Does Mount St. Mary's Hospital & Health Center have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Mount St. Mary's Hospital & Health Center. In a medical emergency, call 911.

Where is Mount St. Mary's Hospital & Health Center?

5300 Military Road, Lewiston, NY 14092, in Niagara County, New York.

What is the phone number of Mount St. Mary's Hospital & Health Center?

(716) 297-4800, as listed by Medicare (CMS).

What is the Medicare star rating of Mount St. Mary's Hospital & Health Center?

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

Mount St. Mary's Hospital & Health Center

Quick answers

Does Mount St. Mary's Hospital & Health Center have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Mount St. Mary's Hospital & Health Center. In a medical emergency, call 911.
Where is Mount St. Mary's Hospital & Health Center?: 5300 Military Road, Lewiston, NY 14092, in Niagara County, New York.
What is the phone number of Mount St. Mary's Hospital & Health Center?: (716) 297-4800, as listed by Medicare (CMS).
What is the Medicare star rating of Mount St. Mary's Hospital & Health Center?: 2 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4][5][7]

Stroke care
Addiction management (Clearview Treatment Center)
Cardiac care
Obstetric care
Cardiology
Wound healing and hyperbaric medicine
Physical therapy
Primary care
Women's Center
Emergency medicine
Wound care and hyperbaric medicine
Imaging
Nuclear medicine

Conditions treated^[5][6]

Stroke
Alcohol and substance use disorders

Treatments^[4][5]

Procedures^[5]

CT scan
MRI
Digital mammography
Bone densitometry (DEXA)
Nuclear medicine

Programs and centers^[4][5][6][7]

Stroke care unit and inpatient rehabilitation
Clearview Treatment Center inpatient addiction treatment
Cardiac rehabilitation
Designated inpatient stroke unit
Lymphedema program
Wound Center

Emergency care (hospital website)^[4][5][6]

Emergency room	Yes
Open 24/7	Yes
Stroke designation	New York State designated Stroke Center

Visiting and practical information

Visiting	Visiting hours 9 a.m. to 9 p.m^[4]
Parking	All parking is free; notify staff if your vehicle is parked on campus during your stay^[8]
Interpreters and languages	Video remote interpreting for 300+ languages; ASL interpreters by video or in person^[8]

Recognition^[4]

New York State designated Stroke Center

Doctors and clinicians (479)

479 doctors and other clinicians list Mount St. Mary's Hospital & Health Center as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 455 more: the button below opens the full list.

Other emergency rooms nearby

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

Niagara Falls Memorial Medical Center6.2 mi · Niagara Falls, NY · Acute Care Hospital
Kenmore Mercy Hospital15 mi · Kenmore, NY · Acute Care Hospital
Upstate New York VA Healthcare System (Western NY VA Healthcare System)18 mi · Buffalo, NY · Federal/VA Acute Care Hospital
Sisters of Charity Hospital18 mi · Buffalo, NY · Acute Care Hospital
Erie County Medical Center19 mi · Buffalo, NY · Acute Care Hospital

Other hospitals nearby

Buffalo Psychiatric Center18 mi · Buffalo, NY · Psychiatric Hospital
Brylin Hosp19 mi · Buffalo, NY · Psychiatric Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Our Lady of Peace Nursing Care Residence2.6 mi · Lewiston, NY · 5 of 5 stars
Niagara Rehabilitation and Nursing Center6.1 mi · Niagara Falls, NY · 3 of 5 stars
Schoellkopf Health Center6.2 mi · Niagara Falls, NY · 3 of 5 stars

All nursing homes in the state →

Hospice providers

Niagara Hospice Inc15 mi · Lockport, NY · 4 of 5 stars
Hospice Buffalo Inc24 mi · Cheektowaga, NY · 5 of 5 stars

All hospice providers in the state →

Home health agencies

Schofield Certified Home Care15 mi · Kenmore, NY · 3 of 5 stars
Rosa Coplon Jewish Home & Infirmary Chha15 mi · Getzville, NY
People Home Health SVS Chha17 mi · Buffalo, NY

All home health agencies in the state →

Dialysis facilities

DaVita Niagara Dialysis Center5.2 mi · Niagara Falls, NY · 3 of 5 stars
DaVita Niagara Falls Kidney Center5.7 mi · Niagara Falls, NY · 2 of 5 stars
Fresenius Kidney Care - Wheatfield10.0 mi · North Tonawanda, NY · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

Ambulatory Surgery Center of Niagara5.2 mi · N Falls, NY
Endoscopy Center of Niagara, LLC5.2 mi · N Falls, NY
Buffalo Surgery Center, LLC13 mi · Amherst, NY

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Community Health Center of Niagara5.0 mi · Niagara Falls, NY · Community health center
New CHCB Mobile Van10 mi · North Tonawanda, NY · Community health center
CHC Lockport15 mi · Lockport, NY · Community health center

Clinics and urgent care

Niagara Falls Urgent Care5.2 mi · Niagara Falls, NY · Urgent care center
Wellnow Urgent Care, PC5.2 mi · Niagara Falls, NY · Urgent care center
Thrive Global LLC5.7 mi · Niagara Falls, NY · Urgent care center

Pharmacies

Lewiston Apothecary, LLC0.0 mi · Lewiston, NY · Community/retail pharmacy
Community Medical Pharmacy Inc3.8 mi · Niagara Falls, NY · Community/retail pharmacy
Rwkii Inc3.8 mi · Niagara Falls, NY · Community/retail pharmacy

Assisted living nearby

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

Elderwood Assisted Living at Wheatfield5.2 mi · Niagara Falls, NY
Heritage Manor of Ransomville Assisted Living Program6.5 mi · Ransomville, NY
Brookdale Niagara Assisted Living10.0 mi · North Tonawanda, NY
Brookdale Niagara Memory Care10.0 mi · North Tonawanda, NY

About the Medicare star rating

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

Medicare quality data

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

What patients said (patient survey)

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

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	4 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	68%National average: 72%
Would definitely recommend the hospital	70%National average: 71%
Nurses “always” communicated well	80%National average: 80%
Doctors “always” communicated well	80%National average: 80%
Staff “always” explained medicines before giving them	60%National average: 62%
Were given information about recovery at home	87%National average: 86%
Room and bathroom “always” clean	72%National average: 74%
Area around the room “always” quiet at night	59%National average: 60%
Completed surveys	425Response rate: 29%

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)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.124Better than the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	Too few cases to report
Deaths within 30 days: heart failure patients	15.2%
Deaths within 30 days: pneumonia patients	20.2%
Deaths within 30 days: COPD patients	6.9%
Deaths within 30 days: stroke patients	12.7%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.98No different from the national rate
Complications after hip or knee replacement	Not reported to Medicare

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	14.7%
Readmitted within 30 days: heart failure	21.6%
Readmitted within 30 days: pneumonia	18.7%
Readmitted within 30 days: COPD	20%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Not reported to Medicare

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	156 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)	40%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 New York Best hospitals in New York

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 81 common services exactly as Mount St. Mary's Hospital & Health Center 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 →

$ 15 amounts are marked with “!”: they are more than 100 times higher or lower than what other hospitals list for the same service, which usually means an error or a different unit in the hospital’s file. They are shown exactly as listed; ask the hospital before relying on them.

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Outpatient New Low Mdm 30 Minutes	$236	$236	$8.08 – $276.03
New patient office visit (about 30–44 minutes): 10 of 281 insurance plan rates AARP [100007] — AARP [10000701]: $134.52 AETNA [100001] — AETNA HMO [10000107]: $119.29 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $119.29 AETNA [100001] — AETNA PPO [10000101]: $119.29 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $119.29 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $134.52 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $99.74 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $99.74 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $99.74 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $99.74
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Hospital (facility) fee In the file: Facility Fee - New Patient - 30 Minutes	$223	$223	$8.08 – $276.03
New patient office visit (about 30–44 minutes): 10 of 190 insurance plan rates AARP [100007] — AARP [10000701]: $127.11 AETNA [100001] — AETNA HMO [10000107]: $64.52 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $64.52 AETNA [100001] — AETNA PPO [10000101]: $64.52 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $174.50 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $127.11 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $8.48 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $8.48 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $8.48 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $127.11
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Hospital (facility) fee · modifier PO In the file: Facility Fee - New Patient - 30 Minutes\|SERV/PROC OFF-CAMPUS PBD	$223	$223	$8.08 – $276.03
New patient office visit (about 30–44 minutes): 10 of 64 insurance plan rates AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $174.50 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $8.08 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $8.08 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $8.08 CATHOLIC HEALTH LIFE PACE [400005] — CATHOLIC HEALTH LIFE PACE [40000501]: $166.19 CATHOLIC HEALTH LIFE PACE MEDICAID [300005] — CATHOLIC HEALTH LIFE PACE MEDICAID [30000501]: $166.19 CIGNA MEDICARE HMO [450113] — CIGNA MEDICARE HMO [45011301]: $166.19 COVID19 HRSA [45013] — COVID19 HRSA [4501301]: $166.19 FALLON HEALTH [450115] — FALLON HEALTH [45011501]: $166.19 FIDELIS DUAL ADVANTAGE [450120] — FIDELIS DUAL ADV FLEX [45012002]: $172.01
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Outpatient New Moderate Mdm 45 Minutes	$350	$350	$8.48 – $332.73
New patient office visit (about 45–59 minutes): 10 of 281 insurance plan rates AARP [100007] — AARP [10000701]: $199.50 AETNA [100001] — AETNA HMO [10000107]: $180.29 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $180.29 AETNA [100001] — AETNA PPO [10000101]: $180.29 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $180.29 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $199.50 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $147.88 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $147.88 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $147.88 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $147.88
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Hospital (facility) fee In the file: Facility Fee - New Patient - 45 Minutes	$331	$331	$8.48 – $332.73
New patient office visit (about 45–59 minutes): 10 of 192 insurance plan rates AARP [100007] — AARP [10000701]: $133.95 AETNA [100001] — AETNA HMO [10000107]: $104.66 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $104.66 AETNA [100001] — AETNA PPO [10000101]: $104.66 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $174.50 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $133.95 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $8.48 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $8.48 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $8.48 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $188.67
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Outpatient New High Mdm 60 Minutes	$462	$462	$8.08 – $416
New patient office visit (about 60–74 minutes): 10 of 281 insurance plan rates AARP [100007] — AARP [10000701]: $231.94 AETNA [100001] — AETNA HMO [10000107]: $240.43 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $240.43 AETNA [100001] — AETNA PPO [10000101]: $240.43 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $240.43 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $263.34 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $195.47 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $195.47 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $195.47 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $195.47
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Hospital (facility) fee In the file: Facility Fee - New Patient - 60 Minutes	$416	$416	$8.08 – $416
New patient office visit (about 60–74 minutes): 10 of 192 insurance plan rates AARP [100007] — AARP [10000701]: $133.95 AETNA [100001] — AETNA HMO [10000107]: $142.02 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $142.02 AETNA [100001] — AETNA PPO [10000101]: $142.02 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $174.50 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $133.95 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $8.08 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $8.08 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $8.08 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $133.95
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Hospital (facility) fee In the file: Facility Fee - Established Patient - 20 Minutes	$235	$235	$5.05 – $276.03
Established patient office visit (about 20–29 minutes): 10 of 189 insurance plan rates AARP [100007] — AARP [10000701]: $133.95 AETNA [100001] — AETNA HMO [10000107]: $188 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $101.60 AETNA [100001] — AETNA PPO [10000101]: $101.60 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $174.50 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $133.95 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $5.05 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $5.05 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $5.05 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $133.95
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Office/Outpatient Established Low Mdm 20 Min	$190	$190	$5.05 – $276.03
Established patient office visit (about 20–29 minutes): 10 of 155 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $82.40 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $82.40 AETNA [100001] — AETNA PPO [10000101]: $82.40 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $82.40 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $68.05 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $66.14 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $66.14 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $66.14 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $66.14 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $66.14
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office/Outpatient Established Low Mdm 20 Min	$190	$190	$5.05 – $276.03
Established patient office visit (about 20–29 minutes): 10 of 154 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $96.94 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $96.94 AETNA [100001] — AETNA PPO [10000101]: $96.94 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $96.94 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $80.06 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $82.67 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $82.67 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $82.67 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $82.67 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $82.67
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/Outpatient Established Mod Mdm 30 Min	$266	$266	$5.05 – $276.03
Established patient office visit (about 30–39 minutes): 10 of 278 insurance plan rates AARP [100007] — AARP [10000701]: $151.62 AETNA [100001] — AETNA HMO [10000107]: $138.11 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $138.11 AETNA [100001] — AETNA PPO [10000101]: $138.11 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $138.11 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $151.62 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $112.37 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $112.37 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $112.37 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $112.37
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Hospital (facility) fee In the file: Facility Fee - Established Patient - 30 Minutes	$192	$192	$5.05 – $276.03
Established patient office visit (about 30–39 minutes): 10 of 189 insurance plan rates AARP [100007] — AARP [10000701]: $133.95 AETNA [100001] — AETNA HMO [10000107]: $153.60 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $188 AETNA [100001] — AETNA PPO [10000101]: $188 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $174.50 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $109.44 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $5.30 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $5.30 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $5.30 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $133.95
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Hospital (facility) fee · modifier PO In the file: Facility Fee - Established Patient - 30 Minutes\|SERV/PROC OFF-CAMPUS PBD	$192	$192	$5.05 – $276.03
Established patient office visit (about 30–39 minutes): 10 of 19 insurance plan rates AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $5.05 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $5.05 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $5.05 MEDICARE [400001] — MEDICARE PART A [40000102]: $66.48 MEDICARE [400001] — MEDICARE PART A AND B [40000101]: $66.48 MEDICARE [400001] — MEDICARE PART B [40000103]: $66.48 MEDICARE [400001] — MEDICARE RAILROAD [40000104]: $66.48 MEDICARE ALTERNATE PAYOR [888] — MEDICARE PART B ALTERNATE [88801]: $66.48 MEDICARE COVID VAC ALT [40000101] — MEDICARE COVID VAC ALT [4000010102]: $66.48 SENECA NATION [450119] — SENECA NATION [45011901]: $66.48
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Initial Preventive Medicine New Pt Age 18-39yrs	$192	$269	$35.34 – $195.49
Preventive checkup, new patient, age 18–39: 10 of 121 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $72.92 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $72.92 AETNA [100001] — AETNA PPO [10000101]: $72.92 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $72.92 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $107.87 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $107.87 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $107.87 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $107.87 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $133.14 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $133.14
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Initial Preventive Medicine New Pt Age 18-39yrs	$192	$269	$35.34 – $195.49
Preventive checkup, new patient, age 18–39: 10 of 114 insurance plan rates AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $113.55 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $113.55 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $113.55 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $113.55 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $166.43 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $166.43 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $166.43 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $166.43 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $166.43 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE POS [10017313]: $166.43
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient · Doctor (professional) fee In the file: Initial Preventive Medicine New Pt Age 18-39yrs	$192	$269	$35.34 – $195.49
Preventive checkup, new patient, age 18–39: 10 of 50 insurance plan rates AARP [100007] — AARP [10000701]: $109.44 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $153.33 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $153.33 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $153.33 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $153.33 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $153.33 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $153.33 COMMERCIAL - OTHER [100172] — GUARDIAN [10017203]: $153.33 COMMERCIAL - OTHER [100172] — HEALTHSOURCE [10017204]: $153.33 COMMERCIAL - OTHER [100172] — HEALTHY LIVING PARTNERSHI [10017212]: $153.33
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Doctor (professional) fee In the file: Initial Preventive Medicine New Patient 40-64yrs	$223	$309	$43.42 – $225.38
Preventive checkup, new patient, age 40–64: 10 of 171 insurance plan rates AARP [100007] — AARP [10000701]: $127.11 AETNA [100001] — AETNA HMO [10000107]: $88.42 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $88.42 AETNA [100001] — AETNA PPO [10000101]: $88.42 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $88.42 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $176.13 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $124.19 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $124.19 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $124.19 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $124.19
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Doctor (professional) fee In the file: Emergency Department Visit Low Mdm	$193.03	$193.03	$24.17 – $1,206
Emergency room visit (moderate): 10 of 220 insurance plan rates AARP [100007] — AARP [10000701]: $110.03 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $110.03 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $110.03 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $83.90 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $83.90 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $83.90 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $83.90 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $83.90 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE POS [10017313]: $83.90 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE TIERED [10017314]: $83.90
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Emergency Department Level 3 Visit Moderate Severity	$1,206	$1,206	$24.17 – $1,206
Emergency room visit (moderate): 10 of 195 insurance plan rates AARP [100007] — AARP [10000701]: $687.42 AETNA [100001] — AETNA HMO [10000107]: $964.80 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $964.80 AETNA [100001] — AETNA PPO [10000101]: $964.80 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $357.79 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $687.42 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $336.42 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $336.42 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $336.42 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $687.42
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency Department Visit Low Mdm	$193.03	$193.03	$24.17 – $1,206
Emergency room visit (moderate): 10 of 67 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $53.22 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $53.22 AETNA [100001] — AETNA PPO [10000101]: $53.22 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $53.22 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $24.41 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $24.41 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $24.41 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $24.41 BCBS MEDICAID [350103] — BC OOA MEDICAID [35010301]: $24.41 BLUE CROSS/BLUE SHIELD [100151] — EMPIRE B/C -YLS [10015107]: $83.90
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency Department Visit Moderate Mdm	$284	$284	$40.54 – $1,878
Emergency room visit (moderately high): 10 of 171 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $89.97 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $89.97 AETNA [100001] — AETNA PPO [10000101]: $89.97 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $89.97 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $45.02 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $45.02 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $45.02 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $45.02 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $147.58 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $147.58
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Emergency Department Visit Moderate Mdm	$284	$284	$40.54 – $1,878
Emergency room visit (moderately high): 10 of 151 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $102.27 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $102.27 AETNA [100001] — AETNA PPO [10000101]: $102.27 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $102.27 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $42.77 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $118.06 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $118.06 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $118.06 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $118.06 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $118.06
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Doctor (professional) fee In the file: Emergency Department Visit Moderate Mdm	$284	$284	$40.54 – $1,878
Emergency room visit (moderately high): 10 of 113 insurance plan rates AARP [100007] — AARP [10000701]: $161.88 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $161.88 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $161.88 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $161.88 CATHOLIC HEALTH LIFE PACE [400005] — CATHOLIC HEALTH LIFE PACE [40000501]: $114.58 CATHOLIC HEALTH LIFE PACE MEDICAID [300005] — CATHOLIC HEALTH LIFE PACE MEDICAID [30000501]: $114.58 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $161.88 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $161.88 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $161.88 COMMERCIAL - OTHER [100172] — GUARDIAN [10017203]: $161.88
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Doctor (professional) fee In the file: Emergency Department Visit High Mdm	$411	$411	$67.19 – $2,300
Emergency room visit (high): 10 of 287 insurance plan rates AARP [100007] — AARP [10000701]: $234.27 AETNA [100001] — AETNA HMO [10000107]: $130.61 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $130.61 AETNA [100001] — AETNA PPO [10000101]: $130.61 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $130.61 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $234.27 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $67.19 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $67.19 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $67.19 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $67.19
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Emergency Department Level 5 Visit High Severity&Threat Func	$2,300	$2,300	$67.19 – $2,300
Emergency room visit (high): 10 of 197 insurance plan rates AARP [100007] — AARP [10000701]: $1,311 AETNA [100001] — AETNA HMO [10000107]: $1,840 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $1,840 AETNA [100001] — AETNA PPO [10000101]: $1,840 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $780.56 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,311 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $517.57 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $517.57 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $517.57 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $1,311

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee In the file: Basic Metabolic Panel (BMP) that includes total calcium	$19	$7.25	$6.35 – $19
Basic metabolic panel (blood test): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $10.83 AETNA [100001] — AETNA HMO [10000107]: $15.20 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $15.20 AETNA [100001] — AETNA PPO [10000101]: $15.20 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $8.88 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $10.83 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $7.32 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $7.32 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $7.32 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $7.32
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee · modifier PN In the file: Basic Metabolic Panel (BMP) that includes total calcium\|PN - NON-EXCEPTED OFF-CAMPUS SVC	$19	$7.25	$6.35 – $19
Basic metabolic panel (blood test): rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $17.10 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $17.10 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $10.64 MVP HEALTHCARE [100168] — MVP [10016801]: $11.02
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee · modifier PO In the file: Basic Metabolic Panel (BMP) that includes total calcium\|SERV/PROC OFF-CAMPUS PBD	$19	$7.25	$6.35 – $19
Basic metabolic panel (blood test): rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $17.10 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $17.10 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $10.64 MVP HEALTHCARE [100168] — MVP [10016801]: $11.02
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$26	$10	$7.92 – $26
Comprehensive metabolic panel (blood test): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $14.82 AETNA [100001] — AETNA HMO [10000107]: $20.80 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $20.80 AETNA [100001] — AETNA PPO [10000101]: $20.80 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $11.09 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $14.82 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $10.10 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $10.10 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $10.10 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $10.10
Obstetric blood test panel CPT 80055 · Inpatient or outpatient · Hospital (facility) fee In the file: Obstetric Panel - Bundled Charge	$81	$81	$10 – $81
Obstetric blood test panel: 10 of 222 insurance plan rates AARP [100007] — AARP [10000701]: $46.17 AETNA [100001] — AETNA HMO [10000107]: $64.80 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $64.80 AETNA [100001] — AETNA PPO [10000101]: $64.80 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $50.20 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $46.17 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $46.17 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $31.87 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $31.87 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $31.87
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Hospital (facility) fee In the file: Lipid Panel Bundle	$54	$6.04	$6.10 – $54
Cholesterol panel (lipid panel): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $30.78 AETNA [100001] — AETNA HMO [10000107]: $43.20 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $43.20 AETNA [100001] — AETNA PPO [10000101]: $43.20 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $14.06 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $30.78 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $6.10 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $6.10 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $6.10 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $6.10
Kidney function panel CPT 80069 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Renal Function Panel - Bundled Charge	$21	$8.68	$6.51 – $21
Kidney function panel: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $11.97 AETNA [100001] — AETNA HMO [10000107]: $16.80 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $16.80 AETNA [100001] — AETNA PPO [10000101]: $16.80 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $9.11 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $11.97 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $8.68 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $8.68 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $8.68 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $8.68
Kidney function panel CPT 80069 · Inpatient or outpatient · Hospital (facility) fee · modifier PO In the file: HC Renal Function Panel - Bundled Charge\|SERV/PROC OFF-CAMPUS PBD	$21	$8.68	$6.51 – $21
Kidney function panel: rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $18.90 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $18.90 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $11.76 MVP HEALTHCARE [100168] — MVP [10016801]: $12.18
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Hepatic Function Panel - Bundled Charge	$19	$7.25	$6.13 – $19
Liver function panel: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $10.83 AETNA [100001] — AETNA HMO [10000107]: $15.20 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $15.20 AETNA [100001] — AETNA PPO [10000101]: $15.20 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $8.58 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $10.83 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $7.32 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $7.32 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $7.32 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $7.32
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee · modifier PN In the file: HC Hepatic Function Panel - Bundled Charge\|PN - NON-EXCEPTED OFF-CAMPUS SVC	$19	$7.25	$6.13 – $19
Liver function panel: rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $17.10 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $17.10 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $10.64 MVP HEALTHCARE [100168] — MVP [10016801]: $11.02
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee · modifier PO In the file: HC Hepatic Function Panel - Bundled Charge\|SERV/PROC OFF-CAMPUS PBD	$19	$7.25	$6.13 – $19
Liver function panel: rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $17.10 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $17.10 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $10.64 MVP HEALTHCARE [100168] — MVP [10016801]: $11.02
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Hospital (facility) fee In the file: Urine Test to Detect Abnormalities, Automated and Microscopic analysis	$8	$3.07	$1.43 – $10
Urine test (automated, with microscope): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $4.56 AETNA [100001] — AETNA HMO [10000107]: $6.40 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $6.40 AETNA [100001] — AETNA PPO [10000101]: $6.40 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $3.33 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $4.56 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $3.17 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $3.17 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $3.17 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $3.17
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Doctor (professional) fee In the file: Urnls Dip Stick/Tablet Reagent Auto Microscopy	$5	$5	$1.43 – $10
Urine test (automated, with microscope): 10 of 248 insurance plan rates AARP [100007] — AARP [10000701]: $2.85 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $2.85 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $3.17 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $3.17 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $3.17 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $3.17 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $2.85 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $2.11 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $2.11 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $2.11
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Hospital (facility) fee · modifier PN In the file: Urine Test to Detect Abnormalities, Automated and Microscopic analysis\|PN - NON-EXCEPTED OFF-CAMPUS SVC	$8	$3.07	$1.43 – $10
Urine test (automated, with microscope): rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $7.20 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $7.20 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $4.48 MVP HEALTHCARE [100168] — MVP [10016801]: $4.64
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Hospital (facility) fee In the file: Urinalysis Nonauto W/O Scope - POCT Urinalysis	$6	$6	$1.57 – $10
Urine test (manual, without microscope): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $3.42 AETNA [100001] — AETNA HMO [10000107]: $4.80 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $4.80 AETNA [100001] — AETNA PPO [10000101]: $4.80 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $3.65 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $3.42 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $2.02 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $2.02 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $2.02 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $2.02
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Pbb Urinalysis Nonauto W/O Scope	$6	$2	$1.57 – $10
Urine test (manual, without microscope): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $3.42 AETNA [100001] — AETNA HMO [10000107]: $4.80 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $4.80 AETNA [100001] — AETNA PPO [10000101]: $4.80 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $3.65 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $3.42 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $2.02 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $2.02 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $2.02 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $2.02
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Doctor (professional) fee In the file: Urnls Dip Stick/Tablet Rgnt Non-Auto W/O Micrscp	$6	$6	$1.57 – $10
Urine test (manual, without microscope): 10 of 248 insurance plan rates AARP [100007] — AARP [10000701]: $3.97 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $3.42 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $2.02 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $2.02 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $2.02 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $2.02 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $3.42 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $2.31 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $2.31 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $2.31
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Hospital (facility) fee In the file: Urine lab test, rapid point-of-care test for ketones	$5	$2	$1.01 – $10
Urine test (automated, without microscope): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $2.85 AETNA [100001] — AETNA HMO [10000107]: $4 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $4 AETNA [100001] — AETNA PPO [10000101]: $4 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $2.36 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $2.85 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $2.02 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $2.02 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $2.02 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $2.02
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Hospital (facility) fee In the file: Urine Sample to Detect Abnormalities	$5	$5	$1.01 – $10
Urine test (automated, without microscope): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $2.85 AETNA [100001] — AETNA HMO [10000107]: $4 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $4 AETNA [100001] — AETNA PPO [10000101]: $4 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $2.36 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $2.85 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $2.02 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $2.02 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $2.02 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $2.02
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Doctor (professional) fee In the file: Urnls Dip Stick/Tablet Rgnt Auto W/O Microscopy	$13.92	$13.92	$1.01 – $10
Urine test (automated, without microscope): 10 of 170 insurance plan rates AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $7.93 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $7.93 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $1.49 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $1.49 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $1.49 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $1.49 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $1.49 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE POS [10017313]: $1.49 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE TIERED [10017314]: $1.49 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 1 AND 2 [10015201]: $2
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee In the file: Prostate Specific Antigen,Total - Psa	$45	$18.39	$10 – $45
PSA (prostate specific antigen) blood test: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $25.65 AETNA [100001] — AETNA HMO [10000107]: $36 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $36 AETNA [100001] — AETNA PPO [10000101]: $36 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $19.31 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $25.65 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $18.39 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $18.39 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $18.39 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee · modifier PN In the file: Prostate Specific Antigen,Total - Psa\|PN - NON-EXCEPTED OFF-CAMPUS SVC	$45	$18.39	$10 – $45
PSA (prostate specific antigen) blood test: rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $40.50 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $40.50 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $25.20 MVP HEALTHCARE [100168] — MVP [10016801]: $26.10
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee · modifier PO In the file: Prostate Specific Antigen,Total - Psa\|SERV/PROC OFF-CAMPUS PBD	$45	$18.39	$10 – $45
PSA (prostate specific antigen) blood test: rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $40.50 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $40.50 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $25.20 MVP HEALTHCARE [100168] — MVP [10016801]: $26.10
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Hospital (facility) fee In the file: Thyroid-Stimulating Hormone (TSH) Test	$68	$9	$9.09 – $68
Thyroid stimulating hormone (TSH) test: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $38.76 AETNA [100001] — AETNA HMO [10000107]: $54.40 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $54.40 AETNA [100001] — AETNA PPO [10000101]: $54.40 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $17.64 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $38.76 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $9.09 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $9.09 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $9.09 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $9.09
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Hospital (facility) fee In the file: Complete Blood Count and White Blood Cell Count	$22	$3.17	$3.20 – $22
Complete blood count (CBC) with differential: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $12.54 AETNA [100001] — AETNA HMO [10000107]: $17.60 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $17.60 AETNA [100001] — AETNA PPO [10000101]: $17.60 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $8.16 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $12.54 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $3.20 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $3.20 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $3.20 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $3.20
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Doctor (professional) fee In the file: Blood Count Complete Auto&Auto Difrntl Wbc	$36.10	$36.10	$3.20 – $22
Complete blood count (CBC) with differential: 10 of 211 insurance plan rates AARP [100007] — AARP [10000701]: $20.58 AETNA [100001] — AETNA HMO [10000107]: $6.60 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $6.60 AETNA [100001] — AETNA PPO [10000101]: $6.60 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $6.60 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $20.58 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $20.58 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $5.18 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $5.18 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $5.18
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Hospital (facility) fee · modifier PN In the file: Complete Blood Count and White Blood Cell Count\|PN - NON-EXCEPTED OFF-CAMPUS SVC	$22	$3.17	$3.20 – $22
Complete blood count (CBC) with differential: rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $19.80 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $19.80 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $12.32 MVP HEALTHCARE [100168] — MVP [10016801]: $12.76
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Hospital (facility) fee In the file: COMPLETE BLOOD COUNT - POINT-OF-CARE device	$16	$16	$2.72 – $16
Complete blood count (CBC), automated: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $9.12 AETNA [100001] — AETNA HMO [10000107]: $12.80 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $12.80 AETNA [100001] — AETNA PPO [10000101]: $12.80 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $6.79 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $9.12 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $3.20 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $3.20 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $3.20 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $3.20
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Hospital (facility) fee In the file: Complete Blood Count test	$16	$3.17	$2.72 – $16
Complete blood count (CBC), automated: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $9.12 AETNA [100001] — AETNA HMO [10000107]: $12.80 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $12.80 AETNA [100001] — AETNA PPO [10000101]: $12.80 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $6.79 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $9.12 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $3.20 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $3.20 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $3.20 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $3.20
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Doctor (professional) fee In the file: Blood Count Complete Automated	$17	$17	$2.72 – $16
Complete blood count (CBC), automated: 10 of 211 insurance plan rates AARP [100007] — AARP [10000701]: $9.69 AETNA [100001] — AETNA HMO [10000107]: $5.50 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $5.50 AETNA [100001] — AETNA PPO [10000101]: $5.50 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $5.50 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $9.69 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $9.69 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $4.31 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $4.31 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $4.31
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Prothrombin Time - Protime-Inr	$10	$3.91	$1.93 – $10
Blood clotting time test (prothrombin time, PT): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $5.70 AETNA [100001] — AETNA HMO [10000107]: $8 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $8 AETNA [100001] — AETNA PPO [10000101]: $8 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $4.50 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $5.70 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $3.95 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $3.95 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $3.95 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $3.95
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Doctor (professional) fee In the file: Prothrombin Time	$9.61	$9.61	$1.93 – $10
Blood clotting time test (prothrombin time, PT): 10 of 211 insurance plan rates AARP [100007] — AARP [10000701]: $5.48 AETNA [100001] — AETNA HMO [10000107]: $3.65 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $3.65 AETNA [100001] — AETNA PPO [10000101]: $3.65 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $3.65 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $5.48 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $5.48 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $2.86 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $2.86 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $2.86
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Hospital (facility) fee · modifier PO In the file: HC Prothrombin Time - Protime-Inr\|SERV/PROC OFF-CAMPUS PBD	$10	$3.91	$1.93 – $10
Blood clotting time test (prothrombin time, PT): rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $9 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $9 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $5.60 MVP HEALTHCARE [100168] — MVP [10016801]: $5.80
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: Thromboplas Time Partial - Additional Charge	$15	$15	$4.51 – $15
Blood clotting test (partial thromboplastin time, PTT): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $8.55 AETNA [100001] — AETNA HMO [10000107]: $12 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $12 AETNA [100001] — AETNA PPO [10000101]: $12 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $6.31 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $8.55 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $6.01 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $6.01 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $6.01 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: Thromboplas Time Partial - PTT CRRT System	$15	$15	$4.51 – $15
Blood clotting test (partial thromboplastin time, PTT): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $8.55 AETNA [100001] — AETNA HMO [10000107]: $12 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $12 AETNA [100001] — AETNA PPO [10000101]: $12 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $6.31 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $8.55 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $6.01 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $6.01 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $6.01 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: Thromboplas Time Partial - APTT	$15	$6.01	$4.51 – $15
Blood clotting test (partial thromboplastin time, PTT): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $8.55 AETNA [100001] — AETNA HMO [10000107]: $12 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $12 AETNA [100001] — AETNA PPO [10000101]: $12 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $6.31 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $8.55 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $6.01 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $6.01 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $6.01 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $6.01

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Doctor (professional) fee In the file: CT Head/Brain W/O Contrast Material	$422.82	$422.82	$26.89 – $852
CT scan of the head or brain, without contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $241.01 AETNA [100001] — AETNA HMO [10000107]: $133.03 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $133.03 AETNA [100001] — AETNA PPO [10000101]: $133.03 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $133.03 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $241.01 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $127.28 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $127.28 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $127.28 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $127.28
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Hospital (facility) fee In the file: CT Scan,Head/Brain,W/O Contrast Matl - CT Head WO Contrast	$852	$72	$26.89 – $852
CT scan of the head or brain, without contrast: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $485.64 AETNA [100001] — AETNA HMO [10000107]: $205.24 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $205.24 AETNA [100001] — AETNA PPO [10000101]: $205.24 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $137.03 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $485.64 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $121.20 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $121.20 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $121.20 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $121.20
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: CT Head/Brain W/O Contrast Material\|PROFESSIONAL COMPONENT	$422.82	$422.82	$26.89 – $852
CT scan of the head or brain, without contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $241.01 AETNA [100001] — AETNA HMO [10000107]: $49.25 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $49.25 AETNA [100001] — AETNA PPO [10000101]: $49.25 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $49.25 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $241.01 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $35.17 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $35.17 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $35.17 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $35.17
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI Brain Brain Stem W/O W/Contrast Material	$1,121.15	$1,121.15	$71.82 – $2,916
MRI of the brain, before and after contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $639.06 AETNA [100001] — AETNA HMO [10000107]: $375 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $375 AETNA [100001] — AETNA PPO [10000101]: $375 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $375 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $639.06 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $514.84 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $514.84 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $514.84 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $514.84
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Hospital (facility) fee In the file: HC MRI Brain Combo - MRI Brain W WO Contrast	$2,916	$300	$71.82 – $2,916
MRI of the brain, before and after contrast: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $1,662.12 AETNA [100001] — AETNA HMO [10000107]: $610.09 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $610.09 AETNA [100001] — AETNA PPO [10000101]: $610.09 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $457.27 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,662.12 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $505 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $505 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $505 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $505
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: MRI Brain Brain Stem W/O W/Contrast Material\|PROFESSIONAL COMPONENT	$1,121.15	$1,121.15	$71.82 – $2,916
MRI of the brain, before and after contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $639.06 AETNA [100001] — AETNA HMO [10000107]: $112.50 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $112.50 AETNA [100001] — AETNA PPO [10000101]: $112.50 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $112.50 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $639.06 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $95.21 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $95.21 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $95.21 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $95.21
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Doctor (professional) fee In the file: Radiologic Exam Chest 2 Views	$72	$72	$6.85 – $233
Chest X-ray, 2 views: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $41.04 AETNA [100001] — AETNA HMO [10000107]: $33.92 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $33.92 AETNA [100001] — AETNA PPO [10000101]: $33.92 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $33.92 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $41.04 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $24.90 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $24.90 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $24.90 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $24.90
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Hospital (facility) fee In the file: Radiologic Exam Chest 2 Views - Xr Chest 2 Views	$233	$9	$6.85 – $233
Chest X-ray, 2 views: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $132.81 AETNA [100001] — AETNA HMO [10000107]: $63.51 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $63.51 AETNA [100001] — AETNA PPO [10000101]: $63.51 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $114.06 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $132.81 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $15.15 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $15.15 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $15.15 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $15.15
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Hospital (facility) fee In the file: Radiologic Exam Chest 2 Views - Xr Chest Inspiration Expiration	$233	$233	$6.85 – $233
Chest X-ray, 2 views: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $132.81 AETNA [100001] — AETNA HMO [10000107]: $63.51 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $63.51 AETNA [100001] — AETNA PPO [10000101]: $63.51 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $114.06 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $132.81 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $15.15 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $15.15 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $15.15 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $15.15
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Doctor (professional) fee In the file: Radex Spine Lumbosacral Minimum 4 Views	$347.53	$347.53	$8.62 – $301
X-ray of the lower spine, at least 4 views: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $198.09 AETNA [100001] — AETNA HMO [10000107]: $51.85 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $51.85 AETNA [100001] — AETNA PPO [10000101]: $51.85 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $51.85 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $198.09 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $35.99 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $35.99 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $35.99 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $35.99
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Pbb X-Ray Lumbar Spine 4 Vw	$301	$301	$8.62 – $301
X-ray of the lower spine, at least 4 views: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $171.57 AETNA [100001] — AETNA HMO [10000107]: $102.39 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $102.39 AETNA [100001] — AETNA PPO [10000101]: $102.39 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $137.03 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $171.57 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $30.30 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $30.30 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $30.30 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $30.30
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Hospital (facility) fee In the file: HC X-Ray Lumbar Spine 4 Vw - Xr Lumbar Spine Complete 4+ Views	$301	$18	$8.62 – $301
X-ray of the lower spine, at least 4 views: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $171.57 AETNA [100001] — AETNA HMO [10000107]: $102.39 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $102.39 AETNA [100001] — AETNA PPO [10000101]: $102.39 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $137.03 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $171.57 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $30.30 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $30.30 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $30.30 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $30.30
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI Spinal Canal Lumbar W/O Contrast Material	$846.63	$846.63	$46.75 – $1,457
MRI of the lower back (lumbar spine), without contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $482.58 AETNA [100001] — AETNA HMO [10000107]: $375 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $375 AETNA [100001] — AETNA PPO [10000101]: $375 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $375 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $482.58 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $334.60 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $334.60 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $334.60 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $334.60
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Hospital (facility) fee In the file: HC MRI, Lumbar Spine - MRI Lumbar Spine WO Contrast	$1,457	$300	$46.75 – $1,457
MRI of the lower back (lumbar spine), without contrast: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $830.49 AETNA [100001] — AETNA HMO [10000107]: $369.26 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $369.26 AETNA [100001] — AETNA PPO [10000101]: $369.26 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $312.74 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $830.49 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $505 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $505 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $505 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $505
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: MRI Spinal Canal Lumbar W/O Contrast Material\|PROFESSIONAL COMPONENT	$846.63	$846.63	$46.75 – $1,457
MRI of the lower back (lumbar spine), without contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $482.58 AETNA [100001] — AETNA HMO [10000107]: $112.50 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $112.50 AETNA [100001] — AETNA PPO [10000101]: $112.50 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $112.50 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $482.58 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $62.25 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $62.25 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $62.25 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $62.25
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Doctor (professional) fee In the file: CT Pelvis W/Contrast Material	$520.06	$520.06	$36.46 – $886
CT scan of the pelvis, with contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $296.43 AETNA [100001] — AETNA HMO [10000107]: $279.90 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $279.90 AETNA [100001] — AETNA PPO [10000101]: $279.90 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $279.90 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $296.43 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $190.72 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $190.72 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $190.72 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $190.72
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Hospital (facility) fee In the file: HC CT Scan of Pelvis Contrast - CT Pelvis W Contrast	$886	$102	$36.46 – $886
CT scan of the pelvis, with contrast: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $505.02 AETNA [100001] — AETNA HMO [10000107]: $433.44 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $433.44 AETNA [100001] — AETNA PPO [10000101]: $433.44 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $229.90 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $505.02 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $171.70 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $171.70 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $171.70 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $171.70
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: CT Pelvis W/Contrast Material\|TECHNICAL COMPONENT	$520.06	$520.06	$36.46 – $886
CT scan of the pelvis, with contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $296.43 AETNA [100001] — AETNA HMO [10000107]: $212.40 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $212.40 AETNA [100001] — AETNA PPO [10000101]: $212.40 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $212.40 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $296.43 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $190.72 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $190.72 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $190.72 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $190.72
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI Any Jt Lower Extrem W/O Contrast Matrl	$815.69	$815.69	$42.90 – $1,296
MRI of a leg joint (such as the knee), without contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $464.94 AETNA [100001] — AETNA HMO [10000107]: $375 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $375 AETNA [100001] — AETNA PPO [10000101]: $375 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $375 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $464.94 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $330.02 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $330.02 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $330.02 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $330.02
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Hospital (facility) fee In the file: HC MRI Jnt of Lwr Extre W/O Dye - MR Lower Ext Joint Lt WO IV Cont	$1,296	$1,296	$42.90 – $1,296
MRI of a leg joint (such as the knee), without contrast: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $738.72 AETNA [100001] — AETNA HMO [10000107]: $393.26 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $393.26 AETNA [100001] — AETNA PPO [10000101]: $393.26 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $312.74 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $738.72 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $505 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $505 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $505 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $505
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Hospital (facility) fee In the file: HC MRI Jnt of Lwr Extre W/O Dye - MR Lower Ext Joint Rt WO IV Cont	$1,296	$300	$42.90 – $1,296
MRI of a leg joint (such as the knee), without contrast: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $738.72 AETNA [100001] — AETNA HMO [10000107]: $393.26 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $393.26 AETNA [100001] — AETNA PPO [10000101]: $393.26 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $312.74 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $738.72 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $505 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $505 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $505 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $505
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Doctor (professional) fee In the file: CT Abdomen & Pelvis W/Contrast Material	$531.35	$531.35	$57.18 – $1,071
CT scan of the abdomen and pelvis, with contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $302.87 AETNA [100001] — AETNA HMO [10000107]: $390.79 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $390.79 AETNA [100001] — AETNA PPO [10000101]: $390.79 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $390.79 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $302.87 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $206.04 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $206.04 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $206.04 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $206.04
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Hospital (facility) fee In the file: HC CT Abd & Pelv W/Contrast - CT Abdomen Pelvis W Contrast	$1,071	$64.76	$57.18 – $1,071
CT scan of the abdomen and pelvis, with contrast: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $610.47 AETNA [100001] — AETNA HMO [10000107]: $577.15 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $577.15 AETNA [100001] — AETNA PPO [10000101]: $577.15 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $457.27 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $610.47 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $109.01 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $109.01 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $109.01 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $109.01
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: CT Abdomen & Pelvis W/Contrast Material\|PROFESSIONAL COMPONENT	$531.35	$531.35	$57.18 – $1,071
CT scan of the abdomen and pelvis, with contrast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $302.87 AETNA [100001] — AETNA HMO [10000107]: $106.31 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $106.31 AETNA [100001] — AETNA PPO [10000101]: $106.31 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $106.31 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $302.87 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $76.04 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $76.04 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $76.04 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $76.04
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Doctor (professional) fee In the file: US Abdominal Real Time W/Image Documentation	$250.45	$250.45	$25.57 – $1,454
Ultrasound of the abdomen, complete: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $142.76 AETNA [100001] — AETNA HMO [10000107]: $119.92 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $119.92 AETNA [100001] — AETNA PPO [10000101]: $119.92 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $119.92 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $142.76 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $106.75 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $106.75 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $106.75 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $106.75
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Hospital (facility) fee In the file: Ultrasound of Abdomen	$1,454	$36	$25.57 – $1,454
Ultrasound of the abdomen, complete: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $828.78 AETNA [100001] — AETNA HMO [10000107]: $219.78 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $219.78 AETNA [100001] — AETNA PPO [10000101]: $219.78 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $137.03 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $828.78 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $60.60 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $60.60 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $60.60 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $60.60
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: US Abdominal Real Time W/Image Documentation\|PROFESSIONAL COMPONENT	$250.45	$250.45	$25.57 – $1,454
Ultrasound of the abdomen, complete: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $142.76 AETNA [100001] — AETNA HMO [10000107]: $39.43 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $39.43 AETNA [100001] — AETNA PPO [10000101]: $39.43 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $39.43 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $142.76 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $33.73 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $33.73 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $33.73 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $33.73
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Hospital (facility) fee In the file: HC OB US >/= 14 Wks Sngl Fetus - US OB 14+ Weeks Single or First Gest	$399	$33	$32.17 – $399
Pregnancy ultrasound (after the first trimester): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $227.43 AETNA [100001] — AETNA HMO [10000107]: $261.67 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $261.67 AETNA [100001] — AETNA PPO [10000101]: $261.67 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $137.03 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $227.43 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $55.55 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $55.55 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $55.55 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $55.55
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Pbb US, OB >/= 14 Wks, Sngl Fetus	$399	$399	$32.17 – $399
Pregnancy ultrasound (after the first trimester): 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $227.43 AETNA [100001] — AETNA HMO [10000107]: $261.67 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $261.67 AETNA [100001] — AETNA PPO [10000101]: $261.67 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $137.03 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $227.43 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $55.55 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $55.55 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $55.55 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $55.55
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Doctor (professional) fee In the file: US Preg Uterus After 1st Trimest 1/1st Gestation	$503.89	$503.89	$32.17 – $399
Pregnancy ultrasound (after the first trimester): 10 of 193 insurance plan rates AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $287.22 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $152.67 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $152.67 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $152.67 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $152.67 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $287.22 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $157.99 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $157.99 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $157.99 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $157.99
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Doctor (professional) fee In the file: US Transvaginal	$518.45	$518.45	$22.10 – $391
Transvaginal ultrasound: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $295.52 AETNA [100001] — AETNA HMO [10000107]: $122.43 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $122.43 AETNA [100001] — AETNA PPO [10000101]: $122.43 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $122.43 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $295.52 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $80.85 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $80.85 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $80.85 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $80.85
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Echography,Transvaginal	$391	$36	$22.10 – $391
Transvaginal ultrasound: 10 of 280 insurance plan rates AARP [100007] — AARP [10000701]: $222.87 AETNA [100001] — AETNA HMO [10000107]: $225.75 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $225.75 AETNA [100001] — AETNA PPO [10000101]: $225.75 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $137.03 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $222.87 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $60.60 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $60.60 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $60.60 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $60.60
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: US Transvaginal\|PROFESSIONAL COMPONENT	$112.70	$112.70	$22.10 – $391
Transvaginal ultrasound: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $64.24 AETNA [100001] — AETNA HMO [10000107]: $33.85 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $33.85 AETNA [100001] — AETNA PPO [10000101]: $33.85 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $33.85 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $64.24 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $29.09 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $29.09 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $29.09 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $29.09
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Doctor (professional) fee In the file: Diagnostic Mammography Computer-Aided Detcj Uni	$277.46	$277.46	$25.21 – $361
Diagnostic mammogram, one breast: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $158.15 AETNA [100001] — AETNA HMO [10000107]: $127.68 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $127.68 AETNA [100001] — AETNA PPO [10000101]: $127.68 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $127.68 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $158.15 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $104.04 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $104.04 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $104.04 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $104.04
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Dx Mammo Incl Cad Uni - Mammo Breast Diagnostic Left	$361	$58.20	$25.21 – $361
Diagnostic mammogram, one breast: 10 of 277 insurance plan rates AARP [100007] — AARP [10000701]: $205.77 AETNA [100001] — AETNA HMO [10000107]: $238.27 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $238.27 AETNA [100001] — AETNA PPO [10000101]: $238.27 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $86.30 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $205.77 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $97.97 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $97.97 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $97.97 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $97.97
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Dx Mammo Incl Cad Uni - Mammo Breast Diagnostic Lt	$361	$361	$25.21 – $361
Diagnostic mammogram, one breast: 10 of 277 insurance plan rates AARP [100007] — AARP [10000701]: $205.77 AETNA [100001] — AETNA HMO [10000107]: $238.27 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $238.27 AETNA [100001] — AETNA PPO [10000101]: $238.27 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $86.30 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $205.77 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $97.97 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $97.97 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $97.97 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $97.97
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Doctor (professional) fee In the file: Diagnostic Mammography Computer-Aided Detcj Bi	$350.63	$350.63	$31.36 – $383
Diagnostic mammogram, both breasts: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $199.86 AETNA [100001] — AETNA HMO [10000107]: $161.28 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $161.28 AETNA [100001] — AETNA PPO [10000101]: $161.28 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $161.28 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $199.86 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $127.22 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $127.22 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $127.22 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $127.22
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Dx Mammo Incl Cad Bi - Mammo Breast Diagnostic Bilateral	$383	$58.20	$31.36 – $383
Diagnostic mammogram, both breasts: 10 of 277 insurance plan rates AARP [100007] — AARP [10000701]: $218.31 AETNA [100001] — AETNA HMO [10000107]: $301.72 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $301.72 AETNA [100001] — AETNA PPO [10000101]: $301.72 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $110.66 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $218.31 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $97.97 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $97.97 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $97.97 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $97.97
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: Diagnostic Mammography Computer-Aided Detcj Bi\|PROFESSIONAL COMPONENT	$350.63	$350.63	$31.36 – $383
Diagnostic mammogram, both breasts: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $199.86 AETNA [100001] — AETNA HMO [10000107]: $48.76 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $48.76 AETNA [100001] — AETNA PPO [10000101]: $48.76 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $48.76 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $199.86 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $46.72 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $46.72 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $46.72 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $46.72
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Doctor (professional) fee In the file: Screening Mammography Bi 2-View Breast Inc Cad	$282.37	$282.37	$23.89 – $376
Screening mammogram, both breasts: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $160.95 AETNA [100001] — AETNA HMO [10000107]: $129.96 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $129.96 AETNA [100001] — AETNA PPO [10000101]: $129.96 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $129.96 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $160.95 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $104.42 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $104.42 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $104.42 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $104.42
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Scr Mammo Bi Incl Cad - Mammo Breast Screening Left	$376	$58.20	$23.89 – $376
Screening mammogram, both breasts: 10 of 277 insurance plan rates AARP [100007] — AARP [10000701]: $214.32 AETNA [100001] — AETNA HMO [10000107]: $242.74 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $242.74 AETNA [100001] — AETNA PPO [10000101]: $242.74 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $91.32 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $214.32 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $97.97 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $97.97 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $97.97 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $97.97
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Scr Mammo Bi Incl Cad - Mammo Breast Screening Bilateral	$376	$58.20	$23.89 – $376
Screening mammogram, both breasts: 10 of 277 insurance plan rates AARP [100007] — AARP [10000701]: $214.32 AETNA [100001] — AETNA HMO [10000107]: $242.74 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $242.74 AETNA [100001] — AETNA PPO [10000101]: $242.74 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $91.32 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $214.32 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $97.97 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $97.97 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $97.97 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $97.97

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient · Doctor (professional) fee In the file: Ecg Routine Ecg W/Least 12 Lds W/I&R	$154.25	$154.25	$10.30 – $87.92
Electrocardiogram (ECG/EKG) with reading: 10 of 281 insurance plan rates AARP [100007] — AARP [10000701]: $35.15 AETNA [100001] — AETNA HMO [10000107]: $15.53 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $15.53 AETNA [100001] — AETNA PPO [10000101]: $15.53 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $15.53 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $87.92 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $15.15 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $15.15 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $15.15 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $15.15
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Hospital (facility) fee In the file: Left Heart Cath w/ Ventriculography	$6,959	$6,959	$76.97 – $6,959
Left heart catheterization (diagnostic): 10 of 195 insurance plan rates AARP [100007] — AARP [10000701]: $3,966.63 AETNA [100001] — AETNA HMO [10000107]: $3,847.53 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $3,847.53 AETNA [100001] — AETNA PPO [10000101]: $3,847.53 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $4,249.19 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $3,966.63 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $2,457.76 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $2,457.76 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $2,457.76 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $3,966.63
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: L Hrt Cath W/Njx L Ventriculography Img S&I\|PROFESSIONAL COMPONENT	$408	$408	$76.97 – $6,959
Left heart catheterization (diagnostic): 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $116.28 AETNA [100001] — AETNA HMO [10000107]: $273.69 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $273.69 AETNA [100001] — AETNA PPO [10000101]: $273.69 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $273.69 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $116.28 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $95.08 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $95.08 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $95.08 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $95.08
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee In the file: Compre Electrophysiologic W/O Arrhyt Induction	$2,319.23	$2,319.23	$125.12 – $16,416
Heart rhythm study (electrophysiology evaluation): 10 of 223 insurance plan rates AARP [100007] — AARP [10000701]: $660.98 AETNA [100001] — AETNA HMO [10000107]: $784.06 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $784.06 AETNA [100001] — AETNA PPO [10000101]: $784.06 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $784.06 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $660.98 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $284.38 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $284.38 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $284.38 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $284.38
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Hospital (facility) fee In the file: Ep Compre Electrophysiologic W/O Arrhyt Induction	$16,416	$16,416	$125.12 – $16,416
Heart rhythm study (electrophysiology evaluation): 10 of 32 insurance plan rates AARP [100007] — AARP [10000701]: $9,357.12 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $9,357.12 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $9,357.12 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $9,357.12 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $9,357.12 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $9,357.12 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $9,357.12 COMMERCIAL - OTHER [100172] — GUARDIAN [10017203]: $9,357.12 COMMERCIAL - OTHER [100172] — HEALTHSOURCE [10017204]: $9,357.12 COMMERCIAL - OTHER [100172] — HEALTHY LIVING PARTNERSHI [10017212]: $9,357.12
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: Compre Electrophysiologic W/O Arrhyt Induction\|PROFESSIONAL COMPONENT	$1,275.58	$1,275.58	$125.12 – $16,416
Heart rhythm study (electrophysiology evaluation): 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $363.54 AETNA [100001] — AETNA HMO [10000107]: $449.83 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $449.83 AETNA [100001] — AETNA PPO [10000101]: $449.83 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $449.83 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $363.54 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $156.28 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $156.28 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $156.28 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $156.28
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Doctor (professional) fee In the file: Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation	$2,188.16	$2,188.16	$250.02 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $53,072
Heart rhythm study with ablation for atrial fibrillation: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $623.63 AETNA [100001] — AETNA HMO [10000107]: $1,290.67 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $1,290.67 AETNA [100001] — AETNA PPO [10000101]: $1,290.67 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $1,290.67 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $623.63 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $286.65 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $286.65 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $286.65 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $286.65 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Hospital (facility) fee In the file: Ep Ephys Evl Trnsptl Tx Atrial Fib Isolat Pulm Vein	$53,072	$53,072	$250.02 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $53,072
Heart rhythm study with ablation for atrial fibrillation: 10 of 199 insurance plan rates AARP [100007] — AARP [10000701]: $30,251.04 AETNA [100001] — AETNA HMO [10000107]: $42,457.60 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $42,457.60 AETNA [100001] — AETNA PPO [10000101]: $42,457.60 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $34,258.84 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $30,251.04 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $2,457.76 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $2,457.76 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $2,457.76 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $30,251.04
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Doctor (professional) fee In the file: Polysom 6/>Yrs Sleep 4/> Addl Param Attnd	$1,153.18	$1,153.18	$81.73 – $2,673
Sleep study (overnight, in a sleep lab): 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $657.31 AETNA [100001] — AETNA HMO [10000107]: $632.16 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $632.16 AETNA [100001] — AETNA PPO [10000101]: $632.16 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $632.16 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $657.31 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $654.30 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $654.30 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $654.30 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $654.30
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Polysomnography	$2,673	$2,673	$81.73 – $2,673
Sleep study (overnight, in a sleep lab): 10 of 217 insurance plan rates AARP [100007] — AARP [10000701]: $1,523.61 AETNA [100001] — AETNA HMO [10000107]: $2,138.40 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $2,138.40 AETNA [100001] — AETNA PPO [10000101]: $2,138.40 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $1,125.55 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,523.61 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $654.30 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $654.30 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $654.30 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $1,523.61
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: Polysom 6/>Yrs Sleep 4/> Addl Param Attnd\|PROFESSIONAL COMPONENT	$302	$302	$81.73 – $2,673
Sleep study (overnight, in a sleep lab): 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $172.14 AETNA [100001] — AETNA HMO [10000107]: $125.37 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $125.37 AETNA [100001] — AETNA PPO [10000101]: $125.37 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $125.37 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $172.14 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $127.83 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $127.83 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $127.83 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $127.83

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Doctor (professional) fee In the file: Therapeutic Px 1/> Areas Each 15 Min Exercises	$53	$53	$15.49 – $125.66
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 233 insurance plan rates AARP [100007] — AARP [10000701]: $30.21 AETNA [100001] — AETNA HMO [10000107]: $15.49 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $15.49 AETNA [100001] — AETNA PPO [10000101]: $15.49 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $15.49 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $30.21 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $30.21 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $24.55 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $24.55 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $24.55
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Pt Therapeutic Exercises	$101	$101	$15.49 – $125.66
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 217 insurance plan rates AARP [100007] — AARP [10000701]: $57.57 AETNA [100001] — AETNA HMO [10000107]: $80.80 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $80.80 AETNA [100001] — AETNA PPO [10000101]: $80.80 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $29.84 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $57.57 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $25.63 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $25.63 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $25.63 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $57.57
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Ot Therapeutic Exercises	$101	$101	$15.49 – $125.66
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 217 insurance plan rates AARP [100007] — AARP [10000701]: $57.57 AETNA [100001] — AETNA HMO [10000107]: $80.80 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $80.80 AETNA [100001] — AETNA PPO [10000101]: $80.80 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $29.84 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $57.57 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $25.63 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $25.63 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $25.63 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $57.57
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Doctor (professional) fee In the file: Physical Therapy Evaluation Low Complex 20 Mins	$181	$181	$34.34 – $232.20
Physical therapy evaluation (low complexity): 10 of 233 insurance plan rates AARP [100007] — AARP [10000701]: $103.17 AETNA [100001] — AETNA HMO [10000107]: $42.27 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $42.27 AETNA [100001] — AETNA PPO [10000101]: $42.27 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $42.27 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $103.17 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $103.17 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $87.17 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $87.17 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $87.17
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Pt Physical Therapy Evaluation Low Complex 20 Mins	$180	$180	$34.34 – $232.20
Physical therapy evaluation (low complexity): 10 of 217 insurance plan rates AARP [100007] — AARP [10000701]: $102.60 AETNA [100001] — AETNA HMO [10000107]: $144 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $144 AETNA [100001] — AETNA PPO [10000101]: $144 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $100.74 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $102.60 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $34.34 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $34.34 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $34.34 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $102.60
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Hospital (facility) fee · modifier PO In the file: HC Pt Physical Therapy Evaluation Low Complex 20 Mins\|SERV/PROC OFF-CAMPUS PBD	$180	$180	$34.34 – $232.20
Physical therapy evaluation (low complexity): rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $162 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $162 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $100.80 MVP HEALTHCARE [100168] — MVP [10016801]: $104.40
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Doctor (professional) fee In the file: Physical Therapy Evaluation Mod Complex 30 Mins	$181	$181	$34.34 – $180
Physical therapy evaluation (moderate complexity): 10 of 233 insurance plan rates AARP [100007] — AARP [10000701]: $103.17 AETNA [100001] — AETNA HMO [10000107]: $59.84 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $59.84 AETNA [100001] — AETNA PPO [10000101]: $59.84 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $59.84 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $103.17 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $103.17 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $87.17 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $87.17 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $87.17
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Pt Physical Therapy Evaluation Mod Complex 30 Mins	$180	$180	$34.34 – $180
Physical therapy evaluation (moderate complexity): 10 of 217 insurance plan rates AARP [100007] — AARP [10000701]: $102.60 AETNA [100001] — AETNA HMO [10000107]: $144 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $144 AETNA [100001] — AETNA PPO [10000101]: $144 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $100.74 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $102.60 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $34.34 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $34.34 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $34.34 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $102.60
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Hospital (facility) fee · modifier PO In the file: HC Pt Physical Therapy Evaluation Mod Complex 30 Mins\|SERV/PROC OFF-CAMPUS PBD	$180	$180	$34.34 – $180
Physical therapy evaluation (moderate complexity): rates for 4 insurance plans CIGNA [100009] — CIGNA [10000901]: $162 CIGNA [100009] — CIGNA GREAT WEST [10000902]: $162 MVP GOLD MEDICARE [450123] — MVP GOLD MEDICARE [45012301]: $100.80 MVP HEALTHCARE [100168] — MVP [10016801]: $104.40
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Doctor (professional) fee In the file: Physical Therapy Evaluation High Complex 45 Mins	$181	$181	$34.34 – $180
Physical therapy evaluation (high complexity): 10 of 233 insurance plan rates AARP [100007] — AARP [10000701]: $103.17 AETNA [100001] — AETNA HMO [10000107]: $59.84 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $59.84 AETNA [100001] — AETNA PPO [10000101]: $59.84 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $59.84 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $103.17 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $103.17 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $87.17 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $87.17 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $87.17
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Pt Physical Therapy Evaluation High Complex 45 Mins	$180	$180	$34.34 – $180
Physical therapy evaluation (high complexity): 10 of 217 insurance plan rates AARP [100007] — AARP [10000701]: $102.60 AETNA [100001] — AETNA HMO [10000107]: $144 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $144 AETNA [100001] — AETNA PPO [10000101]: $144 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $100.74 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $102.60 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $34.34 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $34.34 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $34.34 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $102.60
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Doctor (professional) fee In the file: Psychotherapy W/Patient 30 Minutes	$255.72	$255.72	$22.88 – $348
Psychotherapy, 30 minutes: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $145.76 AETNA [100001] — AETNA HMO [10000107]: $84 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $84 AETNA [100001] — AETNA PPO [10000101]: $84 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $84 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $145.76 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $25.21 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $25.21 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $25.21 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $25.21
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Hospital (facility) fee In the file: Patient Psychotherapy - 30 Minutes	$348	$122.54	$22.88 – $348
Psychotherapy, 30 minutes: 10 of 137 insurance plan rates AARP [100007] — AARP [10000701]: $198.36 AETNA [100001] — AETNA HMO [10000107]: $88.20 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $88.20 AETNA [100001] — AETNA PPO [10000101]: $88.20 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $198.36 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $25.21 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $25.21 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $25.21 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $198.36 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $198.36
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Doctor (professional) fee In the file: Psychotherapy W/Patient 45 Minutes	$300	$300	$36.35 – $348
Psychotherapy, 45 minutes: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $171 AETNA [100001] — AETNA HMO [10000107]: $120.75 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $120.75 AETNA [100001] — AETNA PPO [10000101]: $120.75 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $120.75 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $171 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $37.79 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $37.79 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $37.79 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $37.79
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Hospital (facility) fee In the file: Patient Psychotherapy - 45 Minutes	$348	$348	$36.35 – $348
Psychotherapy, 45 minutes: 10 of 111 insurance plan rates AARP [100007] — AARP [10000701]: $198.36 AETNA [100001] — AETNA HMO [10000107]: $126.79 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $126.79 AETNA [100001] — AETNA PPO [10000101]: $126.79 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $198.36 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $37.79 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $37.79 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $37.79 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $198.36 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $198.36
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Doctor (professional) fee In the file: Psychotherapy W/Patient 60 Minutes	$236.13	$236.13	$53.17 – $348
Psychotherapy, 60 minutes: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $134.59 AETNA [100001] — AETNA HMO [10000107]: $145.71 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $145.71 AETNA [100001] — AETNA PPO [10000101]: $145.71 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $145.71 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $134.59 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $57.05 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $57.05 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $57.05 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $57.05
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Hospital (facility) fee In the file: Patient Psychotherapy - 60 Minutes	$348	$348	$53.17 – $348
Psychotherapy, 60 minutes: 10 of 111 insurance plan rates AARP [100007] — AARP [10000701]: $198.36 AETNA [100001] — AETNA HMO [10000107]: $153 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $153 AETNA [100001] — AETNA PPO [10000101]: $153 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $198.36 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $57.05 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $57.05 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $57.05 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $198.36 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $198.36
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Doctor (professional) fee In the file: Family Psychotherapy W/O Patient Present 50 Mins	$417.46	$417.46	$43.35 – $348
Family psychotherapy, without the patient: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $237.95 AETNA [100001] — AETNA HMO [10000107]: $126 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $126 AETNA [100001] — AETNA PPO [10000101]: $126 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $126 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $237.95 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $43.35 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $43.35 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $43.35 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $43.35
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Hospital (facility) fee In the file: Family Psychotherapy w/o Patient - 50 Minutes	$348	$348	$43.35 – $348
Family psychotherapy, without the patient: 10 of 115 insurance plan rates AARP [100007] — AARP [10000701]: $198.36 AETNA [100001] — AETNA HMO [10000107]: $132.30 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $132.30 AETNA [100001] — AETNA PPO [10000101]: $132.30 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $198.36 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $43.35 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $43.35 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $43.35 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $198.36 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $198.36
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Doctor (professional) fee In the file: Family Psychotherapy W/Patient Present 50 Mins	$373.93	$373.93	$52.03 – $348
Family psychotherapy, with the patient: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $213.14 AETNA [100001] — AETNA HMO [10000107]: $126 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $126 AETNA [100001] — AETNA PPO [10000101]: $126 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $126 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $213.14 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $52.03 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $52.03 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $52.03 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $52.03
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Hospital (facility) fee In the file: Family Psychotherapy w/ Patient - 50 Minutes	$348	$348	$52.03 – $348
Family psychotherapy, with the patient: 10 of 115 insurance plan rates AARP [100007] — AARP [10000701]: $198.36 AETNA [100001] — AETNA HMO [10000107]: $132.30 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $132.30 AETNA [100001] — AETNA PPO [10000101]: $132.30 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $198.36 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $52.03 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $52.03 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $52.03 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $198.36 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $198.36
Group psychotherapy CPT 90853 · Inpatient or outpatient · Doctor (professional) fee In the file: Group Psychotherapy	$50.71	$50.71	$14.69 – $50.71
Group psychotherapy: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $28.90 AETNA [100001] — AETNA HMO [10000107]: $50.71 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $50.71 AETNA [100001] — AETNA PPO [10000101]: $50.71 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $50.71 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $28.90 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $14.69 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $14.69 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $14.69 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $14.69

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
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	$864	$864	$66.89 – $751.26
Removal of breast growth (open surgery): 10 of 202 insurance plan rates AARP [100007] — AARP [10000701]: $246.24 AETNA [100001] — AETNA HMO [10000107]: $377.17 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $377.17 AETNA [100001] — AETNA PPO [10000101]: $377.17 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $377.17 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $91.91 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $91.91 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $91.91 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $91.91 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $245.80
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion	$736.50	$864	$66.89 – $751.26
Removal of breast growth (open surgery): 10 of 201 insurance plan rates AARP [100007] — AARP [10000701]: $209.91 AETNA [100001] — AETNA HMO [10000107]: $572.12 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $572.12 AETNA [100001] — AETNA PPO [10000101]: $572.12 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $572.12 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $242.02 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $242.02 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $242.02 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $242.02 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $301.18
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee In the file: Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion	$864	$864	$66.89 – $751.26
Removal of breast growth (open surgery): 10 of 80 insurance plan rates AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $246.24 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $246.24 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $246.24 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $246.24 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $246.24 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $246.24 COMMERCIAL - OTHER [100172] — GUARDIAN [10017203]: $246.24 COMMERCIAL - OTHER [100172] — HEALTHSOURCE [10017204]: $246.24 COMMERCIAL - OTHER [100172] — HEALTHY LIVING PARTNERSHI [10017212]: $246.24 COMMERCIAL - OTHER [100172] — METRAHEALTH [10017208]: $246.24
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft	$5,463.15	$5,463.15	$231.96 – $2,601.50
Total hip replacement: 10 of 166 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $1,334.40 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $1,334.40 AETNA [100001] — AETNA PPO [10000101]: $1,334.40 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $1,334.40 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $348.64 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $348.64 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $348.64 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $348.64 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $896.15 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $896.15
Total hip replacement CPT 27130 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft	$5,463.15	$5,463.15	$231.96 – $2,601.50
Total hip replacement: 10 of 166 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $988.82 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $988.82 AETNA [100001] — AETNA PPO [10000101]: $988.82 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $988.82 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $590.42 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $590.42 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $590.42 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $501.86 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $716.92 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $716.92
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee In the file: Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft	$5,463.15	$5,463.15	$231.96 – $2,601.50
Total hip replacement: 10 of 116 insurance plan rates AARP [100007] — AARP [10000701]: $1,557 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,557 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $1,557 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $1,557 CATHOLIC HEALTH LIFE PACE [400005] — CATHOLIC HEALTH LIFE PACE [40000501]: $553.96 CATHOLIC HEALTH LIFE PACE MEDICAID [300005] — CATHOLIC HEALTH LIFE PACE MEDICAID [30000501]: $553.96 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $1,557 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $1,557 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $1,557 COMMERCIAL - OTHER [100172] — GUARDIAN [10017203]: $1,557
Total knee replacement CPT 27447 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Arthrp Kne Condyle&Platu Medial&Lat Compartments	$4,138.30	$4,138.30	$249.20 – $1,970.62
Total knee replacement: 10 of 166 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $986.76 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $986.76 AETNA [100001] — AETNA PPO [10000101]: $986.76 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $986.76 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $589.73 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $589.73 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $589.73 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $501.27 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $716.61 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $716.61
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Arthrp Kne Condyle&Platu Medial&Lat Compartments	$4,138.30	$4,138.30	$249.20 – $1,970.62
Total knee replacement: 10 of 166 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $1,333.08 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $1,333.08 AETNA [100001] — AETNA PPO [10000101]: $1,333.08 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $1,333.08 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $374.55 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $374.55 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $374.55 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $374.55 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $895.76 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $895.76
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee In the file: Arthrp Kne Condyle&Platu Medial&Lat Compartments	$4,138.30	$4,138.30	$249.20 – $1,970.62
Total knee replacement: 10 of 116 insurance plan rates AARP [100007] — AARP [10000701]: $1,179.42 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,179.42 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $1,179.42 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $1,179.42 CATHOLIC HEALTH LIFE PACE [400005] — CATHOLIC HEALTH LIFE PACE [40000501]: $552.81 CATHOLIC HEALTH LIFE PACE MEDICAID [300005] — CATHOLIC HEALTH LIFE PACE MEDICAID [30000501]: $552.81 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $1,179.42 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $1,179.42 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $1,179.42 COMMERCIAL - OTHER [100172] — GUARDIAN [10017203]: $1,179.42
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee In the file: Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls	$3,086.99	$3,086.99	$15.72 – $1,759.58
Shoulder arthroscopy: shaving of shoulder bone: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $1,759.58 AETNA [100001] — AETNA HMO [10000107]: $179.15 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $179.15 AETNA [100001] — AETNA PPO [10000101]: $179.15 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $179.15 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,759.58 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $326.86 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $326.86 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $326.86 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $326.86
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee · modifier 80 In the file: Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls\|ASSISTANT SURGEON	$3,086.99	$3,086.99	$15.72 – $1,759.58
Shoulder arthroscopy: shaving of shoulder bone: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $1,759.58 AETNA [100001] — AETNA HMO [10000107]: $28.66 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $28.66 AETNA [100001] — AETNA PPO [10000101]: $28.66 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $28.66 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,759.58 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $65.37 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $65.37 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $65.37 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $65.37
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee In the file: Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg	$1,869.25	$1,869.25	$112.09 – $890.12
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 214 insurance plan rates AARP [100007] — AARP [10000701]: $532.74 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $532.74 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $532.74 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $382.63 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $382.63 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $382.63 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $382.63 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $382.63 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE POS [10017313]: $382.63 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE TIERED [10017314]: $382.63
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg	$1,869.25	$1,869.25	$112.09 – $890.12
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 68 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $565.82 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $565.82 AETNA [100001] — AETNA PPO [10000101]: $565.82 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $565.82 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $154.04 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $154.04 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $154.04 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $154.04 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 1 AND 2 [10015201]: $160.14 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 200-250 [10015203]: $160.14
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg	$1,869.25	$1,869.25	$112.09 – $890.12
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 67 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $516.87 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $516.87 AETNA [100001] — AETNA PPO [10000101]: $516.87 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $516.87 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $249.54 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $249.54 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $249.54 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $249.54 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 1 AND 2 [10015201]: $183.01 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 200-250 [10015203]: $183.01
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee In the file: Tonsillectomy & Adenoidectomy <Age 12	$720.91	$720.91	$51.32 – $352.91
Removal of tonsils and adenoids (under age 12): 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $205.46 AETNA [100001] — AETNA HMO [10000107]: $304.12 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $304.12 AETNA [100001] — AETNA PPO [10000101]: $304.12 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $304.12 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $205.46 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $70.52 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $70.52 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $70.52 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $70.52
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee · modifier 55 In the file: Tonsillectomy & Adenoidectomy <Age 12\|POSTOPERATIVE MANAGEMENT ONLY	$720.91	$720.91	$51.32 – $352.91
Removal of tonsils and adenoids (under age 12): 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $205.46 AETNA [100001] — AETNA HMO [10000107]: $304.12 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $304.12 AETNA [100001] — AETNA PPO [10000101]: $304.12 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $304.12 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $205.46 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $70.52 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $70.52 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $70.52 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $70.52
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee · modifier 56 In the file: Tonsillectomy & Adenoidectomy <Age 12\|PREOPERATIVE MANAGEMENT ONLY	$720.91	$720.91	$51.32 – $352.91
Removal of tonsils and adenoids (under age 12): 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $205.46 AETNA [100001] — AETNA HMO [10000107]: $304.12 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $304.12 AETNA [100001] — AETNA PPO [10000101]: $304.12 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $304.12 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $205.46 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $70.52 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $70.52 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $70.52 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $70.52
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Esophagogastroduodenoscopy Transoral Diagnostic	$546.53	$546.53	$37.26 – $2,029
Upper GI endoscopy (diagnostic): 10 of 189 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $127.35 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $127.35 AETNA [100001] — AETNA PPO [10000101]: $127.35 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $127.35 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $40.40 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $40.40 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $40.40 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $40.40 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $86.78 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $86.78
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Esophagogastroduodenoscopy Transoral Diagnostic	$546.53	$546.53	$37.26 – $2,029
Upper GI endoscopy (diagnostic): 10 of 188 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $324.96 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $324.96 AETNA [100001] — AETNA PPO [10000101]: $324.96 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $324.96 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $138.66 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $138.66 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $138.66 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $138.66 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $199.94 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $199.94
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee In the file: Esophagogastroduodenoscopy Transoral Diagnostic	$546.53	$546.53	$37.26 – $2,029
Upper GI endoscopy (diagnostic): 10 of 93 insurance plan rates AARP [100007] — AARP [10000701]: $155.76 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $155.76 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $155.76 BEACON ESSENTIAL 1 AND 2 ALT [350125] — BEACON ESSENTIAL 1 AND 2 ALT [35012501]: $128.39 BEACON ESSENTIAL [350122] — BEACON ESSENTIAL PLAN 1 AND 2 [35012201]: $128.39 BEACON ESSENTIAL [350122] — BEACON ESSENTIAL PLAN 200-250 [35012203]: $128.39 BEACON ESSENTIAL [350122] — BEACON ESSENTIAL PLAN 3 AND 4 [35012202]: $96.29 BEACON HEALTH MEDICAID [350100] — BEACON HEALTH MEDICAID [35010001]: $96.29 BEACON HEALTH MEDICARE [450127] — BEACON HEALTH MEDICARE [45012701]: $117.69 BEACON HEALTH OPTIONS [100023] — BEACON HEALTH OPTIONS [10002302]: $128.39
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Egd Transoral Biopsy Single/Multiple	$729.88	$729.88	$41.68 – $3,294.68
Upper GI endoscopy with biopsy: 10 of 202 insurance plan rates AARP [100007] — AARP [10000701]: $208.02 AETNA [100001] — AETNA HMO [10000107]: $143.46 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $143.46 AETNA [100001] — AETNA PPO [10000101]: $143.46 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $143.46 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $50.50 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $50.50 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $50.50 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $50.50 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $97.87
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Egd Transoral Biopsy Single/Multiple	$613.88	$729.88	$41.68 – $3,294.68
Upper GI endoscopy with biopsy: 10 of 201 insurance plan rates AARP [100007] — AARP [10000701]: $174.96 AETNA [100001] — AETNA HMO [10000107]: $421.64 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $421.64 AETNA [100001] — AETNA PPO [10000101]: $421.64 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $421.64 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $177.33 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $177.33 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $177.33 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $177.33 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $259.59
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee In the file: Egd Transoral Biopsy Single/Multiple	$729.88	$729.88	$41.68 – $3,294.68
Upper GI endoscopy with biopsy: 10 of 80 insurance plan rates AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $208.02 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $208.02 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $208.02 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $208.02 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $208.02 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $208.02 COMMERCIAL - OTHER [100172] — GUARDIAN [10017203]: $208.02 COMMERCIAL - OTHER [100172] — HEALTHSOURCE [10017204]: $208.02 COMMERCIAL - OTHER [100172] — HEALTHY LIVING PARTNERSHI [10017212]: $208.02 COMMERCIAL - OTHER [100172] — METRAHEALTH [10017208]: $208.02
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$762	$762	$19.16 – $661.99
Colonoscopy (diagnostic): 10 of 202 insurance plan rates AARP [100007] — AARP [10000701]: $217.17 AETNA [100001] — AETNA HMO [10000107]: $191.57 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $191.57 AETNA [100001] — AETNA PPO [10000101]: $191.57 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $191.57 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $51.62 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $51.62 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $51.62 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $51.62 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $160.67
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$721.84	$762	$19.16 – $661.99
Colonoscopy (diagnostic): 10 of 201 insurance plan rates AARP [100007] — AARP [10000701]: $205.73 AETNA [100001] — AETNA HMO [10000107]: $381.07 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $381.07 AETNA [100001] — AETNA PPO [10000101]: $381.07 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $381.07 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $157.33 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $157.33 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $157.33 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $157.33 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $293.38
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee In the file: Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$762	$762	$19.16 – $661.99
Colonoscopy (diagnostic): 10 of 80 insurance plan rates AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $217.17 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $217.17 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $217.17 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $217.17 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $217.17 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $217.17 COMMERCIAL - OTHER [100172] — GUARDIAN [10017203]: $217.17 COMMERCIAL - OTHER [100172] — HEALTHSOURCE [10017204]: $217.17 COMMERCIAL - OTHER [100172] — HEALTHY LIVING PARTNERSHI [10017212]: $217.17 COMMERCIAL - OTHER [100172] — METRAHEALTH [10017208]: $217.17
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy W/Biopsy Single/Multiple	$922.38	$922.38	$59.90 – $796.99
Colonoscopy with biopsy: 10 of 202 insurance plan rates AARP [100007] — AARP [10000701]: $262.88 AETNA [100001] — AETNA HMO [10000107]: $208.11 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $208.11 AETNA [100001] — AETNA PPO [10000101]: $208.11 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $208.11 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $80.80 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $80.80 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $80.80 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $80.80 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $175.98
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Colonoscopy W/Biopsy Single/Multiple	$877.38	$922.38	$59.90 – $796.99
Colonoscopy with biopsy: 10 of 201 insurance plan rates AARP [100007] — AARP [10000701]: $250.06 AETNA [100001] — AETNA HMO [10000107]: $483.62 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $483.62 AETNA [100001] — AETNA PPO [10000101]: $483.62 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $483.62 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $202.67 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $202.67 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $202.67 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $202.67 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $379.20
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee In the file: Colonoscopy W/Biopsy Single/Multiple	$922.38	$922.38	$59.90 – $796.99
Colonoscopy with biopsy: 10 of 80 insurance plan rates AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $262.88 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $262.88 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $262.88 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $262.88 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $262.88 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $262.88 COMMERCIAL - OTHER [100172] — GUARDIAN [10017203]: $262.88 COMMERCIAL - OTHER [100172] — HEALTHSOURCE [10017204]: $262.88 COMMERCIAL - OTHER [100172] — HEALTHY LIVING PARTNERSHI [10017212]: $262.88 COMMERCIAL - OTHER [100172] — METRAHEALTH [10017208]: $262.88
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$1,054.78	$1,054.78	$73.44 – $827.57
Colonoscopy with removal of polyps (snare): 10 of 189 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $264.51 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $264.51 AETNA [100001] — AETNA PPO [10000101]: $264.51 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $264.51 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $73.44 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $73.44 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $73.44 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $73.44 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $222.25 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $222.25
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$1,054.78	$1,054.78	$73.44 – $827.57
Colonoscopy with removal of polyps (snare): 10 of 188 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $504.67 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $504.67 AETNA [100001] — AETNA PPO [10000101]: $504.67 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $504.67 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $210.65 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $210.65 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $210.65 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $210.65 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $393.41 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $393.41
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee In the file: Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$1,054.78	$1,054.78	$73.44 – $827.57
Colonoscopy with removal of polyps (snare): 10 of 93 insurance plan rates AARP [100007] — AARP [10000701]: $300.61 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $300.61 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $300.61 BEACON ESSENTIAL 1 AND 2 ALT [350125] — BEACON ESSENTIAL 1 AND 2 ALT [35012501]: $259.92 BEACON ESSENTIAL [350122] — BEACON ESSENTIAL PLAN 1 AND 2 [35012201]: $259.92 BEACON ESSENTIAL [350122] — BEACON ESSENTIAL PLAN 200-250 [35012203]: $259.92 BEACON ESSENTIAL [350122] — BEACON ESSENTIAL PLAN 3 AND 4 [35012202]: $194.94 BEACON HEALTH MEDICAID [350100] — BEACON HEALTH MEDICAID [35010001]: $194.94 BEACON HEALTH MEDICARE [450127] — BEACON HEALTH MEDICARE [45012701]: $238.26 BEACON HEALTH OPTIONS [100023] — BEACON HEALTH OPTIONS [10002302]: $259.92
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee In the file: Colon ca scrn not hi rsk ind	$614	$614	$14.50 – $196.26
Screening colonoscopy (not high risk): 10 of 183 insurance plan rates AARP [100007] — AARP [10000701]: $174.99 AETNA [100001] — AETNA HMO [10000107]: $144.79 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $144.79 AETNA [100001] — AETNA PPO [10000101]: $144.79 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $144.79 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $174.99 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $174.99 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $94.54 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $94.54 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $94.54
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee · modifier 53 In the file: Colon ca scrn not hi rsk ind\|DISCONTINUED PROCEDURE	$614	$614	$14.50 – $196.26
Screening colonoscopy (not high risk): 10 of 183 insurance plan rates AARP [100007] — AARP [10000701]: $174.99 AETNA [100001] — AETNA HMO [10000107]: $14.50 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $14.50 AETNA [100001] — AETNA PPO [10000101]: $14.50 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $14.50 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $174.99 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $174.99 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $94.54 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $94.54 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $94.54
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee In the file: Laparoscopy Surg Cholecystectomy	$1,862.87	$1,862.87	$16.68 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $887.08
Gallbladder removal by laparoscope: 10 of 214 insurance plan rates AARP [100007] — AARP [10000701]: $530.92 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $530.92 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $530.92 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $392.37 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $392.37 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $392.37 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $392.37 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $392.37 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE POS [10017313]: $392.37 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE TIERED [10017314]: $392.37
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Laparoscopy Surg Cholecystectomy	$1,862.87	$1,862.87	$16.68 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $887.08
Gallbladder removal by laparoscope: 10 of 68 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $690.08 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $690.08 AETNA [100001] — AETNA PPO [10000101]: $690.08 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $690.08 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $166.79 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $166.79 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $166.79 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $166.79 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 1 AND 2 [10015201]: $173.40 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 200-250 [10015203]: $173.40
Gallbladder removal by laparoscope CPT 47562 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Laparoscopy Surg Cholecystectomy	$1,862.87	$1,862.87	$16.68 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $887.08
Gallbladder removal by laparoscope: 10 of 67 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $628.26 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $628.26 AETNA [100001] — AETNA PPO [10000101]: $628.26 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $628.26 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $310.49 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $310.49 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $310.49 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $310.49 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 1 AND 2 [10015201]: $198.17 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 200-250 [10015203]: $198.17
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee In the file: Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible	$1,193	$1,193	$11.69 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $935.15
Groin (inguinal) hernia repair, age 5 or older: 10 of 214 insurance plan rates AARP [100007] — AARP [10000701]: $340.01 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $340.01 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $340.01 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $310.30 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $310.30 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $310.30 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $310.30 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $310.30 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE POS [10017313]: $310.30 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE TIERED [10017314]: $310.30
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible	$1,193	$1,193	$11.69 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $935.15
Groin (inguinal) hernia repair, age 5 or older: 10 of 68 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $546.99 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $546.99 AETNA [100001] — AETNA PPO [10000101]: $546.99 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $546.99 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $116.88 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $116.88 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $116.88 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $116.88 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 1 AND 2 [10015201]: $121.51 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 200-250 [10015203]: $121.51
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible	$1,193	$1,193	$11.69 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $935.15
Groin (inguinal) hernia repair, age 5 or older: 10 of 67 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $505.11 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $505.11 AETNA [100001] — AETNA PPO [10000101]: $505.11 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $505.11 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $245.77 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $245.77 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $245.77 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $245.77 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 1 AND 2 [10015201]: $138.86 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 200-250 [10015203]: $138.86
Prostate biopsy CPT 55700 · Inpatient or outpatient · Doctor (professional) fee In the file: Prostate Needle Biopsy Any Approach	$372.74	$372.74	$34.65 – $172.28
Prostate biopsy: 10 of 146 insurance plan rates AARP [100007] — AARP [10000701]: $106.23 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $106.23 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $106.23 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $79.74 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $79.74 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $79.74 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $79.74 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $79.74 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE POS [10017313]: $79.74 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE TIERED [10017314]: $79.74
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee In the file: Laps Surg Prst8ect Rpbic Rad W/Nerve Sparing	$2,664.74	$2,664.74	$320.71 – $1,859.21
Prostate removal by laparoscope (radical prostatectomy): 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $759.45 AETNA [100001] — AETNA HMO [10000107]: $1,859.21 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $1,859.21 AETNA [100001] — AETNA PPO [10000101]: $1,859.21 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $1,859.21 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $759.45 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $440.71 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $440.71 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $440.71 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $440.71
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee · modifier 56 In the file: Laps Surg Prst8ect Rpbic Rad W/Nerve Sparing\|PREOPERATIVE MANAGEMENT ONLY	$2,664.74	$2,664.74	$320.71 – $1,859.21
Prostate removal by laparoscope (radical prostatectomy): 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $759.45 AETNA [100001] — AETNA HMO [10000107]: $1,859.21 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $1,859.21 AETNA [100001] — AETNA PPO [10000101]: $1,859.21 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $1,859.21 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $759.45 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $440.71 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $440.71 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $440.71 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $440.71
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee · modifier 78 In the file: Laps Surg Prst8ect Rpbic Rad W/Nerve Sparing\|RETURN TO THE OPERATING ROOM FOR A RELATED PROCEDURE DURING THE POSTOPERATIVE PERIOD	$2,664.74	$2,664.74	$320.71 – $1,859.21
Prostate removal by laparoscope (radical prostatectomy): 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $759.45 AETNA [100001] — AETNA HMO [10000107]: $1,301.45 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $1,301.45 AETNA [100001] — AETNA PPO [10000101]: $1,301.45 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $1,301.45 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $759.45 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $440.71 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $440.71 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $440.71 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $440.71
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$1,878	$1,878	$10.93 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $1,492.87
Hysteroscopy with biopsy of the uterus lining: 10 of 202 insurance plan rates AARP [100007] — AARP [10000701]: $535.23 AETNA [100001] — AETNA HMO [10000107]: $199.34 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $199.34 AETNA [100001] — AETNA PPO [10000101]: $199.34 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $199.34 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $65.84 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $65.84 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $65.84 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $65.84 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $132.26
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$1,678.05	$1,878	$10.93 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $1,492.87
Hysteroscopy with biopsy of the uterus lining: 10 of 201 insurance plan rates AARP [100007] — AARP [10000701]: $478.25 AETNA [100001] — AETNA HMO [10000107]: $1,273.95 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $1,273.95 AETNA [100001] — AETNA PPO [10000101]: $1,273.95 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $1,273.95 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $636.37 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $636.37 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $636.37 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $636.37 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $816.10
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee In the file: Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$1,878	$1,878	$10.93 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $1,492.87
Hysteroscopy with biopsy of the uterus lining: 10 of 80 insurance plan rates AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $535.23 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $535.23 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $535.23 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $535.23 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $535.23 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $535.23 COMMERCIAL - OTHER [100172] — GUARDIAN [10017203]: $535.23 COMMERCIAL - OTHER [100172] — HEALTHSOURCE [10017204]: $535.23 COMMERCIAL - OTHER [100172] — HEALTHY LIVING PARTNERSHI [10017212]: $535.23 COMMERCIAL - OTHER [100172] — METRAHEALTH [10017208]: $535.23
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Doctor (professional) fee In the file: Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$481	$481	$27.71 – $1,499
Spinal injection, lower back (epidural), with imaging guidance: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $137.09 AETNA [100001] — AETNA HMO [10000107]: $113.26 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $113.26 AETNA [100001] — AETNA PPO [10000101]: $113.26 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $113.26 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $137.09 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $27.71 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $27.71 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $27.71 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $27.71
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$1,499	$1,499	$27.71 – $1,499
Spinal injection, lower back (epidural), with imaging guidance: 10 of 194 insurance plan rates AARP [100007] — AARP [10000701]: $854.43 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $925.20 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $854.43 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $819.85 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $819.85 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $819.85 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $854.43 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $1,160.91 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $1,160.91 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $1,160.91
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Doctor (professional) fee In the file: Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level	$393	$393	$25.51 – $2,889
Nerve root injection, lower back, with imaging guidance: 10 of 279 insurance plan rates AARP [100007] — AARP [10000701]: $112.01 AETNA [100001] — AETNA HMO [10000107]: $126.86 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $126.86 AETNA [100001] — AETNA PPO [10000101]: $126.86 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $126.86 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $112.01 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $25.51 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $25.51 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $25.51 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $25.51
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Inject Anes/Steroid Foramen Lumbar/Sacral W Img Guide ,1 Level Lt	$1,926	$1,926	$25.51 – $2,889
Nerve root injection, lower back, with imaging guidance: 10 of 40 insurance plan rates AARP [100007] — AARP [10000701]: $1,097.82 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,097.82 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $819.85 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $819.85 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $819.85 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $1,097.82 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $1,097.82 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $1,097.82 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $1,097.82 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $1,097.82
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Hospital (facility) fee In the file: HC Inject Anes/Steroid Foramen Lumbar/Sacral W Img Guide ,1 Level Rt	$1,926	$1,926	$25.51 – $2,889
Nerve root injection, lower back, with imaging guidance: 10 of 40 insurance plan rates AARP [100007] — AARP [10000701]: $1,097.82 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,097.82 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $819.85 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $819.85 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $819.85 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $1,097.82 BOILERMAKERS NATL. HEALTH [100159] — BOILERMAKERS NATL. HEALTH [10015901]: $1,097.82 COMMERCIAL - OTHER [100172] — BOARD OF PENSIONS [10017201]: $1,097.82 COMMERCIAL - OTHER [100172] — COMMERCIAL OTHER [10017215]: $1,097.82 COMMERCIAL - OTHER [100172] — GERBER LIFE INS [10017202]: $1,097.82
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Neuroplasty &/Transpos Median Nrv Carpal Tunne	$888.90	$888.90	$73.01 – $691.85
Carpal tunnel release: 10 of 189 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $498.14 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $498.14 AETNA [100001] — AETNA PPO [10000101]: $498.14 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $498.14 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $100.34 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $100.34 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $100.34 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $100.34 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $313.21 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $313.21
Carpal tunnel release CPT 64721 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Neuroplasty &/Transpos Median Nrv Carpal Tunne	$888.90	$888.90	$73.01 – $691.85
Carpal tunnel release: 10 of 188 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $483.77 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $483.77 AETNA [100001] — AETNA PPO [10000101]: $483.77 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $483.77 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $204.26 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $204.26 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $204.26 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $204.26 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $315.24 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $315.24
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee In the file: Neuroplasty &/Transpos Median Nrv Carpal Tunne	$888.90	$888.90	$73.01 – $691.85
Carpal tunnel release: 10 of 93 insurance plan rates AARP [100007] — AARP [10000701]: $253.34 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $253.34 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $253.34 BEACON ESSENTIAL 1 AND 2 ALT [350125] — BEACON ESSENTIAL 1 AND 2 ALT [35012501]: $484.76 BEACON ESSENTIAL [350122] — BEACON ESSENTIAL PLAN 1 AND 2 [35012201]: $484.76 BEACON ESSENTIAL [350122] — BEACON ESSENTIAL PLAN 200-250 [35012203]: $484.76 BEACON ESSENTIAL [350122] — BEACON ESSENTIAL PLAN 3 AND 4 [35012202]: $363.57 BEACON HEALTH MEDICAID [350100] — BEACON HEALTH MEDICAID [35010001]: $363.57 BEACON HEALTH MEDICARE [450127] — BEACON HEALTH MEDICARE [45012701]: $444.37 BEACON HEALTH OPTIONS [100023] — BEACON HEALTH OPTIONS [10002302]: $484.76

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient · Doctor (professional) fee In the file: OB Care Antepartum Vag Dlvr & Postpartum	$4,665.94	$4,665.94	$853.67 – $2,605.17
Vaginal delivery, with care before and after: 10 of 217 insurance plan rates AARP [100007] — AARP [10000701]: $1,329.80 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,329.80 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $1,329.80 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $1,220.32 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $1,220.32 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $1,220.32 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $1,220.32 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $1,220.32 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE POS [10017313]: $1,220.32 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE TIERED [10017314]: $1,220.32
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OB Care Antepartum Vag Dlvr & Postpartum	$4,665.94	$4,665.94	$853.67 – $2,605.17
Vaginal delivery, with care before and after: 10 of 65 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $2,018 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $2,018 AETNA [100001] — AETNA PPO [10000101]: $2,018 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $2,018 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $868.98 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $868.98 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $868.98 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $868.98 BCBS MEDICAID [350103] — BC OOA MEDICAID [35010301]: $868.98 BLUE CROSS/BLUE SHIELD [100151] — EMPIRE B/C -YLS [10015107]: $1,220.32
Vaginal delivery, with care before and after CPT 59400 · Inpatient (hospital stay) · Doctor (professional) fee In the file: OB Care Antepartum Vag Dlvr & Postpartum	$4,665.94	$4,665.94	$853.67 – $2,605.17
Vaginal delivery, with care before and after: 10 of 64 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $2,193.41 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $2,193.41 AETNA [100001] — AETNA PPO [10000101]: $2,193.41 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $2,193.41 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $1,119.26 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $1,119.26 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $1,119.26 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $1,119.26 BCBS MEDICAID [350103] — BC OOA MEDICAID [35010301]: $1,119.26 BLUE CROSS/BLUE SHIELD [100151] — EMPIRE B/C -YLS [10015107]: $1,148.32
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee In the file: OB Antepartum Care Cesarean Dlvr & Postpartum	$4,869.62	$4,869.62	$868.98 – $2,887.15
Cesarean delivery (C-section), with care before and after: 10 of 171 insurance plan rates AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,387.84 BAKER/CONFECTIONARY UNION [100158] — BAKER/CONFECTIONARY UNION [10015801]: $1,387.84 BCBS COMMUNITY BLUE [100173] — AQUA [10017301]: $1,220.32 BCBS COMMUNITY BLUE [100173] — COMMUNITY BLUE POS [10017310]: $1,220.32 BCBS COMMUNITY BLUE [100173] — HMO ALIGN SELECT [10017311]: $1,220.32 BCBS COMMUNITY BLUE [100173] — OUT OF AREA HMO/POS/BC [10017303]: $1,220.32 BCBS COMMUNITY BLUE [100173] — POS ALIGN SELECT [10017312]: $1,220.32 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE POS [10017313]: $1,220.32 BCBS COMMUNITY BLUE [100173] — PREFERRED CHOICE TIERED [10017314]: $1,220.32 BCBS ESSENTIAL [100152] — BC ESSENTIAL PLAN 1 AND 2 [10015201]: $887.97
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 Dlvr & Postpartum	$4,869.62	$4,869.62	$868.98 – $2,887.15
Cesarean delivery (C-section), with care before and after: 10 of 111 insurance plan rates AARP [100007] — AARP [10000701]: $1,387.84 AETNA [100001] — AETNA HMO [10000107]: $2,018 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $2,018 AETNA [100001] — AETNA PPO [10000101]: $2,018 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $2,018 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $983.79 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $983.79 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $983.79 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $983.79 BCBS MEDICAID [350103] — BC OOA MEDICAID [35010301]: $983.79
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient (hospital stay) · Doctor (professional) fee In the file: OB Antepartum Care Cesarean Dlvr & Postpartum	$4,869.62	$4,869.62	$868.98 – $2,887.15
Cesarean delivery (C-section), with care before and after: 10 of 110 insurance plan rates AARP [100007] — AARP [10000701]: $1,465.19 AETNA [100001] — AETNA HMO [10000107]: $2,438.63 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $2,438.63 AETNA [100001] — AETNA PPO [10000101]: $2,438.63 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $2,438.63 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $1,243.17 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $1,243.17 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $1,243.17 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $1,243.17 BCBS MEDICAID [350103] — BC OOA MEDICAID [35010301]: $1,243.17
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient · Doctor (professional) fee In the file: Routine OB Care Vag Dlvry & Postpartum Care Vb	$4,457	$4,457	$868.98 – $2,721.10
Vaginal delivery after a previous C-section, with care before and after: 10 of 282 insurance plan rates AARP [100007] — AARP [10000701]: $1,270.25 AETNA [100001] — AETNA HMO [10000107]: $2,018 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $2,018 AETNA [100001] — AETNA PPO [10000101]: $2,018 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $2,018 AFFINITY HEALTH PLAN [100129] — AFFINITY ESSENTIAL EXCHANGE [10012901]: $1,270.25 AMERIGROUP [350102] — BCBS AMERIGROUP MCD [35010203]: $914.66 AMERIGROUP [350102] — CHP BCBS AMG MCD [35010201]: $914.66 AMERIGROUP [350102] — CHP BCBS AMG NON MCD [35010202]: $914.66 AMERIGROUP MEDICAID [350002] — AMERIGROUP MEDICAID [35000201]: $914.66

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	$287,930.38	Not listed in the file	$84,093.02 – $186,284.08
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 66 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $168,753.30 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $168,753.30 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $94,384.02 BCBS MEDICARE [450116] — ANTHEM BC MEDICARE OOA [45011607]: $89,889.54 BCBS MEDICARE [450116] — FEDERAL BC OVER 65 [45011602]: $89,889.54 BCBS MEDICARE [450116] — MEDICARE PPO B/C [45011601]: $89,889.54 BCBS MEDICARE [450116] — OUT OF AREA MEDICARE B/C [45011605]: $89,889.54 BCBS MEDICARE [450116] — SENIOR BLUE [45011606]: $89,889.54 BCBS MEDICARE [450116] — SENIOR BLUE BLUESAVER [45011603]: $89,889.54 BCBS MEDICARE [450116] — SENIOR BLUE SELECT [45011604]: $89,889.54
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	$59,113.34	Not listed in the file	$16,817.14 – $36,730.11
Hip or knee replacement (major joint of the leg), without major complications: 10 of 67 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $33,273.53 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $33,273.53 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $18,882.11 BCBS MEDICARE [450116] — ANTHEM BC MEDICARE OOA [45011607]: $17,982.96 BCBS MEDICARE [450116] — FEDERAL BC OVER 65 [45011602]: $17,982.96 BCBS MEDICARE [450116] — MEDICARE PPO B/C [45011601]: $17,982.96 BCBS MEDICARE [450116] — OUT OF AREA MEDICARE B/C [45011605]: $17,982.96 BCBS MEDICARE [450116] — SENIOR BLUE [45011606]: $17,982.96 BCBS MEDICARE [450116] — SENIOR BLUE BLUESAVER [45011603]: $17,982.96 BCBS MEDICARE [450116] — SENIOR BLUE SELECT [45011604]: $17,982.96
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	$61,422.23	Not listed in the file	$21,250.75 – $46,487.23
Neck (cervical) spinal fusion, without complications: 10 of 66 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $42,112.43 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $42,112.43 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $23,908.62 BCBS MEDICARE [450116] — ANTHEM BC MEDICARE OOA [45011607]: $22,770.11 BCBS MEDICARE [450116] — FEDERAL BC OVER 65 [45011602]: $22,770.11 BCBS MEDICARE [450116] — MEDICARE PPO B/C [45011601]: $22,770.11 BCBS MEDICARE [450116] — OUT OF AREA MEDICARE B/C [45011605]: $22,770.11 BCBS MEDICARE [450116] — SENIOR BLUE [45011606]: $22,770.11 BCBS MEDICARE [450116] — SENIOR BLUE BLUESAVER [45011603]: $22,770.11 BCBS MEDICARE [450116] — SENIOR BLUE SELECT [45011604]: $22,770.11
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	$43,637.02	Not listed in the file	$12,065.70 – $23,625.41
Uterus and ovary surgery (not for cancer), without complications: 10 of 65 insurance plan rates AETNA [100001] — AETNA HMO [10000107]: $21,402.08 AETNA [100001] — AETNA OTHER COMMERCIAL [10000109]: $21,402.08 AETNA MEDICARE HMO [450112] — AETNA MEDICARE HMO [45011201]: $14,240.19 BCBS MEDICARE [450116] — ANTHEM BC MEDICARE OOA [45011607]: $13,562.09 BCBS MEDICARE [450116] — FEDERAL BC OVER 65 [45011602]: $13,562.09 BCBS MEDICARE [450116] — MEDICARE PPO B/C [45011601]: $13,562.09 BCBS MEDICARE [450116] — OUT OF AREA MEDICARE B/C [45011605]: $13,562.09 BCBS MEDICARE [450116] — SENIOR BLUE [45011606]: $13,562.09 BCBS MEDICARE [450116] — SENIOR BLUE BLUESAVER [45011603]: $13,562.09 BCBS MEDICARE [450116] — SENIOR BLUE SELECT [45011604]: $13,562.09

Source: Mount St. Mary's Hospital & Health Center’s standard charges file (chsbuffalo.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	5300 Military Road, Lewiston, NY 14092
County	Niagara County
State	New York
Phone	(716) 297‑4800
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	2 of 5 stars
CMS Certification Number	330188
Name in Medicare records	MOUNT ST. MARY'S HOSPITAL & HEALTH CENTER
Profile level	Medicare data + hospital website
Name on the hospital’s website	Mount St. Mary's Hospital
Official website	chsbuffalo.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
U.S. Census Bureau ZIP code areas (Gazetteer) — approximate position (center of the ZIP code area) used for distances

From the hospital’s website

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

Mount St. Mary's Hospital — chsbuffalo.org
Mount St. Mary's Hospital | Catholic Health - The Right Way To Care — chsbuffalo.org
Stroke Care | Catholic Health - The Right Way To Care — chsbuffalo.org
Patient Contacts | Catholic Health - The Right Way To Care — chsbuffalo.org
Mount St. Mary's Hospital Patient & Visitor Information | Catholic Health - The Right Way To Care — chsbuffalo.org