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Acute Care Hospital

Oswego Hospital

Oswego, New York · Oswego County · Emergency services listed

Oswego Hospital is an acute care hospital at 110 West Sixth Street, Oswego, NY 13069. Phone: (315) 349-5511. It has an emergency department. Medicare overall rating: 3 of 5 stars (CMS, October 2026).

Data as of October 26, 2026. Source: CMS Hospital General Information and the hospital’s website (checked October 30, 2026).

Summary

Oswego Hospital is an acute care hospital in Oswego, New York. Medicare data lists emergency services. CMS overall star rating: 3 of 5 stars. Its official website lists 58 services, specialties and programs. Medicare lists 564 affiliated clinicians. Source: CMS Hospital General Information, data updated 2026-10-26.

What is an acute care hospital?

A general hospital for short-term care: emergencies, surgery, illness and injury. Most patients stay a few days. More about hospital types

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Profile from official sources

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

In a medical emergency, call 911.

At a glance

YesEmergency services
3 of 5 stars3 of 5 stars · Medicare rating
132Beds (hospital website)
58Services listed

Quick answers

Does Oswego Hospital have an emergency room?
Yes. Medicare (CMS) data lists emergency services at Oswego Hospital. In a medical emergency, call 911.
Where is Oswego Hospital?
110 West Sixth Street, Oswego, NY 13069, in Oswego County, New York.
What is the phone number of Oswego Hospital?
(315) 349-5511, as listed by Medicare (CMS).
What is the Medicare star rating of Oswego Hospital?
3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to Oswego Hospital for hospital-acquired conditions?
No. For fiscal year 2026, CMS lists no Medicare payment reduction for Oswego Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 0.3700; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas[4][5][7][8][9]

Treatments[7][10]

  • Epidural pain relief for labor
  • Spinal (intrathecal) pain relief for labor
  • Sterile water block for labor back pain
  • Intensive care for critically ill patients
  • Postpartum and newborn care

Procedures[8][9]

  • Lumpectomy
  • Mastectomy
  • Breast biopsy
  • Cardioversion
  • Transesophageal echocardiogram (TEE)
  • Colonoscopy
  • Endoscopy
  • ERCP
  • Appendectomy
  • Thyroid surgery
  • Total joint replacement
  • Hand and wrist surgery (carpal tunnel)
  • Knee arthroscopy
  • Foot and ankle surgery
  • Shoulder surgery
  • Robotic hernia repair
  • Robotic gallbladder surgery
  • CT scan

Programs and centers[4][7][8][10]

  • Maternity Center
  • Intensive care unit
  • Robotic-assisted surgery with da Vinci systems
  • Hospital-based childbirth tours and birth planning

Emergency care (hospital website)[5]

Emergency roomYes
Open 24/7Yes

Visiting and practical information

VisitingInpatients 10 a.m.-8 p.m.; ICU noon-8 p.m.; ER up to two visitors per patient, no hour limits[12]
Patient portalhttps://www.oswegohealth.org/patients-families/patient-portal/

Recognition[9][11]

  • The Joint Commission Gold Seal of Approval (Oswego Hospital)
  • American College of Radiology accredited imaging services
  • MQSA-accredited mammography
  • Becker's Hospital Review 'Great Community Hospitals' list

Doctors and clinicians (564)

564 doctors and other clinicians list Oswego 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 (564)

And 540 more: the button below opens the full list.

Other emergency rooms nearby

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

Find the closest emergency room to where you are → · Compare ER wait times

Other hospitals near Oswego

Hospitals in Oswego County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

All nursing homes in the state →

Home health agencies

All home health agencies in the state →

Dialysis facilities

All dialysis facilities in the state →

Community care nearby

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

Community health centers

Clinics and urgent care

Pharmacies

Assisted living nearby

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

About the Medicare star rating

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

Medicare quality data

What Oswego 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 hospital4 of 5 stars
Would recommend the hospital4 of 5 stars
Nurses communicated well4 of 5 stars
Doctors communicated well4 of 5 stars
Patients got help quickly from staff4 of 5 stars
Staff explained medicines3 of 5 stars
Information about recovery at home4 of 5 stars
Room and bathroom kept clean4 of 5 stars
Restfulness of Environment3 of 5 stars
Care Coordination4 of 5 stars
Symptoms After Stay4 of 5 stars
Rated the hospital 9 or 10 out of 1076%National average: 72%
Would definitely recommend the hospital70%National average: 71%
Nurses “always” communicated well82%National average: 80%
Doctors “always” communicated well84%National average: 80%
“Always” got help as soon as they wanted65%National average: 64%
Staff “always” explained medicines before giving them61%National average: 62%
Were given information about recovery at home91%National average: 86%
Room and bathroom “always” clean75%National average: 73%
Completed surveys404Response rate: 22%

Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged January 2025 to December 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.

Catheter-associated urinary tract infections (CAUTI)0No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections0.566No different from the national benchmark
Not reported to MedicareCentral line bloodstream infections (CLABSI); Surgical site infections after colon surgery; Surgical site infections after abdominal hysterectomy; MRSA bloodstream infections

Source: Healthcare Associated Infections - Hospital — CMS, released October 19, 2026; data from January 2025 to December 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 failure patients13%
Deaths within 30 days: pneumonia patients18.1%
Deaths within 30 days: COPD patients7%
Serious complications (patient safety indicator PSI-90)1.11No different from the national rate
Not reported to MedicareDeaths within 30 days: coronary bypass surgery (CABG)
Too few cases to reportDeaths within 30 days: heart attack patients; Deaths within 30 days: stroke patients; Complications after hip or knee replacement

Source: Complications and Deaths - Hospital — CMS, released October 20, 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)17.8%
Readmitted within 30 days: heart failure22.1%
Readmitted within 30 days: pneumonia18.6%
Readmitted within 30 days: COPD20.3%
Not reported to MedicareReadmitted within 30 days: coronary bypass surgery
Too few cases to reportReadmitted within 30 days: heart attack; Readmitted within 30 days: hip or knee replacement

Source: Unplanned Hospital Visits - Hospital — CMS, released October 20, 2026; data from July 2024 to June 2025.

Emergency room times and sepsis care

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

Emergency room volume (patients per year)Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)192 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)8%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)52%National average: 66%

Source: Timely and Effective Care - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

Medicare payment programs

Medicare (CMS) uses these federal programs to adjust what it pays hospitals, based on quality, safety and cost results. This is a payment to the hospital for Medicare patients, not a price you pay, and not a prediction for any one person. Results for Oswego Hospital, fiscal year 2026 (October 2025 to September 2026).

Show the Medicare payment program results

Hospital-Acquired Condition Reduction Program

What this means: Medicare gives each hospital a Total HAC Score built from patient-safety complications and from infections caught in the hospital. The quarter of hospitals with the highest (worst) scores gets a reduction in its Medicare payments. A lower score is better.

CMS says: Hospitals with a Total HAC Score above the 75th percentile of the Total HAC Score distribution will be subject to a 1-percent payment reduction.

Medicare payment reduction, fiscal year 2026NoCMS lists no payment reduction for this hospital.
Total HAC Score0.3700Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

Source: Hospital-Acquired Condition (HAC) Reduction Program — CMS, released January 26, 2026; patient-safety data from July 2022 to June 2024 and infection data from January 2023 to December 2024.

Hospital Readmissions Reduction Program

What this means: For six conditions, Medicare compares how often this hospital’s patients had to go back into a hospital within 30 days with how often that happens at an average hospital with similar patients. The ratio is that comparison: 1 means as many readmissions as expected, above 1 means more than expected (CMS calls these “excess readmissions”), below 1 means fewer.

CMS says: In October 2012, CMS began reducing Medicare payments for subsection(d) hospitals with excess readmissions under the Hospital Readmissions Reduction Program (HRRP).

Heart failure1.0143More readmissions than expected
Pneumonia1.0705More readmissions than expected
COPD (chronic lung disease)1.0003More readmissions than expected
No result publishedHeart attack; Hip or knee replacement; Coronary bypass surgery (CABG) (not reported, or too few cases)

Source: Hospital Readmissions Reduction Program — CMS, released January 26, 2026; patients discharged July 2021 to June 2024.

Hospital Value-Based Purchasing Program

What this means: Medicare scores hospitals in four areas, each from 0 to 100, and combines them into a Total Performance Score from 0 to 100. A higher score means better results on these measures. Medicare uses the score to adjust what it pays the hospital.

CMS says: This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver.

Total Performance Score20.42 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)0.00 out of 100
Person and community engagement (patient survey)45.00 out of 100
Safety (infections and sepsis care)26.67 out of 100
Efficiency and cost reduction (Medicare spending)10.00 out of 100

Source: Hospital Value-Based Purchasing (HVBP) - Total Performance Score — CMS, released January 26, 2026, fiscal year 2026. Program description: The Hospital Value-Based Purchasing (VBP) Program — CMS, page last modified September 10, 2024.

Medicare spending per patient (MSPB)

What this means: This compares what Medicare spent on a hospital stay, counting the 3 days before it and the 30 days after, with the national median hospital, after adjusting for the patient’s age and health and for local prices. A ratio of 1.00 is the national median hospital; below 1.00 means Medicare spent less, above 1.00 means more. It measures the cost to Medicare, not the quality of care.

CMS says: The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (episode) at a specific hospital compared to all hospitals nationally.

Medicare spending per patient, ratio1.00Same as the national median hospital

Source: Medicare Spending Per Beneficiary - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

ER wait times and Medicare ratings nearby

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

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 Oswego 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 →

Show the prices of 70 common services

Office and emergency visits

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-44 MINUTES $318.98 $239.24 $69.26 – $600
New patient office visit (about 30–44 minutes): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $69.26
  • Capital District Physicians Healthcare — Medicare: $69.26
  • Excellus Health Plan — Commercial: $210.08
  • Excellus Health Plan — Medicare Advantage: $69.26
  • Fedelis Care NY — Medicare Advantage: $69.26
  • Humana ChoiceCare — Medicare Advantage: $69.26
  • Nascentia — Medicare Advantage: $76.19
  • United Healthcare — Commercial: $600
  • United Healthcare — Medicare Advantage: $69.26
  • Wellcare Todays Option — Medicare Advantage: $74.11
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-44 MINUTES $178 $133.50 $69.26 – $210.08
New patient office visit (about 30–44 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $69.26
  • Capital District Physicians Healthcare — Medicare: $69.26
  • Excellus Health Plan — Commercial: $210.08
  • Excellus Health Plan — Medicare Advantage: $69.26
  • Fedelis Care NY — Medicare Advantage: $69.26
  • Humana ChoiceCare — Medicare Advantage: $69.26
  • Nascentia — Medicare Advantage: $76.19
  • United Healthcare — Medicare Advantage: $69.26
  • Wellcare Todays Option — Medicare Advantage: $74.11
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW LOW 30 MIN $106 $79.50 $69.26 – $210.08
New patient office visit (about 30–44 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $69.26
  • Capital District Physicians Healthcare — Medicare: $69.26
  • Excellus Health Plan — Commercial: $210.08
  • Excellus Health Plan — Medicare Advantage: $69.26
  • Fedelis Care NY — Medicare Advantage: $69.26
  • Humana ChoiceCare — Medicare Advantage: $69.26
  • Nascentia — Medicare Advantage: $76.19
  • United Healthcare — Medicare Advantage: $69.26
  • Wellcare Todays Option — Medicare Advantage: $74.11
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 45-59 MINUTES $350.88 $263.16 $113.42 – $600
New patient office visit (about 45–59 minutes): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $113.42
  • Capital District Physicians Healthcare — Medicare: $113.42
  • Excellus Health Plan — Commercial: $344.03
  • Excellus Health Plan — Medicare Advantage: $113.42
  • Fedelis Care NY — Medicare Advantage: $113.42
  • Humana ChoiceCare — Medicare Advantage: $113.42
  • Nascentia — Medicare Advantage: $124.76
  • United Healthcare — Commercial: $600
  • United Healthcare — Medicare Advantage: $113.42
  • Wellcare Todays Option — Medicare Advantage: $121.36
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE O/P NEW MOD 45 MIN $271 $203.25 $113.42 – $344.03
New patient office visit (about 45–59 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $113.42
  • Capital District Physicians Healthcare — Medicare: $113.42
  • Excellus Health Plan — Commercial: $344.03
  • Excellus Health Plan — Medicare Advantage: $113.42
  • Fedelis Care NY — Medicare Advantage: $113.42
  • Humana ChoiceCare — Medicare Advantage: $113.42
  • Nascentia — Medicare Advantage: $124.76
  • United Healthcare — Medicare Advantage: $113.42
  • Wellcare Todays Option — Medicare Advantage: $121.36
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW MOD 45 MIN $371.93 $278.95 $113.42 – $344.03
New patient office visit (about 45–59 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $113.42
  • Capital District Physicians Healthcare — Medicare: $113.42
  • Excellus Health Plan — Commercial: $344.03
  • Excellus Health Plan — Medicare Advantage: $113.42
  • Fedelis Care NY — Medicare Advantage: $113.42
  • Humana ChoiceCare — Medicare Advantage: $113.42
  • Nascentia — Medicare Advantage: $124.76
  • United Healthcare — Medicare Advantage: $113.42
  • Wellcare Todays Option — Medicare Advantage: $121.36
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 60-74 MINUTES $432.54 $324.41 $155.18 – $470.69
New patient office visit (about 60–74 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $155.18
  • Capital District Physicians Healthcare — Medicare: $155.18
  • Excellus Health Plan — Commercial: $470.69
  • Excellus Health Plan — Medicare Advantage: $155.18
  • Fedelis Care NY — Medicare Advantage: $155.18
  • Humana ChoiceCare — Medicare Advantage: $155.18
  • Nascentia — Medicare Advantage: $170.70
  • United Healthcare — Medicare Advantage: $155.18
  • Wellcare Todays Option — Medicare Advantage: $166.04
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW HI 60 MIN $961.61 $721.21 $155.18 – $470.69
New patient office visit (about 60–74 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $155.18
  • Capital District Physicians Healthcare — Medicare: $155.18
  • Excellus Health Plan — Commercial: $470.69
  • Excellus Health Plan — Medicare Advantage: $155.18
  • Fedelis Care NY — Medicare Advantage: $155.18
  • Humana ChoiceCare — Medicare Advantage: $155.18
  • Nascentia — Medicare Advantage: $170.70
  • United Healthcare — Medicare Advantage: $155.18
  • Wellcare Todays Option — Medicare Advantage: $166.04
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE O/P NEW HI 60 MIN $349 $261.75 $155.18 – $470.69
New patient office visit (about 60–74 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $155.18
  • Capital District Physicians Healthcare — Medicare: $155.18
  • Excellus Health Plan — Commercial: $470.69
  • Excellus Health Plan — Medicare Advantage: $155.18
  • Fedelis Care NY — Medicare Advantage: $155.18
  • Humana ChoiceCare — Medicare Advantage: $155.18
  • Nascentia — Medicare Advantage: $170.70
  • United Healthcare — Medicare Advantage: $155.18
  • Wellcare Todays Option — Medicare Advantage: $166.04
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 20-29 MINUTES $255.20 $191.40 $56.01 – $600
Established patient office visit (about 20–29 minutes): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $56.01
  • Capital District Physicians Healthcare — Medicare: $56.01
  • Excellus Health Plan — Commercial: $169.89
  • Excellus Health Plan — Medicare Advantage: $56.01
  • Fedelis Care NY — Medicare Advantage: $56.01
  • Humana ChoiceCare — Medicare Advantage: $56.01
  • Nascentia — Medicare Advantage: $61.61
  • United Healthcare — Commercial: $600
  • United Healthcare — Medicare Advantage: $56.01
  • Wellcare Todays Option — Medicare Advantage: $59.93
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 20-29 MINUTES $127 $95.25 $56.01 – $169.89
Established patient office visit (about 20–29 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $56.01
  • Capital District Physicians Healthcare — Medicare: $56.01
  • Excellus Health Plan — Commercial: $169.89
  • Excellus Health Plan — Medicare Advantage: $56.01
  • Fedelis Care NY — Medicare Advantage: $56.01
  • Humana ChoiceCare — Medicare Advantage: $56.01
  • Nascentia — Medicare Advantage: $61.61
  • United Healthcare — Medicare Advantage: $56.01
  • Wellcare Todays Option — Medicare Advantage: $59.93
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P EST LOW 20 MIN $403.03 $302.27 $56.01 – $169.89
Established patient office visit (about 20–29 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $56.01
  • Capital District Physicians Healthcare — Medicare: $56.01
  • Excellus Health Plan — Commercial: $169.89
  • Excellus Health Plan — Medicare Advantage: $56.01
  • Fedelis Care NY — Medicare Advantage: $56.01
  • Humana ChoiceCare — Medicare Advantage: $56.01
  • Nascentia — Medicare Advantage: $61.61
  • United Healthcare — Medicare Advantage: $56.01
  • Wellcare Todays Option — Medicare Advantage: $59.93
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-39 MINUTES $287.08 $215.31 $82.33 – $600
Established patient office visit (about 30–39 minutes): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $82.33
  • Capital District Physicians Healthcare — Medicare: $82.33
  • Excellus Health Plan — Commercial: $249.72
  • Excellus Health Plan — Medicare Advantage: $82.33
  • Fedelis Care NY — Medicare Advantage: $82.33
  • Humana ChoiceCare — Medicare Advantage: $82.33
  • Nascentia — Medicare Advantage: $90.56
  • United Healthcare — Commercial: $600
  • United Healthcare — Medicare Advantage: $82.33
  • Wellcare Todays Option — Medicare Advantage: $88.09
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-39 MINUTES $179 $134.25 $82.33 – $249.72
Established patient office visit (about 30–39 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $82.33
  • Capital District Physicians Healthcare — Medicare: $82.33
  • Excellus Health Plan — Commercial: $249.72
  • Excellus Health Plan — Medicare Advantage: $82.33
  • Fedelis Care NY — Medicare Advantage: $82.33
  • Humana ChoiceCare — Medicare Advantage: $82.33
  • Nascentia — Medicare Advantage: $90.56
  • United Healthcare — Medicare Advantage: $82.33
  • Wellcare Todays Option — Medicare Advantage: $88.09
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P EST MOD 30 MIN $217.76 $163.32 $82.33 – $249.72
Established patient office visit (about 30–39 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $82.33
  • Capital District Physicians Healthcare — Medicare: $82.33
  • Excellus Health Plan — Commercial: $249.72
  • Excellus Health Plan — Medicare Advantage: $82.33
  • Fedelis Care NY — Medicare Advantage: $82.33
  • Humana ChoiceCare — Medicare Advantage: $82.33
  • Nascentia — Medicare Advantage: $90.56
  • United Healthcare — Medicare Advantage: $82.33
  • Wellcare Todays Option — Medicare Advantage: $88.09
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30 $121 $90.75 Not listed in the file
Office consultation with a specialist (moderate): rates for 5 insurance plans
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
  • Capital District Physicians Healthcare — Commercial: 80% (a percentage in the contract, not a dollar amount)
  • MultiPlan Inc. — Commercial: 75% (a percentage in the contract, not a dollar amount)
  • MVP Health Plan — Commercial: 75% (a percentage in the contract, not a dollar amount)
  • UnitedHealthcare Empire Plan — Commercial: 40% (a percentage in the contract, not a dollar amount)
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40 $121 $90.75 Not listed in the file
Office consultation with a specialist (moderate to high): rates for 5 insurance plans
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
  • Capital District Physicians Healthcare — Commercial: 80% (a percentage in the contract, not a dollar amount)
  • MultiPlan Inc. — Commercial: 75% (a percentage in the contract, not a dollar amount)
  • MVP Health Plan — Commercial: 75% (a percentage in the contract, not a dollar amount)
  • UnitedHealthcare Empire Plan — Commercial: 40% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY $822.98 $617.24 $339.08 – $1,790
Emergency room visit (moderate): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $339.08
  • Capital District Physicians Healthcare — Medicare: $339.08
  • Excellus Health Plan — Commercial: $1,028.50
  • Excellus Health Plan — Medicare Advantage: $339.08
  • Fedelis Care NY — Medicare Advantage: $339.08
  • Humana ChoiceCare — Medicare Advantage: $339.08
  • MVP Health Plan — Commercial: $1,050
  • Nascentia — Medicare Advantage: $372.99
  • United Healthcare — Commercial: $1,790
  • United Healthcare — Medicare Advantage: $339.08
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LOW MDM $872.36 $654.27 $339.08 – $1,790
Emergency room visit (moderate): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $339.08
  • Capital District Physicians Healthcare — Medicare: $339.08
  • Excellus Health Plan — Commercial: $1,028.50
  • Excellus Health Plan — Medicare Advantage: $339.08
  • Fedelis Care NY — Medicare Advantage: $339.08
  • Humana ChoiceCare — Medicare Advantage: $339.08
  • MVP Health Plan — Commercial: $1,050
  • Nascentia — Medicare Advantage: $372.99
  • United Healthcare — Commercial: $1,790
  • United Healthcare — Medicare Advantage: $339.08
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EMERGENCY DEPT VISIT LOW MDM $120 $90 $339.08 – $1,028.50
Emergency room visit (moderate): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $339.08
  • Capital District Physicians Healthcare — Medicare: $339.08
  • Excellus Health Plan — Commercial: $1,028.50
  • Excellus Health Plan — Medicare Advantage: $339.08
  • Fedelis Care NY — Medicare Advantage: $339.08
  • Humana ChoiceCare — Medicare Advantage: $339.08
  • Nascentia — Medicare Advantage: $372.99
  • United Healthcare — Medicare Advantage: $339.08
  • Wellcare Todays Option — Medicare Advantage: $362.82
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY $1,065.41 $799.06 $518.31 – $1,790
Emergency room visit (moderately high): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $518.31
  • Capital District Physicians Healthcare — Medicare: $518.31
  • Excellus Health Plan — Commercial: $1,572.14
  • Excellus Health Plan — Medicare Advantage: $518.31
  • Fedelis Care NY — Medicare Advantage: $518.31
  • Humana ChoiceCare — Medicare Advantage: $518.31
  • MVP Health Plan — Commercial: $1,050
  • Nascentia — Medicare Advantage: $570.14
  • United Healthcare — Commercial: $1,790
  • United Healthcare — Medicare Advantage: $518.31
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT MOD MDM $1,129.33 $847 $518.31 – $1,790
Emergency room visit (moderately high): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $518.31
  • Capital District Physicians Healthcare — Medicare: $518.31
  • Excellus Health Plan — Commercial: $1,572.14
  • Excellus Health Plan — Medicare Advantage: $518.31
  • Fedelis Care NY — Medicare Advantage: $518.31
  • Humana ChoiceCare — Medicare Advantage: $518.31
  • MVP Health Plan — Commercial: $1,050
  • Nascentia — Medicare Advantage: $570.14
  • United Healthcare — Commercial: $1,790
  • United Healthcare — Medicare Advantage: $518.31
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EMERGENCY DEPT VISIT MOD MDM $229 $171.75 $518.31 – $1,572.14
Emergency room visit (moderately high): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $518.31
  • Capital District Physicians Healthcare — Medicare: $518.31
  • Excellus Health Plan — Commercial: $1,572.14
  • Excellus Health Plan — Medicare Advantage: $518.31
  • Fedelis Care NY — Medicare Advantage: $518.31
  • Humana ChoiceCare — Medicare Advantage: $518.31
  • Nascentia — Medicare Advantage: $570.14
  • United Healthcare — Medicare Advantage: $518.31
  • Wellcare Todays Option — Medicare Advantage: $554.59
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY $1,212.14 $909.11 $739.75 – $2,243.81
Emergency room visit (high): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $739.75
  • Capital District Physicians Healthcare — Medicare: $739.75
  • Excellus Health Plan — Commercial: $2,243.81
  • Excellus Health Plan — Medicare Advantage: $739.75
  • Fedelis Care NY — Medicare Advantage: $739.75
  • Humana ChoiceCare — Medicare Advantage: $739.75
  • MVP Health Plan — Commercial: $1,050
  • Nascentia — Medicare Advantage: $813.73
  • United Healthcare — Commercial: $1,790
  • United Healthcare — Medicare Advantage: $739.75
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT HI MDM $1,284.87 $963.65 $739.75 – $2,243.81
Emergency room visit (high): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $739.75
  • Capital District Physicians Healthcare — Medicare: $739.75
  • Excellus Health Plan — Commercial: $2,243.81
  • Excellus Health Plan — Medicare Advantage: $739.75
  • Fedelis Care NY — Medicare Advantage: $739.75
  • Humana ChoiceCare — Medicare Advantage: $739.75
  • MVP Health Plan — Commercial: $1,050
  • Nascentia — Medicare Advantage: $813.72
  • United Healthcare — Commercial: $1,790
  • United Healthcare — Medicare Advantage: $739.75
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25_26 In the file: EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY $1,212.14 $909.11 $739.75 – $2,243.81
Emergency room visit (high): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $739.75
  • Capital District Physicians Healthcare — Medicare: $739.75
  • Excellus Health Plan — Commercial: $2,243.81
  • Excellus Health Plan — Medicare Advantage: $739.75
  • Fedelis Care NY — Medicare Advantage: $739.75
  • Humana ChoiceCare — Medicare Advantage: $739.75
  • MVP Health Plan — Commercial: $1,050
  • Nascentia — Medicare Advantage: $813.73
  • United Healthcare — Commercial: $1,790
  • United Healthcare — Medicare Advantage: $739.75

Lab tests

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL) $126.46 $94.85 $8.46 – $303
Basic metabolic panel (blood test): 10 of 15 insurance plan rates
  • Aetna — Commercial: $15.14
  • Aetna — Medicare Advantage: $8.46
  • Capital District Physicians Healthcare — Medicare: $8.46
  • Excellus Health Plan — Commercial: $11.84
  • Excellus Health Plan — Medicare Advantage: $8.46
  • Fedelis Care NY — Medicare Advantage: $8.46
  • Humana ChoiceCare — Medicare Advantage: $8.46
  • Nascentia — Medicare Advantage: $9.31
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $8.46
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: METABOLIC PANEL TOTAL CA $134.05 $100.54 $8.46 – $303
Basic metabolic panel (blood test): 10 of 15 insurance plan rates
  • Aetna — Commercial: $15.14
  • Aetna — Medicare Advantage: $8.46
  • Capital District Physicians Healthcare — Medicare: $8.46
  • Excellus Health Plan — Commercial: $11.84
  • Excellus Health Plan — Medicare Advantage: $8.46
  • Fedelis Care NY — Medicare Advantage: $8.46
  • Humana ChoiceCare — Medicare Advantage: $8.46
  • Nascentia — Medicare Advantage: $9.31
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $8.46
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier XE In the file: BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL) $126.46 $94.85 $8.46 – $303
Basic metabolic panel (blood test): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $8.46
  • Capital District Physicians Healthcare — Medicare: $8.46
  • Excellus Health Plan — Commercial: $25.66
  • Excellus Health Plan — Medicare Advantage: $8.46
  • Fedelis Care NY — Medicare Advantage: $8.46
  • Humana ChoiceCare — Medicare Advantage: $8.46
  • Nascentia — Medicare Advantage: $9.31
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $8.46
  • Wellcare Todays Option — Medicare Advantage: $9.05
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD TEST; COMPREHENSIVE GROUP OF BLOOD CHEMICALS $11.66 $8.75 $10.56 – $303
Comprehensive metabolic panel (blood test): 10 of 15 insurance plan rates
  • Aetna — Commercial: $18.90
  • Aetna — Medicare Advantage: $10.56
  • Capital District Physicians Healthcare — Medicare: $10.56
  • Excellus Health Plan — Commercial: $14.78
  • Excellus Health Plan — Medicare Advantage: $10.56
  • Fedelis Care NY — Medicare Advantage: $10.56
  • Humana ChoiceCare — Medicare Advantage: $10.56
  • Nascentia — Medicare Advantage: $11.62
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $10.56
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHEN METABOLIC PANEL $7.15 $5.36 $10.56 – $303
Comprehensive metabolic panel (blood test): 10 of 15 insurance plan rates
  • Aetna — Commercial: $18.90
  • Aetna — Medicare Advantage: $10.56
  • Capital District Physicians Healthcare — Medicare: $10.56
  • Excellus Health Plan — Commercial: $14.78
  • Excellus Health Plan — Medicare Advantage: $10.56
  • Fedelis Care NY — Medicare Advantage: $10.56
  • Humana ChoiceCare — Medicare Advantage: $10.56
  • Nascentia — Medicare Advantage: $11.62
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $10.56
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 51 In the file: BLOOD TEST; COMPREHENSIVE GROUP OF BLOOD CHEMICALS $164.53 $123.40 $10.56 – $303
Comprehensive metabolic panel (blood test): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $10.56
  • Capital District Physicians Healthcare — Medicare: $10.56
  • Excellus Health Plan — Commercial: $32.03
  • Excellus Health Plan — Medicare Advantage: $10.56
  • Fedelis Care NY — Medicare Advantage: $10.56
  • Humana ChoiceCare — Medicare Advantage: $10.56
  • Nascentia — Medicare Advantage: $11.62
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $10.56
  • Wellcare Todays Option — Medicare Advantage: $11.30
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL $11.67 $8.75 $13.39 – $303
Cholesterol panel (lipid panel): 10 of 15 insurance plan rates
  • Aetna — Commercial: $23.97
  • Aetna — Medicare Advantage: $13.39
  • Capital District Physicians Healthcare — Medicare: $13.39
  • Excellus Health Plan — Commercial: $18.75
  • Excellus Health Plan — Medicare Advantage: $13.39
  • Fedelis Care NY — Medicare Advantage: $13.39
  • Humana ChoiceCare — Medicare Advantage: $13.39
  • Nascentia — Medicare Advantage: $14.73
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $13.39
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES) $132.60 $99.45 $13.39 – $303
Cholesterol panel (lipid panel): 10 of 15 insurance plan rates
  • Aetna — Commercial: $23.97
  • Aetna — Medicare Advantage: $13.39
  • Capital District Physicians Healthcare — Medicare: $13.39
  • Excellus Health Plan — Commercial: $18.75
  • Excellus Health Plan — Medicare Advantage: $13.39
  • Fedelis Care NY — Medicare Advantage: $13.39
  • Humana ChoiceCare — Medicare Advantage: $13.39
  • Nascentia — Medicare Advantage: $14.73
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $13.39
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GA_PN In the file: BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES) $132.60 $99.45 $13.39 – $303
Cholesterol panel (lipid panel): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $13.39
  • Capital District Physicians Healthcare — Medicare: $13.39
  • Excellus Health Plan — Commercial: $40.61
  • Excellus Health Plan — Medicare Advantage: $13.39
  • Fedelis Care NY — Medicare Advantage: $13.39
  • Humana ChoiceCare — Medicare Advantage: $13.39
  • Nascentia — Medicare Advantage: $14.73
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $13.39
  • Wellcare Todays Option — Medicare Advantage: $14.33
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: KIDNEY FUNCTION BLOOD TEST PANEL $164.53 $123.40 $8.68 – $303
Kidney function panel: 10 of 15 insurance plan rates
  • Aetna — Commercial: $15.54
  • Aetna — Medicare Advantage: $8.68
  • Capital District Physicians Healthcare — Medicare: $8.68
  • Excellus Health Plan — Commercial: $12.15
  • Excellus Health Plan — Medicare Advantage: $8.68
  • Fedelis Care NY — Medicare Advantage: $8.68
  • Humana ChoiceCare — Medicare Advantage: $8.68
  • Nascentia — Medicare Advantage: $9.55
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $8.68
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL $174.40 $130.80 $8.68 – $303
Kidney function panel: 10 of 15 insurance plan rates
  • Aetna — Commercial: $15.54
  • Aetna — Medicare Advantage: $8.68
  • Capital District Physicians Healthcare — Medicare: $8.68
  • Excellus Health Plan — Commercial: $12.15
  • Excellus Health Plan — Medicare Advantage: $8.68
  • Fedelis Care NY — Medicare Advantage: $8.68
  • Humana ChoiceCare — Medicare Advantage: $8.68
  • Nascentia — Medicare Advantage: $9.55
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $8.68
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIVER FUNCTION BLOOD TEST PANEL $78.58 $58.94 $8.17 – $303
Liver function panel: 10 of 15 insurance plan rates
  • Aetna — Commercial: $14.62
  • Aetna — Medicare Advantage: $8.17
  • Capital District Physicians Healthcare — Medicare: $8.17
  • Excellus Health Plan — Commercial: $11.44
  • Excellus Health Plan — Medicare Advantage: $8.17
  • Fedelis Care NY — Medicare Advantage: $8.17
  • Humana ChoiceCare — Medicare Advantage: $8.17
  • Nascentia — Medicare Advantage: $8.99
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $8.17
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL $83.29 $62.47 $8.17 – $303
Liver function panel: 10 of 15 insurance plan rates
  • Aetna — Commercial: $14.62
  • Aetna — Medicare Advantage: $8.17
  • Capital District Physicians Healthcare — Medicare: $8.17
  • Excellus Health Plan — Commercial: $11.44
  • Excellus Health Plan — Medicare Advantage: $8.17
  • Fedelis Care NY — Medicare Advantage: $8.17
  • Humana ChoiceCare — Medicare Advantage: $8.17
  • Nascentia — Medicare Advantage: $8.99
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $8.17
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: LIVER FUNCTION BLOOD TEST PANEL $74.13 $55.60 $8.17 – $303
Liver function panel: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $8.17
  • Capital District Physicians Healthcare — Medicare: $8.17
  • Excellus Health Plan — Commercial: $24.78
  • Excellus Health Plan — Medicare Advantage: $8.17
  • Fedelis Care NY — Medicare Advantage: $8.17
  • Humana ChoiceCare — Medicare Advantage: $8.17
  • Nascentia — Medicare Advantage: $8.99
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $8.17
  • Wellcare Todays Option — Medicare Advantage: $8.74
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/SCOPE $58.57 $43.93 $3.17 – $303
Urine test (automated, with microscope): 10 of 15 insurance plan rates
  • Aetna — Commercial: $5.67
  • Aetna — Medicare Advantage: $3.17
  • Capital District Physicians Healthcare — Medicare: $3.17
  • Excellus Health Plan — Commercial: $4.44
  • Excellus Health Plan — Medicare Advantage: $3.17
  • Fedelis Care NY — Medicare Advantage: $3.17
  • Humana ChoiceCare — Medicare Advantage: $3.17
  • Nascentia — Medicare Advantage: $3.49
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $3.17
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED $104.24 $78.18 $3.17 – $303
Urine test (automated, with microscope): 10 of 15 insurance plan rates
  • Aetna — Commercial: $5.67
  • Aetna — Medicare Advantage: $3.17
  • Capital District Physicians Healthcare — Medicare: $3.17
  • Excellus Health Plan — Commercial: $4.44
  • Excellus Health Plan — Medicare Advantage: $3.17
  • Fedelis Care NY — Medicare Advantage: $3.17
  • Humana ChoiceCare — Medicare Advantage: $3.17
  • Nascentia — Medicare Advantage: $3.49
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $3.17
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 59_91 In the file: MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED $55.25 $41.44 $3.17 – $303
Urine test (automated, with microscope): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $3.17
  • Capital District Physicians Healthcare — Medicare: $3.17
  • Excellus Health Plan — Commercial: $9.62
  • Excellus Health Plan — Medicare Advantage: $3.17
  • Fedelis Care NY — Medicare Advantage: $3.17
  • Humana ChoiceCare — Medicare Advantage: $3.17
  • Nascentia — Medicare Advantage: $3.49
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $3.17
  • Wellcare Todays Option — Medicare Advantage: $3.39
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS; MANUAL TEST $7 $5.25 $3.48 – $303
Urine test (manual, without microscope): 10 of 15 insurance plan rates
  • Aetna — Commercial: $6.23
  • Aetna — Medicare Advantage: $3.48
  • Capital District Physicians Healthcare — Medicare: $3.48
  • Excellus Health Plan — Commercial: $4.87
  • Excellus Health Plan — Medicare Advantage: $3.48
  • Fedelis Care NY — Medicare Advantage: $3.48
  • Humana ChoiceCare — Medicare Advantage: $3.48
  • Nascentia — Medicare Advantage: $3.83
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $3.48
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE $45.56 $34.17 $3.48 – $303
Urine test (manual, without microscope): 10 of 15 insurance plan rates
  • Aetna — Commercial: $6.23
  • Aetna — Medicare Advantage: $3.48
  • Capital District Physicians Healthcare — Medicare: $3.48
  • Excellus Health Plan — Commercial: $4.87
  • Excellus Health Plan — Medicare Advantage: $3.48
  • Fedelis Care NY — Medicare Advantage: $3.48
  • Humana ChoiceCare — Medicare Advantage: $3.48
  • Nascentia — Medicare Advantage: $3.83
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $3.48
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 59 In the file: URINALYSIS; MANUAL TEST $7 $5.25 $3.48 – $303
Urine test (manual, without microscope): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $3.48
  • Capital District Physicians Healthcare — Medicare: $3.48
  • Excellus Health Plan — Commercial: $10.56
  • Excellus Health Plan — Medicare Advantage: $3.48
  • Fedelis Care NY — Medicare Advantage: $3.48
  • Humana ChoiceCare — Medicare Advantage: $3.48
  • Nascentia — Medicare Advantage: $3.83
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $3.48
  • Wellcare Todays Option — Medicare Advantage: $3.72
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/O SCOPE $27.34 $20.51 $2.25 – $303
Urine test (automated, without microscope): 10 of 15 insurance plan rates
  • Aetna — Commercial: $4.03
  • Aetna — Medicare Advantage: $2.25
  • Capital District Physicians Healthcare — Medicare: $2.25
  • Excellus Health Plan — Commercial: $3.15
  • Excellus Health Plan — Medicare Advantage: $2.25
  • Fedelis Care NY — Medicare Advantage: $2.25
  • Humana ChoiceCare — Medicare Advantage: $2.25
  • Nascentia — Medicare Advantage: $2.48
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $2.25
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: AUTOMATED URINALYSIS TEST $51.58 $38.69 $2.25 – $303
Urine test (automated, without microscope): 10 of 15 insurance plan rates
  • Aetna — Commercial: $4.03
  • Aetna — Medicare Advantage: $2.25
  • Capital District Physicians Healthcare — Medicare: $2.25
  • Excellus Health Plan — Commercial: $3.15
  • Excellus Health Plan — Medicare Advantage: $2.25
  • Fedelis Care NY — Medicare Advantage: $2.25
  • Humana ChoiceCare — Medicare Advantage: $2.25
  • Nascentia — Medicare Advantage: $2.48
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $2.25
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PN In the file: AUTOMATED URINALYSIS TEST $22.95 $17.21 $2.25 – $303
Urine test (automated, without microscope): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $2.25
  • Capital District Physicians Healthcare — Medicare: $2.25
  • Excellus Health Plan — Commercial: $6.82
  • Excellus Health Plan — Medicare Advantage: $2.25
  • Fedelis Care NY — Medicare Advantage: $2.25
  • Humana ChoiceCare — Medicare Advantage: $2.25
  • Nascentia — Medicare Advantage: $2.48
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $2.25
  • Wellcare Todays Option — Medicare Advantage: $2.41
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL $127.69 $95.77 $18.39 – $303
PSA (prostate specific antigen) blood test: 10 of 15 insurance plan rates
  • Aetna — Commercial: $32.92
  • Aetna — Medicare Advantage: $18.39
  • Capital District Physicians Healthcare — Medicare: $18.39
  • Excellus Health Plan — Commercial: $25.75
  • Excellus Health Plan — Medicare Advantage: $18.39
  • Fedelis Care NY — Medicare Advantage: $18.39
  • Humana ChoiceCare — Medicare Advantage: $18.39
  • Nascentia — Medicare Advantage: $20.23
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY OF PSA TOTAL $129.75 $97.31 $18.39 – $303
PSA (prostate specific antigen) blood test: 10 of 15 insurance plan rates
  • Aetna — Commercial: $32.92
  • Aetna — Medicare Advantage: $18.39
  • Capital District Physicians Healthcare — Medicare: $18.39
  • Excellus Health Plan — Commercial: $25.75
  • Excellus Health Plan — Medicare Advantage: $18.39
  • Fedelis Care NY — Medicare Advantage: $18.39
  • Humana ChoiceCare — Medicare Advantage: $18.39
  • Nascentia — Medicare Advantage: $20.23
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 59 In the file: PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL $127.69 $95.77 $18.39 – $303
PSA (prostate specific antigen) blood test: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $18.39
  • Capital District Physicians Healthcare — Medicare: $18.39
  • Excellus Health Plan — Commercial: $55.78
  • Excellus Health Plan — Medicare Advantage: $18.39
  • Fedelis Care NY — Medicare Advantage: $18.39
  • Humana ChoiceCare — Medicare Advantage: $18.39
  • Nascentia — Medicare Advantage: $20.23
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $18.39
  • Wellcare Todays Option — Medicare Advantage: $19.68
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD TEST; THYROID STIMULATING HORMONE (TSH) $171.89 $128.92 $16.80 – $303
Thyroid stimulating hormone (TSH) test: 10 of 15 insurance plan rates
  • Aetna — Commercial: $30.07
  • Aetna — Medicare Advantage: $16.80
  • Capital District Physicians Healthcare — Medicare: $16.80
  • Excellus Health Plan — Commercial: $23.52
  • Excellus Health Plan — Medicare Advantage: $16.80
  • Fedelis Care NY — Medicare Advantage: $16.80
  • Humana ChoiceCare — Medicare Advantage: $16.80
  • Nascentia — Medicare Advantage: $18.48
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $16.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY THYROID STIM HORMONE $182.20 $136.65 $16.80 – $303
Thyroid stimulating hormone (TSH) test: 10 of 15 insurance plan rates
  • Aetna — Commercial: $30.07
  • Aetna — Medicare Advantage: $16.80
  • Capital District Physicians Healthcare — Medicare: $16.80
  • Excellus Health Plan — Commercial: $23.52
  • Excellus Health Plan — Medicare Advantage: $16.80
  • Fedelis Care NY — Medicare Advantage: $16.80
  • Humana ChoiceCare — Medicare Advantage: $16.80
  • Nascentia — Medicare Advantage: $18.48
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $16.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 91 In the file: BLOOD TEST; THYROID STIMULATING HORMONE (TSH) $171.89 $128.92 $16.80 – $303
Thyroid stimulating hormone (TSH) test: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $16.80
  • Capital District Physicians Healthcare — Medicare: $16.80
  • Excellus Health Plan — Commercial: $50.96
  • Excellus Health Plan — Medicare Advantage: $16.80
  • Fedelis Care NY — Medicare Advantage: $16.80
  • Humana ChoiceCare — Medicare Advantage: $16.80
  • Nascentia — Medicare Advantage: $18.48
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $16.80
  • Wellcare Todays Option — Medicare Advantage: $17.98
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC W/AUTO DIFF WBC $7.10 $5.33 $7.77 – $303
Complete blood count (CBC) with differential: 10 of 15 insurance plan rates
  • Aetna — Commercial: $13.91
  • Aetna — Medicare Advantage: $7.77
  • Capital District Physicians Healthcare — Medicare: $7.77
  • Excellus Health Plan — Commercial: $10.88
  • Excellus Health Plan — Medicare Advantage: $7.77
  • Fedelis Care NY — Medicare Advantage: $7.77
  • Humana ChoiceCare — Medicare Advantage: $7.77
  • Nascentia — Medicare Advantage: $8.55
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $7.77
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT $100.68 $75.51 $7.77 – $303
Complete blood count (CBC) with differential: 10 of 15 insurance plan rates
  • Aetna — Commercial: $13.91
  • Aetna — Medicare Advantage: $7.77
  • Capital District Physicians Healthcare — Medicare: $7.77
  • Excellus Health Plan — Commercial: $10.88
  • Excellus Health Plan — Medicare Advantage: $7.77
  • Fedelis Care NY — Medicare Advantage: $7.77
  • Humana ChoiceCare — Medicare Advantage: $7.77
  • Nascentia — Medicare Advantage: $8.55
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $7.77
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GZ In the file: COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT $94.98 $71.24 $7.77 – $303
Complete blood count (CBC) with differential: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $7.77
  • Capital District Physicians Healthcare — Medicare: $7.77
  • Excellus Health Plan — Commercial: $23.57
  • Excellus Health Plan — Medicare Advantage: $7.77
  • Fedelis Care NY — Medicare Advantage: $7.77
  • Humana ChoiceCare — Medicare Advantage: $7.77
  • Nascentia — Medicare Advantage: $8.55
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $7.77
  • Wellcare Todays Option — Medicare Advantage: $8.31
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST $45.43 $34.07 $6.47 – $303
Complete blood count (CBC), automated: 10 of 15 insurance plan rates
  • Aetna — Commercial: $11.58
  • Aetna — Medicare Advantage: $6.47
  • Capital District Physicians Healthcare — Medicare: $6.47
  • Excellus Health Plan — Commercial: $9.06
  • Excellus Health Plan — Medicare Advantage: $6.47
  • Fedelis Care NY — Medicare Advantage: $6.47
  • Humana ChoiceCare — Medicare Advantage: $6.47
  • Nascentia — Medicare Advantage: $7.12
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $6.47
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC AUTOMATED $48.16 $36.12 $6.47 – $303
Complete blood count (CBC), automated: 10 of 15 insurance plan rates
  • Aetna — Commercial: $11.58
  • Aetna — Medicare Advantage: $6.47
  • Capital District Physicians Healthcare — Medicare: $6.47
  • Excellus Health Plan — Commercial: $9.06
  • Excellus Health Plan — Medicare Advantage: $6.47
  • Fedelis Care NY — Medicare Advantage: $6.47
  • Humana ChoiceCare — Medicare Advantage: $6.47
  • Nascentia — Medicare Advantage: $7.12
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $6.47
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier AY In the file: COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST $45.43 $34.07 $6.47 – $303
Complete blood count (CBC), automated: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $6.47
  • Capital District Physicians Healthcare — Medicare: $6.47
  • Excellus Health Plan — Commercial: $19.62
  • Excellus Health Plan — Medicare Advantage: $6.47
  • Fedelis Care NY — Medicare Advantage: $6.47
  • Humana ChoiceCare — Medicare Advantage: $6.47
  • Nascentia — Medicare Advantage: $7.12
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $6.47
  • Wellcare Todays Option — Medicare Advantage: $6.92
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD TEST; CLOTTING TIME $25.79 $19.34 $4.29 – $303
Blood clotting time test (prothrombin time, PT): 10 of 15 insurance plan rates
  • Aetna — Commercial: $7.68
  • Aetna — Medicare Advantage: $4.29
  • Capital District Physicians Healthcare — Medicare: $4.29
  • Excellus Health Plan — Commercial: $6.01
  • Excellus Health Plan — Medicare Advantage: $4.29
  • Fedelis Care NY — Medicare Advantage: $4.29
  • Humana ChoiceCare — Medicare Advantage: $4.29
  • Nascentia — Medicare Advantage: $4.72
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $4.29
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME $27.34 $20.51 $4.29 – $303
Blood clotting time test (prothrombin time, PT): 10 of 15 insurance plan rates
  • Aetna — Commercial: $7.68
  • Aetna — Medicare Advantage: $4.29
  • Capital District Physicians Healthcare — Medicare: $4.29
  • Excellus Health Plan — Commercial: $6.01
  • Excellus Health Plan — Medicare Advantage: $4.29
  • Fedelis Care NY — Medicare Advantage: $4.29
  • Humana ChoiceCare — Medicare Advantage: $4.29
  • Nascentia — Medicare Advantage: $4.72
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $4.29
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 91 In the file: BLOOD TEST; CLOTTING TIME $25.79 $19.34 $4.29 – $303
Blood clotting time test (prothrombin time, PT): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $4.29
  • Capital District Physicians Healthcare — Medicare: $4.29
  • Excellus Health Plan — Commercial: $13.01
  • Excellus Health Plan — Medicare Advantage: $4.29
  • Fedelis Care NY — Medicare Advantage: $4.29
  • Humana ChoiceCare — Medicare Advantage: $4.29
  • Nascentia — Medicare Advantage: $4.72
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $4.29
  • Wellcare Todays Option — Medicare Advantage: $4.59
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTIAL $66.37 $49.78 $6.01 – $303
Blood clotting test (partial thromboplastin time, PTT): 10 of 15 insurance plan rates
  • Aetna — Commercial: $10.76
  • Aetna — Medicare Advantage: $6.01
  • Capital District Physicians Healthcare — Medicare: $6.01
  • Excellus Health Plan — Commercial: $8.41
  • Excellus Health Plan — Medicare Advantage: $6.01
  • Fedelis Care NY — Medicare Advantage: $6.01
  • Humana ChoiceCare — Medicare Advantage: $6.01
  • Nascentia — Medicare Advantage: $6.61
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD $118.14 $88.61 $6.01 – $303
Blood clotting test (partial thromboplastin time, PTT): 10 of 15 insurance plan rates
  • Aetna — Commercial: $10.76
  • Aetna — Medicare Advantage: $6.01
  • Capital District Physicians Healthcare — Medicare: $6.01
  • Excellus Health Plan — Commercial: $8.41
  • Excellus Health Plan — Medicare Advantage: $6.01
  • Fedelis Care NY — Medicare Advantage: $6.01
  • Humana ChoiceCare — Medicare Advantage: $6.01
  • Nascentia — Medicare Advantage: $6.61
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 91 In the file: COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD $62.61 $46.96 $6.01 – $303
Blood clotting test (partial thromboplastin time, PTT): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $6.01
  • Capital District Physicians Healthcare — Medicare: $6.01
  • Excellus Health Plan — Commercial: $18.23
  • Excellus Health Plan — Medicare Advantage: $6.01
  • Fedelis Care NY — Medicare Advantage: $6.01
  • Humana ChoiceCare — Medicare Advantage: $6.01
  • Nascentia — Medicare Advantage: $6.61
  • United Healthcare — Commercial: $303
  • United Healthcare — Medicare Advantage: $6.01
  • Wellcare Todays Option — Medicare Advantage: $6.43

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

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT SCAN HEAD OR BRAIN WITHOUT CONTRAST $1,198.32 $898.74 $129.86 – $2,685
CT scan of the head or brain, without contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $2,685
  • United Healthcare — Medicare Advantage: $129.86
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC_XS In the file: CT SCAN HEAD OR BRAIN WITHOUT CONTRAST $1,198.32 $898.74 $129.86 – $2,685
CT scan of the head or brain, without contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $2,685
  • United Healthcare — Medicare Advantage: $129.86
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT HEAD/BRAIN W/O DYE $1,270.22 $952.67 $129.86 – $2,685
CT scan of the head or brain, without contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $2,685
  • United Healthcare — Medicare Advantage: $129.86
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST $4,765.04 $3,573.78 $433.36 – $3,582
MRI of the brain, before and after contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $2,366.15
  • Aetna — Medicare Advantage: $433.36
  • Capital District Physicians Healthcare — Medicare: $433.36
  • Excellus Health Plan — Commercial: $1,314.47
  • Excellus Health Plan — Medicare Advantage: $433.36
  • Fedelis Care NY — Medicare Advantage: $433.36
  • Humana ChoiceCare — Medicare Advantage: $433.36
  • Nascentia — Medicare Advantage: $476.70
  • United Healthcare — Commercial: $3,582
  • United Healthcare — Medicare Advantage: $433.36
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 59_TC In the file: MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST $4,765.04 $3,573.78 $433.36 – $3,582
MRI of the brain, before and after contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $2,366.15
  • Aetna — Medicare Advantage: $433.36
  • Capital District Physicians Healthcare — Medicare: $433.36
  • Excellus Health Plan — Commercial: $1,314.47
  • Excellus Health Plan — Medicare Advantage: $433.36
  • Fedelis Care NY — Medicare Advantage: $433.36
  • Humana ChoiceCare — Medicare Advantage: $433.36
  • Nascentia — Medicare Advantage: $476.70
  • United Healthcare — Commercial: $3,582
  • United Healthcare — Medicare Advantage: $433.36
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI BRAIN STEM W/O & W/DYE $5,050.94 $3,788.21 $433.36 – $3,582
MRI of the brain, before and after contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $2,366.15
  • Aetna — Medicare Advantage: $433.36
  • Capital District Physicians Healthcare — Medicare: $433.36
  • Excellus Health Plan — Commercial: $1,314.47
  • Excellus Health Plan — Medicare Advantage: $433.36
  • Fedelis Care NY — Medicare Advantage: $433.36
  • Humana ChoiceCare — Medicare Advantage: $433.36
  • Nascentia — Medicare Advantage: $476.70
  • United Healthcare — Commercial: $3,582
  • United Healthcare — Medicare Advantage: $433.36
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: X-RAY OF CHEST; 2 VIEWS $162.53 $121.90 $108.10 – $590.23
Chest X-ray, 2 views: 10 of 15 insurance plan rates
  • Aetna — Commercial: $590.23
  • Aetna — Medicare Advantage: $108.10
  • Capital District Physicians Healthcare — Medicare: $108.10
  • Excellus Health Plan — Commercial: $327.89
  • Excellus Health Plan — Medicare Advantage: $108.10
  • Fedelis Care NY — Medicare Advantage: $108.10
  • Humana ChoiceCare — Medicare Advantage: $108.10
  • Nascentia — Medicare Advantage: $118.91
  • United Healthcare — Medicare Advantage: $108.10
  • Wellcare Todays Option — Medicare Advantage: $115.67
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC_XE In the file: X-RAY OF CHEST; 2 VIEWS $162.53 $121.90 $108.10 – $590.23
Chest X-ray, 2 views: 10 of 15 insurance plan rates
  • Aetna — Commercial: $590.23
  • Aetna — Medicare Advantage: $108.10
  • Capital District Physicians Healthcare — Medicare: $108.10
  • Excellus Health Plan — Commercial: $327.89
  • Excellus Health Plan — Medicare Advantage: $108.10
  • Fedelis Care NY — Medicare Advantage: $108.10
  • Humana ChoiceCare — Medicare Advantage: $108.10
  • Nascentia — Medicare Advantage: $118.91
  • United Healthcare — Medicare Advantage: $108.10
  • Wellcare Todays Option — Medicare Advantage: $115.67
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: X-RAY EXAM CHEST 2 VIEWS $172.28 $129.21 $108.10 – $590.23
Chest X-ray, 2 views: 10 of 15 insurance plan rates
  • Aetna — Commercial: $590.23
  • Aetna — Medicare Advantage: $108.10
  • Capital District Physicians Healthcare — Medicare: $108.10
  • Excellus Health Plan — Commercial: $327.89
  • Excellus Health Plan — Medicare Advantage: $108.10
  • Fedelis Care NY — Medicare Advantage: $108.10
  • Humana ChoiceCare — Medicare Advantage: $108.10
  • Nascentia — Medicare Advantage: $118.91
  • United Healthcare — Medicare Advantage: $108.10
  • Wellcare Todays Option — Medicare Advantage: $115.67
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: X-RAY OF LOWER AND SACRAL SPINE; MINIMUM OF 4 VIEWS $450.57 $337.93 $129.86 – $709.04
X-ray of the lower spine, at least 4 views: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Medicare Advantage: $129.86
  • Wellcare Todays Option — Medicare Advantage: $138.95
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: X-RAY EXAM L-2 SPINE 4/>VWS $506.26 $379.70 $129.86 – $709.04
X-ray of the lower spine, at least 4 views: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Medicare Advantage: $129.86
  • Wellcare Todays Option — Medicare Advantage: $138.95
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PN_TC In the file: X-RAY OF LOWER AND SACRAL SPINE; MINIMUM OF 4 VIEWS $477.60 $358.20 $51.94 – $283.59
X-ray of the lower spine, at least 4 views: 10 of 15 insurance plan rates
  • Aetna — Commercial: $283.59
  • Aetna — Medicare Advantage: $51.94
  • Capital District Physicians Healthcare — Medicare: $51.94
  • Excellus Health Plan — Commercial: $157.54
  • Excellus Health Plan — Medicare Advantage: $51.94
  • Fedelis Care NY — Medicare Advantage: $51.94
  • Humana ChoiceCare — Medicare Advantage: $51.94
  • Nascentia — Medicare Advantage: $57.13
  • United Healthcare — Medicare Advantage: $51.94
  • Wellcare Todays Option — Medicare Advantage: $55.58
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QQ_TC In the file: MRI SCAN OF LOWER SPINAL CANAL WITHOUT CONTRAST $2,295.73 $1,721.80 $296.38 – $3,582
MRI of the lower back (lumbar spine), without contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $1,618.23
  • Aetna — Medicare Advantage: $296.38
  • Capital District Physicians Healthcare — Medicare: $296.38
  • Excellus Health Plan — Commercial: $898.98
  • Excellus Health Plan — Medicare Advantage: $296.38
  • Fedelis Care NY — Medicare Advantage: $296.38
  • Humana ChoiceCare — Medicare Advantage: $296.38
  • Nascentia — Medicare Advantage: $326.02
  • United Healthcare — Commercial: $3,582
  • United Healthcare — Medicare Advantage: $296.38
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI SCAN OF LOWER SPINAL CANAL WITHOUT CONTRAST $2,433.47 $1,825.10 $296.38 – $3,582
MRI of the lower back (lumbar spine), without contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $1,618.23
  • Aetna — Medicare Advantage: $296.38
  • Capital District Physicians Healthcare — Medicare: $296.38
  • Excellus Health Plan — Commercial: $898.98
  • Excellus Health Plan — Medicare Advantage: $296.38
  • Fedelis Care NY — Medicare Advantage: $296.38
  • Humana ChoiceCare — Medicare Advantage: $296.38
  • Nascentia — Medicare Advantage: $326.02
  • United Healthcare — Commercial: $3,582
  • United Healthcare — Medicare Advantage: $296.38
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI LUMBAR SPINE W/O DYE $2,579.48 $1,934.61 $296.38 – $3,582
MRI of the lower back (lumbar spine), without contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $1,618.23
  • Aetna — Medicare Advantage: $296.38
  • Capital District Physicians Healthcare — Medicare: $296.38
  • Excellus Health Plan — Commercial: $898.98
  • Excellus Health Plan — Medicare Advantage: $296.38
  • Fedelis Care NY — Medicare Advantage: $296.38
  • Humana ChoiceCare — Medicare Advantage: $296.38
  • Nascentia — Medicare Advantage: $326.02
  • United Healthcare — Commercial: $3,582
  • United Healthcare — Medicare Advantage: $296.38
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT SCAN OF PELVIS WITH CONTRAST $1,319.30 $989.48 $217.88 – $2,685
CT scan of the pelvis, with contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $1,189.62
  • Aetna — Medicare Advantage: $217.88
  • Capital District Physicians Healthcare — Medicare: $217.88
  • Excellus Health Plan — Commercial: $660.87
  • Excellus Health Plan — Medicare Advantage: $217.88
  • Fedelis Care NY — Medicare Advantage: $217.88
  • Humana ChoiceCare — Medicare Advantage: $217.88
  • Nascentia — Medicare Advantage: $239.67
  • United Healthcare — Commercial: $2,685
  • United Healthcare — Medicare Advantage: $217.88
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT PELVIS W/DYE $1,482.37 $1,111.78 $217.88 – $2,685
CT scan of the pelvis, with contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $1,189.62
  • Aetna — Medicare Advantage: $217.88
  • Capital District Physicians Healthcare — Medicare: $217.88
  • Excellus Health Plan — Commercial: $660.87
  • Excellus Health Plan — Medicare Advantage: $217.88
  • Fedelis Care NY — Medicare Advantage: $217.88
  • Humana ChoiceCare — Medicare Advantage: $217.88
  • Nascentia — Medicare Advantage: $239.67
  • United Healthcare — Commercial: $2,685
  • United Healthcare — Medicare Advantage: $217.88
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO_TC In the file: CT SCAN OF PELVIS WITH CONTRAST $1,398.46 $1,048.85 $217.88 – $2,685
CT scan of the pelvis, with contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $1,189.62
  • Aetna — Medicare Advantage: $217.88
  • Capital District Physicians Healthcare — Medicare: $217.88
  • Excellus Health Plan — Commercial: $660.87
  • Excellus Health Plan — Medicare Advantage: $217.88
  • Fedelis Care NY — Medicare Advantage: $217.88
  • Humana ChoiceCare — Medicare Advantage: $217.88
  • Nascentia — Medicare Advantage: $239.67
  • United Healthcare — Commercial: $2,685
  • United Healthcare — Medicare Advantage: $217.88
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT_MG_PO_TC In the file: MRI SCAN OF LEG JOINT WITHOUT CONTRAST $1,795.03 $1,346.27 $296.38 – $3,582
MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $1,618.23
  • Aetna — Medicare Advantage: $296.38
  • Capital District Physicians Healthcare — Medicare: $296.38
  • Excellus Health Plan — Commercial: $898.98
  • Excellus Health Plan — Medicare Advantage: $296.38
  • Fedelis Care NY — Medicare Advantage: $296.38
  • Humana ChoiceCare — Medicare Advantage: $296.38
  • Nascentia — Medicare Advantage: $326.02
  • United Healthcare — Commercial: $3,582
  • United Healthcare — Medicare Advantage: $296.38
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT_PO_TC In the file: MRI SCAN OF LEG JOINT WITHOUT CONTRAST $1,795.03 $1,346.27 $296.38 – $3,582
MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $1,618.23
  • Aetna — Medicare Advantage: $296.38
  • Capital District Physicians Healthcare — Medicare: $296.38
  • Excellus Health Plan — Commercial: $898.98
  • Excellus Health Plan — Medicare Advantage: $296.38
  • Fedelis Care NY — Medicare Advantage: $296.38
  • Humana ChoiceCare — Medicare Advantage: $296.38
  • Nascentia — Medicare Advantage: $326.02
  • United Healthcare — Commercial: $3,582
  • United Healthcare — Medicare Advantage: $296.38
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC_LT In the file: MRI JNT OF LWR EXTRE W/O DYE $2,055.01 $1,541.26 $296.38 – $3,582
MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $1,618.23
  • Aetna — Medicare Advantage: $296.38
  • Capital District Physicians Healthcare — Medicare: $296.38
  • Excellus Health Plan — Commercial: $898.98
  • Excellus Health Plan — Medicare Advantage: $296.38
  • Fedelis Care NY — Medicare Advantage: $296.38
  • Humana ChoiceCare — Medicare Advantage: $296.38
  • Nascentia — Medicare Advantage: $326.02
  • United Healthcare — Commercial: $3,582
  • United Healthcare — Medicare Advantage: $296.38
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier ME_PO_TC In the file: CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST $2,637.43 $1,978.07 $433.36 – $2,685
CT scan of the abdomen and pelvis, with contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $2,366.15
  • Aetna — Medicare Advantage: $433.36
  • Capital District Physicians Healthcare — Medicare: $433.36
  • Excellus Health Plan — Commercial: $1,314.47
  • Excellus Health Plan — Medicare Advantage: $433.36
  • Fedelis Care NY — Medicare Advantage: $433.36
  • Humana ChoiceCare — Medicare Advantage: $433.36
  • Nascentia — Medicare Advantage: $476.70
  • United Healthcare — Commercial: $2,685
  • United Healthcare — Medicare Advantage: $433.36
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST $2,795.68 $2,096.76 $433.36 – $2,685
CT scan of the abdomen and pelvis, with contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $2,366.15
  • Aetna — Medicare Advantage: $433.36
  • Capital District Physicians Healthcare — Medicare: $433.36
  • Excellus Health Plan — Commercial: $1,314.47
  • Excellus Health Plan — Medicare Advantage: $433.36
  • Fedelis Care NY — Medicare Advantage: $433.36
  • Humana ChoiceCare — Medicare Advantage: $433.36
  • Nascentia — Medicare Advantage: $476.70
  • United Healthcare — Commercial: $2,685
  • United Healthcare — Medicare Advantage: $433.36
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT ABD & PELVIS W/CONTRAST $2,963.42 $2,222.57 $433.36 – $2,685
CT scan of the abdomen and pelvis, with contrast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $2,366.15
  • Aetna — Medicare Advantage: $433.36
  • Capital District Physicians Healthcare — Medicare: $433.36
  • Excellus Health Plan — Commercial: $1,314.47
  • Excellus Health Plan — Medicare Advantage: $433.36
  • Fedelis Care NY — Medicare Advantage: $433.36
  • Humana ChoiceCare — Medicare Advantage: $433.36
  • Nascentia — Medicare Advantage: $476.70
  • United Healthcare — Commercial: $2,685
  • United Healthcare — Medicare Advantage: $433.36
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: COMPLETE ULTRASOUND SCAN OF ABDOMEN $635.97 $476.98 $129.86 – $718
Ultrasound of the abdomen, complete: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $718
  • United Healthcare — Medicare Advantage: $129.86
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO_TC In the file: COMPLETE ULTRASOUND SCAN OF ABDOMEN $635.97 $476.98 $129.86 – $718
Ultrasound of the abdomen, complete: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $718
  • United Healthcare — Medicare Advantage: $129.86
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US EXAM ABDOM COMPLETE $674.13 $505.60 $129.86 – $718
Ultrasound of the abdomen, complete: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $718
  • United Healthcare — Medicare Advantage: $129.86
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE); SINGLE OR FIRST FETUS $595.54 $446.66 $129.86 – $718
Pregnancy ultrasound (after the first trimester): 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $718
  • United Healthcare — Medicare Advantage: $129.86
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: OB US >= 14 WKS SNGL FETUS $631.27 $473.45 $129.86 – $718
Pregnancy ultrasound (after the first trimester): 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $718
  • United Healthcare — Medicare Advantage: $129.86
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: ULTRASOUND SCAN OF UTERUS; OVARIES; TUBES; CERVIX AND PELVIC AREA THROUGH VAGINA $529.97 $397.48 $129.86 – $718
Transvaginal ultrasound: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $718
  • United Healthcare — Medicare Advantage: $129.86
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO_TC In the file: ULTRASOUND SCAN OF UTERUS; OVARIES; TUBES; CERVIX AND PELVIC AREA THROUGH VAGINA $529.97 $397.48 $129.86 – $718
Transvaginal ultrasound: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $718
  • United Healthcare — Medicare Advantage: $129.86
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: TRANSVAGINAL US NON-OB $561.77 $421.33 $129.86 – $718
Transvaginal ultrasound: 10 of 15 insurance plan rates
  • Aetna — Commercial: $709.04
  • Aetna — Medicare Advantage: $129.86
  • Capital District Physicians Healthcare — Medicare: $129.86
  • Excellus Health Plan — Commercial: $393.89
  • Excellus Health Plan — Medicare Advantage: $129.86
  • Fedelis Care NY — Medicare Advantage: $129.86
  • Humana ChoiceCare — Medicare Advantage: $129.86
  • Nascentia — Medicare Advantage: $142.85
  • United Healthcare — Commercial: $718
  • United Healthcare — Medicare Advantage: $129.86
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT_TC In the file: DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST $441.31 $330.98 $36.76 – $200.71
Diagnostic mammogram, one breast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $200.71
  • Aetna — Medicare Advantage: $36.76
  • Capital District Physicians Healthcare — Medicare: $36.76
  • Excellus Health Plan — Commercial: $111.50
  • Excellus Health Plan — Medicare Advantage: $36.76
  • Fedelis Care NY — Medicare Advantage: $36.76
  • Humana ChoiceCare — Medicare Advantage: $36.76
  • Nascentia — Medicare Advantage: $40.44
  • United Healthcare — Medicare Advantage: $36.76
  • Wellcare Todays Option — Medicare Advantage: $39.33
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DX MAMMO INCL CAD UNI $421.67 $316.25 $36.76 – $200.71
Diagnostic mammogram, one breast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $200.71
  • Aetna — Medicare Advantage: $36.76
  • Capital District Physicians Healthcare — Medicare: $36.76
  • Excellus Health Plan — Commercial: $111.50
  • Excellus Health Plan — Medicare Advantage: $36.76
  • Fedelis Care NY — Medicare Advantage: $36.76
  • Humana ChoiceCare — Medicare Advantage: $36.76
  • Nascentia — Medicare Advantage: $40.44
  • United Healthcare — Medicare Advantage: $36.76
  • Wellcare Todays Option — Medicare Advantage: $39.33
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC_RT In the file: DX MAMMO INCL CAD UNI $502.37 $376.78 $36.76 – $200.71
Diagnostic mammogram, one breast: 10 of 15 insurance plan rates
  • Aetna — Commercial: $200.71
  • Aetna — Medicare Advantage: $36.76
  • Capital District Physicians Healthcare — Medicare: $36.76
  • Excellus Health Plan — Commercial: $111.50
  • Excellus Health Plan — Medicare Advantage: $36.76
  • Fedelis Care NY — Medicare Advantage: $36.76
  • Humana ChoiceCare — Medicare Advantage: $36.76
  • Nascentia — Medicare Advantage: $40.44
  • United Healthcare — Medicare Advantage: $36.76
  • Wellcare Todays Option — Medicare Advantage: $39.33
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS $559.87 $419.90 $45.25 – $247.06
Diagnostic mammogram, both breasts: 10 of 15 insurance plan rates
  • Aetna — Commercial: $247.06
  • Aetna — Medicare Advantage: $45.25
  • Capital District Physicians Healthcare — Medicare: $45.25
  • Excellus Health Plan — Commercial: $137.25
  • Excellus Health Plan — Medicare Advantage: $45.25
  • Fedelis Care NY — Medicare Advantage: $45.25
  • Humana ChoiceCare — Medicare Advantage: $45.25
  • Nascentia — Medicare Advantage: $49.78
  • United Healthcare — Medicare Advantage: $45.25
  • Wellcare Todays Option — Medicare Advantage: $48.42
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO_TC In the file: DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS $528.18 $396.14 $45.25 – $247.06
Diagnostic mammogram, both breasts: 10 of 15 insurance plan rates
  • Aetna — Commercial: $247.06
  • Aetna — Medicare Advantage: $45.25
  • Capital District Physicians Healthcare — Medicare: $45.25
  • Excellus Health Plan — Commercial: $137.25
  • Excellus Health Plan — Medicare Advantage: $45.25
  • Fedelis Care NY — Medicare Advantage: $45.25
  • Humana ChoiceCare — Medicare Advantage: $45.25
  • Nascentia — Medicare Advantage: $49.78
  • United Healthcare — Medicare Advantage: $45.25
  • Wellcare Todays Option — Medicare Advantage: $48.42
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO_TC_XU In the file: DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS $559.87 $419.90 $45.25 – $247.06
Diagnostic mammogram, both breasts: 10 of 15 insurance plan rates
  • Aetna — Commercial: $247.06
  • Aetna — Medicare Advantage: $45.25
  • Capital District Physicians Healthcare — Medicare: $45.25
  • Excellus Health Plan — Commercial: $137.25
  • Excellus Health Plan — Medicare Advantage: $45.25
  • Fedelis Care NY — Medicare Advantage: $45.25
  • Humana ChoiceCare — Medicare Advantage: $45.25
  • Nascentia — Medicare Advantage: $49.78
  • United Healthcare — Medicare Advantage: $45.25
  • Wellcare Todays Option — Medicare Advantage: $48.42
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: SCREENING MAMMOGRAPHY $525.87 $394.40 $34.22 – $186.84
Screening mammogram, both breasts: 10 of 15 insurance plan rates
  • Aetna — Commercial: $186.84
  • Aetna — Medicare Advantage: $34.22
  • Capital District Physicians Healthcare — Medicare: $34.22
  • Excellus Health Plan — Commercial: $103.80
  • Excellus Health Plan — Medicare Advantage: $34.22
  • Fedelis Care NY — Medicare Advantage: $34.22
  • Humana ChoiceCare — Medicare Advantage: $34.22
  • Nascentia — Medicare Advantage: $37.64
  • United Healthcare — Medicare Advantage: $34.22
  • Wellcare Todays Option — Medicare Advantage: $36.62
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GZ_PO_TC In the file: SCREENING MAMMOGRAPHY $557.42 $418.07 $34.22 – $186.84
Screening mammogram, both breasts: 10 of 15 insurance plan rates
  • Aetna — Commercial: $186.84
  • Aetna — Medicare Advantage: $34.22
  • Capital District Physicians Healthcare — Medicare: $34.22
  • Excellus Health Plan — Commercial: $103.80
  • Excellus Health Plan — Medicare Advantage: $34.22
  • Fedelis Care NY — Medicare Advantage: $34.22
  • Humana ChoiceCare — Medicare Advantage: $34.22
  • Nascentia — Medicare Advantage: $37.64
  • United Healthcare — Medicare Advantage: $34.22
  • Wellcare Todays Option — Medicare Advantage: $36.62
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GZ_TC In the file: SCREENING MAMMOGRAPHY $557.42 $418.07 $34.22 – $186.84
Screening mammogram, both breasts: 10 of 15 insurance plan rates
  • Aetna — Commercial: $186.84
  • Aetna — Medicare Advantage: $34.22
  • Capital District Physicians Healthcare — Medicare: $34.22
  • Excellus Health Plan — Commercial: $103.80
  • Excellus Health Plan — Medicare Advantage: $34.22
  • Fedelis Care NY — Medicare Advantage: $34.22
  • Humana ChoiceCare — Medicare Advantage: $34.22
  • Nascentia — Medicare Advantage: $37.64
  • United Healthcare — Medicare Advantage: $34.22
  • Wellcare Todays Option — Medicare Advantage: $36.62

Heart tests and sleep study

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ELECTROCARDIOGRAM COMPLETE $240.77 $180.58 $74.97
Electrocardiogram (ECG/EKG) with reading: rates for 6 insurance plans
  • Aetna — Commercial: $74.97
  • Capital District Physicians Healthcare — Commercial: 80% (a percentage in the contract, not a dollar amount)
  • MultiPlan Inc. — Commercial: 75% (a percentage in the contract, not a dollar amount)
  • MVP Health Plan — Commercial: 75% (a percentage in the contract, not a dollar amount)
  • United Healthcare — Commercial: 80% (a percentage in the contract, not a dollar amount)
  • UnitedHealthcare Empire Plan — Commercial: 40% (a percentage in the contract, not a dollar amount)

Physical therapy and mental health

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: THERAPEUTIC EXERCISES $141.10 $105.83 $28.27 – $86
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $28.27
  • Capital District Physicians Healthcare — Medicare: $28.27
  • Excellus Health Plan — Commercial: $85.75
  • Excellus Health Plan — Medicare Advantage: $28.27
  • Fedelis Care NY — Medicare Advantage: $28.27
  • Humana ChoiceCare — Medicare Advantage: $28.27
  • MVP Health Plan — Commercial: $86
  • Nascentia — Medicare Advantage: $31.10
  • United Healthcare — Medicare Advantage: $28.27
  • Wellcare Todays Option — Medicare Advantage: $30.25
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier CO_GO In the file: THERAPEUTIC EXERCISES $123 $92.25 $28.27 – $86
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $28.27
  • Capital District Physicians Healthcare — Medicare: $28.27
  • Excellus Health Plan — Commercial: $85.75
  • Excellus Health Plan — Medicare Advantage: $28.27
  • Fedelis Care NY — Medicare Advantage: $28.27
  • Humana ChoiceCare — Medicare Advantage: $28.27
  • MVP Health Plan — Commercial: $86
  • Nascentia — Medicare Advantage: $31.10
  • United Healthcare — Medicare Advantage: $28.27
  • Wellcare Todays Option — Medicare Advantage: $30.25
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GO In the file: THERAPEUTIC EXERCISES $123 $92.25 $28.27 – $86
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $28.27
  • Capital District Physicians Healthcare — Medicare: $28.27
  • Excellus Health Plan — Commercial: $85.75
  • Excellus Health Plan — Medicare Advantage: $28.27
  • Fedelis Care NY — Medicare Advantage: $28.27
  • Humana ChoiceCare — Medicare Advantage: $28.27
  • MVP Health Plan — Commercial: $86
  • Nascentia — Medicare Advantage: $31.10
  • United Healthcare — Medicare Advantage: $28.27
  • Wellcare Todays Option — Medicare Advantage: $30.25
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 20 MINUTES $339.49 $254.62 $86 – $289.55
Physical therapy evaluation (low complexity): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Capital District Physicians Healthcare — Medicare: $95.46
  • Excellus Health Plan — Commercial: $289.55
  • Excellus Health Plan — Medicare Advantage: $95.46
  • Fedelis Care NY — Medicare Advantage: $95.46
  • Humana ChoiceCare — Medicare Advantage: $95.46
  • MVP Health Plan — Commercial: $86
  • Nascentia — Medicare Advantage: $105.01
  • United Healthcare — Medicare Advantage: $95.46
  • Wellcare Todays Option — Medicare Advantage: $102.14
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP_PO In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 20 MINUTES $339.49 $254.62 $95.46 – $289.55
Physical therapy evaluation (low complexity): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Capital District Physicians Healthcare — Medicare: $95.46
  • Excellus Health Plan — Commercial: $289.55
  • Excellus Health Plan — Medicare Advantage: $95.46
  • Fedelis Care NY — Medicare Advantage: $95.46
  • Humana ChoiceCare — Medicare Advantage: $95.46
  • Nascentia — Medicare Advantage: $105.01
  • United Healthcare — Medicare Advantage: $95.46
  • Wellcare Todays Option — Medicare Advantage: $102.14
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP_XP In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 20 MINUTES $339.49 $254.62 $95.46 – $289.55
Physical therapy evaluation (low complexity): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Capital District Physicians Healthcare — Medicare: $95.46
  • Excellus Health Plan — Commercial: $289.55
  • Excellus Health Plan — Medicare Advantage: $95.46
  • Fedelis Care NY — Medicare Advantage: $95.46
  • Humana ChoiceCare — Medicare Advantage: $95.46
  • Nascentia — Medicare Advantage: $105.01
  • United Healthcare — Medicare Advantage: $95.46
  • Wellcare Todays Option — Medicare Advantage: $102.14
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP_CQ In the file: PT EVAL MOD COMPLEX 30 MIN $339.49 $254.62 $95.46 – $289.55
Physical therapy evaluation (moderate complexity): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Capital District Physicians Healthcare — Medicare: $95.46
  • Excellus Health Plan — Commercial: $289.55
  • Excellus Health Plan — Medicare Advantage: $95.46
  • Fedelis Care NY — Medicare Advantage: $95.46
  • Humana ChoiceCare — Medicare Advantage: $95.46
  • Nascentia — Medicare Advantage: $105.01
  • United Healthcare — Medicare Advantage: $95.46
  • Wellcare Todays Option — Medicare Advantage: $102.14
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier CQ_GP In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 30 MINUTES $339.49 $254.62 $86 – $289.55
Physical therapy evaluation (moderate complexity): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Capital District Physicians Healthcare — Medicare: $95.46
  • Excellus Health Plan — Commercial: $289.55
  • Excellus Health Plan — Medicare Advantage: $95.46
  • Fedelis Care NY — Medicare Advantage: $95.46
  • Humana ChoiceCare — Medicare Advantage: $95.46
  • MVP Health Plan — Commercial: $86
  • Nascentia — Medicare Advantage: $105.01
  • United Healthcare — Medicare Advantage: $95.46
  • Wellcare Todays Option — Medicare Advantage: $102.14
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier CQ_GP_PN In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 30 MINUTES $339.49 $254.62 $95.46 – $289.55
Physical therapy evaluation (moderate complexity): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Capital District Physicians Healthcare — Medicare: $95.46
  • Excellus Health Plan — Commercial: $289.55
  • Excellus Health Plan — Medicare Advantage: $95.46
  • Fedelis Care NY — Medicare Advantage: $95.46
  • Humana ChoiceCare — Medicare Advantage: $95.46
  • Nascentia — Medicare Advantage: $105.01
  • United Healthcare — Medicare Advantage: $95.46
  • Wellcare Todays Option — Medicare Advantage: $102.14
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 45 MINUTES $339.49 $254.62 $86 – $289.55
Physical therapy evaluation (high complexity): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Capital District Physicians Healthcare — Medicare: $95.46
  • Excellus Health Plan — Commercial: $289.55
  • Excellus Health Plan — Medicare Advantage: $95.46
  • Fedelis Care NY — Medicare Advantage: $95.46
  • Humana ChoiceCare — Medicare Advantage: $95.46
  • MVP Health Plan — Commercial: $86
  • Nascentia — Medicare Advantage: $105.01
  • United Healthcare — Medicare Advantage: $95.46
  • Wellcare Todays Option — Medicare Advantage: $102.14
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP_PO In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 45 MINUTES $339.49 $254.62 $95.46 – $289.55
Physical therapy evaluation (high complexity): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Capital District Physicians Healthcare — Medicare: $95.46
  • Excellus Health Plan — Commercial: $289.55
  • Excellus Health Plan — Medicare Advantage: $95.46
  • Fedelis Care NY — Medicare Advantage: $95.46
  • Humana ChoiceCare — Medicare Advantage: $95.46
  • Nascentia — Medicare Advantage: $105.01
  • United Healthcare — Medicare Advantage: $95.46
  • Wellcare Todays Option — Medicare Advantage: $102.14
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP_XP In the file: EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 45 MINUTES $339.49 $254.62 $95.46 – $289.55
Physical therapy evaluation (high complexity): 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Capital District Physicians Healthcare — Medicare: $95.46
  • Excellus Health Plan — Commercial: $289.55
  • Excellus Health Plan — Medicare Advantage: $95.46
  • Fedelis Care NY — Medicare Advantage: $95.46
  • Humana ChoiceCare — Medicare Advantage: $95.46
  • Nascentia — Medicare Advantage: $105.01
  • United Healthcare — Medicare Advantage: $95.46
  • Wellcare Todays Option — Medicare Advantage: $102.14
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYTX W PT 30 MINUTES $134 $100.50 $220.47 – $668.73
Psychotherapy, 30 minutes: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY; 30 MINUTES $154 $115.50 $220.47 – $668.73
Psychotherapy, 30 minutes: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 59 In the file: PSYCHOTHERAPY; 30 MINUTES $154 $115.50 $220.47 – $668.73
Psychotherapy, 30 minutes: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYTX W PT 45 MINUTES $254 $190.50 $220.47 – $668.73
Psychotherapy, 45 minutes: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY; 45 MINUTES $215 $161.25 $220.47 – $668.73
Psychotherapy, 45 minutes: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 93 In the file: PSYCHOTHERAPY; 45 MINUTES $215 $161.25 $220.47 – $668.73
Psychotherapy, 45 minutes: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYTX W PT 60 MINUTES $115 $86.25 $220.47 – $668.73
Psychotherapy, 60 minutes: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PSYCHOTHERAPY; 1 HOUR $254 $190.50 $220.47 – $668.73
Psychotherapy, 60 minutes: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 93 In the file: PSYCHOTHERAPY; 1 HOUR $254 $190.50 $220.47 – $668.73
Psychotherapy, 60 minutes: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: FAMILY PSYCHOTHERAPY WITHOUT PATIENT; 50 MINUTES $217 $162.75 $220.47 – $668.73
Family psychotherapy, without the patient: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: FAMILY PSYTX W/O PT 50 MIN $181 $135.75 $220.47 – $668.73
Family psychotherapy, without the patient: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 95 In the file: FAMILY PSYCHOTHERAPY WITHOUT PATIENT; 50 MINUTES $217 $162.75 $220.47 – $668.73
Family psychotherapy, without the patient: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: FAMILY PSYTX W/PT 50 MIN $194 $145.50 $220.47 – $668.73
Family psychotherapy, with the patient: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: FAMILY PSYCHOTHERAPY WITH PATIENT; 50 MINUTES $166 $124.50 $220.47 – $668.73
Family psychotherapy, with the patient: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $220.47
  • Capital District Physicians Healthcare — Medicare: $220.47
  • Excellus Health Plan — Commercial: $668.73
  • Excellus Health Plan — Medicare Advantage: $220.47
  • Fedelis Care NY — Medicare Advantage: $220.47
  • Humana ChoiceCare — Medicare Advantage: $220.47
  • Nascentia — Medicare Advantage: $242.52
  • United Healthcare — Medicare Advantage: $220.47
  • Wellcare Todays Option — Medicare Advantage: $235.90
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier PN In the file: FAMILY PSYCHOTHERAPY WITH PATIENT; 50 MINUTES $166 $124.50 $88.20 – $267.53
Family psychotherapy, with the patient: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $88.20
  • Capital District Physicians Healthcare — Medicare: $88.20
  • Excellus Health Plan — Commercial: $267.53
  • Excellus Health Plan — Medicare Advantage: $88.20
  • Fedelis Care NY — Medicare Advantage: $88.20
  • Humana ChoiceCare — Medicare Advantage: $88.20
  • Nascentia — Medicare Advantage: $97.02
  • United Healthcare — Medicare Advantage: $88.20
  • Wellcare Todays Option — Medicare Advantage: $94.37
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: GROUP PSYCHOTHERAPY $85 $63.75 $126.19 – $382.76
Group psychotherapy: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $126.19
  • Capital District Physicians Healthcare — Medicare: $126.19
  • Excellus Health Plan — Commercial: $382.76
  • Excellus Health Plan — Medicare Advantage: $126.19
  • Fedelis Care NY — Medicare Advantage: $126.19
  • Humana ChoiceCare — Medicare Advantage: $126.19
  • Nascentia — Medicare Advantage: $138.81
  • United Healthcare — Medicare Advantage: $126.19
  • Wellcare Todays Option — Medicare Advantage: $135.02
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier PN In the file: GROUP PSYCHOTHERAPY $34 $25.50 $50.48 – $153.12
Group psychotherapy: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $50.48
  • Capital District Physicians Healthcare — Medicare: $50.48
  • Excellus Health Plan — Commercial: $153.12
  • Excellus Health Plan — Medicare Advantage: $50.48
  • Fedelis Care NY — Medicare Advantage: $50.48
  • Humana ChoiceCare — Medicare Advantage: $50.48
  • Nascentia — Medicare Advantage: $55.53
  • United Healthcare — Medicare Advantage: $50.48
  • Wellcare Todays Option — Medicare Advantage: $54.01
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier U5 In the file: GROUP PSYCHOTHERAPY $74 $55.50 $126.19 – $382.76
Group psychotherapy: 10 of 14 insurance plan rates
  • Aetna — Medicare Advantage: $126.19
  • Capital District Physicians Healthcare — Medicare: $126.19
  • Excellus Health Plan — Commercial: $382.76
  • Excellus Health Plan — Medicare Advantage: $126.19
  • Fedelis Care NY — Medicare Advantage: $126.19
  • Humana ChoiceCare — Medicare Advantage: $126.19
  • Nascentia — Medicare Advantage: $138.81
  • United Healthcare — Medicare Advantage: $126.19
  • Wellcare Todays Option — Medicare Advantage: $135.02
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)

Procedures and surgery

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: REMOVAL OF GROWTH AND TISSUE OF BREAST; DUCT; OR NIPPLE $7,683.26 $5,762.45 $4,863.62 – $14,752.33
Removal of breast growth (open surgery): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $4,863.62
  • Capital District Physicians Healthcare — Medicare: $4,863.62
  • Excellus Health Plan — Commercial: $14,752.33
  • Excellus Health Plan — Medicare Advantage: $4,863.62
  • Fedelis Care NY — Medicare Advantage: $4,863.62
  • Humana ChoiceCare — Medicare Advantage: $4,863.62
  • MVP Health Plan — Commercial: $5,400
  • Nascentia — Medicare Advantage: $5,349.98
  • United Healthcare — Commercial: $9,860
  • United Healthcare — Medicare Advantage: $4,863.62
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: REMOVAL OF GROWTH AND TISSUE OF BREAST; DUCT; OR NIPPLE $5,682.78 $4,262.09 $4,863.62 – $14,752.33
Removal of breast growth (open surgery): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $4,863.62
  • Capital District Physicians Healthcare — Medicare: $4,863.62
  • Excellus Health Plan — Commercial: $14,752.33
  • Excellus Health Plan — Medicare Advantage: $4,863.62
  • Fedelis Care NY — Medicare Advantage: $4,863.62
  • Humana ChoiceCare — Medicare Advantage: $4,863.62
  • MVP Health Plan — Commercial: $5,400
  • Nascentia — Medicare Advantage: $5,349.98
  • United Healthcare — Commercial: $9,860
  • United Healthcare — Medicare Advantage: $4,863.62
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: REMOVAL OF GROWTH AND TISSUE OF BREAST; DUCT; OR NIPPLE $5,682.78 $4,262.09 $4,863.62 – $14,752.33
Removal of breast growth (open surgery): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $4,863.62
  • Capital District Physicians Healthcare — Medicare: $4,863.62
  • Excellus Health Plan — Commercial: $14,752.33
  • Excellus Health Plan — Medicare Advantage: $4,863.62
  • Fedelis Care NY — Medicare Advantage: $4,863.62
  • Humana ChoiceCare — Medicare Advantage: $4,863.62
  • MVP Health Plan — Commercial: $5,400
  • Nascentia — Medicare Advantage: $5,349.98
  • United Healthcare — Commercial: $9,860
  • United Healthcare — Medicare Advantage: $4,863.62
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS $15,015.37 $11,261.53 $9,300 – $48,372.84
Total hip replacement: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $15,947.79
  • Capital District Physicians Healthcare — Medicare: $15,947.79
  • Excellus Health Plan — Commercial: $48,372.84
  • Excellus Health Plan — Medicare Advantage: $15,947.79
  • Fedelis Care NY — Medicare Advantage: $15,947.79
  • Humana ChoiceCare — Medicare Advantage: $15,947.79
  • MVP Health Plan — Commercial: $9,300
  • Nascentia — Medicare Advantage: $17,542.57
  • United Healthcare — Commercial: $19,320
  • United Healthcare — Medicare Advantage: $15,947.79
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS $15,015.37 $11,261.53 $9,300 – $48,372.84
Total hip replacement: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $15,947.79
  • Capital District Physicians Healthcare — Medicare: $15,947.79
  • Excellus Health Plan — Commercial: $48,372.84
  • Excellus Health Plan — Medicare Advantage: $15,947.79
  • Fedelis Care NY — Medicare Advantage: $15,947.79
  • Humana ChoiceCare — Medicare Advantage: $15,947.79
  • MVP Health Plan — Commercial: $9,300
  • Nascentia — Medicare Advantage: $17,542.57
  • United Healthcare — Commercial: $19,320
  • United Healthcare — Medicare Advantage: $15,947.79
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS $16,688.08 $12,516.06 $9,300 – $48,372.84
Total hip replacement: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $15,947.79
  • Capital District Physicians Healthcare — Medicare: $15,947.79
  • Excellus Health Plan — Commercial: $48,372.84
  • Excellus Health Plan — Medicare Advantage: $15,947.79
  • Fedelis Care NY — Medicare Advantage: $15,947.79
  • Humana ChoiceCare — Medicare Advantage: $15,947.79
  • MVP Health Plan — Commercial: $9,300
  • Nascentia — Medicare Advantage: $17,542.57
  • United Healthcare — Commercial: $19,320
  • United Healthcare — Medicare Advantage: $15,947.79
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE $6,671.33 $5,003.50 $9,300 – $48,372.84
Total knee replacement: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $15,947.79
  • Capital District Physicians Healthcare — Medicare: $15,947.79
  • Excellus Health Plan — Commercial: $48,372.84
  • Excellus Health Plan — Medicare Advantage: $15,947.79
  • Fedelis Care NY — Medicare Advantage: $15,947.79
  • Humana ChoiceCare — Medicare Advantage: $15,947.79
  • MVP Health Plan — Commercial: $9,300
  • Nascentia — Medicare Advantage: $17,542.57
  • United Healthcare — Commercial: $19,320
  • United Healthcare — Medicare Advantage: $15,947.79
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE $4,195.82 $3,146.87 $9,300 – $48,372.84
Total knee replacement: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $15,947.79
  • Capital District Physicians Healthcare — Medicare: $15,947.79
  • Excellus Health Plan — Commercial: $48,372.84
  • Excellus Health Plan — Medicare Advantage: $15,947.79
  • Fedelis Care NY — Medicare Advantage: $15,947.79
  • Humana ChoiceCare — Medicare Advantage: $15,947.79
  • MVP Health Plan — Commercial: $9,300
  • Nascentia — Medicare Advantage: $17,542.57
  • United Healthcare — Commercial: $19,320
  • United Healthcare — Medicare Advantage: $15,947.79
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE $8,344.04 $6,258.03 $9,300 – $48,372.84
Total knee replacement: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $15,947.79
  • Capital District Physicians Healthcare — Medicare: $15,947.79
  • Excellus Health Plan — Commercial: $48,372.84
  • Excellus Health Plan — Medicare Advantage: $15,947.79
  • Fedelis Care NY — Medicare Advantage: $15,947.79
  • Humana ChoiceCare — Medicare Advantage: $15,947.79
  • MVP Health Plan — Commercial: $9,300
  • Nascentia — Medicare Advantage: $17,542.57
  • United Healthcare — Commercial: $19,320
  • United Healthcare — Medicare Advantage: $15,947.79
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE $10,227.46 $7,670.60 $3,400 – $12,328.08
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $4,064.38
  • Capital District Physicians Healthcare — Medicare: $4,064.38
  • Excellus Health Plan — Commercial: $12,328.08
  • Excellus Health Plan — Medicare Advantage: $4,064.38
  • Fedelis Care NY — Medicare Advantage: $4,064.38
  • Humana ChoiceCare — Medicare Advantage: $4,064.38
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $4,470.82
  • United Healthcare — Commercial: $12,228
  • United Healthcare — Medicare Advantage: $4,064.38
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE $8,882.53 $6,661.90 $3,400 – $12,328.08
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $4,064.38
  • Capital District Physicians Healthcare — Medicare: $4,064.38
  • Excellus Health Plan — Commercial: $12,328.08
  • Excellus Health Plan — Medicare Advantage: $4,064.38
  • Fedelis Care NY — Medicare Advantage: $4,064.38
  • Humana ChoiceCare — Medicare Advantage: $4,064.38
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $4,470.82
  • United Healthcare — Commercial: $12,228
  • United Healthcare — Medicare Advantage: $4,064.38
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF TONSILS AND ADENOID GLANDS (YOUNGER THAN 12 YEARS) $7,537.60 $5,653.20 $5,400 – $22,304.39
Removal of tonsils and adenoids (under age 12): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $7,353.42
  • Capital District Physicians Healthcare — Medicare: $7,353.42
  • Excellus Health Plan — Commercial: $22,304.39
  • Excellus Health Plan — Medicare Advantage: $7,353.42
  • Fedelis Care NY — Medicare Advantage: $7,353.42
  • Humana ChoiceCare — Medicare Advantage: $7,353.42
  • MVP Health Plan — Commercial: $5,400
  • Nascentia — Medicare Advantage: $8,088.76
  • United Healthcare — Commercial: $9,860
  • United Healthcare — Medicare Advantage: $7,353.42
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $3,391.59 $2,543.69 $1,126.63 – $8,662
Upper GI endoscopy (diagnostic): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,126.63
  • Capital District Physicians Healthcare — Medicare: $1,126.63
  • Excellus Health Plan — Commercial: $3,417.29
  • Excellus Health Plan — Medicare Advantage: $1,126.63
  • Fedelis Care NY — Medicare Advantage: $1,126.63
  • Humana ChoiceCare — Medicare Advantage: $1,126.63
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,239.29
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,126.63
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 74 In the file: DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $4,682.54 $3,511.91 $1,126.63 – $8,662
Upper GI endoscopy (diagnostic): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,126.63
  • Capital District Physicians Healthcare — Medicare: $1,126.63
  • Excellus Health Plan — Commercial: $3,417.29
  • Excellus Health Plan — Medicare Advantage: $1,126.63
  • Fedelis Care NY — Medicare Advantage: $1,126.63
  • Humana ChoiceCare — Medicare Advantage: $1,126.63
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,239.29
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,126.63
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $4,682.54 $3,511.91 $1,126.63 – $8,662
Upper GI endoscopy with biopsy: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,126.63
  • Capital District Physicians Healthcare — Medicare: $1,126.63
  • Excellus Health Plan — Commercial: $3,417.29
  • Excellus Health Plan — Medicare Advantage: $1,126.63
  • Fedelis Care NY — Medicare Advantage: $1,126.63
  • Humana ChoiceCare — Medicare Advantage: $1,126.63
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,239.29
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,126.63
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PT In the file: BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $3,391.59 $2,543.69 $1,126.63 – $8,662
Upper GI endoscopy with biopsy: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,126.63
  • Capital District Physicians Healthcare — Medicare: $1,126.63
  • Excellus Health Plan — Commercial: $3,417.29
  • Excellus Health Plan — Medicare Advantage: $1,126.63
  • Fedelis Care NY — Medicare Advantage: $1,126.63
  • Humana ChoiceCare — Medicare Advantage: $1,126.63
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,239.29
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,126.63
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier XE In the file: BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE $2,341.27 $1,755.95 $1,126.63 – $8,662
Upper GI endoscopy with biopsy: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,126.63
  • Capital District Physicians Healthcare — Medicare: $1,126.63
  • Excellus Health Plan — Commercial: $3,417.29
  • Excellus Health Plan — Medicare Advantage: $1,126.63
  • Fedelis Care NY — Medicare Advantage: $1,126.63
  • Humana ChoiceCare — Medicare Advantage: $1,126.63
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,239.29
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,126.63
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $3,575.65 $2,681.74 $1,155.16 – $8,662
Colonoscopy (diagnostic): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,155.16
  • Capital District Physicians Healthcare — Medicare: $1,155.16
  • Excellus Health Plan — Commercial: $3,503.83
  • Excellus Health Plan — Medicare Advantage: $1,155.16
  • Fedelis Care NY — Medicare Advantage: $1,155.16
  • Humana ChoiceCare — Medicare Advantage: $1,155.16
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,270.68
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,155.16
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 74 In the file: DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $3,575.65 $2,681.74 $1,155.16 – $8,662
Colonoscopy (diagnostic): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,155.16
  • Capital District Physicians Healthcare — Medicare: $1,155.16
  • Excellus Health Plan — Commercial: $3,503.83
  • Excellus Health Plan — Medicare Advantage: $1,155.16
  • Fedelis Care NY — Medicare Advantage: $1,155.16
  • Humana ChoiceCare — Medicare Advantage: $1,155.16
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,270.68
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,155.16
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PT In the file: DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $3,575.65 $2,681.74 $1,155.16 – $8,662
Colonoscopy (diagnostic): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,155.16
  • Capital District Physicians Healthcare — Medicare: $1,155.16
  • Excellus Health Plan — Commercial: $3,503.83
  • Excellus Health Plan — Medicare Advantage: $1,155.16
  • Fedelis Care NY — Medicare Advantage: $1,155.16
  • Humana ChoiceCare — Medicare Advantage: $1,155.16
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,270.68
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,155.16
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $3,575.65 $2,681.74 $1,486.43 – $8,662
Colonoscopy with biopsy: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,486.43
  • Capital District Physicians Healthcare — Medicare: $1,486.43
  • Excellus Health Plan — Commercial: $4,508.64
  • Excellus Health Plan — Medicare Advantage: $1,486.43
  • Fedelis Care NY — Medicare Advantage: $1,486.43
  • Humana ChoiceCare — Medicare Advantage: $1,486.43
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,635.07
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,486.43
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 52 In the file: BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $3,575.65 $2,681.74 $743.21 – $8,662
Colonoscopy with biopsy: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $743.21
  • Capital District Physicians Healthcare — Medicare: $743.21
  • Excellus Health Plan — Commercial: $2,254.30
  • Excellus Health Plan — Medicare Advantage: $743.21
  • Fedelis Care NY — Medicare Advantage: $743.21
  • Humana ChoiceCare — Medicare Advantage: $743.21
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $817.53
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $743.21
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PT_XE In the file: BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE $1,787.83 $1,340.87 $1,486.43 – $8,662
Colonoscopy with biopsy: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,486.43
  • Capital District Physicians Healthcare — Medicare: $1,486.43
  • Excellus Health Plan — Commercial: $4,508.64
  • Excellus Health Plan — Medicare Advantage: $1,486.43
  • Fedelis Care NY — Medicare Advantage: $1,486.43
  • Humana ChoiceCare — Medicare Advantage: $1,486.43
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,635.07
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,486.43
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE $3,391.59 $2,543.69 $1,486.43 – $8,662
Colonoscopy with removal of polyps (snare): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,486.43
  • Capital District Physicians Healthcare — Medicare: $1,486.43
  • Excellus Health Plan — Commercial: $4,508.64
  • Excellus Health Plan — Medicare Advantage: $1,486.43
  • Fedelis Care NY — Medicare Advantage: $1,486.43
  • Humana ChoiceCare — Medicare Advantage: $1,486.43
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,635.07
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,486.43
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 74 In the file: REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE $3,391.59 $2,543.69 $1,486.43 – $8,662
Colonoscopy with removal of polyps (snare): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,486.43
  • Capital District Physicians Healthcare — Medicare: $1,486.43
  • Excellus Health Plan — Commercial: $4,508.64
  • Excellus Health Plan — Medicare Advantage: $1,486.43
  • Fedelis Care NY — Medicare Advantage: $1,486.43
  • Humana ChoiceCare — Medicare Advantage: $1,486.43
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,635.07
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,486.43
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 74_PT In the file: REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE $3,391.59 $2,543.69 $1,486.43 – $8,662
Colonoscopy with removal of polyps (snare): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,486.43
  • Capital District Physicians Healthcare — Medicare: $1,486.43
  • Excellus Health Plan — Commercial: $4,508.64
  • Excellus Health Plan — Medicare Advantage: $1,486.43
  • Fedelis Care NY — Medicare Advantage: $1,486.43
  • Humana ChoiceCare — Medicare Advantage: $1,486.43
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $1,635.07
  • United Healthcare — Commercial: $8,662
  • United Healthcare — Medicare Advantage: $1,486.43
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK $3,575.65 $2,681.74 $1,155.16 – $6,471
Screening colonoscopy (not high risk): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,155.16
  • Capital District Physicians Healthcare — Medicare: $1,155.16
  • Excellus Health Plan — Commercial: $3,503.83
  • Excellus Health Plan — Medicare Advantage: $1,155.16
  • Fedelis Care NY — Medicare Advantage: $1,155.16
  • Humana ChoiceCare — Medicare Advantage: $1,155.16
  • Nascentia — Medicare Advantage: $1,270.68
  • United Healthcare — Commercial: $6,471
  • United Healthcare — Medicare Advantage: $1,155.16
  • Wellcare Todays Option — Medicare Advantage: $1,236.02
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier KX In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK $3,575.65 $2,681.74 $1,155.16 – $6,471
Screening colonoscopy (not high risk): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,155.16
  • Capital District Physicians Healthcare — Medicare: $1,155.16
  • Excellus Health Plan — Commercial: $3,503.83
  • Excellus Health Plan — Medicare Advantage: $1,155.16
  • Fedelis Care NY — Medicare Advantage: $1,155.16
  • Humana ChoiceCare — Medicare Advantage: $1,155.16
  • Nascentia — Medicare Advantage: $1,270.68
  • United Healthcare — Commercial: $6,471
  • United Healthcare — Medicare Advantage: $1,155.16
  • Wellcare Todays Option — Medicare Advantage: $1,236.02
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 74 In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK $3,575.65 $2,681.74 $1,155.16 – $6,471
Screening colonoscopy (not high risk): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $1,155.16
  • Capital District Physicians Healthcare — Medicare: $1,155.16
  • Excellus Health Plan — Commercial: $3,503.83
  • Excellus Health Plan — Medicare Advantage: $1,155.16
  • Fedelis Care NY — Medicare Advantage: $1,155.16
  • Humana ChoiceCare — Medicare Advantage: $1,155.16
  • Nascentia — Medicare Advantage: $1,270.68
  • United Healthcare — Commercial: $6,471
  • United Healthcare — Medicare Advantage: $1,155.16
  • Wellcare Todays Option — Medicare Advantage: $1,236.02
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF GALLBLADDER USING AN ENDOSCOPE $6,671.33 $5,003.50 $7,509.55 – $22,777.97
Gallbladder removal by laparoscope: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $7,509.55
  • Capital District Physicians Healthcare — Medicare: $7,509.55
  • Excellus Health Plan — Commercial: $22,777.97
  • Excellus Health Plan — Medicare Advantage: $7,509.55
  • Fedelis Care NY — Medicare Advantage: $7,509.55
  • Humana ChoiceCare — Medicare Advantage: $7,509.55
  • MVP Health Plan — Commercial: $9,705
  • Nascentia — Medicare Advantage: $8,260.50
  • United Healthcare — Commercial: $16,140
  • United Healthcare — Medicare Advantage: $7,509.55
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: REPAIR OF GROIN HERNIA (5 YEARS OR OLDER) $6,671.33 $5,003.50 $4,447.46 – $13,490.04
Groin (inguinal) hernia repair, age 5 or older: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $4,447.46
  • Capital District Physicians Healthcare — Medicare: $4,447.46
  • Excellus Health Plan — Commercial: $13,490.04
  • Excellus Health Plan — Medicare Advantage: $4,447.46
  • Fedelis Care NY — Medicare Advantage: $4,447.46
  • Humana ChoiceCare — Medicare Advantage: $4,447.46
  • MVP Health Plan — Commercial: $5,400
  • Nascentia — Medicare Advantage: $4,892.21
  • United Healthcare — Commercial: $12,228
  • United Healthcare — Medicare Advantage: $4,447.46
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: REPAIR OF GROIN HERNIA (5 YEARS OR OLDER) $15,015.37 $11,261.53 $4,447.46 – $13,490.04
Groin (inguinal) hernia repair, age 5 or older: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $4,447.46
  • Capital District Physicians Healthcare — Medicare: $4,447.46
  • Excellus Health Plan — Commercial: $13,490.04
  • Excellus Health Plan — Medicare Advantage: $4,447.46
  • Fedelis Care NY — Medicare Advantage: $4,447.46
  • Humana ChoiceCare — Medicare Advantage: $4,447.46
  • MVP Health Plan — Commercial: $5,400
  • Nascentia — Medicare Advantage: $4,892.21
  • United Healthcare — Commercial: $12,228
  • United Healthcare — Medicare Advantage: $4,447.46
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF PROSTATE GLAND $6,192.67 $4,644.50 $8,662
Prostate biopsy: rates for 6 insurance plans
  • United Healthcare — Commercial: $8,662
  • Aetna — Commercial: 100% (a percentage in the contract, not a dollar amount)
  • Capital District Physicians Healthcare — Commercial: 80% (a percentage in the contract, not a dollar amount)
  • MultiPlan Inc. — Commercial: 75% (a percentage in the contract, not a dollar amount)
  • MVP Health Plan — Commercial: 75% (a percentage in the contract, not a dollar amount)
  • UnitedHealthcare Empire Plan — Commercial: 40% (a percentage in the contract, not a dollar amount)
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH NODES USING AN ENDOSCOPE $10,023.25 $7,517.44 $9,705 – $40,050.46
Prostate removal by laparoscope (radical prostatectomy): 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $13,204.03
  • Capital District Physicians Healthcare — Medicare: $13,204.03
  • Excellus Health Plan — Commercial: $40,050.46
  • Excellus Health Plan — Medicare Advantage: $13,204.03
  • Fedelis Care NY — Medicare Advantage: $13,204.03
  • Humana ChoiceCare — Medicare Advantage: $13,204.03
  • MVP Health Plan — Commercial: $9,705
  • Nascentia — Medicare Advantage: $14,524.43
  • United Healthcare — Commercial: $19,320
  • United Healthcare — Medicare Advantage: $13,204.03
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE $6,192.67 $4,644.50 $3,400 – $12,196.65
Hysteroscopy with biopsy of the uterus lining: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $4,021.05
  • Capital District Physicians Healthcare — Medicare: $4,021.05
  • Excellus Health Plan — Commercial: $12,196.65
  • Excellus Health Plan — Medicare Advantage: $4,021.05
  • Fedelis Care NY — Medicare Advantage: $4,021.05
  • Humana ChoiceCare — Medicare Advantage: $4,021.05
  • MVP Health Plan — Commercial: $3,400
  • Nascentia — Medicare Advantage: $4,423.16
  • United Healthcare — Commercial: $9,860
  • United Healthcare — Medicare Advantage: $4,021.05
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: RELEASE AND/OR RELOCATION OF HAND NERVE $7,537.60 $5,653.20 $2,425.62 – $9,860
Carpal tunnel release: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $2,425.62
  • Capital District Physicians Healthcare — Medicare: $2,425.62
  • Excellus Health Plan — Commercial: $7,357.39
  • Excellus Health Plan — Medicare Advantage: $2,425.62
  • Fedelis Care NY — Medicare Advantage: $2,425.62
  • Humana ChoiceCare — Medicare Advantage: $2,425.62
  • MVP Health Plan — Commercial: $5,400
  • Nascentia — Medicare Advantage: $2,668.18
  • United Healthcare — Commercial: $9,860
  • United Healthcare — Medicare Advantage: $2,425.62
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: RELEASE AND/OR RELOCATION OF HAND NERVE $7,537.60 $5,653.20 $2,425.62 – $9,860
Carpal tunnel release: 10 of 15 insurance plan rates
  • Aetna — Medicare Advantage: $2,425.62
  • Capital District Physicians Healthcare — Medicare: $2,425.62
  • Excellus Health Plan — Commercial: $7,357.39
  • Excellus Health Plan — Medicare Advantage: $2,425.62
  • Fedelis Care NY — Medicare Advantage: $2,425.62
  • Humana ChoiceCare — Medicare Advantage: $2,425.62
  • MVP Health Plan — Commercial: $5,400
  • Nascentia — Medicare Advantage: $2,668.18
  • United Healthcare — Commercial: $9,860
  • United Healthcare — Medicare Advantage: $2,425.62

Hospital stays (whole stay, MS-DRG)

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC Not listed in the file Not listed in the file $91,260.94 – $173,812.22
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 12 insurance plan rates
  • Aetna — Commercial: $140,610.39
  • Aetna — Medicare Advantage: $91,260.94
  • Capital District Physicians Healthcare — Medicare: $91,260.94
  • Excellus Health Plan — Medicare Advantage: $91,260.94
  • Fedelis Care NY — Medicare Advantage: $91,260.94
  • Humana ChoiceCare — Medicare Advantage: $91,260.94
  • Nascentia — Medicare Advantage: $100,387.03
  • United Healthcare — Commercial: $173,812.22
  • United Healthcare — Medicare Advantage: $91,260.94
  • Wellcare Todays Option — Medicare Advantage: $93,998.77
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY Not listed in the file Not listed in the file $18,361.95 – $33,699.37
Hip or knee replacement (major joint of the leg), without major complications: 10 of 12 insurance plan rates
  • Aetna — Commercial: $27,262.07
  • Aetna — Medicare Advantage: $18,361.95
  • Capital District Physicians Healthcare — Medicare: $18,361.95
  • Excellus Health Plan — Medicare Advantage: $18,361.95
  • Fedelis Care NY — Medicare Advantage: $18,361.95
  • Humana ChoiceCare — Medicare Advantage: $18,361.95
  • Nascentia — Medicare Advantage: $20,198.14
  • United Healthcare — Commercial: $33,699.37
  • United Healthcare — Medicare Advantage: $18,361.95
  • Wellcare Todays Option — Medicare Advantage: $18,912.81
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC Not listed in the file Not listed in the file $23,118.01 – $44,066.89
Neck (cervical) spinal fusion, without complications: 10 of 12 insurance plan rates
  • Aetna — Commercial: $35,649.17
  • Aetna — Medicare Advantage: $23,118.01
  • Capital District Physicians Healthcare — Medicare: $23,118.01
  • Excellus Health Plan — Medicare Advantage: $23,118.01
  • Fedelis Care NY — Medicare Advantage: $23,118.01
  • Humana ChoiceCare — Medicare Advantage: $23,118.01
  • Nascentia — Medicare Advantage: $25,429.81
  • United Healthcare — Commercial: $44,066.89
  • United Healthcare — Medicare Advantage: $23,118.01
  • Wellcare Todays Option — Medicare Advantage: $23,811.55
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY Not listed in the file Not listed in the file $11,974.17 – $20,810.26
Uterus and ovary surgery (not for cancer), without complications: 10 of 12 insurance plan rates
  • Aetna — Commercial: $16,835.06
  • Aetna — Medicare Advantage: $11,974.17
  • Capital District Physicians Healthcare — Medicare: $11,974.17
  • Excellus Health Plan — Medicare Advantage: $11,974.17
  • Fedelis Care NY — Medicare Advantage: $11,974.17
  • Humana ChoiceCare — Medicare Advantage: $11,974.17
  • Nascentia — Medicare Advantage: $13,171.59
  • United Healthcare — Commercial: $20,810.26
  • United Healthcare — Medicare Advantage: $11,974.17
  • Wellcare Todays Option — Medicare Advantage: $12,333.40

Source: Oswego Hospital’s standard charges file (apim.services.craneware.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on March 27, 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 typeAcute Care Hospital
Address110 West Sixth Street, Oswego, NY 13069
CountyOswego County
StateNew York
Phone(315) 349‑5511
Emergency servicesYes
OwnershipVoluntary non-profit - Private
Medicare overall rating3 of 5 stars
CMS Certification Number330218
Name in Medicare recordsOSWEGO HOSPITAL
Profile levelMedicare data + hospital website
Official websiteoswegohealth.org
CorrectionsReport an error or suggest an update →

Sources

  1. Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-10-26, retrieved 2026-11-13
  2. Medicare Care Compare — official Medicare profile of this hospital
  3. U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

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

  1. Oswego Hospital — oswegohealth.org
  2. Emergency Room — oswegohealth.org
  3. Maternity center | Oswego Health — oswegohealth.org
  4. Comprehensive Surgical Services | Oswego Health — oswegohealth.org
  5. Imaging | Oswego Health — oswegohealth.org
  6. Intensive care unit | Oswego Health — oswegohealth.org
  7. Quality care | Oswego Health — oswegohealth.org
  8. Visitor information | Oswego Health — oswegohealth.org