Quick answers Does Lowell General Hospital have an emergency room? Yes. Medicare (CMS) data lists emergency services at Lowell General Hospital. In a medical emergency, call 911. Where is Lowell General Hospital? 295 Varnum Avenue, Lowell, MA 01854, in Middlesex County, Massachusetts. What is the phone number of Lowell General Hospital? (978) 937-6000, as listed by Medicare (CMS). What is the Medicare star rating of Lowell General Hospital? 2 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26). Does Medicare reduce its payments to Lowell General Hospital for hospital-acquired conditions? Yes. For fiscal year 2026, CMS applies a 1-percent reduction to Medicare payments to Lowell General Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 1.0519; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026). Treatments[11] Radiation oncology Infusion therapy Surgical oncology Bone marrow and stem cell transplant Genetic cancer risk assessment Lung nodule and cancer evaluation Palliative care Cancer Survivorship Program (Adult) Child Life Services Emergency care (hospital website)[4] [5] [6] [7] Emergency room Yes Trauma designation Level III
Visiting and practical information Parking Onsite parking listed for the Varnum Avenue campus locations [6] Interpreters and languages Interpreter services line 978.937.6591 for the main campus [4]
Purple Flag Excellence in Dementia Care accreditation (announced Oct 14, 2026) Level III accredited Trauma Center Gold Safe Sleep Champion (Cribs for Kids National Safe Sleep Hospital Certification Program) Doctors and clinicians (870) 870 doctors and other clinicians list Lowell General 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 (870) Aalia Fathima Mohamed Ghouse, MD Internal Medicine Aaron T. Sparks, MD Cardiac Surgery Aarti Grover, MD Critical Care (Intensivists) Aarti Kakkar, MD Gastroenterology Abdallah O. Gad, MD Internal Medicine Adam J. Blau, MD General Surgery Adam Weston, MD Infectious Disease Adel Malek, MD Neurosurgery Ajay P. Nanavati, MD Internal Medicine Akira Murakami, MD Diagnostic Radiology Alec J. Garabedian, CNA Certified Registered Nurse Anesthetist (CRNA) Aleksandra Yakhkind, MD Neurology Alena Jaffri, PA Physician Assistant Alexa B. Aboshar, PA Physician Assistant Alexander Panda, MD Critical Care (Intensivists) Alexandra B. Argasinski, MD Internal Medicine Alexandra Cornwall Nurse Practitioner Alexandra H. Bente, PA Physician Assistant Alexandra Miniati, MD Internal Medicine Alexandra R. Adler, MD Anesthesiology Alexandra Sturgis, NP Nurse Practitioner Alexi Otrakji, MD Interventional Radiology Alexis L. Beauchesne Nurse Practitioner Alice G. Lee, MD Interventional Radiology And 846 more: the button below opens the full list.
See all 870 clinicians 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 Lowell General Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.
What patients said (patient survey) What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.
Summary star rating (all survey topics) ★★★★★ 3 of 5 stars Overall rating of the hospital 3 of 5 stars Would recommend the hospital 3 of 5 stars Nurses communicated well 3 of 5 stars Doctors communicated well 3 of 5 stars Patients got help quickly from staff 3 of 5 stars Staff explained medicines 3 of 5 stars Information about recovery at home 3 of 5 stars Room and bathroom kept clean 4 of 5 stars Restfulness of Environment 2 of 5 stars Care Coordination 3 of 5 stars Symptoms After Stay 3 of 5 stars Rated the hospital 9 or 10 out of 10 66% National average: 72% Would definitely recommend the hospital 68% National average: 71% Nurses “always” communicated well 79% National average: 80% Doctors “always” communicated well 76% National average: 80% “Always” got help as soon as they wanted 57% National average: 64% Staff “always” explained medicines before giving them 62% National average: 62% Were given information about recovery at home 87% National average: 86% Room and bathroom “always” clean 74% National average: 73% Completed surveys 752Response rate: 19%
Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged January 2025 to December 2025.
Infections caught in the hospital What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.
Central line bloodstream infections (CLABSI) 1.787 No different from the national benchmark Catheter-associated urinary tract infections (CAUTI) 1.143 No different from the national benchmark Surgical site infections after colon surgery 1.789 No different from the national benchmark MRSA bloodstream infections 0.355 No different from the national benchmark Clostridioides difficile (C. diff) intestinal infections 1.267 No different from the national benchmark Not reported to Medicare Surgical site infections after abdominal hysterectomy
Source: Healthcare Associated Infections - Hospital — CMS, released October 19, 2026; data from January 2025 to December 2025.
Complications and deaths What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.
Deaths within 30 days: heart attack patients 12.4% Deaths within 30 days: heart failure patients 10.5% Deaths within 30 days: pneumonia patients 16.3% Deaths within 30 days: COPD patients 8.8% Deaths within 30 days: stroke patients 11.5% Serious complications (patient safety indicator PSI-90) 0.96 No different from the national rate Complications after hip or knee replacement 3.6% Too few cases to report Deaths within 30 days: coronary bypass surgery (CABG)
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) 17.1% Readmitted within 30 days: heart attack 14.7% Readmitted within 30 days: heart failure 21.9% Readmitted within 30 days: pneumonia 19% Readmitted within 30 days: COPD 20.2% Readmitted within 30 days: hip or knee replacement 5.5% Too few cases to report Readmitted within 30 days: coronary bypass surgery
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) Very high (60,000 or more) Average (median) time patients spent in the emergency room before leaving (OP-18b) 258 minutes National average: 162 minutes Patients who left the emergency room before being seen (OP-22) 9% National average: 2% Sepsis patients who got all the recommended early care (SEP-1) 62% National average: 66%
Source: Timely and Effective Care - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.
See every measure on Medicare Care Compare →
Medicare payment programs Medicare (CMS) uses these federal programs to adjust what it pays hospitals, based on quality, safety and cost results. This is a payment to the hospital for Medicare patients, not a price you pay, and not a prediction for any one person. Results for Lowell General Hospital, fiscal year 2026 (October 2025 to September 2026).
Show the Medicare payment program results Hospital-Acquired Condition Reduction Program What this means: Medicare gives each hospital a Total HAC Score built from patient-safety complications and from infections caught in the hospital. The quarter of hospitals with the highest (worst) scores gets a reduction in its Medicare payments. A lower score is better.
CMS says: Hospitals with a Total HAC Score above the 75th percentile of the Total HAC Score distribution will be subject to a 1-percent payment reduction.
Medicare payment reduction, fiscal year 2026 Yes CMS applies a 1-percent payment reduction to this hospital. Total HAC Score 1.0519 Lower is better. Hospitals above the 75th percentile of all scores get the reduction.
Source: Hospital-Acquired Condition (HAC) Reduction Program — CMS, released January 26, 2026; patient-safety data from July 2022 to June 2024 and infection data from January 2023 to December 2024.
Hospital Readmissions Reduction Program What this means: For six conditions, Medicare compares how often this hospital’s patients had to go back into a hospital within 30 days with how often that happens at an average hospital with similar patients. The ratio is that comparison: 1 means as many readmissions as expected, above 1 means more than expected (CMS calls these “excess readmissions”), below 1 means fewer.
CMS says: In October 2012, CMS began reducing Medicare payments for subsection(d) hospitals with excess readmissions under the Hospital Readmissions Reduction Program (HRRP).
Heart attack 1.1177 More readmissions than expected Heart failure 1.0677 More readmissions than expected Pneumonia 1.1036 More readmissions than expected COPD (chronic lung disease) 1.1022 More readmissions than expected Hip or knee replacement 0.9091 Fewer readmissions than expected No result published Coronary bypass surgery (CABG) (not reported, or too few cases)
Source: Hospital Readmissions Reduction Program — CMS, released January 26, 2026; patients discharged July 2021 to June 2024.
Hospital Value-Based Purchasing Program What this means: Medicare scores hospitals in four areas, each from 0 to 100, and combines them into a Total Performance Score from 0 to 100. A higher score means better results on these measures. Medicare uses the score to adjust what it pays the hospital.
CMS says: This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver.
Total Performance Score 17.33 out of 100Median of the 2,455 hospitals in the program: 29.50 Clinical outcomes (deaths and complications) 22.00 out of 100Person and community engagement (patient survey) 34.00 out of 100Safety (infections and sepsis care) 13.33 out of 100Efficiency and cost reduction (Medicare spending) 0.00 out of 100
Source: Hospital Value-Based Purchasing (HVBP) - Total Performance Score — CMS, released January 26, 2026, fiscal year 2026. Program description: The Hospital Value-Based Purchasing (VBP) Program — CMS, page last modified September 10, 2024.
Medicare spending per patient (MSPB) What this means: This compares what Medicare spent on a hospital stay, counting the 3 days before it and the 30 days after, with the national median hospital, after adjusting for the patient’s age and health and for local prices. A ratio of 1.00 is the national median hospital; below 1.00 means Medicare spent less, above 1.00 means more. It measures the cost to Medicare, not the quality of care.
CMS says: The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (episode) at a specific hospital compared to all hospitals nationally.
Medicare spending per patient, ratio 0.98 Below the national median hospital (1.00): Medicare spent less
Source: Medicare Spending Per Beneficiary - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.
ER wait times and Medicare ratings nearby How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.
Prices Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 64 common services exactly as Lowell General 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 64 common services Office and emergency visits Service Hospital charge Cash price Insurance rates (lowest – highest) New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient In the file: HC Office O/P New Pt Level 3 $250 $175 $22.70 – $250 New patient office visit (about 30–44 minutes): 10 of 137 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $230 ALLARACARE [100163] — HB XR ALLARACARE LGH : $115 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $87.50 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $87.50 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $87.50 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $87.50 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $87.50 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $87.50 CARE ONE [950007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $87.50 CARECENTRIX ALTERNATE [100257] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $87.50 New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient In the file: HC Office O/P New Pt Level 4 $305 $213.50 $22.70 – $305 New patient office visit (about 45–59 minutes): 10 of 135 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $280.60 ALLARACARE [100163] — HB XR ALLARACARE LGH : $140.30 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $106.75 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $106.75 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $106.75 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $106.75 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $106.75 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $106.75 CARE ONE [950007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $106.75 CARECENTRIX ALTERNATE [100257] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $106.75 New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient In the file: HC Office O/P New Pt Level 5 $430 $301 $22.70 – $430 New patient office visit (about 60–74 minutes): 10 of 134 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $395.60 ALLARACARE [100163] — HB XR ALLARACARE LGH : $197.80 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $150.50 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $150.50 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $150.50 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $150.50 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $150.50 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $150.50 CARE ONE [950007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $150.50 CARECENTRIX ALTERNATE [100257] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $150.50 Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: HC Office O/P Established Pt Level 3 $219 $153.30 $22.70 – $219 Established patient office visit (about 20–29 minutes): 10 of 138 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $201.48 ALLARACARE [100163] — HB XR ALLARACARE LGH : $100.74 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $76.65 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $76.65 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $76.65 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $76.65 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $76.65 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $76.65 CARE ONE [950007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $76.65 CARECENTRIX ALTERNATE [100257] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $76.65 Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · modifier SA In the file: HC Office O/P Established Pt Level 3|NURSE PRACTIT $219 $153.30 $22.70 – $219 Established patient office visit (about 20–29 minutes): rates for 2 insurance plans MBHP ALTERNATE [300002] — HB XR MBHP LGH MWF TMC : $71.49 MEDICAID MASSHEALTH [300001] — HB XR MBHP LGH MWF TMC : $71.49 Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: HC Office O/P Established Pt Level 4 $264 $184.80 $22.70 – $264 Established patient office visit (about 30–39 minutes): 10 of 139 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $242.88 ALLARACARE [100163] — HB XR ALLARACARE LGH : $121.44 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 CARE ONE [950007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 CARECENTRIX ALTERNATE [100257] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · modifier SA In the file: HC Office O/P Established Pt Level 4|NURSE PRACTIT $264 $184.80 $22.70 – $264 Established patient office visit (about 30–39 minutes): rates for 2 insurance plans MBHP ALTERNATE [300002] — HB XR MBHP LGH MWF TMC : $100.73 MEDICAID MASSHEALTH [300001] — HB XR MBHP LGH MWF TMC : $100.73 Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient In the file: HC Prev Visit New Age 18-39 $264 $184.80 $22.70 – $368.35 Preventive checkup, new patient, age 18–39: 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $242.88 ALLARACARE [100163] — HB XR ALLARACARE LGH : $121.44 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $248.56 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $255.60 Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient In the file: HC Prev Visit New Age 40-64 $264 $184.80 $22.70 – $430.81 Preventive checkup, new patient, age 40–64: 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $242.88 ALLARACARE [100163] — HB XR ALLARACARE LGH : $121.44 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $92.40 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $248.56 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $255.60 Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: HC Emergency Department Level 3 Visit Low Mdm $800 $560 $201.39 – $1,155.97 Emergency room visit (moderate): 10 of 158 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $784 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $800 ALLARACARE [100163] — HB XR ALLARACARE LGH : $368 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $280 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $280 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $280 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $280 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $280 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $280 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $373.07 Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: HC Emergency Department Level 4 Visit Mod Mdm $1,325 $927.50 $201.39 – $2,216.78 Emergency room visit (moderately high): 10 of 155 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $1,182 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $1,325 ALLARACARE [100163] — HB XR ALLARACARE LGH : $609.50 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $463.75 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $463.75 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $463.75 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $463.75 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $463.75 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $463.75 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $602.90 Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · modifier 50 In the file: HC Emergency Department Level 4 Visit Mod Mdm|BILA $1,987.50 $1,391.25 $201.39 – $2,216.78 Emergency room visit (moderately high): 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $1,182 ALLARACARE [100163] — HB XR ALLARACARE LGH : $914.25 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $695.63 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $695.63 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $695.63 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $695.63 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $695.63 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $695.63 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $904.35 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $930.93 Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: HC Emergency Department Level 5 Visit High Mdm $2,240 $1,568 $201.39 – $2,240 Emergency room visit (high): 10 of 169 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $1,182 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $2,240 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,030.40 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $784 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $784 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $784 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $784 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $784 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $784 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $878.84
Lab tests Service Hospital charge Cash price Insurance rates (lowest – highest) Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: HC Basic Metabolic Panel Calcium Total - Bundled C $31 $21.70 $10.85 – $34.73 Basic metabolic panel (blood test): 10 of 166 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $25.78 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $31 ALLARACARE [100163] — HB XR ALLARACARE LGH : $14.26 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.85 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.85 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.85 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.85 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.85 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.85 BLUE CROSS MEDICARE REPLACEMENT [450110] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $31 Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: HC Metabolic Panel Comprehensive - Bundled Charge $39 $27.30 $13.65 – $43.39 Comprehensive metabolic panel (blood test): 10 of 168 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $32.18 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $39 ALLARACARE [100163] — HB XR ALLARACARE LGH : $17.94 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $13.65 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $13.65 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $13.65 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $13.65 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $13.65 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $13.65 BLUE CROSS MEDICARE REPLACEMENT [450110] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $39 Obstetric blood test panel CPT 80055 · Inpatient or outpatient In the file: HC Obstetric Panel - Bundled Charge Including Cpt $168 $117.60 $21.32 – $196.34 Obstetric blood test panel: 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $145.71 ALLARACARE [100163] — HB XR ALLARACARE LGH : $77.28 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $58.80 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $58.80 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $58.80 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $58.80 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $58.80 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $58.80 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $117.43 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $117.43 Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: HC Lipid Panel - Bundled Charge $50 $35 $17.50 – $54.99 Cholesterol panel (lipid panel): 10 of 163 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $40.81 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $50 ALLARACARE [100163] — HB XR ALLARACARE LGH : $23 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $17.50 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $17.50 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $17.50 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $17.50 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $17.50 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $17.50 BLUE CROSS MEDICARE REPLACEMENT [450110] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $50 Kidney function panel CPT 80069 · Inpatient or outpatient In the file: HC Renal Function Panel - Bundled Charge $32 $22.40 $11.20 – $35.67 Kidney function panel: 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $26.45 ALLARACARE [100163] — HB XR ALLARACARE LGH : $14.72 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $11.20 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $11.20 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $11.20 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $11.20 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $11.20 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $11.20 CARE ONE [950007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $11.20 CARECENTRIX ALTERNATE [100257] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $11.20 Liver function panel CPT 80076 · Inpatient or outpatient In the file: HC Hepatic Function Panel - Bundled Charge $29 $20.30 $10.15 – $33.56 Liver function panel: 10 of 150 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $24.90 ALLARACARE [100163] — HB XR ALLARACARE LGH : $13.34 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.15 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.15 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.15 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.15 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.15 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.15 BLUE CROSS MEDICARE REPLACEMENT [450110] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $29 CARE ONE [950007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $10.15 Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: HC Urinalysis Auto W/Scope - Urinalysis Microsco $11 $7.70 $3.85 – $13.02 Urine test (automated, with microscope): 10 of 164 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $9.66 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $11 ALLARACARE [100163] — HB XR ALLARACARE LGH : $5.06 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $3.85 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $3.85 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $3.85 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $3.85 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $3.85 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $3.85 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $7.88 Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: Urinalysis Nonauto W/O Scope $46 $32.20 $4.09 – $46 Urine test (manual, without microscope): 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $10.61 ALLARACARE [100163] — HB XR ALLARACARE LGH : $21.16 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $16.10 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $16.10 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $16.10 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $16.10 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $16.10 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $16.10 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $7.16 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $7.16 Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: HC Urinalysis Auto W/O Scope - Urinalysis Chem O $8 $5.60 $2.80 – $9.23 Urine test (automated, without microscope): 10 of 162 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $6.86 ALLARACARE [100163] — HB XR ALLARACARE LGH : $3.68 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2.80 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2.80 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2.80 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2.80 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2.80 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2.80 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $5.73 BLUE CROSS MEDICARE REPLACEMENT [450110] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $8 PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: HC Prostate Specific Antigen Total - Psa $65 $45.50 $22.75 – $75.56 PSA (prostate specific antigen) blood test: 10 of 157 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $56.05 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $65 ALLARACARE [100163] — HB XR ALLARACARE LGH : $29.90 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $45.11 PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: HC Prostate Specific Antigen Total - Psa Ultrasen $65 $45.50 $22.75 – $75.56 PSA (prostate specific antigen) blood test: 10 of 157 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $56.05 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $65 ALLARACARE [100163] — HB XR ALLARACARE LGH : $29.90 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $22.75 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $45.11 Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: HC Assay Thyroid Stim Hormone - Thyroid Stimulatin $62 $43.40 $21.70 – $69.01 Thyroid stimulating hormone (TSH) test: 10 of 165 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $51.20 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $62 ALLARACARE [100163] — HB XR ALLARACARE LGH : $28.52 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $21.70 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $21.70 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $21.70 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $21.70 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $21.70 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $21.70 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $41.53 Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: HC Complete Cbc & Auto Diff Wbc - Additional Charg $27 $18.90 $9.45 – $31.93 Complete blood count (CBC) with differential: 10 of 175 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $23.68 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $27 ALLARACARE [100163] — HB XR ALLARACARE LGH : $12.42 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $9.45 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $9.45 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $9.45 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $9.45 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $9.45 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $9.45 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $19.34 Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: HC Complete Cbc - Cbc $23 $16.10 $8.05 – $26.56 Complete blood count (CBC), automated: 10 of 173 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $19.72 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $23 ALLARACARE [100163] — HB XR ALLARACARE LGH : $10.58 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $8.05 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $8.05 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $8.05 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $8.05 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $8.05 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $8.05 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $15.75 Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: HC Prothrombin Time - Protime-Inr $15 $10.50 $5.25 – $16.16 Blood clotting time test (prothrombin time, PT): 10 of 168 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $13.07 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $15 ALLARACARE [100163] — HB XR ALLARACARE LGH : $6.90 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $5.25 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $5.25 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $5.25 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $5.25 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $5.25 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $5.25 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $9.31 Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: HC Thromboplas Time Partial - Aptt $21 $14.70 $7.35 – $24.66 Blood clotting test (partial thromboplastin time, PTT): 10 of 165 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $18.32 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $21 ALLARACARE [100163] — HB XR ALLARACARE LGH : $9.66 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $15.04 Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: HC Thromboplas Time Partial - Ptt Crrt System $21 $14.70 $7.35 – $24.66 Blood clotting test (partial thromboplastin time, PTT): 10 of 165 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $18.32 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $21 ALLARACARE [100163] — HB XR ALLARACARE LGH : $9.66 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $7.35 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $15.04
Imaging (X-ray, CT, MRI, ultrasound, mammogram) Service Hospital charge Cash price Insurance rates (lowest – highest) CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: HC CT Scan Head/Brain W/O Contrast $1,304 $912.80 $56.25 – $1,841 CT scan of the head or brain, without contrast: 10 of 171 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $79.23 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $1,304 ALLARACARE [100163] — HB XR ALLARACARE LGH : $599.84 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.40 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.40 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.40 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.40 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.40 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.40 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $205.21 CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · modifier 52|76 In the file: HC CT Scan Head/Brain W/O Contrast|REDUCED SERVICE $652 $456.40 $56.25 – $1,841 CT scan of the head or brain, without contrast: 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $79.23 ALLARACARE [100163] — HB XR ALLARACARE LGH : $299.92 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $228.20 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $228.20 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $228.20 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $228.20 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $228.20 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $228.20 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $102.61 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $102.61 MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: HC MRI Brain W & WO Contrast $3,944 $2,760.80 $250.08 – $3,944 MRI of the brain, before and after contrast: 10 of 147 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $250.08 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,814.24 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,380.40 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,380.40 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,380.40 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,380.40 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,380.40 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,380.40 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $703.84 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $703.84 Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: HC X-Ray Exam Chest 2 Views $378 $264.60 $38.49 – $378 Chest X-ray, 2 views: 10 of 178 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $81.55 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $378 ALLARACARE [100163] — HB XR ALLARACARE LGH : $173.88 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $132.30 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $132.30 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $132.30 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $132.30 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $132.30 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $132.30 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $89.05 X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: HC X-Ray Exam of Lower Spine 4+ Views $723 $506.10 $68.31 – $723 X-ray of the lower spine, at least 4 views: 10 of 163 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $137.78 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $723 ALLARACARE [100163] — HB XR ALLARACARE LGH : $332.58 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $253.05 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $253.05 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $253.05 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $253.05 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $253.05 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $253.05 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $160.83 MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: HC MRI Spine Lumbar WO Contr $1,973 $1,381.10 $144.14 – $2,456 MRI of the lower back (lumbar spine), without contrast: 10 of 145 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $144.14 ALLARACARE [100163] — HB XR ALLARACARE LGH : $907.58 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $690.55 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $690.55 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $690.55 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $690.55 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $690.55 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $690.55 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $420.54 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $420.54 CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: HC CT Pelvis; W Contr $2,060 $1,442 $203.76 – $2,060 CT scan of the pelvis, with contrast: 10 of 161 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $203.76 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $2,060 ALLARACARE [100163] — HB XR ALLARACARE LGH : $947.60 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $721 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $721 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $721 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $721 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $721 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $721 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $367.97 MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: HC MRI - Le Jnt WO Contr $2,611 $1,827.70 $136.77 – $2,611 MRI of a leg joint (such as the knee), without contrast: 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $165.29 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,201.06 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $913.85 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $913.85 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $913.85 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $913.85 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $913.85 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $913.85 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $420.54 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $420.54 MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · modifier 52 In the file: HC MRI - Le Jnt WO Contr|REDUCED SERVICES $1,305.50 $913.85 $136.77 – $2,611 MRI of a leg joint (such as the knee), without contrast: 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $165.29 ALLARACARE [100163] — HB XR ALLARACARE LGH : $600.53 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.93 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.93 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.93 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.93 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.93 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $456.93 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $210.27 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $210.27 CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: HC CT Abd & Pelv W/Contrast $3,617 $2,531.90 $255.65 – $3,617 CT scan of the abdomen and pelvis, with contrast: 10 of 171 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $255.65 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $3,617 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,663.82 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,265.95 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,265.95 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,265.95 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,265.95 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,265.95 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,265.95 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $703.84 Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: HC US Abdom B-Scan &/or Real Time Complete - US A $1,083 $758.10 $89.54 – $1,083 Ultrasound of the abdomen, complete: 10 of 172 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $89.54 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $1,083 ALLARACARE [100163] — HB XR ALLARACARE LGH : $498.18 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $379.05 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $379.05 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $379.05 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $379.05 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $379.05 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $379.05 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $160.83 Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: HC OB US >/= 14 Wks Sngl Fetus - US OB 14+ Weeks S $520 $364 $118.90 – $520 Pregnancy ultrasound (after the first trimester): 10 of 156 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $304.80 ALLARACARE [100163] — HB XR ALLARACARE LGH : $239.20 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $160.83 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $160.83 Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: HC Echography Transvaginal - US Pelvis Transvagina $670 $469 $100.21 – $670 Transvaginal ultrasound: 10 of 171 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $297.78 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $670 ALLARACARE [100163] — HB XR ALLARACARE LGH : $308.20 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $234.50 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $234.50 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $234.50 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $234.50 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $234.50 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $234.50 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $160.83 Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient In the file: HC Dx Mammo Incl Cad Uni $401 $280.70 $62.48 – $409.24 Diagnostic mammogram, one breast: 10 of 147 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $307.13 ALLARACARE [100163] — HB XR ALLARACARE LGH : $184.46 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $140.35 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $140.35 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $140.35 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $140.35 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $140.35 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $140.35 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $209.38 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $209.38 Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient In the file: HC Dx Mammo Incl Cad Uni Gg $759 $531.30 $62.48 – $759 Diagnostic mammogram, one breast: 10 of 147 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $307.13 ALLARACARE [100163] — HB XR ALLARACARE LGH : $349.14 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $265.65 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $265.65 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $265.65 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $265.65 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $265.65 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $265.65 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $209.38 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $209.38 Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · modifier 52 In the file: HC Dx Mammo Incl Cad Uni|REDUCED SERVICES $200.50 $140.35 $62.48 – $409.24 Diagnostic mammogram, one breast: 10 of 146 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $307.13 ALLARACARE [100163] — HB XR ALLARACARE LGH : $92.23 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $70.18 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $70.18 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $70.18 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $70.18 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $70.18 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $70.18 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $104.69 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $104.69 Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient In the file: HC Dx Mammo Incl Cad Bi - Mammo Breast Diagnostic $992 $694.40 $155.85 – $992 Diagnostic mammogram, both breasts: 10 of 170 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $391.46 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $992 ALLARACARE [100163] — HB XR ALLARACARE LGH : $456.32 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $347.20 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $347.20 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $347.20 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $347.20 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $347.20 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $347.20 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $267.96 Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: HC Scr Mammo Bi Incl Cad - Mammo Breast Screening $600 $420 $55.82 – $600 Screening mammogram, both breasts: 10 of 177 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $323.98 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $600 ALLARACARE [100163] — HB XR ALLARACARE LGH : $276 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $210 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $210 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $210 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $210 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $210 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $210 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $221.41 Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · modifier 52 In the file: HC Scr Mammo Bi Incl Cad - Mammo Breast Screening $300 $210 $55.82 – $600 Screening mammogram, both breasts: 10 of 161 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $323.98 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $300 ALLARACARE [100163] — HB XR ALLARACARE LGH : $138 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $105 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $105 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $105 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $105 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $105 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $105 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $110.71
Heart tests and sleep study Service Hospital charge Cash price Insurance rates (lowest – highest) Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient In the file: HC Cath Left Heart Cath Inject Vetriculography Im $8,512 $5,958.40 $1,285.15 – $10,146.91 Left heart catheterization (diagnostic): 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $5,569 ALLARACARE [100163] — HB XR ALLARACARE LGH : $3,915.52 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,979.20 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,979.20 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,979.20 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,979.20 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,979.20 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,979.20 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $4,701.88 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $4,840.07 Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient In the file: HC Ep Compre Electrophysiologic W/O Arrhyt Inducti $13,953 $9,767.10 $1,285.15 – $14,164.38 Heart rhythm study (electrophysiology evaluation): 10 of 145 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $5,569 ALLARACARE [100163] — HB XR ALLARACARE LGH : $6,418.38 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $4,883.55 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $4,883.55 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $4,883.55 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $4,883.55 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $4,883.55 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $4,883.55 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $8,528.06 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $8,778.71 Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: HC Polysom 6/>Yrs Sleep 4/> Addl Param Attnd $3,415 $2,390.50 $597.63 – $3,696.28 Sleep study (overnight, in a sleep lab): 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $3,141.80 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,570.90 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,195.25 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,195.25 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,195.25 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,195.25 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,195.25 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,195.25 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $1,527.12 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $1,572.01 Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · modifier 52 In the file: HC Polysom 6/>Yrs Sleep 4/> Addl Param Attnd|REDUC $1,707.50 $1,195.25 $597.63 – $3,696.28 Sleep study (overnight, in a sleep lab): 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $1,570.90 ALLARACARE [100163] — HB XR ALLARACARE LGH : $785.45 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $597.63 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $597.63 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $597.63 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $597.63 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $597.63 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $597.63 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $763.56 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $786
Physical therapy and mental health Service Hospital charge Cash price Insurance rates (lowest – highest) Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: HC Pt Therapeutic Exercises $145 $101.50 $50.75 – $271.12 Physical therapy: therapeutic exercise (each 15 minutes): 10 of 145 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $133.40 ALLARACARE [100163] — HB XR ALLARACARE LGH : $66.70 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $177.49 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $175.55 Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: HC Ot Therapeutic Exercises $145 $101.50 $50.75 – $271.12 Physical therapy: therapeutic exercise (each 15 minutes): 10 of 145 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $133.40 ALLARACARE [100163] — HB XR ALLARACARE LGH : $66.70 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $50.75 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $225.68 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $232.32 Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: Hosp Physical Therapy Evaluation Low Complex $525 $367.50 $133.78 – $525 Physical therapy evaluation (low complexity): 10 of 145 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $483 ALLARACARE [100163] — HB XR ALLARACARE LGH : $241.50 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $183.75 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $183.75 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $183.75 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $183.75 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $183.75 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $183.75 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $210.99 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $217.20 Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: Hosp Physical Therapy Evaluation Mod Complex $572 $400.40 $133.78 – $572 Physical therapy evaluation (moderate complexity): 10 of 146 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $526.24 ALLARACARE [100163] — HB XR ALLARACARE LGH : $263.12 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $200.20 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $200.20 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $200.20 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $200.20 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $200.20 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $200.20 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $210.99 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $217.20 Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: Hosp Physical Therapy Evaluation High Complex $619 $433.30 $133.78 – $619 Physical therapy evaluation (high complexity): 10 of 145 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $569.48 ALLARACARE [100163] — HB XR ALLARACARE LGH : $284.74 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $216.65 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $216.65 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $216.65 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $216.65 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $216.65 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $216.65 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $210.99 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $217.20 Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient In the file: HC Telemed Psytx W Pt 30 Min $522 $365.40 $21.44 – $522 Psychotherapy, 30 minutes: 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $480.24 ALLARACARE [100163] — HB XR ALLARACARE LGH : $240.12 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $213.39 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $219.67 Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient In the file: Hosp Psychotherapy W Patient Level 1 $177 $123.90 $21.44 – $219.67 Psychotherapy, 30 minutes: 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $162.84 ALLARACARE [100163] — HB XR ALLARACARE LGH : $81.42 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $61.95 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $61.95 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $61.95 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $61.95 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $61.95 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $61.95 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $213.39 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $219.67 Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · modifier AH In the file: Hosp Psychotherapy W Patient Level 1|CLINICAL PSYC $177 $123.90 $21.44 – $219.67 Psychotherapy, 30 minutes: 10 of 13 insurance plan rates COMMONWEALTH CARE ALLIANCE [450067] — HB XR CCA ONE CARE SCO LGH : $62.12 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $96.67 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED RISK HMO POS LGH : $96.67 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED REFERRAL HMO POS PPO LGH : $96.67 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED RISK HMO POS LGH : $96.67 HEALTH PLANS INC [100262] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $96.67 HEALTH PLANS INC [100262] — HB XR HPHC FULLY INSURED RISK HMO POS LGH : $96.67 MBHP ALTERNATE [300002] — HB XR MBHP LGH MWF TMC : $59.16 MEDICAID MASSHEALTH [300001] — HB XR MBHP LGH MWF TMC : $59.16 TUFTS HEALTH MEDICAID REPLACEMENT [350025] — HB XR THP MEDICARE SNP SCO LGH : $59.16 Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient In the file: Hosp Psychotherapy W Patient Level 3 $316 $221.20 $27.16 – $316 Psychotherapy, 45 minutes: 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $290.72 ALLARACARE [100163] — HB XR ALLARACARE LGH : $145.36 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $110.60 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $110.60 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $110.60 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $110.60 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $110.60 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $110.60 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $213.39 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $219.67 Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient In the file: Hosp Psychotherapy Patient Level 4 $233 $163.10 $27.16 – $233 Psychotherapy, 60 minutes: 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $214.36 ALLARACARE [100163] — HB XR ALLARACARE LGH : $107.18 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $213.39 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $219.67 Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient In the file: HC Family Psychotherapy No Pt $522 $365.40 $30.15 – $522 Family psychotherapy, without the patient: 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $480.24 ALLARACARE [100163] — HB XR ALLARACARE LGH : $240.12 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $182.70 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $213.39 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $219.67 Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient In the file: Hosp Family Psychotherapy W Phys $233 $163.10 $30.15 – $233 Family psychotherapy, with the patient: 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $214.36 ALLARACARE [100163] — HB XR ALLARACARE LGH : $107.18 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $81.55 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $213.39 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $219.67 Group psychotherapy CPT 90853 · Inpatient or outpatient In the file: HC Telemed Group Psychotherapy $365 $255.50 $15.25 – $365 Group psychotherapy: 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $335.80 ALLARACARE [100163] — HB XR ALLARACARE LGH : $167.90 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $127.75 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $127.75 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $127.75 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $127.75 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $127.75 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $127.75 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $127.81 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $131.56 Group psychotherapy CPT 90853 · Inpatient or outpatient In the file: HC Group Psychotherapy $178 $124.60 $15.25 – $178 Group psychotherapy: 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $163.76 ALLARACARE [100163] — HB XR ALLARACARE LGH : $81.88 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $62.30 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $62.30 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $62.30 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $62.30 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $62.30 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $62.30 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $127.81 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $131.56
Procedures and surgery Service Hospital charge Cash price Insurance rates (lowest – highest) Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient In the file: HC Esophagogastroduodenoscopy Transoral Diagnostic $2,262 $1,583.40 $318.52 – $3,592 Upper GI endoscopy (diagnostic): 10 of 163 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $2,399 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $2,262 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,040.52 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $791.70 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $791.70 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $791.70 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $791.70 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $791.70 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $791.70 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $870.88 Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · modifier 52 In the file: HC Esophagogastroduodenoscopy Transoral Diagnostic $1,131 $791.70 $318.52 – $3,592 Upper GI endoscopy (diagnostic): 10 of 144 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $2,399 ALLARACARE [100163] — HB XR ALLARACARE LGH : $520.26 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $395.85 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $395.85 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $395.85 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $395.85 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $395.85 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $395.85 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $435.44 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $435.44 Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · modifier 53 In the file: HC Esophagogastroduodenoscopy Transoral Diagnostic $2,262 $1,583.40 $318.52 – $3,592 Upper GI endoscopy (diagnostic): 10 of 12 insurance plan rates BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $318.52 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $327.89 BLUE CROSS OF MA [100274] — HB XR BCBSMA PPO PPA LGH : $318.52 BLUE CROSS OF NH [100265] — HB XR BCBSMA PPO PPA LGH : $318.52 BLUE CROSS OF RI [100266] — HB XR BCBSMA PPO PPA LGH : $318.52 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $533.12 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED RISK HMO POS LGH : $493.80 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED REFERRAL HMO POS PPO LGH : $550.82 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED RISK HMO POS LGH : $561.82 HEALTH PLANS INC [100262] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $533.12 Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient In the file: HC Egd Transoral Biopsy Single/Multiple - Egd $2,360 $1,652 $639.24 – $3,592 Upper GI endoscopy with biopsy: 10 of 167 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $3,469 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $2,360 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,085.60 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $826 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $826 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $826 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $826 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $826 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $826 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $870.88 Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient In the file: HC Colonoscopy Flx Dx W/Collj Spec When Pfrmd - Co $2,449 $1,714.30 $311.55 – $3,592 Colonoscopy (diagnostic): 10 of 167 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $3,469 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $2,449 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,126.54 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $857.15 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $857.15 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $857.15 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $857.15 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $857.15 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $857.15 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $851.82 Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · modifier 52 In the file: HC Colonoscopy Flx Dx W/Collj Spec When Pfrmd - Co $1,224.50 $857.15 $311.55 – $3,592 Colonoscopy (diagnostic): 10 of 146 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $3,469 ALLARACARE [100163] — HB XR ALLARACARE LGH : $563.27 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $428.58 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $428.58 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $428.58 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $428.58 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $428.58 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $428.58 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $425.91 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $425.91 Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · modifier 53 In the file: HC Colonoscopy Flx Dx W/Collj Spec When Pfrmd - Co $2,449 $1,714.30 $311.55 – $3,592 Colonoscopy (diagnostic): 10 of 12 insurance plan rates BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $311.55 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $320.71 BLUE CROSS OF MA [100274] — HB XR BCBSMA PPO PPA LGH : $311.55 BLUE CROSS OF NH [100265] — HB XR BCBSMA PPO PPA LGH : $311.55 BLUE CROSS OF RI [100266] — HB XR BCBSMA PPO PPA LGH : $311.55 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $538.41 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED RISK HMO POS LGH : $498.70 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED REFERRAL HMO POS PPO LGH : $556.29 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED RISK HMO POS LGH : $567.39 HEALTH PLANS INC [100262] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $538.41 Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient In the file: HC Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq $3,864 $2,704.80 $319.62 – $3,864 Colonoscopy with removal of polyps (snare): 10 of 165 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $3,469 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $3,864 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,777.44 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,352.40 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,352.40 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,352.40 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,352.40 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,352.40 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $1,352.40 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $1,120.45 Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · modifier 52 In the file: HC Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq $1,932 $1,352.40 $319.62 – $3,864 Colonoscopy with removal of polyps (snare): 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $3,469 ALLARACARE [100163] — HB XR ALLARACARE LGH : $888.72 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $676.20 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $676.20 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $676.20 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $676.20 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $676.20 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $676.20 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $560.23 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $560.23 Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · modifier 74 In the file: HC Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq $3,864 $2,704.80 $319.62 – $3,864 Colonoscopy with removal of polyps (snare): rates for 7 insurance plans HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $752.76 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED RISK HMO POS LGH : $752.76 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED REFERRAL HMO POS PPO LGH : $752.76 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED RISK HMO POS LGH : $752.76 HEALTH PLANS INC [100262] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $752.76 HEALTH PLANS INC [100262] — HB XR HPHC FULLY INSURED RISK HMO POS LGH : $752.76 UNITED HEALTHCARE [100060] — HB XR HPHC SELF INSURED REFERRAL HMO POS PPO LGH : $752.76 Prostate biopsy CPT 55700 · Inpatient or outpatient In the file: (Ia) HC Biopsy of Prostate Needle/Punch $674 $471.80 $235.90 – $4,494.28 Prostate biopsy: 10 of 164 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $620.08 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $674 ALLARACARE [100163] — HB XR ALLARACARE LGH : $310.04 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $235.90 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $235.90 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $235.90 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $235.90 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $235.90 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $235.90 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $2,910.64 Prostate biopsy CPT 55700 · Inpatient or outpatient · modifier 50 In the file: (Ia) HC Biopsy of Prostate Needle/Punch|BILATERAL $1,011 $707.70 $235.90 – $4,494.28 Prostate biopsy: 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $930.12 ALLARACARE [100163] — HB XR ALLARACARE LGH : $465.06 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $353.85 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $353.85 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $353.85 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $353.85 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $353.85 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $353.85 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $4,365.96 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $4,494.28 Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn $1,510 $1,057 $250.45 – $1,757.92 Spinal injection, lower back (epidural), with imaging guidance: 10 of 161 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $1,389.20 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $1,510 ALLARACARE [100163] — HB XR ALLARACARE LGH : $694.60 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $528.50 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $528.50 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $528.50 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $528.50 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $528.50 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $528.50 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $684.77 Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · modifier 53 In the file: HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn|DI $1,510 $1,057 $250.45 – $1,757.92 Spinal injection, lower back (epidural), with imaging guidance: 10 of 12 insurance plan rates BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $250.45 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $257.82 BLUE CROSS OF MA [100274] — HB XR BCBSMA PPO PPA LGH : $250.45 BLUE CROSS OF NH [100265] — HB XR BCBSMA PPO PPA LGH : $250.45 BLUE CROSS OF RI [100266] — HB XR BCBSMA PPO PPA LGH : $250.45 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $418.54 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED RISK HMO POS LGH : $387.68 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED REFERRAL HMO POS PPO LGH : $432.44 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED RISK HMO POS LGH : $441.07 HEALTH PLANS INC [100262] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $418.54 Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · modifier 73 In the file: HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn|DI $1,510 $1,057 $250.45 – $1,757.92 Spinal injection, lower back (epidural), with imaging guidance: 10 of 12 insurance plan rates BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $684.77 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $684.77 BLUE CROSS OF MA [100274] — HB XR BCBSMA PPO PPA LGH : $684.77 BLUE CROSS OF NH [100265] — HB XR BCBSMA PPO PPA LGH : $684.77 BLUE CROSS OF RI [100266] — HB XR BCBSMA PPO PPA LGH : $684.77 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $585.17 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC FULLY INSURED RISK HMO POS LGH : $585.17 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED REFERRAL HMO POS PPO LGH : $585.17 HARVARD PILGRIM HEALTHCARE [100241] — HB XR HPHC SELF INSURED RISK HMO POS LGH : $585.17 HEALTH PLANS INC [100262] — HB XR HPHC FULLY INSURED REFERRAL HMO POS PPO LGH : $585.17 Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient In the file: HC Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level $1,865 $1,305.50 $319.90 – $2,797.50 Nerve root injection, lower back, with imaging guidance: 10 of 147 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $1,715.80 ALLARACARE [100163] — HB XR ALLARACARE LGH : $857.90 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $652.75 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $652.75 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $652.75 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $652.75 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $652.75 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $652.75 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $874.64 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $874.64 Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · modifier 50 In the file: HC Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level|BI $2,797.50 $1,958.25 $319.90 – $2,797.50 Nerve root injection, lower back, with imaging guidance: 10 of 157 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $2,573.70 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $2,797.50 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,286.85 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $1,311.96 Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · modifier 50|22 In the file: HC Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level|BI $2,797.50 $1,958.25 $319.90 – $2,797.50 Nerve root injection, lower back, with imaging guidance: 10 of 145 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $2,573.70 ALLARACARE [100163] — HB XR ALLARACARE LGH : $1,286.85 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $979.13 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $1,311.96 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $1,311.96 Carpal tunnel release CPT 64721 · Inpatient or outpatient In the file: HC Revise Median Nn/Carpal Tunnel Surg $7,021 $4,914.70 $1,285.15 – $7,021 Carpal tunnel release: 10 of 143 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $6,459.32 ALLARACARE [100163] — HB XR ALLARACARE LGH : $3,229.66 ALLIED BENEFIT SYSTEMS [100015] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,457.35 ALLIED NATIONAL GLOBAL CARE [100107] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,457.35 AMERICAN POSTAL WORKERS [100089] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,457.35 AMERIHEALTH CARITAS NH [350007] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,457.35 ASSURANT [100020] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,457.35 AVMED HEALTH PLAN [100247] — HB XR NON-CONTRACTED 35% OF BILLED CHARGES LGH : $2,457.35 BLUE BENEFITS ADMINISTRATORS [100267] — HB XR BCBSMA PPO PPA LGH : $1,865.69 BLUE CROSS OF MA [100274] — HB XR BCBSMA HMO LGH : $1,865.69
Hospital stays (whole stay, MS-DRG) Service Hospital charge Cash price Insurance rates (lowest – highest) Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCE $283,871.36 $198,709.95 $1,971 – $149,207.27 Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 171 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $5,859 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $86,115.33 AMERIGROUP MEDICARE [450090] — HB XR MEDICARE ADVANTAGE LGH : $86,115.33 BLUE CROSS MEDICARE REPLACEMENT [450110] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $87,783.21 BLUE CROSS OF RI MEDICARE REPLACEMENT [450112] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $87,783.21 CCA MEDICARE REPLACEMENT [450080] — HB XR MEDICARE ADVANTAGE LGH : $86,115.33 CHAMPVA [800006] — HB XR VA MWF : $84,266.75 CIGNA [100009] — HB XR CIGNA LGH : $149,207.27 CIGNA MEDICARE REPLACEMENT [450113] — HB XR MEDICARE ADVANTAGE LGH : $86,115.33 COMMONWEALTH CARE ALLIANCE [450067] — HB XR CCA ONE CARE SCO LGH : $87,783.21 Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHME $29,466.57 $20,626.60 $1,971 – $29,419.58 Hip or knee replacement (major joint of the leg), without major complications: 10 of 171 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $3,959 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $17,298.66 AMERIGROUP MEDICARE [450090] — HB XR MEDICARE ADVANTAGE LGH : $17,298.66 BLUE CROSS MEDICARE REPLACEMENT [450110] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $17,633.70 BLUE CROSS OF RI MEDICARE REPLACEMENT [450112] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $17,633.70 CCA MEDICARE REPLACEMENT [450080] — HB XR MEDICARE ADVANTAGE LGH : $17,298.66 CHAMPVA [800006] — HB XR VA MWF : $16,850.47 CIGNA [100009] — HB XR CIGNA LGH : $29,419.58 CIGNA MEDICARE REPLACEMENT [450113] — HB XR MEDICARE ADVANTAGE LGH : $17,298.66 COMMONWEALTH CARE ALLIANCE [450067] — HB XR CCA ONE CARE SCO LGH : $17,633.70 Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC $55,642.87 $38,950.01 $1,971 – $37,234.71 Neck (cervical) spinal fusion, without complications: 10 of 171 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $3,959 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $21,788.36 AMERIGROUP MEDICARE [450090] — HB XR MEDICARE ADVANTAGE LGH : $21,788.36 BLUE CROSS MEDICARE REPLACEMENT [450110] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $22,210.36 BLUE CROSS OF RI MEDICARE REPLACEMENT [450112] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $22,210.36 CCA MEDICARE REPLACEMENT [450080] — HB XR MEDICARE ADVANTAGE LGH : $21,788.36 CHAMPVA [800006] — HB XR VA MWF : $21,248.80 CIGNA [100009] — HB XR CIGNA LGH : $37,234.71 CIGNA MEDICARE REPLACEMENT [450113] — HB XR MEDICARE ADVANTAGE LGH : $21,788.36 COMMONWEALTH CARE ALLIANCE [450067] — HB XR CCA ONE CARE SCO LGH : $22,210.36 Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY W $26,580.76 $18,606.53 $1,971 – $17,919.44 Uterus and ovary surgery (not for cancer), without complications: 10 of 171 insurance plan rates AETNA [100001] — HB XR AETNA HMO PPO LGH : $3,959 AETNA MEDICARE REPLACEMENT [450001] — HB XR AETNA MEDICARE LGH : $11,268.57 AMERIGROUP MEDICARE [450090] — HB XR MEDICARE ADVANTAGE LGH : $11,268.57 BLUE CROSS MEDICARE REPLACEMENT [450110] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $11,486.82 BLUE CROSS OF RI MEDICARE REPLACEMENT [450112] — HB XR BCBSMA MEDICARE ADVANTAGE LGH : $11,486.82 CCA MEDICARE REPLACEMENT [450080] — HB XR MEDICARE ADVANTAGE LGH : $11,268.57 CHAMPVA [800006] — HB XR VA MWF : $10,943.08 CIGNA MEDICARE REPLACEMENT [450113] — HB XR MEDICARE ADVANTAGE LGH : $11,268.57 COMMONWEALTH CARE ALLIANCE [450067] — HB XR CCA ONE CARE SCO LGH : $11,486.82 ELEMENTCARE [450046] — HB XR ELEMENT CARE PACE LGH : $6,358.87
Source: Lowell General Hospital’s standard charges file (tuftsmedicine.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →
Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS) . We show a selection of common services; the file has every item and service.
Hospital information Hospital type Acute Care Hospital Address 295 Varnum Avenue, Lowell, MA 01854 County Middlesex County State Massachusetts Phone (978) 937‑6000 Emergency services Yes Ownership Voluntary non-profit - Private Medicare overall rating 2 of 5 stars Birthing-friendly designation Yes (meets CMS criteria) CMS Certification Number 220063 Name in Medicare records LOWELL GENERAL HOSPITAL Profile level Medicare data + hospital website Official website tuftsmedicine.org Corrections Report an error or suggest an update →