Does Munson Healthcare Otsego Memorial Hospital have an emergency room?

Yes. The hospital’s official website lists an emergency room at Munson Healthcare Otsego Memorial Hospital. Medicare (CMS) data does not list emergency services for it. In a medical emergency, call 911.

Where is Munson Healthcare Otsego Memorial Hospital?

825 N Center Ave, Gaylord, MI 49735, in Otsego County, Michigan.

What is the phone number of Munson Healthcare Otsego Memorial Hospital?

(989) 731-2100, as listed by Medicare (CMS).

What is the Medicare star rating of Munson Healthcare Otsego Memorial Hospital?

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

Munson Healthcare Otsego Memorial Hospital

Quick answers

Does Munson Healthcare Otsego Memorial Hospital have an emergency room?: Yes. The hospital’s official website lists an emergency room at Munson Healthcare Otsego Memorial Hospital. Medicare (CMS) data does not list emergency services for it. In a medical emergency, call 911.
Where is Munson Healthcare Otsego Memorial Hospital?: 825 N Center Ave, Gaylord, MI 49735, in Otsego County, Michigan.
What is the phone number of Munson Healthcare Otsego Memorial Hospital?: (989) 731-2100, as listed by Medicare (CMS).
What is the Medicare star rating of Munson Healthcare Otsego Memorial Hospital?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4][5]

Emergency care
Surgical services (general and orthopedic)
Heart care
Cancer and infusion care
Birthing center
Physical therapy
Orthopedics and rehab
Cardiology
Oncology
General surgery
Orthopedic surgery
Maternity

Conditions treated^[5]

Heart attack
Stroke
Traumatic injuries

Treatments^[4][5]

Infusion
Robotic surgery (da Vinci system)
Minimally invasive surgery
MRI
CT scan
Ultrasound
Digital mammography
Nuclear medicine
PET-CT imaging
Physical therapy

Procedures^[5]

Robotic surgery (daVinci)
MRI, CT, ultrasound, digital mammography, nuclear medicine, PET-CT

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

OMH Medical Group
Cancer & Infusion Center
Birthing Center with Level 1 nursery
Intensive Care Unit
Rapid Response Team

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

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Interpreters and languages	For language assistance, call 231-935-6632^[8]

Doctors and clinicians (462)

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

Main specialties

Doctors with a page on this site (462)

Aaron Green, MDDiagnostic Radiology
Aaron P. Brown, MDUrology
Abbigale J. Wilson, MDFamily Practice
Adam LeechPhysician Assistant
Aeman Hana, DOInternal Medicine
Aimee Hennessy, NPNurse Practitioner
Alan F. Henke, DOPathology
Alan G. Smith, CNACertified Registered Nurse Anesthetist (CRNA)
Alexis Carroll, PAPhysician Assistant
Alfred J. Wroblewski Jr., MDHand Surgery
Alicia Becker, NPNurse Practitioner
Alison B. Quiring, NPNurse Practitioner
Alissa J. Gracy, NPNurse Practitioner
Allie NavePhysician Assistant
Alyson M. Booth, MDPathology
Alyssa Battle, NPNurse Practitioner
Amanda RadocyNurse Practitioner
Amanda Yanska, NPNurse Practitioner
Amy J. CodeNurse Practitioner
Amy L. Mitchell, MDFamily Practice
Amy W. Ferguson, MDPathology
Andrea L. BrickerNurse Practitioner
Andrew A. Purcell, CNACertified Registered Nurse Anesthetist (CRNA)
Andrew Dygert, DOEmergency Medicine

And 438 more: the button below opens the full list.

Other emergency rooms nearby

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

Munson Healthcare Grayling Hospital25 mi · Grayling, MI · Acute Care Hospital
McLaren Northern Michigan27 mi · Petoskey, MI · Acute Care Hospital
Kalkaska Memorial Health Center32 mi · Kalkaska, MI · Critical Access Hospital
Charlevoix Area Hospital33 mi · Charlevoix, MI · Critical Access Hospital
Munson Medical Center51 mi · Traverse City, MI · Acute Care Hospital

Other hospitals nearby

MyMichigan Medical Center West Branch54 mi · West Branch, MI · Acute Care Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Munson Healthcare Otsego Memorial Hospital LTCU0.1 mi · Gaylord, MI · 4 of 5 stars
Medilodge of Gaylord0.4 mi · Gaylord, MI · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Hospice of Northeastern Michigan2.6 mi · Gaylord, MI · 5 of 5 stars
The Care Team Hospice2.6 mi · Gaylord, MI
McLaren Hospice23 mi · Petoskey, MI · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Evergreen Home Health2.6 mi · Gaylord, MI

All home health agencies in the state →

Dialysis facilities

DaVita Gaylord Dialysis2.6 mi · Gaylord, MI · 4 of 5 stars
DaVita Petoskey Dialysis23 mi · Petoskey, MI · 5 of 5 stars
DaVita Grayling Home Training PD24 mi · Grayling, MI · 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.

Gaylord Surgery Center, LLC2.6 mi · Gaylord, MI
Northern Michigan Surgical Suites, LLC20 mi · Boyne City, MI

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

Vanderbilt Area School7.6 mi · Vanderbilt, MI · Community health center
Johannesburg-Lewiston Area Schools11 mi · Johannesburg, MI · Community health center
Wolverine Elementary School17 mi · Wolverine, MI · Community health center

Clinics and urgent care

McLaren Northern Michigan - Gaylord Family Medicine2.6 mi · Gaylord, MI · Rural health clinic
Munson Healthcare Omh Medical Group Gaylord RHC2.6 mi · Gaylord, MI · Rural health clinic
Munson Healthcare Omh Walk-In Clinic RHC2.6 mi · Gaylord, MI · Rural health clinic

Pharmacies

Family Fare, LLC2.6 mi · Gaylord, MI · Pharmacy
Wal-Mart Stores East LP2.6 mi · Gaylord, MI · Community/retail pharmacy
Walgreen Co2.6 mi · Gaylord, MI · Pharmacy

Assisted living nearby

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

Alpine Adult CRU2.6 mi · Gaylord, MI
Aspen House2.6 mi · Gaylord, MI
Aspen Ridge Retirement Village2.6 mi · Gaylord, MI
Aspen Ridge Retirement Village2.6 mi · Gaylord, MI

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

What patients said (patient survey)

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

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	2 of 5 stars
Would recommend the hospital	2 of 5 stars
Nurses communicated well	3 of 5 stars
Doctors communicated well	4 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Quiet at night	2 of 5 stars
Rated the hospital 9 or 10 out of 10	63%National average: 72%
Would definitely recommend the hospital	56%National average: 71%
Nurses “always” communicated well	78%National average: 80%
Doctors “always” communicated well	81%National average: 80%
Staff “always” explained medicines before giving them	65%National average: 62%
Were given information about recovery at home	89%National average: 86%
Room and bathroom “always” clean	66%National average: 74%
Area around the room “always” quiet at night	43%National average: 60%
Completed surveys	368Response rate: 22%

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	0No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	0No different from 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	15.1%
Deaths within 30 days: pneumonia patients	14.6%
Deaths within 30 days: COPD patients	10.1%
Deaths within 30 days: stroke patients	11.8%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.92No different from the national rate
Complications after hip or knee replacement	Too few cases to report

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	Too few cases to report
Readmitted within 30 days: heart failure	25.3%
Readmitted within 30 days: pneumonia	16.2%
Readmitted within 30 days: COPD	20.3%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Too few cases to report

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	177 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	4%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	62%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 Michigan Best hospitals in Michigan

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 86 common services exactly as Munson Healthcare Otsego Memorial Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Outpatient Visit New L3	$166	$141.10	$59.18 – $192.35
New patient office visit (about 30–44 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $134.46 Aetna — Medicare Advantage: $114.28 ASR Physicians Care Network — Commercial: $132.80 Blue Care Network — Medicare Advantage: $113.15 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $103.67 Blue Cross Complete — Managed Medicaid: $59.18 Cigna — Commercial: $191.94 Cofinity — Commercial: $141.10 Employee Benefit Logistics — Commercial: $192.35 Enterprise Group Planning/Employee Benefit Plan — Commercial: $132.80
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Visit Level 3 New 99203	$139	$118.15	$59.18 – $192.35
New patient office visit (about 30–44 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $112.59 Aetna — Medicare Advantage: $114.28 ASR Physicians Care Network — Commercial: $111.20 Blue Care Network — Medicare Advantage: $113.15 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $86.81 Blue Cross Complete — Managed Medicaid: $59.18 Cigna — Commercial: $191.94 Cofinity — Commercial: $118.15 Employee Benefit Logistics — Commercial: $192.35 Enterprise Group Planning/Employee Benefit Plan — Commercial: $111.20
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VIDEO OV Level 3 New 99203	$201	$170.85	$59.18 – $192.35
New patient office visit (about 30–44 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $162.81 Aetna — Medicare Advantage: $114.28 ASR Physicians Care Network — Commercial: $160.80 Blue Care Network — Medicare Advantage: $113.15 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $125.52 Blue Cross Complete — Managed Medicaid: $59.18 Cigna — Commercial: $191.94 Cofinity — Commercial: $170.85 Employee Benefit Logistics — Commercial: $192.35 Enterprise Group Planning/Employee Benefit Plan — Commercial: $160.80
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Outpatient Visit New L4	$226	$192.10	$89.55 – $291.07
New patient office visit (about 45–59 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $183.06 Aetna — Medicare Advantage: $172.93 ASR Physicians Care Network — Commercial: $180.80 Blue Care Network — Medicare Advantage: $171.22 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $141.14 Blue Cross Complete — Managed Medicaid: $89.55 Cigna — Commercial: $259.29 Cofinity — Commercial: $192.10 Employee Benefit Logistics — Commercial: $291.07 Enterprise Group Planning/Employee Benefit Plan — Commercial: $180.80
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Visit Level 4 New 99204	$139	$118.15	$83.40 – $291.07
New patient office visit (about 45–59 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $112.59 Aetna — Medicare Advantage: $172.93 ASR Physicians Care Network — Commercial: $111.20 Blue Care Network — Medicare Advantage: $171.22 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $86.81 Blue Cross Complete — Managed Medicaid: $89.55 Cigna — Commercial: $259.29 Cofinity — Commercial: $118.15 Employee Benefit Logistics — Commercial: $291.07 Enterprise Group Planning/Employee Benefit Plan — Commercial: $111.20
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VIDEO OV Level 4 New 99204	$239	$203.15	$89.55 – $291.07
New patient office visit (about 45–59 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $193.59 Aetna — Medicare Advantage: $172.93 ASR Physicians Care Network — Commercial: $191.20 Blue Care Network — Medicare Advantage: $171.22 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $149.26 Blue Cross Complete — Managed Medicaid: $89.55 Cigna — Commercial: $259.29 Cofinity — Commercial: $203.15 Employee Benefit Logistics — Commercial: $291.07 Enterprise Group Planning/Employee Benefit Plan — Commercial: $191.20
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Outpatient Visit New L5	$298	$253.30	$119.76 – $389.26
New patient office visit (about 60–74 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $241.38 Aetna — Medicare Advantage: $231.27 ASR Physicians Care Network — Commercial: $238.40 Blue Care Network — Medicare Advantage: $228.98 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $186.10 Blue Cross Complete — Managed Medicaid: $119.76 Cigna — Commercial: $333.04 Cofinity — Commercial: $253.30 Employee Benefit Logistics — Commercial: $389.26 Enterprise Group Planning/Employee Benefit Plan — Commercial: $238.40
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Visit Level 5 New 99205	$139	$118.15	$83.40 – $389.26
New patient office visit (about 60–74 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $112.59 Aetna — Medicare Advantage: $231.27 ASR Physicians Care Network — Commercial: $111.20 Blue Care Network — Medicare Advantage: $228.98 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $86.81 Blue Cross Complete — Managed Medicaid: $119.76 Cigna — Commercial: $333.04 Cofinity — Commercial: $118.15 Employee Benefit Logistics — Commercial: $389.26 Enterprise Group Planning/Employee Benefit Plan — Commercial: $111.20
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VIDEO OV Level 5 New 99205	$335	$284.75	$119.76 – $389.26
New patient office visit (about 60–74 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $271.35 Aetna — Medicare Advantage: $231.27 ASR Physicians Care Network — Commercial: $268 Blue Care Network — Medicare Advantage: $228.98 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $209.21 Blue Cross Complete — Managed Medicaid: $119.76 Cigna — Commercial: $333.04 Cofinity — Commercial: $284.75 Employee Benefit Logistics — Commercial: $389.26 Enterprise Group Planning/Employee Benefit Plan — Commercial: $268
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office/Outpatient Visit Est Lv3	$166	$141.10	$47.77 – $158.91
Established patient office visit (about 20–29 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $134.46 Aetna — Medicare Advantage: $92.25 ASR Physicians Care Network — Commercial: $132.80 Blue Care Network — Medicare Advantage: $91.34 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $103.67 Blue Cross Complete — Managed Medicaid: $47.77 Cigna — Commercial: $158.91 Cofinity — Commercial: $141.10 Employee Benefit Logistics — Commercial: $155.27 Enterprise Group Planning/Employee Benefit Plan — Commercial: $132.80
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: E&M Fac 15 Min Only Serv	$166	$141.10	$47.77 – $158.91
Established patient office visit (about 20–29 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $134.46 Aetna — Medicare Advantage: $92.25 ASR Physicians Care Network — Commercial: $132.80 Blue Care Network — Medicare Advantage: $91.34 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $103.67 Blue Cross Complete — Managed Medicaid: $47.77 Cigna — Commercial: $158.91 Cofinity — Commercial: $141.10 Employee Benefit Logistics — Commercial: $155.27 Enterprise Group Planning/Employee Benefit Plan — Commercial: $132.80
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: E&M Fac 15 Min w/Service	$166	$141.10	$47.77 – $158.91
Established patient office visit (about 20–29 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $134.46 Aetna — Medicare Advantage: $92.25 ASR Physicians Care Network — Commercial: $132.80 Blue Care Network — Medicare Advantage: $91.34 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $103.67 Blue Cross Complete — Managed Medicaid: $47.77 Cigna — Commercial: $158.91 Cofinity — Commercial: $141.10 Employee Benefit Logistics — Commercial: $155.27 Enterprise Group Planning/Employee Benefit Plan — Commercial: $132.80
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office/Outpatient Visit Est Lv4	$226	$192.10	$68.20 – $221.68
Established patient office visit (about 30–39 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $183.06 Aetna — Medicare Advantage: $131.70 ASR Physicians Care Network — Commercial: $180.80 Blue Care Network — Medicare Advantage: $130.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $141.14 Blue Cross Complete — Managed Medicaid: $68.20 Cigna — Commercial: $216.10 Cofinity — Commercial: $192.10 Employee Benefit Logistics — Commercial: $221.68 Enterprise Group Planning/Employee Benefit Plan — Commercial: $180.80
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: E&M Fac 25 Min Only Serv	$226	$192.10	$68.20 – $221.68
Established patient office visit (about 30–39 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $183.06 Aetna — Medicare Advantage: $131.70 ASR Physicians Care Network — Commercial: $180.80 Blue Care Network — Medicare Advantage: $130.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $141.14 Blue Cross Complete — Managed Medicaid: $68.20 Cigna — Commercial: $216.10 Cofinity — Commercial: $192.10 Employee Benefit Logistics — Commercial: $221.68 Enterprise Group Planning/Employee Benefit Plan — Commercial: $180.80
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: E&M Fac 25 Min w/Service	$226	$192.10	$68.20 – $221.68
Established patient office visit (about 30–39 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $183.06 Aetna — Medicare Advantage: $131.70 ASR Physicians Care Network — Commercial: $180.80 Blue Care Network — Medicare Advantage: $130.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $141.14 Blue Cross Complete — Managed Medicaid: $68.20 Cigna — Commercial: $216.10 Cofinity — Commercial: $192.10 Employee Benefit Logistics — Commercial: $221.68 Enterprise Group Planning/Employee Benefit Plan — Commercial: $180.80
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Doctor (professional) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$56.02 – $140.07
Office consultation with a specialist (moderate): 10 of 11 insurance plan rates Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $140.07 Blue Cross Complete — Managed Medicaid: $57.14 Cigna — Commercial: $117.81 McLaren Health Plan — Managed Medicaid: $56.02 Meridian — Managed Medicaid: $56.02 Molina — Managed Medicaid: $56.02 Priority Health — Commercial: $117.81 Priority Health — Managed Medicaid: $56.02 United Healthcare — Commercial: $109.67 United Healthcare — Managed Medicaid: $56.02
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$56.90 – $185.57
Office consultation with a specialist (moderate): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $56.90 Cigna — Commercial: $185.57 McLaren Health Plan — Managed Medicaid: $56.90 Medicare Plus Blue — Medicare Advantage: $108.79 Meridian — Managed Medicaid: $56.90 Molina — Managed Medicaid: $56.90 Priority Health — Commercial: $185.57 Priority Health — Managed Medicaid: $56.90 United Healthcare — Managed Medicaid: $56.90
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$84.99 – $212.51
Office consultation with a specialist (moderate to high): 10 of 11 insurance plan rates Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $212.51 Blue Cross Complete — Managed Medicaid: $86.69 Cigna — Commercial: $178.72 McLaren Health Plan — Managed Medicaid: $84.99 Meridian — Managed Medicaid: $84.99 Molina — Managed Medicaid: $84.99 Priority Health — Commercial: $178.72 Priority Health — Managed Medicaid: $84.99 United Healthcare — Commercial: $174 United Healthcare — Managed Medicaid: $84.99
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$81.60 – $249.15
Office consultation with a specialist (moderate to high): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $81.60 Cigna — Commercial: $249.15 McLaren Health Plan — Managed Medicaid: $81.60 Medicare Plus Blue — Medicare Advantage: $156.03 Meridian — Managed Medicaid: $81.60 Molina — Managed Medicaid: $81.60 Priority Health — Commercial: $249.15 Priority Health — Managed Medicaid: $81.60 United Healthcare — Managed Medicaid: $81.60
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee · modifier KX In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$1,873.94
Office consultation with a specialist (moderate to high): rates for 2 insurance plans Cigna — Commercial: $1,873.94 Priority Health — Commercial: $1,873.94
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient · Doctor (professional) fee In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$69 – $151.52
Preventive checkup, new patient, age 18–39: 10 of 11 insurance plan rates Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $151.52 Blue Cross Complete — Managed Medicaid: $70.38 Cigna — Commercial: $121.95 McLaren Health Plan — Managed Medicaid: $69 Meridian — Managed Medicaid: $69 Molina — Managed Medicaid: $69 Priority Health — Commercial: $121.95 Priority Health — Managed Medicaid: $69 United Healthcare — Commercial: $90.53 United Healthcare — Managed Medicaid: $69
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$67.64 – $221.16
Preventive checkup, new patient, age 18–39: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $67.64 Cigna — Commercial: $221.16 McLaren Health Plan — Managed Medicaid: $67.64 Medicare Plus Blue — Medicare Advantage: $129.34 Meridian — Managed Medicaid: $67.64 Molina — Managed Medicaid: $67.64 Priority Health — Commercial: $221.16 Priority Health — Managed Medicaid: $67.64 United Healthcare — Managed Medicaid: $67.64
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Doctor (professional) fee In the file: PREV VISIT NEW AGE 40-64	Not listed in the file	Not listed in the file	$84.51 – $174.44
Preventive checkup, new patient, age 40–64: 10 of 11 insurance plan rates Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $174.44 Blue Cross Complete — Managed Medicaid: $86.20 Cigna — Commercial: $147.64 McLaren Health Plan — Managed Medicaid: $84.51 Meridian — Managed Medicaid: $84.51 Molina — Managed Medicaid: $84.51 Priority Health — Commercial: $147.64 Priority Health — Managed Medicaid: $84.51 United Healthcare — Commercial: $111.18 United Healthcare — Managed Medicaid: $84.51
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 40-64	Not listed in the file	Not listed in the file	$78.43 – $240.25
Preventive checkup, new patient, age 40–64: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $78.43 Cigna — Commercial: $240.25 McLaren Health Plan — Managed Medicaid: $78.43 Medicare Plus Blue — Medicare Advantage: $149.96 Meridian — Managed Medicaid: $78.43 Molina — Managed Medicaid: $78.43 Priority Health — Commercial: $240.25 Priority Health — Managed Medicaid: $78.43 United Healthcare — Managed Medicaid: $78.43
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED visit for the EM expanded problem focused examination	$835	$709.75	$142.25 – $709.75
Emergency room visit (moderate): 10 of 33 insurance plan rates Aetna — Commercial: $676.35 Aetna — Medicare Advantage: $274.72 ASR Physicians Care Network — Commercial: $668 Blue Care Network — Medicare Advantage: $272 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $521.46 Blue Cross Complete — Managed Medicaid: $142.25 Cigna — Commercial: $493.58 Cofinity — Commercial: $709.75 Employee Benefit Logistics — Commercial: $462.39 Enterprise Group Planning/Employee Benefit Plan — Commercial: $668
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV3	$835	$709.75	$142.25 – $709.75
Emergency room visit (moderate): 10 of 33 insurance plan rates Aetna — Commercial: $676.35 Aetna — Medicare Advantage: $274.72 ASR Physicians Care Network — Commercial: $668 Blue Care Network — Medicare Advantage: $272 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $521.46 Blue Cross Complete — Managed Medicaid: $142.25 Cigna — Commercial: $493.58 Cofinity — Commercial: $709.75 Employee Benefit Logistics — Commercial: $462.39 Enterprise Group Planning/Employee Benefit Plan — Commercial: $668
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV3	$835	$709.75	$142.25 – $709.75
Emergency room visit (moderate): 10 of 33 insurance plan rates Aetna — Commercial: $676.35 Aetna — Medicare Advantage: $274.72 ASR Physicians Care Network — Commercial: $668 Blue Care Network — Medicare Advantage: $272 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $521.46 Blue Cross Complete — Managed Medicaid: $142.25 Cigna — Commercial: $493.58 Cofinity — Commercial: $709.75 Employee Benefit Logistics — Commercial: $462.39 Enterprise Group Planning/Employee Benefit Plan — Commercial: $668
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED visit for the EM of a patient which requires these three key components	$1,372	$1,166.20	$217.44 – $1,166.20
Emergency room visit (moderately high): 10 of 33 insurance plan rates Aetna — Commercial: $1,111.32 Aetna — Medicare Advantage: $419.92 ASR Physicians Care Network — Commercial: $1,097.60 Blue Care Network — Medicare Advantage: $415.76 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $856.81 Blue Cross Complete — Managed Medicaid: $217.44 Cigna — Commercial: $775.17 Cofinity — Commercial: $1,166.20 Employee Benefit Logistics — Commercial: $706.80 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,097.60
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ED visit for the EM of a patient which requires these three key components	$1,372	$1,166.20	$852.12 – $1,166.20
Emergency room visit (moderately high): 10 of 12 insurance plan rates Aetna — Commercial: $1,111.32 ASR Physicians Care Network — Commercial: $1,097.60 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $856.81 Cofinity — Commercial: $1,166.20 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,097.60 HAP (Health Alliance Plan) — Commercial: $1,097.60 McLaren Health Plan — Commercial: $1,150.42 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $1,097.60 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $1,166.20
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Doctor (professional) fee In the file: EMERGENCY DEPT VISIT MOD MDM	Not listed in the file	Not listed in the file	$76.68 – $203.10
Emergency room visit (moderately high): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $119.62 ASR Physicians Care Network — Commercial: $177.66 Blue Care Network — Medicare Advantage: $118.44 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $191.74 Blue Cross Complete — Managed Medicaid: $78.21 Cigna — Commercial: $203.10 Employee Benefit Logistics — Commercial: $201.35 HAP (Health Alliance Plan) — Commercial: $177.66 HAP (Health Alliance Plan) — Medicare Advantage: $118.44 Humana — Medicare Advantage: $118.44
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED visit for the EM of a patient which requires these three key components win the constraints impo	$2,013	$1,711.05	$310.34 – $1,711.05
Emergency room visit (high): 10 of 33 insurance plan rates Aetna — Commercial: $1,630.53 Aetna — Medicare Advantage: $599.32 ASR Physicians Care Network — Commercial: $1,610.40 Blue Care Network — Medicare Advantage: $593.39 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,257.12 Blue Cross Complete — Managed Medicaid: $310.34 Cigna — Commercial: $1,112.67 Cofinity — Commercial: $1,711.05 Employee Benefit Logistics — Commercial: $1,008.76 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,610.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV5	$2,013	$1,711.05	$310.34 – $1,711.05
Emergency room visit (high): 10 of 33 insurance plan rates Aetna — Commercial: $1,630.53 Aetna — Medicare Advantage: $599.32 ASR Physicians Care Network — Commercial: $1,610.40 Blue Care Network — Medicare Advantage: $593.39 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,257.12 Blue Cross Complete — Managed Medicaid: $310.34 Cigna — Commercial: $1,112.67 Cofinity — Commercial: $1,711.05 Employee Benefit Logistics — Commercial: $1,008.76 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,610.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV5	$2,013	$1,711.05	$310.34 – $1,711.05
Emergency room visit (high): 10 of 33 insurance plan rates Aetna — Commercial: $1,630.53 Aetna — Medicare Advantage: $599.32 ASR Physicians Care Network — Commercial: $1,610.40 Blue Care Network — Medicare Advantage: $593.39 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,257.12 Blue Cross Complete — Managed Medicaid: $310.34 Cigna — Commercial: $1,112.67 Cofinity — Commercial: $1,711.05 Employee Benefit Logistics — Commercial: $1,008.76 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,610.40

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic Metabolic Panel	$100	$85	$4.42 – $90
Basic metabolic panel (blood test): 10 of 33 insurance plan rates Aetna — Commercial: $7.24 Aetna — Medicare Advantage: $8.54 ASR Physicians Care Network — Commercial: $80 Blue Care Network — Medicare Advantage: $8.46 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $62.45 Blue Cross Complete — Managed Medicaid: $4.42 Cigna — Commercial: $28.35 Cofinity — Commercial: $90 Employee Benefit Logistics — Commercial: $14.38 Enterprise Group Planning/Employee Benefit Plan — Commercial: $80
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Basic Metabolic Panel	$100	$85	$62.45 – $852.12
Basic metabolic panel (blood test): 10 of 12 insurance plan rates Aetna — Commercial: $81 ASR Physicians Care Network — Commercial: $80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $62.45 Cofinity — Commercial: $85 Enterprise Group Planning/Employee Benefit Plan — Commercial: $80 HAP (Health Alliance Plan) — Commercial: $80 McLaren Health Plan — Commercial: $83.85 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $80 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $85
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Doctor (professional) fee In the file: BASIC METABOLIC PNL TOTAL CA	Not listed in the file	Not listed in the file	$2.96 – $9.98
Basic metabolic panel (blood test): rates for 6 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $9.98 Cigna — Commercial: $8.74 Priority Health — Commercial: $8.74 United Healthcare — Commercial: $7.27 United Healthcare — Managed Medicaid: $6.96 United Healthcare — Medicare Advantage: $2.96
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$140	$119	$5.52 – $126
Comprehensive metabolic panel (blood test): 10 of 33 insurance plan rates Aetna — Commercial: $9.03 Aetna — Medicare Advantage: $10.67 ASR Physicians Care Network — Commercial: $112 Blue Care Network — Medicare Advantage: $10.56 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $87.43 Blue Cross Complete — Managed Medicaid: $5.52 Cigna — Commercial: $28.35 Cofinity — Commercial: $126 Employee Benefit Logistics — Commercial: $17.95 Enterprise Group Planning/Employee Benefit Plan — Commercial: $112
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$140	$119	$87.43 – $852.12
Comprehensive metabolic panel (blood test): 10 of 12 insurance plan rates Aetna — Commercial: $113.40 ASR Physicians Care Network — Commercial: $112 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $87.43 Cofinity — Commercial: $119 Enterprise Group Planning/Employee Benefit Plan — Commercial: $112 HAP (Health Alliance Plan) — Commercial: $112 McLaren Health Plan — Commercial: $117.39 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $112 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $119
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPREHEN METABOLIC PANEL	Not listed in the file	Not listed in the file	$3.70 – $15.19
Comprehensive metabolic panel (blood test): rates for 6 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $15.19 Cigna — Commercial: $11.09 Priority Health — Commercial: $11.09 United Healthcare — Commercial: $8.95 United Healthcare — Managed Medicaid: $8.56 United Healthcare — Medicare Advantage: $3.70
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$25 – $206.33
Obstetric blood test panel: rates for 10 insurance plans Aetna — Commercial: $40.88 Blue Cross Complete — Managed Medicaid: $25 Cigna — Commercial: $206.33 McLaren Health Plan — Managed Medicaid: $25 Medicare Plus Blue — Medicare Advantage: $47.81 Meridian — Managed Medicaid: $25 Molina — Managed Medicaid: $25 Priority Health — Commercial: $206.33 Priority Health — Managed Medicaid: $25 United Healthcare — Managed Medicaid: $25
Obstetric blood test panel CPT 80055 · Inpatient or outpatient · Doctor (professional) fee In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$16.73 – $49.77
Obstetric blood test panel: rates for 6 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $49.77 Cigna — Commercial: $49.76 Priority Health — Commercial: $49.76 United Healthcare — Commercial: $35.12 United Healthcare — Managed Medicaid: $39.35 United Healthcare — Medicare Advantage: $16.73
Obstetric blood test panel CPT 80055 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$43.28
Obstetric blood test panel: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $43.28
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel	$101	$85.85	$7 – $90.90
Cholesterol panel (lipid panel): 10 of 33 insurance plan rates Aetna — Commercial: $11.45 Aetna — Medicare Advantage: $13.52 ASR Physicians Care Network — Commercial: $80.80 Blue Care Network — Medicare Advantage: $13.39 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $63.07 Blue Cross Complete — Managed Medicaid: $7 Cigna — Commercial: $29.53 Cofinity — Commercial: $90.90 Employee Benefit Logistics — Commercial: $22.76 Enterprise Group Planning/Employee Benefit Plan — Commercial: $80.80
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Lipid Panel	$101	$85.85	$63.07 – $852.12
Cholesterol panel (lipid panel): 10 of 12 insurance plan rates Aetna — Commercial: $81.81 ASR Physicians Care Network — Commercial: $80.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $63.07 Cofinity — Commercial: $85.85 Enterprise Group Planning/Employee Benefit Plan — Commercial: $80.80 HAP (Health Alliance Plan) — Commercial: $80.80 McLaren Health Plan — Commercial: $84.69 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $80.80 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $85.85
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Doctor (professional) fee In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$4.69 – $19.07
Cholesterol panel (lipid panel): rates for 6 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $19.07 Cigna — Commercial: $13.78 Priority Health — Commercial: $13.78 United Healthcare — Commercial: $10.98 United Healthcare — Managed Medicaid: $10.52 United Healthcare — Medicare Advantage: $4.69
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel	$125	$106.25	$4.54 – $112.50
Kidney function panel: 10 of 33 insurance plan rates Aetna — Commercial: $7.43 Aetna — Medicare Advantage: $8.77 ASR Physicians Care Network — Commercial: $100 Blue Care Network — Medicare Advantage: $8.68 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $78.06 Blue Cross Complete — Managed Medicaid: $4.54 Cigna — Commercial: $37.46 Cofinity — Commercial: $112.50 Employee Benefit Logistics — Commercial: $14.76 Enterprise Group Planning/Employee Benefit Plan — Commercial: $100
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Renal Function Panel	$125	$106.25	$78.06 – $852.12
Kidney function panel: 10 of 12 insurance plan rates Aetna — Commercial: $101.25 ASR Physicians Care Network — Commercial: $100 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $78.06 Cofinity — Commercial: $106.25 Enterprise Group Planning/Employee Benefit Plan — Commercial: $100 HAP (Health Alliance Plan) — Commercial: $100 McLaren Health Plan — Commercial: $104.81 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $100 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $106.25
Kidney function panel CPT 80069 · Inpatient or outpatient · Doctor (professional) fee In the file: RENAL FUNCTION PANEL	Not listed in the file	Not listed in the file	$3.04 – $10.84
Kidney function panel: rates for 6 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $10.84 Cigna — Commercial: $9.07 Priority Health — Commercial: $9.07 United Healthcare — Commercial: $7.46 United Healthcare — Managed Medicaid: $7.15 United Healthcare — Medicare Advantage: $3.04
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$144	$122.40	$4.27 – $129.60
Liver function panel: 10 of 33 insurance plan rates Aetna — Commercial: $6.98 Aetna — Medicare Advantage: $8.25 ASR Physicians Care Network — Commercial: $115.20 Blue Care Network — Medicare Advantage: $8.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $89.93 Blue Cross Complete — Managed Medicaid: $4.27 Cigna — Commercial: $10.63 Cofinity — Commercial: $129.60 Employee Benefit Logistics — Commercial: $13.89 Enterprise Group Planning/Employee Benefit Plan — Commercial: $115.20
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$144	$122.40	$89.93 – $852.12
Liver function panel: 10 of 12 insurance plan rates Aetna — Commercial: $116.64 ASR Physicians Care Network — Commercial: $115.20 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $89.93 Cofinity — Commercial: $122.40 Enterprise Group Planning/Employee Benefit Plan — Commercial: $115.20 HAP (Health Alliance Plan) — Commercial: $115.20 McLaren Health Plan — Commercial: $120.74 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $115.20 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $122.40
Liver function panel CPT 80076 · Inpatient or outpatient · Doctor (professional) fee In the file: HEPATIC FUNCTION PANEL	Not listed in the file	Not listed in the file	$2.86 – $8.41
Liver function panel: rates for 6 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $7.59 Cigna — Commercial: $8.41 Priority Health — Commercial: $8.41 United Healthcare — Commercial: $3.94 United Healthcare — Managed Medicaid: $3.77 United Healthcare — Medicare Advantage: $2.86
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis with Culture if Indicated	$36	$30.60	$1.66 – $32.40
Urine test (automated, with microscope): 10 of 33 insurance plan rates Aetna — Commercial: $2.71 Aetna — Medicare Advantage: $3.20 ASR Physicians Care Network — Commercial: $28.80 Blue Care Network — Medicare Advantage: $3.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $22.48 Blue Cross Complete — Managed Medicaid: $1.66 Cigna — Commercial: $13.69 Cofinity — Commercial: $32.40 Employee Benefit Logistics — Commercial: $5.39 Enterprise Group Planning/Employee Benefit Plan — Commercial: $28.80
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis with Microscopic	$36	$30.60	$1.66 – $32.40
Urine test (automated, with microscope): 10 of 33 insurance plan rates Aetna — Commercial: $2.71 Aetna — Medicare Advantage: $3.20 ASR Physicians Care Network — Commercial: $28.80 Blue Care Network — Medicare Advantage: $3.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $22.48 Blue Cross Complete — Managed Medicaid: $1.66 Cigna — Commercial: $13.69 Cofinity — Commercial: $32.40 Employee Benefit Logistics — Commercial: $5.39 Enterprise Group Planning/Employee Benefit Plan — Commercial: $28.80
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Dipstick auto w/ Micro POC	$27	$22.95	$1.66 – $22.95
Urine test (automated, with microscope): 10 of 33 insurance plan rates Aetna — Commercial: $21.87 Aetna — Medicare Advantage: $3.20 ASR Physicians Care Network — Commercial: $21.60 Blue Care Network — Medicare Advantage: $3.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $16.86 Blue Cross Complete — Managed Medicaid: $1.66 Cigna — Commercial: $13.69 Cofinity — Commercial: $22.95 Employee Benefit Logistics — Commercial: $5.39 Enterprise Group Planning/Employee Benefit Plan — Commercial: $21.60
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 81002 URINALYSIS NONAUTO W/O SCOP BCE	$16	$13.60	$1.82 – $15.02
Urine test (manual, without microscope): 10 of 33 insurance plan rates Aetna — Commercial: $2.98 Aetna — Medicare Advantage: $3.51 ASR Physicians Care Network — Commercial: $12.80 Blue Care Network — Medicare Advantage: $3.48 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $9.99 Blue Cross Complete — Managed Medicaid: $1.82 Cigna — Commercial: $15.02 Cofinity — Commercial: $14.40 Employee Benefit Logistics — Commercial: $5.92 Enterprise Group Planning/Employee Benefit Plan — Commercial: $12.80
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIPSTICK URINE BCE	$16	$13.60	$1.82 – $15.02
Urine test (manual, without microscope): 10 of 33 insurance plan rates Aetna — Commercial: $2.98 Aetna — Medicare Advantage: $3.51 ASR Physicians Care Network — Commercial: $12.80 Blue Care Network — Medicare Advantage: $3.48 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $9.99 Blue Cross Complete — Managed Medicaid: $1.82 Cigna — Commercial: $15.02 Cofinity — Commercial: $14.40 Employee Benefit Logistics — Commercial: $5.92 Enterprise Group Planning/Employee Benefit Plan — Commercial: $12.80
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: N-AUTOM URINALYS WO MICRO	$22	$18.70	$1.82 – $19.80
Urine test (manual, without microscope): 10 of 33 insurance plan rates Aetna — Commercial: $2.98 Aetna — Medicare Advantage: $3.51 ASR Physicians Care Network — Commercial: $17.60 Blue Care Network — Medicare Advantage: $3.48 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $13.74 Blue Cross Complete — Managed Medicaid: $1.82 Cigna — Commercial: $15.02 Cofinity — Commercial: $19.80 Employee Benefit Logistics — Commercial: $5.92 Enterprise Group Planning/Employee Benefit Plan — Commercial: $17.60
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ketones Urine	$26	$22.10	$1.18 – $23.40
Urine test (automated, without microscope): 10 of 33 insurance plan rates Aetna — Commercial: $1.93 Aetna — Medicare Advantage: $2.27 ASR Physicians Care Network — Commercial: $20.80 Blue Care Network — Medicare Advantage: $2.25 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $16.24 Blue Cross Complete — Managed Medicaid: $1.18 Cigna — Commercial: $9.71 Cofinity — Commercial: $23.40 Employee Benefit Logistics — Commercial: $3.83 Enterprise Group Planning/Employee Benefit Plan — Commercial: $20.80
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: pH Urine	$26	$22.10	$1.18 – $23.40
Urine test (automated, without microscope): 10 of 33 insurance plan rates Aetna — Commercial: $1.93 Aetna — Medicare Advantage: $2.27 ASR Physicians Care Network — Commercial: $20.80 Blue Care Network — Medicare Advantage: $2.25 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $16.24 Blue Cross Complete — Managed Medicaid: $1.18 Cigna — Commercial: $9.71 Cofinity — Commercial: $23.40 Employee Benefit Logistics — Commercial: $3.83 Enterprise Group Planning/Employee Benefit Plan — Commercial: $20.80
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Dipstick (POCT)	$20	$17	$1.18 – $18
Urine test (automated, without microscope): 10 of 33 insurance plan rates Aetna — Commercial: $1.93 Aetna — Medicare Advantage: $2.27 ASR Physicians Care Network — Commercial: $16 Blue Care Network — Medicare Advantage: $2.25 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $12.49 Blue Cross Complete — Managed Medicaid: $1.18 Cigna — Commercial: $9.71 Cofinity — Commercial: $18 Employee Benefit Logistics — Commercial: $3.83 Enterprise Group Planning/Employee Benefit Plan — Commercial: $16
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 84153 4140	$68	$57.80	$9.62 – $61.20
PSA (prostate specific antigen) blood test: 10 of 33 insurance plan rates Aetna — Commercial: $15.72 Aetna — Medicare Advantage: $18.57 ASR Physicians Care Network — Commercial: $54.40 Blue Care Network — Medicare Advantage: $18.39 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $42.47 Blue Cross Complete — Managed Medicaid: $9.62 Cigna — Commercial: $35.43 Cofinity — Commercial: $61.20 Employee Benefit Logistics — Commercial: $31.26 Enterprise Group Planning/Employee Benefit Plan — Commercial: $54.40
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 84153 4727	$68	$57.80	$9.62 – $61.20
PSA (prostate specific antigen) blood test: 10 of 33 insurance plan rates Aetna — Commercial: $15.72 Aetna — Medicare Advantage: $18.57 ASR Physicians Care Network — Commercial: $54.40 Blue Care Network — Medicare Advantage: $18.39 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $42.47 Blue Cross Complete — Managed Medicaid: $9.62 Cigna — Commercial: $35.43 Cofinity — Commercial: $61.20 Employee Benefit Logistics — Commercial: $31.26 Enterprise Group Planning/Employee Benefit Plan — Commercial: $54.40
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA Diagnostic	$68	$57.80	$9.62 – $61.20
PSA (prostate specific antigen) blood test: 10 of 33 insurance plan rates Aetna — Commercial: $15.72 Aetna — Medicare Advantage: $18.57 ASR Physicians Care Network — Commercial: $54.40 Blue Care Network — Medicare Advantage: $18.39 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $42.47 Blue Cross Complete — Managed Medicaid: $9.62 Cigna — Commercial: $35.43 Cofinity — Commercial: $61.20 Employee Benefit Logistics — Commercial: $31.26 Enterprise Group Planning/Employee Benefit Plan — Commercial: $54.40
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thyroid Stimulating Hormone	$132	$112.20	$8.79 – $118.80
Thyroid stimulating hormone (TSH) test: 10 of 33 insurance plan rates Aetna — Commercial: $14.36 Aetna — Medicare Advantage: $16.97 ASR Physicians Care Network — Commercial: $105.60 Blue Care Network — Medicare Advantage: $16.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $82.43 Blue Cross Complete — Managed Medicaid: $8.79 Cigna — Commercial: $33.06 Cofinity — Commercial: $118.80 Employee Benefit Logistics — Commercial: $28.56 Enterprise Group Planning/Employee Benefit Plan — Commercial: $105.60
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thyroid Function Cascade	$132	$112.20	$8.79 – $118.80
Thyroid stimulating hormone (TSH) test: 10 of 33 insurance plan rates Aetna — Commercial: $14.36 Aetna — Medicare Advantage: $16.97 ASR Physicians Care Network — Commercial: $105.60 Blue Care Network — Medicare Advantage: $16.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $82.43 Blue Cross Complete — Managed Medicaid: $8.79 Cigna — Commercial: $33.06 Cofinity — Commercial: $118.80 Employee Benefit Logistics — Commercial: $28.56 Enterprise Group Planning/Employee Benefit Plan — Commercial: $105.60
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thyroid-Stimulating Hormone-Sensitive (s-TSH), Serum	$33.23	$28.25	$8.79 – $33.06
Thyroid stimulating hormone (TSH) test: 10 of 33 insurance plan rates Aetna — Commercial: $14.36 Aetna — Medicare Advantage: $16.97 ASR Physicians Care Network — Commercial: $26.58 Blue Care Network — Medicare Advantage: $16.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $20.75 Blue Cross Complete — Managed Medicaid: $8.79 Cigna — Commercial: $33.06 Cofinity — Commercial: $29.91 Employee Benefit Logistics — Commercial: $28.56 Enterprise Group Planning/Employee Benefit Plan — Commercial: $26.58
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC w/ Differential	$80	$68	$4.06 – $72
Complete blood count (CBC) with differential: 10 of 33 insurance plan rates Aetna — Commercial: $6.64 Aetna — Medicare Advantage: $7.85 ASR Physicians Care Network — Commercial: $64 Blue Care Network — Medicare Advantage: $7.77 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $49.96 Blue Cross Complete — Managed Medicaid: $4.06 Cigna — Commercial: $18.89 Cofinity — Commercial: $72 Employee Benefit Logistics — Commercial: $13.21 Enterprise Group Planning/Employee Benefit Plan — Commercial: $64
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC w/ Differential	$80	$68	$49.96 – $852.12
Complete blood count (CBC) with differential: 10 of 12 insurance plan rates Aetna — Commercial: $64.80 ASR Physicians Care Network — Commercial: $64 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $49.96 Cofinity — Commercial: $68 Enterprise Group Planning/Employee Benefit Plan — Commercial: $64 HAP (Health Alliance Plan) — Commercial: $64 McLaren Health Plan — Commercial: $67.08 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $64 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $68
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPLETE CBC W/AUTO DIFF WBC	Not listed in the file	Not listed in the file	$2.72 – $8.94
Complete blood count (CBC) with differential: rates for 6 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $8.94 Cigna — Commercial: $8.07 Priority Health — Commercial: $8.07 United Healthcare — Commercial: $6.67 United Healthcare — Managed Medicaid: $6.39 United Healthcare — Medicare Advantage: $2.72
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC without Differential	$48	$40.80	$3.38 – $43.20
Complete blood count (CBC), automated: 10 of 33 insurance plan rates Aetna — Commercial: $5.54 Aetna — Medicare Advantage: $6.53 ASR Physicians Care Network — Commercial: $38.40 Blue Care Network — Medicare Advantage: $6.47 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $29.98 Blue Cross Complete — Managed Medicaid: $3.38 Cigna — Commercial: $18.89 Cofinity — Commercial: $43.20 Employee Benefit Logistics — Commercial: $11 Enterprise Group Planning/Employee Benefit Plan — Commercial: $38.40
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC without Differential	$48	$40.80	$29.98 – $852.12
Complete blood count (CBC), automated: 10 of 12 insurance plan rates Aetna — Commercial: $38.88 ASR Physicians Care Network — Commercial: $38.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $29.98 Cofinity — Commercial: $40.80 Enterprise Group Planning/Employee Benefit Plan — Commercial: $38.40 HAP (Health Alliance Plan) — Commercial: $38.40 McLaren Health Plan — Commercial: $40.25 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $38.40 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $40.80
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPLETE CBC AUTOMATED	Not listed in the file	Not listed in the file	$2.26 – $7.44
Complete blood count (CBC), automated: rates for 6 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $7.44 Cigna — Commercial: $6.73 Priority Health — Commercial: $6.73 United Healthcare — Commercial: $4 United Healthcare — Managed Medicaid: $3.82 United Healthcare — Medicare Advantage: $2.26
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time and INR	$44	$37.40	$2.24 – $39.60
Blood clotting time test (prothrombin time, PT): 10 of 33 insurance plan rates Aetna — Commercial: $3.67 Aetna — Medicare Advantage: $4.33 ASR Physicians Care Network — Commercial: $35.20 Blue Care Network — Medicare Advantage: $4.29 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $27.48 Blue Cross Complete — Managed Medicaid: $2.24 Cigna — Commercial: $12.99 Cofinity — Commercial: $39.60 Employee Benefit Logistics — Commercial: $7.29 Enterprise Group Planning/Employee Benefit Plan — Commercial: $35.20
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 85610 4832	$9.72	$8.27	$2.24 – $12.99
Blood clotting time test (prothrombin time, PT): 10 of 33 insurance plan rates Aetna — Commercial: $3.67 Aetna — Medicare Advantage: $4.33 ASR Physicians Care Network — Commercial: $7.78 Blue Care Network — Medicare Advantage: $4.29 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $6.07 Blue Cross Complete — Managed Medicaid: $2.24 Cigna — Commercial: $12.99 Cofinity — Commercial: $8.75 Employee Benefit Logistics — Commercial: $7.29 Enterprise Group Planning/Employee Benefit Plan — Commercial: $7.78
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 85610 PROTHROMBIN TIME/INR	$11	$9.35	$2.24 – $12.99
Blood clotting time test (prothrombin time, PT): 10 of 33 insurance plan rates Aetna — Commercial: $3.67 Aetna — Medicare Advantage: $4.33 ASR Physicians Care Network — Commercial: $8.80 Blue Care Network — Medicare Advantage: $4.29 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $6.87 Blue Cross Complete — Managed Medicaid: $2.24 Cigna — Commercial: $12.99 Cofinity — Commercial: $9.90 Employee Benefit Logistics — Commercial: $7.29 Enterprise Group Planning/Employee Benefit Plan — Commercial: $8.80
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Partial Thromboplastin Time Heparin Protocol	$59	$50.15	$3.14 – $53.10
Blood clotting test (partial thromboplastin time, PTT): 10 of 33 insurance plan rates Aetna — Commercial: $5.14 Aetna — Medicare Advantage: $6.07 ASR Physicians Care Network — Commercial: $47.20 Blue Care Network — Medicare Advantage: $6.01 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $36.85 Blue Cross Complete — Managed Medicaid: $3.14 Cigna — Commercial: $12.99 Cofinity — Commercial: $53.10 Employee Benefit Logistics — Commercial: $10.22 Enterprise Group Planning/Employee Benefit Plan — Commercial: $47.20
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 85730 6787	$46.16	$39.24	$3.14 – $41.54
Blood clotting test (partial thromboplastin time, PTT): 10 of 33 insurance plan rates Aetna — Commercial: $5.14 Aetna — Medicare Advantage: $6.07 ASR Physicians Care Network — Commercial: $36.93 Blue Care Network — Medicare Advantage: $6.01 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $28.83 Blue Cross Complete — Managed Medicaid: $3.14 Cigna — Commercial: $12.99 Cofinity — Commercial: $41.54 Employee Benefit Logistics — Commercial: $10.22 Enterprise Group Planning/Employee Benefit Plan — Commercial: $36.93
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Partial Thromboplastin Time	$59	$50.15	$3.14 – $53.10
Blood clotting test (partial thromboplastin time, PTT): 10 of 33 insurance plan rates Aetna — Commercial: $5.14 Aetna — Medicare Advantage: $6.07 ASR Physicians Care Network — Commercial: $47.20 Blue Care Network — Medicare Advantage: $6.01 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $36.85 Blue Cross Complete — Managed Medicaid: $3.14 Cigna — Commercial: $12.99 Cofinity — Commercial: $53.10 Employee Benefit Logistics — Commercial: $10.22 Enterprise Group Planning/Employee Benefit Plan — Commercial: $47.20

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Exams	$1,552	$1,319.20	$54.48 – $1,319.20
CT scan of the head or brain, without contrast: 10 of 33 insurance plan rates Aetna — Commercial: $1,257.12 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $1,241.60 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $969.22 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $233.80 Cofinity — Commercial: $1,319.20 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,241.60
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT HEAD W/O CONTRAST	$1,552	$1,319.20	$54.48 – $1,319.20
CT scan of the head or brain, without contrast: 10 of 33 insurance plan rates Aetna — Commercial: $1,257.12 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $1,241.60 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $969.22 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $233.80 Cofinity — Commercial: $1,319.20 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,241.60
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT STEALTH HEAD W/O CONTRAST	$1,552	$1,319.20	$54.48 – $1,319.20
CT scan of the head or brain, without contrast: 10 of 33 insurance plan rates Aetna — Commercial: $1,257.12 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $1,241.60 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $969.22 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $233.80 Cofinity — Commercial: $1,319.20 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,241.60
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Exams	$4,780	$4,063	$181.80 – $4,063
MRI of the brain, before and after contrast: 10 of 33 insurance plan rates Aetna — Commercial: $3,871.80 Aetna — Medicare Advantage: $351.10 ASR Physicians Care Network — Commercial: $3,824 Blue Care Network — Medicare Advantage: $347.62 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,985.11 Blue Cross Complete — Managed Medicaid: $181.80 Cigna — Commercial: $763.99 Cofinity — Commercial: $4,063 Employee Benefit Logistics — Commercial: $590.95 Enterprise Group Planning/Employee Benefit Plan — Commercial: $3,824
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI BRAIN W/ + W/O CONTRAST	$4,780	$4,063	$181.80 – $4,063
MRI of the brain, before and after contrast: 10 of 33 insurance plan rates Aetna — Commercial: $3,871.80 Aetna — Medicare Advantage: $351.10 ASR Physicians Care Network — Commercial: $3,824 Blue Care Network — Medicare Advantage: $347.62 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,985.11 Blue Cross Complete — Managed Medicaid: $181.80 Cigna — Commercial: $763.99 Cofinity — Commercial: $4,063 Employee Benefit Logistics — Commercial: $590.95 Enterprise Group Planning/Employee Benefit Plan — Commercial: $3,824
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MR Exams	$4,780	$4,063	$852.12 – $4,063
MRI of the brain, before and after contrast: 10 of 12 insurance plan rates Aetna — Commercial: $3,871.80 ASR Physicians Care Network — Commercial: $3,824 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,985.11 Cofinity — Commercial: $4,063 Enterprise Group Planning/Employee Benefit Plan — Commercial: $3,824 HAP (Health Alliance Plan) — Commercial: $3,824 McLaren Health Plan — Commercial: $4,008.03 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $3,824 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $4,063
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CHEST 2 V	$294	$249.90	$45.35 – $249.90
Chest X-ray, 2 views: 10 of 33 insurance plan rates Aetna — Commercial: $238.14 Aetna — Medicare Advantage: $87.58 ASR Physicians Care Network — Commercial: $235.20 Blue Care Network — Medicare Advantage: $86.71 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $183.60 Blue Cross Complete — Managed Medicaid: $45.35 Cigna — Commercial: $77.93 Cofinity — Commercial: $249.90 Employee Benefit Logistics — Commercial: $147.41 Enterprise Group Planning/Employee Benefit Plan — Commercial: $235.20
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CHEST 2 V W/ABDOMEN (INFANT ONLY)	$294	$249.90	$45.35 – $249.90
Chest X-ray, 2 views: 10 of 33 insurance plan rates Aetna — Commercial: $238.14 Aetna — Medicare Advantage: $87.58 ASR Physicians Care Network — Commercial: $235.20 Blue Care Network — Medicare Advantage: $86.71 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $183.60 Blue Cross Complete — Managed Medicaid: $45.35 Cigna — Commercial: $77.93 Cofinity — Commercial: $249.90 Employee Benefit Logistics — Commercial: $147.41 Enterprise Group Planning/Employee Benefit Plan — Commercial: $235.20
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GD Exams	$294	$249.90	$45.35 – $249.90
Chest X-ray, 2 views: 10 of 33 insurance plan rates Aetna — Commercial: $238.14 Aetna — Medicare Advantage: $87.58 ASR Physicians Care Network — Commercial: $235.20 Blue Care Network — Medicare Advantage: $86.71 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $183.60 Blue Cross Complete — Managed Medicaid: $45.35 Cigna — Commercial: $77.93 Cofinity — Commercial: $564.40 Employee Benefit Logistics — Commercial: $147.41 Enterprise Group Planning/Employee Benefit Plan — Commercial: $531.20
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GD Exams	$484	$411.40	$54.48 – $411.40
X-ray of the lower spine, at least 4 views: 10 of 33 insurance plan rates Aetna — Commercial: $392.04 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $387.20 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $302.26 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $129.89 Cofinity — Commercial: $411.40 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $387.20
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SPINE LUMBAR AP + LAT W/ FLEX + EXT	$484	$411.40	$54.48 – $411.40
X-ray of the lower spine, at least 4 views: 10 of 33 insurance plan rates Aetna — Commercial: $392.04 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $387.20 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $302.26 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $129.89 Cofinity — Commercial: $411.40 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $387.20
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SPINE LUMBAR MIN 4 V	$484	$411.40	$54.48 – $411.40
X-ray of the lower spine, at least 4 views: 10 of 33 insurance plan rates Aetna — Commercial: $392.04 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $387.20 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $302.26 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $129.89 Cofinity — Commercial: $411.40 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $387.20
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Exams	$2,738	$2,327.30	$124.34 – $2,327.30
MRI of the lower back (lumbar spine), without contrast: 10 of 33 insurance plan rates Aetna — Commercial: $2,217.78 Aetna — Medicare Advantage: $240.12 ASR Physicians Care Network — Commercial: $2,190.40 Blue Care Network — Medicare Advantage: $237.74 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,709.88 Blue Cross Complete — Managed Medicaid: $124.34 Cigna — Commercial: $438.09 Cofinity — Commercial: $2,327.30 Employee Benefit Logistics — Commercial: $404.16 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,190.40
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI INCOMPLETE LUMBAR SPINE	$2,738	$2,327.30	$124.34 – $2,327.30
MRI of the lower back (lumbar spine), without contrast: 10 of 33 insurance plan rates Aetna — Commercial: $2,217.78 Aetna — Medicare Advantage: $240.12 ASR Physicians Care Network — Commercial: $2,190.40 Blue Care Network — Medicare Advantage: $237.74 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,709.88 Blue Cross Complete — Managed Medicaid: $124.34 Cigna — Commercial: $438.09 Cofinity — Commercial: $2,327.30 Employee Benefit Logistics — Commercial: $404.16 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,190.40
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LUMBAR SPINE W/O CONTRAST	$2,738	$2,327.30	$124.34 – $2,327.30
MRI of the lower back (lumbar spine), without contrast: 10 of 33 insurance plan rates Aetna — Commercial: $2,217.78 Aetna — Medicare Advantage: $240.12 ASR Physicians Care Network — Commercial: $2,190.40 Blue Care Network — Medicare Advantage: $237.74 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,709.88 Blue Cross Complete — Managed Medicaid: $124.34 Cigna — Commercial: $438.09 Cofinity — Commercial: $2,327.30 Employee Benefit Logistics — Commercial: $404.16 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,190.40
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Exams	$2,034	$1,728.90	$91.40 – $1,728.90
CT scan of the pelvis, with contrast: 10 of 33 insurance plan rates Aetna — Commercial: $1,647.54 Aetna — Medicare Advantage: $176.52 ASR Physicians Care Network — Commercial: $1,627.20 Blue Care Network — Medicare Advantage: $174.77 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,270.23 Blue Cross Complete — Managed Medicaid: $91.40 Cigna — Commercial: $634.10 Cofinity — Commercial: $1,728.90 Employee Benefit Logistics — Commercial: $297.11 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,627.20
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT PELVIS W/ CONTRAST (ORAL + IV)	$2,034	$1,728.90	$91.40 – $1,728.90
CT scan of the pelvis, with contrast: 10 of 33 insurance plan rates Aetna — Commercial: $1,647.54 Aetna — Medicare Advantage: $176.52 ASR Physicians Care Network — Commercial: $1,627.20 Blue Care Network — Medicare Advantage: $174.77 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,270.23 Blue Cross Complete — Managed Medicaid: $91.40 Cigna — Commercial: $634.10 Cofinity — Commercial: $1,728.90 Employee Benefit Logistics — Commercial: $297.11 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,627.20
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT PELVIS W/ IV CONTRAST (NO ORAL CONT)	$2,034	$1,728.90	$91.40 – $1,728.90
CT scan of the pelvis, with contrast: 10 of 33 insurance plan rates Aetna — Commercial: $1,647.54 Aetna — Medicare Advantage: $176.52 ASR Physicians Care Network — Commercial: $1,627.20 Blue Care Network — Medicare Advantage: $174.77 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,270.23 Blue Cross Complete — Managed Medicaid: $91.40 Cigna — Commercial: $634.10 Cofinity — Commercial: $1,728.90 Employee Benefit Logistics — Commercial: $297.11 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,627.20
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR Exams	$2,856	$2,427.60	$124.34 – $2,427.60
MRI of a leg joint (such as the knee), without contrast: 10 of 33 insurance plan rates Aetna — Commercial: $2,313.36 Aetna — Medicare Advantage: $240.12 ASR Physicians Care Network — Commercial: $2,284.80 Blue Care Network — Medicare Advantage: $237.74 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,783.57 Blue Cross Complete — Managed Medicaid: $124.34 Cigna — Commercial: $494.76 Cofinity — Commercial: $2,427.60 Employee Benefit Logistics — Commercial: $404.16 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,284.80
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI ANKLE W/O CONTRAST LT	$2,856	$2,427.60	$124.34 – $2,427.60
MRI of a leg joint (such as the knee), without contrast: 10 of 33 insurance plan rates Aetna — Commercial: $2,313.36 Aetna — Medicare Advantage: $240.12 ASR Physicians Care Network — Commercial: $2,284.80 Blue Care Network — Medicare Advantage: $237.74 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,783.57 Blue Cross Complete — Managed Medicaid: $124.34 Cigna — Commercial: $494.76 Cofinity — Commercial: $2,427.60 Employee Benefit Logistics — Commercial: $404.16 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,284.80
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI ANKLE W/O CONTRAST RT	$2,856	$2,427.60	$124.34 – $2,427.60
MRI of a leg joint (such as the knee), without contrast: 10 of 33 insurance plan rates Aetna — Commercial: $2,313.36 Aetna — Medicare Advantage: $240.12 ASR Physicians Care Network — Commercial: $2,284.80 Blue Care Network — Medicare Advantage: $237.74 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,783.57 Blue Cross Complete — Managed Medicaid: $124.34 Cigna — Commercial: $494.76 Cofinity — Commercial: $2,427.60 Employee Benefit Logistics — Commercial: $404.16 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,284.80
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 93077 CT ABD PELV W/ IV CONT	$3,607	$3,065.95	$181.80 – $3,065.95
CT scan of the abdomen and pelvis, with contrast: 10 of 33 insurance plan rates Aetna — Commercial: $2,921.67 Aetna — Medicare Advantage: $351.10 ASR Physicians Care Network — Commercial: $2,885.60 Blue Care Network — Medicare Advantage: $347.62 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,252.57 Blue Cross Complete — Managed Medicaid: $181.80 Cigna — Commercial: $793.51 Cofinity — Commercial: $3,065.95 Employee Benefit Logistics — Commercial: $590.95 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,885.60
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 93079 CT ABD PELV W/ IV+ORAL CONT	$3,607	$3,065.95	$181.80 – $3,065.95
CT scan of the abdomen and pelvis, with contrast: 10 of 33 insurance plan rates Aetna — Commercial: $2,921.67 Aetna — Medicare Advantage: $351.10 ASR Physicians Care Network — Commercial: $2,885.60 Blue Care Network — Medicare Advantage: $347.62 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,252.57 Blue Cross Complete — Managed Medicaid: $181.80 Cigna — Commercial: $793.51 Cofinity — Commercial: $3,065.95 Employee Benefit Logistics — Commercial: $590.95 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,885.60
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT ABD + PELVIS W/IV CONT (NO ORAL)	$3,607	$3,065.95	$181.80 – $3,065.95
CT scan of the abdomen and pelvis, with contrast: 10 of 33 insurance plan rates Aetna — Commercial: $2,921.67 Aetna — Medicare Advantage: $351.10 ASR Physicians Care Network — Commercial: $2,885.60 Blue Care Network — Medicare Advantage: $347.62 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,252.57 Blue Cross Complete — Managed Medicaid: $181.80 Cigna — Commercial: $793.51 Cofinity — Commercial: $3,065.95 Employee Benefit Logistics — Commercial: $590.95 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,885.60
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US ABDOMEN COMPLETE	$884	$751.40	$54.48 – $751.40
Ultrasound of the abdomen, complete: 10 of 33 insurance plan rates Aetna — Commercial: $716.04 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $707.20 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $552.06 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $288.12 Cofinity — Commercial: $751.40 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $707.20
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Exams	$884	$751.40	$54.48 – $751.40
Ultrasound of the abdomen, complete: 10 of 33 insurance plan rates Aetna — Commercial: $716.04 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $707.20 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $552.06 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $288.12 Cofinity — Commercial: $751.40 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $707.20
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US ABDOMEN COMPLETE	$884	$751.40	$552.06 – $852.12
Ultrasound of the abdomen, complete: 10 of 12 insurance plan rates Aetna — Commercial: $716.04 ASR Physicians Care Network — Commercial: $707.20 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $552.06 Cofinity — Commercial: $751.40 Enterprise Group Planning/Employee Benefit Plan — Commercial: $707.20 HAP (Health Alliance Plan) — Commercial: $707.20 McLaren Health Plan — Commercial: $741.23 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $707.20 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $751.40
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US OB >=14 weeks Single Fetus 76805	$828	$703.80	$54.48 – $703.80
Pregnancy ultrasound (after the first trimester): 10 of 33 insurance plan rates Aetna — Commercial: $670.68 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $662.40 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $517.09 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $297.57 Cofinity — Commercial: $703.80 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $662.40
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OB US >= 14 Wks Single Fetus 76805 READ	$828	$703.80	$54.48 – $703.80
Pregnancy ultrasound (after the first trimester): 10 of 33 insurance plan rates Aetna — Commercial: $670.68 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $662.40 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $517.09 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $297.57 Cofinity — Commercial: $703.80 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $662.40
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Exams	$826	$702.10	$54.48 – $702.10
Pregnancy ultrasound (after the first trimester): 10 of 33 insurance plan rates Aetna — Commercial: $669.06 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $660.80 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $515.84 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $297.57 Cofinity — Commercial: $702.10 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $660.80
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 4611 US TRANSVAGINAL NON OB	$686	$583.10	$54.48 – $583.10
Transvaginal ultrasound: 10 of 33 insurance plan rates Aetna — Commercial: $555.66 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $548.80 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $428.41 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $295.20 Cofinity — Commercial: $583.10 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $548.80
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Pelvis Non-OB 76830	$657	$558.45	$54.48 – $558.45
Transvaginal ultrasound: 10 of 33 insurance plan rates Aetna — Commercial: $532.17 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $525.60 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $410.30 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $295.20 Cofinity — Commercial: $558.45 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $525.60
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Pelvis Complete 76856 READ	$657	$558.45	$54.48 – $558.45
Transvaginal ultrasound: 10 of 33 insurance plan rates Aetna — Commercial: $532.17 Aetna — Medicare Advantage: $105.21 ASR Physicians Care Network — Commercial: $525.60 Blue Care Network — Medicare Advantage: $104.17 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $410.30 Blue Cross Complete — Managed Medicaid: $54.48 Cigna — Commercial: $295.20 Cofinity — Commercial: $558.45 Employee Benefit Logistics — Commercial: $177.09 Enterprise Group Planning/Employee Benefit Plan — Commercial: $525.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Exams	$352	$299.20	$60.60 – $299.20
Diagnostic mammogram, one breast: 10 of 33 insurance plan rates Aetna — Commercial: $285.12 Aetna — Medicare Advantage: $117.02 ASR Physicians Care Network — Commercial: $281.60 Blue Care Network — Medicare Advantage: $115.87 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $219.82 Blue Cross Complete — Managed Medicaid: $60.60 Cigna — Commercial: $294.02 Cofinity — Commercial: $299.20 Employee Benefit Logistics — Commercial: $196.97 Enterprise Group Planning/Employee Benefit Plan — Commercial: $281.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD DX FOLLOW PROCEDURE LT	$368	$312.80	$60.60 – $312.80
Diagnostic mammogram, one breast: 10 of 33 insurance plan rates Aetna — Commercial: $298.08 Aetna — Medicare Advantage: $117.02 ASR Physicians Care Network — Commercial: $294.40 Blue Care Network — Medicare Advantage: $115.87 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $229.82 Blue Cross Complete — Managed Medicaid: $60.60 Cigna — Commercial: $294.02 Cofinity — Commercial: $312.80 Employee Benefit Logistics — Commercial: $196.97 Enterprise Group Planning/Employee Benefit Plan — Commercial: $294.40
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD DX FOLLOW PROCEDURE RT	$368	$312.80	$60.60 – $312.80
Diagnostic mammogram, one breast: 10 of 33 insurance plan rates Aetna — Commercial: $298.08 Aetna — Medicare Advantage: $117.02 ASR Physicians Care Network — Commercial: $294.40 Blue Care Network — Medicare Advantage: $115.87 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $229.82 Blue Cross Complete — Managed Medicaid: $60.60 Cigna — Commercial: $294.02 Cofinity — Commercial: $312.80 Employee Benefit Logistics — Commercial: $196.97 Enterprise Group Planning/Employee Benefit Plan — Commercial: $294.40
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Exams	$452	$384.20	$76.75 – $384.20
Diagnostic mammogram, both breasts: 10 of 33 insurance plan rates Aetna — Commercial: $366.12 Aetna — Medicare Advantage: $148.22 ASR Physicians Care Network — Commercial: $361.60 Blue Care Network — Medicare Advantage: $146.75 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $282.27 Blue Cross Complete — Managed Medicaid: $76.75 Cigna — Commercial: $375.50 Cofinity — Commercial: $384.20 Employee Benefit Logistics — Commercial: $249.48 Enterprise Group Planning/Employee Benefit Plan — Commercial: $361.60
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD DX FOLLOW PROCEDURE BIL	$452	$384.20	$76.75 – $384.20
Diagnostic mammogram, both breasts: 10 of 33 insurance plan rates Aetna — Commercial: $366.12 Aetna — Medicare Advantage: $148.22 ASR Physicians Care Network — Commercial: $361.60 Blue Care Network — Medicare Advantage: $146.75 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $282.27 Blue Cross Complete — Managed Medicaid: $76.75 Cigna — Commercial: $375.50 Cofinity — Commercial: $384.20 Employee Benefit Logistics — Commercial: $249.48 Enterprise Group Planning/Employee Benefit Plan — Commercial: $361.60
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD MAMM DIAGNOSTIC BILAT	$452	$384.20	$76.75 – $384.20
Diagnostic mammogram, both breasts: 10 of 33 insurance plan rates Aetna — Commercial: $366.12 Aetna — Medicare Advantage: $148.22 ASR Physicians Care Network — Commercial: $361.60 Blue Care Network — Medicare Advantage: $146.75 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $282.27 Blue Cross Complete — Managed Medicaid: $76.75 Cigna — Commercial: $375.50 Cofinity — Commercial: $384.20 Employee Benefit Logistics — Commercial: $249.48 Enterprise Group Planning/Employee Benefit Plan — Commercial: $361.60
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Exams	$389	$330.65	$61.60 – $330.65
Screening mammogram, both breasts: 10 of 33 insurance plan rates Aetna — Commercial: $315.09 Aetna — Medicare Advantage: $118.96 ASR Physicians Care Network — Commercial: $311.20 Blue Care Network — Medicare Advantage: $117.78 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $242.93 Blue Cross Complete — Managed Medicaid: $61.60 Cigna — Commercial: $310.56 Cofinity — Commercial: $330.65 Employee Benefit Logistics — Commercial: $200.23 Enterprise Group Planning/Employee Benefit Plan — Commercial: $311.20
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD MAMM SCREEN BILATERAL	$389	$330.65	$61.60 – $330.65
Screening mammogram, both breasts: 10 of 33 insurance plan rates Aetna — Commercial: $315.09 Aetna — Medicare Advantage: $118.96 ASR Physicians Care Network — Commercial: $311.20 Blue Care Network — Medicare Advantage: $117.78 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $242.93 Blue Cross Complete — Managed Medicaid: $61.60 Cigna — Commercial: $310.56 Cofinity — Commercial: $330.65 Employee Benefit Logistics — Commercial: $200.23 Enterprise Group Planning/Employee Benefit Plan — Commercial: $311.20
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA FFD MAMM SCREEN LT UNI	$389	$330.65	$61.60 – $330.65
Screening mammogram, both breasts: 10 of 33 insurance plan rates Aetna — Commercial: $315.09 Aetna — Medicare Advantage: $118.96 ASR Physicians Care Network — Commercial: $311.20 Blue Care Network — Medicare Advantage: $117.78 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $242.93 Blue Cross Complete — Managed Medicaid: $61.60 Cigna — Commercial: $310.56 Cofinity — Commercial: $330.65 Employee Benefit Logistics — Commercial: $200.23 Enterprise Group Planning/Employee Benefit Plan — Commercial: $311.20

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EKG - UC 93000	$187	$158.95	$7.67 – $158.95
Electrocardiogram (ECG/EKG) with reading: 10 of 33 insurance plan rates Aetna — Commercial: $151.47 Aetna — Medicare Advantage: $14.81 ASR Physicians Care Network — Commercial: $149.60 Blue Care Network — Medicare Advantage: $14.67 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $116.78 Blue Cross Complete — Managed Medicaid: $7.67 Cigna — Commercial: $44.99 Cofinity — Commercial: $158.95 Employee Benefit Logistics — Commercial: $24.93 Enterprise Group Planning/Employee Benefit Plan — Commercial: $149.60
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000	$187	$158.95	$7.67 – $158.95
Electrocardiogram (ECG/EKG) with reading: 10 of 33 insurance plan rates Aetna — Commercial: $151.47 Aetna — Medicare Advantage: $14.81 ASR Physicians Care Network — Commercial: $149.60 Blue Care Network — Medicare Advantage: $14.67 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $116.78 Blue Cross Complete — Managed Medicaid: $7.67 Cigna — Commercial: $44.99 Cofinity — Commercial: $158.95 Employee Benefit Logistics — Commercial: $24.93 Enterprise Group Planning/Employee Benefit Plan — Commercial: $149.60
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ELECTROCARDIOGRAM COMPLETE	$155	$131.75	$7.67 – $131.75
Electrocardiogram (ECG/EKG) with reading: 10 of 33 insurance plan rates Aetna — Commercial: $125.55 Aetna — Medicare Advantage: $14.81 ASR Physicians Care Network — Commercial: $124 Blue Care Network — Medicare Advantage: $14.67 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $96.80 Blue Cross Complete — Managed Medicaid: $7.67 Cigna — Commercial: $44.99 Cofinity — Commercial: $131.75 Employee Benefit Logistics — Commercial: $24.93 Enterprise Group Planning/Employee Benefit Plan — Commercial: $124
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$819.13 – $1,393.56
Left heart catheterization (diagnostic): 10 of 20 insurance plan rates Aetna — Medicare Advantage: $827.94 ASR Physicians Care Network — Commercial: $1,229.61 Blue Care Network — Medicare Advantage: $819.74 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,366.65 Cigna — Commercial: $1,214.50 Employee Benefit Logistics — Commercial: $1,393.56 HAP (Health Alliance Plan) — Commercial: $1,229.61 HAP (Health Alliance Plan) — Medicare Advantage: $819.74 Humana — Medicare Advantage: $819.74 McLaren Health Plan — Medicare Advantage: $819.74
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$1,689.43 – $3,230.27
Left heart catheterization (diagnostic): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $1,689.43 Cigna — Commercial: $2,224.08 McLaren Health Plan — Managed Medicaid: $1,689.43 Medicare Plus Blue — Medicare Advantage: $3,230.27 Meridian — Managed Medicaid: $1,689.43 Molina — Managed Medicaid: $1,689.43 Priority Health — Commercial: $2,224.08 Priority Health — Managed Medicaid: $1,689.43 United Healthcare — Managed Medicaid: $1,689.43
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$146.76 – $390.85
Left heart catheterization (diagnostic): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $232.21 ASR Physicians Care Network — Commercial: $344.87 Blue Care Network — Medicare Advantage: $229.91 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $366.96 Blue Cross Complete — Managed Medicaid: $149.70 Cigna — Commercial: $326.11 Employee Benefit Logistics — Commercial: $390.85 HAP (Health Alliance Plan) — Commercial: $344.87 HAP (Health Alliance Plan) — Medicare Advantage: $229.91 Humana — Medicare Advantage: $229.91
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$595.46 – $1,343.12
Heart rhythm study (electrophysiology evaluation): 10 of 20 insurance plan rates Aetna — Medicare Advantage: $797.97 ASR Physicians Care Network — Commercial: $1,185.11 Blue Care Network — Medicare Advantage: $790.07 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $595.46 Cigna — Commercial: $928.15 Employee Benefit Logistics — Commercial: $1,343.12 HAP (Health Alliance Plan) — Commercial: $1,185.11 HAP (Health Alliance Plan) — Medicare Advantage: $790.07 Humana — Medicare Advantage: $790.07 McLaren Health Plan — Medicare Advantage: $790.07
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$901.78 – $7,771.62
Heart rhythm study (electrophysiology evaluation): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $4,064.56 Cigna — Commercial: $901.78 McLaren Health Plan — Managed Medicaid: $4,064.56 Medicare Plus Blue — Medicare Advantage: $7,771.62 Meridian — Managed Medicaid: $4,064.56 Molina — Managed Medicaid: $4,064.56 Priority Health — Commercial: $901.78 Priority Health — Managed Medicaid: $4,064.56 United Healthcare — Managed Medicaid: $4,064.56
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$238.13 – $633.52
Heart rhythm study (electrophysiology evaluation): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $376.39 ASR Physicians Care Network — Commercial: $558.99 Blue Care Network — Medicare Advantage: $372.66 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $595.45 Blue Cross Complete — Managed Medicaid: $242.89 Cigna — Commercial: $529.15 Employee Benefit Logistics — Commercial: $633.52 HAP (Health Alliance Plan) — Commercial: $558.99 HAP (Health Alliance Plan) — Medicare Advantage: $372.66 Humana — Medicare Advantage: $372.66
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	Not listed in the file	Not listed in the file	$590.44 – $1,490.66
Heart rhythm study with ablation for atrial fibrillation: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $820.97 ASR Physicians Care Network — Commercial: $1,219.26 Blue Care Network — Medicare Advantage: $812.84 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,476.37 Blue Cross Complete — Managed Medicaid: $602.25 Cigna — Commercial: $1,312 Employee Benefit Logistics — Commercial: $1,381.83 HAP (Health Alliance Plan) — Commercial: $1,219.26 HAP (Health Alliance Plan) — Medicare Advantage: $812.84 Humana — Medicare Advantage: $812.84
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$13,620.94 – $36,449.21
Heart rhythm study with ablation for atrial fibrillation: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $13,620.94 Cigna — Commercial: $36,449.21 McLaren Health Plan — Managed Medicaid: $13,620.94 Medicare Plus Blue — Medicare Advantage: $26,043.87 Meridian — Managed Medicaid: $13,620.94 Molina — Managed Medicaid: $13,620.94 Priority Health — Commercial: $36,449.21 Priority Health — Managed Medicaid: $13,620.94 United Healthcare — Managed Medicaid: $13,620.94
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom 6/> Yrs 4/> par RDC 95810	$3,420	$2,907	$447.51 – $2,907
Sleep study (overnight, in a sleep lab): 10 of 33 insurance plan rates Aetna — Commercial: $2,770.20 Aetna — Medicare Advantage: $864.21 ASR Physicians Care Network — Commercial: $2,736 Blue Care Network — Medicare Advantage: $855.65 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,135.79 Blue Cross Complete — Managed Medicaid: $447.51 Cigna — Commercial: $1,661.40 Cofinity — Commercial: $2,907 Employee Benefit Logistics — Commercial: $1,454.61 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,736
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Polysom 6/> Yrs 4/> par RDC 95810	$3,420	$2,907	$852.12 – $2,907
Sleep study (overnight, in a sleep lab): 10 of 12 insurance plan rates Aetna — Commercial: $2,770.20 ASR Physicians Care Network — Commercial: $2,736 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,135.79 Cofinity — Commercial: $2,907 Enterprise Group Planning/Employee Benefit Plan — Commercial: $2,736 HAP (Health Alliance Plan) — Commercial: $2,736 McLaren Health Plan — Commercial: $2,867.67 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $2,736 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $2,907
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Doctor (professional) fee In the file: POLYSOM 6/> YRS 4/> PARAM	Not listed in the file	Not listed in the file	$624.05 – $1,061.92
Sleep study (overnight, in a sleep lab): 10 of 20 insurance plan rates Aetna — Medicare Advantage: $630.91 ASR Physicians Care Network — Commercial: $936.99 Blue Care Network — Medicare Advantage: $624.66 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $790.02 Cigna — Commercial: $863.84 Employee Benefit Logistics — Commercial: $1,061.92 HAP (Health Alliance Plan) — Commercial: $936.99 HAP (Health Alliance Plan) — Medicare Advantage: $624.66 Humana — Medicare Advantage: $624.66 McLaren Health Plan — Medicare Advantage: $624.66

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 97110 THERAPEUTIC EXERCISES EA 15 OT IP	$153	$130.05	$14.60 – $130.05
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $123.93 Aetna — Medicare Advantage: $28.19 ASR Physicians Care Network — Commercial: $122.40 Blue Care Network — Medicare Advantage: $27.91 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $95.55 Blue Cross Complete — Managed Medicaid: $14.60 Cigna — Commercial: $93.28 Cofinity — Commercial: $130.05 Employee Benefit Logistics — Commercial: $47.45 Enterprise Group Planning/Employee Benefit Plan — Commercial: $122.40
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COTA Therapeutic Exercise 15min	$153	$130.05	$14.60 – $130.05
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $123.93 Aetna — Medicare Advantage: $28.19 ASR Physicians Care Network — Commercial: $122.40 Blue Care Network — Medicare Advantage: $27.91 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $95.55 Blue Cross Complete — Managed Medicaid: $14.60 Cigna — Commercial: $93.28 Cofinity — Commercial: $130.05 Employee Benefit Logistics — Commercial: $47.45 Enterprise Group Planning/Employee Benefit Plan — Commercial: $122.40
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OT Therapeutic Exercise 15min	$153	$130.05	$14.60 – $130.05
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 33 insurance plan rates Aetna — Commercial: $123.93 Aetna — Medicare Advantage: $28.19 ASR Physicians Care Network — Commercial: $122.40 Blue Care Network — Medicare Advantage: $27.91 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $95.55 Blue Cross Complete — Managed Medicaid: $14.60 Cigna — Commercial: $93.28 Cofinity — Commercial: $130.05 Employee Benefit Logistics — Commercial: $47.45 Enterprise Group Planning/Employee Benefit Plan — Commercial: $122.40
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Low Complexity Evaluation - PT Untimed Charges	$274	$232.90	$49.11 – $232.90
Physical therapy evaluation (low complexity): 10 of 33 insurance plan rates Aetna — Commercial: $221.94 Aetna — Medicare Advantage: $94.84 ASR Physicians Care Network — Commercial: $219.20 Blue Care Network — Medicare Advantage: $93.90 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $171.11 Blue Cross Complete — Managed Medicaid: $49.11 Cigna — Commercial: $111 Cofinity — Commercial: $232.90 Employee Benefit Logistics — Commercial: $159.63 Enterprise Group Planning/Employee Benefit Plan — Commercial: $219.20
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Eval 20 Min - PT MMC	$264	$224.40	$49.11 – $224.40
Physical therapy evaluation (low complexity): 10 of 33 insurance plan rates Aetna — Commercial: $213.84 Aetna — Medicare Advantage: $94.84 ASR Physicians Care Network — Commercial: $211.20 Blue Care Network — Medicare Advantage: $93.90 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $164.87 Blue Cross Complete — Managed Medicaid: $49.11 Cigna — Commercial: $111 Cofinity — Commercial: $224.40 Employee Benefit Logistics — Commercial: $159.63 Enterprise Group Planning/Employee Benefit Plan — Commercial: $211.20
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT 97161 PT EVAL LOW COMPLEX 20M OP	$274	$232.90	$49.11 – $232.90
Physical therapy evaluation (low complexity): 10 of 33 insurance plan rates Aetna — Commercial: $221.94 Aetna — Medicare Advantage: $94.84 ASR Physicians Care Network — Commercial: $219.20 Blue Care Network — Medicare Advantage: $93.90 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $171.11 Blue Cross Complete — Managed Medicaid: $49.11 Cigna — Commercial: $111 Cofinity — Commercial: $232.90 Employee Benefit Logistics — Commercial: $159.63 Enterprise Group Planning/Employee Benefit Plan — Commercial: $219.20
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 97162 PT EVAL 30 MIN PT IP	$318	$270.30	$49.11 – $270.30
Physical therapy evaluation (moderate complexity): 10 of 33 insurance plan rates Aetna — Commercial: $257.58 Aetna — Medicare Advantage: $94.84 ASR Physicians Care Network — Commercial: $254.40 Blue Care Network — Medicare Advantage: $93.90 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $198.59 Blue Cross Complete — Managed Medicaid: $49.11 Cigna — Commercial: $111 Cofinity — Commercial: $270.30 Employee Benefit Logistics — Commercial: $159.63 Enterprise Group Planning/Employee Benefit Plan — Commercial: $254.40
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Moderate Complexity Evaluation - PT Untimed Charges	$318	$270.30	$49.11 – $270.30
Physical therapy evaluation (moderate complexity): 10 of 33 insurance plan rates Aetna — Commercial: $257.58 Aetna — Medicare Advantage: $94.84 ASR Physicians Care Network — Commercial: $254.40 Blue Care Network — Medicare Advantage: $93.90 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $198.59 Blue Cross Complete — Managed Medicaid: $49.11 Cigna — Commercial: $111 Cofinity — Commercial: $270.30 Employee Benefit Logistics — Commercial: $159.63 Enterprise Group Planning/Employee Benefit Plan — Commercial: $254.40
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Eval 30 Min - PT MMC	$318	$270.30	$49.11 – $270.30
Physical therapy evaluation (moderate complexity): 10 of 33 insurance plan rates Aetna — Commercial: $257.58 Aetna — Medicare Advantage: $94.84 ASR Physicians Care Network — Commercial: $254.40 Blue Care Network — Medicare Advantage: $93.90 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $198.59 Blue Cross Complete — Managed Medicaid: $49.11 Cigna — Commercial: $111 Cofinity — Commercial: $270.30 Employee Benefit Logistics — Commercial: $159.63 Enterprise Group Planning/Employee Benefit Plan — Commercial: $254.40
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 97163 PT EVAL 45 MIN PT IP	$427	$362.95	$49.11 – $362.95
Physical therapy evaluation (high complexity): 10 of 33 insurance plan rates Aetna — Commercial: $345.87 Aetna — Medicare Advantage: $94.84 ASR Physicians Care Network — Commercial: $341.60 Blue Care Network — Medicare Advantage: $93.90 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $266.66 Blue Cross Complete — Managed Medicaid: $49.11 Cigna — Commercial: $111 Cofinity — Commercial: $362.95 Employee Benefit Logistics — Commercial: $159.63 Enterprise Group Planning/Employee Benefit Plan — Commercial: $341.60
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: High Complexity Evaluation - PT Untimed Charges	$427	$362.95	$49.11 – $362.95
Physical therapy evaluation (high complexity): 10 of 33 insurance plan rates Aetna — Commercial: $345.87 Aetna — Medicare Advantage: $94.84 ASR Physicians Care Network — Commercial: $341.60 Blue Care Network — Medicare Advantage: $93.90 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $266.66 Blue Cross Complete — Managed Medicaid: $49.11 Cigna — Commercial: $111 Cofinity — Commercial: $362.95 Employee Benefit Logistics — Commercial: $159.63 Enterprise Group Planning/Employee Benefit Plan — Commercial: $341.60
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Eval 45 Min - PT MMC	$427	$362.95	$49.11 – $362.95
Physical therapy evaluation (high complexity): 10 of 33 insurance plan rates Aetna — Commercial: $345.87 Aetna — Medicare Advantage: $94.84 ASR Physicians Care Network — Commercial: $341.60 Blue Care Network — Medicare Advantage: $93.90 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $266.66 Blue Cross Complete — Managed Medicaid: $49.11 Cigna — Commercial: $111 Cofinity — Commercial: $362.95 Employee Benefit Logistics — Commercial: $159.63 Enterprise Group Planning/Employee Benefit Plan — Commercial: $341.60
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psychotherapy 30 Mins 90832	$239	$203.15	$92.50 – $300.66
Psychotherapy, 30 minutes: 10 of 33 insurance plan rates Aetna — Commercial: $193.59 Aetna — Medicare Advantage: $178.63 ASR Physicians Care Network — Commercial: $191.20 Blue Care Network — Medicare Advantage: $176.86 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $149.26 Blue Cross Complete — Managed Medicaid: $92.50 Cigna — Commercial: $226.90 Cofinity — Commercial: $203.15 Employee Benefit Logistics — Commercial: $300.66 Enterprise Group Planning/Employee Benefit Plan — Commercial: $191.20
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Psychotherapy 30 Mins 90832	$239	$203.15	$149.26 – $852.12
Psychotherapy, 30 minutes: 10 of 12 insurance plan rates Aetna — Commercial: $193.59 ASR Physicians Care Network — Commercial: $191.20 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $149.26 Cofinity — Commercial: $203.15 Enterprise Group Planning/Employee Benefit Plan — Commercial: $191.20 HAP (Health Alliance Plan) — Commercial: $191.20 McLaren Health Plan — Commercial: $200.40 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $191.20 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $203.15
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Doctor (professional) fee In the file: PSYTX W PT 30 MINUTES	Not listed in the file	Not listed in the file	$45.37 – $117.54
Psychotherapy, 30 minutes: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $69.83 ASR Physicians Care Network — Commercial: $103.71 Blue Care Network — Medicare Advantage: $69.14 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $89.46 Blue Cross Complete — Managed Medicaid: $46.28 Cigna — Commercial: $89.05 Employee Benefit Logistics — Commercial: $117.54 HAP (Health Alliance Plan) — Commercial: $103.71 HAP (Health Alliance Plan) — Medicare Advantage: $69.14 Humana — Medicare Advantage: $69.14
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psychotherapy 45 Mins 90834	$253	$215.05	$92.50 – $300.66
Psychotherapy, 45 minutes: 10 of 33 insurance plan rates Aetna — Commercial: $204.93 Aetna — Medicare Advantage: $178.63 ASR Physicians Care Network — Commercial: $202.40 Blue Care Network — Medicare Advantage: $176.86 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $158 Blue Cross Complete — Managed Medicaid: $92.50 Cigna — Commercial: $226.90 Cofinity — Commercial: $215.05 Employee Benefit Logistics — Commercial: $300.66 Enterprise Group Planning/Employee Benefit Plan — Commercial: $202.40
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Psychotherapy 45 Mins 90834	$253	$215.05	$158 – $852.12
Psychotherapy, 45 minutes: 10 of 12 insurance plan rates Aetna — Commercial: $204.93 ASR Physicians Care Network — Commercial: $202.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $158 Cofinity — Commercial: $215.05 Enterprise Group Planning/Employee Benefit Plan — Commercial: $202.40 HAP (Health Alliance Plan) — Commercial: $202.40 McLaren Health Plan — Commercial: $212.14 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $202.40 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $215.05
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Doctor (professional) fee In the file: PSYTX W PT 45 MINUTES	Not listed in the file	Not listed in the file	$59.85 – $155.45
Psychotherapy, 45 minutes: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $92.35 ASR Physicians Care Network — Commercial: $137.16 Blue Care Network — Medicare Advantage: $91.44 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $118.02 Blue Cross Complete — Managed Medicaid: $61.05 Cigna — Commercial: $117.40 Employee Benefit Logistics — Commercial: $155.45 HAP (Health Alliance Plan) — Commercial: $137.16 HAP (Health Alliance Plan) — Medicare Advantage: $91.44 Humana — Medicare Advantage: $91.44
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psychotherapy 60 Mins 90837	$291	$247.35	$92.50 – $300.66
Psychotherapy, 60 minutes: 10 of 33 insurance plan rates Aetna — Commercial: $235.71 Aetna — Medicare Advantage: $178.63 ASR Physicians Care Network — Commercial: $232.80 Blue Care Network — Medicare Advantage: $176.86 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $181.73 Blue Cross Complete — Managed Medicaid: $92.50 Cigna — Commercial: $226.90 Cofinity — Commercial: $247.35 Employee Benefit Logistics — Commercial: $300.66 Enterprise Group Planning/Employee Benefit Plan — Commercial: $232.80
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Psychotherapy 60 Mins 90837	$291	$247.35	$181.73 – $852.12
Psychotherapy, 60 minutes: 10 of 12 insurance plan rates Aetna — Commercial: $235.71 ASR Physicians Care Network — Commercial: $232.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $181.73 Cofinity — Commercial: $247.35 Enterprise Group Planning/Employee Benefit Plan — Commercial: $232.80 HAP (Health Alliance Plan) — Commercial: $232.80 McLaren Health Plan — Commercial: $244 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $232.80 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $247.35
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Doctor (professional) fee In the file: PSYTX W PT 60 MINUTES	Not listed in the file	Not listed in the file	$88.61 – $228.87
Psychotherapy, 60 minutes: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $135.98 ASR Physicians Care Network — Commercial: $201.95 Blue Care Network — Medicare Advantage: $134.63 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $174.72 Blue Cross Complete — Managed Medicaid: $90.38 Cigna — Commercial: $173.99 Employee Benefit Logistics — Commercial: $228.87 HAP (Health Alliance Plan) — Commercial: $201.95 HAP (Health Alliance Plan) — Medicare Advantage: $134.63 Humana — Medicare Advantage: $134.63
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Doctor (professional) fee In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$90.08 – $167.88
Family psychotherapy, without the patient: 10 of 20 insurance plan rates Aetna — Medicare Advantage: $99.74 ASR Physicians Care Network — Commercial: $148.13 Blue Care Network — Medicare Advantage: $98.75 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $161.91 Cigna — Commercial: $129.77 Employee Benefit Logistics — Commercial: $167.88 HAP (Health Alliance Plan) — Commercial: $148.13 HAP (Health Alliance Plan) — Medicare Advantage: $98.75 Humana — Medicare Advantage: $98.75 McLaren Health Plan — Medicare Advantage: $98.75
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$92.50 – $226.90
Family psychotherapy, without the patient: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $92.50 Cigna — Commercial: $226.90 McLaren Health Plan — Managed Medicaid: $92.50 Medicare Plus Blue — Medicare Advantage: $176.86 Meridian — Managed Medicaid: $92.50 Molina — Managed Medicaid: $92.50 Priority Health — Commercial: $226.90 Priority Health — Managed Medicaid: $92.50 United Healthcare — Managed Medicaid: $92.50
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Doctor (professional) fee In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$67.52 – $174.05
Family psychotherapy, with the patient: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $103.40 ASR Physicians Care Network — Commercial: $153.57 Blue Care Network — Medicare Advantage: $102.38 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $133.14 Blue Cross Complete — Managed Medicaid: $68.87 Cigna — Commercial: $137.85 Employee Benefit Logistics — Commercial: $174.05 HAP (Health Alliance Plan) — Commercial: $153.57 HAP (Health Alliance Plan) — Medicare Advantage: $102.38 Humana — Medicare Advantage: $102.38
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$92.50 – $226.90
Family psychotherapy, with the patient: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $92.50 Cigna — Commercial: $226.90 McLaren Health Plan — Managed Medicaid: $92.50 Medicare Plus Blue — Medicare Advantage: $176.86 Meridian — Managed Medicaid: $92.50 Molina — Managed Medicaid: $92.50 Priority Health — Commercial: $226.90 Priority Health — Managed Medicaid: $92.50 United Healthcare — Managed Medicaid: $92.50
Group psychotherapy CPT 90853 · Inpatient or outpatient · Doctor (professional) fee In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$15.98 – $41.28
Group psychotherapy: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $24.52 ASR Physicians Care Network — Commercial: $36.42 Blue Care Network — Medicare Advantage: $24.28 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $31.50 Blue Cross Complete — Managed Medicaid: $16.30 Cigna — Commercial: $33.48 Employee Benefit Logistics — Commercial: $41.28 HAP (Health Alliance Plan) — Commercial: $36.42 HAP (Health Alliance Plan) — Medicare Advantage: $24.28 Humana — Medicare Advantage: $24.28
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$52.94 – $127.13
Group psychotherapy: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $52.94 Cigna — Commercial: $127.13 McLaren Health Plan — Managed Medicaid: $52.94 Medicare Plus Blue — Medicare Advantage: $101.22 Meridian — Managed Medicaid: $52.94 Molina — Managed Medicaid: $52.94 Priority Health — Commercial: $127.13 Priority Health — Managed Medicaid: $52.94 United Healthcare — Managed Medicaid: $52.94

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Biopsy 19120	$6,475	$5,503.75	$1,631.89 – $6,632.30
Removal of breast growth (open surgery): 10 of 33 insurance plan rates Aetna — Commercial: $5,244.75 Aetna — Medicare Advantage: $3,940.37 ASR Physicians Care Network — Commercial: $5,180 Blue Care Network — Medicare Advantage: $3,901.35 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $4,043.64 Blue Cross Complete — Managed Medicaid: $2,040.41 Cigna — Commercial: $1,631.89 Cofinity — Commercial: $5,503.75 Employee Benefit Logistics — Commercial: $6,632.30 Enterprise Group Planning/Employee Benefit Plan — Commercial: $5,180
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Biopsy 19120	$6,475	$5,503.75	$852.12 – $5,503.75
Removal of breast growth (open surgery): 10 of 12 insurance plan rates Aetna — Commercial: $5,244.75 ASR Physicians Care Network — Commercial: $5,180 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $4,043.64 Cofinity — Commercial: $5,503.75 Enterprise Group Planning/Employee Benefit Plan — Commercial: $5,180 HAP (Health Alliance Plan) — Commercial: $5,180 McLaren Health Plan — Commercial: $5,429.29 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $5,180 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $5,503.75
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$271.79 – $730.74
Removal of breast growth (open surgery): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $403.57 ASR Physicians Care Network — Commercial: $599.36 Blue Care Network — Medicare Advantage: $399.57 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $730.74 Blue Cross Complete — Managed Medicaid: $277.23 Cigna — Commercial: $581.58 Employee Benefit Logistics — Commercial: $679.27 HAP (Health Alliance Plan) — Commercial: $599.36 HAP (Health Alliance Plan) — Medicare Advantage: $399.57 Humana — Medicare Advantage: $399.57
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$829.21 – $2,449.19
Total hip replacement: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $1,156.75 ASR Physicians Care Network — Commercial: $1,717.95 Blue Care Network — Medicare Advantage: $1,145.30 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,449.19 Blue Cross Complete — Managed Medicaid: $845.79 Cigna — Commercial: $2,072.35 Employee Benefit Logistics — Commercial: $1,947.01 HAP (Health Alliance Plan) — Commercial: $1,717.95 HAP (Health Alliance Plan) — Medicare Advantage: $1,145.30 Humana — Medicare Advantage: $1,145.30
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$6,690.48 – $23,182.94
Total hip replacement: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $6,690.48 Cigna — Commercial: $23,182.94 McLaren Health Plan — Managed Medicaid: $6,690.48 Medicare Plus Blue — Medicare Advantage: $12,792.51 Meridian — Managed Medicaid: $6,690.48 Molina — Managed Medicaid: $6,690.48 Priority Health — Commercial: $23,182.94 Priority Health — Managed Medicaid: $6,690.48 United Healthcare — Managed Medicaid: $6,690.48
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$3,673.80
Total hip replacement: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,673.80
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$828.14 – $2,446.05
Total knee replacement: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $1,154.75 ASR Physicians Care Network — Commercial: $1,714.98 Blue Care Network — Medicare Advantage: $1,143.32 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,446.05 Blue Cross Complete — Managed Medicaid: $844.70 Cigna — Commercial: $2,069.69 Employee Benefit Logistics — Commercial: $1,943.64 HAP (Health Alliance Plan) — Commercial: $1,714.98 HAP (Health Alliance Plan) — Medicare Advantage: $1,143.32 Humana — Medicare Advantage: $1,143.32
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$6,690.48 – $21,837.99
Total knee replacement: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $6,690.48 Cigna — Commercial: $21,837.99 McLaren Health Plan — Managed Medicaid: $6,690.48 Medicare Plus Blue — Medicare Advantage: $12,792.51 Meridian — Managed Medicaid: $6,690.48 Molina — Managed Medicaid: $6,690.48 Priority Health — Commercial: $21,837.99 Priority Health — Managed Medicaid: $6,690.48 United Healthcare — Managed Medicaid: $6,690.48
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$3,669.09
Total knee replacement: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,669.09
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$109.70 – $765.67
Shoulder arthroscopy: shaving of shoulder bone: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $148.96 ASR Physicians Care Network — Commercial: $221.24 Blue Care Network — Medicare Advantage: $147.49 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $232.58 Blue Cross Complete — Managed Medicaid: $111.89 Cigna — Commercial: $274.14 Employee Benefit Logistics — Commercial: $250.73 HAP (Health Alliance Plan) — Commercial: $221.24 HAP (Health Alliance Plan) — Medicare Advantage: $147.49 Humana — Medicare Advantage: $147.49
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$77.14 – $3,620.37
Shoulder arthroscopy: shaving of shoulder bone: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $77.14 Cigna — Commercial: $3,620.37 McLaren Health Plan — Managed Medicaid: $77.14 Medicare Plus Blue — Medicare Advantage: $147.49 Meridian — Managed Medicaid: $77.14 Molina — Managed Medicaid: $77.14 Priority Health — Commercial: $3,620.37 Priority Health — Managed Medicaid: $77.14 United Healthcare — Managed Medicaid: $77.14
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$465.15
Shoulder arthroscopy: shaving of shoulder bone: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $465.15
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$354.43 – $1,046.88
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $506.16 ASR Physicians Care Network — Commercial: $751.73 Blue Care Network — Medicare Advantage: $501.15 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,046.88 Blue Cross Complete — Managed Medicaid: $361.52 Cigna — Commercial: $885.80 Employee Benefit Logistics — Commercial: $851.96 HAP (Health Alliance Plan) — Commercial: $751.73 HAP (Health Alliance Plan) — Medicare Advantage: $501.15 Humana — Medicare Advantage: $501.15
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$1,705.10 – $3,268.50
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $1,705.10 Cigna — Commercial: $3,268.50 McLaren Health Plan — Managed Medicaid: $1,705.10 Medicare Plus Blue — Medicare Advantage: $3,260.23 Meridian — Managed Medicaid: $1,705.10 Molina — Managed Medicaid: $1,705.10 Priority Health — Commercial: $3,268.50 Priority Health — Managed Medicaid: $1,705.10 United Healthcare — Managed Medicaid: $1,705.10
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$973.61
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $973.61
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$189.36 – $539.41
Removal of tonsils and adenoids (under age 12): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $256.91 ASR Physicians Care Network — Commercial: $381.56 Blue Care Network — Medicare Advantage: $254.37 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $473.48 Blue Cross Complete — Managed Medicaid: $193.15 Cigna — Commercial: $539.41 Employee Benefit Logistics — Commercial: $432.43 HAP (Health Alliance Plan) — Commercial: $381.56 HAP (Health Alliance Plan) — Medicare Advantage: $254.37 Humana — Medicare Advantage: $254.37
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$3,084.94 – $5,898.54
Removal of tonsils and adenoids (under age 12): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $3,084.94 Cigna — Commercial: $5,310.12 McLaren Health Plan — Managed Medicaid: $3,084.94 Medicare Plus Blue — Medicare Advantage: $5,898.54 Meridian — Managed Medicaid: $3,084.94 Molina — Managed Medicaid: $3,084.94 Priority Health — Commercial: $5,310.12 Priority Health — Managed Medicaid: $3,084.94 United Healthcare — Managed Medicaid: $3,084.94
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$318.19
Removal of tonsils and adenoids (under age 12): rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $318.19
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$77.75 – $221.46
Upper GI endoscopy (diagnostic): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $109.69 ASR Physicians Care Network — Commercial: $162.90 Blue Care Network — Medicare Advantage: $108.60 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $194.40 Blue Cross Complete — Managed Medicaid: $79.31 Cigna — Commercial: $221.46 Employee Benefit Logistics — Commercial: $184.62 HAP (Health Alliance Plan) — Commercial: $162.90 HAP (Health Alliance Plan) — Medicare Advantage: $108.60 Humana — Medicare Advantage: $108.60
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$472.65 – $1,731.07
Upper GI endoscopy (diagnostic): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $472.65 Cigna — Commercial: $1,731.07 McLaren Health Plan — Managed Medicaid: $472.65 Medicare Plus Blue — Medicare Advantage: $903.72 Meridian — Managed Medicaid: $472.65 Molina — Managed Medicaid: $472.65 Priority Health — Commercial: $1,731.07 Priority Health — Managed Medicaid: $472.65 United Healthcare — Managed Medicaid: $472.65
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee · modifier 82 In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$41.80
Upper GI endoscopy (diagnostic): rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $41.80
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$87.33 – $248.77
Upper GI endoscopy with biopsy: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $122.77 ASR Physicians Care Network — Commercial: $182.33 Blue Care Network — Medicare Advantage: $121.55 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $218.37 Blue Cross Complete — Managed Medicaid: $89.08 Cigna — Commercial: $248.77 Employee Benefit Logistics — Commercial: $206.64 HAP (Health Alliance Plan) — Commercial: $182.33 HAP (Health Alliance Plan) — Medicare Advantage: $121.55 Humana — Medicare Advantage: $121.55
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$472.65 – $1,731.07
Upper GI endoscopy with biopsy: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $472.65 Cigna — Commercial: $1,731.07 McLaren Health Plan — Managed Medicaid: $472.65 Medicare Plus Blue — Medicare Advantage: $903.72 Meridian — Managed Medicaid: $472.65 Molina — Managed Medicaid: $472.65 Priority Health — Commercial: $1,731.07 Priority Health — Managed Medicaid: $472.65 United Healthcare — Managed Medicaid: $472.65
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$146.75
Upper GI endoscopy with biopsy: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $146.75
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$116.72 – $332.51
Colonoscopy (diagnostic): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $164.17 ASR Physicians Care Network — Commercial: $243.81 Blue Care Network — Medicare Advantage: $162.54 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $291.86 Blue Cross Complete — Managed Medicaid: $119.05 Cigna — Commercial: $332.51 Employee Benefit Logistics — Commercial: $276.32 HAP (Health Alliance Plan) — Commercial: $243.81 HAP (Health Alliance Plan) — Medicare Advantage: $162.54 Humana — Medicare Advantage: $162.54
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$484.62 – $1,019.04
Colonoscopy (diagnostic): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $484.62 Cigna — Commercial: $1,019.04 McLaren Health Plan — Managed Medicaid: $484.62 Medicare Plus Blue — Medicare Advantage: $926.61 Meridian — Managed Medicaid: $484.62 Molina — Managed Medicaid: $484.62 Priority Health — Commercial: $1,019.04 Priority Health — Managed Medicaid: $484.62 United Healthcare — Managed Medicaid: $484.62
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee · modifier 53 In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$58.58 – $138.48
Colonoscopy (diagnostic): 10 of 20 insurance plan rates Aetna — Medicare Advantage: $82.27 ASR Physicians Care Network — Commercial: $122.19 Blue Care Network — Medicare Advantage: $81.46 Blue Cross Complete — Managed Medicaid: $59.75 Employee Benefit Logistics — Commercial: $138.48 HAP (Health Alliance Plan) — Commercial: $122.19 HAP (Health Alliance Plan) — Medicare Advantage: $81.46 Humana — Medicare Advantage: $81.46 McLaren Health Plan — Managed Medicaid: $58.58 McLaren Health Plan — Medicare Advantage: $81.46
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$126.95 – $361.64
Colonoscopy with biopsy: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $177.10 ASR Physicians Care Network — Commercial: $263.03 Blue Care Network — Medicare Advantage: $175.35 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $317.43 Blue Cross Complete — Managed Medicaid: $129.49 Cigna — Commercial: $361.64 Employee Benefit Logistics — Commercial: $298.10 HAP (Health Alliance Plan) — Commercial: $263.03 HAP (Health Alliance Plan) — Medicare Advantage: $175.35 Humana — Medicare Advantage: $175.35
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$623.59 – $1,192.34
Colonoscopy with biopsy: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $623.59 Cigna — Commercial: $1,128.85 McLaren Health Plan — Managed Medicaid: $623.59 Medicare Plus Blue — Medicare Advantage: $1,192.34 Meridian — Managed Medicaid: $623.59 Molina — Managed Medicaid: $623.59 Priority Health — Commercial: $1,128.85 Priority Health — Managed Medicaid: $623.59 United Healthcare — Managed Medicaid: $623.59
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$213.31
Colonoscopy with biopsy: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $213.31
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$159.96 – $455.67
Colonoscopy with removal of polyps (snare): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $222.86 ASR Physicians Care Network — Commercial: $330.98 Blue Care Network — Medicare Advantage: $220.65 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $399.98 Blue Cross Complete — Managed Medicaid: $163.16 Cigna — Commercial: $455.67 Employee Benefit Logistics — Commercial: $375.11 HAP (Health Alliance Plan) — Commercial: $330.98 HAP (Health Alliance Plan) — Medicare Advantage: $220.65 Humana — Medicare Advantage: $220.65
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$623.59 – $1,192.34
Colonoscopy with removal of polyps (snare): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $623.59 Cigna — Commercial: $1,128.85 McLaren Health Plan — Managed Medicaid: $623.59 Medicare Plus Blue — Medicare Advantage: $1,192.34 Meridian — Managed Medicaid: $623.59 Molina — Managed Medicaid: $623.59 Priority Health — Commercial: $1,128.85 Priority Health — Managed Medicaid: $623.59 United Healthcare — Managed Medicaid: $623.59
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$268.80
Colonoscopy with removal of polyps (snare): rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $268.80
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$162.09 – $461.75
Ultrasound of the lower bowel by endoscope: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $225.05 ASR Physicians Care Network — Commercial: $334.23 Blue Care Network — Medicare Advantage: $222.82 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $405.31 Blue Cross Complete — Managed Medicaid: $165.33 Cigna — Commercial: $461.75 Employee Benefit Logistics — Commercial: $378.79 HAP (Health Alliance Plan) — Commercial: $334.23 HAP (Health Alliance Plan) — Medicare Advantage: $222.82 Humana — Medicare Advantage: $222.82
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$623.59 – $1,192.34
Ultrasound of the lower bowel by endoscope: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $623.59 Cigna — Commercial: $1,019.04 McLaren Health Plan — Managed Medicaid: $623.59 Medicare Plus Blue — Medicare Advantage: $1,192.34 Meridian — Managed Medicaid: $623.59 Molina — Managed Medicaid: $623.59 Priority Health — Commercial: $1,019.04 Priority Health — Managed Medicaid: $623.59 United Healthcare — Managed Medicaid: $623.59
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Doctor (professional) fee · modifier AS In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$74.08
Ultrasound of the lower bowel by endoscope: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $74.08
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$116.94 – $333.11
Screening colonoscopy (not high risk): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $164.55 ASR Physicians Care Network — Commercial: $244.38 Blue Care Network — Medicare Advantage: $162.92 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $292.40 Blue Cross Complete — Managed Medicaid: $119.28 Cigna — Commercial: $333.11 Employee Benefit Logistics — Commercial: $276.96 HAP (Health Alliance Plan) — Commercial: $244.38 HAP (Health Alliance Plan) — Medicare Advantage: $162.92 Humana — Medicare Advantage: $162.92
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$484.62 – $1,019.04
Screening colonoscopy (not high risk): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $484.62 Cigna — Commercial: $1,019.04 McLaren Health Plan — Managed Medicaid: $484.62 Medicare Plus Blue — Medicare Advantage: $926.61 Meridian — Managed Medicaid: $484.62 Molina — Managed Medicaid: $484.62 Priority Health — Commercial: $1,019.04 Priority Health — Managed Medicaid: $484.62 United Healthcare — Managed Medicaid: $484.62
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	Not listed in the file	Not listed in the file	$58.58 – $138.48
Screening colonoscopy (not high risk): 10 of 22 insurance plan rates Aetna — Medicare Advantage: $82.27 ASR Physicians Care Network — Commercial: $122.19 Blue Care Network — Medicare Advantage: $81.46 Blue Cross Complete — Managed Medicaid: $59.75 Cigna — Commercial: $67.07 Employee Benefit Logistics — Commercial: $138.48 HAP (Health Alliance Plan) — Commercial: $122.19 HAP (Health Alliance Plan) — Medicare Advantage: $81.46 Humana — Medicare Advantage: $81.46 McLaren Health Plan — Managed Medicaid: $58.58
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$427.28 – $1,217.15
Gallbladder removal by laparoscope: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $631.78 ASR Physicians Care Network — Commercial: $938.28 Blue Care Network — Medicare Advantage: $625.52 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,068.40 Blue Cross Complete — Managed Medicaid: $435.83 Cigna — Commercial: $1,217.15 Employee Benefit Logistics — Commercial: $1,063.38 HAP (Health Alliance Plan) — Commercial: $938.28 HAP (Health Alliance Plan) — Medicare Advantage: $625.52 Humana — Medicare Advantage: $625.52
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$3,150.44 – $6,023.79
Gallbladder removal by laparoscope: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $3,150.44 Cigna — Commercial: $5,396.32 McLaren Health Plan — Managed Medicaid: $3,150.44 Medicare Plus Blue — Medicare Advantage: $6,023.79 Meridian — Managed Medicaid: $3,150.44 Molina — Managed Medicaid: $3,150.44 Priority Health — Commercial: $5,396.32 Priority Health — Managed Medicaid: $3,150.44 United Healthcare — Managed Medicaid: $3,150.44
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee · modifier 62 In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$718
Gallbladder removal by laparoscope: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $718
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$339.52 – $967.17
Groin (inguinal) hernia repair, age 5 or older: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $505.80 ASR Physicians Care Network — Commercial: $751.19 Blue Care Network — Medicare Advantage: $500.79 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $912.85 Blue Cross Complete — Managed Medicaid: $346.31 Cigna — Commercial: $967.17 Employee Benefit Logistics — Commercial: $851.34 HAP (Health Alliance Plan) — Commercial: $751.19 HAP (Health Alliance Plan) — Medicare Advantage: $500.79 Humana — Medicare Advantage: $500.79
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$1,865.82 – $4,081.12
Groin (inguinal) hernia repair, age 5 or older: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $1,865.82 Cigna — Commercial: $4,081.12 McLaren Health Plan — Managed Medicaid: $1,865.82 Medicare Plus Blue — Medicare Advantage: $3,567.53 Meridian — Managed Medicaid: $1,865.82 Molina — Managed Medicaid: $1,865.82 Priority Health — Commercial: $4,081.12 Priority Health — Managed Medicaid: $1,865.82 United Healthcare — Managed Medicaid: $1,865.82
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$848.96
Groin (inguinal) hernia repair, age 5 or older: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $848.96
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prostate Biopsy Needle/Punch-1 or more 55700	$4,373	$3,717.05	$2,313.36 – $3,717.05
Prostate biopsy: 10 of 15 insurance plan rates Aetna — Commercial: $3,542.13 ASR Physicians Care Network — Commercial: $3,498.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,730.94 Cigna — Commercial: $2,313.36 Cofinity — Commercial: $3,717.05 Enterprise Group Planning/Employee Benefit Plan — Commercial: $3,498.40 HAP (Health Alliance Plan) — Commercial: $3,498.40 Hospice of Michigan — Commercial: $2,623.80 McLaren Health Plan — Commercial: $3,666.76 Munson Hospice — Commercial: $3,061.10
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Prostate Biopsy Needle/Punch-1 or more 55700	$4,373	$3,717.05	$852.12 – $3,717.05
Prostate biopsy: 10 of 12 insurance plan rates Aetna — Commercial: $3,542.13 ASR Physicians Care Network — Commercial: $3,498.40 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $2,730.94 Cofinity — Commercial: $3,717.05 Enterprise Group Planning/Employee Benefit Plan — Commercial: $3,498.40 HAP (Health Alliance Plan) — Commercial: $3,498.40 McLaren Health Plan — Commercial: $3,666.76 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $3,498.40 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $3,717.05
Prostate biopsy CPT 55700 · Inpatient or outpatient · Doctor (professional) fee In the file: Professional Services	Not listed in the file	Not listed in the file	$82.22 – $205.58
Prostate biopsy: rates for 7 insurance plans Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $205.58 Blue Cross Complete — Managed Medicaid: $83.86 McLaren Health Plan — Managed Medicaid: $82.22 Meridian — Managed Medicaid: $82.22 Molina — Managed Medicaid: $82.22 Priority Health — Managed Medicaid: $82.22 United Healthcare — Commercial: $167.08
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$761.69 – $2,110.05
Prostate removal by laparoscope (radical prostatectomy): 10 of 25 insurance plan rates Aetna — Medicare Advantage: $1,082.12 ASR Physicians Care Network — Commercial: $1,607.12 Blue Care Network — Medicare Advantage: $1,071.41 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,904.58 Blue Cross Complete — Managed Medicaid: $776.92 Cigna — Commercial: $1,939.85 Employee Benefit Logistics — Commercial: $1,821.40 HAP (Health Alliance Plan) — Commercial: $1,607.12 HAP (Health Alliance Plan) — Medicare Advantage: $1,071.41 Humana — Medicare Advantage: $1,071.41
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$5,539.41 – $11,012.74
Prostate removal by laparoscope (radical prostatectomy): rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $5,539.41 Cigna — Commercial: $11,012.74 McLaren Health Plan — Managed Medicaid: $5,539.41 Medicare Plus Blue — Medicare Advantage: $10,591.61 Meridian — Managed Medicaid: $5,539.41 Molina — Managed Medicaid: $5,539.41 Priority Health — Commercial: $11,012.74 Priority Health — Managed Medicaid: $5,539.41 United Healthcare — Managed Medicaid: $5,539.41
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee · modifier 80 In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$409.58
Prostate removal by laparoscope (radical prostatectomy): rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $409.58
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$147.82 – $369.62
Hysteroscopy with biopsy of the uterus lining: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $205.69 ASR Physicians Care Network — Commercial: $305.48 Blue Care Network — Medicare Advantage: $203.65 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $369.62 Blue Cross Complete — Managed Medicaid: $150.78 Cigna — Commercial: $350.01 Employee Benefit Logistics — Commercial: $346.21 HAP (Health Alliance Plan) — Commercial: $305.48 HAP (Health Alliance Plan) — Medicare Advantage: $203.65 Humana — Medicare Advantage: $203.65
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$1,686.93 – $3,225.49
Hysteroscopy with biopsy of the uterus lining: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $1,686.93 Cigna — Commercial: $2,679.27 McLaren Health Plan — Managed Medicaid: $1,686.93 Medicare Plus Blue — Medicare Advantage: $3,225.49 Meridian — Managed Medicaid: $1,686.93 Molina — Managed Medicaid: $1,686.93 Priority Health — Commercial: $2,679.27 Priority Health — Managed Medicaid: $1,686.93 United Healthcare — Managed Medicaid: $1,686.93
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee · modifier 80 In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$79.49
Hysteroscopy with biopsy of the uterus lining: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $79.49
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Injection with imaging guidance 62323	$2,150	$1,827.50	$367.85 – $1,827.50
Spinal injection, lower back (epidural), with imaging guidance: 10 of 33 insurance plan rates Aetna — Commercial: $1,741.50 Aetna — Medicare Advantage: $710.38 ASR Physicians Care Network — Commercial: $1,720 Blue Care Network — Medicare Advantage: $703.34 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,342.68 Blue Cross Complete — Managed Medicaid: $367.85 Cigna — Commercial: $930.84 Cofinity — Commercial: $1,827.50 Employee Benefit Logistics — Commercial: $1,195.68 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,720
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX Interlaminar LMBR/SAC 62323	$2,150	$1,827.50	$367.85 – $1,827.50
Spinal injection, lower back (epidural), with imaging guidance: 10 of 33 insurance plan rates Aetna — Commercial: $1,741.50 Aetna — Medicare Advantage: $710.38 ASR Physicians Care Network — Commercial: $1,720 Blue Care Network — Medicare Advantage: $703.34 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,342.68 Blue Cross Complete — Managed Medicaid: $367.85 Cigna — Commercial: $930.84 Cofinity — Commercial: $1,827.50 Employee Benefit Logistics — Commercial: $1,195.68 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,720
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CISTERNOGRAM INJECTION (NM)	$2,150	$1,827.50	$367.85 – $1,827.50
Spinal injection, lower back (epidural), with imaging guidance: 10 of 33 insurance plan rates Aetna — Commercial: $1,741.50 Aetna — Medicare Advantage: $710.38 ASR Physicians Care Network — Commercial: $1,720 Blue Care Network — Medicare Advantage: $703.34 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,342.68 Blue Cross Complete — Managed Medicaid: $367.85 Cigna — Commercial: $930.84 Cofinity — Commercial: $1,827.50 Employee Benefit Logistics — Commercial: $1,195.68 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,720
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Inj Foramen Epidural L/S 64483	$1,771	$1,505.35	$460.92 – $1,579.93
Nerve root injection, lower back, with imaging guidance: 10 of 33 insurance plan rates Aetna — Commercial: $1,434.51 Aetna — Medicare Advantage: $890.11 ASR Physicians Care Network — Commercial: $1,416.80 Blue Care Network — Medicare Advantage: $881.29 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,105.99 Blue Cross Complete — Managed Medicaid: $460.92 Cigna — Commercial: $1,579.93 Cofinity — Commercial: $1,505.35 Employee Benefit Logistics — Commercial: $1,498.20 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,416.80
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Epidural Transforaminal Lumbar/Sacral 1st Level	$1,771	$1,505.35	$460.92 – $1,579.93
Nerve root injection, lower back, with imaging guidance: 10 of 33 insurance plan rates Aetna — Commercial: $1,434.51 Aetna — Medicare Advantage: $890.11 ASR Physicians Care Network — Commercial: $1,416.80 Blue Care Network — Medicare Advantage: $881.29 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,105.99 Blue Cross Complete — Managed Medicaid: $460.92 Cigna — Commercial: $1,579.93 Cofinity — Commercial: $1,505.35 Employee Benefit Logistics — Commercial: $1,498.20 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,416.80
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Inj Foramen Epidural L/S 64483	$1,771	$1,505.35	$852.12 – $1,505.35
Nerve root injection, lower back, with imaging guidance: 10 of 12 insurance plan rates Aetna — Commercial: $1,434.51 ASR Physicians Care Network — Commercial: $1,416.80 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,105.99 Cofinity — Commercial: $1,505.35 Enterprise Group Planning/Employee Benefit Plan — Commercial: $1,416.80 HAP (Health Alliance Plan) — Commercial: $1,416.80 McLaren Health Plan — Commercial: $1,484.98 Munson Hospice — Commercial: $852.12 Nomi Health — Commercial: $1,416.80 Provider Network of America/Hawaii Mainland Administrative G — Commercial: $1,505.35
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$287.34 – $780.25
Carpal tunnel release: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $411.69 ASR Physicians Care Network — Commercial: $611.42 Blue Care Network — Medicare Advantage: $407.61 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $772.55 Blue Cross Complete — Managed Medicaid: $293.09 Cigna — Commercial: $780.25 Employee Benefit Logistics — Commercial: $692.94 HAP (Health Alliance Plan) — Commercial: $611.42 HAP (Health Alliance Plan) — Medicare Advantage: $407.61 Humana — Medicare Advantage: $407.61
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$1,017.60 – $2,335.92
Carpal tunnel release: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $1,017.60 Cigna — Commercial: $2,335.92 McLaren Health Plan — Managed Medicaid: $1,017.60 Medicare Plus Blue — Medicare Advantage: $1,945.70 Meridian — Managed Medicaid: $1,017.60 Molina — Managed Medicaid: $1,017.60 Priority Health — Commercial: $2,335.92 Priority Health — Managed Medicaid: $1,017.60 United Healthcare — Managed Medicaid: $1,017.60
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$1,158.82
Carpal tunnel release: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $1,158.82
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient · Doctor (professional) fee In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$196.81 – $538.97
Laser treatment of clouding after cataract surgery: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $265.39 ASR Physicians Care Network — Commercial: $394.14 Blue Care Network — Medicare Advantage: $262.76 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $529.15 Blue Cross Complete — Managed Medicaid: $200.75 Cigna — Commercial: $538.97 Employee Benefit Logistics — Commercial: $446.69 HAP (Health Alliance Plan) — Commercial: $394.14 HAP (Health Alliance Plan) — Medicare Advantage: $262.76 Humana — Medicare Advantage: $262.76
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$286.61 – $739.07
Laser treatment of clouding after cataract surgery: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $286.61 Cigna — Commercial: $739.07 McLaren Health Plan — Managed Medicaid: $286.61 Medicare Plus Blue — Medicare Advantage: $548.02 Meridian — Managed Medicaid: $286.61 Molina — Managed Medicaid: $286.61 Priority Health — Commercial: $739.07 Priority Health — Managed Medicaid: $286.61 United Healthcare — Managed Medicaid: $286.61
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$492.12
Laser treatment of clouding after cataract surgery: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $492.12
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Doctor (professional) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$343.57 – $940.87
Cataract removal with lens implant: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $451.86 ASR Physicians Care Network — Commercial: $671.09 Blue Care Network — Medicare Advantage: $447.39 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $923.73 Blue Cross Complete — Managed Medicaid: $350.44 Cigna — Commercial: $940.87 Employee Benefit Logistics — Commercial: $760.56 HAP (Health Alliance Plan) — Commercial: $671.09 HAP (Health Alliance Plan) — Medicare Advantage: $447.39 Humana — Medicare Advantage: $447.39
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$1,202.65 – $2,299.52
Cataract removal with lens implant: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $1,202.65 Cigna — Commercial: $2,258.90 McLaren Health Plan — Managed Medicaid: $1,202.65 Medicare Plus Blue — Medicare Advantage: $2,299.52 Meridian — Managed Medicaid: $1,202.65 Molina — Managed Medicaid: $1,202.65 Priority Health — Commercial: $2,258.90 Priority Health — Managed Medicaid: $1,202.65 United Healthcare — Managed Medicaid: $1,202.65
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Doctor (professional) fee · modifier X In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$859.08
Cataract removal with lens implant: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $859.08

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: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$2,140.75 – $3,748.50
Vaginal delivery, with care before and after: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $2,227.05 ASR Physicians Care Network — Commercial: $3,307.50 Blue Care Network — Medicare Advantage: $2,205 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,504.67 Blue Cross Complete — Managed Medicaid: $2,265.14 Cigna — Commercial: $3,423.23 Employee Benefit Logistics — Commercial: $3,748.50 HAP (Health Alliance Plan) — Commercial: $3,307.50 HAP (Health Alliance Plan) — Medicare Advantage: $2,205 Humana — Medicare Advantage: $2,205
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$1,153.41 – $2,471.41
Vaginal delivery, with care before and after: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $1,153.41 Cigna — Commercial: $2,471.41 McLaren Health Plan — Managed Medicaid: $1,153.41 Medicare Plus Blue — Medicare Advantage: $2,205.38 Meridian — Managed Medicaid: $1,153.41 Molina — Managed Medicaid: $1,153.41 Priority Health — Commercial: $2,471.41 Priority Health — Managed Medicaid: $1,153.41 United Healthcare — Managed Medicaid: $1,153.41
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient · Doctor (professional) fee · modifier 80 In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$736.41
Vaginal delivery, with care before and after: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $736.41
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$2,426.95 – $4,201.62
Cesarean delivery (C-section), with care before and after: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $2,496.26 ASR Physicians Care Network — Commercial: $3,707.31 Blue Care Network — Medicare Advantage: $2,471.54 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,504.67 Blue Cross Complete — Managed Medicaid: $2,525.28 Cigna — Commercial: $3,802.61 Employee Benefit Logistics — Commercial: $4,201.62 HAP (Health Alliance Plan) — Commercial: $3,707.31 HAP (Health Alliance Plan) — Medicare Advantage: $2,471.54 Humana — Medicare Advantage: $2,471.54
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$1,292.45 – $2,642.57
Cesarean delivery (C-section), with care before and after: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $1,292.45 Cigna — Commercial: $2,642.57 McLaren Health Plan — Managed Medicaid: $1,292.45 Medicare Plus Blue — Medicare Advantage: $2,471.23 Meridian — Managed Medicaid: $1,292.45 Molina — Managed Medicaid: $1,292.45 Priority Health — Commercial: $2,642.57 Priority Health — Managed Medicaid: $1,292.45 United Healthcare — Managed Medicaid: $1,292.45
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee · modifier 80 In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$736.41
Cesarean delivery (C-section), with care before and after: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $736.41
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient · Doctor (professional) fee In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$2,257.16 – $3,961.31
Vaginal delivery after a previous C-section, with care before and after: 10 of 25 insurance plan rates Aetna — Medicare Advantage: $2,353.48 ASR Physicians Care Network — Commercial: $3,495.27 Blue Care Network — Medicare Advantage: $2,330.18 Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $3,679.92 Blue Cross Complete — Managed Medicaid: $2,382.51 Cigna — Commercial: $3,585.89 Employee Benefit Logistics — Commercial: $3,961.31 HAP (Health Alliance Plan) — Commercial: $3,495.27 HAP (Health Alliance Plan) — Medicare Advantage: $2,330.18 Humana — Medicare Advantage: $2,330.18
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$1,218.68 – $2,484.58
Vaginal delivery after a previous C-section, with care before and after: rates for 9 insurance plans Blue Cross Complete — Managed Medicaid: $1,218.68 Cigna — Commercial: $2,484.58 McLaren Health Plan — Managed Medicaid: $1,218.68 Medicare Plus Blue — Medicare Advantage: $2,330.18 Meridian — Managed Medicaid: $1,218.68 Molina — Managed Medicaid: $1,218.68 Priority Health — Commercial: $2,484.58 Priority Health — Managed Medicaid: $1,218.68 United Healthcare — Managed Medicaid: $1,218.68
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient · Doctor (professional) fee · modifier 80 In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$773.24
Vaginal delivery after a previous C-section, with care before and after: rates for 1 insurance plan Blue Cross — PPO/Traditional/HMO/Blue Care Network Commercial: $773.24

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	Not listed in the file	Not listed in the file	$90,891.73 – $154,515.94
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 14 insurance plan rates Aetna — Medicare Advantage: $91,800.65 Blue Care Network — Medicare Advantage: $90,891.73 Cigna — Commercial: $118,050.81 Employee Benefit Logistics — Commercial: $154,515.94 HAP (Health Alliance Plan) — Medicare Advantage: $90,891.73 Humana — Medicare Advantage: $90,891.73 McLaren Health Plan — Medicare Advantage: $90,891.73 Medicare Plus Blue — Medicare Advantage: $90,891.73 Michigan Amish Medical Board — Commercial: $90,891.73 Molina — Medicare Advantage: $98,163.07
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$17,921.37 – $30,466.33
Hip or knee replacement (major joint of the leg), without major complications: 10 of 14 insurance plan rates Aetna — Medicare Advantage: $18,100.58 Blue Care Network — Medicare Advantage: $17,921.37 Cigna — Commercial: $21,557.54 Employee Benefit Logistics — Commercial: $30,466.33 HAP (Health Alliance Plan) — Medicare Advantage: $17,921.37 Humana — Medicare Advantage: $17,921.37 McLaren Health Plan — Medicare Advantage: $17,921.37 Medicare Plus Blue — Medicare Advantage: $17,921.37 Michigan Amish Medical Board — Commercial: $17,921.37 Molina — Medicare Advantage: $19,355.08
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$22,682.06 – $38,559.50
Neck (cervical) spinal fusion, without complications: 10 of 14 insurance plan rates Aetna — Medicare Advantage: $22,908.88 Blue Care Network — Medicare Advantage: $22,682.06 Cigna — Commercial: $29,459.61 Employee Benefit Logistics — Commercial: $38,559.50 HAP (Health Alliance Plan) — Medicare Advantage: $22,682.06 Humana — Medicare Advantage: $22,682.06 McLaren Health Plan — Medicare Advantage: $22,682.06 Medicare Plus Blue — Medicare Advantage: $22,682.06 Michigan Amish Medical Board — Commercial: $22,682.06 Molina — Medicare Advantage: $24,496.62
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$11,527.32 – $19,596.44
Uterus and ovary surgery (not for cancer), without complications: 10 of 14 insurance plan rates Aetna — Medicare Advantage: $11,642.59 Blue Care Network — Medicare Advantage: $11,527.32 Cigna — Commercial: $14,971.75 Employee Benefit Logistics — Commercial: $19,596.44 HAP (Health Alliance Plan) — Medicare Advantage: $11,527.32 Humana — Medicare Advantage: $11,527.32 McLaren Health Plan — Medicare Advantage: $11,527.32 Medicare Plus Blue — Medicare Advantage: $11,527.32 Michigan Amish Medical Board — Commercial: $11,527.32 Molina — Medicare Advantage: $12,449.51

Source: Munson Healthcare Otsego Memorial Hospital’s standard charges file (sthpiprd.blob.core.windows.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 17, 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	825 N Center Ave, Gaylord, MI 49735
County	Otsego County
State	Michigan
Phone	(989) 731‑2100
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	230133
Name in Medicare records	MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Profile level	Medicare data + hospital website
Name on the hospital’s website	Otsego Memorial Hospital
Official website	munsonhealthcare.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 Geocoder — map position used for distances

From the hospital’s website

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

Otsego Memorial Hospital | Gaylord, Michigan — munsonhealthcare.org
About Us | Otsego Memorial Hospital | Munson Healthcare | Gaylord, Michigan — munsonhealthcare.org
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