Does Mary Hitchcock Memorial Hospital have an emergency room?

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

Where is Mary Hitchcock Memorial Hospital?

1 Medical Center Drive, Lebanon, NH 03756, in Grafton County, New Hampshire.

What is the phone number of Mary Hitchcock Memorial Hospital?

(603) 650-5000, as listed by Medicare (CMS).

What is the Medicare star rating of Mary Hitchcock Memorial Hospital?

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

Mary Hitchcock Memorial Hospital — Lebanon, NH

Quick answers

Does Mary Hitchcock Memorial Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Mary Hitchcock Memorial Hospital. In a medical emergency, call 911.
Where is Mary Hitchcock Memorial Hospital?: 1 Medical Center Drive, Lebanon, NH 03756, in Grafton County, New Hampshire.
What is the phone number of Mary Hitchcock Memorial Hospital?: (603) 650-5000, as listed by Medicare (CMS).
What is the Medicare star rating of Mary Hitchcock Memorial Hospital?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^{[3][8][9][10]}

Dartmouth Cancer Center
Dartmouth Health Children's
Emergency medicine
Trauma care
Cancer care (Dartmouth Cancer Center)
Pediatrics (Golisano Children's Hospital at Dartmouth Health)

Programs and centers^{[3][8][9][10][11][12]}

Adult Trauma Program
Geriatric Emergency Department (ACEP Level 1 accredited)
Dartmouth Cancer Center (NCI-designated Comprehensive Cancer Center)
Golisano Children's Hospital at Dartmouth Health
DHART air and ground medical transport
Rest Easy lodging assistance program

Emergency care (hospital website)^[5][6][7]

Emergency room	Yes
Open 24/7	Yes
Stroke designation	Joint Commission Gold Seal certification for stroke care (DHMC and Cheshire Medical Center)

Visiting and practical information

Visiting	Inpatient Visitors Entrance (Entrance 2) open 5 am to 11 pm, 7 days a week; Main Entrance hours 5:30 am to 11 pm^[5]
Parking	Visitor parking via Main Entrance (Entrance 1) or Inpatient Visitor lot; parking help weekdays 7:30 am to 4:30 pm at Main Entrance^[5]
Interpreters and languages	Free interpreter services for limited English, deaf and hard-of-hearing patients; request when scheduling. Lebanon line 603-650-5792^[4]
Patient portal	myDH

Recognition^{[3][7][8][9][10]}

Named New Hampshire's Best Hospital 2025-26 (U.S. News & World Report)
Becker's 100 great hospitals in America 2026
U.S. News & World Report high-performing in maternity care (national) 2026
Joint Commission Gold Seal certification for stroke care
Named New Hampshire's Best Hospital (U.S. News & World Report, 2025-26 and 2026-27 editions)
American Heart Association Get With The Guidelines - Stroke Gold Plus
CMS four-star hospital rating
American College of Surgeons verified Adult Level I Trauma Center
Level II Pediatric Trauma Center
ACEP Geriatric Emergency Department Accreditation, Level 1
NCI-designated Comprehensive Cancer Center (Dartmouth Cancer Center)

Doctors and clinicians (2,601)

2,601 doctors and other clinicians list Mary Hitchcock Memorial Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

Nurse Practitioner470
Physician Assistant252
Internal Medicine244
Family Practice222
Diagnostic Radiology114
Certified Registered Nurse Anesthetist (CRNA)104
Anesthesiology95
Emergency Medicine88
Cardiovascular Disease (Cardiology)83
Neurology62
Obstetrics/Gynecology56
General Surgery53

And 2,577 more: the button below opens the full list.

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 Mary Hitchcock Memorial 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	4 of 5 stars
Would recommend the hospital	5 of 5 stars
Nurses communicated well	3 of 5 stars
Doctors communicated well	3 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Quiet at night	2 of 5 stars
Rated the hospital 9 or 10 out of 10	73%National average: 72%
Would definitely recommend the hospital	79%National average: 71%
Nurses “always” communicated well	78%National average: 80%
Doctors “always” communicated well	79%National average: 80%
Staff “always” explained medicines before giving them	60%National average: 62%
Were given information about recovery at home	88%National average: 86%
Room and bathroom “always” clean	68%National average: 74%
Area around the room “always” quiet at night	46%National average: 60%
Completed surveys	1,796Response rate: 27%

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)	0.788No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.374Better than the national benchmark
Surgical site infections after colon surgery	1.701Worse than the national benchmark
Surgical site infections after abdominal hysterectomy	3.351Worse than the national benchmark
MRSA bloodstream infections	0.442Better than the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.476Better than the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	11.3%
Deaths within 30 days: heart failure patients	10.4%
Deaths within 30 days: pneumonia patients	13.9%
Deaths within 30 days: COPD patients	7%
Deaths within 30 days: stroke patients	12.5%
Deaths within 30 days: coronary bypass surgery (CABG)	2.1%
Serious complications (patient safety indicator PSI-90)	1.18No different from the national rate
Complications after hip or knee replacement	3.3%

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	13.8%
Readmitted within 30 days: heart failure	21.1%
Readmitted within 30 days: pneumonia	18.7%
Readmitted within 30 days: COPD	20%
Readmitted within 30 days: coronary bypass surgery	12.2%
Readmitted within 30 days: hip or knee replacement	5.1%

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	264 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	57%National average: 65%

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in Lebanon

Prices

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

What the prices mean

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

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

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: NEW PT, LOW, 30 MIN	$541	$165.55	$61.30 – $513.95
New patient office visit (about 30–44 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $379.78 Aetna — Aetna HMO/POS/PPO - ARNB: $332.17 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $61.30 Anthem Health Plans of NH — Anthem - Federal Employee Program: $471.43 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $296.47 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $296.47 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $361.39 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $66.06 CCMSI — CCMSI - Workers Comp: $513.95 Cigna — Cigna HMO-POS: $327.30
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: WOUND CENTER, NEW PT, LOW, 30 MIN	$541	$165.55	$61.30 – $513.95
New patient office visit (about 30–44 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $379.78 Aetna — Aetna HMO/POS/PPO - ARNB: $332.17 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $61.30 Anthem Health Plans of NH — Anthem - Federal Employee Program: $471.43 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $296.47 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $296.47 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $361.39 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $66.06 CCMSI — CCMSI - Workers Comp: $513.95 Cigna — Cigna HMO-POS: $327.30
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) · Doctor (professional) fee In the file: NEW PT, LOW, 30 MIN	$541	$165.55	$186.64 – $513.95
New patient office visit (about 30–44 minutes): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $379.78 Aetna — Aetna HMO/POS/PPO - ARNB: $332.17 Anthem Health Plans of NH — Anthem - Federal Employee Program: $443.94 Anthem Health Plans of NH — Anthem - Indemnity: $443.94 CCMSI — CCMSI - Workers Comp: $513.95 Corvel — Corvel - Workers Comp: $497.72 Coventry — Coventry- Workers Comp: $470.67 First Health/HCVM — First Health/HCVM: $470.67 Maine Community Health Options — MCHO Indiv - Exchange: $344.62 Maine Community Health Options — MCHO SHOP - Exchange: $397.64
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: NEW PT, MOD, 45 MIN	$798	$244.19	$90.41 – $758.10
New patient office visit (about 45–59 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $560.20 Aetna — Aetna HMO/POS/PPO - ARNB: $489.97 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $90.41 Anthem Health Plans of NH — Anthem - Federal Employee Program: $695.38 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $437.30 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $437.30 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $533.06 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $97.44 CCMSI — CCMSI - Workers Comp: $758.10 Cigna — Cigna HMO-POS: $482.79
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: WOUND CENTER, NEW PT, MOD, 45 MIN	$798	$244.19	$90.41 – $758.10
New patient office visit (about 45–59 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $560.20 Aetna — Aetna HMO/POS/PPO - ARNB: $489.97 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $90.41 Anthem Health Plans of NH — Anthem - Federal Employee Program: $695.38 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $437.30 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $437.30 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $533.06 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $97.44 CCMSI — CCMSI - Workers Comp: $758.10 Cigna — Cigna HMO-POS: $482.79
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) · Doctor (professional) fee In the file: NEW PT, MOD, 45 MIN	$798	$244.19	$275.31 – $758.10
New patient office visit (about 45–59 minutes): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $560.20 Aetna — Aetna HMO/POS/PPO - ARNB: $489.97 Anthem Health Plans of NH — Anthem - Federal Employee Program: $654.84 Anthem Health Plans of NH — Anthem - Indemnity: $654.84 CCMSI — CCMSI - Workers Comp: $758.10 Corvel — Corvel - Workers Comp: $734.16 Coventry — Coventry- Workers Comp: $694.26 First Health/HCVM — First Health/HCVM: $694.26 Maine Community Health Options — MCHO Indiv - Exchange: $508.33 Maine Community Health Options — MCHO SHOP - Exchange: $586.53
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: NEW PT, HIGH, 60 MIN	$999	$305.69	$113.19 – $949.05
New patient office visit (about 60–74 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $701.30 Aetna — Aetna HMO/POS/PPO - ARNB: $613.39 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $113.19 Anthem Health Plans of NH — Anthem - Federal Employee Program: $870.53 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $547.45 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $547.45 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $667.33 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $121.98 CCMSI — CCMSI - Workers Comp: $949.05 Cigna — Cigna HMO-POS: $604.40
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: WOUND CENTER, NEW PT, HIGH, 60 MIN	$999	$305.69	$113.19 – $949.05
New patient office visit (about 60–74 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $701.30 Aetna — Aetna HMO/POS/PPO - ARNB: $613.39 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $113.19 Anthem Health Plans of NH — Anthem - Federal Employee Program: $870.53 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $547.45 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $547.45 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $667.33 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $121.98 CCMSI — CCMSI - Workers Comp: $949.05 Cigna — Cigna HMO-POS: $604.40
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Doctor (professional) fee In the file: NEW PT, HIGH, 60 MIN	$999	$305.69	$344.66 – $949.05
New patient office visit (about 60–74 minutes): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $701.30 Aetna — Aetna HMO/POS/PPO - ARNB: $613.39 Anthem Health Plans of NH — Anthem - Federal Employee Program: $819.78 Anthem Health Plans of NH — Anthem - Indemnity: $819.78 CCMSI — CCMSI - Workers Comp: $949.05 Corvel — Corvel - Workers Comp: $919.08 Coventry — Coventry- Workers Comp: $869.13 First Health/HCVM — First Health/HCVM: $869.13 Maine Community Health Options — MCHO Indiv - Exchange: $636.36 Maine Community Health Options — MCHO SHOP - Exchange: $734.26
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EST PT, LOW, 20 MIN	$331	$101.29	$37.50 – $314.45
Established patient office visit (about 20–29 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $232.36 Aetna — Aetna HMO/POS/PPO - ARNB: $203.23 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $37.50 Anthem Health Plans of NH — Anthem - Federal Employee Program: $288.43 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $181.39 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $181.39 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $221.11 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $40.42 CCMSI — CCMSI - Workers Comp: $314.45 Cigna — Cigna HMO-POS: $200.26
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIRTHING PAVILLION EVAL - LEVEL III	$1,486	$454.72	$168.36 – $1,411.70
Established patient office visit (about 20–29 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,043.17 Aetna — Aetna HMO/POS/PPO - ARNB: $912.40 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $168.36 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,294.90 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $814.33 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $814.33 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $992.65 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $181.44 CCMSI — CCMSI - Workers Comp: $1,411.70 Cigna — Cigna HMO-POS: $899.03
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: WOUND CENTER, EST PT, LOW, 20 MIN	$331	$101.29	$37.50 – $314.45
Established patient office visit (about 20–29 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $232.36 Aetna — Aetna HMO/POS/PPO - ARNB: $203.23 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $37.50 Anthem Health Plans of NH — Anthem - Federal Employee Program: $288.43 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $181.39 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $181.39 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $221.11 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $40.42 CCMSI — CCMSI - Workers Comp: $314.45 Cigna — Cigna HMO-POS: $200.26
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EST PT, MOD, 30 MIN	$510	$156.06	$57.78 – $484.50
Established patient office visit (about 30–39 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $358.02 Aetna — Aetna HMO/POS/PPO - ARNB: $313.14 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $57.78 Anthem Health Plans of NH — Anthem - Federal Employee Program: $444.41 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $279.48 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $279.48 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $340.68 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $62.27 CCMSI — CCMSI - Workers Comp: $484.50 Cigna — Cigna HMO-POS: $308.55
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIRTHING PAVILLION EVAL - LEVEL IV	$2,648	$810.29	$300.02 – $2,515.60
Established patient office visit (about 30–39 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,858.90 Aetna — Aetna HMO/POS/PPO - ARNB: $1,625.87 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $300.02 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,307.47 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $1,451.10 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $1,451.10 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $1,768.86 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $323.32 CCMSI — CCMSI - Workers Comp: $2,515.60 Cigna — Cigna HMO-POS: $1,602.04
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: WOUND CENTER, EST PT, MOD, 30 MIN	$510	$156.06	$57.78 – $484.50
Established patient office visit (about 30–39 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $358.02 Aetna — Aetna HMO/POS/PPO - ARNB: $313.14 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $57.78 Anthem Health Plans of NH — Anthem - Federal Employee Program: $444.41 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $279.48 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $279.48 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $340.68 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $62.27 CCMSI — CCMSI - Workers Comp: $484.50 Cigna — Cigna HMO-POS: $308.55
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CONSULT, ED, LOW 30 MIN	$887	$271.42	$100.50 – $842.65
Office consultation with a specialist (moderate): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $622.67 Aetna — Aetna HMO/POS/PPO - ARNB: $544.62 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $100.50 Anthem Health Plans of NH — Anthem - Federal Employee Program: $772.93 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $486.08 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $486.08 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $592.52 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $108.30 CCMSI — CCMSI - Workers Comp: $842.65 Cigna — Cigna HMO-POS: $536.64
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CONSULT, OP, 30 MIN	$887	$271.42	$100.50 – $842.65
Office consultation with a specialist (moderate): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $622.67 Aetna — Aetna HMO/POS/PPO - ARNB: $544.62 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $100.50 Anthem Health Plans of NH — Anthem - Federal Employee Program: $772.93 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $486.08 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $486.08 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $592.52 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $108.30 CCMSI — CCMSI - Workers Comp: $842.65 Cigna — Cigna HMO-POS: $536.64
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CONSULT, OP, LOW	$887	$271.42	$100.50 – $842.65
Office consultation with a specialist (moderate): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $622.67 Aetna — Aetna HMO/POS/PPO - ARNB: $544.62 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $100.50 Anthem Health Plans of NH — Anthem - Federal Employee Program: $772.93 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $486.08 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $486.08 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $592.52 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $108.30 CCMSI — CCMSI - Workers Comp: $842.65 Cigna — Cigna HMO-POS: $536.64
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CONSULT, ED, MOD 40 MIN	$1,096	$335.38	$124.18 – $1,041.20
Office consultation with a specialist (moderate to high): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $769.39 Aetna — Aetna HMO/POS/PPO - ARNB: $672.94 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $124.18 Anthem Health Plans of NH — Anthem - Federal Employee Program: $955.05 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $600.61 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $600.61 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $732.13 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $133.82 CCMSI — CCMSI - Workers Comp: $1,041.20 Cigna — Cigna HMO-POS: $663.08
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CONSULT, OP, 40 MIN	$1,096	$335.38	$124.18 – $1,041.20
Office consultation with a specialist (moderate to high): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $769.39 Aetna — Aetna HMO/POS/PPO - ARNB: $672.94 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $124.18 Anthem Health Plans of NH — Anthem - Federal Employee Program: $955.05 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $600.61 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $600.61 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $732.13 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $133.82 CCMSI — CCMSI - Workers Comp: $1,041.20 Cigna — Cigna HMO-POS: $663.08
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CONSULT, OP, MOD	$1,096	$335.38	$124.18 – $1,041.20
Office consultation with a specialist (moderate to high): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $769.39 Aetna — Aetna HMO/POS/PPO - ARNB: $672.94 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $124.18 Anthem Health Plans of NH — Anthem - Federal Employee Program: $955.05 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $600.61 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $600.61 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $732.13 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $133.82 CCMSI — CCMSI - Workers Comp: $1,041.20 Cigna — Cigna HMO-POS: $663.08
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: INITIAL PREVENTIVE MED NEW PATIENT 18-39 YRS	$679	$207.77	$76.93 – $645.05
Preventive checkup, new patient, age 18–39: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $476.66 Aetna — Aetna HMO/POS/PPO - ARNB: $416.91 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $76.93 Anthem Health Plans of NH — Anthem - Federal Employee Program: $591.68 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $372.09 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $372.09 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $453.57 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $82.91 CCMSI — CCMSI - Workers Comp: $645.05 Cigna — Cigna HMO-POS: $410.80
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Doctor (professional) fee In the file: INITIAL PREVENTIVE MED NEW PATIENT 18-39 YRS	$679	$207.77	$234.26 – $645.05
Preventive checkup, new patient, age 18–39: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $476.66 Aetna — Aetna HMO/POS/PPO - ARNB: $416.91 Anthem Health Plans of NH — Anthem - Federal Employee Program: $557.19 Anthem Health Plans of NH — Anthem - Indemnity: $557.19 CCMSI — CCMSI - Workers Comp: $645.05 Corvel — Corvel - Workers Comp: $624.68 Coventry — Coventry- Workers Comp: $590.73 First Health/HCVM — First Health/HCVM: $590.73 Maine Community Health Options — MCHO Indiv - Exchange: $432.52 Maine Community Health Options — MCHO SHOP - Exchange: $499.06
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Prev visit new age 18-39	Not listed in the file	Not listed in the file	$42.86 – $580.94
Preventive checkup, new patient, age 18–39: 10 of 70 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $238.77 Aetna — Aetna HMO/POS/PPO: $336.44 Aetna — Aetna HMO/POS/PPO - ARNB: $336.44 Aetna — Aetna Medicare Advantage - DHP: $104.09 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $42.86 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $45.47 Anthem Health Plans of NH — Anthem - Federal Employee Program: $580.94 Anthem Health Plans of NH — Anthem - Indemnity: $580.94 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $513.81 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $319.35
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: INITIAL PREVENTIVE MED NEW PATIENT 40-64 YRS	$769	$235.31	$87.13 – $730.55
Preventive checkup, new patient, age 40–64: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $539.84 Aetna — Aetna HMO/POS/PPO - ARNB: $472.17 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $87.13 Anthem Health Plans of NH — Anthem - Federal Employee Program: $670.11 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $421.41 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $421.41 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $513.69 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $93.89 CCMSI — CCMSI - Workers Comp: $730.55 Cigna — Cigna HMO-POS: $465.24
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Doctor (professional) fee In the file: INITIAL PREVENTIVE MED NEW PATIENT 40-64 YRS	$769	$235.31	$265.30 – $730.55
Preventive checkup, new patient, age 40–64: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $539.84 Aetna — Aetna HMO/POS/PPO - ARNB: $472.17 Anthem Health Plans of NH — Anthem - Federal Employee Program: $631.04 Anthem Health Plans of NH — Anthem - Indemnity: $631.04 CCMSI — CCMSI - Workers Comp: $730.55 Corvel — Corvel - Workers Comp: $707.48 Coventry — Coventry- Workers Comp: $669.03 First Health/HCVM — First Health/HCVM: $669.03 Maine Community Health Options — MCHO Indiv - Exchange: $489.85 Maine Community Health Options — MCHO SHOP - Exchange: $565.22
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Prev visit new age 40-64	Not listed in the file	Not listed in the file	$42.86 – $909.31
Preventive checkup, new patient, age 40–64: 10 of 70 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $393.07 Aetna — Aetna HMO/POS/PPO: $393.07 Aetna — Aetna HMO/POS/PPO - ARNB: $393.07 Aetna — Aetna Medicare Advantage - DHP: $127.76 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $42.86 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $45.47 Anthem Health Plans of NH — Anthem - Federal Employee Program: $909.31 Anthem Health Plans of NH — Anthem - Indemnity: $909.31 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $824.32 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $499.86
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT LOW MDM	$1,505	$460.53	$170.52 – $1,429.75
Emergency room visit (moderate): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,056.51 Aetna — Aetna HMO/POS/PPO - ARNB: $924.07 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $170.52 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,311.46 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $824.74 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $824.74 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $1,005.34 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $183.76 CCMSI — CCMSI - Workers Comp: $1,429.75 Cigna — Cigna HMO-POS: $910.52
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT LOW MDM	$467	$142.90	$52.91 – $443.65
Emergency room visit (moderate): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $327.83 Aetna — Aetna HMO/POS/PPO - ARNB: $286.74 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $52.91 Anthem Health Plans of NH — Anthem - Federal Employee Program: $406.94 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $255.92 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $255.92 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $311.96 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $57.02 CCMSI — CCMSI - Workers Comp: $443.65 Cigna — Cigna HMO-POS: $282.53
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT LOW MDM	$1,505	$460.53	$519.22 – $1,429.75
Emergency room visit (moderate): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,056.51 Aetna — Aetna HMO/POS/PPO - ARNB: $924.07 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,235 Anthem Health Plans of NH — Anthem - Indemnity: $1,235 CCMSI — CCMSI - Workers Comp: $1,429.75 Corvel — Corvel - Workers Comp: $1,384.60 Coventry — Coventry- Workers Comp: $1,309.35 First Health/HCVM — First Health/HCVM: $1,309.35 Maine Community Health Options — MCHO Indiv - Exchange: $958.68 Maine Community Health Options — MCHO SHOP - Exchange: $1,106.18
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT MODERATE MDM	$2,648	$810.29	$300.02 – $2,515.60
Emergency room visit (moderately high): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,858.90 Aetna — Aetna HMO/POS/PPO - ARNB: $1,625.87 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $300.02 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,307.47 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $1,451.10 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $1,451.10 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $1,768.86 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $323.32 CCMSI — CCMSI - Workers Comp: $2,515.60 Cigna — Cigna HMO-POS: $1,602.04
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT MODERATE MDM	$729	$223.07	$82.60 – $692.55
Emergency room visit (moderately high): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $511.76 Aetna — Aetna HMO/POS/PPO - ARNB: $447.61 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $82.60 Anthem Health Plans of NH — Anthem - Federal Employee Program: $635.25 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $399.49 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $399.49 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $486.97 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $89.01 CCMSI — CCMSI - Workers Comp: $692.55 Cigna — Cigna HMO-POS: $441.04
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT MODERATE MDM	$2,648	$810.29	$913.56 – $2,515.60
Emergency room visit (moderately high): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,858.90 Aetna — Aetna HMO/POS/PPO - ARNB: $1,625.87 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,172.95 Anthem Health Plans of NH — Anthem - Indemnity: $2,172.95 CCMSI — CCMSI - Workers Comp: $2,515.60 Corvel — Corvel - Workers Comp: $2,436.16 Coventry — Coventry- Workers Comp: $2,303.76 First Health/HCVM — First Health/HCVM: $2,303.76 Maine Community Health Options — MCHO Indiv - Exchange: $1,686.78 Maine Community Health Options — MCHO SHOP - Exchange: $1,946.28
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT HIGH MDM	$4,119	$1,260.41	$466.68 – $3,913.05
Emergency room visit (high): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,891.54 Aetna — Aetna HMO/POS/PPO - ARNB: $2,529.07 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $466.68 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,589.30 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,257.21 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,257.21 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,751.49 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $502.93 CCMSI — CCMSI - Workers Comp: $3,913.05 Cigna — Cigna HMO-POS: $2,492
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT HIGH MDM	$1,075	$328.95	$121.80 – $1,021.25
Emergency room visit (high): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $754.65 Aetna — Aetna HMO/POS/PPO - ARNB: $660.05 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $121.80 Anthem Health Plans of NH — Anthem - Federal Employee Program: $936.76 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $589.10 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $589.10 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $718.10 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $131.26 CCMSI — CCMSI - Workers Comp: $1,021.25 Cigna — Cigna HMO-POS: $650.38
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT HIGH MDM	$4,119	$1,260.41	$1,421.05 – $3,913.05
Emergency room visit (high): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,891.54 Aetna — Aetna HMO/POS/PPO - ARNB: $2,529.07 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,380.05 Anthem Health Plans of NH — Anthem - Indemnity: $3,380.05 CCMSI — CCMSI - Workers Comp: $3,913.05 Corvel — Corvel - Workers Comp: $3,789.48 Coventry — Coventry- Workers Comp: $3,583.53 First Health/HCVM — First Health/HCVM: $3,583.53 Maine Community Health Options — MCHO Indiv - Exchange: $2,623.80 Maine Community Health Options — MCHO SHOP - Exchange: $3,027.46

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL WITH TOTAL CALCIUM	$91	$27.85	$10.31 – $86.45
Basic metabolic panel (blood test): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $63.88 Aetna — Aetna HMO/POS/PPO - ARNB: $55.87 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $10.31 Anthem Health Plans of NH — Anthem - Federal Employee Program: $79.30 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $49.87 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $49.87 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $60.79 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $11.11 CCMSI — CCMSI - Workers Comp: $86.45 Cigna — Cigna HMO-POS: $55.06
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL WITH TOTAL CALCIUM	$91	$27.85	$31.39 – $86.45
Basic metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $63.88 Aetna — Aetna HMO/POS/PPO - ARNB: $55.87 Anthem Health Plans of NH — Anthem - Federal Employee Program: $74.67 Anthem Health Plans of NH — Anthem - Indemnity: $74.67 CCMSI — CCMSI - Workers Comp: $86.45 Corvel — Corvel - Workers Comp: $83.72 Coventry — Coventry- Workers Comp: $79.17 First Health/HCVM — First Health/HCVM: $79.17 Maine Community Health Options — MCHO Indiv - Exchange: $57.97 Maine Community Health Options — MCHO SHOP - Exchange: $66.89
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Metabolic panel total ca	Not listed in the file	Not listed in the file	$3.55 – $60.56
Basic metabolic panel (blood test): 10 of 58 insurance plan rates Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $7.73 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $7.54 Anthem Health Plans of NH — Anthem - Federal Employee Program: $8.87 Anthem Health Plans of NH — Anthem - Indemnity: $8.87 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $5.50 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $8.87 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $8.87 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $5.50 Anthem Health Plans of NH — Anthem PPO: $8.87 Anthem Health Plans of NH — Anthem PPO - DHP: $5.50
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMP METABOLIC PNL '00	$161	$49.27	$18.24 – $152.95
Comprehensive metabolic panel (blood test): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $113.02 Aetna — Aetna HMO/POS/PPO - ARNB: $98.85 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $18.24 Anthem Health Plans of NH — Anthem - Federal Employee Program: $140.30 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $88.23 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $88.23 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $107.55 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $19.66 CCMSI — CCMSI - Workers Comp: $152.95 Cigna — Cigna HMO-POS: $97.40
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMP METABOLIC PNL '00	$161	$49.27	$55.54 – $152.95
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $113.02 Aetna — Aetna HMO/POS/PPO - ARNB: $98.85 Anthem Health Plans of NH — Anthem - Federal Employee Program: $132.12 Anthem Health Plans of NH — Anthem - Indemnity: $132.12 CCMSI — CCMSI - Workers Comp: $152.95 Corvel — Corvel - Workers Comp: $148.12 Coventry — Coventry- Workers Comp: $140.07 First Health/HCVM — First Health/HCVM: $140.07 Maine Community Health Options — MCHO Indiv - Exchange: $102.56 Maine Community Health Options — MCHO SHOP - Exchange: $118.34
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Comprehen metabolic panel	Not listed in the file	Not listed in the file	$4.44 – $79.98
Comprehensive metabolic panel (blood test): 10 of 58 insurance plan rates Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $9.65 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $9.40 Anthem Health Plans of NH — Anthem - Federal Employee Program: $11.08 Anthem Health Plans of NH — Anthem - Indemnity: $11.08 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $6.86 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $11.08 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $11.08 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $6.86 Anthem Health Plans of NH — Anthem PPO: $11.08 Anthem Health Plans of NH — Anthem PPO - DHP: $6.86
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Obstetric panel	Not listed in the file	Not listed in the file	$19.36 – $175.32
Obstetric blood test panel: 10 of 77 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $50.09 Aetna — Aetna HMO/POS/PPO: $50.09 Aetna — Aetna HMO/POS/PPO - ARNB: $50.09 Aetna — Aetna Medicare Advantage - DHP: $49.24 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $157.17 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $113.40 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $50.20 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $19.36 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $42.60 Anthem Health Plans of NH — Anthem - Federal Employee Program: $50.17
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric panel	Not listed in the file	Not listed in the file	$41.36 – $253.62
Obstetric blood test panel: 10 of 36 insurance plan rates Aetna — Aetna Medicare Advantage: $49.24 Ambetter Health — Ambetter Commercial - Exchange: $102.86 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $65.93 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $42.60 Anthem Health Plans of NH — Anthem - Indemnity: $227.10 Anthem Health Plans of NH — Anthem - Medicare Advantage: $47.81 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $227.10 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $126.70 Anthem Health Plans of NH — Anthem PPO: $227.10 Anthem Health Plans of NH — Anthem SHOP - Exchange: $167.34
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier TC\|26 In the file: Obstetric panel	Not listed in the file	Not listed in the file	$55.28 – $176.08
Obstetric blood test panel: rates for 2 insurance plans Cigna — Cigna HMO-POS: $55.28 Cigna — Cigna PPO - DHP: $176.08
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PROFILE	$154	$47.12	$17.45 – $146.30
Cholesterol panel (lipid panel): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $108.11 Aetna — Aetna HMO/POS/PPO - ARNB: $94.56 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $17.45 Anthem Health Plans of NH — Anthem - Federal Employee Program: $134.20 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $84.39 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $84.39 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $102.87 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $18.80 CCMSI — CCMSI - Workers Comp: $146.30 Cigna — Cigna HMO-POS: $93.17
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: POCT LIPID PANEL	$154	$47.12	$17.45 – $146.30
Cholesterol panel (lipid panel): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $108.11 Aetna — Aetna HMO/POS/PPO - ARNB: $94.56 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $17.45 Anthem Health Plans of NH — Anthem - Federal Employee Program: $134.20 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $84.39 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $84.39 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $102.87 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $18.80 CCMSI — CCMSI - Workers Comp: $146.30 Cigna — Cigna HMO-POS: $93.17
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LIPID PROFILE	$154	$47.12	$53.13 – $146.30
Cholesterol panel (lipid panel): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $108.11 Aetna — Aetna HMO/POS/PPO - ARNB: $94.56 Anthem Health Plans of NH — Anthem - Federal Employee Program: $126.37 Anthem Health Plans of NH — Anthem - Indemnity: $126.37 CCMSI — CCMSI - Workers Comp: $146.30 Corvel — Corvel - Workers Comp: $141.68 Coventry — Coventry- Workers Comp: $133.98 First Health/HCVM — First Health/HCVM: $133.98 Maine Community Health Options — MCHO Indiv - Exchange: $98.10 Maine Community Health Options — MCHO SHOP - Exchange: $113.19
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$114	$34.88	$12.92 – $108.30
Kidney function panel: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $80.03 Aetna — Aetna HMO/POS/PPO - ARNB: $70 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $12.92 Anthem Health Plans of NH — Anthem - Federal Employee Program: $99.34 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $62.47 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $62.47 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $76.15 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $13.92 CCMSI — CCMSI - Workers Comp: $108.30 Cigna — Cigna HMO-POS: $68.97
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$114	$34.88	$39.33 – $108.30
Kidney function panel: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $80.03 Aetna — Aetna HMO/POS/PPO - ARNB: $70 Anthem Health Plans of NH — Anthem - Federal Employee Program: $93.55 Anthem Health Plans of NH — Anthem - Indemnity: $93.55 CCMSI — CCMSI - Workers Comp: $108.30 Corvel — Corvel - Workers Comp: $104.88 Coventry — Coventry- Workers Comp: $99.18 First Health/HCVM — First Health/HCVM: $99.18 Maine Community Health Options — MCHO Indiv - Exchange: $72.62 Maine Community Health Options — MCHO SHOP - Exchange: $83.79
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Renal function panel	Not listed in the file	Not listed in the file	$3.65 – $62.11
Kidney function panel: 10 of 61 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $31.70 Aetna — Aetna HMO/POS/PPO: $31.70 Aetna — Aetna HMO/POS/PPO - ARNB: $31.70 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $7.93 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $7.74 Anthem Health Plans of NH — Anthem - Federal Employee Program: $9.11 Anthem Health Plans of NH — Anthem - Indemnity: $9.11 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $5.64 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $9.11 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $9.11
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PNL '00	$84	$25.70	$9.52 – $79.80
Liver function panel: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $58.97 Aetna — Aetna HMO/POS/PPO - ARNB: $51.58 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $9.52 Anthem Health Plans of NH — Anthem - Federal Employee Program: $73.20 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $46.03 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $46.03 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $56.11 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $10.26 CCMSI — CCMSI - Workers Comp: $79.80 Cigna — Cigna HMO-POS: $50.82
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PNL '00	$84	$25.70	$28.98 – $79.80
Liver function panel: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $58.97 Aetna — Aetna HMO/POS/PPO - ARNB: $51.58 Anthem Health Plans of NH — Anthem - Federal Employee Program: $68.93 Anthem Health Plans of NH — Anthem - Indemnity: $68.93 CCMSI — CCMSI - Workers Comp: $79.80 Corvel — Corvel - Workers Comp: $77.28 Coventry — Coventry- Workers Comp: $73.08 First Health/HCVM — First Health/HCVM: $73.08 Maine Community Health Options — MCHO Indiv - Exchange: $53.51 Maine Community Health Options — MCHO SHOP - Exchange: $61.74
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Hepatic function panel	Not listed in the file	Not listed in the file	$3.43 – $58.44
Liver function panel: 10 of 77 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $29.83 Aetna — Aetna HMO/POS/PPO: $29.83 Aetna — Aetna HMO/POS/PPO - ARNB: $29.83 Aetna — Aetna Medicare Advantage - DHP: $8.41 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $26.78 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $19.37 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $8.57 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $7.46 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $7.28 Anthem Health Plans of NH — Anthem - Federal Employee Program: $8.58
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS ROUTINE	$164	$50.18	$18.58 – $155.80
Urine test (automated, with microscope): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $115.13 Aetna — Aetna HMO/POS/PPO - ARNB: $100.70 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $18.58 Anthem Health Plans of NH — Anthem - Federal Employee Program: $142.91 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $89.87 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $89.87 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $109.55 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $20.02 CCMSI — CCMSI - Workers Comp: $155.80 Cigna — Cigna HMO-POS: $99.22
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS ROUTINE	$164	$50.18	$56.58 – $155.80
Urine test (automated, with microscope): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $115.13 Aetna — Aetna HMO/POS/PPO - ARNB: $100.70 Anthem Health Plans of NH — Anthem - Federal Employee Program: $134.58 Anthem Health Plans of NH — Anthem - Indemnity: $134.58 CCMSI — CCMSI - Workers Comp: $155.80 Corvel — Corvel - Workers Comp: $150.88 Coventry — Coventry- Workers Comp: $142.68 First Health/HCVM — First Health/HCVM: $142.68 Maine Community Health Options — MCHO Indiv - Exchange: $104.47 Maine Community Health Options — MCHO SHOP - Exchange: $120.54
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$1.90 – $23.93
Urine test (automated, with microscope): 10 of 77 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $11.58 Aetna — Aetna HMO/POS/PPO: $11.58 Aetna — Aetna HMO/POS/PPO - ARNB: $11.58 Aetna — Aetna Medicare Advantage - DHP: $3.26 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $10.39 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $7.51 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $3.32 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $2.89 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $2.82 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3.33
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: POCT URINALYSIS NONAUTO W/O SCOPE	$60	$18.36	$6.80 – $57
Urine test (manual, without microscope): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $42.12 Aetna — Aetna HMO/POS/PPO - ARNB: $36.84 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $6.80 Anthem Health Plans of NH — Anthem - Federal Employee Program: $52.28 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $32.88 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $32.88 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $40.08 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $7.33 CCMSI — CCMSI - Workers Comp: $57 Cigna — Cigna HMO-POS: $36.30
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, DIP STICK OR TABLET, NON-AUTO W/O MICROSCOPY	$60	$18.36	$6.80 – $57
Urine test (manual, without microscope): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $42.12 Aetna — Aetna HMO/POS/PPO - ARNB: $36.84 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $6.80 Anthem Health Plans of NH — Anthem - Federal Employee Program: $52.28 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $32.88 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $32.88 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $40.08 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $7.33 CCMSI — CCMSI - Workers Comp: $57 Cigna — Cigna HMO-POS: $36.30
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Doctor (professional) fee In the file: POCT URINALYSIS NONAUTO W/O SCOPE	$60	$18.36	$20.70 – $57
Urine test (manual, without microscope): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $42.12 Aetna — Aetna HMO/POS/PPO - ARNB: $36.84 Anthem Health Plans of NH — Anthem - Federal Employee Program: $49.24 Anthem Health Plans of NH — Anthem - Indemnity: $49.24 CCMSI — CCMSI - Workers Comp: $57 Corvel — Corvel - Workers Comp: $55.20 Coventry — Coventry- Workers Comp: $52.20 First Health/HCVM — First Health/HCVM: $52.20 Maine Community Health Options — MCHO Indiv - Exchange: $38.22 Maine Community Health Options — MCHO SHOP - Exchange: $44.10
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UA W/OUT MICROSCOPIC	$121	$37.03	$13.71 – $114.95
Urine test (automated, without microscope): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $84.94 Aetna — Aetna HMO/POS/PPO - ARNB: $74.29 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $13.71 Anthem Health Plans of NH — Anthem - Federal Employee Program: $105.44 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $66.31 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $66.31 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $80.83 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $14.77 CCMSI — CCMSI - Workers Comp: $114.95 Cigna — Cigna HMO-POS: $73.20
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, AUTO, W/O SCOPE	$115	$35.19	$13.03 – $109.25
Urine test (automated, without microscope): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $80.73 Aetna — Aetna HMO/POS/PPO - ARNB: $70.61 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $13.03 Anthem Health Plans of NH — Anthem - Federal Employee Program: $100.21 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $63.02 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $63.02 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $76.82 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $14.04 CCMSI — CCMSI - Workers Comp: $109.25 Cigna — Cigna HMO-POS: $69.58
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UA W/OUT MICROSCOPIC	$121	$37.03	$41.74 – $114.95
Urine test (automated, without microscope): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $84.94 Aetna — Aetna HMO/POS/PPO - ARNB: $74.29 Anthem Health Plans of NH — Anthem - Federal Employee Program: $99.29 Anthem Health Plans of NH — Anthem - Indemnity: $99.29 CCMSI — CCMSI - Workers Comp: $114.95 Corvel — Corvel - Workers Comp: $111.32 Coventry — Coventry- Workers Comp: $105.27 First Health/HCVM — First Health/HCVM: $105.27 Maine Community Health Options — MCHO Indiv - Exchange: $77.08 Maine Community Health Options — MCHO SHOP - Exchange: $88.94
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROSTATE SPECIFIC ANTIGEN	$127	$38.86	$14.39 – $120.65
PSA (prostate specific antigen) blood test: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $89.15 Aetna — Aetna HMO/POS/PPO - ARNB: $77.98 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $14.39 Anthem Health Plans of NH — Anthem - Federal Employee Program: $110.67 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $69.60 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $69.60 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $84.84 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $15.51 CCMSI — CCMSI - Workers Comp: $120.65 Cigna — Cigna HMO-POS: $76.83
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROSTATE SPECIFIC AG SCREENING	$127	$38.86	$14.39 – $120.65
PSA (prostate specific antigen) blood test: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $89.15 Aetna — Aetna HMO/POS/PPO - ARNB: $77.98 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $14.39 Anthem Health Plans of NH — Anthem - Federal Employee Program: $110.67 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $69.60 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $69.60 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $84.84 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $15.51 CCMSI — CCMSI - Workers Comp: $120.65 Cigna — Cigna HMO-POS: $76.83
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PCH TOTAL PSA (PHI)	$56	$17.14	$6.34 – $53.20
PSA (prostate specific antigen) blood test: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $39.31 Aetna — Aetna HMO/POS/PPO - ARNB: $34.38 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $6.34 Anthem Health Plans of NH — Anthem - Federal Employee Program: $48.80 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $30.69 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $30.69 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $37.41 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $6.84 CCMSI — CCMSI - Workers Comp: $53.20 Cigna — Cigna HMO-POS: $33.88
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THYROID STIMULATING HORMONE, SERUM	$101	$30.91	$11.44 – $95.95
Thyroid stimulating hormone (TSH) test: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $70.90 Aetna — Aetna HMO/POS/PPO - ARNB: $62.01 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $11.44 Anthem Health Plans of NH — Anthem - Federal Employee Program: $88.01 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $55.35 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $55.35 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $67.47 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $12.33 CCMSI — CCMSI - Workers Comp: $95.95 Cigna — Cigna HMO-POS: $61.10
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PCH TSH; NEOGEN	$55	$16.83	$6.23 – $52.25
Thyroid stimulating hormone (TSH) test: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $38.61 Aetna — Aetna HMO/POS/PPO - ARNB: $33.77 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $6.23 Anthem Health Plans of NH — Anthem - Federal Employee Program: $47.93 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $30.14 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $30.14 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $36.74 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $6.72 CCMSI — CCMSI - Workers Comp: $52.25 Cigna — Cigna HMO-POS: $33.28
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THYROID STIMULATING HORMONE, SERUM	$101	$30.91	$34.84 – $95.95
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $70.90 Aetna — Aetna HMO/POS/PPO - ARNB: $62.01 Anthem Health Plans of NH — Anthem - Federal Employee Program: $82.88 Anthem Health Plans of NH — Anthem - Indemnity: $82.88 CCMSI — CCMSI - Workers Comp: $95.95 Corvel — Corvel - Workers Comp: $92.92 Coventry — Coventry- Workers Comp: $87.87 First Health/HCVM — First Health/HCVM: $87.87 Maine Community Health Options — MCHO Indiv - Exchange: $64.34 Maine Community Health Options — MCHO SHOP - Exchange: $74.24
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC,PLT & AUTO DIFF	$87	$26.62	$9.86 – $82.65
Complete blood count (CBC) with differential: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $61.07 Aetna — Aetna HMO/POS/PPO - ARNB: $53.42 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $9.86 Anthem Health Plans of NH — Anthem - Federal Employee Program: $75.81 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $47.68 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $47.68 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $58.12 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $10.62 CCMSI — CCMSI - Workers Comp: $82.65 Cigna — Cigna HMO-POS: $52.64
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD COUNT - HEMO	$53	$16.22	$6 – $50.35
Complete blood count (CBC) with differential: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $37.21 Aetna — Aetna HMO/POS/PPO - ARNB: $32.54 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $6 Anthem Health Plans of NH — Anthem - Federal Employee Program: $46.18 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $29.04 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $29.04 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $35.40 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $6.47 CCMSI — CCMSI - Workers Comp: $50.35 Cigna — Cigna HMO-POS: $32.06
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC,PLT & AUTO DIFF	$87	$26.62	$30.01 – $82.65
Complete blood count (CBC) with differential: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $61.07 Aetna — Aetna HMO/POS/PPO - ARNB: $53.42 Anthem Health Plans of NH — Anthem - Federal Employee Program: $71.39 Anthem Health Plans of NH — Anthem - Indemnity: $71.39 CCMSI — CCMSI - Workers Comp: $82.65 Corvel — Corvel - Workers Comp: $80.04 Coventry — Coventry- Workers Comp: $75.69 First Health/HCVM — First Health/HCVM: $75.69 Maine Community Health Options — MCHO Indiv - Exchange: $55.42 Maine Community Health Options — MCHO SHOP - Exchange: $63.94
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEMOGRAM	$54	$16.52	$6.12 – $51.30
Complete blood count (CBC), automated: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $37.91 Aetna — Aetna HMO/POS/PPO - ARNB: $33.16 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $6.12 Anthem Health Plans of NH — Anthem - Federal Employee Program: $47.06 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $29.59 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $29.59 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $36.07 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $6.59 CCMSI — CCMSI - Workers Comp: $51.30 Cigna — Cigna HMO-POS: $32.67
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HEMOGRAM	$54	$16.52	$18.63 – $51.30
Complete blood count (CBC), automated: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $37.91 Aetna — Aetna HMO/POS/PPO - ARNB: $33.16 Anthem Health Plans of NH — Anthem - Federal Employee Program: $44.31 Anthem Health Plans of NH — Anthem - Indemnity: $44.31 CCMSI — CCMSI - Workers Comp: $51.30 Corvel — Corvel - Workers Comp: $49.68 Coventry — Coventry- Workers Comp: $46.98 First Health/HCVM — First Health/HCVM: $46.98 Maine Community Health Options — MCHO Indiv - Exchange: $34.40 Maine Community Health Options — MCHO SHOP - Exchange: $39.69
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Complete cbc automated	Not listed in the file	Not listed in the file	$2.72 – $46.33
Complete blood count (CBC), automated: 10 of 77 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $23.62 Aetna — Aetna HMO/POS/PPO: $23.63 Aetna — Aetna HMO/POS/PPO - ARNB: $23.63 Aetna — Aetna Medicare Advantage - DHP: $6.66 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $21.21 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $15.34 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $6.79 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $5.91 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $5.77 Anthem Health Plans of NH — Anthem - Federal Employee Program: $6.78
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME	$69	$21.11	$7.82 – $65.55
Blood clotting time test (prothrombin time, PT): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $48.44 Aetna — Aetna HMO/POS/PPO - ARNB: $42.37 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $7.82 Anthem Health Plans of NH — Anthem - Federal Employee Program: $60.13 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $37.81 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $37.81 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $46.09 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $8.42 CCMSI — CCMSI - Workers Comp: $65.55 Cigna — Cigna HMO-POS: $41.74
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME	$69	$21.11	$23.80 – $65.55
Blood clotting time test (prothrombin time, PT): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $48.44 Aetna — Aetna HMO/POS/PPO - ARNB: $42.37 Anthem Health Plans of NH — Anthem - Federal Employee Program: $56.62 Anthem Health Plans of NH — Anthem - Indemnity: $56.62 CCMSI — CCMSI - Workers Comp: $65.55 Corvel — Corvel - Workers Comp: $63.48 Coventry — Coventry- Workers Comp: $60.03 First Health/HCVM — First Health/HCVM: $60.03 Maine Community Health Options — MCHO Indiv - Exchange: $43.95 Maine Community Health Options — MCHO SHOP - Exchange: $50.72
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Prothrombin time	Not listed in the file	Not listed in the file	$2.57 – $28.09
Blood clotting time test (prothrombin time, PT): 10 of 58 insurance plan rates Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $3.58 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $3.82 Anthem Health Plans of NH — Anthem - Federal Employee Program: $4.12 Anthem Health Plans of NH — Anthem - Indemnity: $4.12 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $2.79 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $4.12 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $4.12 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $2.79 Anthem Health Plans of NH — Anthem PPO: $4.12 Anthem Health Plans of NH — Anthem PPO - DHP: $2.79
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PCH PTT (CGP)	$64	$19.58	$7.25 – $60.80
Blood clotting test (partial thromboplastin time, PTT): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $44.93 Aetna — Aetna HMO/POS/PPO - ARNB: $39.30 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $7.25 Anthem Health Plans of NH — Anthem - Federal Employee Program: $55.77 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $35.07 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $35.07 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $42.75 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $7.81 CCMSI — CCMSI - Workers Comp: $60.80 Cigna — Cigna HMO-POS: $38.72
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PARTIAL THROMBOPLASTIN TIME	$68	$20.81	$7.70 – $64.60
Blood clotting test (partial thromboplastin time, PTT): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $47.74 Aetna — Aetna HMO/POS/PPO - ARNB: $41.75 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $7.70 Anthem Health Plans of NH — Anthem - Federal Employee Program: $59.26 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $37.26 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $37.26 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $45.42 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $8.30 CCMSI — CCMSI - Workers Comp: $64.60 Cigna — Cigna HMO-POS: $41.14
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PCH PTT (CGP)	$64	$19.58	$22.08 – $60.80
Blood clotting test (partial thromboplastin time, PTT): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $44.93 Aetna — Aetna HMO/POS/PPO - ARNB: $39.30 Anthem Health Plans of NH — Anthem - Federal Employee Program: $52.52 Anthem Health Plans of NH — Anthem - Indemnity: $52.52 CCMSI — CCMSI - Workers Comp: $60.80 Corvel — Corvel - Workers Comp: $58.88 Coventry — Coventry- Workers Comp: $55.68 First Health/HCVM — First Health/HCVM: $55.68 Maine Community Health Options — MCHO Indiv - Exchange: $40.77 Maine Community Health Options — MCHO SHOP - Exchange: $47.04

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 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT SCAN HEAD/BRAIN	$2,835	$867.51	$321.21 – $2,693.25
CT scan of the head or brain, without contrast: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,990.17 Aetna — Aetna HMO/POS/PPO - ARNB: $1,740.69 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $321.21 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,470.42 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $1,553.58 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $1,553.58 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $1,893.78 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $346.15 CCMSI — CCMSI - Workers Comp: $2,693.25 Cigna — Cigna HMO-POS: $1,715.18
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT SCAN HEAD/BRAIN	$2,835	$867.51	$978.08 – $2,693.25
CT scan of the head or brain, without contrast: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,990.17 Aetna — Aetna HMO/POS/PPO - ARNB: $1,740.69 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,326.40 Anthem Health Plans of NH — Anthem - Indemnity: $2,326.40 CCMSI — CCMSI - Workers Comp: $2,693.25 Corvel — Corvel - Workers Comp: $2,608.20 Coventry — Coventry- Workers Comp: $2,466.45 First Health/HCVM — First Health/HCVM: $2,466.45 Maine Community Health Options — MCHO Indiv - Exchange: $1,805.90 Maine Community Health Options — MCHO SHOP - Exchange: $2,083.72
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct head/brain w/o dye	Not listed in the file	Not listed in the file	$119 – $2,793.47
CT scan of the head or brain, without contrast: 10 of 33 insurance plan rates Aetna — Aetna Medicare Advantage: $122.57 Ambetter Health — Ambetter Commercial - Exchange: $256.03 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $164.11 Anthem Health Plans of NH — Anthem - Indemnity: $463.04 Anthem Health Plans of NH — Anthem - Medicare Advantage: $119 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $429.20 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $182.80 Anthem Health Plans of NH — Anthem PPO: $463.04 Anthem Health Plans of NH — Anthem SHOP - Exchange: $275.06 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $119
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI BRAIN W/O&W CONTRAST	$7,499	$2,294.69	$849.64 – $7,124.05
MRI of the brain, before and after contrast: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $5,264.30 Aetna — Aetna HMO/POS/PPO - ARNB: $4,604.39 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $849.64 Anthem Health Plans of NH — Anthem - Federal Employee Program: $6,534.63 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $4,109.45 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $4,109.45 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $5,009.33 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $915.63 CCMSI — CCMSI - Workers Comp: $7,124.05 Cigna — Cigna HMO-POS: $4,536.89
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI BRAIN W/O&W CONTRAST	$7,499	$2,294.69	$2,587.15 – $7,124.05
MRI of the brain, before and after contrast: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $5,264.30 Aetna — Aetna HMO/POS/PPO - ARNB: $4,604.39 Anthem Health Plans of NH — Anthem - Federal Employee Program: $6,153.68 Anthem Health Plans of NH — Anthem - Indemnity: $6,153.68 CCMSI — CCMSI - Workers Comp: $7,124.05 Corvel — Corvel - Workers Comp: $6,899.08 Coventry — Coventry- Workers Comp: $6,524.13 First Health/HCVM — First Health/HCVM: $6,524.13 Maine Community Health Options — MCHO Indiv - Exchange: $4,776.86 Maine Community Health Options — MCHO SHOP - Exchange: $5,511.76
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri brain stem w/o & w/dye	Not listed in the file	Not listed in the file	$399.65 – $5,235.14
MRI of the brain, before and after contrast: 10 of 33 insurance plan rates Aetna — Aetna Medicare Advantage: $411.64 Ambetter Health — Ambetter Commercial - Exchange: $859.81 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $551.12 Anthem Health Plans of NH — Anthem - Indemnity: $1,555.02 Anthem Health Plans of NH — Anthem - Medicare Advantage: $399.65 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $1,441.40 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $613.90 Anthem Health Plans of NH — Anthem PPO: $1,555.02 Anthem Health Plans of NH — Anthem SHOP - Exchange: $923.74 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $399.65
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-RAY CHEST 2 VIEWS	$615	$188.19	$69.68 – $584.25
Chest X-ray, 2 views: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $431.73 Aetna — Aetna HMO/POS/PPO - ARNB: $377.61 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $69.68 Anthem Health Plans of NH — Anthem - Federal Employee Program: $535.91 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $337.02 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $337.02 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $410.82 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $75.09 CCMSI — CCMSI - Workers Comp: $584.25 Cigna — Cigna HMO-POS: $372.08
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: X-RAY CHEST 2 VIEWS	$615	$188.19	$212.18 – $584.25
Chest X-ray, 2 views: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $431.73 Aetna — Aetna HMO/POS/PPO - ARNB: $377.61 Anthem Health Plans of NH — Anthem - Federal Employee Program: $504.67 Anthem Health Plans of NH — Anthem - Indemnity: $504.67 CCMSI — CCMSI - Workers Comp: $584.25 Corvel — Corvel - Workers Comp: $565.80 Coventry — Coventry- Workers Comp: $535.05 First Health/HCVM — First Health/HCVM: $535.05 Maine Community Health Options — MCHO Indiv - Exchange: $391.76 Maine Community Health Options — MCHO SHOP - Exchange: $452.02
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam chest 2 views	Not listed in the file	Not listed in the file	$98.53 – $484.28
Chest X-ray, 2 views: 10 of 28 insurance plan rates Aetna — Aetna Medicare Advantage: $101.48 Ambetter Health — Ambetter Commercial - Exchange: $211.97 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $135.87 Anthem Health Plans of NH — Anthem - Indemnity: $383.37 Anthem Health Plans of NH — Anthem - Medicare Advantage: $98.53 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $355.36 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $151.35 Anthem Health Plans of NH — Anthem PPO: $383.37 Anthem Health Plans of NH — Anthem SHOP - Exchange: $227.73 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $98.53
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-RAY LUMBAR SPINE MINIMUM 4/5 VW	$1,047	$320.38	$118.63 – $994.65
X-ray of the lower spine, at least 4 views: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $734.99 Aetna — Aetna HMO/POS/PPO - ARNB: $642.86 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $118.63 Anthem Health Plans of NH — Anthem - Federal Employee Program: $912.36 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $573.76 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $573.76 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $699.40 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $127.84 CCMSI — CCMSI - Workers Comp: $994.65 Cigna — Cigna HMO-POS: $633.43
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: X-RAY LUMBAR SPINE MINIMUM 4/5 VW	$1,047	$320.38	$361.22 – $994.65
X-ray of the lower spine, at least 4 views: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $734.99 Aetna — Aetna HMO/POS/PPO - ARNB: $642.86 Anthem Health Plans of NH — Anthem - Federal Employee Program: $859.17 Anthem Health Plans of NH — Anthem - Indemnity: $859.17 CCMSI — CCMSI - Workers Comp: $994.65 Corvel — Corvel - Workers Comp: $963.24 Coventry — Coventry- Workers Comp: $910.89 First Health/HCVM — First Health/HCVM: $910.89 Maine Community Health Options — MCHO Indiv - Exchange: $666.94 Maine Community Health Options — MCHO SHOP - Exchange: $769.54
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam l-2 spine 4/>vws	Not listed in the file	Not listed in the file	$119 – $914.50
X-ray of the lower spine, at least 4 views: 10 of 32 insurance plan rates Aetna — Aetna Medicare Advantage: $122.57 Ambetter Health — Ambetter Commercial - Exchange: $256.03 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $164.11 Anthem Health Plans of NH — Anthem - Indemnity: $463.04 Anthem Health Plans of NH — Anthem - Medicare Advantage: $119 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $429.20 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $182.80 Anthem Health Plans of NH — Anthem PPO: $463.04 Anthem Health Plans of NH — Anthem SHOP - Exchange: $275.06 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $119
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LUMBAR SPINE	$5,096	$1,559.38	$577.38 – $4,841.20
MRI of the lower back (lumbar spine), without contrast: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,577.39 Aetna — Aetna HMO/POS/PPO - ARNB: $3,128.94 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $577.38 Anthem Health Plans of NH — Anthem - Federal Employee Program: $4,440.65 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,792.61 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,792.61 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $3,404.13 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $622.22 CCMSI — CCMSI - Workers Comp: $4,841.20 Cigna — Cigna HMO-POS: $3,083.08
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI LUMBAR SPINE	$5,096	$1,559.38	$1,758.12 – $4,841.20
MRI of the lower back (lumbar spine), without contrast: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,577.39 Aetna — Aetna HMO/POS/PPO - ARNB: $3,128.94 Anthem Health Plans of NH — Anthem - Federal Employee Program: $4,181.78 Anthem Health Plans of NH — Anthem - Indemnity: $4,181.78 CCMSI — CCMSI - Workers Comp: $4,841.20 Corvel — Corvel - Workers Comp: $4,688.32 Coventry — Coventry- Workers Comp: $4,433.52 First Health/HCVM — First Health/HCVM: $4,433.52 Maine Community Health Options — MCHO Indiv - Exchange: $3,246.15 Maine Community Health Options — MCHO SHOP - Exchange: $3,745.56
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri lumbar spine w/o dye	Not listed in the file	Not listed in the file	$270.50 – $3,977.48
MRI of the lower back (lumbar spine), without contrast: 10 of 33 insurance plan rates Aetna — Aetna Medicare Advantage: $278.62 Ambetter Health — Ambetter Commercial - Exchange: $581.95 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $373.02 Anthem Health Plans of NH — Anthem - Indemnity: $1,052.50 Anthem Health Plans of NH — Anthem - Medicare Advantage: $270.50 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $975.59 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $415.51 Anthem Health Plans of NH — Anthem PPO: $1,052.50 Anthem Health Plans of NH — Anthem SHOP - Exchange: $625.22 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $270.50
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT SCAN PELVIS CONTRAST	$3,636	$1,112.62	$411.96 – $3,454.20
CT scan of the pelvis, with contrast: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,552.47 Aetna — Aetna HMO/POS/PPO - ARNB: $2,232.50 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $411.96 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,168.41 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $1,992.53 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $1,992.53 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,428.85 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $443.96 CCMSI — CCMSI - Workers Comp: $3,454.20 Cigna — Cigna HMO-POS: $2,199.78
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT SCAN PELVIS CONTRAST	$3,636	$1,112.62	$1,254.42 – $3,454.20
CT scan of the pelvis, with contrast: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,552.47 Aetna — Aetna HMO/POS/PPO - ARNB: $2,232.50 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,983.70 Anthem Health Plans of NH — Anthem - Indemnity: $2,983.70 CCMSI — CCMSI - Workers Comp: $3,454.20 Corvel — Corvel - Workers Comp: $3,345.12 Coventry — Coventry- Workers Comp: $3,163.32 First Health/HCVM — First Health/HCVM: $3,163.32 Maine Community Health Options — MCHO Indiv - Exchange: $2,316.13 Maine Community Health Options — MCHO SHOP - Exchange: $2,672.46
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct pelvis w/dye	Not listed in the file	Not listed in the file	$199.21 – $1,861.17
CT scan of the pelvis, with contrast: 10 of 33 insurance plan rates Aetna — Aetna Medicare Advantage: $205.19 Ambetter Health — Ambetter Commercial - Exchange: $428.59 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $274.71 Anthem Health Plans of NH — Anthem - Indemnity: $775.12 Anthem Health Plans of NH — Anthem - Medicare Advantage: $199.21 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $718.48 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $306.01 Anthem Health Plans of NH — Anthem PPO: $775.12 Anthem Health Plans of NH — Anthem SHOP - Exchange: $460.45 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $199.21
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LOWER EXTREMITY JOINT	$5,181	$1,585.39	$587.01 – $4,921.95
MRI of a leg joint (such as the knee), without contrast: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,637.06 Aetna — Aetna HMO/POS/PPO - ARNB: $3,181.13 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $587.01 Anthem Health Plans of NH — Anthem - Federal Employee Program: $4,514.72 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,839.19 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,839.19 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $3,460.91 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $632.60 CCMSI — CCMSI - Workers Comp: $4,921.95 Cigna — Cigna HMO-POS: $3,134.50
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI LOWER EXTREMITY JOINT	$5,181	$1,585.39	$1,787.44 – $4,921.95
MRI of a leg joint (such as the knee), without contrast: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,637.06 Aetna — Aetna HMO/POS/PPO - ARNB: $3,181.13 Anthem Health Plans of NH — Anthem - Federal Employee Program: $4,251.53 Anthem Health Plans of NH — Anthem - Indemnity: $4,251.53 CCMSI — CCMSI - Workers Comp: $4,921.95 Corvel — Corvel - Workers Comp: $4,766.52 Coventry — Coventry- Workers Comp: $4,507.47 First Health/HCVM — First Health/HCVM: $4,507.47 Maine Community Health Options — MCHO Indiv - Exchange: $3,300.30 Maine Community Health Options — MCHO SHOP - Exchange: $3,808.04
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	Not listed in the file	$270.50 – $5,225.45
MRI of a leg joint (such as the knee), without contrast: 10 of 33 insurance plan rates Aetna — Aetna Medicare Advantage: $278.62 Ambetter Health — Ambetter Commercial - Exchange: $581.95 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $373.02 Anthem Health Plans of NH — Anthem - Indemnity: $1,052.50 Anthem Health Plans of NH — Anthem - Medicare Advantage: $270.50 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $975.59 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $415.51 Anthem Health Plans of NH — Anthem PPO: $1,052.50 Anthem Health Plans of NH — Anthem SHOP - Exchange: $625.22 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $270.50
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT ABD AND PELVIS CONTRAST	$6,421	$1,964.83	$727.50 – $6,099.95
CT scan of the abdomen and pelvis, with contrast: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $4,507.54 Aetna — Aetna HMO/POS/PPO - ARNB: $3,942.49 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $727.50 Anthem Health Plans of NH — Anthem - Federal Employee Program: $5,595.26 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $3,518.71 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $3,518.71 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $4,289.23 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $784 CCMSI — CCMSI - Workers Comp: $6,099.95 Cigna — Cigna HMO-POS: $3,884.70
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT ABD AND PELVIS CONTRAST	$6,421	$1,964.83	$2,215.24 – $6,099.95
CT scan of the abdomen and pelvis, with contrast: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $4,507.54 Aetna — Aetna HMO/POS/PPO - ARNB: $3,942.49 Anthem Health Plans of NH — Anthem - Federal Employee Program: $5,269.07 Anthem Health Plans of NH — Anthem - Indemnity: $5,269.07 CCMSI — CCMSI - Workers Comp: $6,099.95 Corvel — Corvel - Workers Comp: $5,907.32 Coventry — Coventry- Workers Comp: $5,586.27 First Health/HCVM — First Health/HCVM: $5,586.27 Maine Community Health Options — MCHO Indiv - Exchange: $4,090.18 Maine Community Health Options — MCHO SHOP - Exchange: $4,719.43
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct abd & pelvis w/contrast	Not listed in the file	Not listed in the file	$399.65 – $3,122.94
CT scan of the abdomen and pelvis, with contrast: 10 of 30 insurance plan rates Aetna — Aetna Medicare Advantage: $411.64 Ambetter Health — Ambetter Commercial - Exchange: $859.81 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $551.12 Anthem Health Plans of NH — Anthem - Indemnity: $1,555.02 Anthem Health Plans of NH — Anthem - Medicare Advantage: $399.65 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $1,441.40 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $613.90 Anthem Health Plans of NH — Anthem PPO: $1,555.02 Anthem Health Plans of NH — Anthem SHOP - Exchange: $923.74 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $399.65
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US ABDOM B-SCAN &/OR REAL TIME, COMPLETE	$1,649	$504.59	$186.83 – $1,566.55
Ultrasound of the abdomen, complete: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,157.60 Aetna — Aetna HMO/POS/PPO - ARNB: $1,012.49 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $186.83 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,436.94 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $903.65 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $903.65 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $1,101.53 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $201.34 CCMSI — CCMSI - Workers Comp: $1,566.55 Cigna — Cigna HMO-POS: $997.64
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US ABDOM B-SCAN &/OR REAL TIME, COMPLETE	$1,649	$504.59	$568.90 – $1,566.55
Ultrasound of the abdomen, complete: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,157.60 Aetna — Aetna HMO/POS/PPO - ARNB: $1,012.49 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,353.17 Anthem Health Plans of NH — Anthem - Indemnity: $1,353.17 CCMSI — CCMSI - Workers Comp: $1,566.55 Corvel — Corvel - Workers Comp: $1,517.08 Coventry — Coventry- Workers Comp: $1,434.63 First Health/HCVM — First Health/HCVM: $1,434.63 Maine Community Health Options — MCHO Indiv - Exchange: $1,050.41 Maine Community Health Options — MCHO SHOP - Exchange: $1,212.01
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Us exam abdom complete	Not listed in the file	Not listed in the file	$119 – $1,237.79
Ultrasound of the abdomen, complete: 10 of 34 insurance plan rates Aetna — Aetna Medicare Advantage: $122.57 Ambetter Health — Ambetter Commercial - Exchange: $256.03 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $164.11 Anthem Health Plans of NH — Anthem - Indemnity: $463.04 Anthem Health Plans of NH — Anthem - Medicare Advantage: $119 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $429.20 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $182.80 Anthem Health Plans of NH — Anthem PPO: $463.04 Anthem Health Plans of NH — Anthem SHOP - Exchange: $275.06 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $119
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US PREGNANT UTERUS AFTER 1ST TRIMEST 1ST GESTATION	$1,403	$429.32	$158.96 – $1,332.85
Pregnancy ultrasound (after the first trimester): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $984.91 Aetna — Aetna HMO/POS/PPO - ARNB: $861.44 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $158.96 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,222.57 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $768.84 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $768.84 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $937.20 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $171.31 CCMSI — CCMSI - Workers Comp: $1,332.85 Cigna — Cigna HMO-POS: $848.82
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US PREGNANT UTERUS AFTER 1ST TRIMEST 1ST GESTATION	$1,403	$429.32	$484.04 – $1,332.85
Pregnancy ultrasound (after the first trimester): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $984.91 Aetna — Aetna HMO/POS/PPO - ARNB: $861.44 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,151.30 Anthem Health Plans of NH — Anthem - Indemnity: $1,151.30 CCMSI — CCMSI - Workers Comp: $1,332.85 Corvel — Corvel - Workers Comp: $1,290.76 Coventry — Coventry- Workers Comp: $1,220.61 First Health/HCVM — First Health/HCVM: $1,220.61 Maine Community Health Options — MCHO Indiv - Exchange: $893.71 Maine Community Health Options — MCHO SHOP - Exchange: $1,031.20
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ob us > 14 wks sngl fetus	Not listed in the file	Not listed in the file	$119 – $776.78
Pregnancy ultrasound (after the first trimester): 10 of 32 insurance plan rates Aetna — Aetna Medicare Advantage: $122.57 Ambetter Health — Ambetter Commercial - Exchange: $256.03 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $164.11 Anthem Health Plans of NH — Anthem - Indemnity: $463.04 Anthem Health Plans of NH — Anthem - Medicare Advantage: $119 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $429.20 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $182.80 Anthem Health Plans of NH — Anthem PPO: $463.04 Anthem Health Plans of NH — Anthem SHOP - Exchange: $275.06 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $119
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OVULATION INDUCTION US TRANSVAGINAL	$470	$143.82	$53.25 – $446.50
Transvaginal ultrasound: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $329.94 Aetna — Aetna HMO/POS/PPO - ARNB: $288.58 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $53.25 Anthem Health Plans of NH — Anthem - Federal Employee Program: $409.56 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $257.56 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $257.56 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $313.96 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $57.39 CCMSI — CCMSI - Workers Comp: $446.50 Cigna — Cigna HMO-POS: $284.35
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US TRANSVAGINAL	$1,184	$362.30	$134.15 – $1,124.80
Transvaginal ultrasound: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $831.17 Aetna — Aetna HMO/POS/PPO - ARNB: $726.98 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $134.15 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,031.74 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $648.83 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $648.83 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $790.91 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $144.57 CCMSI — CCMSI - Workers Comp: $1,124.80 Cigna — Cigna HMO-POS: $716.32
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OVULATION INDUCTION US TRANSVAGINAL	$470	$143.82	$162.15 – $446.50
Transvaginal ultrasound: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $329.94 Aetna — Aetna HMO/POS/PPO - ARNB: $288.58 Anthem Health Plans of NH — Anthem - Federal Employee Program: $385.68 Anthem Health Plans of NH — Anthem - Indemnity: $385.68 CCMSI — CCMSI - Workers Comp: $446.50 Corvel — Corvel - Workers Comp: $432.40 Coventry — Coventry- Workers Comp: $408.90 First Health/HCVM — First Health/HCVM: $408.90 Maine Community Health Options — MCHO Indiv - Exchange: $299.39 Maine Community Health Options — MCHO SHOP - Exchange: $345.45
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$854	$261.32	$96.76 – $811.30
Diagnostic mammogram, one breast: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $599.51 Aetna — Aetna HMO/POS/PPO - ARNB: $524.36 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $96.76 Anthem Health Plans of NH — Anthem - Federal Employee Program: $744.18 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $467.99 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $467.99 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $570.47 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $104.27 CCMSI — CCMSI - Workers Comp: $811.30 Cigna — Cigna HMO-POS: $516.67
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$854	$261.32	$294.63 – $811.30
Diagnostic mammogram, one breast: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $599.51 Aetna — Aetna HMO/POS/PPO - ARNB: $524.36 Anthem Health Plans of NH — Anthem - Federal Employee Program: $700.79 Anthem Health Plans of NH — Anthem - Indemnity: $700.79 CCMSI — CCMSI - Workers Comp: $811.30 Corvel — Corvel - Workers Comp: $785.68 Coventry — Coventry- Workers Comp: $742.98 First Health/HCVM — First Health/HCVM: $742.98 Maine Community Health Options — MCHO Indiv - Exchange: $544 Maine Community Health Options — MCHO SHOP - Exchange: $627.69
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$124.94 – $649.40
Diagnostic mammogram, one breast: 10 of 28 insurance plan rates Aetna — Aetna Medicare Advantage: $128.69 Ambetter Health — Ambetter Commercial - Exchange: $268.80 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $172.29 Anthem Health Plans of NH — Anthem - Indemnity: $449.78 Anthem Health Plans of NH — Anthem - Medicare Advantage: $124.94 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $449.78 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $331.09 Anthem Health Plans of NH — Anthem PPO: $449.78 Anthem Health Plans of NH — Anthem SHOP - Exchange: $374.82 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $124.94
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$1,096	$335.38	$124.18 – $1,041.20
Diagnostic mammogram, both breasts: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $769.39 Aetna — Aetna HMO/POS/PPO - ARNB: $672.94 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $124.18 Anthem Health Plans of NH — Anthem - Federal Employee Program: $955.05 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $600.61 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $600.61 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $732.13 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $133.82 CCMSI — CCMSI - Workers Comp: $1,041.20 Cigna — Cigna HMO-POS: $663.08
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$1,096	$335.38	$378.12 – $1,041.20
Diagnostic mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $769.39 Aetna — Aetna HMO/POS/PPO - ARNB: $672.94 Anthem Health Plans of NH — Anthem - Federal Employee Program: $899.38 Anthem Health Plans of NH — Anthem - Indemnity: $899.38 CCMSI — CCMSI - Workers Comp: $1,041.20 Corvel — Corvel - Workers Comp: $1,008.32 Coventry — Coventry- Workers Comp: $953.52 First Health/HCVM — First Health/HCVM: $953.52 Maine Community Health Options — MCHO Indiv - Exchange: $698.15 Maine Community Health Options — MCHO SHOP - Exchange: $805.56
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad bi	Not listed in the file	Not listed in the file	$157.51 – $831.05
Diagnostic mammogram, both breasts: 10 of 28 insurance plan rates Aetna — Aetna Medicare Advantage: $162.24 Ambetter Health — Ambetter Commercial - Exchange: $338.87 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $217.21 Anthem Health Plans of NH — Anthem - Indemnity: $567.04 Anthem Health Plans of NH — Anthem - Medicare Advantage: $157.51 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $567.04 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $417.40 Anthem Health Plans of NH — Anthem PPO: $567.04 Anthem Health Plans of NH — Anthem SHOP - Exchange: $472.53 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $157.51
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$959	$293.45	$108.65 – $911.05
Screening mammogram, both breasts: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $673.22 Aetna — Aetna HMO/POS/PPO - ARNB: $588.83 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $108.65 Anthem Health Plans of NH — Anthem - Federal Employee Program: $835.67 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $525.53 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $525.53 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $640.61 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $117.09 CCMSI — CCMSI - Workers Comp: $911.05 Cigna — Cigna HMO-POS: $580.19
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$959	$293.45	$330.85 – $911.05
Screening mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $673.22 Aetna — Aetna HMO/POS/PPO - ARNB: $588.83 Anthem Health Plans of NH — Anthem - Federal Employee Program: $786.96 Anthem Health Plans of NH — Anthem - Indemnity: $786.96 CCMSI — CCMSI - Workers Comp: $911.05 Corvel — Corvel - Workers Comp: $882.28 Coventry — Coventry- Workers Comp: $834.33 First Health/HCVM — First Health/HCVM: $834.33 Maine Community Health Options — MCHO Indiv - Exchange: $610.88 Maine Community Health Options — MCHO SHOP - Exchange: $704.86
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Scr mammo bi incl cad	Not listed in the file	Not listed in the file	$127.71 – $686.75
Screening mammogram, both breasts: 10 of 28 insurance plan rates Aetna — Aetna Medicare Advantage: $131.54 Ambetter Health — Ambetter Commercial - Exchange: $274.76 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $176.11 Anthem Health Plans of NH — Anthem - Indemnity: $459.76 Anthem Health Plans of NH — Anthem - Medicare Advantage: $127.71 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $459.76 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $338.43 Anthem Health Plans of NH — Anthem PPO: $459.76 Anthem Health Plans of NH — Anthem SHOP - Exchange: $383.13 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $127.71

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: ECG W AT LEAST 12 LEADS W INTERP & RPT (GLOBAL)	$483	$147.80	$54.72 – $458.85
Electrocardiogram (ECG/EKG) with reading: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $339.07 Aetna — Aetna HMO/POS/PPO - ARNB: $296.56 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $54.72 Anthem Health Plans of NH — Anthem - Federal Employee Program: $420.89 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $264.68 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $264.68 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $322.64 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $58.97 CCMSI — CCMSI - Workers Comp: $458.85 Cigna — Cigna HMO-POS: $292.21
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient (hospital stay) · Doctor (professional) fee In the file: ECG W AT LEAST 12 LEADS W INTERP & RPT (GLOBAL)	$483	$147.80	$166.64 – $458.85
Electrocardiogram (ECG/EKG) with reading: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $339.07 Aetna — Aetna HMO/POS/PPO - ARNB: $296.56 Anthem Health Plans of NH — Anthem - Federal Employee Program: $396.35 Anthem Health Plans of NH — Anthem - Indemnity: $396.35 CCMSI — CCMSI - Workers Comp: $458.85 Corvel — Corvel - Workers Comp: $444.36 Coventry — Coventry- Workers Comp: $420.21 First Health/HCVM — First Health/HCVM: $420.21 Maine Community Health Options — MCHO Indiv - Exchange: $307.67 Maine Community Health Options — MCHO SHOP - Exchange: $355
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Electrocardiogram complete	Not listed in the file	Not listed in the file	$10.34 – $148.58
Electrocardiogram (ECG/EKG) with reading: 10 of 84 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $65.54 Aetna — Aetna HMO/POS/PPO: $65.54 Aetna — Aetna HMO/POS/PPO - ARNB: $65.54 Aetna — Aetna Medicare Advantage - DHP: $14.53 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $46.25 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $33.46 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $14.81 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $16.88 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $17.39 Anthem Health Plans of NH — Anthem - Federal Employee Program: $118.22
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HEART CATH W INJ LEFT VENTRICULOGRAPHY IMG S&I	$22,532	$6,894.79	$2,552.88 – $21,405.40
Left heart catheterization (diagnostic): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $15,817.46 Aetna — Aetna HMO/POS/PPO - ARNB: $13,834.65 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $2,552.88 Anthem Health Plans of NH — Anthem - Federal Employee Program: $19,634.38 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $12,347.54 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $12,347.54 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $15,051.38 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $2,751.16 CCMSI — CCMSI - Workers Comp: $21,405.40 Cigna — Cigna HMO-POS: $13,631.86
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LEFT HEART CATH W INJ LEFT VENTRICULOGRAPHY IMG S&I	$22,532	$6,894.79	$7,773.54 – $21,405.40
Left heart catheterization (diagnostic): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $15,817.46 Aetna — Aetna HMO/POS/PPO - ARNB: $13,834.65 Anthem Health Plans of NH — Anthem - Federal Employee Program: $18,489.76 Anthem Health Plans of NH — Anthem - Indemnity: $18,489.76 CCMSI — CCMSI - Workers Comp: $21,405.40 Corvel — Corvel - Workers Comp: $20,729.44 Coventry — Coventry- Workers Comp: $19,602.84 First Health/HCVM — First Health/HCVM: $19,602.84 Maine Community Health Options — MCHO Indiv - Exchange: $14,352.88 Maine Community Health Options — MCHO SHOP - Exchange: $16,561.02
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$3,599.37 – $14,004.93
Left heart catheterization (diagnostic): 10 of 29 insurance plan rates Aetna — Aetna Medicare Advantage: $3,707.36 Ambetter Health — Ambetter Commercial - Exchange: $7,743.71 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $4,963.55 Anthem Health Plans of NH — Anthem - Indemnity: $14,004.93 Anthem Health Plans of NH — Anthem - Medicare Advantage: $3,599.38 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $12,981.59 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $5,528.96 Anthem Health Plans of NH — Anthem PPO: $14,004.93 Anthem Health Plans of NH — Anthem SHOP - Exchange: $8,319.42 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $3,599.38
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE ELECTROPHYSIOLOGIC W/O ARRHYTHMIA INDUCTION	$9,970	$3,050.82	$1,129.60 – $9,471.50
Heart rhythm study (electrophysiology evaluation): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $6,998.94 Aetna — Aetna HMO/POS/PPO - ARNB: $6,121.58 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,129.60 Anthem Health Plans of NH — Anthem - Federal Employee Program: $8,687.86 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $5,463.56 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $5,463.56 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $6,659.96 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,217.34 CCMSI — CCMSI - Workers Comp: $9,471.50 Cigna — Cigna HMO-POS: $6,031.85
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPREHENSIVE ELECTROPHYSIOLOGIC W/O ARRHYTHMIA INDUCTION	$9,970	$3,050.82	$3,439.65 – $9,471.50
Heart rhythm study (electrophysiology evaluation): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $6,998.94 Aetna — Aetna HMO/POS/PPO - ARNB: $6,121.58 Anthem Health Plans of NH — Anthem - Federal Employee Program: $8,181.38 Anthem Health Plans of NH — Anthem - Indemnity: $8,181.38 CCMSI — CCMSI - Workers Comp: $9,471.50 Corvel — Corvel - Workers Comp: $9,172.40 Coventry — Coventry- Workers Comp: $8,673.90 First Health/HCVM — First Health/HCVM: $8,673.90 Maine Community Health Options — MCHO Indiv - Exchange: $6,350.89 Maine Community Health Options — MCHO SHOP - Exchange: $7,327.95
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive ep evaluation	Not listed in the file	Not listed in the file	$8,491.59 – $33,040.15
Heart rhythm study (electrophysiology evaluation): 10 of 27 insurance plan rates Aetna — Aetna Medicare Advantage: $8,746.34 Ambetter Health — Ambetter Commercial - Exchange: $18,268.81 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $11,709.91 Anthem Health Plans of NH — Anthem - Indemnity: $33,040.15 Anthem Health Plans of NH — Anthem - Medicare Advantage: $8,491.59 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $30,625.92 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $13,043.82 Anthem Health Plans of NH — Anthem PPO: $33,040.15 Anthem Health Plans of NH — Anthem SHOP - Exchange: $19,627 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $8,491.59
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE EP EVAL ABLATION ATR FIB PULM VEIN ISOLATION	$67,707	$20,718.34	$7,671.20 – $64,321.65
Heart rhythm study with ablation for atrial fibrillation: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $47,530.31 Aetna — Aetna HMO/POS/PPO - ARNB: $41,572.10 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $7,671.20 Anthem Health Plans of NH — Anthem - Federal Employee Program: $58,999.88 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $37,103.44 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $37,103.44 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $45,228.28 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $8,267.02 CCMSI — CCMSI - Workers Comp: $64,321.65 Cigna — Cigna HMO-POS: $40,962.74
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: COMPREHENSIVE EP EVAL ABLATION ATR FIB PULM VEIN ISOLATION	$44,414	$13,590.68	$5,032.11 – $42,193.30
Heart rhythm study with ablation for atrial fibrillation: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $31,178.63 Aetna — Aetna HMO/POS/PPO - ARNB: $27,270.20 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $5,032.11 Anthem Health Plans of NH — Anthem - Federal Employee Program: $38,702.36 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $24,338.87 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $24,338.87 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $29,668.55 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $5,422.95 CCMSI — CCMSI - Workers Comp: $42,193.30 Cigna — Cigna HMO-POS: $26,870.47
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPREHENSIVE EP EVAL ABLATION ATR FIB PULM VEIN ISOLATION	$67,707	$20,718.34	$23,358.91 – $64,321.65
Heart rhythm study with ablation for atrial fibrillation: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $47,530.31 Aetna — Aetna HMO/POS/PPO - ARNB: $41,572.10 Anthem Health Plans of NH — Anthem - Federal Employee Program: $55,560.36 Anthem Health Plans of NH — Anthem - Indemnity: $55,560.36 CCMSI — CCMSI - Workers Comp: $64,321.65 Corvel — Corvel - Workers Comp: $62,290.44 Coventry — Coventry- Workers Comp: $58,905.09 First Health/HCVM — First Health/HCVM: $58,905.09 Maine Community Health Options — MCHO Indiv - Exchange: $43,129.36 Maine Community Health Options — MCHO SHOP - Exchange: $49,764.64
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom 6/> yrs 4/> param	Not listed in the file	Not listed in the file	$1,138.53 – $4,429.93
Sleep study (overnight, in a sleep lab): 10 of 29 insurance plan rates Aetna — Aetna Medicare Advantage: $1,172.68 Ambetter Health — Ambetter Commercial - Exchange: $2,449.43 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $1,570.03 Anthem Health Plans of NH — Anthem - Indemnity: $4,429.93 Anthem Health Plans of NH — Anthem - Medicare Advantage: $1,138.53 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $4,106.24 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $1,748.88 Anthem Health Plans of NH — Anthem PPO: $4,429.93 Anthem Health Plans of NH — Anthem SHOP - Exchange: $2,631.53 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $1,138.53
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Polysom 6/> yrs 4/> param	Not listed in the file	Not listed in the file	$173.42 – $625.32
Sleep study (overnight, in a sleep lab): 10 of 11 insurance plan rates UnitedHealthCare — UHC - VA Community Care Network - DHPS: $625.32 WellSense Health Plan — WellSense - NH Managed Medicaid - DHP: $173.42 CCMSI — CCMSI - Workers Comp: 95% (a percentage in the contract, not a dollar amount) Corvel — Corvel - Workers Comp: 92% (a percentage in the contract, not a dollar amount) Coventry — Coventry- Workers Comp: 87% (a percentage in the contract, not a dollar amount) First Health/HCVM — First Health/HCVM: 85% (a percentage in the contract, not a dollar amount) First Health/HCVM — First Health/HCVM - DHP: 85% (a percentage in the contract, not a dollar amount) Maine Community Health Options — MCHO Indiv - Exchange: 53.9% (a percentage in the contract, not a dollar amount) Maine Community Health Options — MCHO SHOP - Exchange: 73.5% (a percentage in the contract, not a dollar amount) PHCS — PHCS - PPO: 88% (a percentage in the contract, not a dollar amount)
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: POLYSOM 6+ YRS SLEEP W 4+ ADDL PARAM ATTND	$1,360	$416.16	$154.09 – $1,292
Sleep study (overnight, in a sleep lab): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $954.72 Aetna — Aetna HMO/POS/PPO - ARNB: $835.04 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $154.09 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,185.10 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $745.28 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $745.28 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $908.48 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $166.06 CCMSI — CCMSI - Workers Comp: $1,292 Cigna — Cigna HMO-POS: $822.80

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THERAPEUTIC EX EA 15 MIN	$100	$30.60	$11.33 – $95
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $70.20 Aetna — Aetna HMO/POS/PPO - ARNB: $61.40 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $11.33 Anthem Health Plans of NH — Anthem - Federal Employee Program: $87.14 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $54.80 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $54.80 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $66.80 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $12.21 CCMSI — CCMSI - Workers Comp: $95 Cigna — Cigna HMO-POS: $60.50
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THERAPEUTIC EX EA 15 MIN	$100	$30.60	$34.50 – $95
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $70.20 Aetna — Aetna HMO/POS/PPO - ARNB: $61.40 Anthem Health Plans of NH — Anthem - Federal Employee Program: $82.06 Anthem Health Plans of NH — Anthem - Indemnity: $82.06 CCMSI — CCMSI - Workers Comp: $95 Corvel — Corvel - Workers Comp: $92 Coventry — Coventry- Workers Comp: $87 First Health/HCVM — First Health/HCVM: $87 Maine Community Health Options — MCHO Indiv - Exchange: $63.70 Maine Community Health Options — MCHO SHOP - Exchange: $73.50
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Therapeutic exercises	Not listed in the file	Not listed in the file	$21.42 – $120.86
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 75 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $88.48 Aetna — Aetna HMO/POS/PPO: $88.48 Aetna — Aetna HMO/POS/PPO - ARNB: $88.48 Aetna — Aetna Medicare Advantage - DHP: $30.10 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $95.83 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $69.33 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $30.69 Anthem Health Plans of NH — Anthem - Federal Employee Program: $80.30 Anthem Health Plans of NH — Anthem - Indemnity: $80.30 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $79.45
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION LOW COMPLEXITY	$186	$56.92	$21.07 – $176.70
Physical therapy evaluation (low complexity): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $130.57 Aetna — Aetna HMO/POS/PPO - ARNB: $114.20 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $21.07 Anthem Health Plans of NH — Anthem - Federal Employee Program: $162.08 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $101.93 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $101.93 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $124.25 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $22.71 CCMSI — CCMSI - Workers Comp: $176.70 Cigna — Cigna HMO-POS: $112.53
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION LOW COMPLEXITY	$186	$56.92	$64.17 – $176.70
Physical therapy evaluation (low complexity): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $130.57 Aetna — Aetna HMO/POS/PPO - ARNB: $114.20 Anthem Health Plans of NH — Anthem - Federal Employee Program: $152.63 Anthem Health Plans of NH — Anthem - Indemnity: $152.63 CCMSI — CCMSI - Workers Comp: $176.70 Corvel — Corvel - Workers Comp: $171.12 Coventry — Coventry- Workers Comp: $161.82 First Health/HCVM — First Health/HCVM: $161.82 Maine Community Health Options — MCHO Indiv - Exchange: $118.48 Maine Community Health Options — MCHO SHOP - Exchange: $136.71
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$72.46 – $399.20
Physical therapy evaluation (low complexity): 10 of 66 insurance plan rates Aetna — Aetna Medicare Advantage - DHP: $102.45 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $327 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $235.94 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $104.44 Anthem Health Plans of NH — Anthem - Federal Employee Program: $265.74 Anthem Health Plans of NH — Anthem - Indemnity: $265.74 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $271.76 Anthem Health Plans of NH — Anthem - Medicare Advantage - DHP: $99.47 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $146.08 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $136.12
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION MODERATE COMPLEXITY	$326	$99.76	$36.94 – $309.70
Physical therapy evaluation (moderate complexity): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $228.85 Aetna — Aetna HMO/POS/PPO - ARNB: $200.16 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $36.94 Anthem Health Plans of NH — Anthem - Federal Employee Program: $284.08 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $178.65 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $178.65 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $217.77 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $39.80 CCMSI — CCMSI - Workers Comp: $309.70 Cigna — Cigna HMO-POS: $197.23
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION MODERATE COMPLEXITY	$326	$99.76	$112.47 – $309.70
Physical therapy evaluation (moderate complexity): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $228.85 Aetna — Aetna HMO/POS/PPO - ARNB: $200.16 Anthem Health Plans of NH — Anthem - Federal Employee Program: $267.52 Anthem Health Plans of NH — Anthem - Indemnity: $267.52 CCMSI — CCMSI - Workers Comp: $309.70 Corvel — Corvel - Workers Comp: $299.92 Coventry — Coventry- Workers Comp: $283.62 First Health/HCVM — First Health/HCVM: $283.62 Maine Community Health Options — MCHO Indiv - Exchange: $207.66 Maine Community Health Options — MCHO SHOP - Exchange: $239.61
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval mod complex 30 min	Not listed in the file	Not listed in the file	$72.46 – $428.20
Physical therapy evaluation (moderate complexity): 10 of 66 insurance plan rates Aetna — Aetna Medicare Advantage - DHP: $102.45 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $326.11 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $235.94 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $104.44 Anthem Health Plans of NH — Anthem - Federal Employee Program: $221.46 Anthem Health Plans of NH — Anthem - Indemnity: $221.46 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $271.76 Anthem Health Plans of NH — Anthem - Medicare Advantage - DHP: $99.47 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $121.74 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $113.43
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION HIGH COMPLEXITY	$562	$171.97	$63.67 – $533.90
Physical therapy evaluation (high complexity): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $394.52 Aetna — Aetna HMO/POS/PPO - ARNB: $345.07 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $63.67 Anthem Health Plans of NH — Anthem - Federal Employee Program: $489.73 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $307.98 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $307.98 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $375.42 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $68.62 CCMSI — CCMSI - Workers Comp: $533.90 Cigna — Cigna HMO-POS: $340.01
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION HIGH COMPLEXITY	$562	$171.97	$193.89 – $533.90
Physical therapy evaluation (high complexity): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $394.52 Aetna — Aetna HMO/POS/PPO - ARNB: $345.07 Anthem Health Plans of NH — Anthem - Federal Employee Program: $461.18 Anthem Health Plans of NH — Anthem - Indemnity: $461.18 CCMSI — CCMSI - Workers Comp: $533.90 Corvel — Corvel - Workers Comp: $517.04 Coventry — Coventry- Workers Comp: $488.94 First Health/HCVM — First Health/HCVM: $488.94 Maine Community Health Options — MCHO Indiv - Exchange: $357.99 Maine Community Health Options — MCHO SHOP - Exchange: $413.07
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$72.46 – $399.20
Physical therapy evaluation (high complexity): 10 of 61 insurance plan rates Aetna — Aetna Medicare Advantage - DHP: $102.45 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $327 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $235.94 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $104.44 Anthem Health Plans of NH — Anthem - Federal Employee Program: $265.74 Anthem Health Plans of NH — Anthem - Indemnity: $265.74 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $271.76 Anthem Health Plans of NH — Anthem - Medicare Advantage - DHP: $99.47 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $146.08 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $136.12
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY W PATIENT 30 MINUTES	$238	$72.83	$26.97 – $226.10
Psychotherapy, 30 minutes: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $167.08 Aetna — Aetna HMO/POS/PPO - ARNB: $146.13 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $26.97 Anthem Health Plans of NH — Anthem - Federal Employee Program: $207.39 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $130.42 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $130.42 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $158.98 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $29.06 CCMSI — CCMSI - Workers Comp: $226.10 Cigna — Cigna HMO-POS: $143.99
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY W PATIENT 30 MINUTES	$238	$72.83	$82.11 – $226.10
Psychotherapy, 30 minutes: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $167.08 Aetna — Aetna HMO/POS/PPO - ARNB: $146.13 Anthem Health Plans of NH — Anthem - Federal Employee Program: $195.30 Anthem Health Plans of NH — Anthem - Indemnity: $195.30 CCMSI — CCMSI - Workers Comp: $226.10 Corvel — Corvel - Workers Comp: $218.96 Coventry — Coventry- Workers Comp: $207.06 First Health/HCVM — First Health/HCVM: $207.06 Maine Community Health Options — MCHO Indiv - Exchange: $151.61 Maine Community Health Options — MCHO SHOP - Exchange: $174.93
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psytx w pt 30 minutes	Not listed in the file	Not listed in the file	$49.45 – $280.61
Psychotherapy, 30 minutes: 10 of 73 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $49.45 Aetna — Aetna HMO/POS/PPO: $63.80 Aetna — Aetna HMO/POS/PPO - ARNB: $63.80 Aetna — Aetna Medicare Advantage - DHP: $71.09 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $226.28 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $163.71 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $72.47 Anthem Health Plans of NH — Anthem - Federal Employee Program: $232.91 Anthem Health Plans of NH — Anthem - Indemnity: $232.91 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $218.11
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY W PATIENT 45 MINUTES	$469	$143.51	$53.14 – $445.55
Psychotherapy, 45 minutes: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $329.24 Aetna — Aetna HMO/POS/PPO - ARNB: $287.97 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $53.14 Anthem Health Plans of NH — Anthem - Federal Employee Program: $408.69 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $257.01 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $257.01 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $313.29 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $57.26 CCMSI — CCMSI - Workers Comp: $445.55 Cigna — Cigna HMO-POS: $283.74
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY W PATIENT 45 MINUTES	$469	$143.51	$161.80 – $445.55
Psychotherapy, 45 minutes: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $329.24 Aetna — Aetna HMO/POS/PPO - ARNB: $287.97 Anthem Health Plans of NH — Anthem - Federal Employee Program: $384.86 Anthem Health Plans of NH — Anthem - Indemnity: $384.86 CCMSI — CCMSI - Workers Comp: $445.55 Corvel — Corvel - Workers Comp: $431.48 Coventry — Coventry- Workers Comp: $408.03 First Health/HCVM — First Health/HCVM: $408.03 Maine Community Health Options — MCHO Indiv - Exchange: $298.75 Maine Community Health Options — MCHO SHOP - Exchange: $344.72
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psytx w pt 45 minutes	Not listed in the file	Not listed in the file	$77.50 – $424.24
Psychotherapy, 45 minutes: 10 of 73 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $81.72 Aetna — Aetna HMO/POS/PPO: $81.72 Aetna — Aetna HMO/POS/PPO - ARNB: $81.72 Aetna — Aetna Medicare Advantage - DHP: $107.92 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $344.46 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $248.53 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $110.01 Anthem Health Plans of NH — Anthem - Federal Employee Program: $409.79 Anthem Health Plans of NH — Anthem - Indemnity: $409.79 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $340.50
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY W PATIENT 60 MINUTES	$586	$179.32	$66.39 – $556.70
Psychotherapy, 60 minutes: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $411.37 Aetna — Aetna HMO/POS/PPO - ARNB: $359.80 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $66.39 Anthem Health Plans of NH — Anthem - Federal Employee Program: $510.64 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $321.13 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $321.13 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $391.45 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $71.55 CCMSI — CCMSI - Workers Comp: $556.70 Cigna — Cigna HMO-POS: $354.53
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY W PATIENT 60 MINUTES	$586	$179.32	$202.17 – $556.70
Psychotherapy, 60 minutes: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $411.37 Aetna — Aetna HMO/POS/PPO - ARNB: $359.80 Anthem Health Plans of NH — Anthem - Federal Employee Program: $480.87 Anthem Health Plans of NH — Anthem - Indemnity: $480.87 CCMSI — CCMSI - Workers Comp: $556.70 Corvel — Corvel - Workers Comp: $539.12 Coventry — Coventry- Workers Comp: $509.82 First Health/HCVM — First Health/HCVM: $509.82 Maine Community Health Options — MCHO Indiv - Exchange: $373.28 Maine Community Health Options — MCHO SHOP - Exchange: $430.71
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psytx w pt 60 minutes	Not listed in the file	Not listed in the file	$100.12 – $548.06
Psychotherapy, 60 minutes: 10 of 73 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $111.98 Aetna — Aetna HMO/POS/PPO: $119.51 Aetna — Aetna HMO/POS/PPO - ARNB: $119.51 Aetna — Aetna Medicare Advantage - DHP: $138.83 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $441.90 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $319.72 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $141.52 Anthem Health Plans of NH — Anthem - Federal Employee Program: $421.28 Anthem Health Plans of NH — Anthem - Indemnity: $421.28 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $426.32
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$73.41 – $404.92
Family psychotherapy, without the patient: 10 of 75 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $274.05 Aetna — Aetna HMO/POS/PPO: $274.06 Aetna — Aetna HMO/POS/PPO - ARNB: $274.06 Aetna — Aetna Medicare Advantage - DHP: $101.81 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $324.96 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $234.47 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $103.79 Anthem Health Plans of NH — Anthem - Federal Employee Program: $404.92 Anthem Health Plans of NH — Anthem - Indemnity: $404.92 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $335.85
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$179.80 – $699.61
Family psychotherapy, without the patient: 10 of 21 insurance plan rates Aetna — Aetna Medicare Advantage: $185.20 Ambetter Health — Ambetter Commercial - Exchange: $386.83 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $247.95 Anthem Health Plans of NH — Anthem - Indemnity: $699.61 Anthem Health Plans of NH — Anthem - Medicare Advantage: $179.80 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $648.49 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $276.20 Anthem Health Plans of NH — Anthem PPO: $699.61 Anthem Health Plans of NH — Anthem SHOP - Exchange: $415.59 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $179.80
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier HE\|HW In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$119.79 – $123.38
Family psychotherapy, without the patient: rates for 4 insurance plans Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $123.38 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health - DHP: $119.79 Granite State Health Plan — New Hampshire Healthy Families - NH Managed Medicaid - DHP: $123.38 WellSense Health Plan — WellSense - NH Managed Medicaid - DHP: $123.38
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: FAMILY PSYCHOTHERAPY W PATIENT PRESENT 50 MINS	$514	$157.28	$58.24 – $488.30
Family psychotherapy, with the patient: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $360.83 Aetna — Aetna HMO/POS/PPO - ARNB: $315.60 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $58.24 Anthem Health Plans of NH — Anthem - Federal Employee Program: $447.90 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $281.67 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $281.67 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $343.35 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $62.76 CCMSI — CCMSI - Workers Comp: $488.30 Cigna — Cigna HMO-POS: $310.97
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Doctor (professional) fee In the file: FAMILY PSYCHOTHERAPY W PATIENT PRESENT 50 MINS	$514	$157.28	$177.33 – $488.30
Family psychotherapy, with the patient: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $360.83 Aetna — Aetna HMO/POS/PPO - ARNB: $315.60 Anthem Health Plans of NH — Anthem - Federal Employee Program: $421.79 Anthem Health Plans of NH — Anthem - Indemnity: $421.79 CCMSI — CCMSI - Workers Comp: $488.30 Corvel — Corvel - Workers Comp: $472.88 Coventry — Coventry- Workers Comp: $447.18 First Health/HCVM — First Health/HCVM: $447.18 Maine Community Health Options — MCHO Indiv - Exchange: $327.42 Maine Community Health Options — MCHO SHOP - Exchange: $377.79
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Family psytx w/pt 50 min	Not listed in the file	Not listed in the file	$76.30 – $417.66
Family psychotherapy, with the patient: 10 of 75 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $319.97 Aetna — Aetna HMO/POS/PPO: $341.15 Aetna — Aetna HMO/POS/PPO - ARNB: $341.15 Aetna — Aetna Medicare Advantage - DHP: $105.83 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $336.86 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $243.72 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $107.88 Anthem Health Plans of NH — Anthem - Federal Employee Program: $391.71 Anthem Health Plans of NH — Anthem - Indemnity: $391.71 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $324.89
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: GROUP PSYCHOTHERAPY	$192	$58.75	$21.75 – $182.40
Group psychotherapy: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $134.78 Aetna — Aetna HMO/POS/PPO - ARNB: $117.89 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $21.75 Anthem Health Plans of NH — Anthem - Federal Employee Program: $167.31 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $105.22 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $105.22 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $128.26 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $23.44 CCMSI — CCMSI - Workers Comp: $182.40 Cigna — Cigna HMO-POS: $116.16
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Doctor (professional) fee In the file: GROUP PSYCHOTHERAPY	$192	$58.75	$66.24 – $182.40
Group psychotherapy: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $134.78 Aetna — Aetna HMO/POS/PPO - ARNB: $117.89 Anthem Health Plans of NH — Anthem - Federal Employee Program: $157.56 Anthem Health Plans of NH — Anthem - Indemnity: $157.56 CCMSI — CCMSI - Workers Comp: $182.40 Corvel — Corvel - Workers Comp: $176.64 Coventry — Coventry- Workers Comp: $167.04 First Health/HCVM — First Health/HCVM: $167.04 Maine Community Health Options — MCHO Indiv - Exchange: $122.30 Maine Community Health Options — MCHO SHOP - Exchange: $141.12
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Group psychotherapy	Not listed in the file	Not listed in the file	$18.05 – $141.63
Group psychotherapy: 10 of 75 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $92.05 Aetna — Aetna HMO/POS/PPO: $97.93 Aetna — Aetna HMO/POS/PPO - ARNB: $97.93 Aetna — Aetna Medicare Advantage - DHP: $25 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $79.60 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $57.59 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $25.49 Anthem Health Plans of NH — Anthem - Federal Employee Program: $92.65 Anthem Health Plans of NH — Anthem - Indemnity: $92.65 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $75.63

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$5,524	$1,690.34	$625.87 – $5,247.80
Removal of breast growth (open surgery): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,877.85 Aetna — Aetna HMO/POS/PPO - ARNB: $3,391.74 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $625.87 Anthem Health Plans of NH — Anthem - Federal Employee Program: $4,813.61 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $3,027.15 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $3,027.15 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $3,690.03 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $674.48 CCMSI — CCMSI - Workers Comp: $5,247.80 Cigna — Cigna HMO-POS: $3,342.02
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$3,672	$1,123.63	$416.04 – $3,488.40
Removal of breast growth (open surgery): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,577.74 Aetna — Aetna HMO/POS/PPO - ARNB: $2,254.61 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $416.04 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,199.78 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,012.26 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,012.26 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,452.90 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $448.35 CCMSI — CCMSI - Workers Comp: $3,488.40 Cigna — Cigna HMO-POS: $2,221.56
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$5,524	$1,690.34	$1,905.78 – $5,247.80
Removal of breast growth (open surgery): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,877.85 Aetna — Aetna HMO/POS/PPO - ARNB: $3,391.74 Anthem Health Plans of NH — Anthem - Federal Employee Program: $4,532.99 Anthem Health Plans of NH — Anthem - Indemnity: $4,532.99 CCMSI — CCMSI - Workers Comp: $5,247.80 Corvel — Corvel - Workers Comp: $5,082.08 Coventry — Coventry- Workers Comp: $4,805.88 First Health/HCVM — First Health/HCVM: $4,805.88 Maine Community Health Options — MCHO Indiv - Exchange: $3,518.79 Maine Community Health Options — MCHO SHOP - Exchange: $4,060.14
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: ARTHROPLASTY ACETABULAR/PROX FEM PROSTC AGRFT/ALGRFT	$25,638	$7,845.23	$2,904.79 – $24,356.10
Total hip replacement: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $17,997.88 Aetna — Aetna HMO/POS/PPO - ARNB: $15,741.73 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $2,904.79 Anthem Health Plans of NH — Anthem - Federal Employee Program: $22,340.95 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $14,049.62 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $14,049.62 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $17,126.18 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $3,130.40 CCMSI — CCMSI - Workers Comp: $24,356.10 Cigna — Cigna HMO-POS: $15,510.99
Total hip replacement CPT 27130 · Inpatient (hospital stay) · Doctor (professional) fee In the file: ARTHROPLASTY ACETABULAR/PROX FEM PROSTC AGRFT/ALGRFT	$25,638	$7,845.23	$8,845.11 – $24,356.10
Total hip replacement: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $17,997.88 Aetna — Aetna HMO/POS/PPO - ARNB: $15,741.73 Anthem Health Plans of NH — Anthem - Federal Employee Program: $21,038.54 Anthem Health Plans of NH — Anthem - Indemnity: $21,038.54 CCMSI — CCMSI - Workers Comp: $24,356.10 Corvel — Corvel - Workers Comp: $23,586.96 Coventry — Coventry- Workers Comp: $22,305.06 First Health/HCVM — First Health/HCVM: $22,305.06 Maine Community Health Options — MCHO Indiv - Exchange: $16,331.41 Maine Community Health Options — MCHO SHOP - Exchange: $18,843.93
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$903.52 – $9,382.08
Total hip replacement: 10 of 58 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $5,158.64 Aetna — Aetna HMO/POS/PPO: $5,158.64 Aetna — Aetna HMO/POS/PPO - ARNB: $5,158.64 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $903.52 Anthem Health Plans of NH — Anthem - Federal Employee Program: $9,382.08 Anthem Health Plans of NH — Anthem - Indemnity: $9,382.08 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $6,909.92 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $5,157.46 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $4,805.58 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $3,965.06
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: ARTHROPLASTY KNEE CONDYLE & PLATEAU MEDIAL & LAT COMPARTMENTS	$26,234	$8,027.60	$2,972.31 – $24,922.30
Total knee replacement: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $18,416.27 Aetna — Aetna HMO/POS/PPO - ARNB: $16,107.68 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $2,972.31 Anthem Health Plans of NH — Anthem - Federal Employee Program: $22,860.31 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $14,376.23 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $14,376.23 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $17,524.31 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $3,203.17 CCMSI — CCMSI - Workers Comp: $24,922.30 Cigna — Cigna HMO-POS: $15,871.57
Total knee replacement CPT 27447 · Inpatient (hospital stay) · Doctor (professional) fee In the file: ARTHROPLASTY KNEE CONDYLE & PLATEAU MEDIAL & LAT COMPARTMENTS	$26,234	$8,027.60	$9,050.73 – $24,922.30
Total knee replacement: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $18,416.27 Aetna — Aetna HMO/POS/PPO - ARNB: $16,107.68 Anthem Health Plans of NH — Anthem - Federal Employee Program: $21,527.62 Anthem Health Plans of NH — Anthem - Indemnity: $21,527.62 CCMSI — CCMSI - Workers Comp: $24,922.30 Corvel — Corvel - Workers Comp: $24,135.28 Coventry — Coventry- Workers Comp: $22,823.58 First Health/HCVM — First Health/HCVM: $22,823.58 Maine Community Health Options — MCHO Indiv - Exchange: $16,711.06 Maine Community Health Options — MCHO SHOP - Exchange: $19,281.99
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$935.82 – $9,427.52
Total knee replacement: 10 of 58 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $5,522.62 Aetna — Aetna HMO/POS/PPO: $5,522.62 Aetna — Aetna HMO/POS/PPO - ARNB: $5,522.62 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,200.99 Anthem Health Plans of NH — Anthem - Federal Employee Program: $7,814.38 Anthem Health Plans of NH — Anthem - Indemnity: $7,814.38 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $5,749.31 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $4,295.68 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $4,002.59 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $3,299.08
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: SURGICAL ARTHROSCOPY SHOULDER W CORACOACRM LIGAMENT RELEASE	$13,330	$4,078.98	$1,510.29 – $12,663.50
Shoulder arthroscopy: shaving of shoulder bone: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $9,357.66 Aetna — Aetna HMO/POS/PPO - ARNB: $8,184.62 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,510.29 Anthem Health Plans of NH — Anthem - Federal Employee Program: $11,615.76 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $7,304.84 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $7,304.84 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $8,904.44 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,627.59 CCMSI — CCMSI - Workers Comp: $12,663.50 Cigna — Cigna HMO-POS: $8,064.65
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient (hospital stay) · Doctor (professional) fee In the file: SURGICAL ARTHROSCOPY SHOULDER W CORACOACRM LIGAMENT RELEASE	$13,330	$4,078.98	$4,598.85 – $12,663.50
Shoulder arthroscopy: shaving of shoulder bone: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $9,357.66 Aetna — Aetna HMO/POS/PPO - ARNB: $8,184.62 Anthem Health Plans of NH — Anthem - Federal Employee Program: $10,938.60 Anthem Health Plans of NH — Anthem - Indemnity: $10,938.60 CCMSI — CCMSI - Workers Comp: $12,663.50 Corvel — Corvel - Workers Comp: $12,263.60 Coventry — Coventry- Workers Comp: $11,597.10 First Health/HCVM — First Health/HCVM: $11,597.10 Maine Community Health Options — MCHO Indiv - Exchange: $8,491.21 Maine Community Health Options — MCHO SHOP - Exchange: $9,797.55
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$123.95 – $3,023.65
Shoulder arthroscopy: shaving of shoulder bone: 10 of 67 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,372.57 Aetna — Aetna HMO/POS/PPO - ARNB: $2,372.57 Aetna — Aetna Medicare Advantage - DHP: $171.34 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $545.37 Ambetter Health — Ambetter Commercial - Exchange - DHPS: $394.58 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $174.66 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $509.73 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,014.05 Anthem Health Plans of NH — Anthem - Indemnity: $1,014.05 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $760.21
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: ARTHROSCOPY, KNEE, W MENISCECTOMY, MEDIAL OR LATERAL, W SHAVING	$12,692	$3,883.75	$1,438 – $12,057.40
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $8,909.78 Aetna — Aetna HMO/POS/PPO - ARNB: $7,792.89 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,438 Anthem Health Plans of NH — Anthem - Federal Employee Program: $11,059.81 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $6,955.22 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $6,955.22 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $8,478.26 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,549.69 CCMSI — CCMSI - Workers Comp: $12,057.40 Cigna — Cigna HMO-POS: $7,678.66
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient (hospital stay) · Doctor (professional) fee In the file: ARTHROSCOPY, KNEE, W MENISCECTOMY, MEDIAL OR LATERAL, W SHAVING	$12,692	$3,883.75	$4,378.74 – $12,057.40
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $8,909.78 Aetna — Aetna HMO/POS/PPO - ARNB: $7,792.89 Anthem Health Plans of NH — Anthem - Federal Employee Program: $10,415.06 Anthem Health Plans of NH — Anthem - Indemnity: $10,415.06 CCMSI — CCMSI - Workers Comp: $12,057.40 Corvel — Corvel - Workers Comp: $11,676.64 Coventry — Coventry- Workers Comp: $11,042.04 First Health/HCVM — First Health/HCVM: $11,042.04 Maine Community Health Options — MCHO Indiv - Exchange: $8,084.80 Maine Community Health Options — MCHO SHOP - Exchange: $9,328.62
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Knee arthroscopy/surgery	Not listed in the file	Not listed in the file	$400.51 – $3,769.63
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 46 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,261.11 Aetna — Aetna HMO/POS/PPO - ARNB: $2,261.11 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,737 Anthem Health Plans of NH — Anthem - Indemnity: $3,737 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $2,951.42 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $2,054.28 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $1,914.12 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $1,693.59 Anthem Health Plans of NH — Anthem PPO: $2,054.28 Anthem Health Plans of NH — Anthem PPO - DHP: $1,875.63
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: REMOVE TONSILS/ADENOIDS, <12 Y/O	$4,165	$1,274.49	$471.89 – $3,956.75
Removal of tonsils and adenoids (under age 12): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,923.83 Aetna — Aetna HMO/POS/PPO - ARNB: $2,557.31 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $471.89 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,629.38 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,282.42 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,282.42 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,782.22 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $508.55 CCMSI — CCMSI - Workers Comp: $3,956.75 Cigna — Cigna HMO-POS: $2,519.82
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient (hospital stay) · Doctor (professional) fee In the file: REMOVE TONSILS/ADENOIDS, <12 Y/O	$4,165	$1,274.49	$1,436.92 – $3,956.75
Removal of tonsils and adenoids (under age 12): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,923.83 Aetna — Aetna HMO/POS/PPO - ARNB: $2,557.31 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,417.80 Anthem Health Plans of NH — Anthem - Indemnity: $3,417.80 CCMSI — CCMSI - Workers Comp: $3,956.75 Corvel — Corvel - Workers Comp: $3,831.80 Coventry — Coventry- Workers Comp: $3,623.55 First Health/HCVM — First Health/HCVM: $3,623.55 Maine Community Health Options — MCHO Indiv - Exchange: $2,653.10 Maine Community Health Options — MCHO SHOP - Exchange: $3,061.28
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$213.98 – $1,767.60
Removal of tonsils and adenoids (under age 12): 10 of 46 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,057.33 Aetna — Aetna HMO/POS/PPO - ARNB: $1,057.33 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,767.60 Anthem Health Plans of NH — Anthem - Indemnity: $1,767.60 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $1,408.77 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $971.67 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $905.38 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $808.38 Anthem Health Plans of NH — Anthem PPO: $971.67 Anthem Health Plans of NH — Anthem PPO - DHP: $895.27
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$4,509	$1,379.75	$510.87 – $4,283.55
Upper GI endoscopy (diagnostic): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,165.32 Aetna — Aetna HMO/POS/PPO - ARNB: $2,768.53 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $510.87 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,929.14 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,470.93 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,470.93 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $3,012.01 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $550.55 CCMSI — CCMSI - Workers Comp: $4,283.55 Cigna — Cigna HMO-POS: $2,727.94
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$3,747	$1,146.58	$424.54 – $3,559.65
Upper GI endoscopy (diagnostic): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,630.39 Aetna — Aetna HMO/POS/PPO - ARNB: $2,300.66 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $424.54 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,265.14 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,053.36 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,053.36 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,503 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $457.51 CCMSI — CCMSI - Workers Comp: $3,559.65 Cigna — Cigna HMO-POS: $2,266.94
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$4,509	$1,379.75	$1,555.60 – $4,283.55
Upper GI endoscopy (diagnostic): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,165.32 Aetna — Aetna HMO/POS/PPO - ARNB: $2,768.53 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,700.09 Anthem Health Plans of NH — Anthem - Indemnity: $3,700.09 CCMSI — CCMSI - Workers Comp: $4,283.55 Corvel — Corvel - Workers Comp: $4,148.28 Coventry — Coventry- Workers Comp: $3,922.83 First Health/HCVM — First Health/HCVM: $3,922.83 Maine Community Health Options — MCHO Indiv - Exchange: $2,872.23 Maine Community Health Options — MCHO SHOP - Exchange: $3,314.12
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESOPHAGOGASTRODUODENOSCOPY TRANSORAL BIOPSY SINGLE/MULTIPLE	$3,939	$1,205.33	$446.29 – $3,742.05
Upper GI endoscopy with biopsy: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,765.18 Aetna — Aetna HMO/POS/PPO - ARNB: $2,418.55 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $446.29 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,432.44 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,158.57 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,158.57 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,631.25 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $480.95 CCMSI — CCMSI - Workers Comp: $3,742.05 Cigna — Cigna HMO-POS: $2,383.09
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: ESOPHAGOGASTRODUODENOSCOPY TRANSORAL BIOPSY SINGLE/MULTIPLE	$3,813	$1,166.78	$432.01 – $3,622.35
Upper GI endoscopy with biopsy: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,676.73 Aetna — Aetna HMO/POS/PPO - ARNB: $2,341.18 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $432.01 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,322.65 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,089.52 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,089.52 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,547.08 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $465.57 CCMSI — CCMSI - Workers Comp: $3,622.35 Cigna — Cigna HMO-POS: $2,306.86
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ESOPHAGOGASTRODUODENOSCOPY TRANSORAL BIOPSY SINGLE/MULTIPLE	$3,939	$1,205.33	$1,358.96 – $3,742.05
Upper GI endoscopy with biopsy: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,765.18 Aetna — Aetna HMO/POS/PPO - ARNB: $2,418.55 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,232.34 Anthem Health Plans of NH — Anthem - Indemnity: $3,232.34 CCMSI — CCMSI - Workers Comp: $3,742.05 Corvel — Corvel - Workers Comp: $3,623.88 Coventry — Coventry- Workers Comp: $3,426.93 First Health/HCVM — First Health/HCVM: $3,426.93 Maine Community Health Options — MCHO Indiv - Exchange: $2,509.14 Maine Community Health Options — MCHO SHOP - Exchange: $2,895.16
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY FLEXIBLE DX W COLLECTION SPECIMEN WHEN PFRMD	$4,181	$1,279.39	$473.71 – $3,971.95
Colonoscopy (diagnostic): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,935.06 Aetna — Aetna HMO/POS/PPO - ARNB: $2,567.13 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $473.71 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,643.32 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,291.19 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,291.19 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,792.91 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $510.50 CCMSI — CCMSI - Workers Comp: $3,971.95 Cigna — Cigna HMO-POS: $2,529.50
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLORECTAL CANCER SCREENING, COLONOSCOPY ON PT AT HIGH RISK	$4,181	$1,279.39	$473.71 – $3,971.95
Colonoscopy (diagnostic): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,935.06 Aetna — Aetna HMO/POS/PPO - ARNB: $2,567.13 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $473.71 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,643.32 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,291.19 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,291.19 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,792.91 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $510.50 CCMSI — CCMSI - Workers Comp: $3,971.95 Cigna — Cigna HMO-POS: $2,529.50
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLORECTAL CANCER SCREENING, COLONOSCOPY PT NOT AT HIGH RISK	$4,181	$1,279.39	$473.71 – $3,971.95
Colonoscopy (diagnostic): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,935.06 Aetna — Aetna HMO/POS/PPO - ARNB: $2,567.13 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $473.71 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,643.32 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,291.19 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,291.19 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,792.91 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $510.50 CCMSI — CCMSI - Workers Comp: $3,971.95 Cigna — Cigna HMO-POS: $2,529.50
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W BIOPSY SINGLE/MULTIPLE	$4,321	$1,322.23	$489.57 – $4,104.95
Colonoscopy with biopsy: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,033.34 Aetna — Aetna HMO/POS/PPO - ARNB: $2,653.09 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $489.57 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,765.32 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,367.91 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,367.91 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,886.43 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $527.59 CCMSI — CCMSI - Workers Comp: $4,104.95 Cigna — Cigna HMO-POS: $2,614.20
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: COLONOSCOPY W BIOPSY SINGLE/MULTIPLE	$5,306	$1,623.64	$601.17 – $5,040.70
Colonoscopy with biopsy: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,724.81 Aetna — Aetna HMO/POS/PPO - ARNB: $3,257.88 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $601.17 Anthem Health Plans of NH — Anthem - Federal Employee Program: $4,623.65 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,907.69 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,907.69 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $3,544.41 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $647.86 CCMSI — CCMSI - Workers Comp: $5,040.70 Cigna — Cigna HMO-POS: $3,210.13
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY W BIOPSY SINGLE/MULTIPLE	$4,321	$1,322.23	$1,490.74 – $4,104.95
Colonoscopy with biopsy: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,033.34 Aetna — Aetna HMO/POS/PPO - ARNB: $2,653.09 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,545.81 Anthem Health Plans of NH — Anthem - Indemnity: $3,545.81 CCMSI — CCMSI - Workers Comp: $4,104.95 Corvel — Corvel - Workers Comp: $3,975.32 Coventry — Coventry- Workers Comp: $3,759.27 First Health/HCVM — First Health/HCVM: $3,759.27 Maine Community Health Options — MCHO Indiv - Exchange: $2,752.48 Maine Community Health Options — MCHO SHOP - Exchange: $3,175.94
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY FLEXIBLE W RMVL OF TUMOR POLYP LESION SNARE TQ	$4,321	$1,322.23	$489.57 – $4,104.95
Colonoscopy with removal of polyps (snare): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,033.34 Aetna — Aetna HMO/POS/PPO - ARNB: $2,653.09 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $489.57 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,765.32 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,367.91 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,367.91 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,886.43 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $527.59 CCMSI — CCMSI - Workers Comp: $4,104.95 Cigna — Cigna HMO-POS: $2,614.20
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: COLONOSCOPY FLEXIBLE W RMVL OF TUMOR POLYP LESION SNARE TQ	$6,027	$1,844.26	$682.86 – $5,725.65
Colonoscopy with removal of polyps (snare): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $4,230.95 Aetna — Aetna HMO/POS/PPO - ARNB: $3,700.58 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $682.86 Anthem Health Plans of NH — Anthem - Federal Employee Program: $5,251.93 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $3,302.80 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $3,302.80 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $4,026.04 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $735.90 CCMSI — CCMSI - Workers Comp: $5,725.65 Cigna — Cigna HMO-POS: $3,646.34
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY FLEXIBLE W RMVL OF TUMOR POLYP LESION SNARE TQ	$4,321	$1,322.23	$1,490.74 – $4,104.95
Colonoscopy with removal of polyps (snare): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,033.34 Aetna — Aetna HMO/POS/PPO - ARNB: $2,653.09 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,545.81 Anthem Health Plans of NH — Anthem - Indemnity: $3,545.81 CCMSI — CCMSI - Workers Comp: $4,104.95 Corvel — Corvel - Workers Comp: $3,975.32 Coventry — Coventry- Workers Comp: $3,759.27 First Health/HCVM — First Health/HCVM: $3,759.27 Maine Community Health Options — MCHO Indiv - Exchange: $2,752.48 Maine Community Health Options — MCHO SHOP - Exchange: $3,175.94
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE	$4,321	$1,322.23	$489.57 – $4,104.95
Ultrasound of the lower bowel by endoscope: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,033.34 Aetna — Aetna HMO/POS/PPO - ARNB: $2,653.09 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $489.57 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,765.32 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,367.91 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,367.91 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,886.43 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $527.59 CCMSI — CCMSI - Workers Comp: $4,104.95 Cigna — Cigna HMO-POS: $2,614.20
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: COLONOSCOPY EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE	$3,872	$1,184.83	$438.70 – $3,678.40
Ultrasound of the lower bowel by endoscope: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,718.14 Aetna — Aetna HMO/POS/PPO - ARNB: $2,377.41 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $438.70 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,374.06 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,121.86 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,121.86 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,586.50 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $472.77 CCMSI — CCMSI - Workers Comp: $3,678.40 Cigna — Cigna HMO-POS: $2,342.56
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE	$4,321	$1,322.23	$1,490.74 – $4,104.95
Ultrasound of the lower bowel by endoscope: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,033.34 Aetna — Aetna HMO/POS/PPO - ARNB: $2,653.09 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,545.81 Anthem Health Plans of NH — Anthem - Indemnity: $3,545.81 CCMSI — CCMSI - Workers Comp: $4,104.95 Corvel — Corvel - Workers Comp: $3,975.32 Coventry — Coventry- Workers Comp: $3,759.27 First Health/HCVM — First Health/HCVM: $3,759.27 Maine Community Health Options — MCHO Indiv - Exchange: $2,752.48 Maine Community Health Options — MCHO SHOP - Exchange: $3,175.94
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$113.83 – $1,747.49
Screening colonoscopy (not high risk): 10 of 56 insurance plan rates Aetna — Aetna HMO/POS/PPO: $113.83 Aetna — Aetna HMO/POS/PPO - ARNB: $113.83 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $125.06 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $132.67 Anthem Health Plans of NH — Anthem - Federal Employee Program: $992.15 Anthem Health Plans of NH — Anthem - Indemnity: $992.15 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $894.24 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $545.40 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $508.19 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $513.14
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$493.36 – $7,726
Screening colonoscopy (not high risk): 10 of 31 insurance plan rates Aetna — Aetna Medicare Advantage: $1,050.87 Ambetter Health — Ambetter Commercial - Exchange: $2,194.99 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health: $1,406.94 Anthem Health Plans of NH — Anthem - Indemnity: $3,969.76 Anthem Health Plans of NH — Anthem - Medicare Advantage: $1,020.26 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $3,679.70 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $1,567.21 Anthem Health Plans of NH — Anthem PPO: $3,969.76 Anthem Health Plans of NH — Anthem SHOP - Exchange: $2,358.18 BCBS of Vermont — BCBS of Vermont - Medicare Advantage: $1,020.26
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier SG In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$480.61 – $3,624
Screening colonoscopy (not high risk): 10 of 20 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $1,484 Aetna — Aetna Medicare Advantage - DHP: $495.02 Ambetter Health — Ambetter Commercial - Exchange - DHPN: $480.61 Ambetter Health — Ambetter Commercial - Exchange Behavioral Health - DHP: $504.64 Anthem Health Plans of NH — Anthem - Medicare Advantage - DHP: $480.61 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $902.63 BCBS of Vermont — BCBS of Vermont - Medicare Advantage - DHP: $480.61 Martin's Point Generations Advantage — Martin's Point - Medicare Advantage - DHP: $480.61 Martin's Point Health Care — Martin's Point - US Family Health Plan - DHP: $666 MVP — MVP - HMO/POS/PPO - DHPS: $1,273
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: LAP, CHOLECYSTECTOMY	$11,378	$3,481.67	$1,289.13 – $10,809.10
Gallbladder removal by laparoscope: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $7,987.36 Aetna — Aetna HMO/POS/PPO - ARNB: $6,986.09 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,289.13 Anthem Health Plans of NH — Anthem - Federal Employee Program: $9,914.79 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $6,235.14 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $6,235.14 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $7,600.50 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,389.25 CCMSI — CCMSI - Workers Comp: $10,809.10 Cigna — Cigna HMO-POS: $6,883.69
Gallbladder removal by laparoscope CPT 47562 · Inpatient (hospital stay) · Doctor (professional) fee In the file: LAP, CHOLECYSTECTOMY	$11,378	$3,481.67	$3,925.41 – $10,809.10
Gallbladder removal by laparoscope: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $7,987.36 Aetna — Aetna HMO/POS/PPO - ARNB: $6,986.09 Anthem Health Plans of NH — Anthem - Federal Employee Program: $9,336.79 Anthem Health Plans of NH — Anthem - Indemnity: $9,336.79 CCMSI — CCMSI - Workers Comp: $10,809.10 Corvel — Corvel - Workers Comp: $10,467.76 Coventry — Coventry- Workers Comp: $9,898.86 First Health/HCVM — First Health/HCVM: $9,898.86 Maine Community Health Options — MCHO Indiv - Exchange: $7,247.79 Maine Community Health Options — MCHO SHOP - Exchange: $8,362.83
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$446.64 – $3,844.88
Gallbladder removal by laparoscope: 10 of 52 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,533.97 Aetna — Aetna HMO/POS/PPO - ARNB: $2,533.97 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $446.64 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,844.88 Anthem Health Plans of NH — Anthem - Indemnity: $3,844.88 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $3,054.04 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $2,113.59 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $1,969.38 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $1,752.47 Anthem Health Plans of NH — Anthem PPO: $2,113.59
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: REPAIR 1ST INGUINAL HERNIA AGE 5 YRS OR OLDER REDUCIBLE	$6,781	$2,074.99	$768.29 – $6,441.95
Groin (inguinal) hernia repair, age 5 or older: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $4,760.26 Aetna — Aetna HMO/POS/PPO - ARNB: $4,163.53 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $768.29 Anthem Health Plans of NH — Anthem - Federal Employee Program: $5,908.96 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $3,715.99 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $3,715.99 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $4,529.71 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $827.96 CCMSI — CCMSI - Workers Comp: $6,441.95 Cigna — Cigna HMO-POS: $4,102.50
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient (hospital stay) · Doctor (professional) fee In the file: REPAIR 1ST INGUINAL HERNIA AGE 5 YRS OR OLDER REDUCIBLE	$6,781	$2,074.99	$2,339.44 – $6,441.95
Groin (inguinal) hernia repair, age 5 or older: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $4,760.26 Aetna — Aetna HMO/POS/PPO - ARNB: $4,163.53 Anthem Health Plans of NH — Anthem - Federal Employee Program: $5,564.49 Anthem Health Plans of NH — Anthem - Indemnity: $5,564.49 CCMSI — CCMSI - Workers Comp: $6,441.95 Corvel — Corvel - Workers Comp: $6,238.52 Coventry — Coventry- Workers Comp: $5,899.47 First Health/HCVM — First Health/HCVM: $5,899.47 Maine Community Health Options — MCHO Indiv - Exchange: $4,319.50 Maine Community Health Options — MCHO SHOP - Exchange: $4,984.04
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$383.66 – $3,027.43
Groin (inguinal) hernia repair, age 5 or older: 10 of 46 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,767.63 Aetna — Aetna HMO/POS/PPO - ARNB: $1,767.63 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,452.83 Anthem Health Plans of NH — Anthem - Indemnity: $2,452.83 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $1,803.61 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $1,348.35 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $1,256.36 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $1,034.95 Anthem Health Plans of NH — Anthem PPO: $1,348.35 Anthem Health Plans of NH — Anthem PPO - DHP: $1,146.19
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROSTATE NEEDLE BIOPSY ANY APPROACH	$3,756	$1,149.34	$425.55 – $3,568.20
Prostate biopsy: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,636.71 Aetna — Aetna HMO/POS/PPO - ARNB: $2,306.18 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $425.55 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,272.98 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,058.29 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,058.29 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,509.01 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $458.61 CCMSI — CCMSI - Workers Comp: $3,568.20 Cigna — Cigna HMO-POS: $2,272.38
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PROSTATE NEEDLE BIOPSY ANY APPROACH	$1,582	$484.09	$179.24 – $1,502.90
Prostate biopsy: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $1,110.56 Aetna — Aetna HMO/POS/PPO - ARNB: $971.35 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $179.24 Anthem Health Plans of NH — Anthem - Federal Employee Program: $1,378.55 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $866.94 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $866.94 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $1,056.78 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $193.16 CCMSI — CCMSI - Workers Comp: $1,502.90 Cigna — Cigna HMO-POS: $957.11
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PROSTATE NEEDLE BIOPSY ANY APPROACH	$3,756	$1,149.34	$1,295.82 – $3,568.20
Prostate biopsy: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,636.71 Aetna — Aetna HMO/POS/PPO - ARNB: $2,306.18 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,082.17 Anthem Health Plans of NH — Anthem - Indemnity: $3,082.17 CCMSI — CCMSI - Workers Comp: $3,568.20 Corvel — Corvel - Workers Comp: $3,455.52 Coventry — Coventry- Workers Comp: $3,267.72 First Health/HCVM — First Health/HCVM: $3,267.72 Maine Community Health Options — MCHO Indiv - Exchange: $2,392.57 Maine Community Health Options — MCHO SHOP - Exchange: $2,760.66
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: LAP, PROSTATECTOMY, RADICAL, W/NERVE SPARE	$21,789	$6,667.43	$2,468.69 – $20,699.55
Prostate removal by laparoscope (radical prostatectomy): 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $15,295.88 Aetna — Aetna HMO/POS/PPO - ARNB: $13,378.45 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $2,468.69 Anthem Health Plans of NH — Anthem - Federal Employee Program: $18,986.93 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $11,940.37 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $11,940.37 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $14,555.05 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $2,660.44 CCMSI — CCMSI - Workers Comp: $20,699.55 Cigna — Cigna HMO-POS: $13,182.34
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient (hospital stay) · Doctor (professional) fee In the file: LAP, PROSTATECTOMY, RADICAL, W/NERVE SPARE	$21,789	$6,667.43	$7,517.20 – $20,699.55
Prostate removal by laparoscope (radical prostatectomy): 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $15,295.88 Aetna — Aetna HMO/POS/PPO - ARNB: $13,378.45 Anthem Health Plans of NH — Anthem - Federal Employee Program: $17,880.05 Anthem Health Plans of NH — Anthem - Indemnity: $17,880.05 CCMSI — CCMSI - Workers Comp: $20,699.55 Corvel — Corvel - Workers Comp: $20,045.88 Coventry — Coventry- Workers Comp: $18,956.43 First Health/HCVM — First Health/HCVM: $18,956.43 Maine Community Health Options — MCHO Indiv - Exchange: $13,879.59 Maine Community Health Options — MCHO SHOP - Exchange: $16,014.92
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Laps surg prst8ect rpbic rad	Not listed in the file	Not listed in the file	$860.72 – $9,774.32
Prostate removal by laparoscope (radical prostatectomy): 10 of 59 insurance plan rates Aetna — Aetna - HMO/POS/PPO: $7,052.14 Aetna — Aetna HMO/POS/PPO: $7,052.14 Aetna — Aetna HMO/POS/PPO - ARNB: $7,052.14 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,022.51 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid - DHP: $1,084.79 Anthem Health Plans of NH — Anthem - Federal Employee Program: $9,774.32 Anthem Health Plans of NH — Anthem - Indemnity: $9,774.32 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $7,154.95 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $5,373.08 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $5,006.48
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY W BIOPSY ENDOMETRIUM &/ POLYPECTOMY W/WO D&C	$4,400	$1,346.40	$498.52 – $4,180
Hysteroscopy with biopsy of the uterus lining: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,088.80 Aetna — Aetna HMO/POS/PPO - ARNB: $2,701.60 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $498.52 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,834.16 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,411.20 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,411.20 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,939.20 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $537.24 CCMSI — CCMSI - Workers Comp: $4,180 Cigna — Cigna HMO-POS: $2,662
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HYSTEROSCOPY W BIOPSY ENDOMETRIUM &/ POLYPECTOMY W/WO D&C	$4,778	$1,462.07	$541.35 – $4,539.10
Hysteroscopy with biopsy of the uterus lining: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,354.16 Aetna — Aetna HMO/POS/PPO - ARNB: $2,933.69 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $541.35 Anthem Health Plans of NH — Anthem - Federal Employee Program: $4,163.55 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $2,618.34 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $2,618.34 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $3,191.70 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $583.39 CCMSI — CCMSI - Workers Comp: $4,539.10 Cigna — Cigna HMO-POS: $2,890.69
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HYSTEROSCOPY W BIOPSY ENDOMETRIUM &/ POLYPECTOMY W/WO D&C	$4,400	$1,346.40	$1,518 – $4,180
Hysteroscopy with biopsy of the uterus lining: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $3,088.80 Aetna — Aetna HMO/POS/PPO - ARNB: $2,701.60 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,610.64 Anthem Health Plans of NH — Anthem - Indemnity: $3,610.64 CCMSI — CCMSI - Workers Comp: $4,180 Corvel — Corvel - Workers Comp: $4,048 Coventry — Coventry- Workers Comp: $3,828 First Health/HCVM — First Health/HCVM: $3,828 Maine Community Health Options — MCHO Indiv - Exchange: $2,802.80 Maine Community Health Options — MCHO SHOP - Exchange: $3,234
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ DX/THER SBST INTRLMNR LMBR/SAC W IMG GDN	$3,125	$956.25	$354.06 – $2,968.75
Spinal injection, lower back (epidural), with imaging guidance: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,193.75 Aetna — Aetna HMO/POS/PPO - ARNB: $1,918.75 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $354.06 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,723.12 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $1,712.50 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $1,712.50 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,087.50 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $381.56 CCMSI — CCMSI - Workers Comp: $2,968.75 Cigna — Cigna HMO-POS: $1,890.62
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: INJ DX/THER SBST INTRLMNR LMBR/SAC W IMG GDN	$3,134	$959	$355.08 – $2,977.30
Spinal injection, lower back (epidural), with imaging guidance: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,200.07 Aetna — Aetna HMO/POS/PPO - ARNB: $1,924.28 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $355.08 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,730.97 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $1,717.43 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $1,717.43 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,093.51 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $382.66 CCMSI — CCMSI - Workers Comp: $2,977.30 Cigna — Cigna HMO-POS: $1,896.07
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: INJ DX/THER SBST INTRLMNR LMBR/SAC W IMG GDN	$3,125	$956.25	$1,078.12 – $2,968.75
Spinal injection, lower back (epidural), with imaging guidance: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,193.75 Aetna — Aetna HMO/POS/PPO - ARNB: $1,918.75 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,564.38 Anthem Health Plans of NH — Anthem - Indemnity: $2,564.38 CCMSI — CCMSI - Workers Comp: $2,968.75 Corvel — Corvel - Workers Comp: $2,875 Coventry — Coventry- Workers Comp: $2,718.75 First Health/HCVM — First Health/HCVM: $2,718.75 Maine Community Health Options — MCHO Indiv - Exchange: $1,990.62 Maine Community Health Options — MCHO SHOP - Exchange: $2,296.88
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ ANES/STEROID EPIDURAL LUMBAR/SACRAL SINGLE LEVEL W IMG	$3,515	$1,075.59	$398.25 – $3,339.25
Nerve root injection, lower back, with imaging guidance: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,467.53 Aetna — Aetna HMO/POS/PPO - ARNB: $2,158.21 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $398.25 Anthem Health Plans of NH — Anthem - Federal Employee Program: $3,062.97 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $1,926.22 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $1,926.22 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,348.02 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $429.18 CCMSI — CCMSI - Workers Comp: $3,339.25 Cigna — Cigna HMO-POS: $2,126.57
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: INJ ANES/STEROID EPIDURAL LUMBAR/SACRAL SINGLE LEVEL W IMG	$3,432	$1,050.19	$388.85 – $3,260.40
Nerve root injection, lower back, with imaging guidance: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,409.26 Aetna — Aetna HMO/POS/PPO - ARNB: $2,107.25 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $388.85 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,990.64 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $1,880.74 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $1,880.74 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,292.58 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $419.05 CCMSI — CCMSI - Workers Comp: $3,260.40 Cigna — Cigna HMO-POS: $2,076.36
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: INJ ANES/STEROID EPIDURAL LUMBAR/SACRAL SINGLE LEVEL W IMG	$3,515	$1,075.59	$1,212.68 – $3,339.25
Nerve root injection, lower back, with imaging guidance: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,467.53 Aetna — Aetna HMO/POS/PPO - ARNB: $2,158.21 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,884.41 Anthem Health Plans of NH — Anthem - Indemnity: $2,884.41 CCMSI — CCMSI - Workers Comp: $3,339.25 Corvel — Corvel - Workers Comp: $3,233.80 Coventry — Coventry- Workers Comp: $3,058.05 First Health/HCVM — First Health/HCVM: $3,058.05 Maine Community Health Options — MCHO Indiv - Exchange: $2,239.05 Maine Community Health Options — MCHO SHOP - Exchange: $2,583.52
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEUROPLASTY &/TRANSPOSITION MEDIAN NERVE CARPAL TUNNE	$6,396	$1,957.18	$724.67 – $6,076.20
Carpal tunnel release: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $4,489.99 Aetna — Aetna HMO/POS/PPO - ARNB: $3,927.14 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $724.67 Anthem Health Plans of NH — Anthem - Federal Employee Program: $5,573.47 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $3,505.01 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $3,505.01 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $4,272.53 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $780.95 CCMSI — CCMSI - Workers Comp: $6,076.20 Cigna — Cigna HMO-POS: $3,869.58
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: NEUROPLASTY &/TRANSPOSITION MEDIAN NERVE CARPAL TUNNE	$7,345	$2,247.57	$832.19 – $6,977.75
Carpal tunnel release: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $5,156.19 Aetna — Aetna HMO/POS/PPO - ARNB: $4,509.83 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $832.19 Anthem Health Plans of NH — Anthem - Federal Employee Program: $6,400.43 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $4,025.06 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $4,025.06 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $4,906.46 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $896.82 CCMSI — CCMSI - Workers Comp: $6,977.75 Cigna — Cigna HMO-POS: $4,443.72
Carpal tunnel release CPT 64721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: NEUROPLASTY &/TRANSPOSITION MEDIAN NERVE CARPAL TUNNE	$6,396	$1,957.18	$2,206.62 – $6,076.20
Carpal tunnel release: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $4,489.99 Aetna — Aetna HMO/POS/PPO - ARNB: $3,927.14 Anthem Health Plans of NH — Anthem - Federal Employee Program: $5,248.56 Anthem Health Plans of NH — Anthem - Indemnity: $5,248.56 CCMSI — CCMSI - Workers Comp: $6,076.20 Corvel — Corvel - Workers Comp: $5,884.32 Coventry — Coventry- Workers Comp: $5,564.52 First Health/HCVM — First Health/HCVM: $5,564.52 Maine Community Health Options — MCHO Indiv - Exchange: $4,074.25 Maine Community Health Options — MCHO SHOP - Exchange: $4,701.06
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POST-CATARACT LASER SURGERY	$3,135	$959.31	$355.20 – $2,978.25
Laser treatment of clouding after cataract surgery: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,200.77 Aetna — Aetna HMO/POS/PPO - ARNB: $1,924.89 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $355.20 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,731.84 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $1,717.98 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $1,717.98 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $2,094.18 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $382.78 CCMSI — CCMSI - Workers Comp: $2,978.25 Cigna — Cigna HMO-POS: $1,896.68
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: POST-CATARACT LASER SURGERY	$7,361	$2,252.47	$834 – $6,992.95
Laser treatment of clouding after cataract surgery: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $5,167.42 Aetna — Aetna HMO/POS/PPO - ARNB: $4,519.65 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $834 Anthem Health Plans of NH — Anthem - Federal Employee Program: $6,414.38 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $4,033.83 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $4,033.83 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $4,917.15 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $898.78 CCMSI — CCMSI - Workers Comp: $6,992.95 Cigna — Cigna HMO-POS: $4,453.40
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) · Hospital (facility) fee In the file: POST-CATARACT LASER SURGERY	$3,135	$959.31	$1,081.57 – $2,978.25
Laser treatment of clouding after cataract surgery: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,200.77 Aetna — Aetna HMO/POS/PPO - ARNB: $1,924.89 Anthem Health Plans of NH — Anthem - Federal Employee Program: $2,572.58 Anthem Health Plans of NH — Anthem - Indemnity: $2,572.58 CCMSI — CCMSI - Workers Comp: $2,978.25 Corvel — Corvel - Workers Comp: $2,884.20 Coventry — Coventry- Workers Comp: $2,727.45 First Health/HCVM — First Health/HCVM: $2,727.45 Maine Community Health Options — MCHO Indiv - Exchange: $1,997 Maine Community Health Options — MCHO SHOP - Exchange: $2,304.22
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EXTRACAPSULAR CATARACT RMVL INSERTION IO LENS PROSTH W/O ECP	$11,265	$3,447.09	$1,276.32 – $10,701.75
Cataract removal with lens implant: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $7,908.03 Aetna — Aetna HMO/POS/PPO - ARNB: $6,916.71 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,276.32 Anthem Health Plans of NH — Anthem - Federal Employee Program: $9,816.32 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $6,173.22 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $6,173.22 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $7,525.02 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,375.46 CCMSI — CCMSI - Workers Comp: $10,701.75 Cigna — Cigna HMO-POS: $6,815.32
Cataract removal with lens implant CPT 66984 · Inpatient (hospital stay) · Doctor (professional) fee In the file: EXTRACAPSULAR CATARACT RMVL INSERTION IO LENS PROSTH W/O ECP	$11,265	$3,447.09	$3,886.42 – $10,701.75
Cataract removal with lens implant: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $7,908.03 Aetna — Aetna HMO/POS/PPO - ARNB: $6,916.71 Anthem Health Plans of NH — Anthem - Federal Employee Program: $9,244.06 Anthem Health Plans of NH — Anthem - Indemnity: $9,244.06 CCMSI — CCMSI - Workers Comp: $10,701.75 Corvel — Corvel - Workers Comp: $10,363.80 Coventry — Coventry- Workers Comp: $9,800.55 First Health/HCVM — First Health/HCVM: $9,800.55 Maine Community Health Options — MCHO Indiv - Exchange: $7,175.80 Maine Community Health Options — MCHO SHOP - Exchange: $8,279.78
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	Not listed in the file	$388.23 – $5,340.14
Cataract removal with lens implant: 10 of 46 insurance plan rates Aetna — Aetna HMO/POS/PPO: $2,525.39 Aetna — Aetna HMO/POS/PPO - ARNB: $2,525.39 Anthem Health Plans of NH — Anthem - Federal Employee Program: $4,522.59 Anthem Health Plans of NH — Anthem - Indemnity: $4,522.59 Anthem Health Plans of NH — Anthem - Indemnity/Federal Employee Program: $2,982.04 Anthem Health Plans of NH — Anthem HMO/POS; Individual Non QHP On or Off Exch; SHOP Off : $2,486.13 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange: $2,316.51 Anthem Health Plans of NH — Anthem Indiv QHP - Exchange - DHP: $1,711.16 Anthem Health Plans of NH — Anthem PPO: $2,486.13 Anthem Health Plans of NH — Anthem PPO - DHP: $1,895.08

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OB CARE INCL ANTEPARTUM, VAGINAL DELIVERY AND POSTPARTUM	$13,475	$4,123.35	$1,526.72 – $12,801.25
Vaginal delivery, with care before and after: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $9,459.45 Aetna — Aetna HMO/POS/PPO - ARNB: $8,273.65 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,526.72 Anthem Health Plans of NH — Anthem - Federal Employee Program: $11,742.12 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $7,384.30 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $7,384.30 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $9,001.30 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,645.30 CCMSI — CCMSI - Workers Comp: $12,801.25 Cigna — Cigna HMO-POS: $8,152.38
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OB CARE INCL ANTEPARTUM, VAGINAL DELIVERY AND POSTPARTUM	$8,842	$2,705.65	$1,001.80 – $8,399.90
Vaginal delivery, with care before and after: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $6,207.08 Aetna — Aetna HMO/POS/PPO - ARNB: $5,428.99 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,001.80 Anthem Health Plans of NH — Anthem - Federal Employee Program: $7,704.92 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $4,845.42 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $4,845.42 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $5,906.46 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,079.61 CCMSI — CCMSI - Workers Comp: $8,399.90 Cigna — Cigna HMO-POS: $5,349.41
Vaginal delivery, with care before and after CPT 59400 · Inpatient (hospital stay) · Doctor (professional) fee In the file: OB CARE INCL ANTEPARTUM, VAGINAL DELIVERY AND POSTPARTUM	$13,475	$4,123.35	$4,648.88 – $12,801.25
Vaginal delivery, with care before and after: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $9,459.45 Aetna — Aetna HMO/POS/PPO - ARNB: $8,273.65 Anthem Health Plans of NH — Anthem - Federal Employee Program: $11,057.58 Anthem Health Plans of NH — Anthem - Indemnity: $11,057.58 CCMSI — CCMSI - Workers Comp: $12,801.25 Corvel — Corvel - Workers Comp: $12,397 Coventry — Coventry- Workers Comp: $11,723.25 First Health/HCVM — First Health/HCVM: $11,723.25 Maine Community Health Options — MCHO Indiv - Exchange: $8,583.58 Maine Community Health Options — MCHO SHOP - Exchange: $9,904.12
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OB ANTEPARTUM CARE CESAREAN DELIVERY & POSTPARTUM	$14,782	$4,523.29	$1,674.80 – $14,042.90
Cesarean delivery (C-section), with care before and after: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $10,376.96 Aetna — Aetna HMO/POS/PPO - ARNB: $9,076.15 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,674.80 Anthem Health Plans of NH — Anthem - Federal Employee Program: $12,881.03 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $8,100.54 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $8,100.54 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $9,874.38 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,804.88 CCMSI — CCMSI - Workers Comp: $14,042.90 Cigna — Cigna HMO-POS: $8,943.11
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OB ANTEPARTUM CARE CESAREAN DELIVERY & POSTPARTUM	$15,669	$4,794.71	$1,775.30 – $14,885.55
Cesarean delivery (C-section), with care before and after: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $10,999.64 Aetna — Aetna HMO/POS/PPO - ARNB: $9,620.77 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,775.30 Anthem Health Plans of NH — Anthem - Federal Employee Program: $13,653.97 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $8,586.61 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $8,586.61 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $10,466.89 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,913.18 CCMSI — CCMSI - Workers Comp: $14,885.55 Cigna — Cigna HMO-POS: $9,479.74
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OB ANTEPARTUM CARE CESAREAN DELIVERY & POSTPARTUM	$14,782	$4,523.29	$5,099.79 – $14,042.90
Cesarean delivery (C-section), with care before and after: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $10,376.96 Aetna — Aetna HMO/POS/PPO - ARNB: $9,076.15 Anthem Health Plans of NH — Anthem - Federal Employee Program: $12,130.11 Anthem Health Plans of NH — Anthem - Indemnity: $12,130.11 CCMSI — CCMSI - Workers Comp: $14,042.90 Corvel — Corvel - Workers Comp: $13,599.44 Coventry — Coventry- Workers Comp: $12,860.34 First Health/HCVM — First Health/HCVM: $12,860.34 Maine Community Health Options — MCHO Indiv - Exchange: $9,416.13 Maine Community Health Options — MCHO SHOP - Exchange: $10,864.77
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: ROUTINE OB CARE VAG DELIVERY & POSTPARTUM CARE AFTER PREVIOUS CESAREAN	$13,604	$4,162.82	$1,541.33 – $12,923.80
Vaginal delivery after a previous C-section, with care before and after: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $9,550.01 Aetna — Aetna HMO/POS/PPO - ARNB: $8,352.86 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,541.33 Anthem Health Plans of NH — Anthem - Federal Employee Program: $11,854.53 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $7,454.99 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $7,454.99 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $9,087.47 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,661.05 CCMSI — CCMSI - Workers Comp: $12,923.80 Cigna — Cigna HMO-POS: $8,230.42
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ROUTINE OB CARE VAG DELIVERY & POSTPARTUM CARE AFTER PREVIOUS CESAREAN	$11,034	$3,376.40	$1,250.15 – $10,482.30
Vaginal delivery after a previous C-section, with care before and after: 10 of 29 insurance plan rates Aetna — Aetna HMO/POS/PPO: $7,745.87 Aetna — Aetna HMO/POS/PPO - ARNB: $6,774.88 Amerihealth Caritas NH — Amerihealth Caritas - NH Managed Medicaid: $1,250.15 Anthem Health Plans of NH — Anthem - Federal Employee Program: $9,615.03 BCBS of Vermont — BCBS of Vermont - The Vermont Health Plan: $6,046.63 BCBS of Vermont — BCBS of Vermont - Vermont Health Partnership: $6,046.63 BCBS of Vermont — BCBS of Vermont Non-Managed Care Plans: $7,370.71 Beacon Health Strategies/Carelon — WellSense - NH Managed Medicaid Beh Health: $1,347.25 CCMSI — CCMSI - Workers Comp: $10,482.30 Cigna — Cigna HMO-POS: $6,675.57
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient (hospital stay) · Doctor (professional) fee In the file: ROUTINE OB CARE VAG DELIVERY & POSTPARTUM CARE AFTER PREVIOUS CESAREAN	$13,604	$4,162.82	$4,693.38 – $12,923.80
Vaginal delivery after a previous C-section, with care before and after: 10 of 16 insurance plan rates Aetna — Aetna HMO/POS/PPO: $9,550.01 Aetna — Aetna HMO/POS/PPO - ARNB: $8,352.86 Anthem Health Plans of NH — Anthem - Federal Employee Program: $11,163.44 Anthem Health Plans of NH — Anthem - Indemnity: $11,163.44 CCMSI — CCMSI - Workers Comp: $12,923.80 Corvel — Corvel - Workers Comp: $12,515.68 Coventry — Coventry- Workers Comp: $11,835.48 First Health/HCVM — First Health/HCVM: $11,835.48 Maine Community Health Options — MCHO Indiv - Exchange: $8,665.75 Maine Community Health Options — MCHO SHOP - Exchange: $9,998.94

Source: Mary Hitchcock Memorial Hospital’s standard charges file (dartmouth-hitchcock.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on January 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	1 Medical Center Drive, Lebanon, NH 03756
County	Grafton County
State	New Hampshire
Phone	(603) 650‑5000
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	3 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	300003
Name in Medicare records	MARY HITCHCOCK MEMORIAL HOSPITAL
Profile level	Medicare data + hospital website
Name on the hospital’s website	Dartmouth Hitchcock Medical Center
Official website	dartmouth-hitchcock.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital

From the hospital’s website

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

Dartmouth Hitchcock Medical Center — dartmouth-hitchcock.org
Interpreting | Patients & Visitors | DHMC and Clinics — dartmouth-hitchcock.org
Parking, Transportation, and Maps | Patients & Visitors | DHMC and Clinics — dartmouth-hitchcock.org
Service Dog and Pet Visitation | Patients & Visitors | DHMC and Clinics — dartmouth-hitchcock.org
Awards and Recognition | About | DHMC and Clinics — dartmouth-hitchcock.org
Emergency Department | DHMC and Clinics — dartmouth-hitchcock.org
Adult Trauma Program | DHMC and Clinics — dartmouth-hitchcock.org
About Dartmouth Hitchcock Medical Center and Dartmouth Hitchcock Clinics | DHMC and Clinics — dartmouth-hitchcock.org
At the Hospital | Patients & Visitors | DHMC and Clinics — dartmouth-hitchcock.org
Hospital Stays | Patients & Visitors | DHMC and Clinics — dartmouth-hitchcock.org

Mary Hitchcock Memorial Hospital

Summary

Profile from official sources

At a glance

Quick answers

Specialties and care areas^{[3][8][9][10]}

Programs and centers^{[3][8][9][10][11][12]}

Emergency care (hospital website)^[5][6][7]

Visiting and practical information

Recognition^{[3][7][8][9][10]}

Doctors and clinicians (2,601)

Main specialties

Doctors with a page on this site (2,601)

About the Medicare star rating

Medicare quality data

What patients said (patient survey)

Infections caught in the hospital

Complications and deaths

Return visits to the hospital (readmissions)

Emergency room times and sepsis care

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

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

Heart tests and sleep study

Physical therapy and mental health

Procedures and surgery

Pregnancy and childbirth

Hospital information

Sources

From the hospital’s website

Mary Hitchcock Memorial Hospital

Summary

Profile from official sources

At a glance

Quick answers

Specialties and care areas[3][8][9][10]

Programs and centers[3][8][9][10][11][12]

Emergency care (hospital website)[5][6][7]

Visiting and practical information

Recognition[3][7][8][9][10]

Doctors and clinicians (2,601)

Main specialties

Doctors with a page on this site (2,601)

About the Medicare star rating

Medicare quality data

What patients said (patient survey)

Infections caught in the hospital

Complications and deaths

Return visits to the hospital (readmissions)

Emergency room times and sepsis care

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

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

Heart tests and sleep study

Physical therapy and mental health

Procedures and surgery

Pregnancy and childbirth

Hospital information

Sources

From the hospital’s website

Specialties and care areas^{[3][8][9][10]}

Programs and centers^{[3][8][9][10][11][12]}

Emergency care (hospital website)^[5][6][7]

Recognition^{[3][7][8][9][10]}