Does Northern Light Mayo Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Northern Light Mayo Hospital. In a medical emergency, call 911.

Where is Northern Light Mayo Hospital?

897 West Main Street, Dover Foxcroft, ME 04426, in Piscataquis County, Maine.

What is the phone number of Northern Light Mayo Hospital?

(207) 564-4251, as listed by Medicare (CMS).

What is the Medicare star rating of Northern Light Mayo Hospital?

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

Northern Light Mayo Hospital — Dover Foxcroft, ME

Quick answers

Does Northern Light Mayo Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Northern Light Mayo Hospital. In a medical emergency, call 911.
Where is Northern Light Mayo Hospital?: 897 West Main Street, Dover Foxcroft, ME 04426, in Piscataquis County, Maine.
What is the phone number of Northern Light Mayo Hospital?: (207) 564-4251, as listed by Medicare (CMS).
What is the Medicare star rating of Northern Light Mayo Hospital?: 2 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4]

Programs and centers^[4]

Emergency Medical Services for Piscataquis County

Emergency care (hospital website)^[4]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Interpreters and languages	Language assistance available in many languages, including French, Spanish, Arabic and Chinese^[4]
Patient portal	myNorthernLightHealth

Recognition^[4]

Critical Access Hospital

Doctors and clinicians (203)

203 doctors and other clinicians list Northern Light Mayo Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 179 more: the button below opens the full list.

Other emergency rooms nearby

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

Northern Light C A Dean Hospital26 mi · Greenville, ME · Critical Access Hospital
Northern Light Sebasticook Valley Hospital28 mi · Pittsfield, ME · Critical Access Hospital
St Joseph Hospital34 mi · Bangor, ME · Acute Care Hospital
Northern Light Eastern Maine Medical Center35 mi · Bangor, ME · Acute Care Hospital
Penobscot Valley Hospital37 mi · Lincoln, ME · Critical Access Hospital

Other hospitals nearby

Northern Light Acadia Hospital34 mi · Bangor, ME · Psychiatric Hospital
Dorothea Dix Psychiatric Center35 mi · Bangor, ME · Psychiatric Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Hibbard Skilled Nursing & Rehabilitation Center0.8 mi · Dover Foxcroft, ME · 4 of 5 stars
Dexter Health Care11 mi · Dexter, ME · 3 of 5 stars
Sanfield Rehab & Living Center23 mi · Hartland, ME · 5 of 5 stars

All nursing homes 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

KVHC Foxcroft Academy0.5 mi · Dover Foxcroft, ME · Community health center
KVHC SeDoMoCha Elementary School0.5 mi · Dover Foxcroft, ME · Community health center
KVHC SeDoMoCha Middle School0.7 mi · Dover Foxcroft, ME · Community health center

Clinics and urgent care

Northern Light Primary Care Dover-Foxcroft4.5 mi · Dover Foxcroft, ME · Rural health clinic
Northern Light Primary Care Corinth18 mi · Corinth, ME · Rural health clinic
Northern Light Primary Care Milo18 mi · Milo, ME · Rural health clinic

Pharmacies

Katahdin Valley Health Center4.5 mi · Dover Foxcroft, ME · Community/retail pharmacy
Shaws Supermarkets Inc4.5 mi · Dover Foxcroft, ME · Community/retail pharmacy
Walgreen Eastern Co Inc4.5 mi · Dover Foxcroft, ME · Pharmacy

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

What patients said (patient survey)

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

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	2 of 5 stars
Would recommend the hospital	3 of 5 stars
Nurses communicated well	3 of 5 stars
Doctors communicated well	2 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Quiet at night	2 of 5 stars
Rated the hospital 9 or 10 out of 10	62%National average: 72%
Would definitely recommend the hospital	61%National average: 71%
Nurses “always” communicated well	77%National average: 80%
Doctors “always” communicated well	75%National average: 80%
Staff “always” explained medicines before giving them	50%National average: 62%
Were given information about recovery at home	84%National average: 86%
Room and bathroom “always” clean	64%National average: 74%
Area around the room “always” quiet at night	42%National average: 60%
Completed surveys	159Response rate: 22%

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	0.497No different from the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	Too few cases to report
Deaths within 30 days: heart failure patients	Too few cases to report
Deaths within 30 days: pneumonia patients	16.4%
Deaths within 30 days: COPD patients	Too few cases to report
Deaths within 30 days: stroke patients	15.8%
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 replacement	Too few cases to report

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	Too few cases to report
Readmitted within 30 days: heart failure	22.1%
Readmitted within 30 days: pneumonia	17%
Readmitted within 30 days: COPD	19.7%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Too few cases to report

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	144 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	78%National average: 65%

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in Maine

Prices

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

What the prices mean

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

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

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · both In the file: 99203 OV NEW PT 3 Facility	$439	$144.87	$184.38 – $439
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $302.47 Aetna — MCR Advantage: $184.38 Anthem — Commercial: $285.35 Anthem — MCR Advantage: $184.38 CHO — Commercial: $439 Cigna — Commercial: $327.49 Harvard — Commercial: $308.79 Martin's Point — MCR Advantage: $184.38 UHC — Commercial: $357.78 UHC — MCR Advantage: $184.38
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99203 NEW OUTPATIENT VISIT-INT CHARGE	$252	$83.16	$105.84 – $252
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $173.63 Aetna — MCR Advantage: $105.84 Anthem — Commercial: $163.80 Anthem — MCR Advantage: $105.84 CHO — Commercial: $252 Cigna — Commercial: $187.99 Harvard — Commercial: $177.26 Martin's Point — MCR Advantage: $105.84 UHC — Commercial: $205.38 UHC — MCR Advantage: $105.84
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · both In the file: 99203 Office/OP New Visit Level 3	$439	$144.87	$184.38 – $439
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $302.47 Aetna — MCR Advantage: $184.38 Anthem — Commercial: $285.35 Anthem — MCR Advantage: $184.38 CHO — Commercial: $439 Cigna — Commercial: $327.49 Harvard — Commercial: $308.79 Martin's Point — MCR Advantage: $184.38 UHC — Commercial: $357.78 UHC — MCR Advantage: $184.38
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · both In the file: 99204 OV NEW PT 4 Facility	$634	$209.22	$266.28 – $634
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $436.83 Aetna — MCR Advantage: $266.28 Anthem — Commercial: $412.10 Anthem — MCR Advantage: $266.28 CHO — Commercial: $634 Cigna — Commercial: $472.96 Harvard — Commercial: $445.96 Martin's Point — MCR Advantage: $266.28 UHC — Commercial: $516.71 UHC — MCR Advantage: $266.28
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99204 NEW OUTPATIENT VISIT-EXT CHARGE	$379	$125.07	$159.18 – $379
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $261.13 Aetna — MCR Advantage: $159.18 Anthem — Commercial: $246.35 Anthem — MCR Advantage: $159.18 CHO — Commercial: $379 Cigna — Commercial: $282.73 Harvard — Commercial: $266.59 Martin's Point — MCR Advantage: $159.18 UHC — Commercial: $308.88 UHC — MCR Advantage: $159.18
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · both In the file: 99204 Office/OP New Visit Level 4 99204	$634	$209.22	$266.28 – $634
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $436.83 Aetna — MCR Advantage: $266.28 Anthem — Commercial: $412.10 Anthem — MCR Advantage: $266.28 CHO — Commercial: $634 Cigna — Commercial: $472.96 Harvard — Commercial: $445.96 Martin's Point — MCR Advantage: $266.28 UHC — Commercial: $516.71 UHC — MCR Advantage: $266.28
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99205 OV NEW PT 5 Facility	$947	$312.51	$397.74 – $947
New patient office visit (about 60–74 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $652.48 Aetna — MCR Advantage: $397.74 Anthem — Commercial: $615.55 Anthem — MCR Advantage: $397.74 CHO — Commercial: $947 Cigna — Commercial: $706.46 Harvard — Commercial: $666.12 Martin's Point — MCR Advantage: $397.74 UHC — Commercial: $771.80 UHC — MCR Advantage: $397.74
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99205 NEW OUTPATIENT VISIT-COMP CHARGE	$498	$164.34	$209.16 – $498
New patient office visit (about 60–74 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $343.12 Aetna — MCR Advantage: $209.16 Anthem — Commercial: $323.70 Anthem — MCR Advantage: $209.16 CHO — Commercial: $498 Cigna — Commercial: $371.51 Harvard — Commercial: $350.29 Martin's Point — MCR Advantage: $209.16 UHC — Commercial: $405.87 UHC — MCR Advantage: $209.16
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office/OP New Visit Level 5 99205	$947	$312.51	$397.74 – $947
New patient office visit (about 60–74 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $652.48 Aetna — MCR Advantage: $397.74 Anthem — Commercial: $615.55 Anthem — MCR Advantage: $397.74 CHO — Commercial: $947 Cigna — Commercial: $706.46 Harvard — Commercial: $666.12 Martin's Point — MCR Advantage: $397.74 UHC — Commercial: $771.80 UHC — MCR Advantage: $397.74
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OB TREATMENT ROOM LEVEL 3 CHARGE	$172	$56.76	$72.24 – $172
Established patient office visit (about 20–29 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $118.51 Aetna — MCR Advantage: $72.24 Anthem — Commercial: $111.80 Anthem — MCR Advantage: $72.24 CHO — Commercial: $172 Cigna — Commercial: $128.31 Harvard — Commercial: $120.98 Martin's Point — MCR Advantage: $72.24 UHC — Commercial: $140.18 UHC — MCR Advantage: $72.24
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99213 OV EST PT 3 FACILITY	$354	$116.82	$148.68 – $354
Established patient office visit (about 20–29 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $243.91 Aetna — MCR Advantage: $148.68 Anthem — Commercial: $230.10 Anthem — MCR Advantage: $148.68 CHO — Commercial: $354 Cigna — Commercial: $264.08 Harvard — Commercial: $249 Martin's Point — MCR Advantage: $148.68 UHC — Commercial: $288.51 UHC — MCR Advantage: $148.68
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99213 ESTB OUTPATIENT VISIT-INTER CHARGE	$182	$60.06	$76.44 – $182
Established patient office visit (about 20–29 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $125.40 Aetna — MCR Advantage: $76.44 Anthem — Commercial: $118.30 Anthem — MCR Advantage: $76.44 CHO — Commercial: $182 Cigna — Commercial: $135.77 Harvard — Commercial: $128.02 Martin's Point — MCR Advantage: $76.44 UHC — Commercial: $148.33 UHC — MCR Advantage: $76.44
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OB TREATMENT ROOM LEVEL 4 CHARGE	$226	$74.58	$94.92 – $226
Established patient office visit (about 30–39 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $155.71 Aetna — MCR Advantage: $94.92 Anthem — Commercial: $146.90 Anthem — MCR Advantage: $94.92 CHO — Commercial: $226 Cigna — Commercial: $168.60 Harvard — Commercial: $158.97 Martin's Point — MCR Advantage: $94.92 UHC — Commercial: $184.19 UHC — MCR Advantage: $94.92
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99214 OV EST PT 4 FACILITY	$482	$159.06	$202.44 – $482
Established patient office visit (about 30–39 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $332.10 Aetna — MCR Advantage: $202.44 Anthem — Commercial: $313.30 Anthem — MCR Advantage: $202.44 CHO — Commercial: $482 Cigna — Commercial: $359.57 Harvard — Commercial: $339.04 Martin's Point — MCR Advantage: $202.44 UHC — Commercial: $392.83 UHC — MCR Advantage: $202.44
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99214 ESTB OUTPATIENT VISIT-EXT CHARGE	$256	$84.48	$107.52 – $256
Established patient office visit (about 30–39 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $176.38 Aetna — MCR Advantage: $107.52 Anthem — Commercial: $166.40 Anthem — MCR Advantage: $107.52 CHO — Commercial: $256 Cigna — Commercial: $190.98 Harvard — Commercial: $180.07 Martin's Point — MCR Advantage: $107.52 UHC — Commercial: $208.64 UHC — MCR Advantage: $107.52
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99243 DETAILED OP/ER CONSULTATIONS	$310	$102.30	$130.20 – $310
Office consultation with a specialist (moderate): 10 of 11 insurance plan rates Aetna — Commercial: $213.59 Aetna — MCR Advantage: $130.20 Anthem — Commercial: $201.50 Anthem — MCR Advantage: $130.20 CHO — Commercial: $310 Cigna — Commercial: $231.26 Harvard — Commercial: $218.05 Martin's Point — MCR Advantage: $130.20 UHC — Commercial: $252.65 UHC — MCR Advantage: $130.20
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · both In the file: 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINU	$458	$151.14	$192.36 – $458
Office consultation with a specialist (moderate): 10 of 11 insurance plan rates Aetna — Commercial: $315.56 Aetna — MCR Advantage: $192.36 Anthem — Commercial: $297.70 Anthem — MCR Advantage: $192.36 CHO — Commercial: $458 Cigna — Commercial: $341.67 Harvard — Commercial: $322.16 Martin's Point — MCR Advantage: $192.36 UHC — Commercial: $373.27 UHC — MCR Advantage: $192.36
Office consultation with a specialist (moderate) CPT 99243 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 99243 DETAILED OP/ER CONSULTATIONS	$310	$102.30	$201.50 – $310
Office consultation with a specialist (moderate): rates for 5 insurance plans Aetna — Commercial: $237.46 Anthem — Commercial: $201.50 CHO — Commercial: $310 Cigna — Commercial: $231.26 UHC — Commercial: $239.94
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99244 Outpt Comp/Mod Consult60Min	$437	$144.21	$183.54 – $437
Office consultation with a specialist (moderate to high): 10 of 11 insurance plan rates Aetna — Commercial: $301.09 Aetna — MCR Advantage: $183.54 Anthem — Commercial: $284.05 Anthem — MCR Advantage: $183.54 CHO — Commercial: $437 Cigna — Commercial: $326 Harvard — Commercial: $307.39 Martin's Point — MCR Advantage: $183.54 UHC — Commercial: $356.16 UHC — MCR Advantage: $183.54
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · both In the file: OFFICE CONSULTATION LEVEL 4 - 99244	$647	$213.51	$271.74 – $647
Office consultation with a specialist (moderate to high): 10 of 11 insurance plan rates Aetna — Commercial: $445.78 Aetna — MCR Advantage: $271.74 Anthem — Commercial: $420.55 Anthem — MCR Advantage: $271.74 CHO — Commercial: $647 Cigna — Commercial: $482.66 Harvard — Commercial: $455.10 Martin's Point — MCR Advantage: $271.74 UHC — Commercial: $527.30 UHC — MCR Advantage: $271.74
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 99244 Outpt Comp/Mod Consult60Min	$437	$144.21	$284.05 – $437
Office consultation with a specialist (moderate to high): rates for 5 insurance plans Aetna — Commercial: $334.74 Anthem — Commercial: $284.05 CHO — Commercial: $437 Cigna — Commercial: $326 UHC — Commercial: $338.24
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99385 PHY PHP 1-39	$203	$66.99	$85.26 – $203
Preventive checkup, new patient, age 18–39: 10 of 11 insurance plan rates Aetna — Commercial: $139.87 Aetna — MCR Advantage: $85.26 Anthem — Commercial: $131.95 Anthem — MCR Advantage: $85.26 CHO — Commercial: $203 Cigna — Commercial: $151.44 Harvard — Commercial: $142.79 Martin's Point — MCR Advantage: $85.26 UHC — Commercial: $165.44 UHC — MCR Advantage: $85.26
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · both In the file: 99385 PREVENTIVE MEDICINE 18-39 YEARS NEW	$347	$114.51	$145.74 – $347
Preventive checkup, new patient, age 18–39: 10 of 11 insurance plan rates Aetna — Commercial: $239.08 Aetna — MCR Advantage: $145.74 Anthem — Commercial: $225.55 Anthem — MCR Advantage: $145.74 CHO — Commercial: $347 Cigna — Commercial: $258.86 Harvard — Commercial: $244.08 Martin's Point — MCR Advantage: $145.74 UHC — Commercial: $282.80 UHC — MCR Advantage: $145.74
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 99385 PHY PHP 1-39	$203	$66.99	$131.95 – $203
Preventive checkup, new patient, age 18–39: rates for 5 insurance plans Aetna — Commercial: $155.50 Anthem — Commercial: $131.95 CHO — Commercial: $203 Cigna — Commercial: $151.44 UHC — Commercial: $157.12
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99386 PHY PHP 40-64	$243	$80.19	$102.06 – $243
Preventive checkup, new patient, age 40–64: 10 of 11 insurance plan rates Aetna — Commercial: $167.43 Aetna — MCR Advantage: $102.06 Anthem — Commercial: $157.95 Anthem — MCR Advantage: $102.06 CHO — Commercial: $243 Cigna — Commercial: $181.28 Harvard — Commercial: $170.93 Martin's Point — MCR Advantage: $102.06 UHC — Commercial: $198.04 UHC — MCR Advantage: $102.06
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · both In the file: 99386 PREVENTIVE MEDICINE 40-64 YEARS NEW	$417	$137.61	$175.14 – $417
Preventive checkup, new patient, age 40–64: 10 of 11 insurance plan rates Aetna — Commercial: $287.31 Aetna — MCR Advantage: $175.14 Anthem — Commercial: $271.05 Anthem — MCR Advantage: $175.14 CHO — Commercial: $417 Cigna — Commercial: $311.08 Harvard — Commercial: $293.32 Martin's Point — MCR Advantage: $175.14 UHC — Commercial: $339.85 UHC — MCR Advantage: $175.14
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 99386 PHY PHP 40-64	$243	$80.19	$157.95 – $243
Preventive checkup, new patient, age 40–64: rates for 5 insurance plans Aetna — Commercial: $186.14 Anthem — Commercial: $157.95 CHO — Commercial: $243 Cigna — Commercial: $181.28 UHC — Commercial: $188.08
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99283- ED VISIT LEVEL 3 INTERMEDIATE	$749	$247.17	$314.58 – $749
Emergency room visit (moderate): 10 of 11 insurance plan rates Aetna — Commercial: $516.06 Aetna — MCR Advantage: $314.58 Anthem — Commercial: $486.85 Anthem — MCR Advantage: $314.58 CHO — Commercial: $749 Cigna — Commercial: $558.75 Harvard — Commercial: $526.85 Martin's Point — MCR Advantage: $314.58 UHC — Commercial: $610.43 UHC — MCR Advantage: $314.58
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99283- ED VISIT LEVEL 3 INTERMEDIATE	$749	$247.17	$486.85 – $749
Emergency room visit (moderate): rates for 5 insurance plans Aetna — Commercial: $573.73 Anthem — Commercial: $486.85 CHO — Commercial: $749 Cigna — Commercial: $558.75 UHC — Commercial: $579.73
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency dept visit low mdm	Not listed in the file	Not listed in the file	$65.45 – $132.41
Emergency room visit (moderate): 10 of 11 insurance plan rates Aetna — Commercial: $114.54 Aetna — MCR Advantage: $65.45 Anthem — Commercial: $132.41 Anthem — MCR Advantage: $65.45 CHO — Commercial: $114.54 Cigna — Commercial: $112.69 Harvard — Commercial: $113.94 Martin's Point — MCR Advantage: $66.76 UHC — Commercial: $65.45 UHC — MCR Advantage: $65.45
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99284- ED VISIT LEVEL 4 MODERATE	$1,222	$403.26	$513.24 – $1,222
Emergency room visit (moderately high): 10 of 11 insurance plan rates Aetna — Commercial: $841.96 Aetna — MCR Advantage: $513.24 Anthem — Commercial: $794.30 Anthem — MCR Advantage: $513.24 CHO — Commercial: $1,222 Cigna — Commercial: $911.61 Harvard — Commercial: $859.55 Martin's Point — MCR Advantage: $513.24 UHC — Commercial: $995.93 UHC — MCR Advantage: $513.24
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99284- ED VISIT LEVEL 4 MODERATE	$1,222	$403.26	$794.30 – $1,222
Emergency room visit (moderately high): rates for 5 insurance plans Aetna — Commercial: $936.05 Anthem — Commercial: $794.30 CHO — Commercial: $1,222 Cigna — Commercial: $911.61 UHC — Commercial: $945.83
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency dept visit mod mdm	Not listed in the file	Not listed in the file	$111.56 – $225.91
Emergency room visit (moderately high): 10 of 11 insurance plan rates Aetna — Commercial: $195.23 Aetna — MCR Advantage: $111.56 Anthem — Commercial: $225.91 Anthem — MCR Advantage: $111.56 CHO — Commercial: $195.23 Cigna — Commercial: $190.59 Harvard — Commercial: $193.86 Martin's Point — MCR Advantage: $113.79 UHC — Commercial: $111.56 UHC — MCR Advantage: $111.56
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99285- ED VISIT LEVEL 5 HIGH DECISION MAKING	$2,029	$669.57	$852.18 – $2,029
Emergency room visit (high): 10 of 11 insurance plan rates Aetna — Commercial: $1,397.98 Aetna — MCR Advantage: $852.18 Anthem — Commercial: $1,318.85 Anthem — MCR Advantage: $852.18 CHO — Commercial: $2,029 Cigna — Commercial: $1,513.63 Harvard — Commercial: $1,427.20 Martin's Point — MCR Advantage: $852.18 UHC — Commercial: $1,653.64 UHC — MCR Advantage: $852.18
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99285- ED VISIT LEVEL 5 HIGH DECISION MAKING	$2,029	$669.57	$1,318.85 – $2,029
Emergency room visit (high): rates for 5 insurance plans Aetna — Commercial: $1,554.21 Anthem — Commercial: $1,318.85 CHO — Commercial: $2,029 Cigna — Commercial: $1,513.63 UHC — Commercial: $1,570.45
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency dept visit hi mdm	Not listed in the file	Not listed in the file	$161.76 – $327.57
Emergency room visit (high): 10 of 11 insurance plan rates Aetna — Commercial: $283.08 Aetna — MCR Advantage: $161.76 Anthem — Commercial: $327.57 Anthem — MCR Advantage: $161.76 CHO — Commercial: $283.08 Cigna — Commercial: $276.53 Harvard — Commercial: $280.81 Martin's Point — MCR Advantage: $165 UHC — Commercial: $161.76 UHC — MCR Advantage: $161.76

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: i-STAT BMP 2	$191	$63.03	$80.22 – $191
Basic metabolic panel (blood test): 10 of 11 insurance plan rates Aetna — Commercial: $131.60 Aetna — MCR Advantage: $80.22 Anthem — Commercial: $124.15 Anthem — MCR Advantage: $80.22 CHO — Commercial: $191 Cigna — Commercial: $142.49 Harvard — Commercial: $134.35 Martin's Point — MCR Advantage: $80.22 UHC — Commercial: $155.66 UHC — MCR Advantage: $80.22
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic Metabolic Panel Standard	$191	$63.03	$80.22 – $191
Basic metabolic panel (blood test): 10 of 11 insurance plan rates Aetna — Commercial: $131.60 Aetna — MCR Advantage: $80.22 Anthem — Commercial: $124.15 Anthem — MCR Advantage: $80.22 CHO — Commercial: $191 Cigna — Commercial: $142.49 Harvard — Commercial: $134.35 Martin's Point — MCR Advantage: $80.22 UHC — Commercial: $155.66 UHC — MCR Advantage: $80.22
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic Metabolic Panel ALI	$191	$63.03	$80.22 – $191
Basic metabolic panel (blood test): 10 of 11 insurance plan rates Aetna — Commercial: $131.60 Aetna — MCR Advantage: $80.22 Anthem — Commercial: $124.15 Anthem — MCR Advantage: $80.22 CHO — Commercial: $191 Cigna — Commercial: $142.49 Harvard — Commercial: $134.35 Martin's Point — MCR Advantage: $80.22 UHC — Commercial: $155.66 UHC — MCR Advantage: $80.22
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel Standard	$284	$93.72	$119.28 – $284
Comprehensive metabolic panel (blood test): 10 of 11 insurance plan rates Aetna — Commercial: $195.68 Aetna — MCR Advantage: $119.28 Anthem — Commercial: $184.60 Anthem — MCR Advantage: $119.28 CHO — Commercial: $284 Cigna — Commercial: $211.86 Harvard — Commercial: $199.77 Martin's Point — MCR Advantage: $119.28 UHC — Commercial: $231.46 UHC — MCR Advantage: $119.28
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel ALI	$284	$93.72	$119.28 – $284
Comprehensive metabolic panel (blood test): 10 of 11 insurance plan rates Aetna — Commercial: $195.68 Aetna — MCR Advantage: $119.28 Anthem — Commercial: $184.60 Anthem — MCR Advantage: $119.28 CHO — Commercial: $284 Cigna — Commercial: $211.86 Harvard — Commercial: $199.77 Martin's Point — MCR Advantage: $119.28 UHC — Commercial: $231.46 UHC — MCR Advantage: $119.28
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel Standard	$284	$93.72	$184.60 – $284
Comprehensive metabolic panel (blood test): rates for 5 insurance plans Aetna — Commercial: $217.54 Anthem — Commercial: $184.60 CHO — Commercial: $284 Cigna — Commercial: $211.86 UHC — Commercial: $219.82
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prenatal Panel MAYO	$487	$160.71	$204.54 – $487
Obstetric blood test panel: 10 of 11 insurance plan rates Aetna — Commercial: $335.54 Aetna — MCR Advantage: $204.54 Anthem — Commercial: $316.55 Anthem — MCR Advantage: $204.54 CHO — Commercial: $487 Cigna — Commercial: $363.30 Harvard — Commercial: $342.56 Martin's Point — MCR Advantage: $204.54 UHC — Commercial: $396.90 UHC — MCR Advantage: $204.54
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prenatal Panel Standard	$487	$160.71	$204.54 – $487
Obstetric blood test panel: 10 of 11 insurance plan rates Aetna — Commercial: $335.54 Aetna — MCR Advantage: $204.54 Anthem — Commercial: $316.55 Anthem — MCR Advantage: $204.54 CHO — Commercial: $487 Cigna — Commercial: $363.30 Harvard — Commercial: $342.56 Martin's Point — MCR Advantage: $204.54 UHC — Commercial: $396.90 UHC — MCR Advantage: $204.54
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MAYO PRENATAL PANEL	$487	$160.71	$204.54 – $487
Obstetric blood test panel: 10 of 11 insurance plan rates Aetna — Commercial: $335.54 Aetna — MCR Advantage: $204.54 Anthem — Commercial: $316.55 Anthem — MCR Advantage: $204.54 CHO — Commercial: $487 Cigna — Commercial: $363.30 Harvard — Commercial: $342.56 Martin's Point — MCR Advantage: $204.54 UHC — Commercial: $396.90 UHC — MCR Advantage: $204.54
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel Standard	$135	$44.55	$56.70 – $135
Cholesterol panel (lipid panel): 10 of 11 insurance plan rates Aetna — Commercial: $93.01 Aetna — MCR Advantage: $56.70 Anthem — Commercial: $87.75 Anthem — MCR Advantage: $56.70 CHO — Commercial: $135 Cigna — Commercial: $100.71 Harvard — Commercial: $94.96 Martin's Point — MCR Advantage: $56.70 UHC — Commercial: $110.02 UHC — MCR Advantage: $56.70
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel with Direct LDL if indicated	$135	$44.55	$56.70 – $135
Cholesterol panel (lipid panel): 10 of 11 insurance plan rates Aetna — Commercial: $93.01 Aetna — MCR Advantage: $56.70 Anthem — Commercial: $87.75 Anthem — MCR Advantage: $56.70 CHO — Commercial: $135 Cigna — Commercial: $100.71 Harvard — Commercial: $94.96 Martin's Point — MCR Advantage: $56.70 UHC — Commercial: $110.02 UHC — MCR Advantage: $56.70
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HDL 2 Profile ALI	$135	$44.55	$56.70 – $135
Cholesterol panel (lipid panel): 10 of 11 insurance plan rates Aetna — Commercial: $93.01 Aetna — MCR Advantage: $56.70 Anthem — Commercial: $87.75 Anthem — MCR Advantage: $56.70 CHO — Commercial: $135 Cigna — Commercial: $100.71 Harvard — Commercial: $94.96 Martin's Point — MCR Advantage: $56.70 UHC — Commercial: $110.02 UHC — MCR Advantage: $56.70
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel Standard	$102	$33.66	$42.84 – $102
Kidney function panel: 10 of 11 insurance plan rates Aetna — Commercial: $70.28 Aetna — MCR Advantage: $42.84 Anthem — Commercial: $66.30 Anthem — MCR Advantage: $42.84 CHO — Commercial: $102 Cigna — Commercial: $76.09 Harvard — Commercial: $71.75 Martin's Point — MCR Advantage: $42.84 UHC — Commercial: $83.13 UHC — MCR Advantage: $42.84
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Renal Function Panel Standard	$102	$33.66	$66.30 – $102
Kidney function panel: rates for 5 insurance plans Aetna — Commercial: $78.13 Anthem — Commercial: $66.30 CHO — Commercial: $102 Cigna — Commercial: $76.09 UHC — Commercial: $78.95
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal function panel	Not listed in the file	Not listed in the file	$8.68 – $63.54
Kidney function panel: rates for 8 insurance plans Aetna — Commercial: $8.68 Aetna — MCR Advantage: $8.85 Anthem — Commercial: $10.77 Anthem — MCR Advantage: $8.94 Cigna — Commercial: $63.54 Martin's Point — MCR Advantage: $8.85 UHC — MCR Advantage: $8.85 Wellcare — MCR Advantage: $8.85
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel Standard	$146	$48.18	$61.32 – $146
Liver function panel: 10 of 11 insurance plan rates Aetna — Commercial: $100.59 Aetna — MCR Advantage: $61.32 Anthem — Commercial: $94.90 Anthem — MCR Advantage: $61.32 CHO — Commercial: $146 Cigna — Commercial: $108.92 Harvard — Commercial: $102.70 Martin's Point — MCR Advantage: $61.32 UHC — Commercial: $118.99 UHC — MCR Advantage: $61.32
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Hepatic Function Panel Standard	$146	$48.18	$94.90 – $146
Liver function panel: rates for 5 insurance plans Aetna — Commercial: $111.84 Anthem — Commercial: $94.90 CHO — Commercial: $146 Cigna — Commercial: $108.92 UHC — Commercial: $113
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Hepatic function panel	Not listed in the file	Not listed in the file	$4.90 – $14.30
Liver function panel: rates for 10 insurance plans Aetna — Commercial: $6.62 Aetna — MCR Advantage: $8.17 Anthem — Commercial: $4.90 Anthem — MCR Advantage: $8.17 CHO — Commercial: $14.30 Harvard — Commercial: $8.17 Martin's Point — MCR Advantage: $8.33 UHC — Commercial: $8.17 UHC — MCR Advantage: $8.17 Wellcare — MCR Advantage: $8.33
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$1.90 – $5.55
Urine test (automated, with microscope): rates for 10 insurance plans Aetna — Commercial: $2.57 Aetna — MCR Advantage: $3.17 Anthem — Commercial: $1.90 Anthem — MCR Advantage: $3.17 CHO — Commercial: $5.55 Harvard — Commercial: $3.17 Martin's Point — MCR Advantage: $3.23 UHC — Commercial: $3.17 UHC — MCR Advantage: $3.17 Wellcare — MCR Advantage: $3.23
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$3.17 – $23.20
Urine test (automated, with microscope): rates for 8 insurance plans Aetna — Commercial: $3.17 Aetna — MCR Advantage: $3.23 Anthem — Commercial: $3.93 Anthem — MCR Advantage: $3.27 Cigna — Commercial: $23.20 Martin's Point — MCR Advantage: $3.23 UHC — MCR Advantage: $3.23 Wellcare — MCR Advantage: $3.23
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier TC\|26 In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$3.29
Urine test (automated, with microscope): rates for 1 insurance plan Cigna — Commercial: $3.29
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis	$27	$8.91	$11.34 – $27
Urine test (manual, without microscope): 10 of 11 insurance plan rates Aetna — Commercial: $18.60 Aetna — MCR Advantage: $11.34 Anthem — Commercial: $17.55 Anthem — MCR Advantage: $11.34 CHO — Commercial: $27 Cigna — Commercial: $20.14 Harvard — Commercial: $18.99 Martin's Point — MCR Advantage: $11.34 UHC — Commercial: $22 UHC — MCR Advantage: $11.34
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Reducing Substance Ur ALI	$27	$8.91	$11.34 – $27
Urine test (manual, without microscope): 10 of 11 insurance plan rates Aetna — Commercial: $18.60 Aetna — MCR Advantage: $11.34 Anthem — Commercial: $17.55 Anthem — MCR Advantage: $11.34 CHO — Commercial: $27 Cigna — Commercial: $20.14 Harvard — Commercial: $18.99 Martin's Point — MCR Advantage: $11.34 UHC — Commercial: $22 UHC — MCR Advantage: $11.34
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINE DIPSTICK POC	$27	$8.91	$11.34 – $27
Urine test (manual, without microscope): 10 of 11 insurance plan rates Aetna — Commercial: $18.60 Aetna — MCR Advantage: $11.34 Anthem — Commercial: $17.55 Anthem — MCR Advantage: $11.34 CHO — Commercial: $27 Cigna — Commercial: $20.14 Harvard — Commercial: $18.99 Martin's Point — MCR Advantage: $11.34 UHC — Commercial: $22 UHC — MCR Advantage: $11.34
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis with Culture, if indicated Standard	$37	$12.21	$15.54 – $37
Urine test (automated, without microscope): 10 of 11 insurance plan rates Aetna — Commercial: $25.49 Aetna — MCR Advantage: $15.54 Anthem — Commercial: $24.05 Anthem — MCR Advantage: $15.54 CHO — Commercial: $37 Cigna — Commercial: $27.60 Harvard — Commercial: $26.03 Martin's Point — MCR Advantage: $15.54 UHC — Commercial: $30.15 UHC — MCR Advantage: $15.54
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Dipstick Only Standard	$37	$12.21	$15.54 – $37
Urine test (automated, without microscope): 10 of 11 insurance plan rates Aetna — Commercial: $25.49 Aetna — MCR Advantage: $15.54 Anthem — Commercial: $24.05 Anthem — MCR Advantage: $15.54 CHO — Commercial: $37 Cigna — Commercial: $27.60 Harvard — Commercial: $26.03 Martin's Point — MCR Advantage: $15.54 UHC — Commercial: $30.15 UHC — MCR Advantage: $15.54
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINE DIPSTICK - AUTOMATED POC	$37	$12.21	$15.54 – $37
Urine test (automated, without microscope): 10 of 11 insurance plan rates Aetna — Commercial: $25.49 Aetna — MCR Advantage: $15.54 Anthem — Commercial: $24.05 Anthem — MCR Advantage: $15.54 CHO — Commercial: $37 Cigna — Commercial: $27.60 Harvard — Commercial: $26.03 Martin's Point — MCR Advantage: $15.54 UHC — Commercial: $30.15 UHC — MCR Advantage: $15.54
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA Diagnostic	$147	$48.51	$61.74 – $147
PSA (prostate specific antigen) blood test: 10 of 11 insurance plan rates Aetna — Commercial: $101.28 Aetna — MCR Advantage: $61.74 Anthem — Commercial: $95.55 Anthem — MCR Advantage: $61.74 CHO — Commercial: $147 Cigna — Commercial: $109.66 Harvard — Commercial: $103.40 Martin's Point — MCR Advantage: $61.74 UHC — Commercial: $119.80 UHC — MCR Advantage: $61.74
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSA Diagnostic	$147	$48.51	$95.55 – $147
PSA (prostate specific antigen) blood test: rates for 5 insurance plans Aetna — Commercial: $112.60 Anthem — Commercial: $95.55 CHO — Commercial: $147 Cigna — Commercial: $109.66 UHC — Commercial: $113.78
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Assay of psa total	Not listed in the file	Not listed in the file	$11.03 – $32.18
PSA (prostate specific antigen) blood test: rates for 10 insurance plans Aetna — Commercial: $14.90 Aetna — MCR Advantage: $18.39 Anthem — Commercial: $11.03 Anthem — MCR Advantage: $18.39 CHO — Commercial: $32.18 Harvard — Commercial: $18.39 Martin's Point — MCR Advantage: $18.76 UHC — Commercial: $18.39 UHC — MCR Advantage: $18.39 Wellcare — MCR Advantage: $18.76
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH w/ Reflex to Free T4	$160	$52.80	$67.20 – $160
Thyroid stimulating hormone (TSH) test: 10 of 11 insurance plan rates Aetna — Commercial: $110.24 Aetna — MCR Advantage: $67.20 Anthem — Commercial: $104 Anthem — MCR Advantage: $67.20 CHO — Commercial: $160 Cigna — Commercial: $119.36 Harvard — Commercial: $112.54 Martin's Point — MCR Advantage: $67.20 UHC — Commercial: $130.40 UHC — MCR Advantage: $67.20
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thyroid Stimulating Hormone	$160	$52.80	$67.20 – $160
Thyroid stimulating hormone (TSH) test: 10 of 11 insurance plan rates Aetna — Commercial: $110.24 Aetna — MCR Advantage: $67.20 Anthem — Commercial: $104 Anthem — MCR Advantage: $67.20 CHO — Commercial: $160 Cigna — Commercial: $119.36 Harvard — Commercial: $112.54 Martin's Point — MCR Advantage: $67.20 UHC — Commercial: $130.40 UHC — MCR Advantage: $67.20
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: TSH w/ Reflex to Free T4	$160	$52.80	$104 – $160
Thyroid stimulating hormone (TSH) test: rates for 5 insurance plans Aetna — Commercial: $122.56 Anthem — Commercial: $104 CHO — Commercial: $160 Cigna — Commercial: $119.36 UHC — Commercial: $123.84
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC w/Diff Standard	$122	$40.26	$51.24 – $122
Complete blood count (CBC) with differential: 10 of 11 insurance plan rates Aetna — Commercial: $84.06 Aetna — MCR Advantage: $51.24 Anthem — Commercial: $79.30 Anthem — MCR Advantage: $51.24 CHO — Commercial: $122 Cigna — Commercial: $91.01 Harvard — Commercial: $85.81 Martin's Point — MCR Advantage: $51.24 UHC — Commercial: $99.43 UHC — MCR Advantage: $51.24
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC w/Diff Standard	$122	$40.26	$79.30 – $122
Complete blood count (CBC) with differential: rates for 5 insurance plans Aetna — Commercial: $93.45 Anthem — Commercial: $79.30 CHO — Commercial: $122 Cigna — Commercial: $91.01 UHC — Commercial: $94.43
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc w/auto diff wbc	Not listed in the file	Not listed in the file	$7.77 – $56.88
Complete blood count (CBC) with differential: rates for 8 insurance plans Aetna — Commercial: $7.77 Aetna — MCR Advantage: $7.93 Anthem — Commercial: $9.64 Anthem — MCR Advantage: $8 Cigna — Commercial: $56.88 Martin's Point — MCR Advantage: $7.93 UHC — MCR Advantage: $7.93 Wellcare — MCR Advantage: $7.93
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hemogram Standard	$70	$23.10	$29.40 – $70
Complete blood count (CBC), automated: 10 of 11 insurance plan rates Aetna — Commercial: $48.23 Aetna — MCR Advantage: $29.40 Anthem — Commercial: $45.50 Anthem — MCR Advantage: $29.40 CHO — Commercial: $70 Cigna — Commercial: $52.22 Harvard — Commercial: $49.24 Martin's Point — MCR Advantage: $29.40 UHC — Commercial: $57.05 UHC — MCR Advantage: $29.40
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Hemogram Standard	$70	$23.10	$45.50 – $70
Complete blood count (CBC), automated: rates for 5 insurance plans Aetna — Commercial: $53.62 Anthem — Commercial: $45.50 CHO — Commercial: $70 Cigna — Commercial: $52.22 UHC — Commercial: $54.18
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Complete cbc automated	Not listed in the file	Not listed in the file	$3.88 – $11.32
Complete blood count (CBC), automated: rates for 10 insurance plans Aetna — Commercial: $5.24 Aetna — MCR Advantage: $6.47 Anthem — Commercial: $3.88 Anthem — MCR Advantage: $6.47 CHO — Commercial: $11.32 Harvard — Commercial: $6.47 Martin's Point — MCR Advantage: $6.60 UHC — Commercial: $6.47 UHC — MCR Advantage: $6.47 Wellcare — MCR Advantage: $6.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INR	$47	$15.51	$19.74 – $47
Blood clotting time test (prothrombin time, PT): 10 of 11 insurance plan rates Aetna — Commercial: $32.38 Aetna — MCR Advantage: $19.74 Anthem — Commercial: $30.55 Anthem — MCR Advantage: $19.74 CHO — Commercial: $47 Cigna — Commercial: $35.06 Harvard — Commercial: $33.06 Martin's Point — MCR Advantage: $19.74 UHC — Commercial: $38.30 UHC — MCR Advantage: $19.74
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INR POC (Lab)	$47	$15.51	$19.74 – $47
Blood clotting time test (prothrombin time, PT): 10 of 11 insurance plan rates Aetna — Commercial: $32.38 Aetna — MCR Advantage: $19.74 Anthem — Commercial: $30.55 Anthem — MCR Advantage: $19.74 CHO — Commercial: $47 Cigna — Commercial: $35.06 Harvard — Commercial: $33.06 Martin's Point — MCR Advantage: $19.74 UHC — Commercial: $38.30 UHC — MCR Advantage: $19.74
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INR ALI	$47	$15.51	$19.74 – $47
Blood clotting time test (prothrombin time, PT): 10 of 11 insurance plan rates Aetna — Commercial: $32.38 Aetna — MCR Advantage: $19.74 Anthem — Commercial: $30.55 Anthem — MCR Advantage: $19.74 CHO — Commercial: $47 Cigna — Commercial: $35.06 Harvard — Commercial: $33.06 Martin's Point — MCR Advantage: $19.74 UHC — Commercial: $38.30 UHC — MCR Advantage: $19.74
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time/ PTT	$70	$23.10	$29.40 – $70
Blood clotting test (partial thromboplastin time, PTT): 10 of 11 insurance plan rates Aetna — Commercial: $48.23 Aetna — MCR Advantage: $29.40 Anthem — Commercial: $45.50 Anthem — MCR Advantage: $29.40 CHO — Commercial: $70 Cigna — Commercial: $52.22 Harvard — Commercial: $49.24 Martin's Point — MCR Advantage: $29.40 UHC — Commercial: $57.05 UHC — MCR Advantage: $29.40
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: zzLupus Anticoagulant Panel Reflex ALI	$70	$23.10	$29.40 – $70
Blood clotting test (partial thromboplastin time, PTT): 10 of 11 insurance plan rates Aetna — Commercial: $48.23 Aetna — MCR Advantage: $29.40 Anthem — Commercial: $45.50 Anthem — MCR Advantage: $29.40 CHO — Commercial: $70 Cigna — Commercial: $52.22 Harvard — Commercial: $49.24 Martin's Point — MCR Advantage: $29.40 UHC — Commercial: $57.05 UHC — MCR Advantage: $29.40
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PTT ALI	$70	$23.10	$29.40 – $70
Blood clotting test (partial thromboplastin time, PTT): 10 of 11 insurance plan rates Aetna — Commercial: $48.23 Aetna — MCR Advantage: $29.40 Anthem — Commercial: $45.50 Anthem — MCR Advantage: $29.40 CHO — Commercial: $70 Cigna — Commercial: $52.22 Harvard — Commercial: $49.24 Martin's Point — MCR Advantage: $29.40 UHC — Commercial: $57.05 UHC — MCR Advantage: $29.40

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Stroke Study	$1,714	$565.62	$719.88 – $1,714
CT scan of the head or brain, without contrast: 10 of 11 insurance plan rates Aetna — Commercial: $1,180.95 Aetna — MCR Advantage: $719.88 Anthem — Commercial: $1,114.10 Anthem — MCR Advantage: $719.88 CHO — Commercial: $1,714 Cigna — Commercial: $1,278.64 Harvard — Commercial: $1,205.63 Martin's Point — MCR Advantage: $719.88 UHC — Commercial: $1,396.91 UHC — MCR Advantage: $719.88
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Head or Brain w/o Contrast	$1,714	$565.62	$719.88 – $1,714
CT scan of the head or brain, without contrast: 10 of 11 insurance plan rates Aetna — Commercial: $1,180.95 Aetna — MCR Advantage: $719.88 Anthem — Commercial: $1,114.10 Anthem — MCR Advantage: $719.88 CHO — Commercial: $1,714 Cigna — Commercial: $1,278.64 Harvard — Commercial: $1,205.63 Martin's Point — MCR Advantage: $719.88 UHC — Commercial: $1,396.91 UHC — MCR Advantage: $719.88
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Stroke Study	$1,714	$565.62	$1,114.10 – $1,714
CT scan of the head or brain, without contrast: rates for 5 insurance plans Aetna — Commercial: $1,312.92 Anthem — Commercial: $1,114.10 CHO — Commercial: $1,714 Cigna — Commercial: $1,278.64 UHC — Commercial: $1,326.64
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Brain w/ + w/o Contrast	$2,456	$810.48	$1,031.52 – $2,456
MRI of the brain, before and after contrast: 10 of 11 insurance plan rates Aetna — Commercial: $1,692.18 Aetna — MCR Advantage: $1,031.52 Anthem — Commercial: $1,596.40 Anthem — MCR Advantage: $1,031.52 CHO — Commercial: $2,456 Cigna — Commercial: $1,832.18 Harvard — Commercial: $1,727.55 Martin's Point — MCR Advantage: $1,031.52 UHC — Commercial: $2,001.64 UHC — MCR Advantage: $1,031.52
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI Brain w/ + w/o Contrast	$2,456	$810.48	$1,596.40 – $2,456
MRI of the brain, before and after contrast: rates for 5 insurance plans Aetna — Commercial: $1,881.30 Anthem — Commercial: $1,596.40 CHO — Commercial: $2,456 Cigna — Commercial: $1,832.18 UHC — Commercial: $1,900.94
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri brain stem w/o & w/dye	Not listed in the file	Not listed in the file	$810.99 – $1,934.46
MRI of the brain, before and after contrast: rates for 9 insurance plans Aetna — Commercial: $810.99 Aetna — MCR Advantage: $118.49 Anthem — Commercial: $1,644.21 Anthem — MCR Advantage: $119.66 Cigna — Commercial: $1,934.46 Martin's Point — MCR Advantage: $118.49 UHC — MCR Advantage: $118.49 Wellcare — MCR Advantage: $118.49 Harvard — Commercial: 60.98% (a percentage in the contract, not a dollar amount)
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XR Chest 2 Views	$467	$154.11	$196.14 – $467
Chest X-ray, 2 views: 10 of 11 insurance plan rates Aetna — Commercial: $321.76 Aetna — MCR Advantage: $196.14 Anthem — Commercial: $303.55 Anthem — MCR Advantage: $196.14 CHO — Commercial: $467 Cigna — Commercial: $348.38 Harvard — Commercial: $328.49 Martin's Point — MCR Advantage: $196.14 UHC — Commercial: $380.60 UHC — MCR Advantage: $196.14
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XR Chest Special Views	$467	$154.11	$196.14 – $467
Chest X-ray, 2 views: 10 of 11 insurance plan rates Aetna — Commercial: $321.76 Aetna — MCR Advantage: $196.14 Anthem — Commercial: $303.55 Anthem — MCR Advantage: $196.14 CHO — Commercial: $467 Cigna — Commercial: $348.38 Harvard — Commercial: $328.49 Martin's Point — MCR Advantage: $196.14 UHC — Commercial: $380.60 UHC — MCR Advantage: $196.14
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: XR Chest 2 Views	$467	$154.11	$303.55 – $467
Chest X-ray, 2 views: rates for 5 insurance plans Aetna — Commercial: $357.72 Anthem — Commercial: $303.55 CHO — Commercial: $467 Cigna — Commercial: $348.38 UHC — Commercial: $361.46
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XR Spine Lumbosacral Minimum 4 Views	$566	$186.78	$237.72 – $566
X-ray of the lower spine, at least 4 views: 10 of 11 insurance plan rates Aetna — Commercial: $389.97 Aetna — MCR Advantage: $237.72 Anthem — Commercial: $367.90 Anthem — MCR Advantage: $237.72 CHO — Commercial: $566 Cigna — Commercial: $422.24 Harvard — Commercial: $398.12 Martin's Point — MCR Advantage: $237.72 UHC — Commercial: $461.29 UHC — MCR Advantage: $237.72
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: XR Spine Lumbosacral Minimum 4 Views	$566	$186.78	$367.90 – $566
X-ray of the lower spine, at least 4 views: rates for 5 insurance plans Aetna — Commercial: $433.56 Anthem — Commercial: $367.90 CHO — Commercial: $566 Cigna — Commercial: $422.24 UHC — Commercial: $438.08
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam l-2 spine 4/>vws	Not listed in the file	Not listed in the file	$147.73 – $576.03
X-ray of the lower spine, at least 4 views: rates for 8 insurance plans Aetna — Commercial: $147.73 Aetna — MCR Advantage: $13.92 Anthem — Commercial: $489.60 Anthem — MCR Advantage: $14.06 Cigna — Commercial: $576.03 Martin's Point — MCR Advantage: $13.92 UHC — MCR Advantage: $13.92 Wellcare — MCR Advantage: $13.92
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Spine Lumbar w/o Contrast	$1,849	$610.17	$776.58 – $1,849
MRI of the lower back (lumbar spine), without contrast: 10 of 11 insurance plan rates Aetna — Commercial: $1,273.96 Aetna — MCR Advantage: $776.58 Anthem — Commercial: $1,201.85 Anthem — MCR Advantage: $776.58 CHO — Commercial: $1,849 Cigna — Commercial: $1,379.35 Harvard — Commercial: $1,300.59 Martin's Point — MCR Advantage: $776.58 UHC — Commercial: $1,506.94 UHC — MCR Advantage: $776.58
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI Spine Lumbar w/o Contrast	$1,849	$610.17	$1,201.85 – $1,849
MRI of the lower back (lumbar spine), without contrast: rates for 5 insurance plans Aetna — Commercial: $1,416.33 Anthem — Commercial: $1,201.85 CHO — Commercial: $1,849 Cigna — Commercial: $1,379.35 UHC — Commercial: $1,431.13
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri lumbar spine w/o dye	Not listed in the file	Not listed in the file	$467.46 – $1,309.32
MRI of the lower back (lumbar spine), without contrast: rates for 9 insurance plans Aetna — Commercial: $467.46 Aetna — MCR Advantage: $76.58 Anthem — Commercial: $1,112.86 Anthem — MCR Advantage: $77.33 Cigna — Commercial: $1,309.32 Martin's Point — MCR Advantage: $76.58 UHC — MCR Advantage: $76.58 Wellcare — MCR Advantage: $76.58 Harvard — Commercial: 60.98% (a percentage in the contract, not a dollar amount)
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Pelvis w/ Contrast	$1,788	$590.04	$750.96 – $1,788
CT scan of the pelvis, with contrast: 10 of 11 insurance plan rates Aetna — Commercial: $1,231.93 Aetna — MCR Advantage: $750.96 Anthem — Commercial: $1,162.20 Anthem — MCR Advantage: $750.96 CHO — Commercial: $1,788 Cigna — Commercial: $1,333.85 Harvard — Commercial: $1,257.68 Martin's Point — MCR Advantage: $750.96 UHC — Commercial: $1,457.22 UHC — MCR Advantage: $750.96
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Pelvis w/ Contrast	$1,788	$590.04	$1,162.20 – $1,788
CT scan of the pelvis, with contrast: rates for 5 insurance plans Aetna — Commercial: $1,369.61 Anthem — Commercial: $1,162.20 CHO — Commercial: $1,788 Cigna — Commercial: $1,333.85 UHC — Commercial: $1,383.91
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct pelvis w/dye	Not listed in the file	Not listed in the file	$660.75 – $964.26
CT scan of the pelvis, with contrast: rates for 9 insurance plans Aetna — Commercial: $660.75 Aetna — MCR Advantage: $59.80 Anthem — Commercial: $819.58 Anthem — MCR Advantage: $60.39 Cigna — Commercial: $964.26 Martin's Point — MCR Advantage: $59.80 UHC — MCR Advantage: $59.80 Wellcare — MCR Advantage: $59.80 Harvard — Commercial: 60.98% (a percentage in the contract, not a dollar amount)
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	Not listed in the file	$536.10 – $1,309.32
MRI of a leg joint (such as the knee), without contrast: rates for 9 insurance plans Aetna — Commercial: $536.10 Aetna — MCR Advantage: $70.03 Anthem — Commercial: $1,112.86 Anthem — MCR Advantage: $70.72 Cigna — Commercial: $1,309.32 Martin's Point — MCR Advantage: $70.03 UHC — MCR Advantage: $70.03 Wellcare — MCR Advantage: $70.03 Harvard — Commercial: 60.98% (a percentage in the contract, not a dollar amount)
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	Not listed in the file	$185.84 – $325.22
MRI of a leg joint (such as the knee), without contrast: rates for 2 insurance plans CHO — Commercial: $325.22 UHC — Commercial: $185.84
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: MRI Ankle w/o Contrast Left	$1,933	$637.89	$811.86 – $1,933
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates Aetna — Commercial: $1,331.84 Aetna — MCR Advantage: $811.86 Anthem — Commercial: $1,256.45 Anthem — MCR Advantage: $811.86 CHO — Commercial: $1,933 Cigna — Commercial: $1,442.02 Harvard — Commercial: $1,359.67 Martin's Point — MCR Advantage: $811.86 UHC — Commercial: $1,575.40 UHC — MCR Advantage: $811.86
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Abdomen/Pelvis w/ Contrast	$4,530	$1,494.90	$1,902.60 – $4,530
CT scan of the abdomen and pelvis, with contrast: 10 of 11 insurance plan rates Aetna — Commercial: $3,121.17 Aetna — MCR Advantage: $1,902.60 Anthem — Commercial: $2,944.50 Anthem — MCR Advantage: $1,902.60 CHO — Commercial: $4,530 Cigna — Commercial: $3,379.38 Harvard — Commercial: $3,186.40 Martin's Point — MCR Advantage: $1,902.60 UHC — Commercial: $3,691.95 UHC — MCR Advantage: $1,902.60
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT Abdomen/Pelvis w/ Contrast	$4,530	$1,494.90	$2,944.50 – $4,530
CT scan of the abdomen and pelvis, with contrast: rates for 5 insurance plans Aetna — Commercial: $3,469.98 Anthem — Commercial: $2,944.50 CHO — Commercial: $4,530 Cigna — Commercial: $3,379.38 UHC — Commercial: $3,506.22
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct abd & pelvis w/contrast	Not listed in the file	Not listed in the file	$828.92 – $1,934.46
CT scan of the abdomen and pelvis, with contrast: rates for 9 insurance plans Aetna — Commercial: $828.92 Aetna — MCR Advantage: $94.38 Anthem — Commercial: $1,644.21 Anthem — MCR Advantage: $95.31 Cigna — Commercial: $1,934.46 Martin's Point — MCR Advantage: $94.38 UHC — MCR Advantage: $94.38 Wellcare — MCR Advantage: $94.38 Harvard — Commercial: 60.98% (a percentage in the contract, not a dollar amount)
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Abdomen Complete	$803	$264.99	$337.26 – $803
Ultrasound of the abdomen, complete: 10 of 11 insurance plan rates Aetna — Commercial: $553.27 Aetna — MCR Advantage: $337.26 Anthem — Commercial: $521.95 Anthem — MCR Advantage: $337.26 CHO — Commercial: $803 Cigna — Commercial: $599.04 Harvard — Commercial: $564.83 Martin's Point — MCR Advantage: $337.26 UHC — Commercial: $654.44 UHC — MCR Advantage: $337.26
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Abdomen Complete	$803	$264.99	$521.95 – $803
Ultrasound of the abdomen, complete: rates for 5 insurance plans Aetna — Commercial: $615.10 Anthem — Commercial: $521.95 CHO — Commercial: $803 Cigna — Commercial: $599.04 UHC — Commercial: $621.52
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Us exam abdom complete	Not listed in the file	Not listed in the file	$290.45 – $576.03
Ultrasound of the abdomen, complete: rates for 9 insurance plans Aetna — Commercial: $290.45 Aetna — MCR Advantage: $41.77 Anthem — Commercial: $489.60 Anthem — MCR Advantage: $42.18 Cigna — Commercial: $576.03 Martin's Point — MCR Advantage: $41.77 UHC — MCR Advantage: $41.77 Wellcare — MCR Advantage: $41.77 Harvard — Commercial: 60.98% (a percentage in the contract, not a dollar amount)
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US OB Complete	$729	$240.57	$306.18 – $729
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates Aetna — Commercial: $502.28 Aetna — MCR Advantage: $306.18 Anthem — Commercial: $473.85 Anthem — MCR Advantage: $306.18 CHO — Commercial: $729 Cigna — Commercial: $543.83 Harvard — Commercial: $512.78 Martin's Point — MCR Advantage: $306.18 UHC — Commercial: $594.14 UHC — MCR Advantage: $306.18
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MAYO OB Complete	$729	$240.57	$306.18 – $729
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates Aetna — Commercial: $502.28 Aetna — MCR Advantage: $306.18 Anthem — Commercial: $473.85 Anthem — MCR Advantage: $306.18 CHO — Commercial: $729 Cigna — Commercial: $543.83 Harvard — Commercial: $512.78 Martin's Point — MCR Advantage: $306.18 UHC — Commercial: $594.14 UHC — MCR Advantage: $306.18
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · both In the file: 76805 ULTRASOUND >14 WEEKS	$1,012	$333.96	$425.04 – $1,012
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates Aetna — Commercial: $697.27 Aetna — MCR Advantage: $425.04 Anthem — Commercial: $657.80 Anthem — MCR Advantage: $425.04 CHO — Commercial: $1,012 Cigna — Commercial: $754.95 Harvard — Commercial: $711.84 Martin's Point — MCR Advantage: $425.04 UHC — Commercial: $824.78 UHC — MCR Advantage: $425.04
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Transvaginal Non-OB	$569	$187.77	$238.98 – $569
Transvaginal ultrasound: 10 of 11 insurance plan rates Aetna — Commercial: $392.04 Aetna — MCR Advantage: $238.98 Anthem — Commercial: $369.85 Anthem — MCR Advantage: $238.98 CHO — Commercial: $569 Cigna — Commercial: $424.47 Harvard — Commercial: $400.23 Martin's Point — MCR Advantage: $238.98 UHC — Commercial: $463.73 UHC — MCR Advantage: $238.98
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Transvaginal Non-OB	$569	$187.77	$369.85 – $569
Transvaginal ultrasound: rates for 5 insurance plans Aetna — Commercial: $435.85 Anthem — Commercial: $369.85 CHO — Commercial: $569 Cigna — Commercial: $424.47 UHC — Commercial: $440.41
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Transvaginal us non-ob	Not listed in the file	Not listed in the file	$319.35 – $576.03
Transvaginal ultrasound: rates for 9 insurance plans Aetna — Commercial: $319.35 Aetna — MCR Advantage: $35.92 Anthem — Commercial: $489.60 Anthem — MCR Advantage: $36.28 Cigna — Commercial: $576.03 Martin's Point — MCR Advantage: $35.92 UHC — MCR Advantage: $35.92 Wellcare — MCR Advantage: $35.92 Harvard — Commercial: 60.98% (a percentage in the contract, not a dollar amount)
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$96.15 – $329.38
Diagnostic mammogram, one breast: rates for 8 insurance plans Aetna — Commercial: $329.38 Aetna — MCR Advantage: $41.77 Anthem — Commercial: $96.15 Anthem — MCR Advantage: $42.18 Cigna — Commercial: $214.65 Martin's Point — MCR Advantage: $41.77 UHC — MCR Advantage: $41.77 Wellcare — MCR Advantage: $41.77
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$113.11 – $197.94
Diagnostic mammogram, one breast: rates for 2 insurance plans CHO — Commercial: $197.94 UHC — Commercial: $113.11
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: MA Mammogram Diagnostic Right.	$313	$103.29	$131.46 – $313
Diagnostic mammogram, one breast: 10 of 11 insurance plan rates Aetna — Commercial: $215.66 Aetna — MCR Advantage: $131.46 Anthem — Commercial: $203.45 Anthem — MCR Advantage: $131.46 CHO — Commercial: $313 Cigna — Commercial: $233.50 Harvard — Commercial: $220.16 Martin's Point — MCR Advantage: $131.46 UHC — Commercial: $255.09 UHC — MCR Advantage: $131.46
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Mammogram Diagnostic Bilateral.	$531	$175.23	$223.02 – $531
Diagnostic mammogram, both breasts: 10 of 11 insurance plan rates Aetna — Commercial: $365.86 Aetna — MCR Advantage: $223.02 Anthem — Commercial: $345.15 Anthem — MCR Advantage: $223.02 CHO — Commercial: $531 Cigna — Commercial: $396.13 Harvard — Commercial: $373.51 Martin's Point — MCR Advantage: $223.02 UHC — Commercial: $432.76 UHC — MCR Advantage: $223.02
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Mammo Diagnostic 3D Bilateral.	$531	$175.23	$223.02 – $531
Diagnostic mammogram, both breasts: 10 of 11 insurance plan rates Aetna — Commercial: $365.86 Aetna — MCR Advantage: $223.02 Anthem — Commercial: $345.15 Anthem — MCR Advantage: $223.02 CHO — Commercial: $531 Cigna — Commercial: $396.13 Harvard — Commercial: $373.51 Martin's Point — MCR Advantage: $223.02 UHC — Commercial: $432.76 UHC — MCR Advantage: $223.02
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MA Mammogram Diagnostic Bilateral.	$531	$175.23	$345.15 – $531
Diagnostic mammogram, both breasts: rates for 5 insurance plans Aetna — Commercial: $406.75 Anthem — Commercial: $345.15 CHO — Commercial: $531 Cigna — Commercial: $396.13 UHC — Commercial: $410.99
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Mammogram Routine Screening Bilat.	$361	$119.13	$151.62 – $361
Screening mammogram, both breasts: 10 of 11 insurance plan rates Aetna — Commercial: $248.73 Aetna — MCR Advantage: $151.62 Anthem — Commercial: $234.65 Anthem — MCR Advantage: $151.62 CHO — Commercial: $361 Cigna — Commercial: $269.31 Harvard — Commercial: $253.93 Martin's Point — MCR Advantage: $151.62 UHC — Commercial: $294.21 UHC — MCR Advantage: $151.62
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MA Mammo Screening 3D Bilateral.	$361	$119.13	$151.62 – $361
Screening mammogram, both breasts: 10 of 11 insurance plan rates Aetna — Commercial: $248.73 Aetna — MCR Advantage: $151.62 Anthem — Commercial: $234.65 Anthem — MCR Advantage: $151.62 CHO — Commercial: $361 Cigna — Commercial: $269.31 Harvard — Commercial: $253.93 Martin's Point — MCR Advantage: $151.62 UHC — Commercial: $294.21 UHC — MCR Advantage: $151.62
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MA Mammogram Routine Screening Bilat.	$361	$119.13	$234.65 – $361
Screening mammogram, both breasts: rates for 5 insurance plans Aetna — Commercial: $276.53 Anthem — Commercial: $234.65 CHO — Commercial: $361 Cigna — Commercial: $269.31 UHC — Commercial: $279.41

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EKG 12 LEAD, INTERP/REPORT ONLY CHARGE	$92	$30.36	$38.64 – $92
Electrocardiogram (ECG/EKG) with reading: 10 of 11 insurance plan rates Aetna — Commercial: $63.39 Aetna — MCR Advantage: $38.64 Anthem — Commercial: $59.80 Anthem — MCR Advantage: $38.64 CHO — Commercial: $92 Cigna — Commercial: $68.63 Harvard — Commercial: $64.71 Martin's Point — MCR Advantage: $38.64 UHC — Commercial: $74.98 UHC — MCR Advantage: $38.64
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EKG POC	$146	$48.18	$61.32 – $146
Electrocardiogram (ECG/EKG) with reading: 10 of 11 insurance plan rates Aetna — Commercial: $100.59 Aetna — MCR Advantage: $61.32 Anthem — Commercial: $94.90 Anthem — MCR Advantage: $61.32 CHO — Commercial: $146 Cigna — Commercial: $108.92 Harvard — Commercial: $102.70 Martin's Point — MCR Advantage: $61.32 UHC — Commercial: $118.99 UHC — MCR Advantage: $61.32
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EKG 12 LEAD, INTERP/REPORT ONLY CHARGE	$92	$30.36	$59.80 – $92
Electrocardiogram (ECG/EKG) with reading: rates for 5 insurance plans Aetna — Commercial: $70.47 Anthem — Commercial: $59.80 CHO — Commercial: $92 Cigna — Commercial: $68.63 UHC — Commercial: $71.21
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	$245.25 – $247.65
Left heart catheterization (diagnostic): rates for 8 insurance plans Aetna — MCR Advantage: $245.25 Anthem — Commercial: $14,808.23 Anthem — MCR Advantage: $247.65 Cigna — Commercial: $17,422.29 Martin's Point — MCR Advantage: $245.25 UHC — MCR Advantage: $245.25 Wellcare — MCR Advantage: $245.25 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$763.06 – $1,335.36
Left heart catheterization (diagnostic): rates for 2 insurance plans CHO — Commercial: $1,335.36 UHC — Commercial: $763.06
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$209.08 – $504.94
Left heart catheterization (diagnostic): rates for 9 insurance plans Aetna — Commercial: $365.89 Aetna — MCR Advantage: $209.08 Anthem — Commercial: $432.37 Anthem — MCR Advantage: $209.08 Cigna — Commercial: $498.68 Harvard — Commercial: $504.94 Martin's Point — MCR Advantage: $213.26 UHC — MCR Advantage: $209.08 Wellcare — MCR Advantage: $213.26
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	$397.73 – $401.63
Heart rhythm study (electrophysiology evaluation): rates for 8 insurance plans Aetna — MCR Advantage: $397.73 Anthem — Commercial: $34,935.28 Anthem — MCR Advantage: $401.63 Cigna — Commercial: $41,102.33 Martin's Point — MCR Advantage: $397.73 UHC — MCR Advantage: $397.73 Wellcare — MCR Advantage: $397.73 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Comprehensive ep evaluation	Not listed in the file	Not listed in the file	$648.48 – $1,117.13
Heart rhythm study (electrophysiology evaluation): rates for 2 insurance plans CHO — Commercial: $1,117.13 UHC — Commercial: $648.48
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: Comprehensive ep evaluation	Not listed in the file	Not listed in the file	$339.07 – $821.46
Heart rhythm study (electrophysiology evaluation): rates for 9 insurance plans Aetna — Commercial: $593.37 Aetna — MCR Advantage: $339.07 Anthem — Commercial: $701.56 Anthem — MCR Advantage: $339.07 Cigna — Commercial: $821.46 Harvard — Commercial: $820.80 Martin's Point — MCR Advantage: $345.85 UHC — MCR Advantage: $339.07 Wellcare — MCR Advantage: $345.85
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Compre ep eval abltj atr fib	Not listed in the file	Not listed in the file	$834.07 – $2,351.22
Heart rhythm study with ablation for atrial fibrillation: 10 of 11 insurance plan rates Aetna — Commercial: $1,459.62 Aetna — MCR Advantage: $834.07 Anthem — Commercial: $1,739.48 Anthem — MCR Advantage: $834.07 CHO — Commercial: $1,459.62 Cigna — Commercial: $2,351.22 Harvard — Commercial: $2,029.26 Martin's Point — MCR Advantage: $850.75 UHC — Commercial: $834.07 UHC — MCR Advantage: $834.07
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	$978.36 – $987.96
Heart rhythm study with ablation for atrial fibrillation: rates for 8 insurance plans Aetna — MCR Advantage: $978.36 Anthem — Commercial: $112,945.59 Anthem — MCR Advantage: $987.96 Cigna — Commercial: $132,883.64 Martin's Point — MCR Advantage: $978.36 UHC — MCR Advantage: $978.36 Wellcare — MCR Advantage: $978.36 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 95810 SLEEP STUDY (DIAGNOSTIC) CHARGE	$4,665	$1,539.45	$1,959.30 – $4,665
Sleep study (overnight, in a sleep lab): 10 of 11 insurance plan rates Aetna — Commercial: $3,214.18 Aetna — MCR Advantage: $1,959.30 Anthem — Commercial: $3,032.25 Anthem — MCR Advantage: $1,959.30 CHO — Commercial: $4,665 Cigna — Commercial: $3,480.09 Harvard — Commercial: $3,281.36 Martin's Point — MCR Advantage: $1,959.30 UHC — Commercial: $3,801.98 UHC — MCR Advantage: $1,959.30
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Sleep Study Diagnostic	$4,665	$1,539.45	$1,959.30 – $4,665
Sleep study (overnight, in a sleep lab): 10 of 11 insurance plan rates Aetna — Commercial: $3,214.18 Aetna — MCR Advantage: $1,959.30 Anthem — Commercial: $3,032.25 Anthem — MCR Advantage: $1,959.30 CHO — Commercial: $4,665 Cigna — Commercial: $3,480.09 Harvard — Commercial: $3,281.36 Martin's Point — MCR Advantage: $1,959.30 UHC — Commercial: $3,801.98 UHC — MCR Advantage: $1,959.30
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 95810 SLEEP STUDY (DIAGNOSTIC) CHARGE	$4,665	$1,539.45	$3,032.25 – $4,665
Sleep study (overnight, in a sleep lab): rates for 5 insurance plans Aetna — Commercial: $3,573.39 Anthem — Commercial: $3,032.25 CHO — Commercial: $4,665 Cigna — Commercial: $3,480.09 UHC — Commercial: $3,610.71

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 97110 PTA THERAPEUTIC EXERCISES (TIMED PER 15 MINS	$132	$43.56	$55.44 – $132
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $90.95 Aetna — MCR Advantage: $55.44 Anthem — Commercial: $85.80 Anthem — MCR Advantage: $55.44 CHO — Commercial: $132 Cigna — Commercial: $98.47 Harvard — Commercial: $92.85 Martin's Point — MCR Advantage: $55.44 UHC — Commercial: $107.58 UHC — MCR Advantage: $55.44
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 97110 PTA THERAPEUTIC EXERCISES (TIMED PER 15 MINS	$132	$43.56	$85.80 – $132
Physical therapy: therapeutic exercise (each 15 minutes): rates for 5 insurance plans Aetna — Commercial: $101.11 Anthem — Commercial: $85.80 CHO — Commercial: $132 Cigna — Commercial: $98.47 UHC — Commercial: $102.17
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Therapeutic exercises	Not listed in the file	Not listed in the file	$27.47 – $64.86
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 11 insurance plan rates Aetna — Commercial: $48.07 Aetna — MCR Advantage: $27.47 Anthem — Commercial: $55.85 Anthem — MCR Advantage: $27.47 CHO — Commercial: $48.07 Cigna — Commercial: $64.86 Harvard — Commercial: $64.50 Martin's Point — MCR Advantage: $28.02 UHC — Commercial: $27.47 UHC — MCR Advantage: $27.47
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$93.48 – $220.64
Physical therapy evaluation (low complexity): 10 of 11 insurance plan rates Aetna — Commercial: $163.59 Aetna — MCR Advantage: $93.48 Anthem — Commercial: $190.14 Anthem — MCR Advantage: $93.48 CHO — Commercial: $163.59 Cigna — Commercial: $220.64 Harvard — Commercial: $220.58 Martin's Point — MCR Advantage: $95.35 UHC — Commercial: $93.48 UHC — MCR Advantage: $93.48
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$109.65 – $110.73
Physical therapy evaluation (low complexity): rates for 8 insurance plans Aetna — MCR Advantage: $109.65 Anthem — Commercial: $115.98 Anthem — MCR Advantage: $110.73 Cigna — Commercial: $342 Martin's Point — MCR Advantage: $109.65 UHC — MCR Advantage: $109.65 Wellcare — MCR Advantage: $109.65 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT Low Complex Units	$446	$147.18	$187.32 – $446
Physical therapy evaluation (low complexity): 10 of 11 insurance plan rates Aetna — Commercial: $307.29 Aetna — MCR Advantage: $187.32 Anthem — Commercial: $289.90 Anthem — MCR Advantage: $187.32 CHO — Commercial: $446 Cigna — Commercial: $332.72 Harvard — Commercial: $313.72 Martin's Point — MCR Advantage: $187.32 UHC — Commercial: $363.49 UHC — MCR Advantage: $187.32
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval mod complex 30 min	Not listed in the file	Not listed in the file	$93.48 – $220.64
Physical therapy evaluation (moderate complexity): 10 of 11 insurance plan rates Aetna — Commercial: $163.59 Aetna — MCR Advantage: $93.48 Anthem — Commercial: $190.14 Anthem — MCR Advantage: $93.48 CHO — Commercial: $163.59 Cigna — Commercial: $220.64 Harvard — Commercial: $220.58 Martin's Point — MCR Advantage: $95.35 UHC — Commercial: $93.48 UHC — MCR Advantage: $93.48
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval mod complex 30 min	Not listed in the file	Not listed in the file	$109.65 – $110.73
Physical therapy evaluation (moderate complexity): rates for 8 insurance plans Aetna — MCR Advantage: $109.65 Anthem — Commercial: $115.98 Anthem — MCR Advantage: $110.73 Cigna — Commercial: $342 Martin's Point — MCR Advantage: $109.65 UHC — MCR Advantage: $109.65 Wellcare — MCR Advantage: $109.65 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT Moderate Complex Units	$468	$154.44	$196.56 – $468
Physical therapy evaluation (moderate complexity): 10 of 11 insurance plan rates Aetna — Commercial: $322.45 Aetna — MCR Advantage: $196.56 Anthem — Commercial: $304.20 Anthem — MCR Advantage: $196.56 CHO — Commercial: $468 Cigna — Commercial: $349.13 Harvard — Commercial: $329.19 Martin's Point — MCR Advantage: $196.56 UHC — Commercial: $381.42 UHC — MCR Advantage: $196.56
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$93.48 – $220.64
Physical therapy evaluation (high complexity): 10 of 11 insurance plan rates Aetna — Commercial: $163.59 Aetna — MCR Advantage: $93.48 Anthem — Commercial: $190.14 Anthem — MCR Advantage: $93.48 CHO — Commercial: $163.59 Cigna — Commercial: $220.64 Harvard — Commercial: $220.58 Martin's Point — MCR Advantage: $95.35 UHC — Commercial: $93.48 UHC — MCR Advantage: $93.48
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$109.65 – $110.73
Physical therapy evaluation (high complexity): rates for 8 insurance plans Aetna — MCR Advantage: $109.65 Anthem — Commercial: $115.98 Anthem — MCR Advantage: $110.73 Cigna — Commercial: $342 Martin's Point — MCR Advantage: $109.65 UHC — MCR Advantage: $109.65 Wellcare — MCR Advantage: $109.65 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT High Complex Units	$491	$162.03	$206.22 – $491
Physical therapy evaluation (high complexity): 10 of 11 insurance plan rates Aetna — Commercial: $338.30 Aetna — MCR Advantage: $206.22 Anthem — Commercial: $319.15 Anthem — MCR Advantage: $206.22 CHO — Commercial: $491 Cigna — Commercial: $366.29 Harvard — Commercial: $345.37 Martin's Point — MCR Advantage: $206.22 UHC — Commercial: $400.16 UHC — MCR Advantage: $206.22
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · both In the file: 90832 PSYCHOTHRPY 30 MIN W/ PATIENT AND/OR FAMILY	$345	$113.85	$144.90 – $345
Psychotherapy, 30 minutes: 10 of 11 insurance plan rates Aetna — Commercial: $237.70 Aetna — MCR Advantage: $144.90 Anthem — Commercial: $224.25 Anthem — MCR Advantage: $144.90 CHO — Commercial: $345 Cigna — Commercial: $257.37 Harvard — Commercial: $242.67 Martin's Point — MCR Advantage: $144.90 UHC — Commercial: $281.17 UHC — MCR Advantage: $144.90
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psychotherapy, 30 minutes with patient and/or family member	$345	$113.85	$144.90 – $345
Psychotherapy, 30 minutes: 10 of 11 insurance plan rates Aetna — Commercial: $237.70 Aetna — MCR Advantage: $144.90 Anthem — Commercial: $224.25 Anthem — MCR Advantage: $144.90 CHO — Commercial: $345 Cigna — Commercial: $257.37 Harvard — Commercial: $242.67 Martin's Point — MCR Advantage: $144.90 UHC — Commercial: $281.17 UHC — MCR Advantage: $144.90
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · both In the file: 90832 PSYCHOTHRPY 30 MIN W/ PATIENT AND/OR FAMILY	$345	$113.85	$224.25 – $345
Psychotherapy, 30 minutes: rates for 5 insurance plans Aetna — Commercial: $264.27 Anthem — Commercial: $224.25 CHO — Commercial: $345 Cigna — Commercial: $257.37 UHC — Commercial: $267.03
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · both In the file: Psychotherapy, 45 minutes with patient and/or family member	$528	$174.24	$221.76 – $528
Psychotherapy, 45 minutes: 10 of 11 insurance plan rates Aetna — Commercial: $363.79 Aetna — MCR Advantage: $221.76 Anthem — Commercial: $343.20 Anthem — MCR Advantage: $221.76 CHO — Commercial: $528 Cigna — Commercial: $393.89 Harvard — Commercial: $371.40 Martin's Point — MCR Advantage: $221.76 UHC — Commercial: $430.32 UHC — MCR Advantage: $221.76
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · both In the file: Psychotherapy, 45 minutes with patient and/or family member	$528	$174.24	$343.20 – $528
Psychotherapy, 45 minutes: rates for 5 insurance plans Aetna — Commercial: $404.45 Anthem — Commercial: $343.20 CHO — Commercial: $528 Cigna — Commercial: $393.89 UHC — Commercial: $408.67
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psytx w pt 45 minutes	Not listed in the file	Not listed in the file	$89.46 – $198.61
Psychotherapy, 45 minutes: 10 of 11 insurance plan rates Aetna — Commercial: $156.56 Aetna — MCR Advantage: $89.46 Anthem — Commercial: $176.33 Anthem — MCR Advantage: $89.46 CHO — Commercial: $156.56 Cigna — Commercial: $194.76 Harvard — Commercial: $198.61 Martin's Point — MCR Advantage: $91.25 UHC — Commercial: $89.46 UHC — MCR Advantage: $89.46
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · both In the file: Psychotherapy, 60 minutes with patient	$852	$281.16	$357.84 – $852
Psychotherapy, 60 minutes: 10 of 11 insurance plan rates Aetna — Commercial: $587.03 Aetna — MCR Advantage: $357.84 Anthem — Commercial: $553.80 Anthem — MCR Advantage: $357.84 CHO — Commercial: $852 Cigna — Commercial: $635.59 Harvard — Commercial: $599.30 Martin's Point — MCR Advantage: $357.84 UHC — Commercial: $694.38 UHC — MCR Advantage: $357.84
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · both In the file: Psychotherapy, 60 minutes with patient	$852	$281.16	$553.80 – $852
Psychotherapy, 60 minutes: rates for 5 insurance plans Aetna — Commercial: $652.63 Anthem — Commercial: $553.80 CHO — Commercial: $852 Cigna — Commercial: $635.59 UHC — Commercial: $659.45
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psytx w pt 60 minutes	Not listed in the file	Not listed in the file	$132.39 – $293.14
Psychotherapy, 60 minutes: 10 of 11 insurance plan rates Aetna — Commercial: $231.68 Aetna — MCR Advantage: $132.39 Anthem — Commercial: $261.05 Anthem — MCR Advantage: $132.39 CHO — Commercial: $231.68 Cigna — Commercial: $286.03 Harvard — Commercial: $293.14 Martin's Point — MCR Advantage: $135.04 UHC — Commercial: $132.39 UHC — MCR Advantage: $132.39
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$96.67 – $214
Family psychotherapy, without the patient: 10 of 11 insurance plan rates Aetna — Commercial: $169.17 Aetna — MCR Advantage: $96.67 Anthem — Commercial: $190.76 Anthem — MCR Advantage: $96.67 CHO — Commercial: $169.17 Cigna — Commercial: $209.81 Harvard — Commercial: $214 Martin's Point — MCR Advantage: $98.60 UHC — Commercial: $96.67 UHC — MCR Advantage: $96.67
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$113.73 – $114.85
Family psychotherapy, without the patient: rates for 8 insurance plans Aetna — MCR Advantage: $113.73 Anthem — Commercial: $739.73 Anthem — MCR Advantage: $114.85 Cigna — Commercial: $870.32 Martin's Point — MCR Advantage: $113.73 UHC — MCR Advantage: $113.73 Wellcare — MCR Advantage: $113.73 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 95 In the file: 90846 - TELEHEALTH FAMILY PSYCHOTHERAPY (W/OUT PAT	$212	$69.96	$89.04 – $212
Family psychotherapy, without the patient: 10 of 11 insurance plan rates Aetna — Commercial: $146.07 Aetna — MCR Advantage: $89.04 Anthem — Commercial: $137.80 Anthem — MCR Advantage: $89.04 CHO — Commercial: $212 Cigna — Commercial: $158.15 Harvard — Commercial: $149.12 Martin's Point — MCR Advantage: $89.04 UHC — Commercial: $172.78 UHC — MCR Advantage: $89.04
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WIT	$448	$147.84	$188.16 – $448
Family psychotherapy, with the patient: 10 of 11 insurance plan rates Aetna — Commercial: $308.67 Aetna — MCR Advantage: $188.16 Anthem — Commercial: $291.20 Anthem — MCR Advantage: $188.16 CHO — Commercial: $448 Cigna — Commercial: $334.21 Harvard — Commercial: $315.12 Martin's Point — MCR Advantage: $188.16 UHC — Commercial: $365.12 UHC — MCR Advantage: $188.16
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Doctor (professional) fee In the file: FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WIT	$448	$147.84	$291.20 – $448
Family psychotherapy, with the patient: rates for 5 insurance plans Aetna — Commercial: $343.17 Anthem — Commercial: $291.20 CHO — Commercial: $448 Cigna — Commercial: $334.21 UHC — Commercial: $346.75
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Family psytx w/pt 50 min	Not listed in the file	Not listed in the file	$100.82 – $223.51
Family psychotherapy, with the patient: 10 of 11 insurance plan rates Aetna — Commercial: $176.44 Aetna — MCR Advantage: $100.82 Anthem — Commercial: $198.93 Anthem — MCR Advantage: $100.82 CHO — Commercial: $176.44 Cigna — Commercial: $218.08 Harvard — Commercial: $223.51 Martin's Point — MCR Advantage: $102.84 UHC — Commercial: $100.82 UHC — MCR Advantage: $100.82
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Group psychotherapy	Not listed in the file	Not listed in the file	$23.81 – $52.77
Group psychotherapy: 10 of 11 insurance plan rates Aetna — Commercial: $41.67 Aetna — MCR Advantage: $23.81 Anthem — Commercial: $47.06 Anthem — MCR Advantage: $23.81 CHO — Commercial: $41.67 Cigna — Commercial: $51.39 Harvard — Commercial: $52.77 Martin's Point — MCR Advantage: $24.29 UHC — Commercial: $23.81 UHC — MCR Advantage: $23.81
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Group psychotherapy	Not listed in the file	Not listed in the file	$32.08 – $32.39
Group psychotherapy: rates for 8 insurance plans Aetna — MCR Advantage: $32.08 Anthem — Commercial: $425.88 Anthem — MCR Advantage: $32.39 Cigna — Commercial: $501.06 Martin's Point — MCR Advantage: $32.08 UHC — MCR Advantage: $32.08 Wellcare — MCR Advantage: $32.08 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 95 In the file: 90853 - TELEHEALTH GROUP PSYCHOTHERAPY (OTHER THAN	$77	$25.41	$32.34 – $77
Group psychotherapy: 10 of 11 insurance plan rates Aetna — Commercial: $53.05 Aetna — MCR Advantage: $32.34 Anthem — Commercial: $50.05 Anthem — MCR Advantage: $32.34 CHO — Commercial: $77 Cigna — Commercial: $57.44 Harvard — Commercial: $54.16 Martin's Point — MCR Advantage: $32.34 UHC — Commercial: $62.76 UHC — MCR Advantage: $32.34

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 19120 EXC OF LESION BREAST	$1,218	$401.94	$511.56 – $1,218
Removal of breast growth (open surgery): 10 of 11 insurance plan rates Aetna — Commercial: $839.20 Aetna — MCR Advantage: $511.56 Anthem — Commercial: $791.70 Anthem — MCR Advantage: $511.56 CHO — Commercial: $1,218 Cigna — Commercial: $908.63 Harvard — Commercial: $856.74 Martin's Point — MCR Advantage: $511.56 UHC — Commercial: $992.67 UHC — MCR Advantage: $511.56
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 19120 EXC OF LESION BREAST	$1,218	$401.94	$791.70 – $1,218
Removal of breast growth (open surgery): rates for 5 insurance plans Aetna — Commercial: $932.99 Anthem — Commercial: $791.70 CHO — Commercial: $1,218 Cigna — Commercial: $908.63 UHC — Commercial: $942.73
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	$551.62 – $557.02
Removal of breast growth (open surgery): rates for 8 insurance plans Aetna — MCR Advantage: $551.62 Anthem — Commercial: $17,629.84 Anthem — MCR Advantage: $557.02 Cigna — Commercial: $20,742 Martin's Point — MCR Advantage: $551.62 UHC — MCR Advantage: $551.62 Wellcare — MCR Advantage: $551.62 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 27130 Total Hip Arthroplasty	$2,778	$916.74	$1,166.76 – $2,778
Total hip replacement: 10 of 11 insurance plan rates Aetna — Commercial: $1,914.04 Aetna — MCR Advantage: $1,166.76 Anthem — Commercial: $1,805.70 Anthem — MCR Advantage: $1,166.76 CHO — Commercial: $2,778 Cigna — Commercial: $2,072.39 Harvard — Commercial: $1,954.05 Martin's Point — MCR Advantage: $1,166.76 UHC — Commercial: $2,264.07 UHC — MCR Advantage: $1,166.76
Total hip replacement CPT 27130 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 27130 Total Hip Arthroplasty	$2,778	$916.74	$1,805.70 – $2,778
Total hip replacement: rates for 5 insurance plans Aetna — Commercial: $2,127.95 Anthem — Commercial: $1,805.70 CHO — Commercial: $2,778 Cigna — Commercial: $2,072.39 UHC — Commercial: $2,150.17
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	$1,373.48 – $1,386.95
Total hip replacement: rates for 8 insurance plans Aetna — MCR Advantage: $1,373.48 Anthem — Commercial: $59,238.25 Anthem — MCR Advantage: $1,386.95 Cigna — Commercial: $69,695.45 Martin's Point — MCR Advantage: $1,373.48 UHC — MCR Advantage: $1,373.48 Wellcare — MCR Advantage: $1,373.48 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 27447 Total Knee Replacement	$3,881	$1,280.73	$1,630.02 – $3,881
Total knee replacement: 10 of 11 insurance plan rates Aetna — Commercial: $2,674.01 Aetna — MCR Advantage: $1,630.02 Anthem — Commercial: $2,522.65 Anthem — MCR Advantage: $1,630.02 CHO — Commercial: $3,881 Cigna — Commercial: $2,895.23 Harvard — Commercial: $2,729.90 Martin's Point — MCR Advantage: $1,630.02 UHC — Commercial: $3,163.02 UHC — MCR Advantage: $1,630.02
Total knee replacement CPT 27447 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 27447 Total Knee Replacement	$3,881	$1,280.73	$2,522.65 – $3,881
Total knee replacement: rates for 5 insurance plans Aetna — Commercial: $2,972.85 Anthem — Commercial: $2,522.65 CHO — Commercial: $3,881 Cigna — Commercial: $2,895.23 UHC — Commercial: $3,003.89
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	$1,371.85 – $1,385.30
Total knee replacement: rates for 8 insurance plans Aetna — MCR Advantage: $1,371.85 Anthem — Commercial: $59,238.25 Anthem — MCR Advantage: $1,385.30 Cigna — Commercial: $69,695.45 Martin's Point — MCR Advantage: $1,371.85 UHC — MCR Advantage: $1,371.85 Wellcare — MCR Advantage: $1,371.85 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 29826 SHOULDER ARTHROSCOPY/SURGERY-SC PF	$1,594	$526.02	$669.48 – $1,594
Shoulder arthroscopy: shaving of shoulder bone: 10 of 11 insurance plan rates Aetna — Commercial: $1,098.27 Aetna — MCR Advantage: $669.48 Anthem — Commercial: $1,036.10 Anthem — MCR Advantage: $669.48 CHO — Commercial: $1,594 Cigna — Commercial: $1,189.12 Harvard — Commercial: $1,121.22 Martin's Point — MCR Advantage: $669.48 UHC — Commercial: $1,299.11 UHC — MCR Advantage: $669.48
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 29826 SHOULDER ARTHROSCOPY/SURGERY-SC PF	$1,594	$526.02	$1,036.10 – $1,594
Shoulder arthroscopy: shaving of shoulder bone: rates for 5 insurance plans Aetna — Commercial: $1,221 Anthem — Commercial: $1,036.10 CHO — Commercial: $1,594 Cigna — Commercial: $1,189.12 UHC — Commercial: $1,233.76
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	$182.42 – $184.21
Shoulder arthroscopy: shaving of shoulder bone: rates for 6 insurance plans Aetna — MCR Advantage: $182.42 Anthem — MCR Advantage: $184.21 Martin's Point — MCR Advantage: $182.42 UHC — MCR Advantage: $182.42 Wellcare — MCR Advantage: $182.42 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 29881 Arthro W/Menis Med Or Lat	$1,822	$601.26	$765.24 – $1,822
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 11 insurance plan rates Aetna — Commercial: $1,255.36 Aetna — MCR Advantage: $765.24 Anthem — Commercial: $1,184.30 Anthem — MCR Advantage: $765.24 CHO — Commercial: $1,822 Cigna — Commercial: $1,359.21 Harvard — Commercial: $1,281.59 Martin's Point — MCR Advantage: $765.24 UHC — Commercial: $1,484.93 UHC — MCR Advantage: $765.24
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 29881 Arthro W/Menis Med Or Lat	$1,822	$601.26	$1,184.30 – $1,822
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 5 insurance plans Aetna — Commercial: $1,395.65 Anthem — Commercial: $1,184.30 CHO — Commercial: $1,822 Cigna — Commercial: $1,359.21 UHC — Commercial: $1,410.23
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	$585.78 – $591.52
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 8 insurance plans Aetna — MCR Advantage: $585.78 Anthem — Commercial: $14,938.04 Anthem — MCR Advantage: $591.52 Cigna — Commercial: $17,575.02 Martin's Point — MCR Advantage: $585.78 UHC — MCR Advantage: $585.78 Wellcare — MCR Advantage: $585.78 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
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	$315.80 – $318.90
Removal of tonsils and adenoids (under age 12): rates for 8 insurance plans Aetna — MCR Advantage: $315.80 Anthem — Commercial: $27,235.42 Anthem — MCR Advantage: $318.90 Cigna — Commercial: $32,043.23 Martin's Point — MCR Advantage: $315.80 UHC — MCR Advantage: $315.80 Wellcare — MCR Advantage: $315.80 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$269.23 – $557.87
Removal of tonsils and adenoids (under age 12): rates for 3 insurance plans Anthem — Commercial: $557.87 CHO — Commercial: $471.15 UHC — Commercial: $269.23
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$218.08 – $525.35
Removal of tonsils and adenoids (under age 12): rates for 8 insurance plans Aetna — Commercial: $381.63 Aetna — MCR Advantage: $218.08 Anthem — MCR Advantage: $218.08 Cigna — Commercial: $511.46 Harvard — Commercial: $525.35 Martin's Point — MCR Advantage: $222.44 UHC — MCR Advantage: $218.08 Wellcare — MCR Advantage: $222.44
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 43235 EGD	$649	$214.17	$272.58 – $649
Upper GI endoscopy (diagnostic): 10 of 11 insurance plan rates Aetna — Commercial: $447.16 Aetna — MCR Advantage: $272.58 Anthem — Commercial: $421.85 Anthem — MCR Advantage: $272.58 CHO — Commercial: $649 Cigna — Commercial: $484.15 Harvard — Commercial: $456.51 Martin's Point — MCR Advantage: $272.58 UHC — Commercial: $528.93 UHC — MCR Advantage: $272.58
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 43235 EGD	$649	$214.17	$421.85 – $649
Upper GI endoscopy (diagnostic): rates for 5 insurance plans Aetna — Commercial: $497.13 Anthem — Commercial: $421.85 CHO — Commercial: $649 Cigna — Commercial: $484.15 UHC — Commercial: $502.33
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Egd diagnostic brush wash	Not listed in the file	Not listed in the file	$111.38 – $266.02
Upper GI endoscopy (diagnostic): 10 of 11 insurance plan rates Aetna — Commercial: $194.92 Aetna — MCR Advantage: $111.38 Anthem — Commercial: $229.04 Anthem — MCR Advantage: $111.38 CHO — Commercial: $194.92 Cigna — Commercial: $263.36 Harvard — Commercial: $266.02 Martin's Point — MCR Advantage: $113.61 UHC — Commercial: $111.38 UHC — MCR Advantage: $111.38
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 43239 EGD WITH BIOPSY	$1,006	$331.98	$422.52 – $1,006
Upper GI endoscopy with biopsy: 10 of 11 insurance plan rates Aetna — Commercial: $693.13 Aetna — MCR Advantage: $422.52 Anthem — Commercial: $653.90 Anthem — MCR Advantage: $422.52 CHO — Commercial: $1,006 Cigna — Commercial: $750.48 Harvard — Commercial: $707.62 Martin's Point — MCR Advantage: $422.52 UHC — Commercial: $819.89 UHC — MCR Advantage: $422.52
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 43239 EGD WITH BIOPSY	$1,006	$331.98	$653.90 – $1,006
Upper GI endoscopy with biopsy: rates for 5 insurance plans Aetna — Commercial: $770.60 Anthem — Commercial: $653.90 CHO — Commercial: $1,006 Cigna — Commercial: $750.48 UHC — Commercial: $778.64
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Egd biopsy single/multiple	Not listed in the file	Not listed in the file	$125.34 – $300.47
Upper GI endoscopy with biopsy: 10 of 11 insurance plan rates Aetna — Commercial: $219.35 Aetna — MCR Advantage: $125.34 Anthem — Commercial: $257.28 Anthem — MCR Advantage: $125.34 CHO — Commercial: $219.35 Cigna — Commercial: $296.67 Harvard — Commercial: $300.47 Martin's Point — MCR Advantage: $127.85 UHC — Commercial: $125.34 UHC — MCR Advantage: $125.34
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: G0105 Colonoscopy Screen, High Risk Profee	$1,152	$380.16	$483.84 – $1,152
Colonoscopy (diagnostic): 10 of 11 insurance plan rates Aetna — Commercial: $793.73 Aetna — MCR Advantage: $483.84 Anthem — Commercial: $748.80 Anthem — MCR Advantage: $483.84 CHO — Commercial: $1,152 Cigna — Commercial: $859.39 Harvard — Commercial: $810.32 Martin's Point — MCR Advantage: $483.84 UHC — Commercial: $938.88 UHC — MCR Advantage: $483.84
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: G0121 SCREENING COLONOSCOPY	$1,152	$380.16	$483.84 – $1,152
Colonoscopy (diagnostic): 10 of 11 insurance plan rates Aetna — Commercial: $793.73 Aetna — MCR Advantage: $483.84 Anthem — Commercial: $748.80 Anthem — MCR Advantage: $483.84 CHO — Commercial: $1,152 Cigna — Commercial: $859.39 Harvard — Commercial: $810.32 Martin's Point — MCR Advantage: $483.84 UHC — Commercial: $938.88 UHC — MCR Advantage: $483.84
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: DIAGNOSTIC COLONOSCOPY	$1,152	$380.16	$483.84 – $1,152
Colonoscopy (diagnostic): 10 of 11 insurance plan rates Aetna — Commercial: $793.73 Aetna — MCR Advantage: $483.84 Anthem — Commercial: $748.80 Anthem — MCR Advantage: $483.84 CHO — Commercial: $1,152 Cigna — Commercial: $859.39 Harvard — Commercial: $810.32 Martin's Point — MCR Advantage: $483.84 UHC — Commercial: $938.88 UHC — MCR Advantage: $483.84
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 45380 COLONOSCOPY WITH BIOPSY	$1,252	$413.16	$525.84 – $1,252
Colonoscopy with biopsy: 10 of 11 insurance plan rates Aetna — Commercial: $862.63 Aetna — MCR Advantage: $525.84 Anthem — Commercial: $813.80 Anthem — MCR Advantage: $525.84 CHO — Commercial: $1,252 Cigna — Commercial: $933.99 Harvard — Commercial: $880.66 Martin's Point — MCR Advantage: $525.84 UHC — Commercial: $1,020.38 UHC — MCR Advantage: $525.84
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 45380 COLONOSCOPY WITH BIOPSY	$1,252	$413.16	$813.80 – $1,252
Colonoscopy with biopsy: rates for 5 insurance plans Aetna — Commercial: $959.03 Anthem — Commercial: $813.80 CHO — Commercial: $1,252 Cigna — Commercial: $933.99 UHC — Commercial: $969.05
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy and biopsy	Not listed in the file	Not listed in the file	$182.03 – $433.85
Colonoscopy with biopsy: 10 of 11 insurance plan rates Aetna — Commercial: $318.55 Aetna — MCR Advantage: $182.03 Anthem — Commercial: $374.01 Anthem — MCR Advantage: $182.03 CHO — Commercial: $318.55 Cigna — Commercial: $429.87 Harvard — Commercial: $433.85 Martin's Point — MCR Advantage: $185.67 UHC — Commercial: $182.03 UHC — MCR Advantage: $182.03
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 45385 COLON W/REMOVAL OF TUMOR,POLYP, OR OTHER LES BY SNARE	$1,399	$461.67	$587.58 – $1,399
Colonoscopy with removal of polyps (snare): 10 of 11 insurance plan rates Aetna — Commercial: $963.91 Aetna — MCR Advantage: $587.58 Anthem — Commercial: $909.35 Anthem — MCR Advantage: $587.58 CHO — Commercial: $1,399 Cigna — Commercial: $1,043.65 Harvard — Commercial: $984.06 Martin's Point — MCR Advantage: $587.58 UHC — Commercial: $1,140.18 UHC — MCR Advantage: $587.58
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 45385 COLON W/REMOVAL OF TUMOR,POLYP, OR OTHER LES BY SNARE	$1,399	$461.67	$909.35 – $1,399
Colonoscopy with removal of polyps (snare): rates for 5 insurance plans Aetna — Commercial: $1,071.63 Anthem — Commercial: $909.35 CHO — Commercial: $1,399 Cigna — Commercial: $1,043.65 UHC — Commercial: $1,082.83
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy w/lesion removal	Not listed in the file	Not listed in the file	$229.88 – $548.90
Colonoscopy with removal of polyps (snare): 10 of 11 insurance plan rates Aetna — Commercial: $402.29 Aetna — MCR Advantage: $229.88 Anthem — Commercial: $471.26 Anthem — MCR Advantage: $229.88 CHO — Commercial: $402.29 Cigna — Commercial: $546.03 Harvard — Commercial: $548.90 Martin's Point — MCR Advantage: $234.48 UHC — Commercial: $229.88 UHC — MCR Advantage: $229.88
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy w/endoscope us	Not listed in the file	Not listed in the file	$233.21 – $556.23
Ultrasound of the lower bowel by endoscope: 10 of 11 insurance plan rates Aetna — Commercial: $408.12 Aetna — MCR Advantage: $233.21 Anthem — Commercial: $477.55 Anthem — MCR Advantage: $233.21 CHO — Commercial: $408.12 Cigna — Commercial: $553.58 Harvard — Commercial: $556.23 Martin's Point — MCR Advantage: $237.87 UHC — Commercial: $233.21 UHC — MCR Advantage: $233.21
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	$273.55 – $276.24
Ultrasound of the lower bowel by endoscope: rates for 8 insurance plans Aetna — MCR Advantage: $273.55 Anthem — Commercial: $5,428.44 Anthem — MCR Advantage: $276.24 Cigna — Commercial: $6,386.71 Martin's Point — MCR Advantage: $273.55 UHC — MCR Advantage: $273.55 Wellcare — MCR Advantage: $273.55 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
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	$357.63 – $361.14
Screening colonoscopy (not high risk): rates for 7 insurance plans Aetna — MCR Advantage: $357.63 Anthem — Commercial: $4,197.46 Anthem — MCR Advantage: $361.14 Cigna — Commercial: $4,938.43 Martin's Point — MCR Advantage: $357.63 UHC — MCR Advantage: $357.63 Wellcare — MCR Advantage: $357.63
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$167.56 – $400.13
Screening colonoscopy (not high risk): rates for 4 insurance plans CHO — Commercial: $293.23 Cigna — Commercial: $301.75 Harvard — Commercial: $400.13 UHC — Commercial: $167.56
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 53 In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$152.44 – $318.16
Screening colonoscopy (not high risk): rates for 7 insurance plans Aetna — Commercial: $266.77 Aetna — MCR Advantage: $152.44 Anthem — Commercial: $318.16 Anthem — MCR Advantage: $152.44 Martin's Point — MCR Advantage: $155.49 UHC — MCR Advantage: $152.44 Wellcare — MCR Advantage: $155.49
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 47562 LAP CHOLECYSTECTOMY	$1,895	$625.35	$795.90 – $1,895
Gallbladder removal by laparoscope: 10 of 11 insurance plan rates Aetna — Commercial: $1,305.66 Aetna — MCR Advantage: $795.90 Anthem — Commercial: $1,231.75 Anthem — MCR Advantage: $795.90 CHO — Commercial: $1,895 Cigna — Commercial: $1,413.67 Harvard — Commercial: $1,332.94 Martin's Point — MCR Advantage: $795.90 UHC — Commercial: $1,544.42 UHC — MCR Advantage: $795.90
Gallbladder removal by laparoscope CPT 47562 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 47562 LAP CHOLECYSTECTOMY	$1,895	$625.35	$1,231.75 – $1,895
Gallbladder removal by laparoscope: rates for 5 insurance plans Aetna — Commercial: $1,451.57 Anthem — Commercial: $1,231.75 CHO — Commercial: $1,895 Cigna — Commercial: $1,413.67 UHC — Commercial: $1,466.73
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	$703.32 – $710.22
Gallbladder removal by laparoscope: rates for 8 insurance plans Aetna — MCR Advantage: $703.32 Anthem — Commercial: $26,861.14 Anthem — MCR Advantage: $710.22 Cigna — Commercial: $31,602.88 Martin's Point — MCR Advantage: $703.32 UHC — MCR Advantage: $703.32 Wellcare — MCR Advantage: $703.32 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 49505 REP INGU HERN 5 UP W	$1,135	$374.55	$476.70 – $1,135
Groin (inguinal) hernia repair, age 5 or older: 10 of 11 insurance plan rates Aetna — Commercial: $782.02 Aetna — MCR Advantage: $476.70 Anthem — Commercial: $737.75 Anthem — MCR Advantage: $476.70 CHO — Commercial: $1,135 Cigna — Commercial: $846.71 Harvard — Commercial: $798.36 Martin's Point — MCR Advantage: $476.70 UHC — Commercial: $925.02 UHC — MCR Advantage: $476.70
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 49505 REP INGU HERN 5 UP W	$1,135	$374.55	$737.75 – $1,135
Groin (inguinal) hernia repair, age 5 or older: rates for 5 insurance plans Aetna — Commercial: $869.41 Anthem — Commercial: $737.75 CHO — Commercial: $1,135 Cigna — Commercial: $846.71 UHC — Commercial: $878.49
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	$558.60 – $564.08
Groin (inguinal) hernia repair, age 5 or older: rates for 8 insurance plans Aetna — MCR Advantage: $558.60 Anthem — Commercial: $16,247.63 Anthem — MCR Advantage: $564.08 Cigna — Commercial: $19,115.79 Martin's Point — MCR Advantage: $558.60 UHC — MCR Advantage: $558.60 Wellcare — MCR Advantage: $558.60 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 55700 Bx Prostate 1 Or >Anyappr	$449	$148.17	$188.58 – $449
Prostate biopsy: 10 of 11 insurance plan rates Aetna — Commercial: $309.36 Aetna — MCR Advantage: $188.58 Anthem — Commercial: $291.85 Anthem — MCR Advantage: $188.58 CHO — Commercial: $449 Cigna — Commercial: $334.95 Harvard — Commercial: $315.83 Martin's Point — MCR Advantage: $188.58 UHC — Commercial: $365.94 UHC — MCR Advantage: $188.58
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · both In the file: 55700 BIOPSY PROSTATE NEEDLE/PU	$1,001	$330.33	$420.42 – $1,001
Prostate biopsy: 10 of 11 insurance plan rates Aetna — Commercial: $689.69 Aetna — MCR Advantage: $420.42 Anthem — Commercial: $650.65 Anthem — MCR Advantage: $420.42 CHO — Commercial: $1,001 Cigna — Commercial: $746.75 Harvard — Commercial: $704.10 Martin's Point — MCR Advantage: $420.42 UHC — Commercial: $815.82 UHC — MCR Advantage: $420.42
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 55700 Bx Prostate 1 Or >Anyappr	$449	$148.17	$291.85 – $449
Prostate biopsy: rates for 5 insurance plans Aetna — Commercial: $343.93 Anthem — Commercial: $291.85 CHO — Commercial: $449 Cigna — Commercial: $334.95 UHC — Commercial: $347.53
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	$1,285.58 – $1,298.18
Prostate removal by laparoscope (radical prostatectomy): rates for 8 insurance plans Aetna — MCR Advantage: $1,285.58 Anthem — Commercial: $47,932.78 Anthem — MCR Advantage: $1,298.18 Cigna — Commercial: $56,394.26 Martin's Point — MCR Advantage: $1,285.58 UHC — MCR Advantage: $1,285.58 Wellcare — MCR Advantage: $1,285.58 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Laps surg prst8ect rpbic rad	Not listed in the file	Not listed in the file	$1,095.97 – $2,244.02
Prostate removal by laparoscope (radical prostatectomy): rates for 3 insurance plans Anthem — Commercial: $2,244.02 CHO — Commercial: $1,917.95 UHC — Commercial: $1,095.97
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Laps surg prst8ect rpbic rad	Not listed in the file	Not listed in the file	$909.66 – $2,553.87
Prostate removal by laparoscope (radical prostatectomy): rates for 8 insurance plans Aetna — Commercial: $1,591.90 Aetna — MCR Advantage: $909.66 Anthem — MCR Advantage: $909.66 Cigna — Commercial: $2,553.87 Harvard — Commercial: $2,161.16 Martin's Point — MCR Advantage: $927.85 UHC — MCR Advantage: $909.66 Wellcare — MCR Advantage: $927.85
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 58558 HYSTEROSCOPY SURGICAL; WITH SAMPLING OF ENDOMETRIUM	$1,062	$350.46	$446.04 – $1,062
Hysteroscopy with biopsy of the uterus lining: 10 of 11 insurance plan rates Aetna — Commercial: $731.72 Aetna — MCR Advantage: $446.04 Anthem — Commercial: $690.30 Anthem — MCR Advantage: $446.04 CHO — Commercial: $1,062 Cigna — Commercial: $792.25 Harvard — Commercial: $747.01 Martin's Point — MCR Advantage: $446.04 UHC — Commercial: $865.53 UHC — MCR Advantage: $446.04
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 58558 HYSTEROSCOPY SURGICAL; WITH SAMPLING OF ENDOMETRIUM	$1,062	$350.46	$690.30 – $1,062
Hysteroscopy with biopsy of the uterus lining: rates for 5 insurance plans Aetna — Commercial: $813.49 Anthem — Commercial: $690.30 CHO — Commercial: $1,062 Cigna — Commercial: $792.25 UHC — Commercial: $821.99
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$1,299.50 – $1,312.24
Hysteroscopy with biopsy of the uterus lining: rates for 8 insurance plans Aetna — MCR Advantage: $1,299.50 Anthem — Commercial: $14,638.39 Anthem — MCR Advantage: $1,312.24 Cigna — Commercial: $17,222.48 Martin's Point — MCR Advantage: $1,299.50 UHC — MCR Advantage: $1,299.50 Wellcare — MCR Advantage: $1,299.50 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 62323 INJ INTERLAMINAR LMBR/SAC	$276	$91.08	$115.92 – $276
Spinal injection, lower back (epidural), with imaging guidance: 10 of 11 insurance plan rates Aetna — Commercial: $190.16 Aetna — MCR Advantage: $115.92 Anthem — Commercial: $179.40 Anthem — MCR Advantage: $115.92 CHO — Commercial: $276 Cigna — Commercial: $205.90 Harvard — Commercial: $194.14 Martin's Point — MCR Advantage: $115.92 UHC — Commercial: $224.94 UHC — MCR Advantage: $115.92
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 62323 INJ INTERLAMINAR LMBR/SAC	$276	$91.08	$179.40 – $276
Spinal injection, lower back (epidural), with imaging guidance: rates for 5 insurance plans Aetna — Commercial: $211.42 Anthem — Commercial: $179.40 CHO — Commercial: $276 Cigna — Commercial: $205.90 UHC — Commercial: $213.62
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Njx interlaminar lmbr/sac	Not listed in the file	Not listed in the file	$91.33 – $216.93
Spinal injection, lower back (epidural), with imaging guidance: 10 of 11 insurance plan rates Aetna — Commercial: $159.83 Aetna — MCR Advantage: $91.33 Anthem — Commercial: $186.38 Anthem — MCR Advantage: $91.33 CHO — Commercial: $159.83 Cigna — Commercial: $213.83 Harvard — Commercial: $216.93 Martin's Point — MCR Advantage: $93.16 UHC — Commercial: $91.33 UHC — MCR Advantage: $91.33
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 64483 TRANSFORAMINAL INJ LUM/SAC PRO	$552	$182.16	$231.84 – $552
Nerve root injection, lower back, with imaging guidance: 10 of 11 insurance plan rates Aetna — Commercial: $380.33 Aetna — MCR Advantage: $231.84 Anthem — Commercial: $358.80 Anthem — MCR Advantage: $231.84 CHO — Commercial: $552 Cigna — Commercial: $411.79 Harvard — Commercial: $388.28 Martin's Point — MCR Advantage: $231.84 UHC — Commercial: $449.88 UHC — MCR Advantage: $231.84
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 64483 TRANSFORAMINAL INJ LUM/SAC PRO	$552	$182.16	$358.80 – $552
Nerve root injection, lower back, with imaging guidance: rates for 5 insurance plans Aetna — Commercial: $422.83 Anthem — Commercial: $358.80 CHO — Commercial: $552 Cigna — Commercial: $411.79 UHC — Commercial: $427.25
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx aa&/strd tfrm epi l/s 1	Not listed in the file	Not listed in the file	$257.56 – $260.09
Nerve root injection, lower back, with imaging guidance: rates for 8 insurance plans Aetna — MCR Advantage: $257.56 Anthem — Commercial: $4,098.85 Anthem — MCR Advantage: $260.09 Cigna — Commercial: $4,822.42 Martin's Point — MCR Advantage: $257.56 UHC — MCR Advantage: $257.56 Wellcare — MCR Advantage: $257.56 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 64721 Neuroplasty Median Nerve	$1,147	$378.51	$481.74 – $1,147
Carpal tunnel release: 10 of 11 insurance plan rates Aetna — Commercial: $790.28 Aetna — MCR Advantage: $481.74 Anthem — Commercial: $745.55 Anthem — MCR Advantage: $481.74 CHO — Commercial: $1,147 Cigna — Commercial: $855.66 Harvard — Commercial: $806.80 Martin's Point — MCR Advantage: $481.74 UHC — Commercial: $934.80 UHC — MCR Advantage: $481.74
Carpal tunnel release CPT 64721 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 64721 Neuroplasty Median Nerve	$1,147	$378.51	$745.55 – $1,147
Carpal tunnel release: rates for 5 insurance plans Aetna — Commercial: $878.60 Anthem — Commercial: $745.55 CHO — Commercial: $1,147 Cigna — Commercial: $855.66 UHC — Commercial: $887.78
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	$481.81 – $486.53
Carpal tunnel release: rates for 8 insurance plans Aetna — MCR Advantage: $481.81 Anthem — Commercial: $8,990.48 Anthem — MCR Advantage: $486.53 Cigna — Commercial: $10,577.56 Martin's Point — MCR Advantage: $481.81 UHC — MCR Advantage: $481.81 Wellcare — MCR Advantage: $481.81 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
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	$351.40 – $354.85
Laser treatment of clouding after cataract surgery: rates for 8 insurance plans Aetna — MCR Advantage: $351.40 Anthem — Commercial: $2,525.74 Anthem — MCR Advantage: $354.85 Cigna — Commercial: $2,971.61 Martin's Point — MCR Advantage: $351.40 UHC — MCR Advantage: $351.40 Wellcare — MCR Advantage: $351.40 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: After cataract laser surgery	Not listed in the file	Not listed in the file	$280.38 – $579.83
Laser treatment of clouding after cataract surgery: rates for 3 insurance plans Anthem — Commercial: $579.83 CHO — Commercial: $490.67 UHC — Commercial: $280.38
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: After cataract laser surgery	Not listed in the file	Not listed in the file	$420.57 – $1,021.22
Laser treatment of clouding after cataract surgery: rates for 8 insurance plans Aetna — Commercial: $736.01 Aetna — MCR Advantage: $420.57 Anthem — MCR Advantage: $420.57 Cigna — Commercial: $1,008.90 Harvard — Commercial: $1,021.22 Martin's Point — MCR Advantage: $428.98 UHC — MCR Advantage: $420.57 Wellcare — MCR Advantage: $428.98
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	$577.53 – $583.20
Cataract removal with lens implant: rates for 8 insurance plans Aetna — MCR Advantage: $577.53 Anthem — Commercial: $10,500.37 Anthem — MCR Advantage: $583.20 Cigna — Commercial: $12,353.98 Martin's Point — MCR Advantage: $577.53 UHC — MCR Advantage: $577.53 Wellcare — MCR Advantage: $577.53 Harvard — Commercial: 70.34% (a percentage in the contract, not a dollar amount)
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	Not listed in the file	$492.36 – $1,012.20
Cataract removal with lens implant: rates for 3 insurance plans Anthem — Commercial: $1,012.20 CHO — Commercial: $861.63 UHC — Commercial: $492.36
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	Not listed in the file	$738.54 – $1,774.23
Cataract removal with lens implant: rates for 8 insurance plans Aetna — Commercial: $1,292.45 Aetna — MCR Advantage: $738.54 Anthem — MCR Advantage: $738.54 Cigna — Commercial: $1,752.27 Harvard — Commercial: $1,774.23 Martin's Point — MCR Advantage: $753.31 UHC — MCR Advantage: $738.54 Wellcare — MCR Advantage: $753.31

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 59400 OB CARE COMPL 59400	$10,968	$3,619.44	$4,606.56 – $10,968
Vaginal delivery, with care before and after: 10 of 11 insurance plan rates Aetna — Commercial: $7,556.95 Aetna — MCR Advantage: $4,606.56 Anthem — Commercial: $7,129.20 Anthem — MCR Advantage: $4,606.56 CHO — Commercial: $10,968 Cigna — Commercial: $8,182.13 Harvard — Commercial: $7,714.89 Martin's Point — MCR Advantage: $4,606.56 UHC — Commercial: $8,938.92 UHC — MCR Advantage: $4,606.56
Vaginal delivery, with care before and after CPT 59400 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 59400 OB CARE COMPL 59400	$10,968	$3,619.44	$7,129.20 – $10,968
Vaginal delivery, with care before and after: rates for 5 insurance plans Aetna — Commercial: $8,401.49 Anthem — Commercial: $7,129.20 CHO — Commercial: $10,968 Cigna — Commercial: $8,182.13 UHC — Commercial: $8,489.23
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Obstetrical care	Not listed in the file	Not listed in the file	$2,169.09 – $5,349.80
Vaginal delivery, with care before and after: 10 of 11 insurance plan rates Aetna — Commercial: $3,795.91 Aetna — MCR Advantage: $2,169.09 Anthem — Commercial: $4,569.61 Anthem — MCR Advantage: $2,169.09 CHO — Commercial: $3,795.91 Cigna — Commercial: $5,095.10 Harvard — Commercial: $5,349.80 Martin's Point — MCR Advantage: $2,212.47 UHC — Commercial: $2,169.09 UHC — MCR Advantage: $2,169.09
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 59510 C-SECTION CHARGE	$12,057	$3,978.81	$5,063.94 – $12,057
Cesarean delivery (C-section), with care before and after: 10 of 11 insurance plan rates Aetna — Commercial: $8,307.27 Aetna — MCR Advantage: $5,063.94 Anthem — Commercial: $7,837.05 Anthem — MCR Advantage: $5,063.94 CHO — Commercial: $12,057 Cigna — Commercial: $8,994.52 Harvard — Commercial: $8,480.89 Martin's Point — MCR Advantage: $5,063.94 UHC — Commercial: $9,826.46 UHC — MCR Advantage: $5,063.94
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 59510 C-SECTION CHARGE	$12,057	$3,978.81	$7,837.05 – $12,057
Cesarean delivery (C-section), with care before and after: rates for 5 insurance plans Aetna — Commercial: $9,235.66 Anthem — Commercial: $7,837.05 CHO — Commercial: $12,057 Cigna — Commercial: $8,994.52 UHC — Commercial: $9,332.12
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Cesarean delivery	Not listed in the file	Not listed in the file	$2,399.76 – $5,948.54
Cesarean delivery (C-section), with care before and after: 10 of 11 insurance plan rates Aetna — Commercial: $4,199.58 Aetna — MCR Advantage: $2,399.76 Anthem — Commercial: $5,076.03 Anthem — MCR Advantage: $2,399.76 CHO — Commercial: $4,199.58 Cigna — Commercial: $5,601.09 Harvard — Commercial: $5,948.54 Martin's Point — MCR Advantage: $2,447.76 UHC — Commercial: $2,399.76 UHC — MCR Advantage: $2,399.76
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 59610 TOTAL OB/VBAC	$5,203	$1,716.99	$2,185.26 – $5,203
Vaginal delivery after a previous C-section, with care before and after: 10 of 11 insurance plan rates Aetna — Commercial: $3,584.87 Aetna — MCR Advantage: $2,185.26 Anthem — Commercial: $3,381.95 Anthem — MCR Advantage: $2,185.26 CHO — Commercial: $5,203 Cigna — Commercial: $3,881.44 Harvard — Commercial: $3,659.79 Martin's Point — MCR Advantage: $2,185.26 UHC — Commercial: $4,240.44 UHC — MCR Advantage: $2,185.26
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 59610 TOTAL OB/VBAC	$5,203	$1,716.99	$3,381.95 – $5,203
Vaginal delivery after a previous C-section, with care before and after: rates for 5 insurance plans Aetna — Commercial: $3,985.50 Anthem — Commercial: $3,381.95 CHO — Commercial: $5,203 Cigna — Commercial: $3,881.44 UHC — Commercial: $4,027.12
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Vbac delivery	Not listed in the file	Not listed in the file	$2,261.79 – $5,608.49
Vaginal delivery after a previous C-section, with care before and after: 10 of 11 insurance plan rates Aetna — Commercial: $3,958.13 Aetna — MCR Advantage: $2,261.79 Anthem — Commercial: $4,786.74 Anthem — MCR Advantage: $2,261.79 CHO — Commercial: $3,958.13 Cigna — Commercial: $5,301.19 Harvard — Commercial: $5,608.49 Martin's Point — MCR Advantage: $2,307.03 UHC — Commercial: $2,261.79 UHC — MCR Advantage: $2,261.79

Source: Northern Light Mayo Hospital’s standard charges file (northernlighthealth.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on March 30, 2026; retrieved November 5, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Critical Access Hospital
Address	897 West Main Street, Dover Foxcroft, ME 04426
County	Piscataquis County
State	Maine
Phone	(207) 564‑4251
Emergency services	Yes
Ownership	Government - Hospital District or Authority
Medicare overall rating	2 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	201309
Name in Medicare records	NORTHERN LIGHT MAYO HOSPITAL
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(207) 564‑8401^[4]
Official website	northernlighthealth.org
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

Numbers match the citations above. Checked 2026-11-02.

Northern Light Mayo Hospital - Northern Light Mayo Hospital - Northern Light Health — northernlighthealth.org

Northern Light Mayo Hospital

Summary

Profile from official sources

At a glance

Quick answers

Specialties and care areas^[4]

Programs and centers^[4]

Emergency care (hospital website)^[4]

Visiting and practical information

Recognition^[4]

Doctors and clinicians (203)

Main specialties

Doctors with a page on this site (203)

Other emergency rooms nearby

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

Nursing homes

Community care nearby

Community health centers

Clinics and urgent care

Pharmacies

About the Medicare star rating

Medicare quality data

What patients said (patient survey)

Infections caught in the hospital

Complications and deaths

Return visits to the hospital (readmissions)

Emergency room times and sepsis care

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

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

Heart tests and sleep study

Physical therapy and mental health

Procedures and surgery

Pregnancy and childbirth

Hospital information

Sources

From the hospital’s website

Northern Light Mayo Hospital

Summary

Profile from official sources

At a glance

Quick answers

Specialties and care areas[4]

Programs and centers[4]

Emergency care (hospital website)[4]

Visiting and practical information

Recognition[4]

Doctors and clinicians (203)

Main specialties

Doctors with a page on this site (203)

Other emergency rooms nearby

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

Nursing homes

Community care nearby

Community health centers

Clinics and urgent care

Pharmacies

About the Medicare star rating

Medicare quality data

What patients said (patient survey)

Infections caught in the hospital

Complications and deaths

Return visits to the hospital (readmissions)

Emergency room times and sepsis care

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

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

Heart tests and sleep study

Physical therapy and mental health

Procedures and surgery

Pregnancy and childbirth

Hospital information

Sources

From the hospital’s website

Specialties and care areas^[4]

Programs and centers^[4]

Emergency care (hospital website)^[4]

Recognition^[4]