Does Highland Hospital have an emergency room?

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

Where is Highland Hospital?

1000 South Avenue, Rochester, NY 14617, in Monroe County, New York.

What is the phone number of Highland Hospital?

(585) 341-6711, as listed by Medicare (CMS).

What is the Medicare star rating of Highland Hospital?

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

Highland Hospital — Rochester, NY

Quick answers

Does Highland Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Highland Hospital. In a medical emergency, call 911.
Where is Highland Hospital?: 1000 South Avenue, Rochester, NY 14617, in Monroe County, New York.
What is the phone number of Highland Hospital?: (585) 341-6711, as listed by Medicare (CMS).
What is the Medicare star rating of Highland Hospital?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4][5][9]

Anesthesiology
Audiology
Bariatric Center
Breast Imaging Center
Cancer
Cardiology
Colon and Rectal Surgery
Emergency
Family Medicine
Gastroenterology
Geriatrics
Neurology
Neurosurgery
Obstetrics and Gynecology
Orthopaedics
Otolaryngology
Palliative Care
Primary Care
Radiology
Rehabilitation Services
Surgery
Maternity
Intensive Care Unit
Total joint replacement
Gynecologic oncology
Women's health

Conditions treated^{[4][9][10][11][12]}

Knee pain
Pregnancy and childbirth
Adult cystic fibrosis
Prostate cancer
Breast cancer
Gynecologic cancer
Bladder cancer
Hernia
Appendicitis
Heart disease
Arrhythmias
Heart failure
Hypertension

Treatments^[9][11]

Radiation oncology
Medical oncology
Infusion therapy
HDR prostate brachytherapy
Minimally invasive robotic surgery

Procedures^[4][9]

Total joint replacement
Bariatric surgery
Appendectomy
Cholecystectomy (gallbladder removal)
Lung cancer screening

Programs and centers^[4][5][6]

Stroke Center
Acute Care for Elders Unit
Evarts Joint Center
Family Maternity Center
Geriatric Fracture Center
Hospital Elder Life Program
Perinatal Center
Lifestyle Medicine
Special Care Nursery
Emergency Observation Unit
Breastfeeding and lactation support

Emergency care (hospital website)^[5][6][8]

Emergency room	Yes

Visiting and practical information

Visiting	Visiting hours daily 8 a.m. to 8 p.m^[4]
Parking	Adjacent ramp garage open 24/7 with hourly, daily and weekly rates; passes bought at garage exit^[4]
Interpreters and languages	Interpreting services for patients who do not speak English or are Deaf or hard of hearing; ask your nurse^[7]
Patient portal	MyChart

Recognition^[5]

Joint Commission Certification
NICHE Accreditation

Doctors and clinicians (1,050)

1,050 doctors and other clinicians list Highland 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 1,026 more: the button below opens the full list.

Other emergency rooms nearby

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

Rochester Psychiatric Center0.8 mi · Rochester, NY · Psychiatric Hospital
Strong Memorial Hospital1.1 mi · Rochester, NY · Acute Care Hospital
Rochester General Hospital4.0 mi · Rochester, NY · Acute Care Hospital
Unity Hospital6.3 mi · Rochester, NY · Acute Care Hospital
F F Thompson Hospital24 mi · Canandaigua, NY · Acute Care Hospital

Other hospitals nearby

Unity Specialty Hospital1.7 mi · Rochester, NY · Acute Care Hospital

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

St. John's Health Care Corporation0.4 mi · Rochester, NY · 1 of 5 stars
Church Home of the Protestant Episcopal Church0.5 mi · Rochester, NY · 3 of 5 stars
Kirkhaven1.3 mi · Rochester, NY · 1 of 5 stars

All nursing homes in the state →

Hospice providers

Rochester Regional Health Hospice Care1.5 mi · Rochester, NY · 3 of 5 stars
Ur Medicine Hospice10.0 mi · Webster, NY · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Rochester Regional Health Home Care1.5 mi · Rochester, NY · 5 of 5 stars
HCR / HCR Home Care Chha (Rochester)3.7 mi · Rochester, NY
Ur Medicine Home Care, Certified Services, Inc10.0 mi · Webster, NY · 3 of 5 stars

All home health agencies in the state →

Dialysis facilities

University of Rochester Strong Memorial Pediatric ESRD1.2 mi · Rochester, NY
Unity Hospital of Rochester - St. Mary's2.2 mi · Rochester, NY · 2 of 5 stars
FMC - Freedom Center of Rochester3.0 mi · Rochester, NY · 1 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

Rochester Surgery Center0.5 mi · Rochester, NY
Lindsay House Surgery Center, LLC1.5 mi · Rochester, NY
Brighton Surgery Center, LLC3.0 mi · Rochester, 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

Trillium Health at Monroe Square (THMS)1.1 mi · Rochester, NY · Community health center
Regional Health Reach Monroe1.1 mi · Rochester, NY · Community health center
Trillium Health at 924 Jefferson Avenue1.1 mi · Rochester, NY · Community health center

Clinics and urgent care

Home Acres Medicine PLLC3.0 mi · Rochester, NY · Urgent care center
University of Rochester Urgent Care3.7 mi · Rochester, NY · Urgent care center
Genesee Valley Group Health Association3.8 mi · Rochester, NY · Urgent care center

Pharmacies

Costco Wholesale Corporation0.5 mi · Rochester, NY · Community/retail pharmacy
Genoa Healthcare LLC0.5 mi · Rochester, NY · Community/retail pharmacy
Medical Administrative Associates, Inc0.5 mi · Rochester, NY · Community/retail pharmacy

Assisted living nearby

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

Cobbs Hill Manor0.5 mi · Rochester, NY
The Hawthorne0.5 mi · Rochester, NY
Rochester Presbyterian Home2.1 mi · Rochester, NY
The Landing of Brighton3.0 mi · Rochester, 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 Highland Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

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

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	3 of 5 stars
Doctors communicated well	3 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	2 of 5 stars
Quiet at night	2 of 5 stars
Rated the hospital 9 or 10 out of 10	66%National average: 72%
Would definitely recommend the hospital	72%National average: 71%
Nurses “always” communicated well	75%National average: 80%
Doctors “always” communicated well	79%National average: 80%
Staff “always” explained medicines before giving them	57%National average: 62%
Were given information about recovery at home	83%National average: 86%
Room and bathroom “always” clean	56%National average: 74%
Area around the room “always” quiet at night	50%National average: 60%
Completed surveys	1,104Response rate: 27%

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)	1.231No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.461Better than the national benchmark
Surgical site infections after colon surgery	0.999No different from the national benchmark
Surgical site infections after abdominal hysterectomy	0.514No different from the national benchmark
MRSA bloodstream infections	1.205No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.403Better than the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	Too few cases to report
Deaths within 30 days: heart failure patients	9.7%
Deaths within 30 days: pneumonia patients	9.6%
Deaths within 30 days: COPD patients	6.9%
Deaths within 30 days: stroke patients	10.4%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.97No different from the national rate
Complications after hip or knee replacement	3.7%

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	13.9%
Readmitted within 30 days: heart failure	21.5%
Readmitted within 30 days: pneumonia	16.4%
Readmitted within 30 days: COPD	20.4%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	5%

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	304 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	4%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	50%National average: 65%

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in Rochester Best hospitals in Rochester

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 82 common services exactly as Highland Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: Office/Outpt Visit, New, Level lII	Not listed in the file	Not listed in the file	$32.43 – $475.95
New patient office visit (about 30–44 minutes): 10 of 38 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $198.25 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $271 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $152.50 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $164.70 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $475.95 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $296.01 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $32.43 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $32.43 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $215.04 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $271
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: Office/Outpt Visit, New, Level lV	Not listed in the file	Not listed in the file	$49.56 – $475.95
New patient office visit (about 45–59 minutes): 10 of 37 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $198.25 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $414 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $152.50 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $164.70 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $475.95 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $296.01 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $49.56 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $49.56 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $215.04 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $414
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: HB Initial Comp Evaluation	Not listed in the file	Not listed in the file	$102.85 – $852
New patient office visit (about 60–74 minutes): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $198.25 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $852 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $152.50 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $164.70 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $475.95 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $102.85 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $102.85 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $215.04 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $852 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $102.85
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: HB Renal Donor Evaluation	Not listed in the file	Not listed in the file	$128.71 – $2,981
New patient office visit (about 60–74 minutes): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $198.25 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $2,981 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $152.50 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $164.70 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $475.95 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $360.05 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $360.05 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $215.04 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $2,981 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $360.05
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: HB Renal Recipient Evaluation	Not listed in the file	Not listed in the file	$128.71 – $2,981
New patient office visit (about 60–74 minutes): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $198.25 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $2,981 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $152.50 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $164.70 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $475.95 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $360.05 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $360.05 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $215.04 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $2,981 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $360.05
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Office/Outpt Visit, Est, Level III	Not listed in the file	$179.35	$17.01 – $193.25
Established patient office visit (about 20–29 minutes): 10 of 37 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $80.50 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $187 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $61.92 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $61.92 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $193.25 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $17.01 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $17.01 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $215.04 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $187 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $17.01
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Office/Outpt Visit, New, Level lII	Not listed in the file	$256.70	Not listed in the file
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: Office/Outpt Visit, New, Level lII	$302	Not listed in the file	Not listed in the file
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Office/Outpt Visit, Est, Level IV	Not listed in the file	$259.25	$24.95 – $284.45
Established patient office visit (about 30–39 minutes): 10 of 37 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $118.48 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $276 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $91.14 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $91.14 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $284.45 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $24.95 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $24.95 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $215.04 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $276 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $24.95
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Office/Outpt Visit, New, Level lV	Not listed in the file	$391.85	Not listed in the file
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: Office/Outpt Visit, New, Level lV	$461	Not listed in the file	Not listed in the file
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: HB Office/OP Consltj New/Est Pt Low Mdm 30 Minutes	Not listed in the file	$332.35	$40.26 – $475.95
Office consultation with a specialist (moderate): 10 of 37 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $198.25 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $314 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $152.50 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $164.70 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $475.95 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $40.26 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $40.26 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $215.04 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $314 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $40.26
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient In the file: HB Office/OP Consltj New/Est Pt Low Mdm 30 Minutes	$391	Not listed in the file	Not listed in the file
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: HB Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes	Not listed in the file	$498.10	$60.44 – $475.95
Office consultation with a specialist (moderate to high): 10 of 37 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $198.25 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $472 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $152.50 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $164.70 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $475.95 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $60.44 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $60.44 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $215.04 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $472 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $60.44
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient In the file: HB Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes	$586	Not listed in the file	Not listed in the file
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) In the file: HB Initial Preventive Medicine New Pt Age 18-39yrs	Not listed in the file	$323.85	$40.94 – $342
Preventive checkup, new patient, age 18–39: 10 of 31 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $136.46 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $342 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $144.40 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $254.51 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $40.94 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $40.94 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $342 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $40.94 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $342 FIDELIS [5155] — FIDELIS METAL TIERS [515501]: $342
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) In the file: HB Ped New Wcc, 18-39 Years	Not listed in the file	Not listed in the file	$40.94 – $342
Preventive checkup, new patient, age 18–39: 10 of 31 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $136.46 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $342 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $144.40 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $254.51 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $40.94 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $40.94 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $342 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $40.94 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $342 FIDELIS [5155] — FIDELIS METAL TIERS [515501]: $342
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient In the file: HB Initial Preventive Medicine New Pt Age 18-39yrs	$381	Not listed in the file	Not listed in the file
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) In the file: HB Initial Preventive Medicine New Patient 40-64yrs	Not listed in the file	$374.85	$47.40 – $396
Preventive checkup, new patient, age 40–64: 10 of 31 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $158 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $396 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $167.20 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $294.69 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $47.40 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $47.40 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $396 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $47.40 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $396 FIDELIS [5155] — FIDELIS METAL TIERS [515501]: $396
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient In the file: HB Initial Preventive Medicine New Patient 40-64yrs	$441	Not listed in the file	Not listed in the file
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: HB Medical Visit Fee III	Not listed in the file	$1,114.35	$219.66 – $1,714
Emergency room visit (moderate): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $425.95 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $1,714 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $327.66 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $353.87 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,022.63 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $219.66 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $219.66 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $1,714 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $219.66 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $1,714
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: Emergency dept visit low mdm	Not listed in the file	$324.02	$323.35 – $578.70
Emergency room visit (moderate): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $374.22 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $349.68 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $578.70 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $480.71 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $480.71 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $386.50 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $340.75 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $340.75 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $371.99 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $340.75
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: HB Cpep Triage/Screening-Level 3	Not listed in the file	Not listed in the file	$236.67 – $1,847
Emergency room visit (moderate): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $425.95 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $1,847 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $327.66 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $353.87 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,022.63 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $236.67 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $236.67 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $1,847 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $236.67 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $1,847
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: HB Medical Visit Fee IV	Not listed in the file	$1,751.85	$371.73 – $2,901
Emergency room visit (moderately high): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $655.07 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $2,901 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $503.90 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $544.21 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,572.67 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $371.73 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $371.73 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $2,901 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $371.73 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $2,901
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: Emergency dept visit mod mdm	Not listed in the file	$495.28	$494.26 – $884.58
Emergency room visit (moderately high): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $572.02 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $534.50 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $884.58 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $734.80 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $734.80 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $590.79 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $520.86 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $520.86 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $568.61 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $520.86
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: HB Cpep Triage/Screening-Level 4	Not listed in the file	Not listed in the file	$364.58 – $2,845
Emergency room visit (moderately high): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $655.07 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $2,845 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $503.90 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $544.21 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,572.67 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $364.58 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $364.58 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $2,845 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $364.58 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $2,845
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: HB Medical Visit Fee V	Not listed in the file	$2,513.45	$412.32 – $3,218
Emergency room visit (high): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $943.17 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $3,218 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $725.52 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $783.56 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $2,264.34 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $412.32 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $412.32 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $3,218 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $412.32 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $3,218
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: Emergency dept visit hi mdm	Not listed in the file	$706.89	$705.43 – $1,262.50
Emergency room visit (high): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $816.40 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $762.86 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,262.50 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $1,048.73 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $1,048.73 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $843.20 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $743.39 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $743.39 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $811.54 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $743.39
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: HB Cpep Triage/Screening-Level 5	Not listed in the file	Not listed in the file	$404.72 – $3,158
Emergency room visit (high): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $943.17 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $3,158 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $725.52 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $783.56 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $2,264.34 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $404.72 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $404.72 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $3,158 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $404.72 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $3,158

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: HB Basic Metabolic Panel Calcium Total	Not listed in the file	$39.10	$7.53 – $17.33
Basic metabolic panel (blood test): 10 of 37 insurance plan rates AETNA [2700] — AETNA [270002]: $13.96 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $11 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $7.64 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $8.46 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $8.46 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $7.87 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $9.50 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $7.64 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $7.64 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $9.50
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: HB Basic Metabolic Panel Calcium Total	$46	Not listed in the file	Not listed in the file
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: HB Comprehensive Metabolic Panel	Not listed in the file	$51	$9.40 – $22.73
Comprehensive metabolic panel (blood test): 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $17.42 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $13.73 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $10.08 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $10.56 CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP) [5149] — CAPITAL DISTRICT PHYSICIANS (CDPHP) [514901]: $10.56 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $10.56 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $9.82 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $11.86 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $10.08 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $10.08
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: HB Comprehensive Metabolic Panel	$60	Not listed in the file	Not listed in the file
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: HB Lipid Panel	Not listed in the file	$62.90	$7.02 – $22.09
Cholesterol panel (lipid panel): 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $22.09 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $17.41 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $12.78 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $13.39 CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP) [5149] — CAPITAL DISTRICT PHYSICIANS (CDPHP) [514901]: $13.39 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $13.39 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $12.45 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $15.04 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $12.78 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $12.78
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: HB Lipid Panel	$74	Not listed in the file	Not listed in the file
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: HB Renal Function Panel	Not listed in the file	$41.65	$7.73 – $19.53
Kidney function panel: 10 of 37 insurance plan rates AETNA [2700] — AETNA [270002]: $14.32 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $11.28 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $8.29 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $8.68 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $8.68 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $8.07 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $9.75 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $8.29 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $8.29 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $9.75
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: HB Renal Function Panel	$49	Not listed in the file	Not listed in the file
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HB Hepatic Function Panel	Not listed in the file	$39.10	$7.27 – $16.74
Liver function panel: 10 of 37 insurance plan rates AETNA [2700] — AETNA [270002]: $13.48 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $10.62 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $7.64 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $8.17 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $8.17 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $7.60 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $9.18 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $7.64 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $7.64 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $9.18
Liver function panel CPT 80076 · Inpatient or outpatient In the file: HB Hepatic Function Panel	$46	Not listed in the file	Not listed in the file
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: HB Urnls Dip Stick/Tablet Reagent Auto Microscopy	Not listed in the file	$12.75	$2.82 – $7.13
Urine test (automated, with microscope): 10 of 37 insurance plan rates AETNA [2700] — AETNA [270002]: $5.23 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $4.12 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $3.02 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $3.17 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $3.17 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $2.95 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $3.56 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $3.02 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $3.02 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $3.56
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: HB Urnls Dip Stick/Tablet Reagent Auto Microscopy	$15	Not listed in the file	Not listed in the file
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: HB Urnls Dip Stick/Tablet Rgnt Non-Auto W/O Micrscp	Not listed in the file	$11.90	$2.32 – $5.74
Urine test (manual, without microscope): 10 of 37 insurance plan rates AETNA [2700] — AETNA [270002]: $5.74 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $4.52 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $2.44 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $3.48 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $3.48 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $3.24 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $3.91 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $2.44 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $2.44 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $3.91
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: HB Urnls Dip Stick/Tablet Rgnt Non-Auto W/O Micrscp	$14	Not listed in the file	Not listed in the file
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: HB Urnls Dip Stick/Tablet Rgnt Auto W/O Microscopy	Not listed in the file	$7.65	$2 – $4.61
Urine test (automated, without microscope): 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $3.71 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $2.93 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $2.14 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $2.25 CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP) [5149] — CAPITAL DISTRICT PHYSICIANS (CDPHP) [514901]: $2.25 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $2.25 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $2.09 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $2.53 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $2.14 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $2.14
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: HB Urnls Dip Stick/Tablet Rgnt Auto W/O Microscopy	$9	Not listed in the file	Not listed in the file
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: HB Prostate Health Index	Not listed in the file	$20.40	$16.37 – $41.38
PSA (prostate specific antigen) blood test: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $30.34 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $23.91 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $17.55 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $18.39 CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP) [5149] — CAPITAL DISTRICT PHYSICIANS (CDPHP) [514901]: $18.39 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $18.39 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $17.10 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $20.65 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $17.55 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $17.55
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: HB Assay of Prostate Specific Antigen Total	Not listed in the file	$89.25	$16.37 – $41.38
PSA (prostate specific antigen) blood test: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $30.34 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $23.91 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $17.55 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $18.39 CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP) [5149] — CAPITAL DISTRICT PHYSICIANS (CDPHP) [514901]: $18.39 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $18.39 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $17.10 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $20.65 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $17.55 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $17.55
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: HB Assay of Prostate Specific Antigen Total	$105	Not listed in the file	Not listed in the file
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: HB Assay of Thyroid Stimulating Hormone Tsh	Not listed in the file	$81.60	$10.45 – $27.72
Thyroid stimulating hormone (TSH) test: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $27.72 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $21.84 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $16.03 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $16.80 CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP) [5149] — CAPITAL DISTRICT PHYSICIANS (CDPHP) [514901]: $16.80 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $16.80 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $15.62 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $18.87 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $16.03 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $16.03
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: HB Assay of Thyroid Stimulating Hormone Tsh	$96	Not listed in the file	Not listed in the file
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: HB Blood Count Complete Auto&Auto Difrntl Wbc	Not listed in the file	$38.25	$3.68 – $12.82
Complete blood count (CBC) with differential: 10 of 37 insurance plan rates AETNA [2700] — AETNA [270002]: $12.82 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $10.10 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $7.38 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $7.77 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $7.77 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $7.22 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $8.73 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $7.38 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $7.38 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $8.73
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: HB Blood Count Complete Auto&Auto Difrntl Wbc	$45	Not listed in the file	Not listed in the file
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: HB Blood Count Complete Automated	Not listed in the file	$32.30	$3.68 – $13.26
Complete blood count (CBC), automated: 10 of 37 insurance plan rates AETNA [2700] — AETNA [270002]: $10.68 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $8.41 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $6.17 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $6.47 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $6.47 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $6.02 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $7.27 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $6.17 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $6.17 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $7.27
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: HB Blood Count Complete Automated	$38	Not listed in the file	Not listed in the file
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: Prothrombin Time	Not listed in the file	$25.50	$3.75 – $8.89
Blood clotting time test (prothrombin time, PT): 10 of 37 insurance plan rates AETNA [2700] — AETNA [270002]: $7.08 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $5.58 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $3.75 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $4.29 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $4.29 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $3.99 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $4.82 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $3.75 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $3.75 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $4.82
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: Prothrombin Time	$30	Not listed in the file	Not listed in the file
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: HB Thromboplastin Time Partial Plasma/Whole Blood	Not listed in the file	$30.60	$5.35 – $34
Blood clotting test (partial thromboplastin time, PTT): 10 of 37 insurance plan rates AETNA [2700] — AETNA [270002]: $9.92 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $7.81 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $5.73 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $6.01 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $6.01 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $5.59 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $6.75 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $5.73 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $5.73 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $6.75
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: HB Thromboplastin Time Partial Plasma/Whole Blood	$36	Not listed in the file	Not listed in the file

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: HB CT Head/Brain W/O Contrast Material	Not listed in the file	$793.90	$106.21 – $392.74
CT scan of the head or brain, without contrast: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $314.30 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $163.59 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $121.20 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $125.84 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $135.90 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $392.74 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $244.26 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $121.20 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $121.20 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $177.44
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: Ct head/brain w/o dye	Not listed in the file	$124.09	$123.84 – $221.63
CT scan of the head or brain, without contrast: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $143.32 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $133.92 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $221.63 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $184.10 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $184.10 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $148.02 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $130.50 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $130.50 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $142.47 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $130.50
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: HB CT Head/Brain W/O Contrast Material	$934	Not listed in the file	Not listed in the file
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: HB MRI Brain Brain Stem W/O W/Contrast Material	Not listed in the file	$2,680.05	$356.68 – $1,318.98
MRI of the brain, before and after contrast: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $992 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $549.39 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $505 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $422.61 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $456.41 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,318.98 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $820.33 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $505 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $505 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $595.92
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: Mri brain stem w/o & w/dye	Not listed in the file	$414.11	$413.25 – $739.60
MRI of the brain, before and after contrast: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $478.26 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $446.90 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $739.60 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $614.36 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $614.36 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $493.96 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $435.49 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $435.49 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $475.41 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $435.49
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: HB MRI Brain Brain Stem W/O W/Contrast Material	$3,153	Not listed in the file	Not listed in the file
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: HB Radiologic Exam Chest 2 Views	Not listed in the file	$371.45	$15.15 – $325.19
Chest X-ray, 2 views: 10 of 36 insurance plan rates AETNA [2700] — AETNA [270002]: $107.10 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $135.44 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $15.15 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $104.19 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $112.52 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $325.19 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $15.15 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $15.15 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $15.15 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $15.15
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: X-ray exam chest 2 views	Not listed in the file	$103.30	$103.08 – $184.49
Chest X-ray, 2 views: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $119.30 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $111.48 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $184.49 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $153.25 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $153.25 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $123.22 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $108.63 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $108.63 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $118.59 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $108.63
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: HB Radiologic Exam Chest 2 Views	$437	Not listed in the file	Not listed in the file
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: HB Radex Spine Lumbosacral Minimum 4 Views	Not listed in the file	$501.50	$30.30 – $392.74
X-ray of the lower spine, at least 4 views: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $180.75 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $163.59 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $30.30 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $125.84 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $135.90 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $392.74 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $244.26 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $30.30 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $30.30 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $177.44
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: X-ray exam l-2 spine 4/>vws	Not listed in the file	$124.09	$123.84 – $221.63
X-ray of the lower spine, at least 4 views: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $143.32 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $133.92 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $221.63 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $184.10 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $184.10 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $148.02 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $130.50 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $130.50 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $142.47 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $130.50
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: HB Radex Spine Lumbosacral Minimum 4 Views	$590	Not listed in the file	Not listed in the file
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: HB MRI Spinal Canal Lumbar W/O Contrast Material	Not listed in the file	$1,675.35	$241.42 – $1,136.25
MRI of the lower back (lumbar spine), without contrast: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $571.80 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $371.85 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $505 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $286.04 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $308.92 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $892.74 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $555.23 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $505 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $505 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $403.34
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: Mri lumbar spine w/o dye	Not listed in the file	$283.22	$282.63 – $505.83
MRI of the lower back (lumbar spine), without contrast: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $327.10 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $305.64 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $505.83 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $420.18 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $420.18 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $337.83 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $297.84 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $297.84 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $325.15 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $297.84
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: HB MRI Spinal Canal Lumbar W/O Contrast Material	$1,971	Not listed in the file	Not listed in the file
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: HB CT Pelvis W/Contrast Material	Not listed in the file	$1,301.35	$171.70 – $808.15
CT scan of the pelvis, with contrast: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $808.15 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $273.85 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $171.70 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $210.66 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $227.51 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $657.48 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $408.91 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $171.70 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $171.70 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $297.05
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: Ct pelvis w/dye	Not listed in the file	$208.20	$207.77 – $371.84
CT scan of the pelvis, with contrast: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $240.45 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $224.68 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $371.84 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $308.88 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $308.88 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $248.35 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $218.95 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $218.95 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $239.02 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $218.95
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: HB CT Pelvis W/Contrast Material	$1,531	Not listed in the file	Not listed in the file
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: HB MRI Any Jt Lower Extrem W/O Contrast Matrl	Not listed in the file	$1,675.35	$241.42 – $1,136.25
MRI of a leg joint (such as the knee), without contrast: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $655.85 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $371.85 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $505 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $286.04 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $308.92 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $892.74 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $555.23 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $505 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $505 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $403.34
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	$283.22	$282.63 – $505.83
MRI of a leg joint (such as the knee), without contrast: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $327.10 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $305.64 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $505.83 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $420.18 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $420.18 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $337.83 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $297.84 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $297.84 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $325.15 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $297.84
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: HB MRI Any Jt Lower Extrem W/O Contrast Matrl	$1,971	Not listed in the file	Not listed in the file
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: HB CT Abdomen & Pelvis W/Contrast Material	Not listed in the file	$2,680.05	$109.01 – $1,318.98
CT scan of the abdomen and pelvis, with contrast: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $1,013.85 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $549.39 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $109.01 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $422.61 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $456.41 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,318.98 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $820.33 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $109.01 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $109.01 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $595.92
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: Ct abd & pelvis w/contrast	Not listed in the file	$414.11	$413.25 – $739.60
CT scan of the abdomen and pelvis, with contrast: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $478.26 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $446.90 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $739.60 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $614.36 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $614.36 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $493.96 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $435.49 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $435.49 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $475.41 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $435.49
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: HB CT Abdomen & Pelvis W/Contrast Material	$3,153	Not listed in the file	Not listed in the file
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: HB US Abdominal Real Time W/Image Documentation	Not listed in the file	$631.55	$60.60 – $392.74
Ultrasound of the abdomen, complete: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $355.40 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $163.59 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $60.60 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $125.84 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $135.90 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $392.74 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $244.26 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $60.60 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $60.60 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $177.44
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: Us exam abdom complete	Not listed in the file	$124.09	$123.84 – $221.63
Ultrasound of the abdomen, complete: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $143.32 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $133.92 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $221.63 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $184.10 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $184.10 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $148.02 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $130.50 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $130.50 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $142.47 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $130.50
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: HB US Abdominal Real Time W/Image Documentation	$743	Not listed in the file	Not listed in the file
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: HB US Preg Uterus After 1st Trimest 1/1st Gestation	Not listed in the file	$501.50	$55.55 – $399.90
Pregnancy ultrasound (after the first trimester): 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $399.90 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $163.59 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $55.55 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $125.84 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $135.90 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $392.74 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $244.26 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $55.55 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $55.55 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $177.44
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: Ob us >/= 14 wks sngl fetus	Not listed in the file	$124.09	$123.84 – $221.63
Pregnancy ultrasound (after the first trimester): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $143.32 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $133.92 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $221.63 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $184.10 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $184.10 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $148.02 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $130.50 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $130.50 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $142.47 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $130.50
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: HB US Preg Uterus After 1st Trimest 1/1st Gestation	$590	Not listed in the file	Not listed in the file
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: HB Ultrasound Transvaginal	Not listed in the file	$501.50	$60.60 – $392.74
Transvaginal ultrasound: 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $390.70 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $163.59 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $60.60 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $125.84 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $135.90 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $392.74 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $244.26 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $60.60 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $60.60 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $177.44
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: Transvaginal us non-ob	Not listed in the file	$124.09	$123.84 – $221.63
Transvaginal ultrasound: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $143.32 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $133.92 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $221.63 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $184.10 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $184.10 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $148.02 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $130.50 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $130.50 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $142.47 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $130.50
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: HB Ultrasound Transvaginal	$590	Not listed in the file	Not listed in the file
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: HB Diagnostic Mammography Computer-Aided Detcj Uni	Not listed in the file	$441.15	$68.02 – $572.88
Diagnostic mammogram, one breast: 10 of 36 insurance plan rates AETNA [2700] — AETNA [270002]: $402.95 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $104.77 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $97.97 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $80.59 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $80.59 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $572.88 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $97.97 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $97.97 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $97.97 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $97.97
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient In the file: HB Diagnostic Mammography Computer-Aided Detcj Uni	$519	Not listed in the file	Not listed in the file
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: HB Diagnostic Mammography Computer-Aided Detcj Bi	Not listed in the file	$586.50	$86.67 – $724.81
Diagnostic mammogram, both breasts: 10 of 36 insurance plan rates AETNA [2700] — AETNA [270002]: $513.45 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $133.50 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $97.97 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $102.69 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $102.69 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $724.81 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $97.97 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $97.97 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $97.97 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $97.97
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient In the file: HB Diagnostic Mammography Computer-Aided Detcj Bi	$690	Not listed in the file	Not listed in the file
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: HB Screening Mammography Bi 2-View Breast Inc Cad	Not listed in the file	$586.50	$71.71 – $584.56
Screening mammogram, both breasts: 10 of 36 insurance plan rates AETNA [2700] — AETNA [270002]: $424.80 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $110.45 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $97.97 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $84.96 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $84.96 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $584.56 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $97.97 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $97.97 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $97.97 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $97.97
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: HB Screening Mammography Bi 2-View Breast Inc Cad	$690	Not listed in the file	Not listed in the file

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) In the file: HB Ecg Routine Ecg W/Least 12 Lds W/I&R	Not listed in the file	$42.50	$7.19 – $41.63
Electrocardiogram (ECG/EKG) with reading: 10 of 35 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $17.34 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $15.15 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $13.34 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $13.34 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $41.63 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $15.15 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $15.15 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $15.15 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $15.15 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $34.09
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient In the file: HB Ecg Routine Ecg W/Least 12 Lds W/I&R	$50	Not listed in the file	Not listed in the file
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	$3,848.12	$3,840.17 – $6,872.78
Left heart catheterization (diagnostic): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $4,444.31 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $4,152.84 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $6,872.78 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $5,709.02 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $5,709.02 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $4,590.18 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $4,046.85 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $4,046.85 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $4,417.81 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $4,046.85
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: Lt Heart Cath/Inj/Vntrclgrm/S&I	Not listed in the file	Not listed in the file	$3,212.41 – $11,879.06
Left heart catheterization (diagnostic): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $4,948.02 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $11,692 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $3,806.17 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $4,110.66 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $11,879.06 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $11,692 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $11,692 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $11,692 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $11,692 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $11,692
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: Comprehensive ep evaluation	Not listed in the file	$9,258.08	$9,238.95 – $16,535
Heart rhythm study (electrophysiology evaluation): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $10,692.43 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $9,991.19 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $16,535 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $13,735.16 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $13,735.16 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $11,043.36 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $9,736.19 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $9,736.19 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $10,628.68 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $9,736.19
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: HB Compre Electrophysiologic W/O Arrhyt Induction	Not listed in the file	Not listed in the file	$7,578.66 – $28,024.88
Heart rhythm study (electrophysiology evaluation): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $11,673.28 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $17,864 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $8,979.45 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $9,697.80 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $28,024.88 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $17,864 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $17,864 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $17,864 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $17,864 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $17,864
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: Compre ep eval abltj atr fib	Not listed in the file	$31,025.23	$30,961.14 – $55,411.31
Heart rhythm study with ablation for atrial fibrillation: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $35,831.95 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $33,482 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $55,411.31 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $46,028.60 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $46,028.60 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $37,007.99 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $32,627.47 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $32,627.47 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $35,618.32 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $32,627.47
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: Ablation Atrial Fib	Not listed in the file	Not listed in the file	$7,412.39 – $90,604.32
Heart rhythm study with ablation for atrial fibrillation: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $37,739.70 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $57,845 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $29,030.54 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $31,352.98 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $90,604.32 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $7,412.39 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $7,412.39 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $57,845 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $7,412.39 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $57,845
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: Polysom 6/> yrs 4/> param	Not listed in the file	$1,019.31	$1,017.21 – $1,820.50
Sleep study (overnight, in a sleep lab): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,177.23 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $1,100.03 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,820.50 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $1,512.24 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $1,512.24 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $1,215.87 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $1,071.95 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $1,071.95 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $1,170.21 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $1,071.95
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: HB Polysom 6/>Yrs Sleep 4/> Addl Param Attnd	Not listed in the file	Not listed in the file	$441.13 – $3,890
Sleep study (overnight, in a sleep lab): 10 of 38 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,565.12 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $3,890 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $1,203.94 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $1,300.25 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $3,757.49 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $2,336.96 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $441.13 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $441.13 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $1,697.67 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $3,890

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) In the file: HB Therapeutic Px 1/> Areas Each 15 Min Exercises	Not listed in the file	$84.15	$10.21 – $87
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $41.99 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $24.37 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $87 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $18.74 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $18.74 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $78.19 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $23.43 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $10.21 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $10.21 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $23.43
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: HB Ot Therapeutic Px 1/> Areas Ea 15 Min Exercises	Not listed in the file	Not listed in the file	$10.21 – $87
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $41.99 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $24.37 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $87 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $18.74 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $18.74 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $78.19 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $23.43 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $10.21 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $10.21 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $23.43
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: HB Therapeutic Px 1/> Areas Each 15 Min Exercises	$99	Not listed in the file	Not listed in the file
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: HB Physical Therapy Evaluation Low Complex 20 Mins	Not listed in the file	$114.75	$27.67 – $267.33
Physical therapy evaluation (low complexity): 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $142.91 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $66.07 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $237 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $50.82 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $50.82 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $267.33 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $63.53 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $27.67 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $27.67 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $63.53
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: HB Physical Therapy Evaluation Low Complex 20 Mins	$135	Not listed in the file	Not listed in the file
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: HB Physical Therapy Evaluation Mod Complex 30 Mins	Not listed in the file	$218.45	$32.66 – $280
Physical therapy evaluation (moderate complexity): 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $142.91 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $77.98 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $280 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $59.99 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $59.99 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $267.33 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $74.98 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $32.66 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $32.66 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $74.98
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: HB Physical Therapy Evaluation Mod Complex 30 Mins	$257	Not listed in the file	Not listed in the file
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: HB Physical Therapy Evaluation High Complex 45 Mins	Not listed in the file	$334.05	$37.76 – $323
Physical therapy evaluation (high complexity): 10 of 38 insurance plan rates AETNA [2700] — AETNA [270002]: $142.91 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $90.17 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $323 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $69.36 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $69.36 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $267.33 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $86.70 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $37.76 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $37.76 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $86.70
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: HB Physical Therapy Evaluation High Complex 45 Mins	$393	Not listed in the file	Not listed in the file
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: HB Psychotherapy Patient 30 Minutes	Not listed in the file	$221.85	$26.88 – $536.17
Psychotherapy, 30 minutes: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $247.16 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $210 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $190.13 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $205.34 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $206 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $26.88 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $26.88 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $210 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $26.88 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $210
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: Psytx w pt 30 minutes	Not listed in the file	$210.68	$210.25 – $376.28
Psychotherapy, 30 minutes: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $243.33 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $227.37 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $376.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $312.57 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $312.57 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $251.31 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $221.56 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $221.56 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $241.87 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $221.56
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: HB Postadmit Brief Tx Ea 16min	Not listed in the file	Not listed in the file	$26.88 – $536.17
Psychotherapy, 30 minutes: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $247.16 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $210 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $190.13 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $205.34 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $206 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $26.88 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $26.88 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $210 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $26.88 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $210
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: HB Psychotherapy Patient 45 Minutes	Not listed in the file	$299.20	$36.29 – $593.40
Psychotherapy, 45 minutes: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $247.16 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $283 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $190.13 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $205.34 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $593.40 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $36.29 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $36.29 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $283 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $36.29 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $283
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: Psytx w pt 45 minutes	Not listed in the file	$210.68	$210.25 – $376.28
Psychotherapy, 45 minutes: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $243.33 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $227.37 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $376.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $312.57 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $312.57 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $251.31 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $221.56 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $221.56 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $241.87 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $221.56
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: HB Ph Crisis Visit (1 Hr)	Not listed in the file	Not listed in the file	$60.67 – $593.40
Psychotherapy, 45 minutes: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $247.16 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $535 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $190.13 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $205.34 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $593.40 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $60.67 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $60.67 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $535 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $60.67 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $535
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: HB Psychotherapy Patient 60 Minutes	Not listed in the file	$448.80	$54.43 – $593.40
Psychotherapy, 60 minutes: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $247.16 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $425 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $190.13 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $205.34 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $593.40 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $54.43 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $54.43 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $425 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $54.43 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $425
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: Psytx w pt 60 minutes	Not listed in the file	$210.68	$210.25 – $376.28
Psychotherapy, 60 minutes: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $243.33 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $227.37 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $376.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $312.57 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $312.57 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $251.31 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $221.56 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $221.56 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $241.87 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $221.56
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: HB Ph Crisis Visit (2 Hr)	Not listed in the file	Not listed in the file	$60.67 – $593.40
Psychotherapy, 60 minutes: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $247.16 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $535 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $190.13 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $205.34 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $593.40 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $60.67 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $60.67 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $535 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $60.67 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $535
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: Family psytx w/o pt 50 min	Not listed in the file	$210.68	$210.25 – $376.28
Family psychotherapy, without the patient: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $243.33 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $227.37 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $376.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $312.57 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $312.57 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $251.31 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $221.56 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $221.56 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $241.87 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $221.56
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: HB Family Psychotherapy W/O Patient Present	Not listed in the file	Not listed in the file	$40.14 – $536.17
Family psychotherapy, without the patient: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $247.16 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $313 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $190.13 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $205.34 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $304 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $40.14 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $40.14 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $313 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $40.14 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $313
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: Family psytx w/pt 50 min	Not listed in the file	$210.68	$210.25 – $376.28
Family psychotherapy, with the patient: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $243.33 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $227.37 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $376.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $312.57 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $312.57 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $251.31 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $221.56 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $221.56 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $241.87 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $221.56
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: HB Family Psychotherapy W/Patient Present	Not listed in the file	Not listed in the file	$41.62 – $536.17
Family psychotherapy, with the patient: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $247.16 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $325 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $190.13 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $205.34 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $304 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $41.62 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $41.62 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $325 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $41.62 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $325
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: Group psychotherapy	Not listed in the file	$120.59	$120.34 – $215.37
Group psychotherapy: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $139.27 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $130.13 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $215.37 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $178.90 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $178.90 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $143.84 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $126.81 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $126.81 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $138.44 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $126.81
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: HB Group Psychotherapy	Not listed in the file	Not listed in the file	$20.53 – $308.68
Group psychotherapy: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $142.29 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $160 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $109.46 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $118.21 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $152 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $20.53 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $20.53 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $160 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $20.53 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $160

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: Removal of breast lesion	Not listed in the file	$4,647.56	$4,637.96 – $8,300.58
Removal of breast growth (open surgery): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $5,367.60 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $5,015.58 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $8,300.58 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $6,895.05 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $6,895.05 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $5,543.77 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $4,887.57 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $4,887.57 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $5,335.60 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $4,887.57
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: Total hip arthroplasty	Not listed in the file	$15,239.31	$15,207.83 – $27,217.54
Total hip replacement: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $17,600.33 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $16,446.06 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $27,217.54 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $22,608.83 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $22,608.83 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $18,177.99 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $16,026.32 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $16,026.32 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $17,495.40 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $16,026.32
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: Total knee arthroplasty	Not listed in the file	$15,239.31	$15,207.83 – $27,217.54
Total knee replacement: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $17,600.33 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $16,446.06 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $27,217.54 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $22,608.83 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $22,608.83 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $18,177.99 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $16,026.32 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $16,026.32 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $17,495.40 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $16,026.32
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: Arthrs kne srg mnisectmy m/l	Not listed in the file	$3,883.81	$3,875.79 – $6,936.52
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $4,485.53 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $4,191.36 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $6,936.52 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $5,761.97 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $5,761.97 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $4,632.75 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $4,084.39 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $4,084.39 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $4,458.79 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $4,084.39
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: Remove tonsils and adenoids	Not listed in the file	$7,026.75	$7,012.23 – $12,549.82
Removal of tonsils and adenoids (under age 12): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $8,115.39 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $7,583.17 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $12,549.82 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $10,424.78 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $10,424.78 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $8,381.75 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $7,389.63 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $7,389.63 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $8,067.01 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $7,389.63
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: Esophagogastroduodenoscopy Transoral Diagnostic	Not listed in the file	$3,818.20	$463.13 – $3,614
Upper GI endoscopy (diagnostic): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,442.31 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $3,614 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $1,109.47 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $1,198.22 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $3,462.66 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $463.13 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $463.13 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $3,614 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $463.13 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $3,614
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: Egd diagnostic brush wash	Not listed in the file	$1,076.58	$1,074.35 – $1,922.78
Upper GI endoscopy (diagnostic): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,243.37 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $1,161.83 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,922.78 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $1,597.20 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $1,597.20 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $1,284.18 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $1,132.18 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $1,132.18 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $1,235.96 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $1,132.18
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient In the file: Esophagogastroduodenoscopy Transoral Diagnostic	$4,492	Not listed in the file	Not listed in the file
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: Edg Transoral Biopsy Single/Multiple	Not listed in the file	$3,818.20	$463.13 – $3,614
Upper GI endoscopy with biopsy: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,442.31 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $3,614 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $1,109.47 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $1,198.22 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $3,462.66 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $463.13 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $463.13 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $3,614 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $463.13 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $3,614
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: Egd biopsy single/multiple	Not listed in the file	$1,076.58	$1,074.35 – $1,922.78
Upper GI endoscopy with biopsy: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,243.37 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $1,161.83 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,922.78 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $1,597.20 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $1,597.20 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $1,284.18 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $1,132.18 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $1,132.18 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $1,235.96 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $1,132.18
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient In the file: Edg Transoral Biopsy Single/Multiple	$4,492	Not listed in the file	Not listed in the file
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: Colonoscopy Flx Dx W/WO Collj Specimens	Not listed in the file	$3,819.90	$463.24 – $3,615
Colonoscopy (diagnostic): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,402.54 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $3,615 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $1,078.88 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $1,165.19 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $3,367.19 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $463.24 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $463.24 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $3,615 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $463.24 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $3,615
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: Diagnostic colonoscopy	Not listed in the file	$1,103.85	$1,101.56 – $1,971.48
Colonoscopy (diagnostic): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,274.86 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $1,191.25 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,971.48 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $1,637.65 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $1,637.65 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $1,316.71 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $1,160.85 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $1,160.85 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $1,267.26 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $1,160.85
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient In the file: Colonoscopy Flx Dx W/WO Collj Specimens	$4,494	Not listed in the file	Not listed in the file
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: Colonoscopy W/Biopsy Single/Multiple	Not listed in the file	$4,973.35	$603.17 – $4,707
Colonoscopy with biopsy: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,813.86 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $4,707 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $1,395.28 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $1,506.90 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $4,354.66 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $603.17 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $603.17 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $4,707 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $603.17 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $4,707
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: Colonoscopy and biopsy	Not listed in the file	$1,420.39	$1,417.46 – $2,536.84
Colonoscopy with biopsy: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,640.46 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $1,532.87 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $2,536.84 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $2,107.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $2,107.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $1,694.30 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $1,493.75 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $1,493.75 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $1,630.67 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $1,493.75
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient In the file: Colonoscopy W/Biopsy Single/Multiple	$5,851	Not listed in the file	Not listed in the file
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: Colsc Flx Prox Splenic Flxr Rmvl Les Snare Tq	Not listed in the file	$4,973.35	$603.17 – $4,707
Colonoscopy with removal of polyps (snare): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,813.86 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $4,707 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $1,395.28 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $1,506.90 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $4,354.66 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $603.17 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $603.17 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $4,707 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $603.17 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $4,707
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: Colonoscopy w/lesion removal	Not listed in the file	$1,420.39	$1,417.46 – $2,536.84
Colonoscopy with removal of polyps (snare): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,640.46 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $1,532.87 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $2,536.84 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $2,107.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $2,107.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $1,694.30 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $1,493.75 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $1,493.75 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $1,630.67 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $1,493.75
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient In the file: Colsc Flx Prox Splenic Flxr Rmvl Les Snare Tq	$5,851	Not listed in the file	Not listed in the file
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) In the file: Colsc Flx Prox Splenic Flxr Ndsc US Xm	Not listed in the file	$4,973.35	$603.17 – $4,707
Ultrasound of the lower bowel by endoscope: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,813.86 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $4,707 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $1,395.28 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $1,506.90 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $4,354.66 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $603.17 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $603.17 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $4,707 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $603.17 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $4,707
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) In the file: Colonoscopy w/endoscope us	Not listed in the file	$1,420.39	$1,417.46 – $2,536.84
Ultrasound of the lower bowel by endoscope: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,640.46 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $1,532.87 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $2,536.84 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $2,107.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $2,107.28 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $1,694.30 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $1,493.75 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $1,493.75 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $1,630.67 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $1,493.75
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient In the file: Colsc Flx Prox Splenic Flxr Ndsc US Xm	$5,851	Not listed in the file	Not listed in the file
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: Colon Ca Scrn Not Hi Rsk Ind	Not listed in the file	$2,852.60	$345.98 – $3,367.19
Screening colonoscopy (not high risk): 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,402.54 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $2,700 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $1,078.88 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $1,165.19 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $3,367.19 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $345.98 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $345.98 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $2,700 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $345.98 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $2,700
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: Colon ca scrn not hi rsk ind	Not listed in the file	$1,103.85	$1,101.56 – $1,971.48
Screening colonoscopy (not high risk): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,274.86 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $1,191.25 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,971.48 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $1,637.65 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $1,637.65 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $1,316.71 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $1,160.85 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $1,160.85 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $1,267.26 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $1,160.85
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient In the file: Colon Ca Scrn Not Hi Rsk Ind	$3,356	Not listed in the file	Not listed in the file
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: Laparoscopic cholecystectomy	Not listed in the file	$7,175.95	$7,161.12 – $12,816.30
Gallbladder removal by laparoscope: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $8,287.71 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $7,744.18 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $12,816.30 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $10,646.13 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $10,646.13 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $8,559.72 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $7,546.53 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $7,546.53 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $8,238.30 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $7,546.53
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: Prp i/hern init reduc >5 yr	Not listed in the file	$4,249.88	$4,241.10 – $7,590.32
Groin (inguinal) hernia repair, age 5 or older: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $4,908.31 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $4,586.41 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $7,590.32 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $6,305.06 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $6,305.06 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $5,069.41 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $4,469.36 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $4,469.36 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $4,879.05 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $4,469.36
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: HB Prostate Needle Biopsy Any Approach	Not listed in the file	Not listed in the file	$982.84 – $7,670
Prostate biopsy: 10 of 38 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $3,151.35 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $7,670 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $2,424.12 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $2,618.04 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $7,565.69 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $4,705.46 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $982.84 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $982.84 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $3,418.25 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $7,670
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) In the file: Laps surg prst8ect rpbic rad	Not listed in the file	$12,617.45	$12,591.38 – $22,534.86
Prostate removal by laparoscope (radical prostatectomy): 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $14,572.26 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $13,616.57 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $22,534.86 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $18,719.07 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $18,719.07 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $15,050.54 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $13,269.05 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $13,269.05 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $14,485.38 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $13,269.05
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: HB Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	Not listed in the file	$12,465.25	$3,175.58 – $11,798
Hysteroscopy with biopsy of the uterus lining: 10 of 38 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $4,891.28 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $11,798 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $3,762.53 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $4,063.53 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $11,742.85 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $7,303.44 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $11,798 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $11,798 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $5,305.54 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $11,798
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: Hysteroscopy biopsy	Not listed in the file	$3,842.42	$3,834.48 – $6,862.59
Hysteroscopy with biopsy of the uterus lining: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $4,437.72 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $4,146.68 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $6,862.59 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $5,700.56 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $5,700.56 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $4,583.37 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $4,040.85 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $4,040.85 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $4,411.26 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $4,040.85
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient In the file: HB Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$14,665	Not listed in the file	Not listed in the file
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: HB Plc Cath Interlaminar Lmbr/Sac W/Img	Not listed in the file	$3,048.95	$369.80 – $2,886
Spinal injection, lower back (epidural), with imaging guidance: 10 of 36 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,065.35 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $2,886 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $819.50 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $885.06 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $2,557.66 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $369.80 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $369.80 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $2,886 EXCELLUS MEDICAID [1706] — EXCELLUS ESSENTIAL (W/ MEDICAID) [170604]: $369.80 FIDELIS [5155] — FIDELIS ESSENTIAL (NO MEDICAID) [515503]: $2,886
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: Njx interlaminar lmbr/sac	Not listed in the file	$837.87	$836.14 – $1,496.44
Spinal injection, lower back (epidural), with imaging guidance: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $967.68 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $904.22 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,496.44 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $1,243.05 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $1,243.05 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $999.44 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $881.14 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $881.14 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $961.91 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $881.14
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: HB Plc Cath Interlaminar Lmbr/Sac W/Img	$3,587	Not listed in the file	Not listed in the file
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: Njx aa&/strd tfrm epi l/s 1	Not listed in the file	$1,049.86	$1,047.69 – $1,875.05
Nerve root injection, lower back, with imaging guidance: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,212.51 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $1,132.99 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,875.05 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $1,557.55 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $1,557.55 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $1,252.30 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $1,104.07 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $1,104.07 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $1,205.28 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $1,104.07
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: HB Njx Anes&/Strd W/Img Tfrml Edrl Lmbr/Sac 1 Lvl	Not listed in the file	Not listed in the file	$479.23 – $3,740
Nerve root injection, lower back, with imaging guidance: 10 of 38 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $1,369.58 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $3,740 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $1,053.53 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $1,137.81 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $3,288.08 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $2,045.01 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $479.23 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $479.23 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $1,485.58 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $3,740
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: Carpal tunnel surgery	Not listed in the file	$2,317.85	$2,313.07 – $4,139.71
Carpal tunnel release: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $2,676.96 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $2,501.40 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $4,139.71 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $3,438.74 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $3,438.74 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $2,764.82 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $2,437.56 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $2,437.56 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $2,661 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $2,437.56
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) In the file: After cataract laser surgery	Not listed in the file	$652.84	$651.49 – $1,165.97
Laser treatment of clouding after cataract surgery: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $753.98 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $704.53 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $1,165.97 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $968.54 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $968.54 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $778.73 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $686.55 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $686.55 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $749.49 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $686.55
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) In the file: HB Post-Cataract Laser Surgery	Not listed in the file	Not listed in the file	$294.16 – $2,296
Laser treatment of clouding after cataract surgery: 10 of 38 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $843.94 AMERIGROUP (BSWNY ALTERNATE) [1720] — AMERIGROUP (BSWNY ALTERNATE) [172001]: $2,296 BC/BS OF WESTERN NY MEDICARE [1301] — HIGHMARK BC/BS MEDICARE [130101]: $649.19 CDPHP MEDICARE [1320] — CAPITAL DISTRICT PHYSICIANS MEDICARE [132001]: $701.12 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $2,026.13 EXCELLUS [2201] — EXCELLUS BLUE CHOICE [220107], EXCELLUS HEALTHY NY [220110],: $1,260.14 EXCELLUS [2201] — EXCELLUS CHILD HEALTH PLUS [220108]: $294.16 EXCELLUS [2201] — EXCELLUS ESSENTIAL (NO MEDICAID) [220109]: $294.16 EXCELLUS [2201] — EXCELLUS METAL TIERS [220102]: $915.42 EXCELLUS MEDICAID [1706] — BLUE CHOICE OPTION MEDICAID [170601]: $2,296
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	$2,739.35	$2,733.69 – $4,892.50
Cataract removal with lens implant: 10 of 16 insurance plan rates AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $3,163.76 CDPHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $2,956.27 CIGNA [5144] — CIGNA HEALTHCARE (POB 182223) [514405]: $4,892.50 EXCELLUS BLUE CROSS BLUE SHIELD [2201] — EXCELLUS HIGH PERFORMANCE [220103]: $4,064.06 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS [220101], EXCELLUS SIMPLY BLUE [220106], EXCELLUS B: $4,064.06 EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS — EXCELLUS METAL TIERS [220102]: $3,267.59 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $2,880.82 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $2,880.82 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $3,144.89 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $2,880.82

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) In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	$87,588.78	$86,970.52 – $121,607.41
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 13 insurance plan rates AETNA [2700] — AETNA [270002]: $121,607.41 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $103,045.70 CAPITAL DISTRICT PHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $103,045.67 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $103,045.70 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $103,045.70 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $105,106.61 INDEPENDENT HEALTH MEDICARE [1305] — INDEPENDENT HEALTH MEDICARE [130501]: $103,045.70 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $103,045.70 MEDICARE BLUE CHOICE BLUE CROSS BLUE SHIELD [1306] — MEDICARE BLUE CHOICE [130601]: $86,970.52 MVP MEDICARE [1307] — MVP MEDICARE [130701]: $103,045.70
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) In the file: SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	Not listed in the file	$33,288.63	$33,053.66 – $45,833.49
Spinal fusion (not neck), without major complications: 10 of 12 insurance plan rates AETNA [2700] — AETNA [270002]: $45,833.49 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $39,163.12 CAPITAL DISTRICT PHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $39,163.11 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $39,163.12 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $39,163.12 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $39,946.38 INDEPENDENT HEALTH MEDICARE [1305] — INDEPENDENT HEALTH MEDICARE [130501]: $39,163.12 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $39,163.12 MEDICARE BLUE CHOICE BLUE CROSS BLUE SHIELD [1306] — MEDICARE BLUE CHOICE [130601]: $33,053.66 MVP MEDICARE [1307] — MVP MEDICARE [130701]: $39,163.12
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	$17,339.97	$17,217.57 – $23,577.70
Hip or knee replacement (major joint of the leg), without major complications: 10 of 13 insurance plan rates AETNA [2700] — AETNA [270002]: $23,577.70 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $20,399.98 CAPITAL DISTRICT PHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $20,399.97 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $20,399.98 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $20,399.98 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $20,807.98 INDEPENDENT HEALTH MEDICARE [1305] — INDEPENDENT HEALTH MEDICARE [130501]: $20,399.98 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $20,399.98 MEDICARE BLUE CHOICE BLUE CROSS BLUE SHIELD [1306] — MEDICARE BLUE CHOICE [130601]: $17,217.57 MVP MEDICARE [1307] — MVP MEDICARE [130701]: $20,399.98
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	$22,537.96	$22,378.88 – $30,831.32
Neck (cervical) spinal fusion, without complications: 10 of 13 insurance plan rates AETNA [2700] — AETNA [270002]: $30,831.32 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $26,515.27 CAPITAL DISTRICT PHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $26,515.26 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $26,515.27 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $26,515.27 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $27,045.58 INDEPENDENT HEALTH MEDICARE [1305] — INDEPENDENT HEALTH MEDICARE [130501]: $26,515.27 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $26,515.27 MEDICARE BLUE CHOICE BLUE CROSS BLUE SHIELD [1306] — MEDICARE BLUE CHOICE [130601]: $22,378.88 MVP MEDICARE [1307] — MVP MEDICARE [130701]: $26,515.27
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	$10,877.72	$10,800.94 – $14,559.86
Uterus and ovary surgery (not for cancer), without complications: 10 of 13 insurance plan rates AETNA [2700] — AETNA [270002]: $14,559.86 AETNA MEDICARE [1300] — AETNA MEDICARE [130001]: $12,797.32 CAPITAL DISTRICT PHP MEDICARE [1320] — CDPHP MEDICARE [132001]: $12,797.32 FIDELIS MEDICARE [1311] — FIDELIS MEDICARE [131101]: $12,797.32 HIGHMARK BLUE CROSS BLUE SHIELD MEDICARE [1301] — HIGHMARK BCBS MEDICARE [130101]: $12,797.32 HUMANA MEDICARE [1312] — HUMANA MEDICARE [131201]: $13,053.27 INDEPENDENT HEALTH MEDICARE [1305] — INDEPENDENT HEALTH MEDICARE [130501]: $12,797.32 MARTINS POINT [1205] — US FAMILY PLAN AT MARTIN'S POINT [120501]: $12,797.32 MEDICARE BLUE CHOICE BLUE CROSS BLUE SHIELD [1306] — MEDICARE BLUE CHOICE [130601]: $10,800.94 MVP MEDICARE [1307] — MVP MEDICARE [130701]: $12,797.32

Source: Highland Hospital’s standard charges file (urmc.rochester.edu, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on July 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	1000 South Avenue, Rochester, NY 14617
County	Monroe County
State	New York
Phone	(585) 341‑6711
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	330164
Name in Medicare records	HIGHLAND HOSPITAL
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(585) 473‑2200^[4]
Official website	urmc.rochester.edu
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

Highland Hospital | Rochester | URochester Medicine — urmc.rochester.edu
Highland Hospital departments and services — urmc.rochester.edu
Visiting Information - Highland Hospital - URochester Medicine — urmc.rochester.edu
Hospital Services - Highland Hospital - URochester Medicine — urmc.rochester.edu
Food and Dining Services - Highland Hospital - URochester Medicine — urmc.rochester.edu
General Surgery | Highland Hospital | Rochester | URochester Medicine — urmc.rochester.edu
Highland Hospital - URochester Medicine — urmc.rochester.edu
Cancer Treatment - Highland Hospital - URochester Medicine — urmc.rochester.edu
Highland Hospital - URochester Medicine — urmc.rochester.edu

Highland Hospital

Summary

Profile from official sources

At a glance