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Children's Hospital

Nationwide Children's Hospital Toledo, LLC

Toledo, Ohio · Lucas County

Summary

Nationwide Children's Hospital Toledo, LLC is a children's hospital in Toledo, Ohio. Medicare data does not list emergency services. Its official website lists 94 services, specialties and programs. Medicare lists 1 affiliated clinicians. Source: CMS Hospital General Information, data updated 2026-07-22.

What is a children's hospital?

A hospital that treats babies, children and teenagers, with doctors and equipment made for young patients. More about hospital types

Call(419) 251‑3232 Directions Website Medicare profile
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Profile from official sources

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

In a medical emergency, call 911.

At a glance

Not listedEmergency services
Not ratedNot rated by CMSMedicare rating
1Doctors and clinicians
94Services listed

Quick answers

Does Nationwide Children's Hospital Toledo, LLC have an emergency room?
Medicare (CMS) data does not list emergency services at Nationwide Children's Hospital Toledo, LLC. The closest hospitals that do: Mercy St Vincent Medical Center (0.0 mi), ProMedica Toledo Hospital (2.7 mi) and Northwest Ohio Psychiatric Hospital (4.3 mi). In a medical emergency, call 911.
Where is Nationwide Children's Hospital Toledo, LLC?
2213 Cherry Street, Toledo, OH 43608, in Lucas County, Ohio.
What is the phone number of Nationwide Children's Hospital Toledo, LLC?
(419) 251-3232, as listed by Medicare (CMS).
What is the Medicare star rating of Nationwide Children's Hospital Toledo, LLC?
CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas[8][9][17][19]

Conditions treated[10][11][12][13][14][15][16][17][19]

Treatments[10][13][16][17][18][19]

Procedures[14]

  • Advanced laparoscopic minimally invasive surgery
  • Image guided surgical techniques
  • 3D surgical planning
  • Prenatal consultation and diagnosis
  • Cryoablation for pain management

Programs and centers[6][7][8][12][17]

  • Pediatric inpatient and intensive care
  • Neonatal intensive care
  • Autism Center
  • Child maltreatment center
  • Developmental and behavioral pediatrics clinic

Visiting and practical information

Patient portalMyChart

Recognition[7][9]

  • Level III neonatal intensive care unit designation (Ohio Department of Health)

Doctors and clinicians (1)

1 doctors and other clinicians list Nationwide Children's Hospital Toledo, LLC 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 (1)

Nearest emergency rooms

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

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

All nursing homes in the state →

Hospice providers

All hospice providers in the state →

Home health agencies

All home health agencies in the state →

Dialysis facilities

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

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

Clinics and urgent care

Pharmacies

Assisted living nearby

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

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 Nationwide Children's Hospital Toledo, LLC 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.

Not reported to Medicare

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 surgeryNot reported to Medicare
Surgical site infections after abdominal hysterectomyNot reported to Medicare
MRSA bloodstream infectionsNot reported to Medicare
Clostridioides difficile (C. diff) intestinal infectionsNot reported to Medicare

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026.

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 patientsNot reported to Medicare
Deaths within 30 days: heart failure patientsNot reported to Medicare
Deaths within 30 days: pneumonia patientsNot reported to Medicare
Deaths within 30 days: COPD patientsNot reported to Medicare
Deaths within 30 days: stroke patientsNot reported to Medicare
Deaths within 30 days: coronary bypass surgery (CABG)Not reported to Medicare
Serious complications (patient safety indicator PSI-90)Not reported to Medicare
Complications after hip or knee replacementNot reported to Medicare

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026.

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 attackNot reported to Medicare
Readmitted within 30 days: heart failureNot reported to Medicare
Readmitted within 30 days: pneumoniaNot reported to Medicare
Readmitted within 30 days: COPDNot reported to Medicare
Readmitted within 30 days: coronary bypass surgeryNot reported to Medicare
Readmitted within 30 days: hip or knee replacementNot reported to Medicare

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026.

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.

Average (median) time patients spent in the emergency room before leaving (OP-18b)Not reported to Medicare
Patients who left the emergency room before being seen (OP-22)Not reported to Medicare
Sepsis patients who got all the recommended early care (SEP-1)Not reported to Medicare

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026.

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 ToledoBest hospitals in Toledo

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 Nationwide Children's Hospital Toledo, LLC 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

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NEW PT E/M LEVEL 3 $299 $179.40 $74.75 – $230.23
New patient office visit (about 30–44 minutes): 10 of 22 insurance plan rates
  • Aetna — All Products: $115.12
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $143.52
  • Anthem — Blue Preferred: $143.52
  • Anthem — Blue Traditional: $152.49
  • Anthem — Enhanced Choice / Pathway: $125.58
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Cigna — All Products: $214.09
  • First Health — All Products: $230.23
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES $279 $167.40 $43.49 – $150.54
New patient office visit (about 30–44 minutes): 10 of 17 insurance plan rates
  • Aetna — All Products: $149.83
  • Amerihealth — Managed Medicaid - Non-Cap: $44.33
  • Anthem — All Products: $106.25
  • Anthem — Managed Medicaid: $73.94
  • BCHP — Managed Medicaid - Non-Cap: $44.33
  • Caresource — Just4Me/Marketplace: $70.42
  • Caresource — Managed Medicaid - Non-Cap: $43.49
  • Cigna — All Products: $150.54
  • Front Path Health Coalition — All Products: $129.37
  • McClaren Health Plan — All Products: $91.54
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NEW PT E/M LEVEL 3 $299 $179.40 $74.75 – $230.23
New patient office visit (about 30–44 minutes): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $134.55
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NEW PT E/M LEVEL 4 $344 $206.40 $86 – $264.88
New patient office visit (about 45–59 minutes): 10 of 22 insurance plan rates
  • Aetna — All Products: $132.44
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $165.12
  • Anthem — Blue Preferred: $165.12
  • Anthem — Blue Traditional: $175.44
  • Anthem — Enhanced Choice / Pathway: $144.48
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Cigna — All Products: $344
  • First Health — All Products: $264.88
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES $518 $310.80 $70.40 – $231.61
New patient office visit (about 45–59 minutes): 10 of 17 insurance plan rates
  • Aetna — All Products: $231.61
  • Amerihealth — Managed Medicaid - Non-Cap: $71.77
  • Anthem — All Products: $150.16
  • Anthem — Managed Medicaid: $120.80
  • BCHP — Managed Medicaid - Non-Cap: $71.77
  • Caresource — Just4Me/Marketplace: $115.05
  • Caresource — Managed Medicaid - Non-Cap: $70.40
  • Cigna — All Products: $226.43
  • Front Path Health Coalition — All Products: $195.78
  • McClaren Health Plan — All Products: $149.56
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NEW PT E/M LEVEL 4 $344 $206.40 $86 – $264.88
New patient office visit (about 45–59 minutes): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $154.80
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NEW PT E/M LEVEL 5 $394 $236.40 $98.50 – $303.38
New patient office visit (about 60–74 minutes): 10 of 22 insurance plan rates
  • Aetna — All Products: $151.69
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $189.12
  • Anthem — Blue Preferred: $189.12
  • Anthem — Blue Traditional: $200.94
  • Anthem — Enhanced Choice / Pathway: $165.48
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Cigna — All Products: $394
  • First Health — All Products: $303.38
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES $648 $388.80 $95.53 – $299.47
New patient office visit (about 60–74 minutes): 10 of 17 insurance plan rates
  • Aetna — All Products: $292.71
  • Amerihealth — Managed Medicaid - Non-Cap: $97.39
  • Anthem — All Products: $195.64
  • Anthem — Managed Medicaid: $165.57
  • BCHP — Managed Medicaid - Non-Cap: $97.39
  • Caresource — Just4Me/Marketplace: $157.69
  • Caresource — Managed Medicaid - Non-Cap: $95.53
  • Cigna — All Products: $299.47
  • Front Path Health Coalition — All Products: $261.65
  • McClaren Health Plan — All Products: $205
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NEW PT E/M LEVEL 5 $394 $236.40 $98.50 – $303.38
New patient office visit (about 60–74 minutes): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $177.30
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EST PT E/M LEVEL 3 $256 $153.60 $64 – $197.12
Established patient office visit (about 20–29 minutes): 10 of 22 insurance plan rates
  • Aetna — All Products: $98.56
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $122.88
  • Anthem — Blue Preferred: $122.88
  • Anthem — Blue Traditional: $130.56
  • Anthem — Enhanced Choice / Pathway: $107.52
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Cigna — All Products: $145.02
  • First Health — All Products: $197.12
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN $199 $119.40 $34.75 – $122.65
Established patient office visit (about 20–29 minutes): 10 of 17 insurance plan rates
  • Aetna — All Products: $99.46
  • Amerihealth — Managed Medicaid - Non-Cap: $35.43
  • Anthem — All Products: $65.16
  • Anthem — Managed Medicaid: $59.34
  • BCHP — Managed Medicaid - Non-Cap: $35.43
  • Caresource — Just4Me/Marketplace: $56.51
  • Caresource — Managed Medicaid - Non-Cap: $34.75
  • Cigna — All Products: $122.65
  • Front Path Health Coalition — All Products: $104.62
  • McClaren Health Plan — All Products: $73.47
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EST PT E/M LEVEL 3 $256 $153.60 $64 – $197.12
Established patient office visit (about 20–29 minutes): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $115.20
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EST PT E/M LEVEL 4 $295 $177 $73.75 – $227.15
Established patient office visit (about 30–39 minutes): 10 of 22 insurance plan rates
  • Aetna — All Products: $113.58
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $141.60
  • Anthem — Blue Preferred: $141.60
  • Anthem — Blue Traditional: $150.45
  • Anthem — Enhanced Choice / Pathway: $123.90
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Cigna — All Products: $222.92
  • First Health — All Products: $227.15
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN $305 $183 $50.97 – $173.03
Established patient office visit (about 30–39 minutes): 10 of 17 insurance plan rates
  • Aetna — All Products: $150.01
  • Amerihealth — Managed Medicaid - Non-Cap: $51.96
  • Anthem — All Products: $82.44
  • Anthem — Managed Medicaid: $87.33
  • BCHP — Managed Medicaid - Non-Cap: $51.96
  • Caresource — Just4Me/Marketplace: $83.18
  • Caresource — Managed Medicaid - Non-Cap: $50.97
  • Cigna — All Products: $173.03
  • Front Path Health Coalition — All Products: $149.31
  • McClaren Health Plan — All Products: $108.13
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EST PT E/M LEVEL 4 $295 $177 $73.75 – $227.15
Established patient office visit (about 30–39 minutes): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $132.75
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES $299 $179.40 $74.75 – $230.23
Office consultation with a specialist (moderate): 10 of 22 insurance plan rates
  • Aetna — All Products: $115.12
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $143.52
  • Anthem — Blue Preferred: $143.52
  • Anthem — Blue Traditional: $152.49
  • Anthem — Enhanced Choice / Pathway: $125.58
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Cigna — All Products: $274.40
  • First Health — All Products: $230.23
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES $551 $330.60 $49.19 – $203.72
Office consultation with a specialist (moderate): 10 of 12 insurance plan rates
  • Aetna — All Products: $203.72
  • Amerihealth — Managed Medicaid - Non-Cap: $50.15
  • Anthem — All Products: $101.67
  • BCHP — Managed Medicaid - Non-Cap: $50.15
  • Caresource — Managed Medicaid - Non-Cap: $49.19
  • Cigna — All Products: $151.57
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $68.76
  • OHC — All Products: $413.25
  • Ohio PPO Connect — All Products: $413.25
  • Tricare CHAMPUS — All Products: $99.99
Office consultation with a specialist (moderate) CPT 99243 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES $299 $179.40 $74.75 – $230.23
Office consultation with a specialist (moderate): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $134.55
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES $758 $454.80 $78.60 – $301.35
Office consultation with a specialist (moderate to high): 10 of 12 insurance plan rates
  • Aetna — All Products: $301.35
  • Amerihealth — Managed Medicaid - Non-Cap: $80.13
  • Anthem — All Products: $150.16
  • BCHP — Managed Medicaid - Non-Cap: $80.13
  • Caresource — Managed Medicaid - Non-Cap: $78.60
  • Cigna — All Products: $216.17
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $98.34
  • OHC — All Products: $568.50
  • Ohio PPO Connect — All Products: $568.50
  • Tricare CHAMPUS — All Products: $142.61
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 $77.70 – $78.45
Office consultation with a specialist (moderate to high): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Humana — Managed Medicaid: $78.45
  • Molina — Managed Medicaid - Non-Cap: $77.70
  • UHC — Managed Medicaid: $77.70
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 $441.73
Office consultation with a specialist (moderate to high): rates for 1 insurance plan
  • Cigna — All Products: $441.73
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PREV VISIT NEW AGE18-39 $182 $109.20 $45.50 – $140.14
Preventive checkup, new patient, age 18–39: 10 of 22 insurance plan rates
  • Aetna — All Products: $70.07
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $87.36
  • Anthem — Blue Preferred: $87.36
  • Anthem — Blue Traditional: $92.82
  • Anthem — Enhanced Choice / Pathway: $76.44
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Cigna — All Products: $182
  • First Health — All Products: $140.14
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS $316 $189.60 $50.44 – $174.19
Preventive checkup, new patient, age 18–39: 10 of 11 insurance plan rates
  • Amerihealth — Managed Medicaid - Non-Cap: $51.42
  • Anthem — All Products: $151.79
  • BCHP — Managed Medicaid - Non-Cap: $51.42
  • Caresource — Managed Medicaid - Non-Cap: $50.44
  • Cigna — All Products: $174.19
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $88.77
  • OHC — All Products: $237
  • Ohio PPO Connect — All Products: $237
  • Tricare CHAMPUS — All Products: $114.91
  • UHC — All Products: $126.40
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PREV VISIT NEW AGE18-39 $182 $109.20 $45.50 – $140.14
Preventive checkup, new patient, age 18–39: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $81.90
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PREV VISIT NEW AGE40-64 $182 $109.20 $45.50 – $140.14
Preventive checkup, new patient, age 40–64: 10 of 22 insurance plan rates
  • Aetna — All Products: $70.07
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $87.36
  • Anthem — Blue Preferred: $87.36
  • Anthem — Blue Traditional: $92.82
  • Anthem — Enhanced Choice / Pathway: $76.44
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Cigna — All Products: $182
  • First Health — All Products: $140.14
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PREV VISIT NEW AGE40-64 $182 $109.20 $45.50 – $140.14
Preventive checkup, new patient, age 40–64: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $81.90
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR EMERGENCY DEPARTMENT VISIT LOW MDM $260 $156 $46.29 – $102.41
Emergency room visit (moderate): 10 of 13 insurance plan rates
  • Aetna — All Products: $102.41
  • Anthem — All Products: $93.35
  • Anthem — Managed Medicaid: $72.15
  • Caresource — Just4Me/Marketplace: $68.71
  • Front Path Health Coalition — All Products: $79.02
  • McClaren Health Plan — All Products: $89.33
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $46.29
  • MMO — All Products: $260
  • OHC — All Products: $195
  • Ohio PPO Connect — All Products: $195
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LOW MDM Not listed in the file Not listed in the file $263.05 – $836.67
Emergency room visit (moderate): rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $292.83
  • Caresource — Medicare Advantage_DSNP: $278.89
  • Caresource — My Care Ohio: $278.89
  • Cigna — All Products: $186.05
  • Front Path Health Coalition — All Products: $836.67
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $287.26
  • Molina — Marketplace: $332.27
  • Molina — Medicare Advantage_DSNP: $278.89
  • Molina — My Care Ohio: $278.89
  • Tricare CHAMPUS — All Products: $263.05
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit low mdm Not listed in the file Not listed in the file $77.70 – $78.45
Emergency room visit (moderate): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Humana — Managed Medicaid: $78.45
  • Molina — Managed Medicaid - Non-Cap: $77.70
  • UHC — Managed Medicaid: $77.70
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR EMERGENCY DEPARTMENT VISIT MODERATE MDM $468 $280.80 $78.98 – $190.72
Emergency room visit (moderately high): 10 of 13 insurance plan rates
  • Aetna — All Products: $190.72
  • Anthem — All Products: $145.72
  • Anthem — Managed Medicaid: $122.88
  • Caresource — Just4Me/Marketplace: $117.03
  • Front Path Health Coalition — All Products: $134.58
  • McClaren Health Plan — All Products: $152.13
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $78.98
  • MMO — All Products: $468
  • OHC — All Products: $351
  • Ohio PPO Connect — All Products: $351
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT MOD MDM Not listed in the file Not listed in the file $404.53 – $1,278.90
Emergency room visit (moderately high): rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $447.62
  • Caresource — Medicare Advantage_DSNP: $426.30
  • Caresource — My Care Ohio: $426.30
  • Cigna — All Products: $342.11
  • Front Path Health Coalition — All Products: $1,278.90
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $439.09
  • Molina — Marketplace: $510.98
  • Molina — Medicare Advantage_DSNP: $426.30
  • Molina — My Care Ohio: $426.30
  • Tricare CHAMPUS — All Products: $404.53
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit mod mdm Not listed in the file Not listed in the file $77.70 – $78.45
Emergency room visit (moderately high): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Humana — Managed Medicaid: $78.45
  • Molina — Managed Medicaid - Non-Cap: $77.70
  • UHC — Managed Medicaid: $77.70
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR EMERGENCY DEPARTMENT VISIT HIGH MDM $685 $411 $114.53 – $284.30
Emergency room visit (high): 10 of 13 insurance plan rates
  • Aetna — All Products: $284.30
  • Anthem — All Products: $228.26
  • Anthem — Managed Medicaid: $178.07
  • Caresource — Just4Me/Marketplace: $169.59
  • Front Path Health Coalition — All Products: $195.02
  • McClaren Health Plan — All Products: $220.46
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $114.53
  • MMO — All Products: $685
  • OHC — All Products: $513.75
  • Ohio PPO Connect — All Products: $513.75
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT HI MDM Not listed in the file Not listed in the file $582.45 – $1,825.29
Emergency room visit (high): rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $638.85
  • Caresource — Medicare Advantage_DSNP: $608.43
  • Caresource — My Care Ohio: $608.43
  • Cigna — All Products: $497.30
  • Front Path Health Coalition — All Products: $1,825.29
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $626.68
  • Molina — Marketplace: $735.72
  • Molina — Medicare Advantage_DSNP: $608.43
  • Molina — My Care Ohio: $608.43
  • Tricare CHAMPUS — All Products: $582.45
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit hi mdm Not listed in the file Not listed in the file $77.70 – $78.45
Emergency room visit (high): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $78.45
  • Anthem — Managed Medicaid - Non-Cap: $78.45
  • BCHP — Managed Medicaid - Non-Cap: $78.45
  • Humana — Managed Medicaid: $78.45
  • Molina — Managed Medicaid - Non-Cap: $77.70
  • UHC — Managed Medicaid: $77.70

Lab tests

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL CALCIUM TOTAL $375 $225 $93.75 – $288.75
Basic metabolic panel (blood test): 10 of 28 insurance plan rates
  • Aetna — All Products: $144.38
  • Amerihealth — Managed Medicaid - Non-Cap: $22.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $180
  • Anthem — Blue Preferred: $180
  • Anthem — Blue Traditional: $191.25
  • Anthem — Enhanced Choice / Pathway: $157.50
  • Anthem — Managed Medicaid - Non-Cap: $22.45
  • BCHP — Managed Medicaid - Non-Cap: $22.45
  • Caresource — Just4Me/Marketplace: $8.88
  • Caresource — Medicare Advantage_DSNP: $8.46
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL CALCIUM TOTAL $375 $225 $93.75 – $288.75
Basic metabolic panel (blood test): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $168.75
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: BASIC METABOLIC PNL TOTAL CA Not listed in the file Not listed in the file $13.38
Basic metabolic panel (blood test): rates for 1 insurance plan
  • Cigna — All Products: $13.38
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL $448 $268.80 $112 – $344.96
Comprehensive metabolic panel (blood test): 10 of 28 insurance plan rates
  • Aetna — All Products: $172.48
  • Amerihealth — Managed Medicaid - Non-Cap: $22.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $215.04
  • Anthem — Blue Preferred: $215.04
  • Anthem — Blue Traditional: $228.48
  • Anthem — Enhanced Choice / Pathway: $188.16
  • Anthem — Managed Medicaid - Non-Cap: $22.45
  • BCHP — Managed Medicaid - Non-Cap: $22.45
  • Caresource — Just4Me/Marketplace: $11.09
  • Caresource — Medicare Advantage_DSNP: $10.56
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL $448 $268.80 $112 – $344.96
Comprehensive metabolic panel (blood test): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $201.60
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: COMPREHEN METABOLIC PANEL Not listed in the file Not listed in the file $17
Comprehensive metabolic panel (blood test): rates for 1 insurance plan
  • Cigna — All Products: $17
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL Not listed in the file Not listed in the file $47.81 – $143.43
Obstetric blood test panel: rates for 9 insurance plans
  • Caresource — Just4Me/Marketplace: $50.20
  • Caresource — Medicare Advantage_DSNP: $47.81
  • Caresource — My Care Ohio: $47.81
  • Cigna — All Products: $75.72
  • Front Path Health Coalition — All Products: $143.43
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $49.24
  • Molina — Marketplace: $57.37
  • Molina — Medicare Advantage_DSNP: $47.81
  • Molina — My Care Ohio: $47.81
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 $22.24 – $22.45
Obstetric blood test panel: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $22.45
  • Anthem — Managed Medicaid - Non-Cap: $22.45
  • BCHP — Managed Medicaid - Non-Cap: $22.45
  • Humana — Managed Medicaid: $22.45
  • Molina — Managed Medicaid - Non-Cap: $22.24
  • UHC — Managed Medicaid: $22.24
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: OBSTETRIC PANEL Not listed in the file Not listed in the file $75.72
Obstetric blood test panel: rates for 1 insurance plan
  • Cigna — All Products: $75.72
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL $285 $171 $71.25 – $219.45
Cholesterol panel (lipid panel): 10 of 28 insurance plan rates
  • Aetna — All Products: $109.73
  • Amerihealth — Managed Medicaid - Non-Cap: $22.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $136.80
  • Anthem — Blue Preferred: $136.80
  • Anthem — Blue Traditional: $145.35
  • Anthem — Enhanced Choice / Pathway: $119.70
  • Anthem — Managed Medicaid - Non-Cap: $22.45
  • BCHP — Managed Medicaid - Non-Cap: $22.45
  • Caresource — Just4Me/Marketplace: $14.06
  • Caresource — Medicare Advantage_DSNP: $13.39
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SO LIPID PANEL $262 $157.20 $65.50 – $201.74
Cholesterol panel (lipid panel): 10 of 28 insurance plan rates
  • Aetna — All Products: $100.87
  • Amerihealth — Managed Medicaid - Non-Cap: $22.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $125.76
  • Anthem — Blue Preferred: $125.76
  • Anthem — Blue Traditional: $133.62
  • Anthem — Enhanced Choice / Pathway: $110.04
  • Anthem — Managed Medicaid - Non-Cap: $22.45
  • BCHP — Managed Medicaid - Non-Cap: $22.45
  • Caresource — Just4Me/Marketplace: $14.06
  • Caresource — Medicare Advantage_DSNP: $13.39
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CHG LIPID PANEL $148 $88.80 $8.13 – $11.74
Cholesterol panel (lipid panel): rates for 6 insurance plans
  • Anthem — All Products: $8.13
  • MMO — All Products: $19.36
  • OHC — All Products: $111
  • Ohio PPO Connect — All Products: $111
  • Tricare CHAMPUS — All Products: $11.74
  • UHC — All Products: $59.20
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL $171 $102.60 $42.75 – $131.67
Kidney function panel: 10 of 28 insurance plan rates
  • Aetna — All Products: $65.84
  • Amerihealth — Managed Medicaid - Non-Cap: $22.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $82.08
  • Anthem — Blue Preferred: $82.08
  • Anthem — Blue Traditional: $87.21
  • Anthem — Enhanced Choice / Pathway: $71.82
  • Anthem — Managed Medicaid - Non-Cap: $22.45
  • BCHP — Managed Medicaid - Non-Cap: $22.45
  • Caresource — Just4Me/Marketplace: $9.11
  • Caresource — Medicare Advantage_DSNP: $8.68
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL $171 $102.60 $42.75 – $131.67
Kidney function panel: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $76.95
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: RENAL FUNCTION PANEL Not listed in the file Not listed in the file $13.92
Kidney function panel: rates for 1 insurance plan
  • Cigna — All Products: $13.92
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL $190 $114 $47.50 – $146.30
Liver function panel: 10 of 28 insurance plan rates
  • Aetna — All Products: $73.15
  • Amerihealth — Managed Medicaid - Non-Cap: $22.45
  • Anthem — Blue Access / Blue Access OHI/OHII: $91.20
  • Anthem — Blue Preferred: $91.20
  • Anthem — Blue Traditional: $96.90
  • Anthem — Enhanced Choice / Pathway: $79.80
  • Anthem — Managed Medicaid - Non-Cap: $22.45
  • BCHP — Managed Medicaid - Non-Cap: $22.45
  • Caresource — Just4Me/Marketplace: $8.58
  • Caresource — Medicare Advantage_DSNP: $8.17
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL $190 $114 $47.50 – $146.30
Liver function panel: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $85.50
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: HEPATIC FUNCTION PANEL Not listed in the file Not listed in the file $12.89
Liver function panel: rates for 1 insurance plan
  • Cigna — All Products: $12.89
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS W/ MICROSCOPY $88 $52.80 $22 – $67.76
Urine test (automated, with microscope): 10 of 28 insurance plan rates
  • Aetna — All Products: $33.88
  • Amerihealth — Managed Medicaid - Non-Cap: $7.28
  • Anthem — Blue Access / Blue Access OHI/OHII: $42.24
  • Anthem — Blue Preferred: $42.24
  • Anthem — Blue Traditional: $44.88
  • Anthem — Enhanced Choice / Pathway: $36.96
  • Anthem — Managed Medicaid - Non-Cap: $7.28
  • BCHP — Managed Medicaid - Non-Cap: $7.28
  • Caresource — Just4Me/Marketplace: $3.33
  • Caresource — Medicare Advantage_DSNP: $3.17
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/ MICROSCOPY $88 $52.80 $22 – $67.76
Urine test (automated, with microscope): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $39.60
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: URINALYSIS AUTO W/SCOPE Not listed in the file Not listed in the file $5.15
Urine test (automated, with microscope): rates for 1 insurance plan
  • Cigna — All Products: $5.15
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NON-AUTOURINE W/O MICROSCOPY $40 $24 $10 – $30.80
Urine test (manual, without microscope): 10 of 28 insurance plan rates
  • Aetna — All Products: $15.40
  • Amerihealth — Managed Medicaid - Non-Cap: $7.28
  • Anthem — Blue Access / Blue Access OHI/OHII: $19.20
  • Anthem — Blue Preferred: $19.20
  • Anthem — Blue Traditional: $20.40
  • Anthem — Enhanced Choice / Pathway: $16.80
  • Anthem — Managed Medicaid - Non-Cap: $7.28
  • BCHP — Managed Medicaid - Non-Cap: $7.28
  • Caresource — Just4Me/Marketplace: $3.65
  • Caresource — Medicare Advantage_DSNP: $3.48
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP $34 $20.40 $3.05 – $3.74
Urine test (manual, without microscope): rates for 6 insurance plans
  • Anthem — All Products: $3.74
  • MMO — All Products: $5.03
  • OHC — All Products: $25.50
  • Ohio PPO Connect — All Products: $25.50
  • Tricare CHAMPUS — All Products: $3.05
  • UHC — All Products: $13.60
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NON-AUTOURINE W/O MICROSCOPY $40 $24 $10 – $30.80
Urine test (manual, without microscope): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $18
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS AUTO W/O SCOPE $50 $30 $12.50 – $38.50
Urine test (automated, without microscope): 10 of 28 insurance plan rates
  • Aetna — All Products: $19.25
  • Amerihealth — Managed Medicaid - Non-Cap: $7.28
  • Anthem — Blue Access / Blue Access OHI/OHII: $24
  • Anthem — Blue Preferred: $24
  • Anthem — Blue Traditional: $25.50
  • Anthem — Enhanced Choice / Pathway: $21
  • Anthem — Managed Medicaid - Non-Cap: $7.28
  • BCHP — Managed Medicaid - Non-Cap: $7.28
  • Caresource — Just4Me/Marketplace: $2.36
  • Caresource — Medicare Advantage_DSNP: $2.25
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY $10 $6 $1.43 – $1.98
Urine test (automated, without microscope): rates for 6 insurance plans
  • Anthem — All Products: $1.43
  • MMO — All Products: $3.25
  • OHC — All Products: $7.50
  • Ohio PPO Connect — All Products: $7.50
  • Tricare CHAMPUS — All Products: $1.98
  • UHC — All Products: $4
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS AUTO W/O SCOPE $50 $30 $12.50 – $38.50
Urine test (automated, without microscope): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $22.50
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL $138 $82.80 $34.50 – $106.26
PSA (prostate specific antigen) blood test: 10 of 28 insurance plan rates
  • Aetna — All Products: $53.13
  • Amerihealth — Managed Medicaid - Non-Cap: $20.72
  • Anthem — Blue Access / Blue Access OHI/OHII: $66.24
  • Anthem — Blue Preferred: $66.24
  • Anthem — Blue Traditional: $70.38
  • Anthem — Enhanced Choice / Pathway: $57.96
  • Anthem — Managed Medicaid - Non-Cap: $20.72
  • BCHP — Managed Medicaid - Non-Cap: $20.72
  • Caresource — Just4Me/Marketplace: $19.31
  • Caresource — Medicare Advantage_DSNP: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SO ASSAY OF PSA TOTAL $107 $64.20 $26.75 – $82.39
PSA (prostate specific antigen) blood test: 10 of 28 insurance plan rates
  • Aetna — All Products: $41.20
  • Amerihealth — Managed Medicaid - Non-Cap: $20.72
  • Anthem — Blue Access / Blue Access OHI/OHII: $51.36
  • Anthem — Blue Preferred: $51.36
  • Anthem — Blue Traditional: $54.57
  • Anthem — Enhanced Choice / Pathway: $44.94
  • Anthem — Managed Medicaid - Non-Cap: $20.72
  • BCHP — Managed Medicaid - Non-Cap: $20.72
  • Caresource — Just4Me/Marketplace: $19.31
  • Caresource — Medicare Advantage_DSNP: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL $138 $82.80 $34.50 – $106.26
PSA (prostate specific antigen) blood test: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $62.10
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC THYROID STIMULATING HORMONE $339 $203.40 $84.75 – $261.03
Thyroid stimulating hormone (TSH) test: 10 of 28 insurance plan rates
  • Aetna — All Products: $130.52
  • Amerihealth — Managed Medicaid - Non-Cap: $25.12
  • Anthem — Blue Access / Blue Access OHI/OHII: $162.72
  • Anthem — Blue Preferred: $162.72
  • Anthem — Blue Traditional: $172.89
  • Anthem — Enhanced Choice / Pathway: $142.38
  • Anthem — Managed Medicaid - Non-Cap: $25.12
  • BCHP — Managed Medicaid - Non-Cap: $25.12
  • Caresource — Just4Me/Marketplace: $17.64
  • Caresource — Medicare Advantage_DSNP: $16.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC THYROID STIMULATING HORMONE $339 $203.40 $84.75 – $261.03
Thyroid stimulating hormone (TSH) test: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $152.55
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: ASSAY THYROID STIM HORMONE Not listed in the file Not listed in the file $26.80
Thyroid stimulating hormone (TSH) test: rates for 1 insurance plan
  • Cigna — All Products: $26.80
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC $228 $136.80 $57 – $175.56
Complete blood count (CBC) with differential: 10 of 28 insurance plan rates
  • Aetna — All Products: $87.78
  • Amerihealth — Managed Medicaid - Non-Cap: $9.69
  • Anthem — Blue Access / Blue Access OHI/OHII: $109.44
  • Anthem — Blue Preferred: $109.44
  • Anthem — Blue Traditional: $116.28
  • Anthem — Enhanced Choice / Pathway: $95.76
  • Anthem — Managed Medicaid - Non-Cap: $9.69
  • BCHP — Managed Medicaid - Non-Cap: $9.69
  • Caresource — Just4Me/Marketplace: $8.16
  • Caresource — Medicare Advantage_DSNP: $7.77
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC $228 $136.80 $57 – $175.56
Complete blood count (CBC) with differential: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $102.60
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: COMPLETE CBC W/AUTO DIFF WBC Not listed in the file Not listed in the file $12.36
Complete blood count (CBC) with differential: rates for 1 insurance plan
  • Cigna — All Products: $12.36
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC (HEMOGRAM) $203 $121.80 $50.75 – $156.31
Complete blood count (CBC), automated: 10 of 28 insurance plan rates
  • Aetna — All Products: $78.16
  • Amerihealth — Managed Medicaid - Non-Cap: $9.69
  • Anthem — Blue Access / Blue Access OHI/OHII: $97.44
  • Anthem — Blue Preferred: $97.44
  • Anthem — Blue Traditional: $103.53
  • Anthem — Enhanced Choice / Pathway: $85.26
  • Anthem — Managed Medicaid - Non-Cap: $9.69
  • BCHP — Managed Medicaid - Non-Cap: $9.69
  • Caresource — Just4Me/Marketplace: $6.79
  • Caresource — Medicare Advantage_DSNP: $6.47
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC (HEMOGRAM) $203 $121.80 $50.75 – $156.31
Complete blood count (CBC), automated: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $91.35
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: COMPLETE CBC AUTOMATED Not listed in the file Not listed in the file $10.30
Complete blood count (CBC), automated: rates for 1 insurance plan
  • Cigna — All Products: $10.30
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME $118 $70.80 $29.50 – $90.86
Blood clotting time test (prothrombin time, PT): 10 of 28 insurance plan rates
  • Aetna — All Products: $45.43
  • Amerihealth — Managed Medicaid - Non-Cap: $11.09
  • Anthem — Blue Access / Blue Access OHI/OHII: $56.64
  • Anthem — Blue Preferred: $56.64
  • Anthem — Blue Traditional: $60.18
  • Anthem — Enhanced Choice / Pathway: $49.56
  • Anthem — Managed Medicaid - Non-Cap: $11.09
  • BCHP — Managed Medicaid - Non-Cap: $11.09
  • Caresource — Just4Me/Marketplace: $4.50
  • Caresource — Medicare Advantage_DSNP: $4.29
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME $118 $70.80 $29.50 – $90.86
Blood clotting time test (prothrombin time, PT): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $53.10
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: PROTHROMBIN TIME Not listed in the file Not listed in the file $6.18
Blood clotting time test (prothrombin time, PT): rates for 1 insurance plan
  • Cigna — All Products: $6.18
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PTT $174 $104.40 $43.50 – $133.98
Blood clotting test (partial thromboplastin time, PTT): 10 of 28 insurance plan rates
  • Aetna — All Products: $66.99
  • Amerihealth — Managed Medicaid - Non-Cap: $11.09
  • Anthem — Blue Access / Blue Access OHI/OHII: $83.52
  • Anthem — Blue Preferred: $83.52
  • Anthem — Blue Traditional: $88.74
  • Anthem — Enhanced Choice / Pathway: $73.08
  • Anthem — Managed Medicaid - Non-Cap: $11.09
  • BCHP — Managed Medicaid - Non-Cap: $11.09
  • Caresource — Just4Me/Marketplace: $6.31
  • Caresource — Medicare Advantage_DSNP: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PTT $174 $104.40 $43.50 – $133.98
Blood clotting test (partial thromboplastin time, PTT): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $78.30
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: THROMBOPLASTIN TIME PARTIAL Not listed in the file Not listed in the file $9.27
Blood clotting test (partial thromboplastin time, PTT): rates for 1 insurance plan
  • Cigna — All Products: $9.27

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

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT BRAIN W/O CONTRAST $3,194 $1,916.40 $798.50 – $2,459.38
CT scan of the head or brain, without contrast: 10 of 28 insurance plan rates
  • Aetna — All Products: $1,229.69
  • Amerihealth — Managed Medicaid - Non-Cap: $449.44
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,084
  • Anthem — Blue Preferred: $1,084
  • Anthem — Blue Traditional: $1,628.94
  • Anthem — Enhanced Choice / Pathway: $954
  • Anthem — Managed Medicaid - Non-Cap: $449.44
  • BCHP — Managed Medicaid - Non-Cap: $449.44
  • Caresource — Just4Me/Marketplace: $112.15
  • Caresource — Medicare Advantage_DSNP: $106.81
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT BRAIN W/O CONTRAST $3,194 $1,916.40 $798.50 – $2,459.38
CT scan of the head or brain, without contrast: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $1,437.30
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL $230 $138 $38.55 – $71.98
CT scan of the head or brain, without contrast: rates for 10 insurance plans
  • Aetna — All Products: $71.98
  • Anthem — All Products: $57.70
  • Anthem — Managed Medicaid: $40.48
  • Caresource — Just4Me/Marketplace: $38.55
  • Front Path Health Coalition — All Products: $50.12
  • McClaren Health Plan — All Products: $53.98
  • OHC — All Products: $172.50
  • Ohio PPO Connect — All Products: $172.50
  • Paramount — Other: $38.55
  • UHC — All Products: $92
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI-BRAIN WO & W CONTRAST $6,900 $4,140 $1,725 – $5,313
MRI of the brain, before and after contrast: 10 of 28 insurance plan rates
  • Aetna — All Products: $2,656.50
  • Amerihealth — Managed Medicaid - Non-Cap: $440.69
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,565
  • Anthem — Blue Preferred: $1,565
  • Anthem — Blue Traditional: $3,519
  • Anthem — Enhanced Choice / Pathway: $1,377
  • Anthem — Managed Medicaid - Non-Cap: $440.69
  • BCHP — Managed Medicaid - Non-Cap: $440.69
  • Caresource — Just4Me/Marketplace: $374.25
  • Caresource — Medicare Advantage_DSNP: $356.43
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI-BRAIN WO & W CONTRAST $6,900 $4,140 $1,725 – $5,313
MRI of the brain, before and after contrast: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $3,105
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL $681 $408.60 $102.95 – $198.03
MRI of the brain, before and after contrast: rates for 10 insurance plans
  • Aetna — All Products: $198.03
  • Anthem — All Products: $160.16
  • Anthem — Managed Medicaid: $108.10
  • Caresource — Just4Me/Marketplace: $102.95
  • Front Path Health Coalition — All Products: $133.84
  • McClaren Health Plan — All Products: $144.13
  • OHC — All Products: $510.75
  • Ohio PPO Connect — All Products: $510.75
  • Paramount — Other: $102.95
  • UHC — All Products: $272.40
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC X-RAY EXAM CHEST 2 VIEWS $1,110 $666 $277.50 – $854.70
Chest X-ray, 2 views: 10 of 28 insurance plan rates
  • Aetna — All Products: $427.35
  • Amerihealth — Managed Medicaid - Non-Cap: $64.82
  • Anthem — Blue Access / Blue Access OHI/OHII: $532.80
  • Anthem — Blue Preferred: $532.80
  • Anthem — Blue Traditional: $566.10
  • Anthem — Enhanced Choice / Pathway: $466.20
  • Anthem — Managed Medicaid - Non-Cap: $64.82
  • BCHP — Managed Medicaid - Non-Cap: $64.82
  • Caresource — Just4Me/Marketplace: $93.36
  • Caresource — Medicare Advantage_DSNP: $88.91
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC X-RAY EXAM CHEST 2 VIEWS $1,110 $666 $277.50 – $854.70
Chest X-ray, 2 views: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $499.50
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: X-RAY EXAM CHEST 2 VIEWS Not listed in the file Not listed in the file $32.48
Chest X-ray, 2 views: rates for 1 insurance plan
  • Cigna — All Products: $32.48
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC L-SPINE MIN 4 VIEWS $1,680 $1,008 $420 – $1,293.60
X-ray of the lower spine, at least 4 views: 10 of 28 insurance plan rates
  • Aetna — All Products: $646.80
  • Amerihealth — Managed Medicaid - Non-Cap: $64.82
  • Anthem — Blue Access / Blue Access OHI/OHII: $806.40
  • Anthem — Blue Preferred: $806.40
  • Anthem — Blue Traditional: $856.80
  • Anthem — Enhanced Choice / Pathway: $705.60
  • Anthem — Managed Medicaid - Non-Cap: $64.82
  • BCHP — Managed Medicaid - Non-Cap: $64.82
  • Caresource — Just4Me/Marketplace: $112.15
  • Caresource — Medicare Advantage_DSNP: $106.81
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC L-SPINE MIN 4 VIEWS $1,680 $1,008 $420 – $1,293.60
X-ray of the lower spine, at least 4 views: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $756
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS $87 $52.20 $12.38 – $25.54
X-ray of the lower spine, at least 4 views: rates for 10 insurance plans
  • Aetna — All Products: $25.54
  • Anthem — All Products: $22.34
  • Anthem — Managed Medicaid: $13
  • Caresource — Just4Me/Marketplace: $12.38
  • Front Path Health Coalition — All Products: $16.09
  • McClaren Health Plan — All Products: $17.33
  • OHC — All Products: $65.25
  • Ohio PPO Connect — All Products: $65.25
  • Paramount — Other: $12.38
  • UHC — All Products: $34.80
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI-SPINE LUMBAR WO CONTRAST $5,234 $3,140.40 $1,308.50 – $4,030.18
MRI of the lower back (lumbar spine), without contrast: 10 of 28 insurance plan rates
  • Aetna — All Products: $2,015.09
  • Amerihealth — Managed Medicaid - Non-Cap: $291.62
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,565
  • Anthem — Blue Preferred: $1,565
  • Anthem — Blue Traditional: $2,669.34
  • Anthem — Enhanced Choice / Pathway: $1,377
  • Anthem — Managed Medicaid - Non-Cap: $291.62
  • BCHP — Managed Medicaid - Non-Cap: $291.62
  • Caresource — Just4Me/Marketplace: $255.96
  • Caresource — Medicare Advantage_DSNP: $243.77
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI-SPINE LUMBAR WO CONTRAST $5,234 $3,140.40 $1,308.50 – $4,030.18
MRI of the lower back (lumbar spine), without contrast: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $2,355.30
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL $425 $255 $66.95 – $124.41
MRI of the lower back (lumbar spine), without contrast: rates for 10 insurance plans
  • Aetna — All Products: $124.41
  • Anthem — All Products: $101.34
  • Anthem — Managed Medicaid: $70.30
  • Caresource — Just4Me/Marketplace: $66.95
  • Front Path Health Coalition — All Products: $87.04
  • McClaren Health Plan — All Products: $93.73
  • OHC — All Products: $318.75
  • Ohio PPO Connect — All Products: $318.75
  • Paramount — Other: $66.95
  • UHC — All Products: $170
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT PELVIS W/ CONTRAST $4,186 $2,511.60 $1,046.50 – $3,223.22
CT scan of the pelvis, with contrast: 10 of 28 insurance plan rates
  • Aetna — All Products: $1,611.61
  • Amerihealth — Managed Medicaid - Non-Cap: $449.44
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,084
  • Anthem — Blue Preferred: $1,084
  • Anthem — Blue Traditional: $2,134.86
  • Anthem — Enhanced Choice / Pathway: $954
  • Anthem — Managed Medicaid - Non-Cap: $449.44
  • BCHP — Managed Medicaid - Non-Cap: $449.44
  • Caresource — Just4Me/Marketplace: $188.16
  • Caresource — Medicare Advantage_DSNP: $179.20
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT PELVIS W/ CONTRAST $4,186 $2,511.60 $1,046.50 – $3,223.22
CT scan of the pelvis, with contrast: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $1,883.70
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CHG CT PELVIS W/CONTRAST MATERIAL $332 $199.20 $52.30 – $97.54
CT scan of the pelvis, with contrast: rates for 10 insurance plans
  • Aetna — All Products: $97.54
  • Anthem — All Products: $78.73
  • Anthem — Managed Medicaid: $54.91
  • Caresource — Just4Me/Marketplace: $52.30
  • Front Path Health Coalition — All Products: $67.99
  • McClaren Health Plan — All Products: $73.22
  • OHC — All Products: $249
  • Ohio PPO Connect — All Products: $249
  • Paramount — Other: $52.30
  • UHC — All Products: $132.80
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI LOWER EXT JNT W/O CONT $5,234 $3,140.40 $1,308.50 – $4,030.18
MRI of a leg joint (such as the knee), without contrast: 10 of 28 insurance plan rates
  • Aetna — All Products: $2,015.09
  • Amerihealth — Managed Medicaid - Non-Cap: $291.62
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,565
  • Anthem — Blue Preferred: $1,565
  • Anthem — Blue Traditional: $2,669.34
  • Anthem — Enhanced Choice / Pathway: $1,377
  • Anthem — Managed Medicaid - Non-Cap: $291.62
  • BCHP — Managed Medicaid - Non-Cap: $291.62
  • Caresource — Just4Me/Marketplace: $255.96
  • Caresource — Medicare Advantage_DSNP: $243.77
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI LOWER EXT JNT W/O CONT $5,234 $3,140.40 $1,308.50 – $4,030.18
MRI of a leg joint (such as the knee), without contrast: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $2,355.30
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL $349 $209.40 $61.39 – $113.06
MRI of a leg joint (such as the knee), without contrast: rates for 10 insurance plans
  • Aetna — All Products: $113.06
  • Anthem — All Products: $91.67
  • Anthem — Managed Medicaid: $64.46
  • Caresource — Just4Me/Marketplace: $61.39
  • Front Path Health Coalition — All Products: $79.81
  • McClaren Health Plan — All Products: $85.94
  • OHC — All Products: $261.75
  • Ohio PPO Connect — All Products: $261.75
  • Paramount — Other: $61.39
  • UHC — All Products: $139.60
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT ABD/PEL W CONT $6,281 $3,768.60 $1,570.25 – $4,836.37
CT scan of the abdomen and pelvis, with contrast: 10 of 28 insurance plan rates
  • Aetna — All Products: $2,418.19
  • Amerihealth — Managed Medicaid - Non-Cap: $449.44
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,084
  • Anthem — Blue Preferred: $1,084
  • Anthem — Blue Traditional: $3,203.31
  • Anthem — Enhanced Choice / Pathway: $954
  • Anthem — Managed Medicaid - Non-Cap: $449.44
  • BCHP — Managed Medicaid - Non-Cap: $449.44
  • Caresource — Just4Me/Marketplace: $374.25
  • Caresource — Medicare Advantage_DSNP: $356.43
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT ABD/PEL W CONT $6,281 $3,768.60 $1,570.25 – $4,836.37
CT scan of the abdomen and pelvis, with contrast: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $2,826.45
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: CT ABD & PELVIS W/CONTRAST Not listed in the file Not listed in the file $268.48
CT scan of the abdomen and pelvis, with contrast: rates for 1 insurance plan
  • Cigna — All Products: $268.48
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US ABDOMEN COMPLETE $2,156 $1,293.60 $539 – $1,660.12
Ultrasound of the abdomen, complete: 10 of 28 insurance plan rates
  • Aetna — All Products: $830.06
  • Amerihealth — Managed Medicaid - Non-Cap: $171.52
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,034.88
  • Anthem — Blue Preferred: $1,034.88
  • Anthem — Blue Traditional: $1,099.56
  • Anthem — Enhanced Choice / Pathway: $905.52
  • Anthem — Managed Medicaid - Non-Cap: $171.52
  • BCHP — Managed Medicaid - Non-Cap: $171.52
  • Caresource — Just4Me/Marketplace: $112.15
  • Caresource — Medicare Advantage_DSNP: $106.81
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US ABDOMEN COMPLETE $2,156 $1,293.60 $539 – $1,660.12
Ultrasound of the abdomen, complete: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $970.20
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION $232 $139.20 $36.58 – $67.91
Ultrasound of the abdomen, complete: rates for 10 insurance plans
  • Aetna — All Products: $67.91
  • Anthem — All Products: $58.98
  • Anthem — Managed Medicaid: $38.41
  • Caresource — Just4Me/Marketplace: $36.58
  • Front Path Health Coalition — All Products: $47.55
  • McClaren Health Plan — All Products: $51.21
  • OHC — All Products: $174
  • Ohio PPO Connect — All Products: $174
  • Paramount — Other: $36.58
  • UHC — All Products: $92.80
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FETAL EVAL 2-3 TRIM SGL GEST $309 $185.40 $77.25 – $237.93
Pregnancy ultrasound (after the first trimester): 10 of 29 insurance plan rates
  • Aetna — All Products: $118.97
  • Amerihealth — Managed Medicaid - Non-Cap: $133.42
  • Anthem — Blue Access / Blue Access OHI/OHII: $148.32
  • Anthem — Blue Preferred: $148.32
  • Anthem — Blue Traditional: $157.59
  • Anthem — Enhanced Choice / Pathway: $129.78
  • Anthem — Managed Medicaid - Non-Cap: $133.42
  • BCHP — Managed Medicaid - Non-Cap: $133.42
  • Caresource — Just4Me/Marketplace: $112.15
  • Caresource — Medicare Advantage_DSNP: $106.81
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC FETAL EVAL 2-3 TRIM SGL GEST $309 $185.40 $77.25 – $237.93
Pregnancy ultrasound (after the first trimester): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $139.05
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION $283 $169.80 $30.93 – $81.53
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates
  • Aetna — All Products: $81.53
  • Anthem — All Products: $72.13
  • Anthem — Managed Medicaid: $48.27
  • Caresource — Just4Me/Marketplace: $45.98
  • Front Path Health Coalition — All Products: $59.77
  • McClaren Health Plan — All Products: $64.37
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $30.93
  • OHC — All Products: $212.25
  • Ohio PPO Connect — All Products: $212.25
  • Paramount — Other: $45.98
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL NON OB $2,029 $1,217.40 $507.25 – $1,562.33
Transvaginal ultrasound: 10 of 29 insurance plan rates
  • Aetna — All Products: $781.17
  • Amerihealth — Managed Medicaid - Non-Cap: $111.52
  • Anthem — Blue Access / Blue Access OHI/OHII: $973.92
  • Anthem — Blue Preferred: $973.92
  • Anthem — Blue Traditional: $1,034.79
  • Anthem — Enhanced Choice / Pathway: $852.18
  • Anthem — Managed Medicaid - Non-Cap: $111.52
  • BCHP — Managed Medicaid - Non-Cap: $111.52
  • Caresource — Just4Me/Marketplace: $112.15
  • Caresource — Medicare Advantage_DSNP: $106.81
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL NON OB $2,029 $1,217.40 $507.25 – $1,562.33
Transvaginal ultrasound: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $913.05
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CHG US TRANSVAGINAL $200 $120 $21.50 – $57.15
Transvaginal ultrasound: 10 of 11 insurance plan rates
  • Aetna — All Products: $57.15
  • Anthem — All Products: $49.83
  • Anthem — Managed Medicaid: $33.24
  • Caresource — Just4Me/Marketplace: $31.65
  • Front Path Health Coalition — All Products: $41.15
  • McClaren Health Plan — All Products: $44.32
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $21.50
  • OHC — All Products: $150
  • Ohio PPO Connect — All Products: $150
  • Paramount — Other: $31.65
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MAMMO DGX UNILATERAL INCL CAD IF PERF $880 $528 $220 – $677.60
Diagnostic mammogram, one breast: 10 of 28 insurance plan rates
  • Aetna — All Products: $338.80
  • Amerihealth — Managed Medicaid - Non-Cap: $59.17
  • Anthem — Blue Access / Blue Access OHI/OHII: $422.40
  • Anthem — Blue Preferred: $422.40
  • Anthem — Blue Traditional: $448.80
  • Anthem — Enhanced Choice / Pathway: $369.60
  • Anthem — Managed Medicaid - Non-Cap: $59.17
  • BCHP — Managed Medicaid - Non-Cap: $59.17
  • Caresource — Just4Me/Marketplace: $176.52
  • Caresource — Medicare Advantage_DSNP: $168.11
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MAMMO DGX UNILATERAL INCL CAD IF PERF $880 $528 $220 – $677.60
Diagnostic mammogram, one breast: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $396
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: DX MAMMO INCL CAD UNI Not listed in the file Not listed in the file $121.62
Diagnostic mammogram, one breast: rates for 1 insurance plan
  • Cigna — All Products: $121.62
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MAMMO DGX BILATERAL INCL CAD IF PERF $1,087 $652.20 $271.75 – $836.99
Diagnostic mammogram, both breasts: 10 of 28 insurance plan rates
  • Aetna — All Products: $418.50
  • Amerihealth — Managed Medicaid - Non-Cap: $59.17
  • Anthem — Blue Access / Blue Access OHI/OHII: $521.76
  • Anthem — Blue Preferred: $521.76
  • Anthem — Blue Traditional: $554.37
  • Anthem — Enhanced Choice / Pathway: $456.54
  • Anthem — Managed Medicaid - Non-Cap: $59.17
  • BCHP — Managed Medicaid - Non-Cap: $59.17
  • Caresource — Just4Me/Marketplace: $223.73
  • Caresource — Medicare Advantage_DSNP: $213.08
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MAMMO DGX BILATERAL INCL CAD IF PERF $1,087 $652.20 $271.75 – $836.99
Diagnostic mammogram, both breasts: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $489.15
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: DX MAMMO INCL CAD BI Not listed in the file Not listed in the file $148.79
Diagnostic mammogram, both breasts: rates for 1 insurance plan
  • Cigna — All Products: $148.79
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MAMMO SCREENING INCL CAD IF PERF $1,108 $664.80 $277 – $853.16
Screening mammogram, both breasts: 10 of 28 insurance plan rates
  • Aetna — All Products: $426.58
  • Amerihealth — Managed Medicaid - Non-Cap: $59.17
  • Anthem — Blue Access / Blue Access OHI/OHII: $531.84
  • Anthem — Blue Preferred: $531.84
  • Anthem — Blue Traditional: $565.08
  • Anthem — Enhanced Choice / Pathway: $465.36
  • Anthem — Managed Medicaid - Non-Cap: $59.17
  • BCHP — Managed Medicaid - Non-Cap: $59.17
  • Caresource — Just4Me/Marketplace: $180.96
  • Caresource — Medicare Advantage_DSNP: $172.34
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MAMMO SCREENING INCL CAD IF PERF $1,108 $664.80 $277 – $853.16
Screening mammogram, both breasts: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $498.60
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: SCR MAMMO BI INCL CAD Not listed in the file Not listed in the file $114.32
Screening mammogram, both breasts: rates for 1 insurance plan
  • Cigna — All Products: $114.32

Heart tests and sleep study

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R $84 $50.40 $12.58 – $33.66
Electrocardiogram (ECG/EKG) with reading: 10 of 11 insurance plan rates
  • Aetna — All Products: $33.66
  • Anthem — All Products: $31.14
  • Anthem — Managed Medicaid: $15.31
  • Caresource — Just4Me/Marketplace: $14.59
  • Front Path Health Coalition — All Products: $18.96
  • McClaren Health Plan — All Products: $20.42
  • OHC — All Products: $63
  • Ohio PPO Connect — All Products: $63
  • Paramount — Other: $14.59
  • Tricare CHAMPUS — All Products: $12.58
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Electrocardiogram complete Not listed in the file Not listed in the file $26.57 – $26.83
Electrocardiogram (ECG/EKG) with reading: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $26.83
  • Anthem — Managed Medicaid - Non-Cap: $26.83
  • BCHP — Managed Medicaid - Non-Cap: $26.83
  • Humana — Managed Medicaid: $26.83
  • Molina — Managed Medicaid - Non-Cap: $26.57
  • UHC — Managed Medicaid: $26.57
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ELECTROCARDIOGRAM COMPLETE Not listed in the file Not listed in the file $49.83
Electrocardiogram (ECG/EKG) with reading: rates for 1 insurance plan
  • Cigna — All Products: $49.83
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY Not listed in the file Not listed in the file $3,055.59 – $9,936.45
Left heart catheterization (diagnostic): rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $3,477.76
  • Caresource — Medicare Advantage_DSNP: $3,312.15
  • Caresource — My Care Ohio: $3,312.15
  • Cigna — All Products: $2,643.45
  • Front Path Health Coalition — All Products: $9,936.45
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $3,411.51
  • Molina — Marketplace: $3,859.69
  • Molina — Medicare Advantage_DSNP: $3,312.15
  • Molina — My Care Ohio: $3,312.15
  • Tricare CHAMPUS — All Products: $3,055.59
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 $2,202.17 – $2,223.34
Left heart catheterization (diagnostic): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $2,223.34
  • Anthem — Managed Medicaid - Non-Cap: $2,223.34
  • BCHP — Managed Medicaid - Non-Cap: $2,223.34
  • Humana — Managed Medicaid: $2,223.34
  • Molina — Managed Medicaid - Non-Cap: $2,202.17
  • UHC — Managed Medicaid: $2,202.17
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I $1,063 $637.80 $226.48 – $438.57
Left heart catheterization (diagnostic): rates for 9 insurance plans
  • Anthem — All Products: $438.57
  • Anthem — Managed Medicaid: $237.80
  • Caresource — Just4Me/Marketplace: $226.48
  • Front Path Health Coalition — All Products: $294.42
  • McClaren Health Plan — All Products: $317.07
  • OHC — All Products: $797.25
  • Ohio PPO Connect — All Products: $797.25
  • Paramount — Other: $226.48
  • UHC — All Products: $425.20
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 $7,208.70 – $23,905.80
Heart rhythm study (electrophysiology evaluation): rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $8,367.03
  • Caresource — Medicare Advantage_DSNP: $7,968.60
  • Caresource — My Care Ohio: $7,968.60
  • Cigna — All Products: $2,077.64
  • Front Path Health Coalition — All Products: $23,905.80
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $8,207.66
  • Molina — Marketplace: $9,105.72
  • Molina — Medicare Advantage_DSNP: $7,968.60
  • Molina — My Care Ohio: $7,968.60
  • Tricare CHAMPUS — All Products: $7,208.70
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 $1,763.77 – $1,780.73
Heart rhythm study (electrophysiology evaluation): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,780.73
  • Anthem — Managed Medicaid - Non-Cap: $1,780.73
  • BCHP — Managed Medicaid - Non-Cap: $1,780.73
  • Humana — Managed Medicaid: $1,780.73
  • Molina — Managed Medicaid - Non-Cap: $1,763.77
  • UHC — Managed Medicaid: $1,763.77
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PR COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION $3,644 $2,186.40 $367.28 – $687.09
Heart rhythm study (electrophysiology evaluation): rates for 10 insurance plans
  • Aetna — All Products: $687.09
  • Anthem — All Products: $571.83
  • Anthem — Managed Medicaid: $385.65
  • Caresource — Just4Me/Marketplace: $367.28
  • Front Path Health Coalition — All Products: $477.47
  • McClaren Health Plan — All Products: $514.19
  • OHC — All Products: $2,733
  • Ohio PPO Connect — All Products: $2,733
  • Paramount — Other: $367.28
  • UHC — All Products: $1,457.60
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 $23,305.69 – $80,111.97
Heart rhythm study with ablation for atrial fibrillation: rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $28,039.19
  • Caresource — Medicare Advantage_DSNP: $26,703.99
  • Caresource — My Care Ohio: $26,703.99
  • Cigna — All Products: $3,507.63
  • Front Path Health Coalition — All Products: $80,111.97
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $27,505.11
  • Molina — Marketplace: $29,438.76
  • Molina — Medicare Advantage_DSNP: $26,703.99
  • Molina — My Care Ohio: $26,703.99
  • Tricare CHAMPUS — All Products: $23,305.69
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 $13,705.29 – $13,837.07
Heart rhythm study with ablation for atrial fibrillation: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $13,837.07
  • Anthem — Managed Medicaid - Non-Cap: $13,837.07
  • BCHP — Managed Medicaid - Non-Cap: $13,837.07
  • Humana — Managed Medicaid: $13,837.07
  • Molina — Managed Medicaid - Non-Cap: $13,705.29
  • UHC — Managed Medicaid: $13,705.29
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POLYSOM 6/> YRS 4/> PARAM Not listed in the file Not listed in the file $833.47 – $2,632.02
Sleep study (overnight, in a sleep lab): rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $921.21
  • Caresource — Medicare Advantage_DSNP: $877.34
  • Caresource — My Care Ohio: $877.34
  • Cigna — All Products: $1,440.07
  • Front Path Health Coalition — All Products: $2,632.02
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $903.66
  • Molina — Marketplace: $1,220.87
  • Molina — Medicare Advantage_DSNP: $877.34
  • Molina — My Care Ohio: $877.34
  • Tricare CHAMPUS — All Products: $833.47
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom 6/> yrs 4/> param Not listed in the file Not listed in the file $796.62 – $804.28
Sleep study (overnight, in a sleep lab): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $804.28
  • Anthem — Managed Medicaid - Non-Cap: $804.28
  • BCHP — Managed Medicaid - Non-Cap: $804.28
  • Humana — Managed Medicaid: $804.28
  • Molina — Managed Medicaid - Non-Cap: $796.62
  • UHC — Managed Medicaid: $796.62
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND $604 $362.40 $116.61 – $280.29
Sleep study (overnight, in a sleep lab): rates for 10 insurance plans
  • Aetna — All Products: $280.29
  • Anthem — All Products: $168.36
  • Anthem — Managed Medicaid: $122.44
  • Caresource — Just4Me/Marketplace: $116.61
  • Front Path Health Coalition — All Products: $151.59
  • McClaren Health Plan — All Products: $163.26
  • OHC — All Products: $453
  • Ohio PPO Connect — All Products: $453
  • Paramount — Other: $116.61
  • UHC — All Products: $241.60

Physical therapy and mental health

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT THERAPEUTIC EXERCISEEA 15 MIN $252 $151.20 $63 – $194.04
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 28 insurance plan rates
  • Aetna — All Products: $97.02
  • Amerihealth — Managed Medicaid - Non-Cap: $97.11
  • Anthem — Blue Access / Blue Access OHI/OHII: $120.96
  • Anthem — Blue Preferred: $120.96
  • Anthem — Blue Traditional: $128.52
  • Anthem — Enhanced Choice / Pathway: $105.84
  • Anthem — Managed Medicaid - Non-Cap: $97.11
  • BCHP — Managed Medicaid - Non-Cap: $97.11
  • Caresource — Just4Me/Marketplace: $39.18
  • Caresource — Medicare Advantage_DSNP: $37.31
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES $234 $140.40 $26.18 – $45.86
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 12 insurance plan rates
  • Aetna — All Products: $45.86
  • Anthem — All Products: $26.43
  • Anthem — Managed Medicaid: $29.26
  • Caresource — Just4Me/Marketplace: $27.87
  • Front Path Health Coalition — All Products: $36.23
  • McClaren Health Plan — All Products: $39.02
  • MMO — All Products: $53.95
  • OHC — All Products: $175.50
  • Ohio PPO Connect — All Products: $175.50
  • Paramount — Other: $27.87
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT THERAPEUTIC EXERCISEEA 15 MIN $252 $151.20 $63 – $194.04
Physical therapy: therapeutic exercise (each 15 minutes): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $113.40
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL LOW COMPLEX $407 $244.20 $101.75 – $313.39
Physical therapy evaluation (low complexity): 10 of 28 insurance plan rates
  • Aetna — All Products: $156.70
  • Amerihealth — Managed Medicaid - Non-Cap: $106.37
  • Anthem — Blue Access / Blue Access OHI/OHII: $195.36
  • Anthem — Blue Preferred: $195.36
  • Anthem — Blue Traditional: $207.57
  • Anthem — Enhanced Choice / Pathway: $170.94
  • Anthem — Managed Medicaid - Non-Cap: $106.37
  • BCHP — Managed Medicaid - Non-Cap: $106.37
  • Caresource — Just4Me/Marketplace: $132.75
  • Caresource — Medicare Advantage_DSNP: $126.43
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL LOW COMPLEX $407 $244.20 $101.75 – $313.39
Physical therapy evaluation (low complexity): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $183.15
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL MOD COMPLEX $479 $287.40 $119.75 – $368.83
Physical therapy evaluation (moderate complexity): 10 of 28 insurance plan rates
  • Aetna — All Products: $184.42
  • Amerihealth — Managed Medicaid - Non-Cap: $106.37
  • Anthem — Blue Access / Blue Access OHI/OHII: $229.92
  • Anthem — Blue Preferred: $229.92
  • Anthem — Blue Traditional: $244.29
  • Anthem — Enhanced Choice / Pathway: $201.18
  • Anthem — Managed Medicaid - Non-Cap: $106.37
  • BCHP — Managed Medicaid - Non-Cap: $106.37
  • Caresource — Just4Me/Marketplace: $132.75
  • Caresource — Medicare Advantage_DSNP: $126.43
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL MOD COMPLEX $479 $287.40 $119.75 – $368.83
Physical therapy evaluation (moderate complexity): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $215.55
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL HIGH COMPLEX $551 $330.60 $137.75 – $424.27
Physical therapy evaluation (high complexity): 10 of 28 insurance plan rates
  • Aetna — All Products: $212.14
  • Amerihealth — Managed Medicaid - Non-Cap: $106.37
  • Anthem — Blue Access / Blue Access OHI/OHII: $264.48
  • Anthem — Blue Preferred: $264.48
  • Anthem — Blue Traditional: $281.01
  • Anthem — Enhanced Choice / Pathway: $231.42
  • Anthem — Managed Medicaid - Non-Cap: $106.37
  • BCHP — Managed Medicaid - Non-Cap: $106.37
  • Caresource — Just4Me/Marketplace: $132.75
  • Caresource — Medicare Advantage_DSNP: $126.43
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL HIGH COMPLEX $551 $330.60 $137.75 – $424.27
Physical therapy evaluation (high complexity): rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $247.95
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OP PSYCH TX 30 MIN $284 $170.40 $71 – $218.68
Psychotherapy, 30 minutes: 10 of 28 insurance plan rates
  • Aetna — All Products: $109.34
  • Amerihealth — Managed Medicaid - Non-Cap: $95.19
  • Anthem — Blue Access / Blue Access OHI/OHII: $136.32
  • Anthem — Blue Preferred: $136.32
  • Anthem — Blue Traditional: $144.84
  • Anthem — Enhanced Choice / Pathway: $119.28
  • Anthem — Managed Medicaid - Non-Cap: $95.19
  • BCHP — Managed Medicaid - Non-Cap: $95.19
  • Caresource — Just4Me/Marketplace: $190.41
  • Caresource — Medicare Advantage_DSNP: $181.34
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR PSYCHOTHERAPY W/PATIENT 30 MINUTES $223 $133.80 $36.65 – $111.48
Psychotherapy, 30 minutes: 10 of 17 insurance plan rates
  • Amerihealth — Managed Medicaid - Non-Cap: $37.36
  • Anthem — All Products: $83.65
  • Anthem — Managed Medicaid: $72.55
  • BCHP — Managed Medicaid - Non-Cap: $37.36
  • Caresource — Just4Me/Marketplace: $69.10
  • Caresource — Managed Medicaid - Non-Cap: $36.65
  • Cigna — All Products: $111.48
  • Front Path Health Coalition — All Products: $105.05
  • McClaren Health Plan — All Products: $96.74
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $45.51
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OP PSYCH TX 30 MIN $284 $170.40 $71 – $218.68
Psychotherapy, 30 minutes: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $127.80
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYCHOTHERAPY - INDIVIDUAL $2,789 $1,673.40 $697.25 – $2,147.53
Psychotherapy, 45 minutes: 10 of 28 insurance plan rates
  • Aetna — All Products: $1,073.77
  • Amerihealth — Managed Medicaid - Non-Cap: $119.08
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,338.72
  • Anthem — Blue Preferred: $1,338.72
  • Anthem — Blue Traditional: $1,422.39
  • Anthem — Enhanced Choice / Pathway: $1,171.38
  • Anthem — Managed Medicaid - Non-Cap: $119.08
  • BCHP — Managed Medicaid - Non-Cap: $119.08
  • Caresource — Just4Me/Marketplace: $190.41
  • Caresource — Medicare Advantage_DSNP: $181.34
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OP TX 45 MIN $384 $230.40 $96 – $295.68
Psychotherapy, 45 minutes: 10 of 28 insurance plan rates
  • Aetna — All Products: $147.84
  • Amerihealth — Managed Medicaid - Non-Cap: $119.08
  • Anthem — Blue Access / Blue Access OHI/OHII: $184.32
  • Anthem — Blue Preferred: $184.32
  • Anthem — Blue Traditional: $195.84
  • Anthem — Enhanced Choice / Pathway: $161.28
  • Anthem — Managed Medicaid - Non-Cap: $119.08
  • BCHP — Managed Medicaid - Non-Cap: $119.08
  • Caresource — Just4Me/Marketplace: $190.41
  • Caresource — Medicare Advantage_DSNP: $181.34
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR PSYCHOTHERAPY W/PATIENT 45 MINUTES $335 $201 $50.91 – $147.07
Psychotherapy, 45 minutes: 10 of 17 insurance plan rates
  • Amerihealth — Managed Medicaid - Non-Cap: $51.90
  • Anthem — All Products: $125.83
  • Anthem — Managed Medicaid: $95.93
  • BCHP — Managed Medicaid - Non-Cap: $51.90
  • Caresource — Just4Me/Marketplace: $91.36
  • Caresource — Managed Medicaid - Non-Cap: $50.91
  • Cigna — All Products: $147.07
  • Front Path Health Coalition — All Products: $139.36
  • McClaren Health Plan — All Products: $127.91
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $60.19
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OP PSYCH TX 60 MIN $449 $269.40 $112.25 – $345.73
Psychotherapy, 60 minutes: 10 of 28 insurance plan rates
  • Aetna — All Products: $172.87
  • Amerihealth — Managed Medicaid - Non-Cap: $119.08
  • Anthem — Blue Access / Blue Access OHI/OHII: $215.52
  • Anthem — Blue Preferred: $215.52
  • Anthem — Blue Traditional: $228.99
  • Anthem — Enhanced Choice / Pathway: $188.58
  • Anthem — Managed Medicaid - Non-Cap: $119.08
  • BCHP — Managed Medicaid - Non-Cap: $119.08
  • Caresource — Just4Me/Marketplace: $190.41
  • Caresource — Medicare Advantage_DSNP: $181.34
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR PSYCHOTHERAPY W/PATIENT 60 MINUTES $505 $303 $78.04 – $217.91
Psychotherapy, 60 minutes: 10 of 17 insurance plan rates
  • Amerihealth — Managed Medicaid - Non-Cap: $79.56
  • Anthem — All Products: $187.84
  • Anthem — Managed Medicaid: $141.28
  • BCHP — Managed Medicaid - Non-Cap: $79.56
  • Caresource — Just4Me/Marketplace: $134.55
  • Caresource — Managed Medicaid - Non-Cap: $78.04
  • Cigna — All Products: $217.91
  • Front Path Health Coalition — All Products: $204.40
  • McClaren Health Plan — All Products: $188.37
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $88.56
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OP PSYCH TX 60 MIN $449 $269.40 $112.25 – $345.73
Psychotherapy, 60 minutes: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $202.05
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OP FAMILY TX WO PT PPRESENT 50MIN $370 $222 $92.50 – $284.90
Family psychotherapy, without the patient: 10 of 28 insurance plan rates
  • Aetna — All Products: $142.45
  • Amerihealth — Managed Medicaid - Non-Cap: $158.95
  • Anthem — Blue Access / Blue Access OHI/OHII: $177.60
  • Anthem — Blue Preferred: $177.60
  • Anthem — Blue Traditional: $188.70
  • Anthem — Enhanced Choice / Pathway: $155.40
  • Anthem — Managed Medicaid - Non-Cap: $158.95
  • BCHP — Managed Medicaid - Non-Cap: $158.95
  • Caresource — Just4Me/Marketplace: $190.41
  • Caresource — Medicare Advantage_DSNP: $181.34
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS $354 $212.40 $59.39 – $143.82
Family psychotherapy, without the patient: 10 of 17 insurance plan rates
  • Aetna — All Products: $143.82
  • Amerihealth — Managed Medicaid - Non-Cap: $60.54
  • Anthem — All Products: $122.05
  • Anthem — Managed Medicaid: $103.56
  • BCHP — Managed Medicaid - Non-Cap: $60.54
  • Caresource — Just4Me/Marketplace: $98.63
  • Caresource — Managed Medicaid - Non-Cap: $59.39
  • Cigna — All Products: $140.66
  • Front Path Health Coalition — All Products: $130.91
  • McClaren Health Plan — All Products: $138.08
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OP FAMILY TX WO PT PPRESENT 50MIN $370 $222 $92.50 – $284.90
Family psychotherapy, without the patient: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $166.50
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OP PSYCH FAMILY W/PATIENT PRESENT 50MINS $370 $222 $92.50 – $284.90
Family psychotherapy, with the patient: 10 of 28 insurance plan rates
  • Aetna — All Products: $142.45
  • Amerihealth — Managed Medicaid - Non-Cap: $158.95
  • Anthem — Blue Access / Blue Access OHI/OHII: $177.60
  • Anthem — Blue Preferred: $177.60
  • Anthem — Blue Traditional: $188.70
  • Anthem — Enhanced Choice / Pathway: $155.40
  • Anthem — Managed Medicaid - Non-Cap: $158.95
  • BCHP — Managed Medicaid - Non-Cap: $158.95
  • Caresource — Just4Me/Marketplace: $190.41
  • Caresource — Medicare Advantage_DSNP: $181.34
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS $438 $262.80 $59.99 – $178.58
Family psychotherapy, with the patient: 10 of 18 insurance plan rates
  • Aetna — All Products: $178.58
  • Amerihealth — Managed Medicaid - Non-Cap: $71.10
  • Anthem — All Products: $146.34
  • Anthem — Managed Medicaid: $107.41
  • BCHP — Managed Medicaid - Non-Cap: $71.10
  • Caresource — Just4Me/Marketplace: $102.30
  • Caresource — Managed Medicaid - Non-Cap: $69.74
  • Cigna — All Products: $146.64
  • Front Path Health Coalition — All Products: $135.50
  • McClaren Health Plan — All Products: $143.22
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OP PSYCH FAMILY W/PATIENT PRESENT 50MINS $370 $222 $92.50 – $284.90
Family psychotherapy, with the patient: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $166.50
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OP GROUP $223 $133.80 $55.75 – $171.71
Group psychotherapy: 10 of 28 insurance plan rates
  • Aetna — All Products: $85.86
  • Amerihealth — Managed Medicaid - Non-Cap: $131.87
  • Anthem — Blue Access / Blue Access OHI/OHII: $107.04
  • Anthem — Blue Preferred: $107.04
  • Anthem — Blue Traditional: $113.73
  • Anthem — Enhanced Choice / Pathway: $93.66
  • Anthem — Managed Medicaid - Non-Cap: $131.87
  • BCHP — Managed Medicaid - Non-Cap: $131.87
  • Caresource — Just4Me/Marketplace: $108.98
  • Caresource — Medicare Advantage_DSNP: $103.79
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR GROUP PSYCHOTHERAPY $123 $73.80 $16.12 – $50.77
Group psychotherapy: 10 of 14 insurance plan rates
  • Aetna — All Products: $50.77
  • Anthem — All Products: $40.15
  • Anthem — Managed Medicaid: $25.45
  • Caresource — Just4Me/Marketplace: $24.24
  • Cigna — All Products: $39.72
  • Front Path Health Coalition — All Products: $37.16
  • McClaren Health Plan — All Products: $33.94
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $16.12
  • MMO — All Products: $123
  • OHC — All Products: $92.25
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OP GROUP $223 $133.80 $55.75 – $171.71
Group psychotherapy: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $100.35

Procedures and surgery

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION $1,696 $1,017.60 $221.53 – $708.06
Removal of breast growth (open surgery): 10 of 18 insurance plan rates
  • Aetna — All Products: $683
  • Amerihealth — Managed Medicaid - Non-Cap: $225.83
  • Anthem — All Products: $465.09
  • Anthem — Managed Medicaid: $413.40
  • BCHP — Managed Medicaid - Non-Cap: $225.83
  • Caresource — Just4Me/Marketplace: $393.71
  • Caresource — Managed Medicaid - Non-Cap: $221.53
  • Cigna — All Products: $702.43
  • Front Path Health Coalition — All Products: $708.06
  • McClaren Health Plan — All Products: $551.20
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF BREAST LESION Not listed in the file Not listed in the file $3,637.82 – $12,000.72
Removal of breast growth (open surgery): rates for 9 insurance plans
  • Caresource — Just4Me/Marketplace: $4,200.25
  • Caresource — Medicare Advantage_DSNP: $4,000.24
  • Caresource — My Care Ohio: $4,000.24
  • Front Path Health Coalition — All Products: $12,000.72
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $4,120.25
  • Molina — Marketplace: $4,595.14
  • Molina — Medicare Advantage_DSNP: $4,000.24
  • Molina — My Care Ohio: $4,000.24
  • Tricare CHAMPUS — All Products: $3,637.82
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Removal of breast lesion Not listed in the file Not listed in the file $1,166.53 – $1,177.74
Removal of breast growth (open surgery): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,177.74
  • Anthem — Managed Medicaid - Non-Cap: $1,177.74
  • BCHP — Managed Medicaid - Non-Cap: $1,177.74
  • Humana — Managed Medicaid: $1,177.74
  • Molina — Managed Medicaid - Non-Cap: $1,166.53
  • UHC — Managed Medicaid: $1,166.53
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT $5,914 $3,548.40 $854.09 – $2,263.10
Total hip replacement: 10 of 13 insurance plan rates
  • Aetna — All Products: $2,263.10
  • Anthem — All Products: $1,854.75
  • Anthem — Managed Medicaid: $1,185.77
  • Caresource — Just4Me/Marketplace: $1,129.30
  • Front Path Health Coalition — All Products: $1,468.10
  • McClaren Health Plan — All Products: $1,581.03
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $854.09
  • MMO — All Products: $5,914
  • OHC — All Products: $4,435.50
  • Ohio PPO Connect — All Products: $4,435.50
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 $12,223.48 – $39,350.28
Total hip replacement: rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $13,772.60
  • Caresource — Medicare Advantage_DSNP: $13,116.76
  • Caresource — My Care Ohio: $13,116.76
  • Cigna — All Products: $4,300.08
  • Front Path Health Coalition — All Products: $39,350.28
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $13,510.26
  • Molina — Marketplace: $15,440.18
  • Molina — Medicare Advantage_DSNP: $13,116.76
  • Molina — My Care Ohio: $13,116.76
  • Tricare CHAMPUS — All Products: $12,223.48
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 $8,911.46 – $8,997.15
Total hip replacement: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $8,997.15
  • Anthem — Managed Medicaid - Non-Cap: $8,997.15
  • BCHP — Managed Medicaid - Non-Cap: $8,997.15
  • Humana — Managed Medicaid: $8,997.15
  • Molina — Managed Medicaid - Non-Cap: $8,911.46
  • UHC — Managed Medicaid: $8,911.46
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS $6,315 $3,789 $852.98 – $2,424.26
Total knee replacement: 10 of 13 insurance plan rates
  • Aetna — All Products: $2,424.26
  • Anthem — All Products: $1,996.08
  • Anthem — Managed Medicaid: $1,183.11
  • Caresource — Just4Me/Marketplace: $1,126.77
  • Front Path Health Coalition — All Products: $1,464.80
  • McClaren Health Plan — All Products: $1,577.48
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $852.98
  • MMO — All Products: $6,315
  • OHC — All Products: $4,736.25
  • Ohio PPO Connect — All Products: $4,736.25
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 $12,223.48 – $39,350.28
Total knee replacement: rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $13,772.60
  • Caresource — Medicare Advantage_DSNP: $13,116.76
  • Caresource — My Care Ohio: $13,116.76
  • Cigna — All Products: $4,294.62
  • Front Path Health Coalition — All Products: $39,350.28
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $13,510.26
  • Molina — Marketplace: $15,440.18
  • Molina — Medicare Advantage_DSNP: $13,116.76
  • Molina — My Care Ohio: $13,116.76
  • Tricare CHAMPUS — All Products: $12,223.48
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 $8,911.46 – $8,997.15
Total knee replacement: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $8,997.15
  • Anthem — Managed Medicaid - Non-Cap: $8,997.15
  • BCHP — Managed Medicaid - Non-Cap: $8,997.15
  • Humana — Managed Medicaid: $8,997.15
  • Molina — Managed Medicaid - Non-Cap: $8,911.46
  • UHC — Managed Medicaid: $8,911.46
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS $1,818 $1,090.80 $112.99 – $1,031.91
Shoulder arthroscopy: shaving of shoulder bone: 10 of 12 insurance plan rates
  • Aetna — All Products: $1,031.91
  • Anthem — All Products: $234.68
  • Anthem — Managed Medicaid: $152.40
  • Caresource — Just4Me/Marketplace: $145.14
  • Front Path Health Coalition — All Products: $188.69
  • McClaren Health Plan — All Products: $203.20
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $112.99
  • OHC — All Products: $1,363.50
  • Ohio PPO Connect — All Products: $1,363.50
  • Paramount — Other: $145.14
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 $2,070.62 – $2,090.53
Shoulder arthroscopy: shaving of shoulder bone: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $2,090.53
  • Anthem — Managed Medicaid - Non-Cap: $2,090.53
  • BCHP — Managed Medicaid - Non-Cap: $2,090.53
  • Humana — Managed Medicaid: $2,090.53
  • Molina — Managed Medicaid - Non-Cap: $2,070.62
  • UHC — Managed Medicaid: $2,070.62
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG $2,521 $1,512.60 $365.06 – $976.23
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 13 insurance plan rates
  • Aetna — All Products: $976.23
  • Anthem — All Products: $813.29
  • Anthem — Managed Medicaid: $519.95
  • Caresource — Just4Me/Marketplace: $495.19
  • Front Path Health Coalition — All Products: $643.75
  • McClaren Health Plan — All Products: $693.27
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $365.06
  • MMO — All Products: $2,521
  • OHC — All Products: $1,890.75
  • Ohio PPO Connect — All Products: $1,890.75
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 $3,082.38 – $10,028.61
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 9 insurance plans
  • Caresource — Just4Me/Marketplace: $3,510.01
  • Caresource — Medicare Advantage_DSNP: $3,342.87
  • Caresource — My Care Ohio: $3,342.87
  • Front Path Health Coalition — All Products: $10,028.61
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $3,443.16
  • Molina — Marketplace: $3,893.53
  • Molina — Medicare Advantage_DSNP: $3,342.87
  • Molina — My Care Ohio: $3,342.87
  • Tricare CHAMPUS — All Products: $3,082.38
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 $2,070.62 – $2,090.53
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $2,090.53
  • Anthem — Managed Medicaid - Non-Cap: $2,090.53
  • BCHP — Managed Medicaid - Non-Cap: $2,090.53
  • Humana — Managed Medicaid: $2,090.53
  • Molina — Managed Medicaid - Non-Cap: $2,070.62
  • UHC — Managed Medicaid: $2,070.62
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12 $1,207 $724.20 $195.04 – $441.97
Removal of tonsils and adenoids (under age 12): 10 of 13 insurance plan rates
  • Aetna — All Products: $441.97
  • Anthem — All Products: $380.75
  • Anthem — Managed Medicaid: $264.58
  • Caresource — Just4Me/Marketplace: $251.98
  • Front Path Health Coalition — All Products: $327.58
  • McClaren Health Plan — All Products: $352.77
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $195.04
  • MMO — All Products: $1,207
  • OHC — All Products: $905.25
  • Ohio PPO Connect — All Products: $905.25
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 $2,956 – $18,144.15
Removal of tonsils and adenoids (under age 12): 10 of 11 insurance plan rates
  • Anthem — Blue Access / Blue Access OHI/OHII: $5,042
  • Caresource — Just4Me/Marketplace: $6,350.45
  • Caresource — Medicare Advantage_DSNP: $6,048.05
  • Caresource — My Care Ohio: $6,048.05
  • Front Path Health Coalition — All Products: $18,144.15
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $6,229.49
  • Molina — Marketplace: $7,098.79
  • Molina — Medicare Advantage_DSNP: $6,048.05
  • Molina — My Care Ohio: $6,048.05
  • Tricare CHAMPUS — All Products: $5,619.88
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 $1,621.86 – $1,637.45
Removal of tonsils and adenoids (under age 12): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,637.45
  • Anthem — Managed Medicaid - Non-Cap: $1,637.45
  • BCHP — Managed Medicaid - Non-Cap: $1,637.45
  • Humana — Managed Medicaid: $1,637.45
  • Molina — Managed Medicaid - Non-Cap: $1,621.86
  • UHC — Managed Medicaid: $1,621.86
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC $1,279 $767.40 $80.08 – $445.89
Upper GI endoscopy (diagnostic): 10 of 18 insurance plan rates
  • Aetna — All Products: $445.89
  • Amerihealth — Managed Medicaid - Non-Cap: $130.45
  • Anthem — All Products: $184.52
  • Anthem — Managed Medicaid: $113.01
  • BCHP — Managed Medicaid - Non-Cap: $130.45
  • Caresource — Just4Me/Marketplace: $107.63
  • Caresource — Managed Medicaid - Non-Cap: $127.97
  • Cigna — All Products: $372.58
  • Front Path Health Coalition — All Products: $391.65
  • McClaren Health Plan — All Products: $150.68
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 $880.30 – $2,779.89
Upper GI endoscopy (diagnostic): rates for 9 insurance plans
  • Caresource — Just4Me/Marketplace: $972.96
  • Caresource — Medicare Advantage_DSNP: $926.63
  • Caresource — My Care Ohio: $926.63
  • Front Path Health Coalition — All Products: $2,779.89
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $954.43
  • Molina — Marketplace: $1,125.07
  • Molina — Medicare Advantage_DSNP: $926.63
  • Molina — My Care Ohio: $926.63
  • Tricare CHAMPUS — All Products: $880.30
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 $882.17 – $890.65
Upper GI endoscopy (diagnostic): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $890.65
  • Anthem — Managed Medicaid - Non-Cap: $890.65
  • BCHP — Managed Medicaid - Non-Cap: $890.65
  • Humana — Managed Medicaid: $890.65
  • Molina — Managed Medicaid - Non-Cap: $882.17
  • UHC — Managed Medicaid: $882.17
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE $1,417 $850.20 $89.95 – $516.62
Upper GI endoscopy with biopsy: 10 of 18 insurance plan rates
  • Aetna — All Products: $516.62
  • Amerihealth — Managed Medicaid - Non-Cap: $146.80
  • Anthem — All Products: $218.85
  • Anthem — Managed Medicaid: $126.48
  • BCHP — Managed Medicaid - Non-Cap: $146.80
  • Caresource — Just4Me/Marketplace: $120.46
  • Caresource — Managed Medicaid - Non-Cap: $144
  • Cigna — All Products: $480.02
  • Front Path Health Coalition — All Products: $507.05
  • McClaren Health Plan — All Products: $168.64
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 $880.30 – $2,779.89
Upper GI endoscopy with biopsy: 10 of 12 insurance plan rates
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,327
  • Caresource — Just4Me/Marketplace: $972.96
  • Caresource — Medicare Advantage_DSNP: $926.63
  • Caresource — My Care Ohio: $926.63
  • Cigna — All Products: $2,661
  • Front Path Health Coalition — All Products: $2,779.89
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $954.43
  • Molina — Marketplace: $1,125.07
  • Molina — Medicare Advantage_DSNP: $926.63
  • Molina — My Care Ohio: $926.63
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 $882.17 – $890.65
Upper GI endoscopy with biopsy: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $890.65
  • Anthem — Managed Medicaid - Non-Cap: $890.65
  • BCHP — Managed Medicaid - Non-Cap: $890.65
  • Humana — Managed Medicaid: $890.65
  • Molina — Managed Medicaid - Non-Cap: $882.17
  • UHC — Managed Medicaid: $882.17
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD $1,843 $1,105.80 $96.24 – $592.56
Colonoscopy (diagnostic): 10 of 18 insurance plan rates
  • Aetna — All Products: $592.56
  • Amerihealth — Managed Medicaid - Non-Cap: $98.11
  • Anthem — All Products: $277.91
  • Anthem — Managed Medicaid: $168.93
  • BCHP — Managed Medicaid - Non-Cap: $98.11
  • Caresource — Just4Me/Marketplace: $160.88
  • Caresource — Managed Medicaid - Non-Cap: $96.24
  • Cigna — All Products: $445.81
  • Front Path Health Coalition — All Products: $462.47
  • McClaren Health Plan — All Products: $225.23
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 $902.60 – $2,850.30
Colonoscopy (diagnostic): rates for 9 insurance plans
  • Caresource — Just4Me/Marketplace: $997.61
  • Caresource — Medicare Advantage_DSNP: $950.10
  • Caresource — My Care Ohio: $950.10
  • Front Path Health Coalition — All Products: $2,850.30
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $978.60
  • Molina — Marketplace: $1,094.05
  • Molina — Medicare Advantage_DSNP: $950.10
  • Molina — My Care Ohio: $950.10
  • Tricare CHAMPUS — All Products: $902.60
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 $1,006.47 – $1,016.15
Colonoscopy (diagnostic): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,016.15
  • Anthem — Managed Medicaid - Non-Cap: $1,016.15
  • BCHP — Managed Medicaid - Non-Cap: $1,016.15
  • Humana — Managed Medicaid: $1,016.15
  • Molina — Managed Medicaid - Non-Cap: $1,006.47
  • UHC — Managed Medicaid: $1,006.47
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE $2,074 $1,244.40 $130.76 – $711.13
Colonoscopy with biopsy: 10 of 18 insurance plan rates
  • Aetna — All Products: $711.13
  • Amerihealth — Managed Medicaid - Non-Cap: $212.93
  • Anthem — All Products: $332.03
  • Anthem — Managed Medicaid: $182.33
  • BCHP — Managed Medicaid - Non-Cap: $212.93
  • Caresource — Just4Me/Marketplace: $173.65
  • Caresource — Managed Medicaid - Non-Cap: $208.87
  • Cigna — All Products: $561.42
  • Front Path Health Coalition — All Products: $584.52
  • McClaren Health Plan — All Products: $243.11
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 $1,161.43 – $3,667.68
Colonoscopy with biopsy: 10 of 11 insurance plan rates
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,857
  • Caresource — Just4Me/Marketplace: $1,283.69
  • Caresource — Medicare Advantage_DSNP: $1,222.56
  • Caresource — My Care Ohio: $1,222.56
  • Front Path Health Coalition — All Products: $3,667.68
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $1,259.24
  • Molina — Marketplace: $1,414.90
  • Molina — Medicare Advantage_DSNP: $1,222.56
  • Molina — My Care Ohio: $1,222.56
  • Tricare CHAMPUS — All Products: $1,161.43
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 $1,006.47 – $1,016.15
Colonoscopy with biopsy: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,016.15
  • Anthem — Managed Medicaid - Non-Cap: $1,016.15
  • BCHP — Managed Medicaid - Non-Cap: $1,016.15
  • Humana — Managed Medicaid: $1,016.15
  • Molina — Managed Medicaid - Non-Cap: $1,006.47
  • UHC — Managed Medicaid: $1,006.47
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ $2,703 $1,621.80 $164.76 – $803.84
Colonoscopy with removal of polyps (snare): 10 of 18 insurance plan rates
  • Aetna — All Products: $803.84
  • Amerihealth — Managed Medicaid - Non-Cap: $270.71
  • Anthem — All Products: $394.83
  • Anthem — Managed Medicaid: $229.52
  • BCHP — Managed Medicaid - Non-Cap: $270.71
  • Caresource — Just4Me/Marketplace: $218.59
  • Caresource — Managed Medicaid - Non-Cap: $265.55
  • Cigna — All Products: $593.28
  • Front Path Health Coalition — All Products: $612.42
  • McClaren Health Plan — All Products: $306.03
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 $1,161.43 – $3,667.68
Colonoscopy with removal of polyps (snare): rates for 9 insurance plans
  • Caresource — Just4Me/Marketplace: $1,283.69
  • Caresource — Medicare Advantage_DSNP: $1,222.56
  • Caresource — My Care Ohio: $1,222.56
  • Front Path Health Coalition — All Products: $3,667.68
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $1,259.24
  • Molina — Marketplace: $1,414.90
  • Molina — Medicare Advantage_DSNP: $1,222.56
  • Molina — My Care Ohio: $1,222.56
  • Tricare CHAMPUS — All Products: $1,161.43
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 $1,006.47 – $1,016.15
Colonoscopy with removal of polyps (snare): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,016.15
  • Anthem — Managed Medicaid - Non-Cap: $1,016.15
  • BCHP — Managed Medicaid - Non-Cap: $1,016.15
  • Humana — Managed Medicaid: $1,016.15
  • Molina — Managed Medicaid - Non-Cap: $1,006.47
  • UHC — Managed Medicaid: $1,006.47
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX $1,222 $733.20 $166.95 – $475.93
Ultrasound of the lower bowel by endoscope: 10 of 13 insurance plan rates
  • Aetna — All Products: $475.93
  • Anthem — All Products: $393.51
  • Anthem — Managed Medicaid: $232.20
  • Caresource — Just4Me/Marketplace: $221.14
  • Front Path Health Coalition — All Products: $287.48
  • McClaren Health Plan — All Products: $309.60
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $166.95
  • MMO — All Products: $1,222
  • OHC — All Products: $916.50
  • Ohio PPO Connect — All Products: $916.50
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 $1,161.43 – $3,667.68
Ultrasound of the lower bowel by endoscope: rates for 9 insurance plans
  • Caresource — Just4Me/Marketplace: $1,283.69
  • Caresource — Medicare Advantage_DSNP: $1,222.56
  • Caresource — My Care Ohio: $1,222.56
  • Front Path Health Coalition — All Products: $3,667.68
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $1,259.24
  • Molina — Marketplace: $1,414.90
  • Molina — Medicare Advantage_DSNP: $1,222.56
  • Molina — My Care Ohio: $1,222.56
  • Tricare CHAMPUS — All Products: $1,161.43
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 $1,006.47 – $1,016.15
Ultrasound of the lower bowel by endoscope: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,016.15
  • Anthem — Managed Medicaid - Non-Cap: $1,016.15
  • BCHP — Managed Medicaid - Non-Cap: $1,016.15
  • Humana — Managed Medicaid: $1,016.15
  • Molina — Managed Medicaid - Non-Cap: $1,006.47
  • UHC — Managed Medicaid: $1,006.47
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 $1,006.47 – $1,016.15
Screening colonoscopy (not high risk): 10 of 15 insurance plan rates
  • Amerihealth — Managed Medicaid - Non-Cap: $1,016.15
  • Anthem — Managed Medicaid - Non-Cap: $1,016.15
  • BCHP — Managed Medicaid - Non-Cap: $1,016.15
  • Caresource — Just4Me/Marketplace: $997.61
  • Caresource — Medicare Advantage_DSNP: $950.10
  • Caresource — My Care Ohio: $950.10
  • Front Path Health Coalition — All Products: $2,850.30
  • Humana — Managed Medicaid: $1,016.15
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $978.60
  • Molina — Managed Medicaid - Non-Cap: $1,006.47
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR LAPAROSCOPY SURG CHOLECYSTECTOMY $2,881 $1,728.60 $440.10 – $1,105.21
Gallbladder removal by laparoscope: 10 of 13 insurance plan rates
  • Aetna — All Products: $1,105.21
  • Anthem — All Products: $908.46
  • Anthem — Managed Medicaid: $645.86
  • Caresource — Just4Me/Marketplace: $615.11
  • Front Path Health Coalition — All Products: $799.64
  • McClaren Health Plan — All Products: $861.15
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $440.10
  • MMO — All Products: $2,881
  • OHC — All Products: $2,160.75
  • Ohio PPO Connect — All Products: $2,160.75
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 $5,542.64 – $18,529.41
Gallbladder removal by laparoscope: rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $6,485.29
  • Caresource — Medicare Advantage_DSNP: $6,176.47
  • Caresource — My Care Ohio: $6,176.47
  • Cigna — All Products: $2,093.89
  • Front Path Health Coalition — All Products: $18,529.41
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $6,361.76
  • Molina — Marketplace: $7,001.23
  • Molina — Medicare Advantage_DSNP: $6,176.47
  • Molina — My Care Ohio: $6,176.47
  • Tricare CHAMPUS — All Products: $5,542.64
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 $3,417.74 – $3,450.60
Gallbladder removal by laparoscope: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $3,450.60
  • Anthem — Managed Medicaid - Non-Cap: $3,450.60
  • BCHP — Managed Medicaid - Non-Cap: $3,450.60
  • Humana — Managed Medicaid: $3,450.60
  • Molina — Managed Medicaid - Non-Cap: $3,417.74
  • UHC — Managed Medicaid: $3,417.74
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE $2,691 $1,614.60 $349.71 – $770.03
Groin (inguinal) hernia repair, age 5 or older: 10 of 13 insurance plan rates
  • Aetna — All Products: $770.03
  • Anthem — All Products: $635.81
  • Anthem — Managed Medicaid: $517.53
  • Caresource — Just4Me/Marketplace: $492.88
  • Front Path Health Coalition — All Products: $640.75
  • McClaren Health Plan — All Products: $690.04
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $349.71
  • MMO — All Products: $2,691
  • OHC — All Products: $2,018.25
  • Ohio PPO Connect — All Products: $2,018.25
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 $3,352.61 – $10,973.85
Groin (inguinal) hernia repair, age 5 or older: rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $3,840.85
  • Caresource — Medicare Advantage_DSNP: $3,657.95
  • Caresource — My Care Ohio: $3,657.95
  • Front Path Health Coalition — All Products: $10,973.85
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $3,767.69
  • Molina — Marketplace: $4,234.87
  • Molina — Medicare Advantage_DSNP: $3,657.95
  • Molina — My Care Ohio: $3,657.95
  • Tricare CHAMPUS — All Products: $3,352.61
  • UHC — All Products: $3,783
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 $2,754.70 – $2,781.19
Groin (inguinal) hernia repair, age 5 or older: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $2,781.19
  • Anthem — Managed Medicaid - Non-Cap: $2,781.19
  • BCHP — Managed Medicaid - Non-Cap: $2,781.19
  • Humana — Managed Medicaid: $2,781.19
  • Molina — Managed Medicaid - Non-Cap: $2,754.70
  • UHC — Managed Medicaid: $2,754.70
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR PROSTATE NEEDLE BIOPSY ANY APPROACH $759 $455.40 $67.37 – $378.85
Prostate biopsy: 10 of 12 insurance plan rates
  • Aetna — All Products: $378.85
  • Amerihealth — Managed Medicaid - Non-Cap: $68.68
  • Anthem — All Products: $115.82
  • BCHP — Managed Medicaid - Non-Cap: $68.68
  • Caresource — Managed Medicaid - Non-Cap: $67.37
  • Cigna — All Products: $317.95
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $84.69
  • OHC — All Products: $569.25
  • Ohio PPO Connect — All Products: $569.25
  • Tricare CHAMPUS — All Products: $209.76
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF PROSTATE Not listed in the file Not listed in the file $2,458.21
Prostate biopsy: rates for 1 insurance plan
  • Molina — Marketplace: $2,458.21
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR LAPS SURG PRST8ECT RPBIC RAD W/NRV SPARING ROBOT $7,158 $4,294.80 $784.54 – $2,981.65
Prostate removal by laparoscope (radical prostatectomy): 10 of 13 insurance plan rates
  • Aetna — All Products: $2,981.65
  • Anthem — All Products: $2,227.38
  • Anthem — Managed Medicaid: $1,113.37
  • Caresource — Just4Me/Marketplace: $1,060.35
  • Front Path Health Coalition — All Products: $1,325.44
  • McClaren Health Plan — All Products: $1,484.49
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $784.54
  • MMO — All Products: $7,158
  • OHC — All Products: $5,368.50
  • Ohio PPO Connect — All Products: $5,368.50
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 $9,890.66 – $32,580.21
Prostate removal by laparoscope (radical prostatectomy): rates for 10 insurance plans
  • Caresource — Just4Me/Marketplace: $11,403.07
  • Caresource — Medicare Advantage_DSNP: $10,860.07
  • Caresource — My Care Ohio: $10,860.07
  • Cigna — All Products: $4,368.47
  • Front Path Health Coalition — All Products: $32,580.21
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $11,185.87
  • Molina — Marketplace: $12,493.46
  • Molina — Medicare Advantage_DSNP: $10,860.07
  • Molina — My Care Ohio: $10,860.07
  • Tricare CHAMPUS — All Products: $9,890.66
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 $3,713.63 – $3,749.34
Prostate removal by laparoscope (radical prostatectomy): rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $3,749.34
  • Anthem — Managed Medicaid - Non-Cap: $3,749.34
  • BCHP — Managed Medicaid - Non-Cap: $3,749.34
  • Humana — Managed Medicaid: $3,749.34
  • Molina — Managed Medicaid - Non-Cap: $3,713.63
  • UHC — Managed Medicaid: $3,713.63
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HYSTEROSCOPYW/ENDO BX $7,069 $4,241.40 $1,767.25 – $5,443.13
Hysteroscopy with biopsy of the uterus lining: 10 of 29 insurance plan rates
  • Aetna — All Products: $2,721.57
  • Amerihealth — Managed Medicaid - Non-Cap: $1,944.90
  • Anthem — Blue Access / Blue Access OHI/OHII: $3,393.12
  • Anthem — Blue Preferred: $3,393.12
  • Anthem — Blue Traditional: $3,605.19
  • Anthem — Enhanced Choice / Pathway: $2,968.98
  • Anthem — Managed Medicaid - Non-Cap: $1,944.90
  • BCHP — Managed Medicaid - Non-Cap: $1,944.90
  • Caresource — Just4Me/Marketplace: $3,472.60
  • Caresource — Medicare Advantage_DSNP: $3,307.24
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C $1,181 $708.60 $121.19 – $1,181
Hysteroscopy with biopsy of the uterus lining: 10 of 18 insurance plan rates
  • Aetna — All Products: $511.18
  • Amerihealth — Managed Medicaid - Non-Cap: $123.54
  • Anthem — All Products: $373.26
  • Anthem — Managed Medicaid: $210.78
  • BCHP — Managed Medicaid - Non-Cap: $123.54
  • Caresource — Just4Me/Marketplace: $200.74
  • Caresource — Managed Medicaid - Non-Cap: $121.19
  • Cigna — All Products: $1,181
  • Front Path Health Coalition — All Products: $1,181
  • McClaren Health Plan — All Products: $281.04
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC HYSTEROSCOPYW/ENDO BX $7,069 $4,241.40 $1,767.25 – $5,443.13
Hysteroscopy with biopsy of the uterus lining: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $3,181.05
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN $4,472 $2,683.20 $1,118 – $3,443.44
Spinal injection, lower back (epidural), with imaging guidance: 10 of 29 insurance plan rates
  • Aetna — All Products: $1,721.72
  • Amerihealth — Managed Medicaid - Non-Cap: $645.53
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,327
  • Anthem — Blue Preferred: $1,327
  • Anthem — Blue Traditional: $2,280.72
  • Anthem — Enhanced Choice / Pathway: $1,168
  • Anthem — Managed Medicaid - Non-Cap: $645.53
  • BCHP — Managed Medicaid - Non-Cap: $645.53
  • Caresource — Just4Me/Marketplace: $757.23
  • Caresource — Medicare Advantage_DSNP: $721.17
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN $485 $291 $65.16 – $332.20
Spinal injection, lower back (epidural), with imaging guidance: 10 of 17 insurance plan rates
  • Amerihealth — Managed Medicaid - Non-Cap: $84.91
  • Anthem — All Products: $136.47
  • Anthem — Managed Medicaid: $91.43
  • BCHP — Managed Medicaid - Non-Cap: $84.91
  • Caresource — Just4Me/Marketplace: $87.08
  • Caresource — Managed Medicaid - Non-Cap: $83.30
  • Cigna — All Products: $332.20
  • Front Path Health Coalition — All Products: $318.88
  • McClaren Health Plan — All Products: $121.91
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $65.16
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN $4,472 $2,683.20 $1,118 – $3,443.44
Spinal injection, lower back (epidural), with imaging guidance: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $2,012.40
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ A/S TRANSFORAM LUMBAR $6,445 $3,867 $1,611.25 – $4,962.65
Nerve root injection, lower back, with imaging guidance: 10 of 29 insurance plan rates
  • Aetna — All Products: $2,481.33
  • Amerihealth — Managed Medicaid - Non-Cap: $645.53
  • Anthem — Blue Access / Blue Access OHI/OHII: $1,327
  • Anthem — Blue Preferred: $1,327
  • Anthem — Blue Traditional: $3,286.95
  • Anthem — Enhanced Choice / Pathway: $1,168
  • Anthem — Managed Medicaid - Non-Cap: $645.53
  • BCHP — Managed Medicaid - Non-Cap: $645.53
  • Caresource — Just4Me/Marketplace: $948.81
  • Caresource — Medicare Advantage_DSNP: $903.63
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL $697 $418.20 $58.10 – $392.05
Nerve root injection, lower back, with imaging guidance: 10 of 18 insurance plan rates
  • Aetna — All Products: $392.05
  • Amerihealth — Managed Medicaid - Non-Cap: $59.23
  • Anthem — All Products: $134.89
  • Anthem — Managed Medicaid: $101.63
  • BCHP — Managed Medicaid - Non-Cap: $59.23
  • Caresource — Just4Me/Marketplace: $96.79
  • Caresource — Managed Medicaid - Non-Cap: $58.10
  • Cigna — All Products: $318.55
  • Front Path Health Coalition — All Products: $309.68
  • McClaren Health Plan — All Products: $135.51
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ A/S TRANSFORAM LUMBAR $6,445 $3,867 $1,611.25 – $4,962.65
Nerve root injection, lower back, with imaging guidance: rates for 1 insurance plan
  • Front Path Health Coalition — All Products: $2,900.25
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE $1,747 $1,048.20 $270.93 – $620.02
Carpal tunnel release: 10 of 18 insurance plan rates
  • Aetna — All Products: $620.02
  • Amerihealth — Managed Medicaid - Non-Cap: $276.19
  • Anthem — All Products: $519.08
  • Anthem — Managed Medicaid: $423.79
  • BCHP — Managed Medicaid - Non-Cap: $276.19
  • Caresource — Just4Me/Marketplace: $403.61
  • Caresource — Managed Medicaid - Non-Cap: $270.93
  • Cigna — All Products: $608.41
  • Front Path Health Coalition — All Products: $572.36
  • McClaren Health Plan — All Products: $565.05
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 $1,855.13 – $5,985.06
Carpal tunnel release: rates for 9 insurance plans
  • Caresource — Just4Me/Marketplace: $2,094.77
  • Caresource — Medicare Advantage_DSNP: $1,995.02
  • Caresource — My Care Ohio: $1,995.02
  • Front Path Health Coalition — All Products: $5,985.06
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $2,054.87
  • Molina — Marketplace: $2,343.32
  • Molina — Medicare Advantage_DSNP: $1,995.02
  • Molina — My Care Ohio: $1,995.02
  • Tricare CHAMPUS — All Products: $1,855.13
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 $1,232.55 – $1,244.40
Carpal tunnel release: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,244.40
  • Anthem — Managed Medicaid - Non-Cap: $1,244.40
  • BCHP — Managed Medicaid - Non-Cap: $1,244.40
  • Humana — Managed Medicaid: $1,244.40
  • Molina — Managed Medicaid - Non-Cap: $1,232.55
  • UHC — Managed Medicaid: $1,232.55
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR POST-CATARACT LASER SURGERY $1,306 $783.60 $161.11 – $435.26
Laser treatment of clouding after cataract surgery: 10 of 18 insurance plan rates
  • Aetna — All Products: $428.98
  • Amerihealth — Managed Medicaid - Non-Cap: $164.24
  • Anthem — All Products: $368.44
  • Anthem — Managed Medicaid: $274.84
  • BCHP — Managed Medicaid - Non-Cap: $164.24
  • Caresource — Just4Me/Marketplace: $261.75
  • Caresource — Managed Medicaid - Non-Cap: $161.11
  • Cigna — All Products: $435.26
  • Front Path Health Coalition — All Products: $411.63
  • McClaren Health Plan — All Products: $366.45
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 $533.81 – $1,685.73
Laser treatment of clouding after cataract surgery: rates for 9 insurance plans
  • Caresource — Just4Me/Marketplace: $590.01
  • Caresource — Medicare Advantage_DSNP: $561.91
  • Caresource — My Care Ohio: $561.91
  • Front Path Health Coalition — All Products: $1,685.73
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $578.77
  • Molina — Marketplace: $658.32
  • Molina — Medicare Advantage_DSNP: $561.91
  • Molina — My Care Ohio: $561.91
  • Tricare CHAMPUS — All Products: $533.81
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 $359.93 – $363.39
Laser treatment of clouding after cataract surgery: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $363.39
  • Anthem — Managed Medicaid - Non-Cap: $363.39
  • BCHP — Managed Medicaid - Non-Cap: $363.39
  • Humana — Managed Medicaid: $363.39
  • Molina — Managed Medicaid - Non-Cap: $359.93
  • UHC — Managed Medicaid: $359.93
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP $2,894 $1,736.40 $353.88 – $1,040.92
Cataract removal with lens implant: 10 of 13 insurance plan rates
  • Aetna — All Products: $1,040.92
  • Anthem — All Products: $894.04
  • Anthem — Managed Medicaid: $467.15
  • Caresource — Just4Me/Marketplace: $444.90
  • Front Path Health Coalition — All Products: $578.38
  • McClaren Health Plan — All Products: $622.87
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $353.88
  • MMO — All Products: $2,894
  • OHC — All Products: $2,170.50
  • Ohio PPO Connect — All Products: $2,170.50
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 $2,166.69 – $7,073.43
Cataract removal with lens implant: rates for 9 insurance plans
  • Caresource — Just4Me/Marketplace: $2,475.70
  • Caresource — Medicare Advantage_DSNP: $2,357.81
  • Caresource — My Care Ohio: $2,357.81
  • Front Path Health Coalition — All Products: $7,073.43
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $2,428.54
  • Molina — Marketplace: $2,736.88
  • Molina — Medicare Advantage_DSNP: $2,357.81
  • Molina — My Care Ohio: $2,357.81
  • Tricare CHAMPUS — All Products: $2,166.69
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 $1,492.46 – $1,506.81
Cataract removal with lens implant: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,506.81
  • Anthem — Managed Medicaid - Non-Cap: $1,506.81
  • BCHP — Managed Medicaid - Non-Cap: $1,506.81
  • Humana — Managed Medicaid: $1,506.81
  • Molina — Managed Medicaid - Non-Cap: $1,492.46
  • UHC — Managed Medicaid: $1,492.46

Pregnancy and childbirth

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM $8,803 $5,281.80 $2,162.78 – $3,311.20
Vaginal delivery, with care before and after: 10 of 12 insurance plan rates
  • Aetna — All Products: $2,841.94
  • Anthem — All Products: $3,311.20
  • Anthem — Managed Medicaid: $2,270.92
  • Caresource — Just4Me/Marketplace: $2,162.78
  • Front Path Health Coalition — All Products: $2,811.62
  • McClaren Health Plan — All Products: $3,027.89
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $2,287.35
  • OHC — All Products: $6,602.25
  • Ohio PPO Connect — All Products: $6,602.25
  • Paramount — Other: $2,162.78
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 $1,748.91 – $1,765.72
Vaginal delivery, with care before and after: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,765.72
  • Anthem — Managed Medicaid - Non-Cap: $1,765.72
  • BCHP — Managed Medicaid - Non-Cap: $1,765.72
  • Humana — Managed Medicaid: $1,765.72
  • Molina — Managed Medicaid - Non-Cap: $1,748.91
  • UHC — Managed Medicaid: $1,748.91
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 $6,837.51
Vaginal delivery, with care before and after: rates for 1 insurance plan
  • Cigna — All Products: $6,837.51
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM $9,736 $5,841.60 $2,418.69 – $3,386.17
Cesarean delivery (C-section), with care before and after: 10 of 12 insurance plan rates
  • Aetna — All Products: $3,218.92
  • Anthem — All Products: $3,311.20
  • Anthem — Managed Medicaid: $2,539.63
  • Caresource — Just4Me/Marketplace: $2,418.69
  • Front Path Health Coalition — All Products: $3,144.30
  • McClaren Health Plan — All Products: $3,386.17
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $2,550.03
  • OHC — All Products: $7,302
  • Ohio PPO Connect — All Products: $7,302
  • Paramount — Other: $2,418.69
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 $1,214.73 – $1,226.41
Cesarean delivery (C-section), with care before and after: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,226.41
  • Anthem — Managed Medicaid - Non-Cap: $1,226.41
  • BCHP — Managed Medicaid - Non-Cap: $1,226.41
  • Humana — Managed Medicaid: $1,226.41
  • Molina — Managed Medicaid - Non-Cap: $1,214.73
  • UHC — Managed Medicaid: $1,214.73
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 $7,593.92
Cesarean delivery (C-section), with care before and after: rates for 1 insurance plan
  • Cigna — All Products: $7,593.92
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB $9,237 $5,542.20 $2,279.90 – $3,300.52
Vaginal delivery after a previous C-section, with care before and after: 10 of 12 insurance plan rates
  • Aetna — All Products: $2,995.55
  • Anthem — All Products: $3,300.52
  • Anthem — Managed Medicaid: $2,393.90
  • Caresource — Just4Me/Marketplace: $2,279.90
  • Front Path Health Coalition — All Products: $2,963.87
  • McClaren Health Plan — All Products: $3,191.86
  • McClaren Health Plan - Michigan — Medicaid - MI Medicaid: $2,405.86
  • OHC — All Products: $6,927.75
  • Ohio PPO Connect — All Products: $6,927.75
  • Paramount — Other: $2,279.90
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 $1,748.91 – $1,765.72
Vaginal delivery after a previous C-section, with care before and after: rates for 6 insurance plans
  • Amerihealth — Managed Medicaid - Non-Cap: $1,765.72
  • Anthem — Managed Medicaid - Non-Cap: $1,765.72
  • BCHP — Managed Medicaid - Non-Cap: $1,765.72
  • Humana — Managed Medicaid: $1,765.72
  • Molina — Managed Medicaid - Non-Cap: $1,748.91
  • UHC — Managed Medicaid: $1,748.91
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 $7,206.83
Vaginal delivery after a previous C-section, with care before and after: rates for 1 insurance plan
  • Cigna — All Products: $7,206.83

Hospital stays (whole stay, MS-DRG)

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC Not listed in the file Not listed in the file $129,608.96 – $176,100.18
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 17 insurance plan rates
  • Cigna — All Products: $176,100.18
  • Tricare CHAMPUS — All Products: $129,608.96
  • UHC — All Products: $146,340.91
  • Aetna — All Products: 38.5% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Access / Blue Access OHI/OHII: 48% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Preferred: 48% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Traditional: 51% (a percentage in the contract, not a dollar amount)
  • Anthem — Enhanced Choice / Pathway: 42% (a percentage in the contract, not a dollar amount)
  • Caresource — Just4Me/Marketplace: 20% (a percentage in the contract, not a dollar amount)
  • First Health — All Products: 77% (a percentage in the contract, not a dollar amount)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Major joint replacement or reattachment of lower extremity w/o MCC Not listed in the file Not listed in the file $24,331.98 – $34,722.13
Hip or knee replacement (major joint of the leg), without major complications: 10 of 16 insurance plan rates
  • Cigna — All Products: $34,722.13
  • UHC — All Products: $28,854.42
  • Aetna — All Products: 38.5% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Access / Blue Access OHI/OHII: 48% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Preferred: 48% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Traditional: 51% (a percentage in the contract, not a dollar amount)
  • Anthem — Enhanced Choice / Pathway: 42% (a percentage in the contract, not a dollar amount)
  • Caresource — Just4Me/Marketplace: 20% (a percentage in the contract, not a dollar amount)
  • First Health — All Products: 77% (a percentage in the contract, not a dollar amount)
  • Front Path Health Coalition — All Products: 45% (a percentage in the contract, not a dollar amount)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC Not listed in the file Not listed in the file $24,331.98 – $34,722.13
Hip or knee replacement (major joint of the leg), without major complications: rates for 1 insurance plan
  • Tricare CHAMPUS — All Products: $24,331.98
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 $31,531.37 – $43,945.84
Neck (cervical) spinal fusion, without complications: 10 of 17 insurance plan rates
  • Cigna — All Products: $43,945.84
  • Tricare CHAMPUS — All Products: $31,531.37
  • UHC — All Products: $36,519.41
  • Aetna — All Products: 38.5% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Access / Blue Access OHI/OHII: 48% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Preferred: 48% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Traditional: 51% (a percentage in the contract, not a dollar amount)
  • Anthem — Enhanced Choice / Pathway: 42% (a percentage in the contract, not a dollar amount)
  • Caresource — Just4Me/Marketplace: 20% (a percentage in the contract, not a dollar amount)
  • First Health — All Products: 77% (a percentage in the contract, not a dollar amount)
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC Not listed in the file Not listed in the file $17,963.05 – $22,333.84
Uterus and ovary surgery (not for cancer), without complications: 10 of 17 insurance plan rates
  • Cigna — All Products: $22,333.84
  • Tricare CHAMPUS — All Products: $17,963.05
  • UHC — All Products: $18,559.63
  • Aetna — All Products: 38.5% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Access / Blue Access OHI/OHII: 48% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Preferred: 48% (a percentage in the contract, not a dollar amount)
  • Anthem — Blue Traditional: 51% (a percentage in the contract, not a dollar amount)
  • Anthem — Enhanced Choice / Pathway: 42% (a percentage in the contract, not a dollar amount)
  • Caresource — Just4Me/Marketplace: 20% (a percentage in the contract, not a dollar amount)
  • First Health — All Products: 77% (a percentage in the contract, not a dollar amount)

Source: Nationwide Children's Hospital Toledo, LLC’s standard charges file (nationwidechildrens.pt.panaceainc.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital typeChildren's Hospital
Address2213 Cherry Street, Toledo, OH 43608
CountyLucas County
StateOhio
Phone(419) 251‑3232
Emergency servicesNot listed
OwnershipVoluntary non-profit - Private
Medicare overall ratingNot rated by CMS
CMS Certification Number363309
Name in Medicare recordsNATIONWIDE CHILDREN'S HOSPITAL TOLEDO, LLC
Profile levelMedicare data + hospital website
Main phone on the hospital’s website(567) 290‑6543[4][5]
Name on the hospital’s websiteNationwide Children's Hospital - Toledo
Official websitenationwidechildrens.org
CorrectionsReport an error or suggest an update →

Sources

  1. Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
  2. Medicare Care Compare — official Medicare profile of this hospital
  3. U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

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

  1. Nationwide Children's Hospital - Toledo — nationwidechildrens.org
  2. Your Visit — nationwidechildrens.org
  3. Services We Offer — nationwidechildrens.org
  4. Pediatric Inpatient and Intensive Care — nationwidechildrens.org
  5. Outpatient Care — nationwidechildrens.org
  6. Clinics and Locations — nationwidechildrens.org
  7. Neurosurgery — nationwidechildrens.org
  8. Wood County Developmental and Behavioral Pediatrics — nationwidechildrens.org
  9. Developmental and Behavioral Pediatrics — nationwidechildrens.org
  10. Cardiology — nationwidechildrens.org
  11. General Surgery — nationwidechildrens.org
  12. Neurology — nationwidechildrens.org
  13. Orthopedics — nationwidechildrens.org
  14. Autism Center — nationwidechildrens.org
  15. Pediatric Genetics — nationwidechildrens.org
  16. Psychology and Behavioral Health — nationwidechildrens.org