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Critical Access Hospital

Huggins Hospital

Wolfeboro, New Hampshire · Carroll County · Emergency services listed

Huggins Hospital is a critical access hospital at 240 South Main Street, Wolfeboro, NH 03894. Phone: (603) 569-7500. It has an emergency department. Medicare overall rating: 4 of 5 stars (CMS, October 2026).

Data as of October 26, 2026. Source: CMS Hospital General Information and the hospital’s website (checked October 30, 2026).

Summary

Huggins Hospital is a critical access hospital in Wolfeboro, New Hampshire. Medicare data lists emergency services. CMS overall star rating: 4 of 5 stars. Its official website lists 60 services, specialties and programs. Medicare lists 375 affiliated clinicians. Source: CMS Hospital General Information, data updated 2026-10-26.

What is a critical access hospital?

A small rural hospital with 24-hour emergency care, designated by Medicare to keep care available far from big cities. More about hospital types

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Profile from official sources

Built from official Medicare (CMS) data and the hospital’s own website (checked 2026-10-30). Every service links to the page that lists it. Services change: call the hospital to confirm before you go.

In a medical emergency, call 911.

At a glance

YesEmergency services
4 of 5 stars4 of 5 stars · Medicare rating
60Services listed

Quick answers

Does Huggins Hospital have an emergency room?
Yes. Medicare (CMS) data lists emergency services at Huggins Hospital. In a medical emergency, call 911.
Where is Huggins Hospital?
240 South Main Street, Wolfeboro, NH 03894, in Carroll County, New Hampshire.
What is the phone number of Huggins Hospital?
(603) 569-7500, as listed by Medicare (CMS).
What is the Medicare star rating of Huggins Hospital?
4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).

Specialties and care areas[5]

Conditions treated[9][10][14]

Treatments[5][9]

Procedures[5][10][15][16][19][20]

  • CT
  • MRI
  • Mammography
  • Bone density screening
  • Echocardiogram
  • Day surgery
  • Colonoscopy
  • Upper GI endoscopy
  • EKG/electrocardiogram
  • Cardiac stress testing
  • Holter and loop monitors
  • Pulmonary function tests
  • Spirometry
  • Joint replacement
  • Mako robotic-arm assisted surgery
  • Arthroscopy
  • Fracture repair
  • Sports medicine

Programs and centers[5][9][13][14][16]

  • Swing Bed Program
  • Cancer Care & Infusion Center
  • Neuro Rehab
  • Cardiology telemedicine office visits
  • Telestroke
  • Cardiac rehabilitation

Emergency care (hospital website)[5][13]

Emergency roomYes
Open 24/7Yes

Visiting and practical information

VisitingNormal visiting 8 a.m.-8 p.m.; ICU immediate family 24 hours with physician approval[6]
ParkingUse the main parking lot to the Main Lobby; Medical Arts Center entrance is off Christian Ridge Road[6]
Interpreters and languagesCertified ASL and video/telephonic interpreters; on-site interpreters if needed, free of charge[8]
Patient portalHuggins Hospital Health Portal

Recognition[9]

  • National recognition, "100 Critical Access Hospitals to Know" list 2026

Doctors and clinicians (375)

375 doctors and other clinicians list Huggins 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

Doctors with a page on this site (375)

And 351 more: the button below opens the full list.

Other emergency rooms nearby

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

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

Other hospitals near Wolfeboro

Hospitals in Carroll County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

All nursing homes in the state →

Hospice providers

All hospice providers in the state →

Home health agencies

All home health agencies in the state →

Dialysis facilities

All dialysis facilities 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

Clinics and urgent care

Pharmacies

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

What patients said (patient survey)

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

Summary star rating (all survey topics) 4 of 5 stars
Overall rating of the hospital4 of 5 stars
Would recommend the hospital5 of 5 stars
Nurses communicated well5 of 5 stars
Doctors communicated well4 of 5 stars
Patients got help quickly from staff4 of 5 stars
Staff explained medicines5 of 5 stars
Information about recovery at home4 of 5 stars
Room and bathroom kept clean3 of 5 stars
Restfulness of Environment4 of 5 stars
Care Coordination4 of 5 stars
Symptoms After Stay4 of 5 stars
Rated the hospital 9 or 10 out of 1076%National average: 72%
Would definitely recommend the hospital78%National average: 71%
Nurses “always” communicated well85%National average: 80%
Doctors “always” communicated well82%National average: 80%
“Always” got help as soon as they wanted66%National average: 64%
Staff “always” explained medicines before giving them72%National average: 62%
Were given information about recovery at home90%National average: 86%
Room and bathroom “always” clean75%National average: 73%
Completed surveys157Response rate: 32%

Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged January 2025 to December 2025.

Infections caught in the hospital

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

Clostridioides difficile (C. diff) intestinal infections0No different from the national benchmark
Not reported to MedicareCentral line bloodstream infections (CLABSI); Catheter-associated urinary tract infections (CAUTI); Surgical site infections after colon surgery; Surgical site infections after abdominal hysterectomy; MRSA bloodstream infections

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

Complications and deaths

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

Deaths within 30 days: heart failure patients10.5%
Deaths within 30 days: pneumonia patients14.2%
Deaths within 30 days: COPD patients8.5%
Not reported to MedicareDeaths within 30 days: coronary bypass surgery (CABG); Serious complications (patient safety indicator PSI-90); Complications after hip or knee replacement
Too few cases to reportDeaths within 30 days: heart attack patients; Deaths within 30 days: stroke patients

Source: Complications and Deaths - Hospital — CMS, released October 20, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)17.8%
Readmitted within 30 days: heart failure21.3%
Readmitted within 30 days: pneumonia17.4%
Readmitted within 30 days: COPD20.3%
Not reported to MedicareReadmitted within 30 days: coronary bypass surgery; Readmitted within 30 days: hip or knee replacement
Too few cases to reportReadmitted within 30 days: heart attack

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)192 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)2%National average: 2%
Not reported to MedicareSepsis patients who got all the recommended early care (SEP-1)

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 72 common services exactly as Huggins Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

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

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

Show the prices of 72 common services

Office and emergency visits

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-44 MINUTES $110 $55 Not listed in the file
New patient office visit (about 30–44 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW LOW 30 MIN $116 $58 Not listed in the file
New patient office visit (about 30–44 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-44 MINUTES $165 $82.50 Not listed in the file
New patient office visit (about 30–44 minutes): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 45-59 MINUTES $167 $83.50 Not listed in the file
New patient office visit (about 45–59 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 45-59 MINUTES $250 $125 Not listed in the file
New patient office visit (about 45–59 minutes): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE O/P NEW MOD 45 MIN $417 $208.50 Not listed in the file
New patient office visit (about 45–59 minutes): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 60-74 MINUTES $206 $103 Not listed in the file
New patient office visit (about 60–74 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 60-74 MINUTES $310 $155 Not listed in the file
New patient office visit (about 60–74 minutes): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE O/P NEW HI 60 MIN $516 $258 Not listed in the file
New patient office visit (about 60–74 minutes): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 20-29 MINUTES $74 $37 Not listed in the file
Established patient office visit (about 20–29 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P EST LOW 20 MIN $272 $136 Not listed in the file
Established patient office visit (about 20–29 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE O/P EST LOW 20 MIN $185 $92.50 Not listed in the file
Established patient office visit (about 20–29 minutes): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-39 MINUTES $109 $54.50 Not listed in the file
Established patient office visit (about 30–39 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P EST MOD 30 MIN $338 $169 Not listed in the file
Established patient office visit (about 30–39 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE O/P EST MOD 30 MIN $272 $136 Not listed in the file
Established patient office visit (about 30–39 minutes): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30 $121 $60.50 Not listed in the file
Office consultation with a specialist (moderate): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30 $303 $151.50 Not listed in the file
Office consultation with a specialist (moderate): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40 $179 $89.50 Not listed in the file
Office consultation with a specialist (moderate to high): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40 $268 $134 Not listed in the file
Office consultation with a specialist (moderate to high): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 18-39 $137 $68.50 Not listed in the file
Preventive checkup, new patient, age 18–39: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PREV VISIT NEW AGE 18-39 $205 $102.50 Not listed in the file
Preventive checkup, new patient, age 18–39: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (40-64 YEARS) $153 $76.50 Not listed in the file
Preventive checkup, new patient, age 40–64: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (40-64 YEARS) $230 $115 Not listed in the file
Preventive checkup, new patient, age 40–64: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PREV VISIT NEW AGE 40-64 $383 $191.50 Not listed in the file
Preventive checkup, new patient, age 40–64: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY $768 $384 Not listed in the file
Emergency room visit (moderate): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LOW MDM $806 $403 Not listed in the file
Emergency room visit (moderate): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY $150 $75 Not listed in the file
Emergency room visit (moderate): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY $1,205 $602.50 Not listed in the file
Emergency room visit (moderately high): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT MOD MDM $1,265 $632.50 Not listed in the file
Emergency room visit (moderately high): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EMERGENCY DEPT VISIT MOD MDM $286 $143 Not listed in the file
Emergency room visit (moderately high): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY $1,577 $788.50 Not listed in the file
Emergency room visit (high): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT HI MDM $1,656 $828 Not listed in the file
Emergency room visit (high): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY $419 $209.50 Not listed in the file
Emergency room visit (high): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)

Lab tests

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL) $135 $67.50 $74.38
Basic metabolic panel (blood test): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $74.38
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: METABOLIC PANEL TOTAL CA $142 $71 $74.38
Basic metabolic panel (blood test): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $74.38
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 91 In the file: BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL) $135 $67.50 Not listed in the file
Basic metabolic panel (blood test): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD TEST; COMPREHENSIVE GROUP OF BLOOD CHEMICALS $116 $58 $92.84
Comprehensive metabolic panel (blood test): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $92.84
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHEN METABOLIC PANEL $133 $66.50 $92.84
Comprehensive metabolic panel (blood test): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $92.84
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier AY In the file: BLOOD TEST; COMPREHENSIVE GROUP OF BLOOD CHEMICALS $116 $58 Not listed in the file
Comprehensive metabolic panel (blood test): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES) $136 $68 $117.72
Cholesterol panel (lipid panel): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $117.72
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL $143 $71.50 $117.72
Cholesterol panel (lipid panel): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $117.72
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GA In the file: BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES) $136 $68 Not listed in the file
Cholesterol panel (lipid panel): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: KIDNEY FUNCTION BLOOD TEST PANEL $304 $152 $76.31
Kidney function panel: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $76.31
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL $319 $159.50 $76.31
Kidney function panel: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $76.31
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIVER FUNCTION BLOOD TEST PANEL $109 $54.50 $71.83
Liver function panel: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $71.83
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL $114 $57 $71.83
Liver function panel: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $71.83
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier XS In the file: LIVER FUNCTION BLOOD TEST PANEL $109 $54.50 Not listed in the file
Liver function panel: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED $160 $80 $27.87
Urine test (automated, with microscope): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $27.87
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/SCOPE $168 $84 $27.87
Urine test (automated, with microscope): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $27.87
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 91 In the file: MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED $160 $80 Not listed in the file
Urine test (automated, with microscope): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS; MANUAL TEST $9 $4.50 $9
Urine test (manual, without microscope): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $9
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier XU In the file: URINALYSIS; MANUAL TEST $9 $4.50 Not listed in the file
Urine test (manual, without microscope): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 91 In the file: URINALYSIS; MANUAL TEST $9 $4.50 Not listed in the file
Urine test (manual, without microscope): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: AUTOMATED URINALYSIS TEST $51 $25.50 $19.78
Urine test (automated, without microscope): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $19.78
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/O SCOPE $72 $36 $19.78
Urine test (automated, without microscope): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $19.78
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL $213 $106.50 $161.68
PSA (prostate specific antigen) blood test: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $161.68
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY OF PSA TOTAL $224 $112 $161.68
PSA (prostate specific antigen) blood test: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $161.68
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GZ In the file: PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL $213 $106.50 Not listed in the file
PSA (prostate specific antigen) blood test: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD TEST; THYROID STIMULATING HORMONE (TSH) $176 $88 $147.70
Thyroid stimulating hormone (TSH) test: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $147.70
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY THYROID STIM HORMONE $190 $95 $147.70
Thyroid stimulating hormone (TSH) test: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $147.70
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GA In the file: BLOOD TEST; THYROID STIMULATING HORMONE (TSH) $176 $88 Not listed in the file
Thyroid stimulating hormone (TSH) test: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT $81 $40.50 $68.31
Complete blood count (CBC) with differential: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $68.31
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC W/AUTO DIFF WBC $89 $44.50 $68.31
Complete blood count (CBC) with differential: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $68.31
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 91 In the file: COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT $81 $40.50 Not listed in the file
Complete blood count (CBC) with differential: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST $68 $34 $56.88
Complete blood count (CBC), automated: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $56.88
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC AUTOMATED $71 $35.50 $56.88
Complete blood count (CBC), automated: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $56.88
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 91 In the file: COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST $68 $34 Not listed in the file
Complete blood count (CBC), automated: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD TEST; CLOTTING TIME $153 $76.50 $37.72
Blood clotting time test (prothrombin time, PT): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $37.72
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME $161 $80.50 $37.72
Blood clotting time test (prothrombin time, PT): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $37.72
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: BLOOD TEST; CLOTTING TIME $47 $23.50 Not listed in the file
Blood clotting time test (prothrombin time, PT): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD $139 $69.50 $52.84
Blood clotting test (partial thromboplastin time, PTT): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $52.84
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTIAL $146 $73 $52.84
Blood clotting test (partial thromboplastin time, PTT): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $52.84
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 91 In the file: COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD $278 $139 Not listed in the file
Blood clotting test (partial thromboplastin time, PTT): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)

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

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT SCAN HEAD OR BRAIN WITHOUT CONTRAST $2,663 $1,331.50 $703.39
CT scan of the head or brain, without contrast: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $703.39
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT HEAD/BRAIN W/O DYE $2,796 $1,398 $703.39
CT scan of the head or brain, without contrast: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $703.39
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier XU In the file: CT SCAN HEAD OR BRAIN WITHOUT CONTRAST $2,663 $1,331.50 Not listed in the file
CT scan of the head or brain, without contrast: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST $3,562 $1,781 $2,261.34
MRI of the brain, before and after contrast: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $2,261.34
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI BRAIN STEM W/O & W/DYE $3,740 $1,870 $2,261.34
MRI of the brain, before and after contrast: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $2,261.34
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-RAY OF CHEST; 2 VIEWS $551 $275.50 $235.29
Chest X-ray, 2 views: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $235.29
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-RAY EXAM CHEST 2 VIEWS $579 $289.50 $235.29
Chest X-ray, 2 views: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $235.29
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 76 In the file: X-RAY OF CHEST; 2 VIEWS $579 $289.50 Not listed in the file
Chest X-ray, 2 views: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-RAY OF LOWER AND SACRAL SPINE; MINIMUM OF 4 VIEWS $708 $354 $393.56
X-ray of the lower spine, at least 4 views: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $393.56
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-RAY EXAM L-2 SPINE 4/>VWS $743 $371.50 $393.56
X-ray of the lower spine, at least 4 views: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $393.56
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier XU In the file: X-RAY OF LOWER AND SACRAL SPINE; MINIMUM OF 4 VIEWS $708 $354 Not listed in the file
X-ray of the lower spine, at least 4 views: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI SCAN OF LOWER SPINAL CANAL WITHOUT CONTRAST $2,232 $1,116 $1,299.06
MRI of the lower back (lumbar spine), without contrast: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $1,299.06
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LUMBAR SPINE W/O DYE $2,344 $1,172 $1,299.06
MRI of the lower back (lumbar spine), without contrast: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $1,299.06
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT SCAN OF PELVIS WITH CONTRAST $2,925 $1,462.50 $1,790.65
CT scan of the pelvis, with contrast: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $1,790.65
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT PELVIS W/DYE $3,071 $1,535.50 $1,790.65
CT scan of the pelvis, with contrast: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $1,790.65
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50_LT In the file: MRI SCAN OF LEG JOINT WITHOUT CONTRAST $2,138 $1,069 Not listed in the file
MRI of a leg joint (such as the knee), without contrast: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: MRI SCAN OF LEG JOINT WITHOUT CONTRAST $2,138 $1,069 Not listed in the file
MRI of a leg joint (such as the knee), without contrast: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: MRI SCAN OF LEG JOINT WITHOUT CONTRAST $2,138 $1,069 Not listed in the file
MRI of a leg joint (such as the knee), without contrast: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST $5,078 $2,539 $2,336.25
CT scan of the abdomen and pelvis, with contrast: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $2,336.25
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT ABD & PELVIS W/CONTRAST $5,332 $2,666 $2,336.25
CT scan of the abdomen and pelvis, with contrast: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $2,336.25
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier XU In the file: CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST $5,078 $2,539 Not listed in the file
CT scan of the abdomen and pelvis, with contrast: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE ULTRASOUND SCAN OF ABDOMEN $795 $397.50 $795
Ultrasound of the abdomen, complete: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $795
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US EXAM ABDOM COMPLETE $835 $417.50 $797.68
Ultrasound of the abdomen, complete: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $797.68
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE); SINGLE OR FIRST FETUS $885 $442.50 $885
Pregnancy ultrasound (after the first trimester): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $885
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OB US >= 14 WKS SNGL FETUS $929 $464.50 $898.30
Pregnancy ultrasound (after the first trimester): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $898.30
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ULTRASOUND SCAN OF UTERUS; OVARIES; TUBES; CERVIX AND PELVIC AREA THROUGH VAGINA $845 $422.50 $845
Transvaginal ultrasound: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $845
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TRANSVAGINAL US NON-OB $887 $443.50 $881.90
Transvaginal ultrasound: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $881.90
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST $911 $455.50 Not listed in the file
Diagnostic mammogram, one breast: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST $911 $455.50 Not listed in the file
Diagnostic mammogram, one breast: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: DX MAMMO INCL CAD UNI $957 $478.50 Not listed in the file
Diagnostic mammogram, one breast: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS $1,161 $580.50 $1,124.29
Diagnostic mammogram, both breasts: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $1,124.29
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DX MAMMO INCL CAD BI $1,219 $609.50 $1,124.29
Diagnostic mammogram, both breasts: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $1,124.29
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS $1,161 $580.50 Not listed in the file
Diagnostic mammogram, both breasts: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SCREENING MAMMOGRAPHY $961 $480.50 $932.35
Screening mammogram, both breasts: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $932.35
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SCR MAMMO BI INCL CAD $1,009 $504.50 $932.35
Screening mammogram, both breasts: 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $932.35
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 52 In the file: SCREENING MAMMOGRAPHY $961 $480.50 Not listed in the file
Screening mammogram, both breasts: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)

Heart tests and sleep study

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH INTERPRETATION AND REPORT $48 $24 Not listed in the file
Electrocardiogram (ECG/EKG) with reading: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)

Physical therapy and mental health

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 1P_GP In the file: THERAPY PROCEDURE USING EXERCISE TO DEVELOP STRENGTH; ENDURANCE; RANGE OF MOTION; AND FLEXIBILITY; EACH 15 MINUTES $498 $249 Not listed in the file
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier CQ_GP In the file: THERAPY PROCEDURE USING EXERCISE TO DEVELOP STRENGTH; ENDURANCE; RANGE OF MOTION; AND FLEXIBILITY; EACH 15 MINUTES $166 $83 Not listed in the file
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GO_KX_XU In the file: THERAPY PROCEDURE USING EXERCISE TO DEVELOP STRENGTH; ENDURANCE; RANGE OF MOTION; AND FLEXIBILITY; EACH 15 MINUTES $166 $83 Not listed in the file
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 20 MINUTES $333 $166.50 Not listed in the file
Physical therapy evaluation (low complexity): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP_KX In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 20 MINUTES $333 $166.50 Not listed in the file
Physical therapy evaluation (low complexity): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL LOW COMPLEX 20 MIN $350 $175 Not listed in the file
Physical therapy evaluation (low complexity): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 30 MINUTES $333 $166.50 Not listed in the file
Physical therapy evaluation (moderate complexity): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP_KX In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 30 MINUTES $333 $166.50 Not listed in the file
Physical therapy evaluation (moderate complexity): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL MOD COMPLEX 30 MIN $350 $175 Not listed in the file
Physical therapy evaluation (moderate complexity): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 45 MINUTES $333 $166.50 Not listed in the file
Physical therapy evaluation (high complexity): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP_KX In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 45 MINUTES $333 $166.50 Not listed in the file
Physical therapy evaluation (high complexity): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL HIGH COMPLEX 45 MIN $350 $175 Not listed in the file
Physical therapy evaluation (high complexity): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 79.24% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.35% (a percentage in the contract, not a dollar amount)
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY; 30 MINUTES $162 $81 Not listed in the file
Psychotherapy, 30 minutes: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier AJ In the file: PSYCHOTHERAPY; 30 MINUTES $162 $81 Not listed in the file
Psychotherapy, 30 minutes: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 95 In the file: PSYCHOTHERAPY; 30 MINUTES $162 $81 Not listed in the file
Psychotherapy, 30 minutes: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY; 45 MINUTES $215 $107.50 Not listed in the file
Psychotherapy, 45 minutes: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier AJ In the file: PSYCHOTHERAPY; 45 MINUTES $215 $107.50 Not listed in the file
Psychotherapy, 45 minutes: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 25 In the file: PSYCHOTHERAPY; 45 MINUTES $215 $107.50 Not listed in the file
Psychotherapy, 45 minutes: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYTX W PT 60 MINUTES $322 $161 Not listed in the file
Psychotherapy, 60 minutes: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier AJ In the file: PSYCHOTHERAPY; 1 HOUR $322 $161 Not listed in the file
Psychotherapy, 60 minutes: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: FAMILY PSYTX W/O PT 50 MIN $260 $130 Not listed in the file
Family psychotherapy, without the patient: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: FAMILY PSYCHOTHERAPY WITH PATIENT; 50 MINUTES $270 $135 Not listed in the file
Family psychotherapy, with the patient: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: GROUP PSYCHOTHERAPY $65 $32.50 Not listed in the file
Group psychotherapy: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)

Procedures and surgery

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: REMOVAL OF BREAST LESION $1,267 $633.50 Not listed in the file
Removal of breast growth (open surgery): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: TOTAL HIP ARTHROPLASTY $3,648 $1,824 Not listed in the file
Total hip replacement: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS $51,324 $25,662 Not listed in the file
Total hip replacement: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 74_RT In the file: REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS $21,525 $10,762.50 Not listed in the file
Total hip replacement: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: TOTAL KNEE ARTHROPLASTY $3,894 $1,947 Not listed in the file
Total knee replacement: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE $51,051 $25,525.50 Not listed in the file
Total knee replacement: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE $26,481 $13,240.50 Not listed in the file
Total knee replacement: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: SHO ARTHRS SRG DECOMPRESSION $467 $233.50 Not listed in the file
Shoulder arthroscopy: shaving of shoulder bone: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80_AS_LT In the file: SHAVING OF PART OF SHOULDER BONE AND REPAIR OF LIGAMENT USING AN ENDOSCOPE $467 $233.50 Not listed in the file
Shoulder arthroscopy: shaving of shoulder bone: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80_AS_RT In the file: SHAVING OF PART OF SHOULDER BONE AND REPAIR OF LIGAMENT USING AN ENDOSCOPE $467 $233.50 Not listed in the file
Shoulder arthroscopy: shaving of shoulder bone: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: KNEE ARTHROSCOPY/SURGERY $1,392 $696 Not listed in the file
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE $15,879 $7,939.50 Not listed in the file
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE $16,827 $8,413.50 Not listed in the file
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $2,886 $1,443 Not listed in the file
Upper GI endoscopy (diagnostic): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $799 $399.50 Not listed in the file
Upper GI endoscopy (diagnostic): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 53 In the file: DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $799 $399.50 Not listed in the file
Upper GI endoscopy (diagnostic): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $3,458 $1,729 Not listed in the file
Upper GI endoscopy with biopsy: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $920 $460 Not listed in the file
Upper GI endoscopy with biopsy: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier XS In the file: BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $3,458 $1,729 Not listed in the file
Upper GI endoscopy with biopsy: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $3,709 $1,854.50 Not listed in the file
Colonoscopy (diagnostic): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $1,049 $524.50 Not listed in the file
Colonoscopy (diagnostic): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 33 In the file: DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $3,709 $1,854.50 Not listed in the file
Colonoscopy (diagnostic): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $4,373 $2,186.50 Not listed in the file
Colonoscopy with biopsy: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $1,250 $625 Not listed in the file
Colonoscopy with biopsy: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PT In the file: BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $4,373 $2,186.50 Not listed in the file
Colonoscopy with biopsy: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE $4,373 $2,186.50 Not listed in the file
Colonoscopy with removal of polyps (snare): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE $1,404 $702 Not listed in the file
Colonoscopy with removal of polyps (snare): 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 33 In the file: REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE $4,373 $2,186.50 Not listed in the file
Colonoscopy with removal of polyps (snare): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK $6,595 $3,297.50 $3,266.30
Screening colonoscopy (not high risk): 10 of 24 insurance plan rates
  • Anthem — HMO/PPO/POS: $3,266.30
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK $1,049 $524.50 $1,049
Screening colonoscopy (not high risk): 10 of 23 insurance plan rates
  • Anthem — HMO/PPO/POS: $1,049
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 74 In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK $7,167 $3,583.50 Not listed in the file
Screening colonoscopy (not high risk): 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF GALLBLADDER USING AN ENDOSCOPE $14,288 $7,144 Not listed in the file
Gallbladder removal by laparoscope: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: REMOVAL OF GALLBLADDER USING AN ENDOSCOPE $1,657 $828.50 Not listed in the file
Gallbladder removal by laparoscope: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PRP I/HERN INIT REDUC >5 YR $1,316 $658 Not listed in the file
Groin (inguinal) hernia repair, age 5 or older: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: REPAIR OF GROIN HERNIA (5 YEARS OR OLDER) $23,556 $11,778 Not listed in the file
Groin (inguinal) hernia repair, age 5 or older: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: REPAIR OF GROIN HERNIA (5 YEARS OR OLDER) $21,670 $10,835 Not listed in the file
Groin (inguinal) hernia repair, age 5 or older: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE $6,840 $3,420 Not listed in the file
Hysteroscopy with biopsy of the uterus lining: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE $1,029 $514.50 Not listed in the file
Hysteroscopy with biopsy of the uterus lining: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE $2,035 $1,017.50 Not listed in the file
Spinal injection, lower back (epidural), with imaging guidance: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX INTERLAMINAR LMBR/SAC $2,137 $1,068.50 Not listed in the file
Spinal injection, lower back (epidural), with imaging guidance: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE; SINGLE LEVEL $2,329 $1,164.50 Not listed in the file
Nerve root injection, lower back, with imaging guidance: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX AA&/STRD TFRM EPI L/S 1 $2,445 $1,222.50 Not listed in the file
Nerve root injection, lower back, with imaging guidance: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.85% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE; SINGLE LEVEL $2,592 $1,296 Not listed in the file
Nerve root injection, lower back, with imaging guidance: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CARPAL TUNNEL SURGERY $1,104 $552 Not listed in the file
Carpal tunnel release: 10 of 23 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: RELEASE AND/OR RELOCATION OF HAND NERVE $7,092 $3,546 Not listed in the file
Carpal tunnel release: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: RELEASE AND/OR RELOCATION OF HAND NERVE $6,304 $3,152 Not listed in the file
Carpal tunnel release: 10 of 24 insurance plan rates
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Aetna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
  • Anthem — HMO/PPO/POS: 63.75% (a percentage in the contract, not a dollar amount)
  • Anthem — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Anthem — Other Commercial: 62.76% (a percentage in the contract, not a dollar amount)
  • Cigna — Commercial: 71% (a percentage in the contract, not a dollar amount)
  • Cigna — Medicare Advantage: 40% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Commercial: 78.89% (a percentage in the contract, not a dollar amount)
  • Harvard Pilgrim Health Plan — Individual Market: 67.02% (a percentage in the contract, not a dollar amount)

Hospital stays (whole stay, MS-DRG)

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC Not listed in the file Not listed in the file $4,366.43
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 24 insurance plan rates
  • Aetna — Medicare Advantage: $4,366.43
  • Anthem — Medicare Advantage: $4,366.43
  • Cigna — Medicare Advantage: $4,366.43
  • Humana — Medicare Advantage Plans: $4,366.43
  • Martins Point — Medicare Advantage: $4,366.43
  • United Healthcare — Medicare Advantage: $4,366.43
  • WellCare — Medicare Advantage: $4,366.43
  • WellSense — Medicare Advantage: $4,366.43
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC Not listed in the file Not listed in the file $4,366.43
Hip or knee replacement (major joint of the leg), without major complications: 10 of 24 insurance plan rates
  • Aetna — Medicare Advantage: $4,366.43
  • Anthem — Medicare Advantage: $4,366.43
  • Cigna — Medicare Advantage: $4,366.43
  • Humana — Medicare Advantage Plans: $4,366.43
  • Martins Point — Medicare Advantage: $4,366.43
  • United Healthcare — Medicare Advantage: $4,366.43
  • WellCare — Medicare Advantage: $4,366.43
  • WellSense — Medicare Advantage: $4,366.43
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC Not listed in the file Not listed in the file $4,366.43
Neck (cervical) spinal fusion, without complications: 10 of 24 insurance plan rates
  • Aetna — Medicare Advantage: $4,366.43
  • Anthem — Medicare Advantage: $4,366.43
  • Cigna — Medicare Advantage: $4,366.43
  • Humana — Medicare Advantage Plans: $4,366.43
  • Martins Point — Medicare Advantage: $4,366.43
  • United Healthcare — Medicare Advantage: $4,366.43
  • WellCare — Medicare Advantage: $4,366.43
  • WellSense — Medicare Advantage: $4,366.43
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC Not listed in the file Not listed in the file $4,366.43
Uterus and ovary surgery (not for cancer), without complications: 10 of 24 insurance plan rates
  • Aetna — Medicare Advantage: $4,366.43
  • Anthem — Medicare Advantage: $4,366.43
  • Cigna — Medicare Advantage: $4,366.43
  • Humana — Medicare Advantage Plans: $4,366.43
  • Martins Point — Medicare Advantage: $4,366.43
  • United Healthcare — Medicare Advantage: $4,366.43
  • WellCare — Medicare Advantage: $4,366.43
  • WellSense — Medicare Advantage: $4,366.43
  • Aetna — Commercial: 85% (a percentage in the contract, not a dollar amount)
  • Allways — Commercial: 70% (a percentage in the contract, not a dollar amount)

Source: Huggins Hospital’s standard charges file (apim.services.craneware.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on May 28, 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 typeCritical Access Hospital
Address240 South Main Street, Wolfeboro, NH 03894
CountyCarroll County
StateNew Hampshire
Phone(603) 569‑7500
Emergency servicesYes
OwnershipVoluntary non-profit - Private
Medicare overall rating4 of 5 stars
CMS Certification Number301312
Name in Medicare recordsHUGGINS HOSPITAL
Profile levelMedicare data + hospital website
Official websitehugginshospital.org
CorrectionsReport an error or suggest an update →

Sources

  1. Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-10-26, retrieved 2026-11-13
  2. Medicare Care Compare — official Medicare profile of this hospital
  3. U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

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

  1. Huggins Hospital services — hugginshospital.org
  2. Huggins Hospital For Visitors — hugginshospital.org
  3. Huggins Hospital Communication and Interpretation Services — hugginshospital.org
  4. Huggins Hospital Cancer Care — hugginshospital.org
  5. Huggins Hospital Orthopedics — hugginshospital.org
  6. Huggins Hospital Emergency Services — hugginshospital.org
  7. Huggins Hospital Neuro Rehab — hugginshospital.org
  8. Huggins Hospital Cancer Diagnostics — hugginshospital.org
  9. Huggins Hospital Cardiology — hugginshospital.org
  10. Huggins Hospital EKG/Electrocardiogram — hugginshospital.org
  11. Huggins Hospital General Surgery — hugginshospital.org