare — United Healthcare: $137.60
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99386P PREV VISIT NEW AGE 40-64	$172	$86	$86 – $154.80
Preventive checkup, new patient, age 40–64: rates for 7 insurance plans Aetna — Aetna: $146.20 Coventry — Coventry: $142.76 Non-Contracted — Non-Contracted: $154.80 POMCO — POMCO: $134.16 RMSCO — RMSCO: $154.80 Self-Pay — Self-Pay: $86 United Healthcare — United Healthcare: $137.60
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER FACILITY CHG 3	$1,459	$729.50	$340.75 – $1,832
Emergency room visit (moderate): 10 of 20 insurance plan rates Aetna — Aetna: $1,210.97 Blue Shield Senior — Blue Shield Senior: $356.03 CDPHP — CDPHP: $1,469 Charity Care Tier 2 — Charity Care Tier 2: $169.54 Coventry — Coventry: $1,210.97 Empire BC — Empire BC: $1,825 GHI — GHI: $986 Managed Medicare — Managed Medicare: $339.08 Medicare — Medicare: $340.75 Medicare HMO 101 — Medicare HMO 101: $342.47
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROF ER PROFESSIONAL LVL 3	$205	$102.50	$102.50 – $1,825
Emergency room visit (moderate): 10 of 20 insurance plan rates Aetna — Aetna: $170.15 Blue Shield Senior — Blue Shield Senior: $356.03 CDPHP — CDPHP: $1,469 Charity Care Tier 2 — Charity Care Tier 2: $169.54 Coventry — Coventry: $170.15 Empire BC — Empire BC: $1,825 GHI — GHI: $986 Managed Medicare — Managed Medicare: $339.08 Medicare — Medicare: $340.75 Medicare HMO 101 — Medicare HMO 101: $342.47
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER VISIT LEVEL 3	$216	$108	$108 – $1,825
Emergency room visit (moderate): 10 of 20 insurance plan rates Aetna — Aetna: $179.28 Blue Shield Senior — Blue Shield Senior: $356.03 CDPHP — CDPHP: $1,469 Charity Care Tier 2 — Charity Care Tier 2: $169.54 Coventry — Coventry: $179.28 Empire BC — Empire BC: $1,825 GHI — GHI: $986 Managed Medicare — Managed Medicare: $339.08 Medicare — Medicare: $340.75 Medicare HMO 101 — Medicare HMO 101: $342.47
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER FACILITY CHG 4	$1,824	$912	$520.86 – $1,971
Emergency room visit (moderately high): 10 of 20 insurance plan rates Aetna — Aetna: $1,513.92 Blue Shield Senior — Blue Shield Senior: $544.23 CDPHP — CDPHP: $1,469 Charity Care Tier 2 — Charity Care Tier 2: $259.15 Coventry — Coventry: $1,513.92 Empire BC — Empire BC: $1,825 GHI — GHI: $986 Managed Medicare — Managed Medicare: $518.31 Medicare — Medicare: $520.86 Medicare HMO 101 — Medicare HMO 101: $523.49
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROF ER PROFESSIONAL LVL 4	$368	$184	$184 – $1,825
Emergency room visit (moderately high): 10 of 20 insurance plan rates Aetna — Aetna: $305.44 Blue Shield Senior — Blue Shield Senior: $544.23 CDPHP — CDPHP: $1,469 Charity Care Tier 2 — Charity Care Tier 2: $259.15 Coventry — Coventry: $305.44 Empire BC — Empire BC: $1,825 GHI — GHI: $986 Managed Medicare — Managed Medicare: $518.31 Medicare — Medicare: $520.86 Medicare HMO 101 — Medicare HMO 101: $523.49
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER VISIT LEVEL 4	$387	$193.50	$193.50 – $1,825
Emergency room visit (moderately high): 10 of 20 insurance plan rates Aetna — Aetna: $321.21 Blue Shield Senior — Blue Shield Senior: $544.23 CDPHP — CDPHP: $1,469 Charity Care Tier 2 — Charity Care Tier 2: $259.15 Coventry — Coventry: $321.21 Empire BC — Empire BC: $1,825 GHI — GHI: $986 Managed Medicare — Managed Medicare: $518.31 Medicare — Medicare: $520.86 Medicare HMO 101 — Medicare HMO 101: $523.49
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER FACILITY CHG 5	$2,360	$1,180	$743.39 – $2,253
Emergency room visit (high): 10 of 20 insurance plan rates Aetna — Aetna: $1,958.80 Blue Shield Senior — Blue Shield Senior: $776.74 CDPHP — CDPHP: $1,694 Charity Care Tier 2 — Charity Care Tier 2: $369.88 Coventry — Coventry: $1,958.80 Empire BC — Empire BC: $1,825 GHI — GHI: $986 Managed Medicare — Managed Medicare: $739.75 Medicare — Medicare: $743.39 Medicare HMO 101 — Medicare HMO 101: $747.15
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROF ER PROFESSIONAL LVL 5	$517	$258.50	$258.50 – $1,825
Emergency room visit (high): 10 of 20 insurance plan rates Aetna — Aetna: $429.11 Blue Shield Senior — Blue Shield Senior: $776.74 CDPHP — CDPHP: $1,694 Charity Care Tier 2 — Charity Care Tier 2: $369.88 Coventry — Coventry: $429.11 Empire BC — Empire BC: $1,825 GHI — GHI: $986 Managed Medicare — Managed Medicare: $739.75 Medicare — Medicare: $743.39 Medicare HMO 101 — Medicare HMO 101: $747.15
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER VISIT LEVEL 5	$570	$285	$285 – $1,825
Emergency room visit (high): 10 of 20 insurance plan rates Aetna — Aetna: $473.10 Blue Shield Senior — Blue Shield Senior: $776.74 CDPHP — CDPHP: $1,694 Charity Care Tier 2 — Charity Care Tier 2: $369.88 Coventry — Coventry: $473.10 Empire BC — Empire BC: $1,825 GHI — GHI: $986 Managed Medicare — Managed Medicare: $739.75 Medicare — Medicare: $743.39 Medicare HMO 101 — Medicare HMO 101: $747.15

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL	$120	$60	$1.69 – $108
Basic metabolic panel (blood test): 10 of 20 insurance plan rates Aetna — Aetna: $99.60 Blue Shield Senior — Blue Shield Senior: $8.88 CDPHP — CDPHP: $9.31 Charity Care Tier 2 — Charity Care Tier 2: $4.23 Coventry — Coventry: $99.60 Empire BC — Empire BC: $11.17 GHI — GHI: $13.47 Managed Medicare — Managed Medicare: $8.46 Medicare — Medicare: $8.46 Medicare HMO 101 — Medicare HMO 101: $8.54
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL	$120	$60	$60 – $108
Basic metabolic panel (blood test): rates for 7 insurance plans Aetna — Aetna: $102 Coventry — Coventry: $99.60 Non-Contracted — Non-Contracted: $108 POMCO — POMCO: $93.60 RMSCO — RMSCO: $108 Self-Pay — Self-Pay: $60 United Healthcare — United Healthcare: $96
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMP METABOLIC PANEL	$154	$77	$2.11 – $138.60
Comprehensive metabolic panel (blood test): 10 of 20 insurance plan rates Aetna — Aetna: $127.82 Blue Shield Senior — Blue Shield Senior: $11.09 CDPHP — CDPHP: $11.62 Charity Care Tier 2 — Charity Care Tier 2: $5.28 Coventry — Coventry: $127.82 Empire BC — Empire BC: $13.94 GHI — GHI: $16.81 Managed Medicare — Managed Medicare: $10.56 Medicare — Medicare: $10.56 Medicare HMO 101 — Medicare HMO 101: $10.67
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMP METABOLIC PANEL	$154	$77	$77 – $138.60
Comprehensive metabolic panel (blood test): rates for 7 insurance plans Aetna — Aetna: $130.90 Coventry — Coventry: $127.82 Non-Contracted — Non-Contracted: $138.60 POMCO — POMCO: $120.12 RMSCO — RMSCO: $138.60 Self-Pay — Self-Pay: $77 United Healthcare — United Healthcare: $123.20
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PROFILE	$198	$99	$2.68 – $178.20
Cholesterol panel (lipid panel): 10 of 20 insurance plan rates Aetna — Aetna: $164.34 Blue Shield Senior — Blue Shield Senior: $14.06 CDPHP — CDPHP: $14.73 Charity Care Tier 2 — Charity Care Tier 2: $6.70 Coventry — Coventry: $164.34 Empire BC — Empire BC: $17.67 GHI — GHI: $21.31 Managed Medicare — Managed Medicare: $13.39 Medicare — Medicare: $13.39 Medicare HMO 101 — Medicare HMO 101: $13.52
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL	$54	$27	$2.68 – $48.60
Cholesterol panel (lipid panel): 10 of 20 insurance plan rates Aetna — Aetna: $44.82 Blue Shield Senior — Blue Shield Senior: $14.06 CDPHP — CDPHP: $14.73 Charity Care Tier 2 — Charity Care Tier 2: $6.70 Coventry — Coventry: $44.82 Empire BC — Empire BC: $17.67 GHI — GHI: $21.31 Managed Medicare — Managed Medicare: $13.39 Medicare — Medicare: $13.39 Medicare HMO 101 — Medicare HMO 101: $13.52
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LIPID PROFILE	$198	$99	$99 – $178.20
Cholesterol panel (lipid panel): rates for 7 insurance plans Aetna — Aetna: $168.30 Coventry — Coventry: $164.34 Non-Contracted — Non-Contracted: $178.20 POMCO — POMCO: $154.44 RMSCO — RMSCO: $178.20 Self-Pay — Self-Pay: $99 United Healthcare — United Healthcare: $158.40
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$102	$51	$1.74 – $91.80
Kidney function panel: 10 of 20 insurance plan rates Aetna — Aetna: $84.66 Blue Shield Senior — Blue Shield Senior: $9.11 CDPHP — CDPHP: $9.55 Charity Care Tier 2 — Charity Care Tier 2: $4.34 Coventry — Coventry: $84.66 Empire BC — Empire BC: $11.46 GHI — GHI: $13.82 Managed Medicare — Managed Medicare: $8.68 Medicare — Medicare: $8.68 Medicare HMO 101 — Medicare HMO 101: $8.77
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$102	$51	$51 – $91.80
Kidney function panel: rates for 7 insurance plans Aetna — Aetna: $86.70 Coventry — Coventry: $84.66 Non-Contracted — Non-Contracted: $91.80 POMCO — POMCO: $79.56 RMSCO — RMSCO: $91.80 Self-Pay — Self-Pay: $51 United Healthcare — United Healthcare: $81.60
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNC PANEL	$120	$60	$1.63 – $108
Liver function panel: 10 of 20 insurance plan rates Aetna — Aetna: $99.60 Blue Shield Senior — Blue Shield Senior: $8.58 CDPHP — CDPHP: $8.99 Charity Care Tier 2 — Charity Care Tier 2: $4.08 Coventry — Coventry: $99.60 Empire BC — Empire BC: $10.78 GHI — GHI: $13.01 Managed Medicare — Managed Medicare: $8.17 Medicare — Medicare: $8.17 Medicare HMO 101 — Medicare HMO 101: $8.25
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HEPATIC FUNC PANEL	$120	$60	$60 – $108
Liver function panel: rates for 7 insurance plans Aetna — Aetna: $102 Coventry — Coventry: $99.60 Non-Contracted — Non-Contracted: $108 POMCO — POMCO: $93.60 RMSCO — RMSCO: $108 Self-Pay — Self-Pay: $60 United Healthcare — United Healthcare: $96
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER URINALYSIS/MICROSCOPIC	$50	$25	$0.63 – $45
Urine test (automated, with microscope): 10 of 20 insurance plan rates Aetna — Aetna: $41.50 Blue Shield Senior — Blue Shield Senior: $3.33 CDPHP — CDPHP: $3.49 Charity Care Tier 2 — Charity Care Tier 2: $1.58 Coventry — Coventry: $41.50 Empire BC — Empire BC: $4.18 GHI — GHI: $5.05 Managed Medicare — Managed Medicare: $3.17 Medicare — Medicare: $3.17 Medicare HMO 101 — Medicare HMO 101: $3.20
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS W/MICROSCOPIC(AUTO)	$50	$25	$0.63 – $45
Urine test (automated, with microscope): 10 of 20 insurance plan rates Aetna — Aetna: $41.50 Blue Shield Senior — Blue Shield Senior: $3.33 CDPHP — CDPHP: $3.49 Charity Care Tier 2 — Charity Care Tier 2: $1.58 Coventry — Coventry: $41.50 Empire BC — Empire BC: $4.18 GHI — GHI: $5.05 Managed Medicare — Managed Medicare: $3.17 Medicare — Medicare: $3.17 Medicare HMO 101 — Medicare HMO 101: $3.20
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS/MICRO REFLX CULTURE	$50	$25	$0.63 – $45
Urine test (automated, with microscope): 10 of 20 insurance plan rates Aetna — Aetna: $41.50 Blue Shield Senior — Blue Shield Senior: $3.33 CDPHP — CDPHP: $3.49 Charity Care Tier 2 — Charity Care Tier 2: $1.58 Coventry — Coventry: $41.50 Empire BC — Empire BC: $4.18 GHI — GHI: $5.05 Managed Medicare — Managed Medicare: $3.17 Medicare — Medicare: $3.17 Medicare HMO 101 — Medicare HMO 101: $3.20
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POCT-URINALYSIS, DIP STICK	$60	$30	$0.70 – $54
Urine test (manual, without microscope): 10 of 20 insurance plan rates Aetna — Aetna: $49.80 Blue Shield Senior — Blue Shield Senior: $3.65 CDPHP — CDPHP: $3.83 Charity Care Tier 2 — Charity Care Tier 2: $1.74 Coventry — Coventry: $49.80 Empire BC — Empire BC: $4.59 GHI — GHI: $5.54 Managed Medicare — Managed Medicare: $3.48 Medicare — Medicare: $3.48 Medicare HMO 101 — Medicare HMO 101: $3.51
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00131T URINALYSIS NONAUTO W/O SCOPE	$60	$30	$0.70 – $54
Urine test (manual, without microscope): 10 of 20 insurance plan rates Aetna — Aetna: $49.80 Blue Shield Senior — Blue Shield Senior: $3.65 CDPHP — CDPHP: $3.83 Charity Care Tier 2 — Charity Care Tier 2: $1.74 Coventry — Coventry: $49.80 Empire BC — Empire BC: $4.59 GHI — GHI: $5.54 Managed Medicare — Managed Medicare: $3.48 Medicare — Medicare: $3.48 Medicare HMO 101 — Medicare HMO 101: $3.51
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINE REDUCING SUBSTANCES	$60	$30	$0.70 – $54
Urine test (manual, without microscope): 10 of 20 insurance plan rates Aetna — Aetna: $49.80 Blue Shield Senior — Blue Shield Senior: $3.65 CDPHP — CDPHP: $3.83 Charity Care Tier 2 — Charity Care Tier 2: $1.74 Coventry — Coventry: $49.80 Empire BC — Empire BC: $4.59 GHI — GHI: $5.54 Managed Medicare — Managed Medicare: $3.48 Medicare — Medicare: $3.48 Medicare HMO 101 — Medicare HMO 101: $3.51
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/O SCOPE	$36	$18	$0.45 – $32.40
Urine test (automated, without microscope): 10 of 20 insurance plan rates Aetna — Aetna: $29.88 Blue Shield Senior — Blue Shield Senior: $2.36 CDPHP — CDPHP: $2.48 Charity Care Tier 2 — Charity Care Tier 2: $1.13 Coventry — Coventry: $29.88 Empire BC — Empire BC: $2.97 GHI — GHI: $3.58 Managed Medicare — Managed Medicare: $2.25 Medicare — Medicare: $2.25 Medicare HMO 101 — Medicare HMO 101: $2.27
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LACT TOL, FASTING URN	$36	$18	$0.45 – $32.40
Urine test (automated, without microscope): 10 of 20 insurance plan rates Aetna — Aetna: $29.88 Blue Shield Senior — Blue Shield Senior: $2.36 CDPHP — CDPHP: $2.48 Charity Care Tier 2 — Charity Care Tier 2: $1.13 Coventry — Coventry: $29.88 Empire BC — Empire BC: $2.97 GHI — GHI: $3.58 Managed Medicare — Managed Medicare: $2.25 Medicare — Medicare: $2.25 Medicare HMO 101 — Medicare HMO 101: $2.27
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LACT TOL, 20MIN URN	$36	$18	$0.45 – $32.40
Urine test (automated, without microscope): 10 of 20 insurance plan rates Aetna — Aetna: $29.88 Blue Shield Senior — Blue Shield Senior: $2.36 CDPHP — CDPHP: $2.48 Charity Care Tier 2 — Charity Care Tier 2: $1.13 Coventry — Coventry: $29.88 Empire BC — Empire BC: $2.97 GHI — GHI: $3.58 Managed Medicare — Managed Medicare: $2.25 Medicare — Medicare: $2.25 Medicare HMO 101 — Medicare HMO 101: $2.27
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA, ULTRASENSITIVE	$238	$119	$3.68 – $214.20
PSA (prostate specific antigen) blood test: 10 of 20 insurance plan rates Aetna — Aetna: $197.54 Blue Shield Senior — Blue Shield Senior: $19.31 CDPHP — CDPHP: $20.23 Charity Care Tier 2 — Charity Care Tier 2: $9.20 Coventry — Coventry: $197.54 Empire BC — Empire BC: $24.27 GHI — GHI: $29.27 Managed Medicare — Managed Medicare: $18.39 Medicare — Medicare: $18.39 Medicare HMO 101 — Medicare HMO 101: $18.57
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA DIAGNOSTIC (TOTAL)	$238	$119	$3.68 – $214.20
PSA (prostate specific antigen) blood test: 10 of 20 insurance plan rates Aetna — Aetna: $197.54 Blue Shield Senior — Blue Shield Senior: $19.31 CDPHP — CDPHP: $20.23 Charity Care Tier 2 — Charity Care Tier 2: $9.20 Coventry — Coventry: $197.54 Empire BC — Empire BC: $24.27 GHI — GHI: $29.27 Managed Medicare — Managed Medicare: $18.39 Medicare — Medicare: $18.39 Medicare HMO 101 — Medicare HMO 101: $18.57
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSA, ULTRASENSITIVE	$238	$119	$119 – $214.20
PSA (prostate specific antigen) blood test: rates for 7 insurance plans Aetna — Aetna: $202.30 Coventry — Coventry: $197.54 Non-Contracted — Non-Contracted: $214.20 POMCO — POMCO: $185.64 RMSCO — RMSCO: $214.20 Self-Pay — Self-Pay: $119 United Healthcare — United Healthcare: $190.40
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THYROID STIM HORM	$245	$122.50	$3.36 – $220.50
Thyroid stimulating hormone (TSH) test: 10 of 20 insurance plan rates Aetna — Aetna: $203.35 Blue Shield Senior — Blue Shield Senior: $17.64 CDPHP — CDPHP: $18.48 Charity Care Tier 2 — Charity Care Tier 2: $8.40 Coventry — Coventry: $203.35 Empire BC — Empire BC: $22.18 GHI — GHI: $26.74 Managed Medicare — Managed Medicare: $16.80 Medicare — Medicare: $16.80 Medicare HMO 101 — Medicare HMO 101: $16.97
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH,3RD GENERATION-R	$245	$122.50	$3.36 – $220.50
Thyroid stimulating hormone (TSH) test: 10 of 20 insurance plan rates Aetna — Aetna: $203.35 Blue Shield Senior — Blue Shield Senior: $17.64 CDPHP — CDPHP: $18.48 Charity Care Tier 2 — Charity Care Tier 2: $8.40 Coventry — Coventry: $203.35 Empire BC — Empire BC: $22.18 GHI — GHI: $26.74 Managed Medicare — Managed Medicare: $16.80 Medicare — Medicare: $16.80 Medicare HMO 101 — Medicare HMO 101: $16.97
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THYROID STIM HORM	$245	$122.50	$122.50 – $220.50
Thyroid stimulating hormone (TSH) test: rates for 7 insurance plans Aetna — Aetna: $208.25 Coventry — Coventry: $203.35 Non-Contracted — Non-Contracted: $220.50 POMCO — POMCO: $191.10 RMSCO — RMSCO: $220.50 Self-Pay — Self-Pay: $122.50 United Healthcare — United Healthcare: $196
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PED CBC/DIFF/PLT	$115	$57.50	$1.55 – $103.50
Complete blood count (CBC) with differential: 10 of 20 insurance plan rates Aetna — Aetna: $95.45 Blue Shield Senior — Blue Shield Senior: $8.16 CDPHP — CDPHP: $8.55 Charity Care Tier 2 — Charity Care Tier 2: $3.88 Coventry — Coventry: $95.45 Empire BC — Empire BC: $10.26 GHI — GHI: $12.37 Managed Medicare — Managed Medicare: $7.77 Medicare — Medicare: $7.77 Medicare HMO 101 — Medicare HMO 101: $7.85
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC INCL DIFF & PLAT	$115	$57.50	$1.55 – $103.50
Complete blood count (CBC) with differential: 10 of 20 insurance plan rates Aetna — Aetna: $95.45 Blue Shield Senior — Blue Shield Senior: $8.16 CDPHP — CDPHP: $8.55 Charity Care Tier 2 — Charity Care Tier 2: $3.88 Coventry — Coventry: $95.45 Empire BC — Empire BC: $10.26 GHI — GHI: $12.37 Managed Medicare — Managed Medicare: $7.77 Medicare — Medicare: $7.77 Medicare HMO 101 — Medicare HMO 101: $7.85
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PED CBC/DIFF/PLT	$115	$57.50	$57.50 – $103.50
Complete blood count (CBC) with differential: rates for 7 insurance plans Aetna — Aetna: $97.75 Coventry — Coventry: $95.45 Non-Contracted — Non-Contracted: $103.50 POMCO — POMCO: $89.70 RMSCO — RMSCO: $103.50 Self-Pay — Self-Pay: $57.50 United Healthcare — United Healthcare: $92
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC W/0 DIFF	$97	$48.50	$1.29 – $87.30
Complete blood count (CBC), automated: 10 of 20 insurance plan rates Aetna — Aetna: $80.51 Blue Shield Senior — Blue Shield Senior: $6.79 CDPHP — CDPHP: $7.12 Charity Care Tier 2 — Charity Care Tier 2: $3.23 Coventry — Coventry: $80.51 Empire BC — Empire BC: $8.54 GHI — GHI: $10.30 Managed Medicare — Managed Medicare: $6.47 Medicare — Medicare: $6.47 Medicare HMO 101 — Medicare HMO 101: $6.53
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC W/0 DIFF	$97	$48.50	$48.50 – $87.30
Complete blood count (CBC), automated: rates for 7 insurance plans Aetna — Aetna: $82.45 Coventry — Coventry: $80.51 Non-Contracted — Non-Contracted: $87.30 POMCO — POMCO: $75.66 RMSCO — RMSCO: $87.30 Self-Pay — Self-Pay: $48.50 United Healthcare — United Healthcare: $77.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTIME	$47	$23.50	$0.86 – $42.30
Blood clotting time test (prothrombin time, PT): 10 of 20 insurance plan rates Aetna — Aetna: $39.01 Blue Shield Senior — Blue Shield Senior: $4.50 CDPHP — CDPHP: $4.72 Charity Care Tier 2 — Charity Care Tier 2: $2.15 Coventry — Coventry: $39.01 Empire BC — Empire BC: $5.66 GHI — GHI: $6.83 Managed Medicare — Managed Medicare: $4.29 Medicare — Medicare: $4.29 Medicare HMO 101 — Medicare HMO 101: $4.33
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTIME MIX STUDY	$47	$23.50	$0.86 – $42.30
Blood clotting time test (prothrombin time, PT): 10 of 20 insurance plan rates Aetna — Aetna: $39.01 Blue Shield Senior — Blue Shield Senior: $4.50 CDPHP — CDPHP: $4.72 Charity Care Tier 2 — Charity Care Tier 2: $2.15 Coventry — Coventry: $39.01 Empire BC — Empire BC: $5.66 GHI — GHI: $6.83 Managed Medicare — Managed Medicare: $4.29 Medicare — Medicare: $4.29 Medicare HMO 101 — Medicare HMO 101: $4.33
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LUPUS PANEL - PT	$47	$23.50	$0.86 – $42.30
Blood clotting time test (prothrombin time, PT): 10 of 20 insurance plan rates Aetna — Aetna: $39.01 Blue Shield Senior — Blue Shield Senior: $4.50 CDPHP — CDPHP: $4.72 Charity Care Tier 2 — Charity Care Tier 2: $2.15 Coventry — Coventry: $39.01 Empire BC — Empire BC: $5.66 GHI — GHI: $6.83 Managed Medicare — Managed Medicare: $4.29 Medicare — Medicare: $4.29 Medicare HMO 101 — Medicare HMO 101: $4.33
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: APTT	$91	$45.50	$1.20 – $81.90
Blood clotting test (partial thromboplastin time, PTT): 10 of 20 insurance plan rates Aetna — Aetna: $75.53 Blue Shield Senior — Blue Shield Senior: $6.31 CDPHP — CDPHP: $6.61 Charity Care Tier 2 — Charity Care Tier 2: $3 Coventry — Coventry: $75.53 Empire BC — Empire BC: $7.93 GHI — GHI: $9.57 Managed Medicare — Managed Medicare: $6.01 Medicare — Medicare: $6.01 Medicare HMO 101 — Medicare HMO 101: $6.07
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LUPUS PANEL - APTT	$91	$45.50	$1.20 – $81.90
Blood clotting test (partial thromboplastin time, PTT): 10 of 20 insurance plan rates Aetna — Aetna: $75.53 Blue Shield Senior — Blue Shield Senior: $6.31 CDPHP — CDPHP: $6.61 Charity Care Tier 2 — Charity Care Tier 2: $3 Coventry — Coventry: $75.53 Empire BC — Empire BC: $7.93 GHI — GHI: $9.57 Managed Medicare — Managed Medicare: $6.01 Medicare — Medicare: $6.01 Medicare HMO 101 — Medicare HMO 101: $6.07
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: APTT MIX STUDY	$91	$45.50	$1.20 – $81.90
Blood clotting test (partial thromboplastin time, PTT): 10 of 20 insurance plan rates Aetna — Aetna: $75.53 Blue Shield Senior — Blue Shield Senior: $6.31 CDPHP — CDPHP: $6.61 Charity Care Tier 2 — Charity Care Tier 2: $3 Coventry — Coventry: $75.53 Empire BC — Empire BC: $7.93 GHI — GHI: $9.57 Managed Medicare — Managed Medicare: $6.01 Medicare — Medicare: $6.01 Medicare HMO 101 — Medicare HMO 101: $6.07

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 · modifier 26 In the file: R70450P- CT HEAD W/O-423	$143	$71.50	$71.50 – $365.57
CT scan of the head or brain, without contrast: 10 of 20 insurance plan rates Aetna — Aetna: $118.69 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $102.42 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $118.69 Empire BC — Empire BC: $365.57 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT HEAD WO	$1,351	$675.50	$100.60 – $1,215.90
CT scan of the head or brain, without contrast: 10 of 20 insurance plan rates Aetna — Aetna: $1,121.33 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $102.42 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $1,121.33 Empire BC — Empire BC: $365.57 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT STROKE PROTOCOL	$1,351	$675.50	$100.60 – $1,215.90
CT scan of the head or brain, without contrast: 10 of 20 insurance plan rates Aetna — Aetna: $1,121.33 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $102.42 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $1,121.33 Empire BC — Empire BC: $365.57 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R70553P- MRI BRAIN W&W/O CONTRAST-424	$381	$190.50	$190.50 – $1,255.35
MRI of the brain, before and after contrast: 10 of 20 insurance plan rates Aetna — Aetna: $316.23 Blue Shield Senior — Blue Shield Senior: $455.03 CDPHP — CDPHP: $323.25 Charity Care Tier 2 — Charity Care Tier 2: $216.68 Coventry — Coventry: $316.23 Empire BC — Empire BC: $1,255.35 GHI — GHI: $879.72 Managed Medicare — Managed Medicare: $433.36 Medicare — Medicare: $435.49 Medicare HMO 101 — Medicare HMO 101: $437.69
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI BRAIN W&W/O CONTRAST-424	$5,531	$2,765.50	$323.25 – $4,977.90
MRI of the brain, before and after contrast: 10 of 20 insurance plan rates Aetna — Aetna: $4,590.73 Blue Shield Senior — Blue Shield Senior: $455.03 CDPHP — CDPHP: $323.25 Charity Care Tier 2 — Charity Care Tier 2: $216.68 Coventry — Coventry: $4,590.73 Empire BC — Empire BC: $1,255.35 GHI — GHI: $879.72 Managed Medicare — Managed Medicare: $433.36 Medicare — Medicare: $435.49 Medicare HMO 101 — Medicare HMO 101: $437.69
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee · modifier 26 In the file: R70553P- MRI BRAIN W&W/O CONTRAST-424	$381	$190.50	$190.50 – $342.90
MRI of the brain, before and after contrast: rates for 7 insurance plans Aetna — Aetna: $323.85 Coventry — Coventry: $316.23 Non-Contracted — Non-Contracted: $342.90 POMCO — POMCO: $297.18 RMSCO — RMSCO: $342.90 Self-Pay — Self-Pay: $190.50 United Healthcare — United Healthcare: $304.80
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R71046P-CHEST PA/LAT-420	$38	$19	$19 – $110.54
Chest X-ray, 2 views: 10 of 20 insurance plan rates Aetna — Aetna: $31.54 Blue Shield Senior — Blue Shield Senior: $113.50 CDPHP — CDPHP: $34.90 Charity Care Tier 2 — Charity Care Tier 2: $54.05 Coventry — Coventry: $31.54 Empire BC — Empire BC: $110.54 GHI — GHI: $219.44 Managed Medicare — Managed Medicare: $108.10 Medicare — Medicare: $108.63 Medicare HMO 101 — Medicare HMO 101: $109.18
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: PS CHEST XRAY (PAT)	$459	$229.50	$34.90 – $413.10
Chest X-ray, 2 views: 10 of 20 insurance plan rates Aetna — Aetna: $380.97 Blue Shield Senior — Blue Shield Senior: $113.50 CDPHP — CDPHP: $34.90 Charity Care Tier 2 — Charity Care Tier 2: $54.05 Coventry — Coventry: $380.97 Empire BC — Empire BC: $110.54 GHI — GHI: $219.44 Managed Medicare — Managed Medicare: $108.10 Medicare — Medicare: $108.63 Medicare HMO 101 — Medicare HMO 101: $109.18
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CHEST PA/LAT-420	$459	$229.50	$34.90 – $413.10
Chest X-ray, 2 views: 10 of 20 insurance plan rates Aetna — Aetna: $380.97 Blue Shield Senior — Blue Shield Senior: $113.50 CDPHP — CDPHP: $34.90 Charity Care Tier 2 — Charity Care Tier 2: $54.05 Coventry — Coventry: $380.97 Empire BC — Empire BC: $110.54 GHI — GHI: $219.44 Managed Medicare — Managed Medicare: $108.10 Medicare — Medicare: $108.63 Medicare HMO 101 — Medicare HMO 101: $109.18
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R72110P-LUM SPINE - WITH OBLIQUE-420	$54	$27	$27 – $178.31
X-ray of the lower spine, at least 4 views: 10 of 20 insurance plan rates Aetna — Aetna: $44.82 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $58.90 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $44.82 Empire BC — Empire BC: $178.31 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: LUM SPINE - WITH OBLIQUE-420	$392	$196	$58.90 – $352.80
X-ray of the lower spine, at least 4 views: 10 of 20 insurance plan rates Aetna — Aetna: $325.36 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $58.90 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $325.36 Empire BC — Empire BC: $178.31 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: FLUORO LUMBAR SPINE 4 OR MORE VIEWS	$392	$196	$58.90 – $352.80
X-ray of the lower spine, at least 4 views: 10 of 20 insurance plan rates Aetna — Aetna: $325.36 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $58.90 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $325.36 Empire BC — Empire BC: $178.31 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R72148P- MRI LUM SPINE W/O CONTRAST-424	$248	$124	$124 – $716.85
MRI of the lower back (lumbar spine), without contrast: 10 of 20 insurance plan rates Aetna — Aetna: $205.84 Blue Shield Senior — Blue Shield Senior: $311.20 CDPHP — CDPHP: $186.33 Charity Care Tier 2 — Charity Care Tier 2: $148.19 Coventry — Coventry: $205.84 Empire BC — Empire BC: $716.85 GHI — GHI: $601.65 Managed Medicare — Managed Medicare: $296.38 Medicare — Medicare: $297.84 Medicare HMO 101 — Medicare HMO 101: $299.34
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI LUM SPINE W/O CONTRAST-424	$2,305	$1,152.50	$186.33 – $2,074.50
MRI of the lower back (lumbar spine), without contrast: 10 of 20 insurance plan rates Aetna — Aetna: $1,913.15 Blue Shield Senior — Blue Shield Senior: $311.20 CDPHP — CDPHP: $186.33 Charity Care Tier 2 — Charity Care Tier 2: $148.19 Coventry — Coventry: $1,913.15 Empire BC — Empire BC: $716.85 GHI — GHI: $601.65 Managed Medicare — Managed Medicare: $296.38 Medicare — Medicare: $297.84 Medicare HMO 101 — Medicare HMO 101: $299.34
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee · modifier 26 In the file: R72148P- MRI LUM SPINE W/O CONTRAST-424	$248	$124	$124 – $223.20
MRI of the lower back (lumbar spine), without contrast: rates for 7 insurance plans Aetna — Aetna: $210.80 Coventry — Coventry: $205.84 Non-Contracted — Non-Contracted: $223.20 POMCO — POMCO: $193.44 RMSCO — RMSCO: $223.20 Self-Pay — Self-Pay: $124 United Healthcare — United Healthcare: $198.40
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R72193P- CT PELVIS W IV CONTRAST	$195	$97.50	$97.50 – $902.28
CT scan of the pelvis, with contrast: 10 of 20 insurance plan rates Aetna — Aetna: $161.85 Blue Shield Senior — Blue Shield Senior: $228.77 CDPHP — CDPHP: $263.34 Charity Care Tier 2 — Charity Care Tier 2: $108.94 Coventry — Coventry: $161.85 Empire BC — Empire BC: $902.28 GHI — GHI: $442.30 Managed Medicare — Managed Medicare: $217.88 Medicare — Medicare: $218.95 Medicare HMO 101 — Medicare HMO 101: $220.06
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT PELVIS W IV CONTRAST	$1,710	$855	$218.95 – $1,539
CT scan of the pelvis, with contrast: 10 of 20 insurance plan rates Aetna — Aetna: $1,419.30 Blue Shield Senior — Blue Shield Senior: $228.77 CDPHP — CDPHP: $263.34 Charity Care Tier 2 — Charity Care Tier 2: $108.94 Coventry — Coventry: $1,419.30 Empire BC — Empire BC: $902.28 GHI — GHI: $442.30 Managed Medicare — Managed Medicare: $217.88 Medicare — Medicare: $218.95 Medicare HMO 101 — Medicare HMO 101: $220.06
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT PELVIS W ORAL AND IV CONTRAST	$1,710	$855	$218.95 – $1,539
CT scan of the pelvis, with contrast: 10 of 20 insurance plan rates Aetna — Aetna: $1,419.30 Blue Shield Senior — Blue Shield Senior: $228.77 CDPHP — CDPHP: $263.34 Charity Care Tier 2 — Charity Care Tier 2: $108.94 Coventry — Coventry: $1,419.30 Empire BC — Empire BC: $902.28 GHI — GHI: $442.30 Managed Medicare — Managed Medicare: $217.88 Medicare — Medicare: $218.95 Medicare HMO 101 — Medicare HMO 101: $220.06
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R73721P- MRI LOWER JOINT W/O CONTRAST-424	$227	$113.50	$113.50 – $809.56
MRI of a leg joint (such as the knee), without contrast: 10 of 20 insurance plan rates Aetna — Aetna: $188.41 Blue Shield Senior — Blue Shield Senior: $311.20 CDPHP — CDPHP: $213.72 Charity Care Tier 2 — Charity Care Tier 2: $148.19 Coventry — Coventry: $188.41 Empire BC — Empire BC: $809.56 GHI — GHI: $601.65 Managed Medicare — Managed Medicare: $296.38 Medicare — Medicare: $297.84 Medicare HMO 101 — Medicare HMO 101: $299.34
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R73721P- BILAT HIPS WO	$454	$227	$213.72 – $809.56
MRI of a leg joint (such as the knee), without contrast: 10 of 20 insurance plan rates Aetna — Aetna: $376.82 Blue Shield Senior — Blue Shield Senior: $311.20 CDPHP — CDPHP: $213.72 Charity Care Tier 2 — Charity Care Tier 2: $148.19 Coventry — Coventry: $376.82 Empire BC — Empire BC: $809.56 GHI — GHI: $601.65 Managed Medicare — Managed Medicare: $296.38 Medicare — Medicare: $297.84 Medicare HMO 101 — Medicare HMO 101: $299.34
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R73721P- MRI LOWER JOINT W/O-LT-424	$227	$113.50	$113.50 – $809.56
MRI of a leg joint (such as the knee), without contrast: 10 of 20 insurance plan rates Aetna — Aetna: $188.41 Blue Shield Senior — Blue Shield Senior: $311.20 CDPHP — CDPHP: $213.72 Charity Care Tier 2 — Charity Care Tier 2: $148.19 Coventry — Coventry: $188.41 Empire BC — Empire BC: $809.56 GHI — GHI: $601.65 Managed Medicare — Managed Medicare: $296.38 Medicare — Medicare: $297.84 Medicare HMO 101 — Medicare HMO 101: $299.34
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R74177P- CT-ABDOM/PELVIS W CONTRAST	$304	$152	$152 – $1,184
CT scan of the abdomen and pelvis, with contrast: 10 of 20 insurance plan rates Aetna — Aetna: $252.32 Blue Shield Senior — Blue Shield Senior: $455.03 CDPHP — CDPHP: $330.37 Charity Care Tier 2 — Charity Care Tier 2: $216.68 Coventry — Coventry: $252.32 Empire BC — Empire BC: $1,184 GHI — GHI: $879.72 Managed Medicare — Managed Medicare: $433.36 Medicare — Medicare: $435.49 Medicare HMO 101 — Medicare HMO 101: $437.69
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT ABD/PEL W IV CONTRAST	$2,380	$1,190	$329.99 – $2,142
CT scan of the abdomen and pelvis, with contrast: 10 of 20 insurance plan rates Aetna — Aetna: $1,975.40 Blue Shield Senior — Blue Shield Senior: $455.03 CDPHP — CDPHP: $330.37 Charity Care Tier 2 — Charity Care Tier 2: $216.68 Coventry — Coventry: $1,975.40 Empire BC — Empire BC: $1,184 GHI — GHI: $879.72 Managed Medicare — Managed Medicare: $433.36 Medicare — Medicare: $435.49 Medicare HMO 101 — Medicare HMO 101: $437.69
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT ABD/PEL W ORAL AND IV CONTRAST	$2,380	$1,190	$329.99 – $2,142
CT scan of the abdomen and pelvis, with contrast: 10 of 20 insurance plan rates Aetna — Aetna: $1,975.40 Blue Shield Senior — Blue Shield Senior: $455.03 CDPHP — CDPHP: $330.37 Charity Care Tier 2 — Charity Care Tier 2: $216.68 Coventry — Coventry: $1,975.40 Empire BC — Empire BC: $1,184 GHI — GHI: $879.72 Managed Medicare — Managed Medicare: $433.36 Medicare — Medicare: $435.49 Medicare HMO 101 — Medicare HMO 101: $437.69
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R76700P-US ABDOMEN COMPLETE	$136	$68	$68 – $413.67
Ultrasound of the abdomen, complete: 10 of 20 insurance plan rates Aetna — Aetna: $112.88 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $115.81 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $112.88 Empire BC — Empire BC: $413.67 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US ABDOMEN COMPLETE	$933	$466.50	$115.81 – $839.70
Ultrasound of the abdomen, complete: 10 of 20 insurance plan rates Aetna — Aetna: $774.39 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $115.81 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $774.39 Empire BC — Empire BC: $413.67 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee · modifier 26 In the file: R76700P-US ABDOMEN COMPLETE	$136	$68	$68 – $122.40
Ultrasound of the abdomen, complete: rates for 7 insurance plans Aetna — Aetna: $115.60 Coventry — Coventry: $112.88 Non-Contracted — Non-Contracted: $122.40 POMCO — POMCO: $106.08 RMSCO — RMSCO: $122.40 Self-Pay — Self-Pay: $68 United Healthcare — United Healthcare: $108.80
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R76805P-US OB BIO WO STRESS SET	$170	$85	$85 – $454.70
Pregnancy ultrasound (after the first trimester): 10 of 20 insurance plan rates Aetna — Aetna: $141.10 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $130.31 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $141.10 Empire BC — Empire BC: $454.70 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: 76805T OB US >= 14 WKS SNGL FETUS	$792	$396	$130.31 – $712.80
Pregnancy ultrasound (after the first trimester): 10 of 20 insurance plan rates Aetna — Aetna: $657.36 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $130.31 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $657.36 Empire BC — Empire BC: $454.70 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MULTIPLE OB BIO WO STR SET	$792	$396	$130.31 – $712.80
Pregnancy ultrasound (after the first trimester): 10 of 20 insurance plan rates Aetna — Aetna: $657.36 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $130.31 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $657.36 Empire BC — Empire BC: $454.70 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROF TRANSVAGINAL US NON-OB	$105	$52.50	$52.50 – $445.79
Transvaginal ultrasound: 10 of 20 insurance plan rates Aetna — Aetna: $87.15 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $127.31 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $87.15 Empire BC — Empire BC: $445.79 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PROF TRANSVAGINAL US NON-OB	$105	$52.50	$52.50 – $94.50
Transvaginal ultrasound: rates for 7 insurance plans Aetna — Aetna: $89.25 Coventry — Coventry: $87.15 Non-Contracted — Non-Contracted: $94.50 POMCO — POMCO: $81.90 RMSCO — RMSCO: $94.50 Self-Pay — Self-Pay: $52.50 United Healthcare — United Healthcare: $84
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: TRANSVAGINAL US NON-OB	$850	$425	$127.31 – $765
Transvaginal ultrasound: 10 of 20 insurance plan rates Aetna — Aetna: $705.50 Blue Shield Senior — Blue Shield Senior: $136.35 CDPHP — CDPHP: $127.31 Charity Care Tier 2 — Charity Care Tier 2: $64.93 Coventry — Coventry: $705.50 Empire BC — Empire BC: $445.79 GHI — GHI: $263.62 Managed Medicare — Managed Medicare: $129.86 Medicare — Medicare: $130.50 Medicare HMO 101 — Medicare HMO 101: $131.16
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R77065P- DIAGNOSTIC MAMMO UNI W OR W/O CAD	$137	$68.50	$40.89 – $468.99
Diagnostic mammogram, one breast: 10 of 20 insurance plan rates Aetna — Aetna: $113.71 Blue Shield Senior — Blue Shield Senior: $85.87 CDPHP — CDPHP: $131.31 Charity Care Tier 2 — Charity Care Tier 2: $40.89 Coventry — Coventry: $113.71 Empire BC — Empire BC: $468.99 GHI — GHI: $130.18 Managed Medicare — Managed Medicare: $81.78 Medicare — Medicare: $81.78 Medicare HMO 101 — Medicare HMO 101: $82.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R77065P- DIAGN MAMMO W OR W/O CAD-LT	$137	$68.50	$40.89 – $468.99
Diagnostic mammogram, one breast: 10 of 20 insurance plan rates Aetna — Aetna: $113.71 Blue Shield Senior — Blue Shield Senior: $85.87 CDPHP — CDPHP: $131.31 Charity Care Tier 2 — Charity Care Tier 2: $40.89 Coventry — Coventry: $113.71 Empire BC — Empire BC: $468.99 GHI — GHI: $130.18 Managed Medicare — Managed Medicare: $81.78 Medicare — Medicare: $81.78 Medicare HMO 101 — Medicare HMO 101: $82.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R77065P- DIAGN MAMMO W OR W/O CAD-RT	$137	$68.50	$40.89 – $468.99
Diagnostic mammogram, one breast: 10 of 20 insurance plan rates Aetna — Aetna: $113.71 Blue Shield Senior — Blue Shield Senior: $85.87 CDPHP — CDPHP: $131.31 Charity Care Tier 2 — Charity Care Tier 2: $40.89 Coventry — Coventry: $113.71 Empire BC — Empire BC: $468.99 GHI — GHI: $130.18 Managed Medicare — Managed Medicare: $81.78 Medicare — Medicare: $81.78 Medicare HMO 101 — Medicare HMO 101: $82.60
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R77066P- DIAGN MAMMO W OR W/O CAD-BI	$168	$84	$52.43 – $597.35
Diagnostic mammogram, both breasts: 10 of 20 insurance plan rates Aetna — Aetna: $139.44 Blue Shield Senior — Blue Shield Senior: $110.10 CDPHP — CDPHP: $167.31 Charity Care Tier 2 — Charity Care Tier 2: $52.43 Coventry — Coventry: $139.44 Empire BC — Empire BC: $597.35 GHI — GHI: $166.92 Managed Medicare — Managed Medicare: $104.86 Medicare — Medicare: $104.86 Medicare HMO 101 — Medicare HMO 101: $105.91
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DIAGNOSTIC MAMMO BILATERAL -NO CAD	$1,773	$886.50	$52.43 – $1,595.70
Diagnostic mammogram, both breasts: 10 of 20 insurance plan rates Aetna — Aetna: $1,471.59 Blue Shield Senior — Blue Shield Senior: $110.10 CDPHP — CDPHP: $167.31 Charity Care Tier 2 — Charity Care Tier 2: $52.43 Coventry — Coventry: $1,471.59 Empire BC — Empire BC: $597.35 GHI — GHI: $166.92 Managed Medicare — Managed Medicare: $104.86 Medicare — Medicare: $104.86 Medicare HMO 101 — Medicare HMO 101: $105.91
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DIGITAL,DIAGNOSTIC MAMMO-BILAT-426	$1,773	$886.50	$52.43 – $1,595.70
Diagnostic mammogram, both breasts: 10 of 20 insurance plan rates Aetna — Aetna: $1,471.59 Blue Shield Senior — Blue Shield Senior: $110.10 CDPHP — CDPHP: $167.31 Charity Care Tier 2 — Charity Care Tier 2: $52.43 Coventry — Coventry: $1,471.59 Empire BC — Empire BC: $597.35 GHI — GHI: $166.92 Managed Medicare — Managed Medicare: $104.86 Medicare — Medicare: $104.86 Medicare HMO 101 — Medicare HMO 101: $105.91
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R77067P- DIGITAL, SCREENING MAMMO-BILAT-426	$128	$64	$43.27 – $495.73
Screening mammogram, both breasts: 10 of 20 insurance plan rates Aetna — Aetna: $106.24 Blue Shield Senior — Blue Shield Senior: $90.87 CDPHP — CDPHP: $138.43 Charity Care Tier 2 — Charity Care Tier 2: $43.27 Coventry — Coventry: $106.24 Empire BC — Empire BC: $495.73 GHI — GHI: $128 Managed Medicare — Managed Medicare: $86.54 Medicare — Medicare: $86.54 Medicare HMO 101 — Medicare HMO 101: $87.41
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R77067P- DIGITAL, SCREENING-UNILAT-426	$128	$64	$43.27 – $495.73
Screening mammogram, both breasts: 10 of 20 insurance plan rates Aetna — Aetna: $106.24 Blue Shield Senior — Blue Shield Senior: $90.87 CDPHP — CDPHP: $138.43 Charity Care Tier 2 — Charity Care Tier 2: $43.27 Coventry — Coventry: $106.24 Empire BC — Empire BC: $495.73 GHI — GHI: $128 Managed Medicare — Managed Medicare: $86.54 Medicare — Medicare: $86.54 Medicare HMO 101 — Medicare HMO 101: $87.41
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: R77067P- SCREENING MAMMO-UNI W/TOMO LT	$128	$64	$43.27 – $495.73
Screening mammogram, both breasts: 10 of 20 insurance plan rates Aetna — Aetna: $106.24 Blue Shield Senior — Blue Shield Senior: $90.87 CDPHP — CDPHP: $138.43 Charity Care Tier 2 — Charity Care Tier 2: $43.27 Coventry — Coventry: $106.24 Empire BC — Empire BC: $495.73 GHI — GHI: $128 Managed Medicare — Managed Medicare: $86.54 Medicare — Medicare: $86.54 Medicare HMO 101 — Medicare HMO 101: $87.41

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CARDIOGRAM	$157	$78.50	$14.71 – $141.30
Electrocardiogram (ECG/EKG) with reading: 10 of 11 insurance plan rates Aetna — Aetna: $130.31 CDPHP — CDPHP: $21.65 Coventry — Coventry: $130.31 Empire BC — Empire BC: $84.90 MVP Commercial/Select — MVP Commercial/Select: $48.22 Non-Contracted — Non-Contracted: $141.30 POMCO — POMCO: $122.46 RMSCO — RMSCO: $133.45 Self-Pay — Self-Pay: $78.50 Tricare — Tricare: $14.71
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIOGRAM	$157	$78.50	$78.50 – $141.30
Electrocardiogram (ECG/EKG) with reading: rates for 7 insurance plans Aetna — Aetna: $133.45 Coventry — Coventry: $130.31 Non-Contracted — Non-Contracted: $141.30 POMCO — POMCO: $122.46 RMSCO — RMSCO: $141.30 Self-Pay — Self-Pay: $78.50 United Healthcare — United Healthcare: $125.60
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: LHC-NO CORS	$13,577	$6,788.50	$3,000 – $12,219.30
Left heart catheterization (diagnostic): 10 of 20 insurance plan rates Aetna — Aetna: $3,000 Blue Shield Senior — Blue Shield Senior: $4,228.37 CDPHP — CDPHP: $10,123 Charity Care Tier 2 — Charity Care Tier 2: $2,013.51 Coventry — Coventry: $11,268.91 Empire BC — Empire BC: $3,407.65 GHI — GHI: $8,174.85 Managed Medicare — Managed Medicare: $4,027.02 Medicare — Medicare: $4,046.85 Medicare HMO 101 — Medicare HMO 101: $4,067.29
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: LHC-NO CORS	$13,577	$6,788.50	$6,788.50 – $12,219.30
Left heart catheterization (diagnostic): rates for 7 insurance plans Aetna — Aetna: $11,540.45 Coventry — Coventry: $11,268.91 Non-Contracted — Non-Contracted: $12,219.30 POMCO — POMCO: $10,590.06 RMSCO — RMSCO: $12,219.30 Self-Pay — Self-Pay: $6,788.50 United Healthcare — United Healthcare: $10,861.60
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: COMPR W/OUT ARRHY	$15,592	$7,796	$7,796 – $15,592
Heart rhythm study (electrophysiology evaluation): 10 of 20 insurance plan rates Aetna — Aetna: $12,941.36 Blue Shield Senior — Blue Shield Senior: $10,172.91 CDPHP — CDPHP: $10,657.34 Charity Care Tier 2 — Charity Care Tier 2: $4,844.24 Coventry — Coventry: $12,941.36 Empire BC — Empire BC: $7,796 GHI — GHI: $19,667.63 Managed Medicare — Managed Medicare: $9,688.49 Medicare — Medicare: $9,736.19 Medicare HMO 101 — Medicare HMO 101: $9,785.37
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: COMPR W/OUT ARRHY	$15,592	$7,796	$7,796 – $14,032.80
Heart rhythm study (electrophysiology evaluation): rates for 7 insurance plans Aetna — Aetna: $13,253.20 Coventry — Coventry: $12,941.36 Non-Contracted — Non-Contracted: $14,032.80 POMCO — POMCO: $12,161.76 RMSCO — RMSCO: $14,032.80 Self-Pay — Self-Pay: $7,796 United Healthcare — United Healthcare: $12,473.60
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 93656P TX ATRIAL FIB PULM VEIN ISOL	$3,716	$1,858	$1,380.46 – $42,191
Heart rhythm study with ablation for atrial fibrillation: 10 of 20 insurance plan rates Aetna — Aetna: $3,084.28 Blue Shield Senior — Blue Shield Senior: $34,090.97 CDPHP — CDPHP: $1,380.46 Charity Care Tier 2 — Charity Care Tier 2: $16,233.80 Coventry — Coventry: $3,084.28 Empire BC — Empire BC: $6,102.15 GHI — GHI: $65,909.21 Managed Medicare — Managed Medicare: $32,467.59 Medicare — Medicare: $32,627.47 Medicare HMO 101 — Medicare HMO 101: $32,792.27
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	$38,838	$19,419	$6,102.15 – $42,191
Heart rhythm study with ablation for atrial fibrillation: 10 of 20 insurance plan rates Aetna — Aetna: $32,235.54 Blue Shield Senior — Blue Shield Senior: $34,090.97 CDPHP — CDPHP: $31,419 Charity Care Tier 2 — Charity Care Tier 2: $16,233.80 Coventry — Coventry: $32,235.54 Empire BC — Empire BC: $6,102.15 GHI — GHI: $65,909.21 Managed Medicare — Managed Medicare: $32,467.59 Medicare — Medicare: $32,627.47 Medicare HMO 101 — Medicare HMO 101: $32,792.27
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 93656P TX ATRIAL FIB PULM VEIN ISOL	$3,716	$1,858	$1,858 – $3,344.40
Heart rhythm study with ablation for atrial fibrillation: rates for 7 insurance plans Aetna — Aetna: $3,158.60 Coventry — Coventry: $3,084.28 Non-Contracted — Non-Contracted: $3,344.40 POMCO — POMCO: $2,898.48 RMSCO — RMSCO: $3,344.40 Self-Pay — Self-Pay: $1,858 United Healthcare — United Healthcare: $2,972.80
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: 95810P POLYSOM 6/> YRS 4/> PARAM	$300	$150	$150 – $3,181
Sleep study (overnight, in a sleep lab): 10 of 20 insurance plan rates Aetna — Aetna: $249 Blue Shield Senior — Blue Shield Senior: $1,120.04 CDPHP — CDPHP: $765.40 Charity Care Tier 2 — Charity Care Tier 2: $533.35 Coventry — Coventry: $249 Empire BC — Empire BC: $2,473.22 GHI — GHI: $2,165.40 Managed Medicare — Managed Medicare: $1,066.70 Medicare — Medicare: $1,071.95 Medicare HMO 101 — Medicare HMO 101: $1,077.37
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: 95810P - POLYSOM 6/> YRS 4/> PARAM 26 MOD	$300	$150	$150 – $3,181
Sleep study (overnight, in a sleep lab): 10 of 20 insurance plan rates Aetna — Aetna: $249 Blue Shield Senior — Blue Shield Senior: $1,120.04 CDPHP — CDPHP: $765.40 Charity Care Tier 2 — Charity Care Tier 2: $533.35 Coventry — Coventry: $249 Empire BC — Empire BC: $2,473.22 GHI — GHI: $2,165.40 Managed Medicare — Managed Medicare: $1,066.70 Medicare — Medicare: $1,071.95 Medicare HMO 101 — Medicare HMO 101: $1,077.37
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 52 In the file: POLYSOM,4 OR MORE PARA,LIMITD-441	$2,189	$1,094.50	$535.98 – $3,181
Sleep study (overnight, in a sleep lab): 10 of 20 insurance plan rates Aetna — Aetna: $1,816.87 Blue Shield Senior — Blue Shield Senior: $560.02 CDPHP — CDPHP: $765.40 Charity Care Tier 2 — Charity Care Tier 2: $266.68 Coventry — Coventry: $1,816.87 Empire BC — Empire BC: $2,473.22 GHI — GHI: $1,082.70 Managed Medicare — Managed Medicare: $533.35 Medicare — Medicare: $535.98 Medicare HMO 101 — Medicare HMO 101: $538.68

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 · modifier GP In the file: 97110T THERAPEUTIC EXERCISES	$171	$85.50	$14.13 – $153.90
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 20 insurance plan rates Aetna — Aetna: $85 Blue Shield Senior — Blue Shield Senior: $29.68 CDPHP — CDPHP: $45.39 Charity Care Tier 2 — Charity Care Tier 2: $14.13 Coventry — Coventry: $141.93 Empire BC — Empire BC: $147.46 GHI — GHI: $144 Managed Medicare — Managed Medicare: $28.27 Medicare — Medicare: $28.27 Medicare HMO 101 — Medicare HMO 101: $28.55
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: THERA-EXERCISES 15 MIN	$171	$85.50	$14.13 – $153.90
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 20 insurance plan rates Aetna — Aetna: $85 Blue Shield Senior — Blue Shield Senior: $29.68 CDPHP — CDPHP: $45.39 Charity Care Tier 2 — Charity Care Tier 2: $14.13 Coventry — Coventry: $141.93 Empire BC — Empire BC: $147.46 GHI — GHI: $144 Managed Medicare — Managed Medicare: $28.27 Medicare — Medicare: $28.27 Medicare HMO 101 — Medicare HMO 101: $28.55
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GO In the file: OT-THER EXERCISE 15 MIN	$171	$85.50	$14.13 – $153.90
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 20 insurance plan rates Aetna — Aetna: $141.93 Blue Shield Senior — Blue Shield Senior: $29.68 CDPHP — CDPHP: $45.39 Charity Care Tier 2 — Charity Care Tier 2: $14.13 Coventry — Coventry: $141.93 Empire BC — Empire BC: $147.46 GHI — GHI: $144 Managed Medicare — Managed Medicare: $28.27 Medicare — Medicare: $28.27 Medicare HMO 101 — Medicare HMO 101: $28.55
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL-LOW COMPLEXITY	$557	$278.50	$47.73 – $501.30
Physical therapy evaluation (low complexity): 10 of 20 insurance plan rates Aetna — Aetna: $85 Blue Shield Senior — Blue Shield Senior: $100.23 CDPHP — CDPHP: $154.49 Charity Care Tier 2 — Charity Care Tier 2: $47.73 Coventry — Coventry: $462.31 Empire BC — Empire BC: $412.25 GHI — GHI: $176 Managed Medicare — Managed Medicare: $95.46 Medicare — Medicare: $95.46 Medicare HMO 101 — Medicare HMO 101: $96.41
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL-LOW COMPLEXITY	$557	$278.50	$278.50 – $501.30
Physical therapy evaluation (low complexity): rates for 7 insurance plans Aetna — Aetna: $473.45 Coventry — Coventry: $462.31 Non-Contracted — Non-Contracted: $501.30 POMCO — POMCO: $434.46 RMSCO — RMSCO: $501.30 Self-Pay — Self-Pay: $278.50 United Healthcare — United Healthcare: $445.60
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL-MODERATE COMPLEX	$537	$268.50	$47.73 – $483.30
Physical therapy evaluation (moderate complexity): 10 of 20 insurance plan rates Aetna — Aetna: $85 Blue Shield Senior — Blue Shield Senior: $100.23 CDPHP — CDPHP: $154.49 Charity Care Tier 2 — Charity Care Tier 2: $47.73 Coventry — Coventry: $445.71 Empire BC — Empire BC: $412.25 GHI — GHI: $176 Managed Medicare — Managed Medicare: $95.46 Medicare — Medicare: $95.46 Medicare HMO 101 — Medicare HMO 101: $96.41
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL-MODERATE COMPLEX	$537	$268.50	$268.50 – $483.30
Physical therapy evaluation (moderate complexity): rates for 7 insurance plans Aetna — Aetna: $456.45 Coventry — Coventry: $445.71 Non-Contracted — Non-Contracted: $483.30 POMCO — POMCO: $418.86 RMSCO — RMSCO: $483.30 Self-Pay — Self-Pay: $268.50 United Healthcare — United Healthcare: $429.60
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL-HIGH COMPLEXITY	$543	$271.50	$47.73 – $488.70
Physical therapy evaluation (high complexity): 10 of 20 insurance plan rates Aetna — Aetna: $85 Blue Shield Senior — Blue Shield Senior: $100.23 CDPHP — CDPHP: $154.49 Charity Care Tier 2 — Charity Care Tier 2: $47.73 Coventry — Coventry: $450.69 Empire BC — Empire BC: $412.25 GHI — GHI: $176 Managed Medicare — Managed Medicare: $95.46 Medicare — Medicare: $95.46 Medicare HMO 101 — Medicare HMO 101: $96.41
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL-HIGH COMPLEXITY	$543	$271.50	$271.50 – $488.70
Physical therapy evaluation (high complexity): rates for 7 insurance plans Aetna — Aetna: $461.55 Coventry — Coventry: $450.69 Non-Contracted — Non-Contracted: $488.70 POMCO — POMCO: $423.54 RMSCO — RMSCO: $488.70 Self-Pay — Self-Pay: $271.50 United Healthcare — United Healthcare: $434.40
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00291P PSYTX PT&/FAMILY 30 MINUTES	$212	$106	$106 – $288.85
Psychotherapy, 30 minutes: 10 of 20 insurance plan rates Aetna — Aetna: $175.96 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $110.19 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $175.96 Empire BC — Empire BC: $288.85 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90832 P- PSYTX OFFICE 20-30 MIN (00384)	$212	$106	$106 – $288.85
Psychotherapy, 30 minutes: 10 of 20 insurance plan rates Aetna — Aetna: $175.96 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $110.19 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $175.96 Empire BC — Empire BC: $288.85 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00644P PSYTX OFFICE 20-30 MIN	$212	$106	$106 – $288.85
Psychotherapy, 30 minutes: 10 of 20 insurance plan rates Aetna — Aetna: $175.96 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $110.19 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $175.96 Empire BC — Empire BC: $288.85 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00293P PSYTX PT&/FAMILY 45 MINUTES	$279	$139.50	$139.50 – $385.10
Psychotherapy, 45 minutes: 10 of 20 insurance plan rates Aetna — Aetna: $231.57 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $145.40 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $231.57 Empire BC — Empire BC: $385.10 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90834 P- PSYTX OFFICE 45-50 MIN (00385)	$279	$139.50	$139.50 – $385.10
Psychotherapy, 45 minutes: 10 of 20 insurance plan rates Aetna — Aetna: $231.57 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $145.40 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $231.57 Empire BC — Empire BC: $385.10 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00643P PSYTX OFFICE 45-50 MIN	$279	$139.50	$139.50 – $385.10
Psychotherapy, 45 minutes: 10 of 20 insurance plan rates Aetna — Aetna: $231.57 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $145.40 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $231.57 Empire BC — Empire BC: $385.10 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00386P PSYTX OFFICE 60 MIN	$416	$208	$208 – $574.11
Psychotherapy, 60 minutes: 10 of 20 insurance plan rates Aetna — Aetna: $345.28 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $215.18 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $345.28 Empire BC — Empire BC: $574.11 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00642P PSYTX OFFICE 60 MIN	$416	$208	$208 – $574.11
Psychotherapy, 60 minutes: 10 of 20 insurance plan rates Aetna — Aetna: $345.28 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $215.18 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $345.28 Empire BC — Empire BC: $574.11 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90837P PSYTX OFFICE 60 MIN	$416	$208	$208 – $574.11
Psychotherapy, 60 minutes: 10 of 20 insurance plan rates Aetna — Aetna: $345.28 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $215.18 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $345.28 Empire BC — Empire BC: $574.11 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00295P FAMILY PSYTX W/O PATIENT	$339	$169.50	$157.18 – $464.31
Family psychotherapy, without the patient: 10 of 20 insurance plan rates Aetna — Aetna: $281.37 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $157.18 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $281.37 Empire BC — Empire BC: $464.31 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00387P FAMILY PSYTX W/O PATIENT	$339	$169.50	$157.18 – $464.31
Family psychotherapy, without the patient: 10 of 20 insurance plan rates Aetna — Aetna: $281.37 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $157.18 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $281.37 Empire BC — Empire BC: $464.31 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90846P FAMILY PSYTX W/O PATIENT	$339	$169.50	$157.18 – $464.31
Family psychotherapy, without the patient: 10 of 20 insurance plan rates Aetna — Aetna: $281.37 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $157.18 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $281.37 Empire BC — Empire BC: $464.31 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00296P FAMILY PSYTX W/PATIENT	$350	$175	$163.92 – $481.40
Family psychotherapy, with the patient: 10 of 20 insurance plan rates Aetna — Aetna: $290.50 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $163.92 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $290.50 Empire BC — Empire BC: $481.40 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00388P FAMILY PSYTX W PATIENT	$350	$175	$163.92 – $481.40
Family psychotherapy, with the patient: 10 of 20 insurance plan rates Aetna — Aetna: $290.50 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $163.92 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $290.50 Empire BC — Empire BC: $481.40 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90847P FAMILY PSYTX W PATIENT	$350	$175	$163.92 – $481.40
Family psychotherapy, with the patient: 10 of 20 insurance plan rates Aetna — Aetna: $290.50 Blue Shield Senior — Blue Shield Senior: $231.50 CDPHP — CDPHP: $163.92 Charity Care Tier 2 — Charity Care Tier 2: $110.24 Coventry — Coventry: $290.50 Empire BC — Empire BC: $481.40 GHI — GHI: $447.57 Managed Medicare — Managed Medicare: $220.48 Medicare — Medicare: $221.56 Medicare HMO 101 — Medicare HMO 101: $222.68
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 00298P GROUP PSYCHOTHERAPY	$86	$43	$38.73 – $113.63
Group psychotherapy: 10 of 20 insurance plan rates Aetna — Aetna: $71.38 Blue Shield Senior — Blue Shield Senior: $132.50 CDPHP — CDPHP: $38.73 Charity Care Tier 2 — Charity Care Tier 2: $63.09 Coventry — Coventry: $71.38 Empire BC — Empire BC: $113.63 GHI — GHI: $256.17 Managed Medicare — Managed Medicare: $126.19 Medicare — Medicare: $126.81 Medicare HMO 101 — Medicare HMO 101: $127.45
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90853P GROUP PSYCHOTHERAPY	$86	$43	$38.73 – $126.81
Group psychotherapy: 10 of 20 insurance plan rates Aetna — Aetna: $71.38 Blue Shield Senior — Blue Shield Senior: $132.50 CDPHP — CDPHP: $38.73 Charity Care Tier 2 — Charity Care Tier 2: $63.09 Coventry — Coventry: $71.38 Empire BC — Empire BC: $113.63 GHI — GHI: $256.17 Managed Medicare — Managed Medicare: $126.19 Medicare — Medicare: $126.81 Medicare HMO 101 — Medicare HMO 101: $127.45
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 00298P GROUP PSYCHOTHERAPY	$86	$43	$43 – $77.40
Group psychotherapy: rates for 7 insurance plans Aetna — Aetna: $73.10 Coventry — Coventry: $71.38 Non-Contracted — Non-Contracted: $77.40 POMCO — POMCO: $67.08 RMSCO — RMSCO: $77.40 Self-Pay — Self-Pay: $43 United Healthcare — United Healthcare: $68.80

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: 19120P REMOVAL OF BREAST LESION	$1,348	$674	$674 – $7,850
Removal of breast growth (open surgery): 10 of 20 insurance plan rates Aetna — Aetna: $1,118.84 Blue Shield Senior — Blue Shield Senior: $5,106.80 CDPHP — CDPHP: $5,349.98 Charity Care Tier 2 — Charity Care Tier 2: $2,431.81 Coventry — Coventry: $1,118.84 Empire BC — Empire BC: $674 GHI — GHI: $9,873.15 Managed Medicare — Managed Medicare: $4,863.62 Medicare — Medicare: $4,887.57 Medicare HMO 101 — Medicare HMO 101: $4,912.26
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 19120P REMOVAL OF BREAST LESION	$1,348	$674	$674 – $1,213.20
Removal of breast growth (open surgery): rates for 7 insurance plans Aetna — Aetna: $1,145.80 Coventry — Coventry: $1,118.84 Non-Contracted — Non-Contracted: $1,213.20 POMCO — POMCO: $1,051.44 RMSCO — RMSCO: $1,213.20 Self-Pay — Self-Pay: $674 United Healthcare — United Healthcare: $1,078.40
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$5,120 – $7,850
Removal of breast growth (open surgery): 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,702.10 CDPHP — CDPHP: $5,120 Charity Care Tier 2 — Charity Care Tier 2: $3,191.47 GHI — GHI: $6,385.95 Managed Medicare — Managed Medicare: $6,382.95 Medicare — Medicare: $6,385.95 Medicare HMO 101 — Medicare HMO 101: $6,446.78 Medicare HMO 102 — Medicare HMO 102: $6,510.61 Medicare HMO 103 — Medicare HMO 103: $6,382.95 Medicare HMO 105 — Medicare HMO 105: $6,702.10
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 27130P TOTAL HIP ARTHROPLASTY	$4,441	$2,220.50	$2,220.50 – $10,500
Total hip replacement: 10 of 20 insurance plan rates Aetna — Aetna: $3,686.03 Blue Shield Senior — Blue Shield Senior: $16,745.18 CDPHP — CDPHP: $17,542.57 Charity Care Tier 2 — Charity Care Tier 2: $7,973.90 Coventry — Coventry: $3,686.03 Empire BC — Empire BC: $2,220.50 GHI — GHI: $32,374.01 Managed Medicare — Managed Medicare: $15,947.79 Medicare — Medicare: $16,026.32 Medicare HMO 101 — Medicare HMO 101: $16,107.27
Total hip replacement CPT 27130 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 27130P TOTAL HIP ARTHROPLASTY	$4,441	$2,220.50	$2,220.50 – $3,996.90
Total hip replacement: rates for 7 insurance plans Aetna — Aetna: $3,774.85 Coventry — Coventry: $3,686.03 Non-Contracted — Non-Contracted: $3,996.90 POMCO — POMCO: $3,463.98 RMSCO — RMSCO: $3,996.90 Self-Pay — Self-Pay: $2,220.50 United Healthcare — United Healthcare: $3,552.80
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL HIP REPLACEMENT	Not listed in the file	Not listed in the file	$7,973.90 – $16,745.18
Total hip replacement: 10 of 19 insurance plan rates Blue Shield Senior — Blue Shield Senior: $16,745.18 CDPHP — CDPHP: $8,775 Charity Care Tier 2 — Charity Care Tier 2: $7,973.90 GHI — GHI: $16,026.32 Managed Medicare — Managed Medicare: $15,947.79 Medicare — Medicare: $16,026.32 Medicare HMO 101 — Medicare HMO 101: $16,107.27 Medicare HMO 102 — Medicare HMO 102: $16,266.75 Medicare HMO 103 — Medicare HMO 103: $15,947.79 Medicare HMO 105 — Medicare HMO 105: $16,745.18
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 27447P TOTAL KNEE ARTHROPLASTY	$4,440	$2,220	$2,220 – $10,500
Total knee replacement: 10 of 20 insurance plan rates Aetna — Aetna: $3,685.20 Blue Shield Senior — Blue Shield Senior: $16,745.18 CDPHP — CDPHP: $17,542.57 Charity Care Tier 2 — Charity Care Tier 2: $7,973.90 Coventry — Coventry: $3,685.20 Empire BC — Empire BC: $2,220 GHI — GHI: $32,374.01 Managed Medicare — Managed Medicare: $15,947.79 Medicare — Medicare: $16,026.32 Medicare HMO 101 — Medicare HMO 101: $16,107.27
Total knee replacement CPT 27447 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 27447P TOTAL KNEE ARTHROPLASTY	$4,440	$2,220	$2,220 – $3,996
Total knee replacement: rates for 7 insurance plans Aetna — Aetna: $3,774 Coventry — Coventry: $3,685.20 Non-Contracted — Non-Contracted: $3,996 POMCO — POMCO: $3,463.20 RMSCO — RMSCO: $3,996 Self-Pay — Self-Pay: $2,220 United Healthcare — United Healthcare: $3,552
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL KNEE REPLACEMENT	Not listed in the file	Not listed in the file	$7,973.90 – $16,745.18
Total knee replacement: 10 of 19 insurance plan rates Blue Shield Senior — Blue Shield Senior: $16,745.18 CDPHP — CDPHP: $6,802 Charity Care Tier 2 — Charity Care Tier 2: $7,973.90 GHI — GHI: $16,026.32 Managed Medicare — Managed Medicare: $15,947.79 Medicare — Medicare: $16,026.32 Medicare HMO 101 — Medicare HMO 101: $16,107.27 Medicare HMO 102 — Medicare HMO 102: $16,266.75 Medicare HMO 103 — Medicare HMO 103: $15,947.79 Medicare HMO 105 — Medicare HMO 105: $16,745.18
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 29826P SHOULDER ARTHROSCOPY/SURGERY	$580	$290	$290 – $3,600
Shoulder arthroscopy: shaving of shoulder bone: rates for 10 insurance plans Aetna — Aetna: $481.40 Coventry — Coventry: $481.40 Empire BC — Empire BC: $290 MVP Commercial/Select — MVP Commercial/Select: $3,600 Non-Contracted — Non-Contracted: $522 POMCO — POMCO: $452.40 RMSCO — RMSCO: $493 Self-Pay — Self-Pay: $290 Tricare — Tricare: $580 United Healthcare — United Healthcare: $464
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 29826P SHOULDER ARTHROSCOPY/SURGERY	$580	$290	$290 – $522
Shoulder arthroscopy: shaving of shoulder bone: rates for 7 insurance plans Aetna — Aetna: $493 Coventry — Coventry: $481.40 Non-Contracted — Non-Contracted: $522 POMCO — POMCO: $452.40 RMSCO — RMSCO: $522 Self-Pay — Self-Pay: $290 United Healthcare — United Healthcare: $464
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SHOULDER ARTHROSCOPY/SURGERY	Not listed in the file	Not listed in the file	$3,600 – $5,120
Shoulder arthroscopy: shaving of shoulder bone: rates for 10 insurance plans CDPHP — CDPHP: $5,120 MVP Commercial/Select — MVP Commercial/Select: $3,600 Aetna — Aetna: 83% (a percentage in the contract, not a dollar amount) Coventry — Coventry: 83% (a percentage in the contract, not a dollar amount) Empire BC — Empire BC: 5,000% (a percentage in the contract, not a dollar amount) Non-Contracted — Non-Contracted: 90% (a percentage in the contract, not a dollar amount) POMCO — POMCO: 78% (a percentage in the contract, not a dollar amount) RMSCO — RMSCO: 85% (a percentage in the contract, not a dollar amount) Self-Pay — Self-Pay: 50% (a percentage in the contract, not a dollar amount) United Healthcare — United Healthcare: 80% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 29881P KNEE ARTHROSCOPY/SURGERY	$1,769	$884.50	$884.50 – $3,600
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 20 insurance plan rates Aetna — Aetna: $1,468.27 Blue Shield Senior — Blue Shield Senior: $4,267.59 CDPHP — CDPHP: $4,470.81 Charity Care Tier 2 — Charity Care Tier 2: $2,032.18 Coventry — Coventry: $1,468.27 Empire BC — Empire BC: $884.50 GHI — GHI: $8,250.67 Managed Medicare — Managed Medicare: $4,064.37 Medicare — Medicare: $4,084.39 Medicare HMO 101 — Medicare HMO 101: $4,105.01
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 29881P KNEE ARTHROSCOPY/SURGERY	$1,769	$884.50	$884.50 – $1,592.10
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 7 insurance plans Aetna — Aetna: $1,503.65 Coventry — Coventry: $1,468.27 Non-Contracted — Non-Contracted: $1,592.10 POMCO — POMCO: $1,379.82 RMSCO — RMSCO: $1,592.10 Self-Pay — Self-Pay: $884.50 United Healthcare — United Healthcare: $1,415.20
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: KNEE ARTHROSCOPY/SURGERY	Not listed in the file	Not listed in the file	$3,600 – $6,585.55
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,597.20 CDPHP — CDPHP: $6,149 Charity Care Tier 2 — Charity Care Tier 2: $3,141.52 GHI — GHI: $6,285.55 Managed Medicare — Managed Medicare: $6,283.05 Medicare — Medicare: $6,285.55 Medicare HMO 101 — Medicare HMO 101: $6,345.88 Medicare HMO 102 — Medicare HMO 102: $6,408.71 Medicare HMO 103 — Medicare HMO 103: $6,283.05 Medicare HMO 105 — Medicare HMO 105: $6,597.20
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 42820P REMOVE TONSILS AND ADENOIDS	$965	$482.50	$482.50 – $7,850
Removal of tonsils and adenoids (under age 12): 10 of 20 insurance plan rates Aetna — Aetna: $800.95 Blue Shield Senior — Blue Shield Senior: $7,721.09 CDPHP — CDPHP: $8,088.76 Charity Care Tier 2 — Charity Care Tier 2: $3,676.71 Coventry — Coventry: $800.95 Empire BC — Empire BC: $482.50 GHI — GHI: $14,927.44 Managed Medicare — Managed Medicare: $7,353.42 Medicare — Medicare: $7,389.63 Medicare HMO 101 — Medicare HMO 101: $7,426.95
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 42820P REMOVE TONSILS AND ADENOIDS	$965	$482.50	$482.50 – $868.50
Removal of tonsils and adenoids (under age 12): rates for 7 insurance plans Aetna — Aetna: $820.25 Coventry — Coventry: $800.95 Non-Contracted — Non-Contracted: $868.50 POMCO — POMCO: $752.70 RMSCO — RMSCO: $868.50 Self-Pay — Self-Pay: $482.50 United Healthcare — United Healthcare: $772
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$5,120 – $7,850
Removal of tonsils and adenoids (under age 12): 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $7,721.09 CDPHP — CDPHP: $5,120 Charity Care Tier 2 — Charity Care Tier 2: $3,676.71 GHI — GHI: $7,389.63 Managed Medicare — Managed Medicare: $7,353.42 Medicare — Medicare: $7,389.63 Medicare HMO 101 — Medicare HMO 101: $7,426.95 Medicare HMO 102 — Medicare HMO 102: $7,500.49 Medicare HMO 103 — Medicare HMO 103: $7,353.42 Medicare HMO 105 — Medicare HMO 105: $7,721.09
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD DIAGNOSTIC BRUSH WASH	$2,685	$1,342.50	$1,132.18 – $3,600
Upper GI endoscopy (diagnostic): 10 of 20 insurance plan rates Aetna — Aetna: $2,228.55 Blue Shield Senior — Blue Shield Senior: $1,182.96 CDPHP — CDPHP: $1,239.29 Charity Care Tier 2 — Charity Care Tier 2: $563.32 Coventry — Coventry: $2,228.55 Empire BC — Empire BC: $1,342.50 GHI — GHI: $2,287.06 Managed Medicare — Managed Medicare: $1,126.63 Medicare — Medicare: $1,132.18 Medicare HMO 101 — Medicare HMO 101: $1,137.90
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 43235P UPPR GI ENDOSCOPY DIAGNOSIS	$431	$215.50	$215.50 – $3,600
Upper GI endoscopy (diagnostic): 10 of 20 insurance plan rates Aetna — Aetna: $357.73 Blue Shield Senior — Blue Shield Senior: $1,182.96 CDPHP — CDPHP: $1,239.29 Charity Care Tier 2 — Charity Care Tier 2: $563.32 Coventry — Coventry: $357.73 Empire BC — Empire BC: $215.50 GHI — GHI: $2,287.06 Managed Medicare — Managed Medicare: $1,126.63 Medicare — Medicare: $1,132.18 Medicare HMO 101 — Medicare HMO 101: $1,137.90
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EGD DIAGNOSTIC BRUSH WASH	$2,685	$1,342.50	$1,342.50 – $2,416.50
Upper GI endoscopy (diagnostic): rates for 7 insurance plans Aetna — Aetna: $2,282.25 Coventry — Coventry: $2,228.55 Non-Contracted — Non-Contracted: $2,416.50 POMCO — POMCO: $2,094.30 RMSCO — RMSCO: $2,416.50 Self-Pay — Self-Pay: $1,342.50 United Healthcare — United Healthcare: $2,148
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD BIOPSY SINGLE/MULTIPLE	$2,767	$1,383.50	$1,132.18 – $3,600
Upper GI endoscopy with biopsy: 10 of 20 insurance plan rates Aetna — Aetna: $2,296.61 Blue Shield Senior — Blue Shield Senior: $1,182.96 CDPHP — CDPHP: $1,239.29 Charity Care Tier 2 — Charity Care Tier 2: $563.32 Coventry — Coventry: $2,296.61 Empire BC — Empire BC: $1,383.50 GHI — GHI: $2,287.06 Managed Medicare — Managed Medicare: $1,126.63 Medicare — Medicare: $1,132.18 Medicare HMO 101 — Medicare HMO 101: $1,137.90
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 43239P UPPER GI ENDOSCOPY BIOPSY	$486	$243	$243 – $3,600
Upper GI endoscopy with biopsy: 10 of 20 insurance plan rates Aetna — Aetna: $403.38 Blue Shield Senior — Blue Shield Senior: $1,182.96 CDPHP — CDPHP: $1,239.29 Charity Care Tier 2 — Charity Care Tier 2: $563.32 Coventry — Coventry: $403.38 Empire BC — Empire BC: $243 GHI — GHI: $2,287.06 Managed Medicare — Managed Medicare: $1,126.63 Medicare — Medicare: $1,132.18 Medicare HMO 101 — Medicare HMO 101: $1,137.90
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EGD BIOPSY SINGLE/MULTIPLE	$2,767	$1,383.50	$1,383.50 – $2,490.30
Upper GI endoscopy with biopsy: rates for 7 insurance plans Aetna — Aetna: $2,351.95 Coventry — Coventry: $2,296.61 Non-Contracted — Non-Contracted: $2,490.30 POMCO — POMCO: $2,158.26 RMSCO — RMSCO: $2,490.30 Self-Pay — Self-Pay: $1,383.50 United Healthcare — United Healthcare: $2,213.60
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 45378P Diagnostic colonoscopy	$622	$311	$311 – $1,409
Colonoscopy (diagnostic): 10 of 20 insurance plan rates Aetna — Aetna: $516.26 Blue Shield Senior — Blue Shield Senior: $1,212.92 CDPHP — CDPHP: $1,270.68 Charity Care Tier 2 — Charity Care Tier 2: $577.58 Coventry — Coventry: $516.26 Empire BC — Empire BC: $311 GHI — GHI: $2,344.97 Managed Medicare — Managed Medicare: $1,155.16 Medicare — Medicare: $1,160.85 Medicare HMO 101 — Medicare HMO 101: $1,166.71
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 45378P Diagnostic colonoscopy	$622	$311	$311 – $559.80
Colonoscopy (diagnostic): rates for 7 insurance plans Aetna — Aetna: $528.70 Coventry — Coventry: $516.26 Non-Contracted — Non-Contracted: $559.80 POMCO — POMCO: $485.16 RMSCO — RMSCO: $559.80 Self-Pay — Self-Pay: $311 United Healthcare — United Healthcare: $497.60
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$1,290 – $6,220.11
Colonoscopy (diagnostic): 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,215.36 CDPHP — CDPHP: $1,290 Charity Care Tier 2 — Charity Care Tier 2: $2,959.69 GHI — GHI: $5,920.11 Managed Medicare — Managed Medicare: $5,919.39 Medicare — Medicare: $5,920.11 Medicare HMO 101 — Medicare HMO 101: $5,978.58 Medicare HMO 102 — Medicare HMO 102: $6,037.78 Medicare HMO 103 — Medicare HMO 103: $5,919.39 Medicare HMO 105 — Medicare HMO 105: $6,215.36
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 45380P Colonoscopy and biopsy	$695	$347.50	$347.50 – $1,409
Colonoscopy with biopsy: 10 of 20 insurance plan rates Aetna — Aetna: $576.85 Blue Shield Senior — Blue Shield Senior: $1,560.75 CDPHP — CDPHP: $1,635.07 Charity Care Tier 2 — Charity Care Tier 2: $743.22 Coventry — Coventry: $576.85 Empire BC — Empire BC: $347.50 GHI — GHI: $3,017.45 Managed Medicare — Managed Medicare: $1,486.43 Medicare — Medicare: $1,493.75 Medicare HMO 101 — Medicare HMO 101: $1,501.29
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 45380P Colonoscopy and biopsy	$695	$347.50	$347.50 – $625.50
Colonoscopy with biopsy: rates for 7 insurance plans Aetna — Aetna: $590.75 Coventry — Coventry: $576.85 Non-Contracted — Non-Contracted: $625.50 POMCO — POMCO: $542.10 RMSCO — RMSCO: $625.50 Self-Pay — Self-Pay: $347.50 United Healthcare — United Healthcare: $556
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$1,290 – $6,261.72
Colonoscopy with biopsy: 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,258.84 CDPHP — CDPHP: $1,290 Charity Care Tier 2 — Charity Care Tier 2: $2,980.40 GHI — GHI: $5,961.72 Managed Medicare — Managed Medicare: $5,960.80 Medicare — Medicare: $5,961.72 Medicare HMO 101 — Medicare HMO 101: $6,020.41 Medicare HMO 102 — Medicare HMO 102: $6,080.02 Medicare HMO 103 — Medicare HMO 103: $5,960.80 Medicare HMO 105 — Medicare HMO 105: $6,258.84
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 45385P Lesion removal colonoscopy	$876	$438	$438 – $3,600
Colonoscopy with removal of polyps (snare): 10 of 20 insurance plan rates Aetna — Aetna: $727.08 Blue Shield Senior — Blue Shield Senior: $1,560.75 CDPHP — CDPHP: $1,635.07 Charity Care Tier 2 — Charity Care Tier 2: $743.22 Coventry — Coventry: $727.08 Empire BC — Empire BC: $438 GHI — GHI: $3,017.45 Managed Medicare — Managed Medicare: $1,486.43 Medicare — Medicare: $1,493.75 Medicare HMO 101 — Medicare HMO 101: $1,501.29
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 45385P Lesion removal colonoscopy	$876	$438	$438 – $788.40
Colonoscopy with removal of polyps (snare): rates for 7 insurance plans Aetna — Aetna: $744.60 Coventry — Coventry: $727.08 Non-Contracted — Non-Contracted: $788.40 POMCO — POMCO: $683.28 RMSCO — RMSCO: $788.40 Self-Pay — Self-Pay: $438 United Healthcare — United Healthcare: $700.80
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LESION REMOVAL COLONOSCOPY	Not listed in the file	Not listed in the file	$3,600 – $6,261.72
Colonoscopy with removal of polyps (snare): 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,258.84 CDPHP — CDPHP: $4,415 Charity Care Tier 2 — Charity Care Tier 2: $2,980.40 GHI — GHI: $5,961.72 Managed Medicare — Managed Medicare: $5,960.80 Medicare — Medicare: $5,961.72 Medicare HMO 101 — Medicare HMO 101: $6,020.41 Medicare HMO 102 — Medicare HMO 102: $6,080.02 Medicare HMO 103 — Medicare HMO 103: $5,960.80 Medicare HMO 105 — Medicare HMO 105: $6,258.84
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$3,600 – $6,261.72
Ultrasound of the lower bowel by endoscope: 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,258.84 CDPHP — CDPHP: $4,415 Charity Care Tier 2 — Charity Care Tier 2: $2,980.40 GHI — GHI: $5,961.72 Managed Medicare — Managed Medicare: $5,960.80 Medicare — Medicare: $5,961.72 Medicare HMO 101 — Medicare HMO 101: $6,020.41 Medicare HMO 102 — Medicare HMO 102: $6,080.02 Medicare HMO 103 — Medicare HMO 103: $5,960.80 Medicare HMO 105 — Medicare HMO 105: $6,258.84
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: G0121P Colon ca scrn not hi rsk ind	$622	$311	$276.77 – $1,409
Screening colonoscopy (not high risk): 10 of 20 insurance plan rates Aetna — Aetna: $516.26 Blue Shield Senior — Blue Shield Senior: $1,212.92 CDPHP — CDPHP: $276.77 Charity Care Tier 2 — Charity Care Tier 2: $577.58 Coventry — Coventry: $516.26 Empire BC — Empire BC: $949.08 GHI — GHI: $2,344.97 Managed Medicare — Managed Medicare: $1,155.16 Medicare — Medicare: $1,160.85 Medicare HMO 101 — Medicare HMO 101: $1,166.71
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) · Hospital (facility) fee In the file: G0121P Colon ca scrn not hi rsk ind	$622	$311	$311 – $559.80
Screening colonoscopy (not high risk): rates for 7 insurance plans Aetna — Aetna: $528.70 Coventry — Coventry: $516.26 Non-Contracted — Non-Contracted: $559.80 POMCO — POMCO: $485.16 RMSCO — RMSCO: $559.80 Self-Pay — Self-Pay: $311 United Healthcare — United Healthcare: $497.60
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: G0121T Colon ca scrn not hi rsk ind	$2,442	$1,221	$949.08 – $2,197.80
Screening colonoscopy (not high risk): 10 of 20 insurance plan rates Aetna — Aetna: $2,026.86 Blue Shield Senior — Blue Shield Senior: $485.17 CDPHP — CDPHP: $1,290 Charity Care Tier 2 — Charity Care Tier 2: $231.03 Coventry — Coventry: $2,026.86 Empire BC — Empire BC: $949.08 GHI — GHI: $464.34 Managed Medicare — Managed Medicare: $462.07 Medicare — Medicare: $464.34 Medicare HMO 101 — Medicare HMO 101: $466.69
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 47562P LAPAROSCOPIC CHOLECYSTECTOMY	$2,156	$1,078	$1,078 – $15,050
Gallbladder removal by laparoscope: 10 of 20 insurance plan rates Aetna — Aetna: $1,789.48 Blue Shield Senior — Blue Shield Senior: $7,885.04 CDPHP — CDPHP: $8,260.52 Charity Care Tier 2 — Charity Care Tier 2: $3,754.78 Coventry — Coventry: $1,789.48 Empire BC — Empire BC: $1,078 GHI — GHI: $15,244.41 Managed Medicare — Managed Medicare: $7,509.56 Medicare — Medicare: $7,546.53 Medicare HMO 101 — Medicare HMO 101: $7,584.66
Gallbladder removal by laparoscope CPT 47562 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 47562P LAPAROSCOPIC CHOLECYSTECTOMY	$2,156	$1,078	$1,078 – $1,940.40
Gallbladder removal by laparoscope: rates for 7 insurance plans Aetna — Aetna: $1,832.60 Coventry — Coventry: $1,789.48 Non-Contracted — Non-Contracted: $1,940.40 POMCO — POMCO: $1,681.68 RMSCO — RMSCO: $1,940.40 Self-Pay — Self-Pay: $1,078 United Healthcare — United Healthcare: $1,724.80
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$6,149 – $15,050
Gallbladder removal by laparoscope: 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $7,885.04 CDPHP — CDPHP: $6,149 Charity Care Tier 2 — Charity Care Tier 2: $3,754.78 GHI — GHI: $7,546.53 Managed Medicare — Managed Medicare: $7,509.56 Medicare — Medicare: $7,546.53 Medicare HMO 101 — Medicare HMO 101: $7,584.66 Medicare HMO 102 — Medicare HMO 102: $7,659.75 Medicare HMO 103 — Medicare HMO 103: $7,509.56 Medicare HMO 105 — Medicare HMO 105: $7,885.04
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 49505P Prp i/hern init reduc >5 yr	$1,707	$853.50	$853.50 – $7,850
Groin (inguinal) hernia repair, age 5 or older: 10 of 20 insurance plan rates Aetna — Aetna: $1,416.81 Blue Shield Senior — Blue Shield Senior: $4,669.83 CDPHP — CDPHP: $4,892.21 Charity Care Tier 2 — Charity Care Tier 2: $2,223.73 Coventry — Coventry: $1,416.81 Empire BC — Empire BC: $853.50 GHI — GHI: $9,028.34 Managed Medicare — Managed Medicare: $4,447.46 Medicare — Medicare: $4,469.36 Medicare HMO 101 — Medicare HMO 101: $4,491.93
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 49505P Prp i/hern init reduc >5 yr	$1,707	$853.50	$853.50 – $1,536.30
Groin (inguinal) hernia repair, age 5 or older: rates for 7 insurance plans Aetna — Aetna: $1,450.95 Coventry — Coventry: $1,416.81 Non-Contracted — Non-Contracted: $1,536.30 POMCO — POMCO: $1,331.46 RMSCO — RMSCO: $1,536.30 Self-Pay — Self-Pay: $853.50 United Healthcare — United Healthcare: $1,365.60
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REPAIR INGUINAL HERNIA	Not listed in the file	Not listed in the file	$6,149 – $7,850
Groin (inguinal) hernia repair, age 5 or older: 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,647.48 CDPHP — CDPHP: $6,149 Charity Care Tier 2 — Charity Care Tier 2: $3,165.47 GHI — GHI: $6,333.67 Managed Medicare — Managed Medicare: $6,330.93 Medicare — Medicare: $6,333.67 Medicare HMO 101 — Medicare HMO 101: $6,394.24 Medicare HMO 102 — Medicare HMO 102: $6,457.55 Medicare HMO 103 — Medicare HMO 103: $6,330.93 Medicare HMO 105 — Medicare HMO 105: $6,647.48
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 55700P BX/PROSTATE/NEEDLE/PUNCH/SNG/MUL	$404	$202	$202 – $404
Prostate biopsy: rates for 10 insurance plans Aetna — Aetna: $335.32 Coventry — Coventry: $335.32 Empire BC — Empire BC: $202 MVP Commercial/Select — MVP Commercial/Select: $202 Non-Contracted — Non-Contracted: $363.60 POMCO — POMCO: $315.12 RMSCO — RMSCO: $343.40 Self-Pay — Self-Pay: $202 Tricare — Tricare: $404 United Healthcare — United Healthcare: $323.20
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 55700P BX/PROSTATE/NEEDLE/PUNCH/SNG/MUL	$404	$202	$202 – $363.60
Prostate biopsy: rates for 7 insurance plans Aetna — Aetna: $343.40 Coventry — Coventry: $335.32 Non-Contracted — Non-Contracted: $363.60 POMCO — POMCO: $315.12 RMSCO — RMSCO: $363.60 Self-Pay — Self-Pay: $202 United Healthcare — United Healthcare: $323.20
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$4,415
Prostate biopsy: rates for 10 insurance plans CDPHP — CDPHP: $4,415 Aetna — Aetna: 83% (a percentage in the contract, not a dollar amount) Coventry — Coventry: 83% (a percentage in the contract, not a dollar amount) Empire BC — Empire BC: 5,000% (a percentage in the contract, not a dollar amount) MVP Commercial/Select — MVP Commercial/Select: 5,000% (a percentage in the contract, not a dollar amount) Non-Contracted — Non-Contracted: 90% (a percentage in the contract, not a dollar amount) POMCO — POMCO: 78% (a percentage in the contract, not a dollar amount) RMSCO — RMSCO: 85% (a percentage in the contract, not a dollar amount) Self-Pay — Self-Pay: 50% (a percentage in the contract, not a dollar amount) United Healthcare — United Healthcare: 80% (a percentage in the contract, not a dollar amount)
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 55866P LAPARO RADICAL PROSTATECTOMY	$4,784	$2,392	$2,392 – $15,050
Prostate removal by laparoscope (radical prostatectomy): 10 of 20 insurance plan rates Aetna — Aetna: $3,970.72 Blue Shield Senior — Blue Shield Senior: $13,864.23 CDPHP — CDPHP: $14,524.43 Charity Care Tier 2 — Charity Care Tier 2: $6,602.02 Coventry — Coventry: $3,970.72 Empire BC — Empire BC: $2,392 GHI — GHI: $26,804.18 Managed Medicare — Managed Medicare: $13,204.03 Medicare — Medicare: $13,269.05 Medicare HMO 101 — Medicare HMO 101: $13,336.07
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 55866P LAPARO RADICAL PROSTATECTOMY	$4,784	$2,392	$2,392 – $4,305.60
Prostate removal by laparoscope (radical prostatectomy): rates for 7 insurance plans Aetna — Aetna: $4,066.40 Coventry — Coventry: $3,970.72 Non-Contracted — Non-Contracted: $4,305.60 POMCO — POMCO: $3,731.52 RMSCO — RMSCO: $4,305.60 Self-Pay — Self-Pay: $2,392 United Healthcare — United Healthcare: $3,827.20
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$8,775 – $15,050
Prostate removal by laparoscope (radical prostatectomy): 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $13,864.23 CDPHP — CDPHP: $8,775 Charity Care Tier 2 — Charity Care Tier 2: $6,602.02 GHI — GHI: $13,269.05 Managed Medicare — Managed Medicare: $13,204.03 Medicare — Medicare: $13,269.05 Medicare HMO 101 — Medicare HMO 101: $13,336.07 Medicare HMO 102 — Medicare HMO 102: $13,468.11 Medicare HMO 103 — Medicare HMO 103: $13,204.03 Medicare HMO 105 — Medicare HMO 105: $13,864.23
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 58558P HYSTEROSCOPY BIOPSY	$828	$414	$414 – $3,600
Hysteroscopy with biopsy of the uterus lining: 10 of 20 insurance plan rates Aetna — Aetna: $687.24 Blue Shield Senior — Blue Shield Senior: $4,222.10 CDPHP — CDPHP: $4,423.16 Charity Care Tier 2 — Charity Care Tier 2: $2,010.53 Coventry — Coventry: $687.24 Empire BC — Empire BC: $414 GHI — GHI: $8,162.73 Managed Medicare — Managed Medicare: $4,021.05 Medicare — Medicare: $4,040.85 Medicare HMO 101 — Medicare HMO 101: $4,061.26
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 58558P HYSTEROSCOPY BIOPSY	$828	$414	$414 – $745.20
Hysteroscopy with biopsy of the uterus lining: rates for 7 insurance plans Aetna — Aetna: $703.80 Coventry — Coventry: $687.24 Non-Contracted — Non-Contracted: $745.20 POMCO — POMCO: $645.84 RMSCO — RMSCO: $745.20 Self-Pay — Self-Pay: $414 United Healthcare — United Healthcare: $662.40
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY, BIOPSY	Not listed in the file	Not listed in the file	$3,600 – $6,580.11
Hysteroscopy with biopsy of the uterus lining: 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,591.51 CDPHP — CDPHP: $5,120 Charity Care Tier 2 — Charity Care Tier 2: $3,138.82 GHI — GHI: $6,280.11 Managed Medicare — Managed Medicare: $6,277.63 Medicare — Medicare: $6,280.11 Medicare HMO 101 — Medicare HMO 101: $6,340.41 Medicare HMO 102 — Medicare HMO 102: $6,403.18 Medicare HMO 103 — Medicare HMO 103: $6,277.63 Medicare HMO 105 — Medicare HMO 105: $6,591.51
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 62323P- NJX INTERLAMINAR LMBR/SAC	$330	$165	$165 – $330
Spinal injection, lower back (epidural), with imaging guidance: 10 of 20 insurance plan rates Aetna — Aetna: $273.90 Blue Shield Senior — Blue Shield Senior: $920.66 CDPHP — CDPHP: $964.50 Charity Care Tier 2 — Charity Care Tier 2: $438.41 Coventry — Coventry: $273.90 Empire BC — Empire BC: $165 GHI — GHI: $1,779.94 Managed Medicare — Managed Medicare: $876.82 Medicare — Medicare: $881.14 Medicare HMO 101 — Medicare HMO 101: $885.59
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 62323P- NJX INTERLAMINAR LMBR/SAC	$330	$165	$165 – $297
Spinal injection, lower back (epidural), with imaging guidance: rates for 7 insurance plans Aetna — Aetna: $280.50 Coventry — Coventry: $273.90 Non-Contracted — Non-Contracted: $297 POMCO — POMCO: $257.40 RMSCO — RMSCO: $297 Self-Pay — Self-Pay: $165 United Healthcare — United Healthcare: $264
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$2,957 – $6,185.14
Spinal injection, lower back (epidural), with imaging guidance: 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,178.83 CDPHP — CDPHP: $2,957 Charity Care Tier 2 — Charity Care Tier 2: $2,942.30 GHI — GHI: $5,885.14 Managed Medicare — Managed Medicare: $5,884.60 Medicare — Medicare: $5,885.14 Medicare HMO 101 — Medicare HMO 101: $5,943.45 Medicare HMO 102 — Medicare HMO 102: $6,002.30 Medicare HMO 103 — Medicare HMO 103: $5,884.60 Medicare HMO 105 — Medicare HMO 105: $6,178.83
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 64483P INJ FORAMEN EPIDURAL L/S	$377	$188.50	$188.50 – $377
Nerve root injection, lower back, with imaging guidance: 10 of 20 insurance plan rates Aetna — Aetna: $312.91 Blue Shield Senior — Blue Shield Senior: $1,153.59 CDPHP — CDPHP: $1,208.53 Charity Care Tier 2 — Charity Care Tier 2: $549.33 Coventry — Coventry: $312.91 Empire BC — Empire BC: $188.50 GHI — GHI: $2,230.28 Managed Medicare — Managed Medicare: $1,098.66 Medicare — Medicare: $1,104.07 Medicare HMO 101 — Medicare HMO 101: $1,109.65
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 64483P INJ FORAMEN EPIDURAL L/S	$377	$188.50	$188.50 – $339.30
Nerve root injection, lower back, with imaging guidance: rates for 7 insurance plans Aetna — Aetna: $320.45 Coventry — Coventry: $312.91 Non-Contracted — Non-Contracted: $339.30 POMCO — POMCO: $294.06 RMSCO — RMSCO: $339.30 Self-Pay — Self-Pay: $188.50 United Healthcare — United Healthcare: $301.60
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ FORAMEN EPIDURAL L/S	Not listed in the file	Not listed in the file	$2,957 – $6,213.01
Nerve root injection, lower back, with imaging guidance: 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,207.95 CDPHP — CDPHP: $2,957 Charity Care Tier 2 — Charity Care Tier 2: $2,956.16 GHI — GHI: $5,913.01 Managed Medicare — Managed Medicare: $5,912.33 Medicare — Medicare: $5,913.01 Medicare HMO 101 — Medicare HMO 101: $5,971.45 Medicare HMO 102 — Medicare HMO 102: $6,030.58 Medicare HMO 103 — Medicare HMO 103: $5,912.33 Medicare HMO 105 — Medicare HMO 105: $6,207.95
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 64721P Carpal tunnel surgery	$1,384	$692	$692 – $7,850
Carpal tunnel release: 10 of 20 insurance plan rates Aetna — Aetna: $1,148.72 Blue Shield Senior — Blue Shield Senior: $2,546.89 CDPHP — CDPHP: $2,668.17 Charity Care Tier 2 — Charity Care Tier 2: $1,212.81 Coventry — Coventry: $1,148.72 Empire BC — Empire BC: $692 GHI — GHI: $4,923.99 Managed Medicare — Managed Medicare: $2,425.61 Medicare — Medicare: $2,437.56 Medicare HMO 101 — Medicare HMO 101: $2,449.87
Carpal tunnel release CPT 64721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 64721P Carpal tunnel surgery	$1,384	$692	$692 – $1,245.60
Carpal tunnel release: rates for 7 insurance plans Aetna — Aetna: $1,176.40 Coventry — Coventry: $1,148.72 Non-Contracted — Non-Contracted: $1,245.60 POMCO — POMCO: $1,079.52 RMSCO — RMSCO: $1,245.60 Self-Pay — Self-Pay: $692 United Healthcare — United Healthcare: $1,107.20
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$4,415 – $7,850
Carpal tunnel release: 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,382.11 CDPHP — CDPHP: $4,415 Charity Care Tier 2 — Charity Care Tier 2: $3,039.10 GHI — GHI: $6,079.70 Managed Medicare — Managed Medicare: $6,078.20 Medicare — Medicare: $6,079.70 Medicare HMO 101 — Medicare HMO 101: $6,138.98 Medicare HMO 102 — Medicare HMO 102: $6,199.76 Medicare HMO 103 — Medicare HMO 103: $6,078.20 Medicare HMO 105 — Medicare HMO 105: $6,382.11
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$4,415 – $6,160.82
Laser treatment of clouding after cataract surgery: 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,153.42 CDPHP — CDPHP: $4,415 Charity Care Tier 2 — Charity Care Tier 2: $2,930.20 GHI — GHI: $5,860.82 Managed Medicare — Managed Medicare: $5,860.40 Medicare — Medicare: $5,860.82 Medicare HMO 101 — Medicare HMO 101: $5,919 Medicare HMO 102 — Medicare HMO 102: $5,977.60 Medicare HMO 103 — Medicare HMO 103: $5,860.40 Medicare HMO 105 — Medicare HMO 105: $6,153.42
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVE CATARACT/INSERT LENS	Not listed in the file	Not listed in the file	$6,435.10 – $8,644
Cataract removal with lens implant: 10 of 20 insurance plan rates Blue Shield Senior — Blue Shield Senior: $6,440.01 CDPHP — CDPHP: $8,644 Charity Care Tier 2 — Charity Care Tier 2: $3,066.67 GHI — GHI: $6,135.10 Managed Medicare — Managed Medicare: $6,133.34 Medicare — Medicare: $6,135.10 Medicare HMO 101 — Medicare HMO 101: $6,194.67 Medicare HMO 102 — Medicare HMO 102: $6,256 Medicare HMO 103 — Medicare HMO 103: $6,133.34 Medicare HMO 105 — Medicare HMO 105: $6,440.01

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 59400P OBSTETRICAL CARE	$6,797	$3,398.50	$3,398.50 – $10,500
Vaginal delivery, with care before and after: rates for 10 insurance plans Aetna — Aetna: $5,641.51 Coventry — Coventry: $5,641.51 Empire BC — Empire BC: $3,398.50 MVP Commercial/Select — MVP Commercial/Select: $10,500 Non-Contracted — Non-Contracted: $6,117.30 POMCO — POMCO: $5,301.66 RMSCO — RMSCO: $5,777.45 Self-Pay — Self-Pay: $3,398.50 Tricare — Tricare: $6,797 United Healthcare — United Healthcare: $5,437.60
Vaginal delivery, with care before and after CPT 59400 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 59400P OBSTETRICAL CARE	$6,797	$3,398.50	$3,398.50 – $6,117.30
Vaginal delivery, with care before and after: rates for 7 insurance plans Aetna — Aetna: $5,777.45 Coventry — Coventry: $5,641.51 Non-Contracted — Non-Contracted: $6,117.30 POMCO — POMCO: $5,301.66 RMSCO — RMSCO: $6,117.30 Self-Pay — Self-Pay: $3,398.50 United Healthcare — United Healthcare: $5,437.60
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$7,358.98 – $10,500
Vaginal delivery, with care before and after: rates for 10 insurance plans MVP Commercial/Select — MVP Commercial/Select: $10,500 Tricare — Tricare: $7,358.98 Aetna — Aetna: 83% (a percentage in the contract, not a dollar amount) Coventry — Coventry: 83% (a percentage in the contract, not a dollar amount) Empire BC — Empire BC: 5,000% (a percentage in the contract, not a dollar amount) Non-Contracted — Non-Contracted: 90% (a percentage in the contract, not a dollar amount) POMCO — POMCO: 78% (a percentage in the contract, not a dollar amount) RMSCO — RMSCO: 85% (a percentage in the contract, not a dollar amount) Self-Pay — Self-Pay: 50% (a percentage in the contract, not a dollar amount) United Healthcare — United Healthcare: 80% (a percentage in the contract, not a dollar amount)
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 59510P CESAREAN DELIVERY	$7,486	$3,743	$3,743 – $10,500
Cesarean delivery (C-section), with care before and after: rates for 10 insurance plans Aetna — Aetna: $6,213.38 Coventry — Coventry: $6,213.38 Empire BC — Empire BC: $3,743 MVP Commercial/Select — MVP Commercial/Select: $10,500 Non-Contracted — Non-Contracted: $6,737.40 POMCO — POMCO: $5,839.08 RMSCO — RMSCO: $6,363.10 Self-Pay — Self-Pay: $3,743 Tricare — Tricare: $7,486 United Healthcare — United Healthcare: $5,988.80
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 59510P CESAREAN DELIVERY	$7,486	$3,743	$3,743 – $6,737.40
Cesarean delivery (C-section), with care before and after: rates for 7 insurance plans Aetna — Aetna: $6,363.10 Coventry — Coventry: $6,213.38 Non-Contracted — Non-Contracted: $6,737.40 POMCO — POMCO: $5,839.08 RMSCO — RMSCO: $6,737.40 Self-Pay — Self-Pay: $3,743 United Healthcare — United Healthcare: $5,988.80
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$10,500
Cesarean delivery (C-section), with care before and after: rates for 9 insurance plans MVP Commercial/Select — MVP Commercial/Select: $10,500 Aetna — Aetna: 83% (a percentage in the contract, not a dollar amount) Coventry — Coventry: 83% (a percentage in the contract, not a dollar amount) Empire BC — Empire BC: 5,000% (a percentage in the contract, not a dollar amount) Non-Contracted — Non-Contracted: 90% (a percentage in the contract, not a dollar amount) POMCO — POMCO: 78% (a percentage in the contract, not a dollar amount) RMSCO — RMSCO: 85% (a percentage in the contract, not a dollar amount) Self-Pay — Self-Pay: 50% (a percentage in the contract, not a dollar amount) United Healthcare — United Healthcare: 80% (a percentage in the contract, not a dollar amount)
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 59610P VBAC DELIVERY	$7,096	$3,548	$3,548 – $10,500
Vaginal delivery after a previous C-section, with care before and after: rates for 10 insurance plans Aetna — Aetna: $5,889.68 Coventry — Coventry: $5,889.68 Empire BC — Empire BC: $3,548 MVP Commercial/Select — MVP Commercial/Select: $10,500 Non-Contracted — Non-Contracted: $6,386.40 POMCO — POMCO: $5,534.88 RMSCO — RMSCO: $6,031.60 Self-Pay — Self-Pay: $3,548 Tricare — Tricare: $7,096 United Healthcare — United Healthcare: $5,676.80
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 59610P VBAC DELIVERY	$7,096	$3,548	$3,548 – $6,386.40
Vaginal delivery after a previous C-section, with care before and after: rates for 7 insurance plans Aetna — Aetna: $6,031.60 Coventry — Coventry: $5,889.68 Non-Contracted — Non-Contracted: $6,386.40 POMCO — POMCO: $5,534.88 RMSCO — RMSCO: $6,386.40 Self-Pay — Self-Pay: $3,548 United Healthcare — United Healthcare: $5,676.80
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$10,500
Vaginal delivery after a previous C-section, with care before and after: rates for 9 insurance plans MVP Commercial/Select — MVP Commercial/Select: $10,500 Aetna — Aetna: 83% (a percentage in the contract, not a dollar amount) Coventry — Coventry: 83% (a percentage in the contract, not a dollar amount) Empire BC — Empire BC: 5,000% (a percentage in the contract, not a dollar amount) Non-Contracted — Non-Contracted: 90% (a percentage in the contract, not a dollar amount) POMCO — POMCO: 78% (a percentage in the contract, not a dollar amount) RMSCO — RMSCO: 85% (a percentage in the contract, not a dollar amount) Self-Pay — Self-Pay: 50% (a percentage in the contract, not a dollar amount) United Healthcare — United Healthcare: 80% (a percentage in the contract, not a dollar amount)

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$46,346.35 – $155,751.96
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 16 insurance plan rates Aetna — Aetna: $57,500 Blue Shield Senior — Blue Shield Senior: $97,327.32 Charity Care Tier 2 — Charity Care Tier 2: $46,346.35 GHI — GHI: $155,751.96 Managed Medicare — Managed Medicare: $92,692.69 Medicare — Medicare: $92,692.69 Medicare HMO 101 — Medicare HMO 101: $93,619.62 Medicare HMO 102 — Medicare HMO 102: $94,546.54 Medicare HMO 103 — Medicare HMO 103: $95,473.47 Medicare HMO 105 — Medicare HMO 105: $97,327.32
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) · Hospital (facility) fee In the file: SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	Not listed in the file	Not listed in the file	$17,492.67 – $36,734.60
Spinal fusion (not neck), without major complications: 10 of 15 insurance plan rates Blue Shield Senior — Blue Shield Senior: $36,734.60 Charity Care Tier 2 — Charity Care Tier 2: $17,492.67 Managed Medicare — Managed Medicare: $34,985.33 Medicare — Medicare: $34,985.33 Medicare HMO 101 — Medicare HMO 101: $35,335.18 Medicare HMO 102 — Medicare HMO 102: $35,685.04 Medicare HMO 103 — Medicare HMO 103: $36,034.89 Medicare HMO 105 — Medicare HMO 105: $36,734.60 Aetna — Aetna: 85% (a percentage in the contract, not a dollar amount) Coventry — Coventry: 83% (a percentage in the contract, not a dollar amount)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$9,347.56 – $30,710.02
Hip or knee replacement (major joint of the leg), without major complications: 10 of 16 insurance plan rates Blue Shield Senior — Blue Shield Senior: $19,629.88 Charity Care Tier 2 — Charity Care Tier 2: $9,347.56 GHI — GHI: $30,710.02 Managed Medicare — Managed Medicare: $18,695.12 Medicare — Medicare: $18,695.12 Medicare HMO 101 — Medicare HMO 101: $18,882.07 Medicare HMO 102 — Medicare HMO 102: $19,069.02 Medicare HMO 103 — Medicare HMO 103: $19,255.97 Medicare HMO 105 — Medicare HMO 105: $19,629.88 Aetna — Aetna: 85% (a percentage in the contract, not a dollar amount)
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$11,761.42 – $38,867.94
Neck (cervical) spinal fusion, without complications: 10 of 16 insurance plan rates Blue Shield Senior — Blue Shield Senior: $24,698.97 Charity Care Tier 2 — Charity Care Tier 2: $11,761.42 GHI — GHI: $38,867.94 Managed Medicare — Managed Medicare: $23,522.83 Medicare — Medicare: $23,522.83 Medicare HMO 101 — Medicare HMO 101: $23,758.06 Medicare HMO 102 — Medicare HMO 102: $23,993.29 Medicare HMO 103 — Medicare HMO 103: $24,228.51 Medicare HMO 105 — Medicare HMO 105: $24,698.97 Aetna — Aetna: 85% (a percentage in the contract, not a dollar amount)
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$6,105.52 – $19,753.18
Uterus and ovary surgery (not for cancer), without complications: 10 of 16 insurance plan rates Blue Shield Senior — Blue Shield Senior: $12,821.60 Charity Care Tier 2 — Charity Care Tier 2: $6,105.52 GHI — GHI: $19,753.18 Managed Medicare — Managed Medicare: $12,211.05 Medicare — Medicare: $12,211.05 Medicare HMO 101 — Medicare HMO 101: $12,333.16 Medicare HMO 102 — Medicare HMO 102: $12,455.27 Medicare HMO 103 — Medicare HMO 103: $12,577.38 Medicare HMO 105 — Medicare HMO 105: $12,821.60 Aetna — Aetna: 85% (a percentage in the contract, not a dollar amount)

Source: Ellis Hospital’s standard charges file (ellismedicine.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on June 25, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	1101 Nott Street, Schenectady, NY 12308
County	Schenectady County
State	New York
Phone	(518) 243‑4196
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	3 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	330153
Name in Medicare records	ELLIS HOSPITAL
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(518) 243‑4000^[4]
Official website	ellismedicine.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-10-26, retrieved 2026-11-13
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.

Ellis Hospital - Ellis Medicine — ellismedicine.org
Visiting Hours - Ellis Medicine — ellismedicine.org
Emergency - Ellis Medicine — ellismedicine.org
Stroke Center - Ellis Hospital Emergency Department — ellismedicine.org

Ellis Hospital

Summary

Profile from official sources

At a glance