Does Northwestern Medicine Delnor Community Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Northwestern Medicine Delnor Community Hospital. In a medical emergency, call 911.

Where is Northwestern Medicine Delnor Community Hospital?

300 Randall Rd, Geneva, IL 60134, in Kane County, Illinois.

What is the phone number of Northwestern Medicine Delnor Community Hospital?

(630) 208-3000, as listed by Medicare (CMS).

What is the Medicare star rating of Northwestern Medicine Delnor Community Hospital?

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

Northwestern Medicine Delnor Community Hospital

Quick answers

Does Northwestern Medicine Delnor Community Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Northwestern Medicine Delnor Community Hospital. In a medical emergency, call 911.
Where is Northwestern Medicine Delnor Community Hospital?: 300 Randall Rd, Geneva, IL 60134, in Kane County, Illinois.
What is the phone number of Northwestern Medicine Delnor Community Hospital?: (630) 208-3000, as listed by Medicare (CMS).
What is the Medicare star rating of Northwestern Medicine Delnor Community Hospital?: 5 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4]

Cancer Care
Cardiovascular Care
Clinical Genetics
Diabetes
Ear, Nose and Throat
Emergency Medicine
Imaging
Neurosciences
Occupational Health
Orthopaedics
Pediatrics
Primary Care
Pulmonary
Rehabilitation
Rheumatology
Surgical Services
Weight Management
Women's Health
Wound Care

Conditions treated^[8][10]

Heart attack
Open-heart surgery
Atherectomy
Angioplasty/stent
Angina
Cardiomyopathy
Congestive heart failure
Heart transplant
Asthma
Chronic bronchitis
COPD
Cystic/pulmonary fibrosis
Emphysema
Lung cancer
Sarcoidosis
Lung transplant
Diabetic foot ulcers

Treatments^[7][8][10]

Cardiac rehabilitation
Pulmonary rehabilitation
Advanced wound care therapies
Pain management during labor (including epidural)

Procedures^[6]

3-D mammography
Automated breast ultrasound (ABUS)
Breast MRI and MRI-guided biopsies
Breast ultrasound and ultrasound-guided biopsies
Stereotactic breast biopsies
Needle localizations
Diagnostic mammograms with computer-assisted diagnosis
Bone density scans (DEXA)

Programs and centers^{[4][7][8][9][10]}

Breast health center
Cancer center
Labor and delivery
Level II-E Special Care Nursery
Cardiac and pulmonary rehabilitation
Wound care
Human milk depot (Mothers' Milk Bank of the Western Great Lakes)

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

Emergency room	Yes
Open 24/7	Yes
Trauma designation	Level II

Visiting and practical information

Visiting	Visiting hours 8 a.m.-8 p.m., Monday through Sunday^[4]
Parking	General parking available 24/7 and patrolled by security; valet at main lobby Mon-Fri 7:30 a.m.-6 p.m^[4]
Interpreters and languages	Free medically trained language interpreters, ASL interpreters, video interpreting and TTY devices^[4]
Patient portal	MyNM Patient Portal

Recognition^[4][6]

Magnet Recognition (ANCC)
U.S. News & World Report: No. 13 in Illinois and Chicago Metro Area (2026-2027)
Accredited Breast Center (National Accreditation Program for Breast Centers)

Doctors and clinicians (1,147)

1,147 doctors and other clinicians list Northwestern Medicine Delnor Community Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

Doctors with a page on this site (1,147)

Aaron A. Bare, MDOrthopedic Surgery
Aaron M. Miller, MDNeurology
Abdullah Melhim, MDEndocrinology
Abigail K. Alexander, CNACertified Registered Nurse Anesthetist (CRNA)
Abrahim U. Syed, MDRheumatology
Achal Garbharran, MDEndocrinology
Adam B. Murphy, MDUrology
Adam C. Stein, MDGastroenterology
Adam D. Stein, MDEndocrinology
Adam J. Buffington, DPMPodiatry
Adeola L. AdeoyeNurse Practitioner
Adil S. Akthar, MDRadiation Oncology
Adriana Acurio, MDPathology
Aileen H. Westrick, MDEndocrinology
Ajay J. Patel, MDPathology
Ajith R. Susai, DOHospitalist
Akhil Chawla, MDSurgical Oncology
Alana A. Lewis, MDCardiovascular Disease (Cardiology)
Albert C. Lin, MDCardiac Electrophysiology
Alex A. Stanziola, MDAnesthesiology
Alexander Geevarghese, DOInternal Medicine
Alexander L. Schneider, MDOtolaryngology
Alexander Tomas, CNACertified Registered Nurse Anesthetist (CRNA)
Alexandra A. Frogameni, MDCritical Care (Intensivists)

And 1,123 more: the button below opens the full list.

Other emergency rooms nearby

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

Presence Mercy Medical Center7.0 mi · Aurora, IL · Acute Care Hospital
Elgin Mental Health Center9.3 mi · Elgin, IL · Psychiatric Hospital
Northwestern Medicine Central Dupage Hospital9.5 mi · Winfield, IL · Acute Care Hospital
Saint Joseph Hospital-Elgin10 mi · Elgin, IL · Acute Care Hospital
Copley Memorial Hospital12 mi · Aurora, IL · Acute Care Hospital

Other hospitals nearby

Advocate Sherman Hospital12 mi · Elgin, IL · Acute Care Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Greenfields of Geneva1.6 mi · Geneva, IL · 5 of 5 stars
Batavia Rehabilitation and Health Care Center1.9 mi · Batavia, IL · 4 of 5 stars
Michaelsen Health Center2.2 mi · Batavia, IL · 5 of 5 stars

All nursing homes in the state →

Hospice providers

Covenantcare Hospice3.7 mi · Saint Charles, IL · 4 of 5 stars
Solace Hospice & Palliative Care Inc4.9 mi · St Charles, IL
Cadre Hospice - Chicago LLC9.0 mi · Warrenville, IL

All hospice providers in the state →

Home health agencies

Accucare Physical Therapy and Rehabilitation Services3.7 mi · Saint Charles, IL
Covenantcare at Home3.7 mi · Saint Charles, IL · 4 of 5 stars
Absolute Home Wellness4.9 mi · Saint Charles, IL

All home health agencies in the state →

Dialysis facilities

Tri Cities Dialysis LLC0.6 mi · Geneva, IL · 3 of 5 stars
FMC - West Batavia3.4 mi · Batavia, IL · 3 of 5 stars
Vitality Home Therapies Inc3.7 mi · Saint Charles, IL

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

Fox Valley Orthopaedic Institute0.6 mi · Geneva, IL
Valley Ambulatory Surgery Center4.9 mi · Saint Charles, IL
Cadence Ambulatory Surgery Center LLC9.0 mi · Warrenville, IL

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

ACCESS West Chicago Family Health Center7.0 mi · West Chicago, IL · Community health center
Gateway Foundation7.1 mi · Aurora, IL · Community health center
Association for Individual Development - New Indian Trail Court7.2 mi · Aurora, IL · Community health center

Clinics and urgent care

Adventist Health Partners, Inc8.0 mi · Aurora, IL · Urgent care center
Prime Urgent Care, PLLC9.0 mi · Warrenville, IL · Urgent care center
Aurora Immediate Care9.0 mi · Aurora, IL · Urgent care center

Pharmacies

Geneva Pharmacy LLC0.6 mi · Geneva, IL · Community/retail pharmacy
Walgreen Co0.6 mi · Geneva, IL · Pharmacy
Walgreen Co3.4 mi · Batavia, IL · 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 Northwestern Medicine Delnor Community 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)	4 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	5 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	4 of 5 stars
Staff explained medicines	4 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	80%National average: 72%
Would definitely recommend the hospital	79%National average: 71%
Nurses “always” communicated well	80%National average: 80%
Doctors “always” communicated well	82%National average: 80%
Staff “always” explained medicines before giving them	66%National average: 62%
Were given information about recovery at home	88%National average: 86%
Room and bathroom “always” clean	76%National average: 74%
Area around the room “always” quiet at night	65%National average: 60%
Completed surveys	748Response rate: 31%

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)	0.34No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0No different from the national benchmark
Surgical site infections after colon surgery	0.78No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.301Better than the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	11.7%
Deaths within 30 days: heart failure patients	8.1%
Deaths within 30 days: pneumonia patients	15.4%
Deaths within 30 days: COPD patients	8.5%
Deaths within 30 days: stroke patients	11.3%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.69No different from the national rate
Complications after hip or knee replacement	3.6%

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	13.3%
Readmitted within 30 days: heart failure	20.6%
Readmitted within 30 days: pneumonia	15.1%
Readmitted within 30 days: COPD	18.2%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	5.5%

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	212 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	2%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	68%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 Illinois Best hospitals in Illinois

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 70 common services exactly as Northwestern Medicine Delnor Community 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) In the file: HB Office/Outpatient Visit New Level 3	$543	$380.10	$80.91 – $543
New patient office visit (about 30–44 minutes): 10 of 35 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $346.43 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $379.56 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $88.51 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $378.58 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $126.52 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $488.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $80.91 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $97.74 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $80.91 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $378.58
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: HB Office/Outpatient Visit New Level 4	$626	$438.20	$93.27 – $626
New patient office visit (about 45–59 minutes): 10 of 35 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $399.39 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $437.57 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $102.04 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $436.45 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $145.86 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $563.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $93.27 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $112.68 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $93.27 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $436.45
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: HB Office/Outpatient Visit New Level 5	$915	$640.50	$136.34 – $915
New patient office visit (about 60–74 minutes): 10 of 35 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $583.77 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $639.59 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $149.15 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $637.94 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $213.20 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $823.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $136.34 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $164.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $136.34 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $637.94
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: HB Office/Outpatient Visit Established Level 3	$416	$291.20	$61.98 – $416
Established patient office visit (about 20–29 minutes): 10 of 35 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $265.41 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $290.78 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $67.81 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $290.04 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $96.93 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $374.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $61.98 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $74.88 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $61.98 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $290.04
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Hcpf Established Patient Level 3 Bh	$216	$151.20	$32.18 – $216
Established patient office visit (about 20–29 minutes): 10 of 33 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $133.92 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $146.66 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $35.21 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $50.33 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $194.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $32.18 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $38.88 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $32.18 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $120.74 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $50.33
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: HB Office/Outpatient Visit Established Level 4	$569	$398.30	$84.78 – $569
Established patient office visit (about 30–39 minutes): 10 of 35 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $363.02 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $397.73 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $92.75 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $396.71 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $132.58 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $512.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $84.78 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $102.42 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $84.78 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $396.71
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Hcpf Established Patient Level 4 Bh	$235	$164.50	$35.02 – $235
Established patient office visit (about 30–39 minutes): 10 of 33 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $145.70 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $159.57 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $38.31 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $54.76 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $211.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $35.02 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $42.30 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $35.02 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $131.37 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $54.76
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: HB ED Visit Level 3	$1,924	$1,346.80	$286.68 – $1,924
Emergency room visit (moderate): 10 of 37 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $1,192.88 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $1,306.40 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $313.61 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $1,341.41 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $448.29 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $1,731.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $286.68 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $346.32 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $286.68 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $1,341.41
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: HB ED Visit Level 4	$6,723	$4,706.10	$537.44 – $3,607
Emergency room visit (moderately high): 10 of 37 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: 62% (a percentage in the contract, not a dollar amount) AETNA HEALTH PLAN [171] — DCH AETNA ASA: 67.9% (a percentage in the contract, not a dollar amount) AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 69.72% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 23.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): 93% (a percentage in the contract, not a dollar amount) BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: 90% (a percentage in the contract, not a dollar amount) BLUE CROSS BLUE SHIELD [1401] — DCH ADVOCATE IPA: 120% (a percentage in the contract, not a dollar amount)
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: HB ED Visit Level 5	$5,049	$3,534.30	$752.30 – $5,049
Emergency room visit (high): 10 of 37 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $3,130.38 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $3,428.27 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $822.99 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $3,520.16 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $1,176.42 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $4,544.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $752.30 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $908.82 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $752.30 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $3,520.16

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: HB Bmp With Bun/Creat Ratio	$314	$219.80	$46.79 – $314
Basic metabolic panel (blood test): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $51.18 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $218.92 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $73.16 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $282.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $46.79 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $56.52 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $46.79 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $218.92 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $175.53 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $73.16
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: HB Basic Metabolic Panel	$314	$219.80	$46.79 – $314
Basic metabolic panel (blood test): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $51.18 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $218.92 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $73.16 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $282.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $46.79 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $56.52 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $46.79 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $218.92 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $175.53 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $73.16
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: HB Ref Cmp With Bun/Creat Ratio	$438	$306.60	$65.26 – $438
Comprehensive metabolic panel (blood test): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $71.39 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $305.37 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $102.05 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $394.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $65.26 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $78.84 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $65.26 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $305.37 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $244.84 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $102.05
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: HB Comprehensive Metabolic Panel	$438	$306.60	$65.26 – $438
Comprehensive metabolic panel (blood test): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $71.39 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $305.37 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $102.05 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $394.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $65.26 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $78.84 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $65.26 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $305.37 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $244.84 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $102.05
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: HB Ref Chem-12/Alt (Gva)	$438	$306.60	$65.26 – $438
Comprehensive metabolic panel (blood test): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $71.39 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $305.37 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $102.05 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $394.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $65.26 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $78.84 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $65.26 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $305.37 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $244.84 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $102.05
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: HB Ref Lipid Panel (Lc)	$263	$184.10	$39.19 – $263
Cholesterol panel (lipid panel): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $42.87 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $183.36 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $61.28 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $236.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $39.19 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $47.34 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $39.19 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $183.36 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $147.02 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $61.28
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: HB Lipid Panel	$263	$184.10	$39.19 – $263
Cholesterol panel (lipid panel): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $42.87 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $183.36 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $61.28 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $236.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $39.19 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $47.34 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $39.19 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $183.36 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $147.02 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $61.28
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: HB Lipid Panel, Reflex Ldl-D	$263	$184.10	$39.19 – $263
Cholesterol panel (lipid panel): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $42.87 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $183.36 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $61.28 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $236.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $39.19 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $47.34 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $39.19 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $183.36 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $147.02 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $61.28
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: HB Renal Function Panel	$238	$166.60	$35.46 – $238
Kidney function panel: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $38.79 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $165.93 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $55.45 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $214.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $35.46 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $42.84 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $35.46 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $165.93 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $133.04 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $55.45
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: HB Ref Renal Function Panel	$212	$148.40	$31.59 – $212
Kidney function panel: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $34.56 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $147.81 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $49.40 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $190.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $31.59 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $38.16 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $31.59 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $147.81 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $118.51 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $49.40
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HB Ref Liver Fibrosis Risk Profile, Hepatic Function Panel (Lc)	$172	$120.40	$25.63 – $172
Liver function panel: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $28.04 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $119.92 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $40.08 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $154.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $25.63 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $30.96 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $25.63 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $119.92 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $96.15 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $40.08
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HB Ref Liver Fibrosis, Hepatic Function Panel (Q)	$199	$139.30	$29.65 – $199
Liver function panel: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $32.44 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $138.74 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $46.37 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $179.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $29.65 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $35.82 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $29.65 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $138.74 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $111.24 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $46.37
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HB Hepatic Function Panel	$266	$186.20	$39.63 – $266
Liver function panel: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $43.36 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $185.46 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $61.98 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $239.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $39.63 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $47.88 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $39.63 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $185.46 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $148.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $61.98
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: HB Ref Urinalysis W Microscopic (Q)	$106	$74.20	$15.79 – $106
Urine test (automated, with microscope): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $17.28 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $73.90 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $24.70 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $95.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $15.79 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $19.08 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $15.79 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $73.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $59.25 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $24.70
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: HB Urinalysis W Microscopic	$119	$83.30	$17.73 – $119
Urine test (automated, with microscope): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $19.40 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $82.97 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $27.73 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $107.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $17.73 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $21.42 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $17.73 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $82.97 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $66.52 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $27.73
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: HB Ketone, Urine	$84	$58.80	$12.52 – $84
Urine test (automated, with microscope): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $13.69 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $58.56 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $19.57 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $75.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $12.52 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $15.12 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $12.52 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $58.56 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $46.96 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $19.57
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: HB Specific Gravity, Urine	$53	$37.10	$7.90 – $53
Urine test (manual, without microscope): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $8.64 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $36.95 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $12.35 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $47.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $7.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $9.54 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $7.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $36.95 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $29.63 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $12.35
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: HB Urinalysis Nonauto W/O Scope (POC)	$31	$21.70	$4.62 – $31
Urine test (manual, without microscope): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $5.05 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $21.61 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $7.22 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $27.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $4.62 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $5.58 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $4.62 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $21.61 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $17.33 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $7.22
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: HB Urine Analysis (POCT)	$31	$21.70	$4.62 – $31
Urine test (manual, without microscope): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $5.05 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $21.61 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $7.22 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $27.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $4.62 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $5.58 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $4.62 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $21.61 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $17.33 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $7.22
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: HB Ref Urinalysis W/O Microscopic	$53	$37.10	$7.90 – $53
Urine test (automated, without microscope): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $8.64 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $36.95 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $12.35 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $47.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $7.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $9.54 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $7.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $36.95 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $29.63 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $12.35
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: HB Urinalysis W/O Microscopic	$122	$85.40	$18.18 – $122
Urine test (automated, without microscope): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $19.89 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $85.06 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $28.43 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $109.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $18.18 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $21.96 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $18.18 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $85.06 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $68.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $28.43
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: HB Ketone, Urine	$53	$37.10	$7.90 – $53
Urine test (automated, without microscope): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $8.64 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $36.95 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $12.35 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $47.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $7.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $9.54 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $7.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $36.95 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $29.63 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $12.35
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: HB Prostate Specific Antigen, Diagnostic	$196	$137.20	$29.20 – $196
PSA (prostate specific antigen) blood test: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $31.95 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $136.65 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $45.67 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $176.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $29.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $35.28 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $29.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $136.65 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $109.56 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $45.67
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: HB Ref Psa, Post Prostatectomy�With Hama�Treatment (Q)	$162	$113.40	$24.14 – $162
PSA (prostate specific antigen) blood test: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $26.41 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $112.95 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $37.75 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $145.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $24.14 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $29.16 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $24.14 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $112.95 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $90.56 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $37.75
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: HB Prostate Specific Antigen, Total	$196	$137.20	$29.20 – $196
PSA (prostate specific antigen) blood test: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $31.95 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $136.65 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $45.67 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $176.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $29.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $35.28 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $29.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $136.65 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $109.56 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $45.67
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: HB Ref Thyroid-Stimulating Hormone (Tsh) (Lc)	$232	$162.40	$34.57 – $232
Thyroid stimulating hormone (TSH) test: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $37.82 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $161.75 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $54.06 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $208.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $34.57 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $41.76 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $34.57 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $161.75 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $129.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $54.06
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: HB Ref Tsh With Reflex to Free T4 (Q)	$232	$162.40	$34.57 – $232
Thyroid stimulating hormone (TSH) test: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $37.82 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $161.75 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $54.06 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $208.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $34.57 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $41.76 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $34.57 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $161.75 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $129.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $54.06
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: HB Ref Newborn Metabolic Screen, Tsh/T4	$232	$162.40	$34.57 – $232
Thyroid stimulating hormone (TSH) test: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $37.82 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $161.75 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $54.06 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $208.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $34.57 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $41.76 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $34.57 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $161.75 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $129.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $54.06
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: HB Ref Cbc W/ Platelets & Differential	$219	$153.30	$32.63 – $219
Complete blood count (CBC) with differential: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $35.70 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $152.69 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $51.03 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $197.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $32.63 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $39.42 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $32.63 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $152.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $122.42 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $51.03
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: HB Ref Liver Fibrosis Risk Profile, Cbc W/Diff (Lc)	$112	$78.40	$16.69 – $112
Complete blood count (CBC) with differential: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $18.26 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $78.09 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $26.10 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $100.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $16.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $20.16 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $16.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $78.09 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $62.61 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $26.10
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: HB Ref Anemia Profile B, Cbc (Lc)	$112	$78.40	$16.69 – $112
Complete blood count (CBC) with differential: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $18.26 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $78.09 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $26.10 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $100.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $16.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $20.16 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $16.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $78.09 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $62.61 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $26.10
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: HB Ref Cbc (Q)	$93	$65.10	$13.86 – $93
Complete blood count (CBC), automated: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $15.16 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $64.84 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $21.67 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $83.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $13.86 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $16.74 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $13.86 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $64.84 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $51.99 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $21.67
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: HB Cbc	$123	$86.10	$18.33 – $123
Complete blood count (CBC), automated: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $20.05 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $85.76 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $28.66 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $110.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $18.33 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $22.14 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $18.33 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $85.76 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $68.76 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $28.66
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: HB Ref Hemoglobinopathy Fractionation Cascade, Cbc (Lc)	$97	$67.90	$14.45 – $97
Complete blood count (CBC), automated: 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $15.81 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $67.63 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $22.60 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $87.30 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $14.45 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $17.46 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $14.45 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $67.63 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $54.22 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $22.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: HB Prothrombin Time Mixing Study	$75	$52.50	$11.18 – $75
Blood clotting time test (prothrombin time, PT): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $12.23 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $52.29 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $17.48 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $67.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $11.18 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $13.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $11.18 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $52.29 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $41.93 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $17.48
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: HB Ref Disseminated Intravascular Coagulation (Dic) Profile, Pt (Lc)	$74	$51.80	$11.03 – $74
Blood clotting time test (prothrombin time, PT): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $12.06 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $51.59 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $17.24 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $66.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $11.03 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $13.32 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $11.03 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $51.59 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $41.37 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $17.24
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: HB Ref Lupus Anticoagulant Profile, Prothrombin Time (Mayo)	$71	$49.70	$10.58 – $71
Blood clotting time test (prothrombin time, PT): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $11.57 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $49.50 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $16.54 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $63.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $10.58 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $12.78 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $10.58 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $49.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $39.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $16.54
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: HB Ref Thrombophilia Profile, Thromboplastin Time Partial (Mayo)	$110	$77	$16.39 – $110
Blood clotting test (partial thromboplastin time, PTT): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $17.93 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $76.69 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $25.63 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $99 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $16.39 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $19.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $16.39 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $76.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $61.49 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $25.63
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: HB Lupus Anticoagulant Evaluation Panel, Silica Clotting Time Screen	$110	$77	$16.39 – $110
Blood clotting test (partial thromboplastin time, PTT): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $17.93 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $76.69 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $25.63 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $99 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $16.39 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $19.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $16.39 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $76.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $61.49 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $25.63
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: HB Aptt Mixing Study	$110	$77	$16.39 – $110
Blood clotting test (partial thromboplastin time, PTT): 10 of 27 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $17.93 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $76.69 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $25.63 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $99 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $16.39 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $19.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $16.39 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $76.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $61.49 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $25.63

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) In the file: HB CT Head/Brain W/O Dye	$3,535	$2,474.50	$526.72 – $3,535
CT scan of the head or brain, without contrast: 10 of 29 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA ASA: $2,400.27 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $576.21 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $2,464.60 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $823.66 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $3,181.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $526.72 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $636.30 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $526.72 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $2,464.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $1,976.07
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: HB MRI Brain Stem W/O & W/Dye	$7,693	$5,385.10	$1,146.26 – $7,693
MRI of the brain, before and after contrast: 10 of 29 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA ASA: $5,223.55 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $1,253.96 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $5,363.56 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $1,792.47 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $6,923.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $1,146.26 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $1,384.74 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $1,146.26 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $5,363.56 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $4,300.39
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: HB-Xray Exam Chest 2 Views	$963	$674.10	$143.49 – $963
Chest X-ray, 2 views: 10 of 31 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $597.06 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $653.88 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $156.97 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $671.40 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $224.38 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $866.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $143.49 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $173.34 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $143.49 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $671.40
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: HB X-Ray Exam L-2 Spine 4/>Vws	$1,299	$909.30	$193.55 – $1,299
X-ray of the lower spine, at least 4 views: 10 of 31 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $805.38 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $882.02 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $211.74 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $905.66 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $302.67 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $1,169.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $193.55 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $233.82 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $193.55 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $905.66
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: HB MRI Lumbar Spine W/O Dye	$5,482	$3,837.40	$816.82 – $5,482
MRI of the lower back (lumbar spine), without contrast: 10 of 29 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA ASA: $3,722.28 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $893.57 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $3,822.05 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $1,277.31 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $4,933.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $816.82 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $986.76 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $816.82 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $3,822.05 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $3,064.44
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: HB CT Pelvis W/Dye	$4,154	$2,907.80	$618.95 – $4,154
CT scan of the pelvis, with contrast: 10 of 29 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA ASA: $2,820.57 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $677.10 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $2,896.17 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $967.88 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $3,738.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $618.95 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $747.72 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $618.95 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $2,896.17 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $2,322.09
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: HB MRI Jnt of Lwr Extre W/O Dye	$5,479	$3,835.30	$816.37 – $5,479
MRI of a leg joint (such as the knee), without contrast: 10 of 29 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA ASA: $3,720.24 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $893.08 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $3,819.96 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $1,276.61 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $4,931.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $816.37 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $986.22 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $816.37 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $3,819.96 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $3,062.76
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: HB CT Abd & Pelv W/Contrast	$8,642	$6,049.40	$1,287.66 – $8,642
CT scan of the abdomen and pelvis, with contrast: 10 of 29 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA ASA: $5,867.92 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $1,408.65 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $6,025.20 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $2,013.59 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $7,777.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $1,287.66 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $1,555.56 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $1,287.66 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $6,025.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $4,830.88
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: HB US Exam Abdom Complete	$2,532	$1,772.40	$377.27 – $2,532
Ultrasound of the abdomen, complete: 10 of 31 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $1,569.84 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $1,719.23 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $412.72 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $1,765.31 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $589.96 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $2,278.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $377.27 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $455.76 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $377.27 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $1,765.31
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: HB OB US >/= 14 Wks Sngl Fetus	$1,723	$1,206.10	$256.73 – $1,723
Pregnancy ultrasound (after the first trimester): 10 of 31 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $1,068.26 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $1,169.92 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $280.85 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $1,201.28 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $401.46 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $1,550.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $256.73 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $310.14 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $256.73 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $1,201.28
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: HB Transvaginal US Non-OB	$1,542	$1,079.40	$229.76 – $1,542
Transvaginal ultrasound: 10 of 31 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $956.04 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $1,047.02 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $251.35 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $1,075.08 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $359.29 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $1,387.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $229.76 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $277.56 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $229.76 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $1,075.08
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: HB Diagnostic Mammography Incl Cad Unilateral	$664	$464.80	$98.94 – $664
Diagnostic mammogram, one breast: 10 of 31 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $411.68 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $450.86 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $108.23 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $462.94 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $154.71 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $597.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $98.94 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $119.52 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $98.94 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $462.94
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: HB Diagnostic Mammography Incl Cad Bilateral	$734	$513.80	$109.37 – $734
Diagnostic mammogram, both breasts: 10 of 31 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $455.08 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $498.39 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $119.64 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $511.74 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $171.02 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $660.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $109.37 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $132.12 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $109.37 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $511.74
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: HB Screening Mammography Bilateral Incl Cad	$748	$523.60	$111.45 – $748
Screening mammogram, both breasts: 10 of 31 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $463.76 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $507.89 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $121.92 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $521.51 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $174.28 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $673.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $111.45 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $134.64 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $111.45 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $521.51

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: HB Left Hrt Cath W/Ventrclgrphy	$15,397	$10,777.90	$2,509.71 – $15,397
Left heart catheterization (diagnostic): 10 of 30 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $2,509.71 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $13,689.47 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $5,142.60 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $13,857.30 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $4,311.16 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $4,449.73 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $4,311.16 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $13,689.47 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $8,606.92 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $5,142.60
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: HB Ep Evaluation Without Induction	$12,822	$8,975.40	$1,910.48 – $12,822
Heart rhythm study (electrophysiology evaluation): 10 of 30 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $2,089.99 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $8,939.50 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $2,987.53 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $11,539.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $1,910.48 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $2,307.96 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $1,910.48 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $8,939.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $7,167.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $2,987.53
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: HB Electrophysiology Evaluation Without Induction	$18,842	$13,189.40	$2,807.46 – $18,842
Heart rhythm study (electrophysiology evaluation): 10 of 30 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $3,071.25 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $13,136.64 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $4,390.19 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $16,957.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $2,807.46 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $3,391.56 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $2,807.46 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $13,136.64 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $10,532.68 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $4,390.19
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: HB Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation	$26,424	$18,496.80	$3,937.18 – $26,424
Heart rhythm study with ablation for atrial fibrillation: 10 of 30 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $4,307.11 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $18,422.81 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $6,156.79 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $23,781.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $3,937.18 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $4,756.32 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $3,937.18 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $18,422.81 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $14,771.02 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $6,156.79
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: HB Polysom 6/> Yrs 4/> Param	$6,270	$4,389	$934.23 – $6,270
Sleep study (overnight, in a sleep lab): 10 of 33 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $4,000.26 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $4,382.73 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $1,022.01 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $4,371.44 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $1,460.91 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $5,643 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $934.23 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $1,128.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $934.23 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $4,371.44

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) In the file: HB Therapeutic Exercises	$236	$165.20	$35.16 – $236
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 33 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $146.32 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $160.24 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $38.47 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $164.54 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $54.99 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $212.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $35.16 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $42.48 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $35.16 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $164.54
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: HB Pt Eval Low Complex	$419	$293.30	$62.43 – $419
Physical therapy evaluation (low complexity): 10 of 33 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $259.78 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $284.50 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $68.30 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $292.13 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $97.63 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $377.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $62.43 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $75.42 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $62.43 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $292.13
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: HB Pt Eval Mod Complex	$503	$352.10	$74.95 – $503
Physical therapy evaluation (moderate complexity): 10 of 33 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $311.86 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $341.54 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $81.99 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $350.69 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $117.20 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $452.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $74.95 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $90.54 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $74.95 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $350.69
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: HB Pt Eval High Complex	$638	$446.60	$95.06 – $638
Physical therapy evaluation (high complexity): 10 of 33 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $395.56 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $433.20 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $103.99 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $444.81 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $148.65 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $574.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $95.06 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $114.84 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $95.06 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $444.81
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: HB Cdh C/D OP Counseling Ind- 45 Min	$205	$143.50	$30.55 – $205
Psychotherapy, 45 minutes: 10 of 29 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $33.42 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $47.77 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $184.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $30.55 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $36.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $30.55 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $114.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $47.77 CARELON BEHAVIORAL HEALTH [159] — DCH BEACON HEALTH OPTIONS BHS: $102.50 CIGNA HEALTH PLAN [178] — DCH CIGNA ALTERNATIVE: $44.69
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: HB Cdh C/D OP Mat Therapy	$205	$143.50	$30.55 – $205
Psychotherapy, 45 minutes: 10 of 29 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $33.42 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $47.77 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $184.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $30.55 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $36.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $30.55 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $114.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $47.77 CARELON BEHAVIORAL HEALTH [159] — DCH BEACON HEALTH OPTIONS BHS: $102.50 CIGNA HEALTH PLAN [178] — DCH CIGNA ALTERNATIVE: $44.69
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: HB Cdh M/H OP Counseling Ind- 45 Min	$205	$143.50	$30.55 – $205
Psychotherapy, 45 minutes: 10 of 29 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $33.42 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $47.77 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $184.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $30.55 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $36.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $30.55 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $114.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $47.77 CARELON BEHAVIORAL HEALTH [159] — DCH BEACON HEALTH OPTIONS BHS: $102.50 CIGNA HEALTH PLAN [178] — DCH CIGNA ALTERNATIVE: $44.69
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: HB Cdh C/D OP Counseling Ind- 60 Min	$256	$179.20	$38.14 – $256
Psychotherapy, 60 minutes: 10 of 30 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $41.73 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $59.65 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $230.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $38.14 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $46.08 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $38.14 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $143.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $59.65 CARELON BEHAVIORAL HEALTH [159] — DCH BEACON HEALTH OPTIONS BHS: $128 CIGNA HEALTH PLAN [178] — DCH CIGNA ALTERNATIVE: $55.81
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: HB Cdh M/H OP Counseling Ind- 60 Min	$256	$179.20	$38.14 – $256
Psychotherapy, 60 minutes: 10 of 30 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $41.73 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $59.65 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $230.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $38.14 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $46.08 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $38.14 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $143.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $59.65 CARELON BEHAVIORAL HEALTH [159] — DCH BEACON HEALTH OPTIONS BHS: $128 CIGNA HEALTH PLAN [178] — DCH CIGNA ALTERNATIVE: $55.81
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: HB Cdh Family Psytx W/Patient	$256	$179.20	$38.14 – $256
Family psychotherapy, with the patient: 10 of 30 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $41.73 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $59.65 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $230.40 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $38.14 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $46.08 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $38.14 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $143.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $59.65 CARELON BEHAVIORAL HEALTH [159] — DCH BEACON HEALTH OPTIONS BHS: $128 CIGNA HEALTH PLAN [178] — DCH CIGNA ALTERNATIVE: $55.81
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: HB M/H Group Therapy	$90	$63	$13.41 – $90
Group psychotherapy: 10 of 33 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $55.80 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $61.11 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $14.67 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $20.97 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $81 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $13.41 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $16.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $13.41 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $50.31 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $20.97
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: HB Continuing Care Group Psychotherapy	$118	$82.60	$17.58 – $118
Group psychotherapy: 10 of 33 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $73.16 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $80.12 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $19.23 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $27.49 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $106.20 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $17.58 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $21.24 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $17.58 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $65.96 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $27.49
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: HB Group Psychotherapy	$121	$84.70	$18.03 – $121
Group psychotherapy: 10 of 33 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $75.02 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $82.16 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $19.72 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $28.19 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $108.90 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $18.03 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $21.78 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $18.03 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $67.64 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $28.19

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: HB Arthro/Surg Shld Decompress	$74,707.11	$52,294.98	$892.50 – $7,839
Shoulder arthroscopy: shaving of shoulder bone: 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $892.50 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $982 FIRST HEALTH PLAN [6034] — DCH AETNA: $892.50 UNITED HEALTHCARE [158] — DCH UHC CORE: $7,055 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $7,839 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: HB Arthroscop Knee Med and Lat	$32,447.91	$22,713.54	$5,282 – $5,868
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 38 insurance plan rates UNITED HEALTHCARE [158] — DCH UHC CORE: $5,282 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $5,868 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): 93% (a percentage in the contract, not a dollar amount) BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: 90% (a percentage in the contract, not a dollar amount) BLUE CROSS BLUE SHIELD [1401] — DCH ADVOCATE IPA: 120% (a percentage in the contract, not a dollar amount)
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: HB Tonsillectomy & Adenoidectomy <Age 12	$18,425.77	$12,898.04	$3,577 – $3,975
Removal of tonsils and adenoids (under age 12): 10 of 38 insurance plan rates UNITED HEALTHCARE [158] — DCH UHC CORE: $3,577 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $3,975 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): 93% (a percentage in the contract, not a dollar amount) BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: 90% (a percentage in the contract, not a dollar amount) BLUE CROSS BLUE SHIELD [1401] — DCH ADVOCATE IPA: 120% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: HB Esophagogastroduodenoscopy Transoral Diagnostic	$11,547.14	$8,083	$689.50 – $1,187
Upper GI endoscopy (diagnostic): 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $689.50 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $758.50 FIRST HEALTH PLAN [6034] — DCH AETNA: $689.50 UNITED HEALTHCARE [158] — DCH UHC CORE: $1,068.50 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $1,187 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 69.72% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 23.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: HB Egd Transoral Biopsy Single/Multiple	$16,309.43	$11,416.60	$1,068.50 – $1,725
Upper GI endoscopy with biopsy: 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $1,568 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $1,725 FIRST HEALTH PLAN [6034] — DCH AETNA: $1,568 UNITED HEALTHCARE [158] — DCH UHC CORE: $1,068.50 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $1,187 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 69.72% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 23.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount)
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: HB Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$7,191.91	$5,034.34	$2,741 – $3,045
Colonoscopy (diagnostic): 10 of 38 insurance plan rates UNITED HEALTHCARE [158] — DCH UHC CORE: $2,741 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $3,045 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 69.72% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 23.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): 93% (a percentage in the contract, not a dollar amount) BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: 90% (a percentage in the contract, not a dollar amount) BLUE CROSS BLUE SHIELD [1401] — DCH ADVOCATE IPA: 120% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: HB Colonoscopy W/Biopsy Single/Multiple	$5,849	$4,094.30	$871.50 – $5,849
Colonoscopy with biopsy: 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $1,568 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $1,725 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $953.39 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $4,077.92 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $1,362.82 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $5,264.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $871.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $1,052.82 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $871.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $4,077.92
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: HB Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$5,849	$4,094.30	$871.50 – $5,849
Colonoscopy with removal of polyps (snare): 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $784 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $862.50 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $953.39 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $4,077.92 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $1,362.82 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $5,264.10 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $871.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $1,052.82 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $871.50 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $4,077.92
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) In the file: HB Colonoscopy W/Endoscope US	$24,410.14	$17,087.10	$784 – $3,045
Ultrasound of the lower bowel by endoscope: 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $784 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $862.50 FIRST HEALTH PLAN [6034] — DCH AETNA: $784 UNITED HEALTHCARE [158] — DCH UHC CORE: $2,741 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $3,045 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 69.72% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 23.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount)
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: HB Colon Ca Scrn Not Hi Rsk Ind	$4,112	$2,878.40	$612.69 – $4,112
Screening colonoscopy (not high risk): 10 of 30 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $670.26 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $2,866.89 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $958.10 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $3,700.80 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $612.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $740.16 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $612.69 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $2,866.89 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $2,298.61 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $958.10
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: Laparoscopy Surg Cholecystectomy	$43,772.34	$30,640.64	$7,055 – $7,839
Gallbladder removal by laparoscope: 10 of 38 insurance plan rates UNITED HEALTHCARE [158] — DCH UHC CORE: $7,055 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $7,839 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): 93% (a percentage in the contract, not a dollar amount) BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: 90% (a percentage in the contract, not a dollar amount) BLUE CROSS BLUE SHIELD [1401] — DCH ADVOCATE IPA: 120% (a percentage in the contract, not a dollar amount)
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: HB Laparoscopy Surg Cholecystectomy	$22,604	$15,822.80	$3,684.45 – $22,604
Gallbladder removal by laparoscope: 10 of 26 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $3,684.45 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $15,759.51 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $12,113.48 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $20,343.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $10,684.91 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $10,476.95 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $10,372.98 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $15,759.51 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PAR/INDEMNITY ADP: $12,635.64 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $12,113.48
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible	$35,937.71	$25,156.40	$5,282 – $5,868
Groin (inguinal) hernia repair, age 5 or older: 10 of 38 insurance plan rates UNITED HEALTHCARE [158] — DCH UHC CORE: $5,282 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $5,868 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): 93% (a percentage in the contract, not a dollar amount) BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: 90% (a percentage in the contract, not a dollar amount) BLUE CROSS BLUE SHIELD [1401] — DCH ADVOCATE IPA: 120% (a percentage in the contract, not a dollar amount)
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: HB Biopsy of Prostate_Biopsy, Prostate; Needle or Punch, Single or Multiple, Any Approach	$7,184	$5,028.80	$7,184
Prostate biopsy: 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $4,454.08 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $4,877.94 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: $1,170.99 ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $5,008.68 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $1,673.87 BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: $6,465.60 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $1,070.42 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $1,293.12 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $1,070.42 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $5,008.68
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) In the file: Laps Surg Prst8ect Rpbic Rad W/Nrv Sparing Robot	$120,939.41	$84,657.59	$700 – $11,492
Prostate removal by laparoscope (radical prostatectomy): 10 of 38 insurance plan rates OPTUM/UNITED BEHAVIORAL HEALTH [157] — DCH UNITED BEHAVIORAL HEALTH: $700 UNITED HEALTHCARE [158] — DCH UHC CORE: $10,343 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $11,492 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): 93% (a percentage in the contract, not a dollar amount) BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: 90% (a percentage in the contract, not a dollar amount)
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$29,404.41	$20,583.09	$3,577 – $3,975
Hysteroscopy with biopsy of the uterus lining: 10 of 38 insurance plan rates UNITED HEALTHCARE [158] — DCH UHC CORE: $3,577 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $3,975 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): 93% (a percentage in the contract, not a dollar amount) BEECHSTREET [176] — DCH BEECH STREET/CAPP CARE: 90% (a percentage in the contract, not a dollar amount) BLUE CROSS BLUE SHIELD [1401] — DCH ADVOCATE IPA: 120% (a percentage in the contract, not a dollar amount)
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: HB Injection Inclu Needle/Cath Plct Interlaminar Lmbr/Sac W/ Flouro	$3,973.74	$2,781.62	$1,334 – $1,481
Spinal injection, lower back (epidural), with imaging guidance: 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $2,328.72 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $2,550.32 FIRST HEALTH PLAN [6034] — DCH AETNA: $2,328.72 UNITED HEALTHCARE [158] — DCH UHC CORE: $1,334 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $1,481 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount)
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: HB Inj Foramen Epidural L/S	$5,087.74	$3,561.42	$2,001 – $2,221.50
Nerve root injection, lower back, with imaging guidance: 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $2,990.88 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $3,275.50 FIRST HEALTH PLAN [6034] — DCH AETNA: $2,990.88 UNITED HEALTHCARE [158] — DCH UHC CORE: $2,001 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $2,221.50 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount)
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: HB Carpal Tunnel Surgery	$25,601.46	$17,921.02	$784 – $1,987.50
Carpal tunnel release: 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $784 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $862.50 FIRST HEALTH PLAN [6034] — DCH AETNA: $784 UNITED HEALTHCARE [158] — DCH UHC CORE: $1,788.50 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $1,987.50 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount)
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) In the file: HB Extracapsular Catarct Removal W/O Ecp	$19,514.04	$13,659.83	$2,325 – $3,975
Cataract removal with lens implant: 10 of 41 insurance plan rates AETNA HEALTH PLAN [171] — DCH AETNA: $2,325 AETNA HEALTH PLAN [171] — DCH AETNA ASA: $2,558 FIRST HEALTH PLAN [6034] — DCH AETNA: $2,325 UNITED HEALTHCARE [158] — DCH UHC CORE: $3,577 UNITED HEALTHCARE [158] — DCH UHC HMO/PPO: $3,975 AETNA HEALTH PLAN [171] — DCH AETNA NM EMPLOYEES: 16.3% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: 88.91% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: 33.4% (a percentage in the contract, not a dollar amount) ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount) ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: 100% (a percentage in the contract, not a dollar amount)

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	$113,280.70	$79,296.49	$13,725.73 – $30,065.76
Hip or knee replacement (major joint of the leg), without major complications: 10 of 25 insurance plan rates ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $14,507.26 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $30,065.76 ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: $13,725.73 ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: $13,725.73 BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): $13,725.73 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $17,323.45 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $14,603.70 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $14,316.30 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $14,507.26 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $30,065.76
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	$140,718.30	$98,502.80	$17,371.88 – $38,052.54
Neck (cervical) spinal fusion, without complications: 10 of 25 insurance plan rates ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $18,361.02 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $38,052.54 ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: $17,371.88 ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: $17,371.88 BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): $17,371.88 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $21,925.32 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $18,483.08 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $18,119.33 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $18,361.02 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $38,052.54
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	$54,676.64	$38,273.65	$8,828.61 – $19,338.79
Uterus and ovary surgery (not for cancer), without complications: 10 of 25 insurance plan rates ALTERNATE BLUE CROSS [1402] — DCH BCBS HMO: $9,331.30 ALTERNATE BLUE CROSS [1402] — DCH BCBS PPO: $19,338.79 ALTERNATE BLUE CROSS MEDICARE ADV [2304] — DCH BLUE CROSS MEDICARE ADVT: $8,828.61 ALTERNATE HUMANA MEDICARE ADV [2409] — DCH HUMANA MEDICARE ADVT: $8,828.61 BCBS MEDICARE ADVANTAGE [1304] — DCH BLUE CROSS MMAI (MEDICARE): $8,828.61 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE OPTIONS: $11,142.73 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE PREFERRED: $9,393.34 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS BLUECHOICE SELECT: $9,208.48 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS HMO: $9,331.30 BLUE CROSS BLUE SHIELD [1401] — DCH BCBS PPO: $19,338.79

Source: Northwestern Medicine Delnor Community Hospital’s standard charges file (nm.org, JSON, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	300 Randall Rd, Geneva, IL 60134
County	Kane County
State	Illinois
Phone	(630) 208‑3000
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	5 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	140211
Name in Medicare records	NORTHWESTERN MEDICINE DELNOR COMMUNITY HOSPITAL
Profile level	Medicare data + hospital website
Name on the hospital’s website	Northwestern Medicine Delnor Hospital
Official website	nm.org
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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