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Acute Care Hospital

Richmond University Medical Center

Staten Island, New York · Richmond County · Emergency services listed

Summary

Richmond University Medical Center is an acute care hospital in Staten Island, New York. Medicare data lists emergency services. CMS overall star rating: 1 of 5 stars. Its official website lists 119 services, specialties and programs. Medicare lists 307 affiliated clinicians. Source: CMS Hospital General Information, data updated 2026-07-22.

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

Call(718) 354‑5047 Directions Website Medicare profile
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Exterior of Richmond University Medical Center
Photo: Jim.henderson, CC BY-SA 3.0, via Wikimedia Commons · source · licence

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
1 of 5 stars1 of 5 stars · Medicare rating
YesBirthing-friendly (CMS)
307Doctors and clinicians
119Services listed

Quick answers

Does Richmond University Medical Center have an emergency room?
Yes. Medicare (CMS) data lists emergency services at Richmond University Medical Center. In a medical emergency, call 911.
Where is Richmond University Medical Center?
355 Bard Avenue, Staten Island, NY 10310, in Richmond County, New York.
What is the phone number of Richmond University Medical Center?
(718) 354-5047, as listed by Medicare (CMS).
What is the Medicare star rating of Richmond University Medical Center?
1 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas[5][8][10][11][12][18]

Conditions treated[5][8][12][13][14][15][20][21][22]

Treatments[5][8][10][14][18][21]

Procedures[5][11][13][14][15][22]

Programs and centers[4][5][8][9][10][14][17][18][19][20][21]

  • Center for Cancer Care
  • Breast and Women's Center
  • Center for Integrative Behavioral Medicine
  • Maternity
  • Prenatal Care Assistance Program (PCAP)
  • Psychiatric Emergency Services
  • Mobile crisis outreach service
  • Adult inpatient psychiatric unit
  • Child and adolescent inpatient psychiatric unit
  • Sexual Assault Forensic Examiner (SAFE) program
  • Family Care & Support Program (pediatric oncology)
  • Cardiopulmonary rehabilitation
  • Neurological rehabilitation
  • Cancer rehabilitation
  • Sleep Disorder Center
  • Wound Care/Hyperbaric Center
  • VIP Program for US Military

Emergency care (hospital website)[4][6][8][9][12]

Emergency roomYes
Open 24/7Yes
Trauma designationLevel I Adult; Level II Pediatric
Stroke designationThrombectomy Capable Stroke Center

Visiting and practical information

VisitingGenerally 8 a.m.-8 p.m., varies by unit; behavioral health 2-3 p.m. and 7-8 p.m[7]
ParkingSeparate patient parking lot next to the Emergency Department front entrance[9]
Patient portalhttps://rumcsi.org/patients-visitors/patient-portal/

Recognition[6][8][11][12][14]

  • Level I Adult Trauma Center and Level II Pediatric Trauma Center (American College of Surgeons / NYS DOH)
  • Thrombectomy Capable Stroke Center (Joint Commission / NYS DOH)
  • Geriatric Emergency Department Bronze certification (ACEP)
  • Commission on Cancer accreditation (American College of Surgeons)
  • Metabolic and Bariatric Surgery Accreditation (MBSAQIP)
  • Sexual Assault Forensic Examiner (SAFE) Center of Excellence
  • Level III Neonatal Intensive Care Unit (NYS DOH)
  • Level I Adult Trauma Center (American College of Surgeons, verified)
  • Advanced Thrombectomy Capable Stroke Center (The Joint Commission)
  • Gold Seal of Approval for advanced primary stroke care (The Joint Commission)
  • Gold Seal of Approval for quality and patient safety (The Joint Commission)
  • Bronze Level Geriatric Emergency Department Accreditation (American College of Emergency Physicians)

Doctors and clinicians (307)

307 doctors and other clinicians list Richmond University Medical Center 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 (307)

And 283 more: the button below opens the full list.

Other emergency rooms nearby

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

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

All nursing homes in the state →

Hospice providers

All hospice providers in the state →

Home health agencies

All home health agencies in the state →

Dialysis facilities

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Clinics and urgent care

Pharmacies

Assisted living nearby

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

About the Medicare star rating

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

Medicare quality data

What Richmond University Medical Center 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) 2 of 5 stars
Overall rating of the hospital1 of 5 stars
Would recommend the hospital1 of 5 stars
Nurses communicated well1 of 5 stars
Doctors communicated well2 of 5 stars
Staff explained medicines2 of 5 stars
Information about recovery at home2 of 5 stars
Room and bathroom kept clean2 of 5 stars
Quiet at night1 of 5 stars
Rated the hospital 9 or 10 out of 1045%National average: 72%
Would definitely recommend the hospital47%National average: 71%
Nurses “always” communicated well71%National average: 80%
Doctors “always” communicated well73%National average: 80%
Staff “always” explained medicines before giving them55%National average: 62%
Were given information about recovery at home79%National average: 86%
Room and bathroom “always” clean60%National average: 74%
Area around the room “always” quiet at night36%National average: 60%
Completed surveys378Response rate: 11%

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)1.079No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)0.065Better than the national benchmark
Surgical site infections after colon surgery0.668No different from the national benchmark
Surgical site infections after abdominal hysterectomy0No different from the national benchmark
MRSA bloodstream infections1.288No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections0.259Better than the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients10.7%
Deaths within 30 days: heart failure patients8.1%
Deaths within 30 days: pneumonia patients14.2%
Deaths within 30 days: COPD patients9.3%
Deaths within 30 days: stroke patients11.7%
Deaths within 30 days: coronary bypass surgery (CABG)Not reported to Medicare
Serious complications (patient safety indicator PSI-90)1.08No different from the national rate
Complications after hip or knee replacement5.2%

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)Not reported to Medicare
Readmitted within 30 days: heart attack14.6%
Readmitted within 30 days: heart failure23.7%
Readmitted within 30 days: pneumonia20.3%
Readmitted within 30 days: COPD21.2%
Readmitted within 30 days: coronary bypass surgeryNot reported to Medicare
Readmitted within 30 days: hip or knee replacement7.5%

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)200 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)0%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)40%National average: 65%

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in Staten IslandBest hospitals in New York

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 86 common services exactly as Richmond University Medical Center 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 →

$ 9 amounts are marked with “!”: they are more than 100 times higher or lower than what other hospitals list for the same service, which usually means an error or a different unit in the hospital’s file. They are shown exactly as listed; ask the hospital before relying on them.

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: PSYCH ASSESSMNT BRIEF/NP 30 MI $772 Not listed in the file $73.69 – $1,006
New patient office visit (about 30–44 minutes): 10 of 24 insurance plan rates
  • Aetna — All Products: $263
  • Aetna — High Performance: $409
  • Aetna — Medicare Advantage: $81.88
  • Beacon Health — Managed Medicaid: $81.88
  • Beacon Health — Medicare Advantage/ Health Exchange: $81.88
  • Beacon Health — Medicare Emblem & VNS: $386
  • Cigna — All Products: $81.88
  • Elderplan — Medicare Advantage: $540.40
  • Emblem — GHI PPO EPO HMO: $188.17
  • Emblem — HIP PPO EPO HMO: $188.17
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VISIT NEW MID $772 Not listed in the file $386 – $789.76
New patient office visit (about 30–44 minutes): 10 of 22 insurance plan rates
  • Aetna — All Products: $426.14
  • Aetna — High Performance: $386
  • Aetna — Medicare Advantage: $81.88
  • Beacon Health — Managed Medicaid: $81.88
  • Beacon Health — Medicare Advantage/ Health Exchange: $81.88
  • Beacon Health — Medicare Emblem & VNS: $386
  • Cigna — All Products: $81.88
  • Elderplan — Medicare Advantage: $540.40
  • Emblem — GHI PPO EPO HMO: $188.17
  • Emblem — HIP PPO EPO HMO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
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 $772 Not listed in the file $386 – $789.76
New patient office visit (about 30–44 minutes): 10 of 22 insurance plan rates
  • Aetna — All Products: $426.14
  • Aetna — High Performance: $386
  • Aetna — Medicare Advantage: $81.88
  • Beacon Health — Managed Medicaid: $81.88
  • Beacon Health — Medicare Advantage/ Health Exchange: $81.88
  • Beacon Health — Medicare Emblem & VNS: $386
  • Cigna — All Products: $81.88
  • Elderplan — Medicare Advantage: $540.40
  • Emblem — GHI PPO EPO HMO: $188.17
  • Emblem — HIP PPO EPO HMO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCH ASSESSMNT/EVAL-NP 45 MIN $976 Not listed in the file $120.15 – $1,006
New patient office visit (about 45–59 minutes): 10 of 24 insurance plan rates
  • Aetna — All Products: $263
  • Aetna — High Performance: $409
  • Aetna — Medicare Advantage: $133.50
  • Beacon Health — Managed Medicaid: $133.50
  • Beacon Health — Medicare Advantage/ Health Exchange: $133.50
  • Beacon Health — Medicare Emblem & VNS: $488
  • Cigna — All Products: $133.50
  • Elderplan — Medicare Advantage: $683.20
  • Emblem — GHI PPO EPO HMO: $305.53
  • Emblem — HIP PPO EPO HMO: $305.53
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VISIT NEW MOD-HIGH $976 Not listed in the file $488 – $998.45
New patient office visit (about 45–59 minutes): 10 of 22 insurance plan rates
  • Aetna — All Products: $538.75
  • Aetna — High Performance: $488
  • Aetna — Medicare Advantage: $133.50
  • Beacon Health — Managed Medicaid: $133.50
  • Beacon Health — Medicare Advantage/ Health Exchange: $133.50
  • Beacon Health — Medicare Emblem & VNS: $488
  • Cigna — All Products: $133.50
  • Elderplan — Medicare Advantage: $683.20
  • Emblem — GHI PPO EPO HMO: $305.53
  • Emblem — HIP PPO EPO HMO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VISIT NEW MOD- HIGH $976 Not listed in the file $488 – $998.45
New patient office visit (about 45–59 minutes): 10 of 22 insurance plan rates
  • Aetna — All Products: $538.75
  • Aetna — High Performance: $488
  • Aetna — Medicare Advantage: $133.50
  • Beacon Health — Managed Medicaid: $133.50
  • Beacon Health — Medicare Advantage/ Health Exchange: $133.50
  • Beacon Health — Medicare Emblem & VNS: $488
  • Cigna — All Products: $133.50
  • Elderplan — Medicare Advantage: $683.20
  • Emblem — GHI PPO EPO HMO: $305.53
  • Emblem — HIP PPO EPO HMO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCH ASSESSMNT/EVAL-NP 60 MIN $1,102 Not listed in the file $165.64 – $1,006
New patient office visit (about 60–74 minutes): 10 of 24 insurance plan rates
  • Aetna — All Products: $263
  • Aetna — High Performance: $409
  • Aetna — Medicare Advantage: $184.04
  • Beacon Health — Managed Medicaid: $184.04
  • Beacon Health — Medicare Advantage/ Health Exchange: $184.04
  • Beacon Health — Medicare Emblem & VNS: $551
  • Cigna — All Products: $184.04
  • Elderplan — Medicare Advantage: $771.40
  • Emblem — GHI PPO EPO HMO: $416.78
  • Emblem — HIP PPO EPO HMO: $416.78
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHIATRIC ASSESS MID-HIGH NE $1,102 Not listed in the file $184.04
New patient office visit (about 60–74 minutes): 10 of 24 insurance plan rates
  • Aetna — All Products: $263
  • Aetna — High Performance: $409
  • Aetna — Medicare Advantage: $184.04
  • Beacon Health — Managed Medicaid: $184.04
  • Beacon Health — Medicare Advantage/ Health Exchange: $184.04
  • Beacon Health — Medicare Emblem & VNS: $551
  • Cigna — All Products: $184.04
  • Elderplan — Medicare Advantage: $771.40
  • Emblem — GHI PPO EPO HMO: $416.78
  • Emblem — HIP PPO EPO HMO: $416.78
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VISIT NEW HIGH $1,102 Not listed in the file $551 – $1,127.35
New patient office visit (about 60–74 minutes): 10 of 22 insurance plan rates
  • Aetna — All Products: $608.30
  • Aetna — High Performance: $551
  • Aetna — Medicare Advantage: $184.04
  • Beacon Health — Managed Medicaid: $184.04
  • Beacon Health — Medicare Advantage/ Health Exchange: $184.04
  • Beacon Health — Medicare Emblem & VNS: $551
  • Cigna — All Products: $184.04
  • Elderplan — Medicare Advantage: $771.40
  • Emblem — GHI PPO EPO HMO: $416.78
  • Emblem — HIP PPO EPO HMO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MED MGT PHP $640 Not listed in the file $64.89
Established patient office visit (about 20–29 minutes): 10 of 24 insurance plan rates
  • Aetna — All Products: $263
  • Aetna — High Performance: $409
  • Aetna — Medicare Advantage: $64.89
  • Beacon Health — Managed Medicaid: $64.89
  • Beacon Health — Medicare Advantage/ Health Exchange: $64.89
  • Beacon Health — Medicare Emblem & VNS: $320
  • Cigna — All Products: $64.89
  • Elderplan — Medicare Advantage: $448
  • Emblem — GHI PPO EPO HMO: $149.83
  • Emblem — HIP PPO EPO HMO: $149.83
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MEDICATION MANAGEMENT 15 MIN $520 Not listed in the file $58.40 – $1,006
Established patient office visit (about 20–29 minutes): 10 of 24 insurance plan rates
  • Aetna — All Products: $263
  • Aetna — High Performance: $409
  • Aetna — Medicare Advantage: $64.89
  • Beacon Health — Managed Medicaid: $64.89
  • Beacon Health — Medicare Advantage/ Health Exchange: $64.89
  • Beacon Health — Medicare Emblem & VNS: $260
  • Cigna — All Products: $64.89
  • Elderplan — Medicare Advantage: $364
  • Emblem — GHI PPO EPO HMO: $149.83
  • Emblem — HIP PPO EPO HMO: $149.83
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MEDICATION MANAGEMENT MID $347 Not listed in the file $64.89
Established patient office visit (about 20–29 minutes): 10 of 24 insurance plan rates
  • Aetna — All Products: $263
  • Aetna — High Performance: $409
  • Aetna — Medicare Advantage: $64.89
  • Beacon Health — Managed Medicaid: $64.89
  • Beacon Health — Medicare Advantage/ Health Exchange: $64.89
  • Beacon Health — Medicare Emblem & VNS: $173.50
  • Cigna — All Products: $64.89
  • Elderplan — Medicare Advantage: $242.90
  • Emblem — GHI PPO EPO HMO: $149.83
  • Emblem — HIP PPO EPO HMO: $149.83
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MEDICATION MANAGEMENT MID-HIGH $673 Not listed in the file $86.02 – $1,006
Established patient office visit (about 30–39 minutes): 10 of 24 insurance plan rates
  • Aetna — All Products: $263
  • Aetna — High Performance: $409
  • Aetna — Medicare Advantage: $95.58
  • Beacon Health — Managed Medicaid: $95.58
  • Beacon Health — Medicare Advantage/ Health Exchange: $95.58
  • Beacon Health — Medicare Emblem & VNS: $336.50
  • Cigna — All Products: $95.58
  • Elderplan — Medicare Advantage: $471.10
  • Emblem — GHI PPO EPO HMO: $220.64
  • Emblem — HIP PPO EPO HMO: $220.64
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MEDICATION MANAGEMENT 25 MIN $598 Not listed in the file $86.02 – $1,006
Established patient office visit (about 30–39 minutes): 10 of 24 insurance plan rates
  • Aetna — All Products: $263
  • Aetna — High Performance: $409
  • Aetna — Medicare Advantage: $95.58
  • Beacon Health — Managed Medicaid: $95.58
  • Beacon Health — Medicare Advantage/ Health Exchange: $95.58
  • Beacon Health — Medicare Emblem & VNS: $299
  • Cigna — All Products: $95.58
  • Elderplan — Medicare Advantage: $418.60
  • Emblem — GHI PPO EPO HMO: $220.64
  • Emblem — HIP PPO EPO HMO: $220.64
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCH ASSESSMNT/EVAL-EP 40 MIN $626 Not listed in the file $86.02 – $1,006
Established patient office visit (about 30–39 minutes): 10 of 24 insurance plan rates
  • Aetna — All Products: $263
  • Aetna — High Performance: $409
  • Aetna — Medicare Advantage: $95.58
  • Beacon Health — Managed Medicaid: $95.58
  • Beacon Health — Medicare Advantage/ Health Exchange: $95.58
  • Beacon Health — Medicare Emblem & VNS: $313
  • Cigna — All Products: $95.58
  • Elderplan — Medicare Advantage: $438.20
  • Emblem — GHI PPO EPO HMO: $220.64
  • Emblem — HIP PPO EPO HMO: $220.64
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30 Not listed in the file Not listed in the file $87.29 – $198.82
Office consultation with a specialist (moderate): rates for 7 insurance plans
  • Emblem — GHI PPO EPO HMO: $198.82
  • Emblem — HIP PPO EPO HMO: $198.82
  • Empire — HealthPlus Medicaid: $87.29
  • Empire — HMO: $98.36
  • Empire — Indemnity: $98.36
  • Healthfirst — Medicare Advantage: $95.05
  • Local 1199 — Local 1199: $134
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: OFF/OP CNSLTJ NEW/EST LOW 30 Not listed in the file Not listed in the file $134
Office consultation with a specialist (moderate): rates for 1 insurance plan
  • Local 1199 — Local 1199: $134
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40 Not listed in the file Not listed in the file $129.93 – $300.96
Office consultation with a specialist (moderate to high): rates for 7 insurance plans
  • Emblem — GHI PPO EPO HMO: $300.96
  • Emblem — HIP PPO EPO HMO: $300.96
  • Empire — HealthPlus Medicaid: $132.13
  • Empire — HMO: $129.93
  • Empire — Indemnity: $129.93
  • Healthfirst — Medicare Advantage: $143.87
  • Local 1199 — Local 1199: $189
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: OFF/OP CNSLTJ NEW/EST MOD 40 Not listed in the file Not listed in the file $189
Office consultation with a specialist (moderate to high): rates for 1 insurance plan
  • Local 1199 — Local 1199: $189
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INIT PREVENT VST 18-39 $297 Not listed in the file $127.71 – $303.83
Preventive checkup, new patient, age 18–39: 10 of 19 insurance plan rates
  • Aetna — All Products: $163.94
  • Aetna — High Performance: $148.50
  • Aetna — Medicare Advantage: $127.71
  • Beacon Health — Medicare Emblem & VNS: $148.50
  • Cigna — All Products: $133.65
  • Elderplan — Medicare Advantage: $207.90
  • Emblem — GHI PPO EPO HMO: $211.74
  • Emblem — HIP PPO EPO HMO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
  • Empire — EPO PPO: $154.56
  • Empire — HealthPlus Medicaid: $92.96
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INITIAL PREV VISIT 18-39 Y $297 Not listed in the file $127.71 – $303.83
Preventive checkup, new patient, age 18–39: 10 of 19 insurance plan rates
  • Aetna — All Products: $163.94
  • Aetna — High Performance: $148.50
  • Aetna — Medicare Advantage: $127.71
  • Beacon Health — Medicare Emblem & VNS: $148.50
  • Cigna — All Products: $133.65
  • Elderplan — Medicare Advantage: $207.90
  • Emblem — GHI PPO EPO HMO: $211.74
  • Emblem — HIP PPO EPO HMO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
  • Empire — EPO PPO: $154.56
  • Empire — HealthPlus Medicaid: $92.96
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INIT PREVENT VST 40-64 $387 Not listed in the file $166.41 – $395.90
Preventive checkup, new patient, age 40–64: 10 of 19 insurance plan rates
  • Aetna — All Products: $213.62
  • Aetna — High Performance: $193.50
  • Aetna — Medicare Advantage: $166.41
  • Beacon Health — Medicare Emblem & VNS: $193.50
  • Cigna — All Products: $174.15
  • Elderplan — Medicare Advantage: $270.90
  • Emblem — GHI PPO EPO HMO: $255.96
  • Emblem — HIP PPO EPO HMO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
  • Empire — EPO PPO: $201.39
  • Empire — HealthPlus Medicaid: $112.37
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED VISIT MODERATE $4,833 Not listed in the file $321.11 – $2,806
Emergency room visit (moderate): 10 of 37 insurance plan rates
  • Aetna — All Products: $1,910
  • Aetna — High Performance: $1,719
  • Aetna — Medicare Advantage: $340.75
  • Affinity — Medicare Advantage: $340.75
  • Amerigroup — Medicare Advantage: $347.57
  • Amida Care — Medicare Advantage: $374.83
  • ArchCare — Medicare Advantage: $357.79
  • Beacon Health — Managed Medicaid: $80.39
  • Beacon Health — Medicare Advantage/ Health Exchange: $492
  • Beacon Health — Medicare Emblem & VNS: $2,416.50
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: EMERGENCY DEPT VISIT LOW MDM Not listed in the file Not listed in the file $66
Emergency room visit (moderate): rates for 1 insurance plan
  • Local 1199 — Local 1199: $66
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED VISIT URGENT $5,896 Not listed in the file $493.82 – $3,375
Emergency room visit (moderately high): 10 of 37 insurance plan rates
  • Aetna — All Products: $1,910
  • Aetna — High Performance: $1,719
  • Aetna — Medicare Advantage: $520.86
  • Affinity — Medicare Advantage: $520.86
  • Amerigroup — Medicare Advantage: $531.28
  • Amida Care — Medicare Advantage: $572.95
  • ArchCare — Medicare Advantage: $546.90
  • Beacon Health — Managed Medicaid: $136.96
  • Beacon Health — Medicare Advantage/ Health Exchange: $492
  • Beacon Health — Medicare Emblem & VNS: $2,948
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LABOR&DEL.E/R CARE UNIT $3,277 Not listed in the file $1,638.50 – $1,808.90
Emergency room visit (moderately high): 10 of 37 insurance plan rates
  • Aetna — All Products: $1,808.90
  • Aetna — High Performance: $1,638.50
  • Aetna — Medicare Advantage: $520.86
  • Affinity — Medicare Advantage: $520.86
  • Amerigroup — Medicare Advantage: $531.28
  • Amida Care — Medicare Advantage: $572.95
  • ArchCare — Medicare Advantage: $546.90
  • Beacon Health — Managed Medicaid: $136.96
  • Beacon Health — Medicare Advantage/ Health Exchange: $136.96
  • Beacon Health — Medicare Emblem & VNS: $1,638.50
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TRAUMA G READINESS LEVEL 5 $6,960 Not listed in the file $711.01 – $3,944
Emergency room visit (high): 10 of 37 insurance plan rates
  • Aetna — All Products: $1,910
  • Aetna — High Performance: $1,719
  • Aetna — Medicare Advantage: $743.39
  • Affinity — Medicare Advantage: $743.39
  • Amerigroup — Medicare Advantage: $758.26
  • Amida Care — Medicare Advantage: $817.73
  • ArchCare — Medicare Advantage: $780.56
  • Beacon Health — Managed Medicaid: $197.74
  • Beacon Health — Medicare Advantage/ Health Exchange: $492
  • Beacon Health — Medicare Emblem & VNS: $3,480
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED VISIT SEVERE $6,960 Not listed in the file $711.01 – $3,944
Emergency room visit (high): 10 of 37 insurance plan rates
  • Aetna — All Products: $1,910
  • Aetna — High Performance: $1,719
  • Aetna — Medicare Advantage: $743.39
  • Affinity — Medicare Advantage: $743.39
  • Amerigroup — Medicare Advantage: $758.26
  • Amida Care — Medicare Advantage: $817.73
  • ArchCare — Medicare Advantage: $780.56
  • Beacon Health — Managed Medicaid: $197.74
  • Beacon Health — Medicare Advantage/ Health Exchange: $492
  • Beacon Health — Medicare Emblem & VNS: $3,480
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TRAUMA READINESS LEVEL 5 $6,960 Not listed in the file $711.01 – $3,944
Emergency room visit (high): 10 of 37 insurance plan rates
  • Aetna — All Products: $1,910
  • Aetna — High Performance: $1,719
  • Aetna — Medicare Advantage: $743.39
  • Affinity — Medicare Advantage: $743.39
  • Amerigroup — Medicare Advantage: $758.26
  • Amida Care — Medicare Advantage: $817.73
  • ArchCare — Medicare Advantage: $780.56
  • Beacon Health — Managed Medicaid: $197.74
  • Beacon Health — Medicare Advantage/ Health Exchange: $492
  • Beacon Health — Medicare Emblem & VNS: $3,480

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: BASIC METABOLIC PANEL $407 Not listed in the file $175.01 – $398.86
Basic metabolic panel (blood test): 10 of 41 insurance plan rates
  • Aetna — All Products: $10.58
  • Aetna — High Performance: $203.50
  • Aetna — Medicare Advantage: $175.01
  • Affinity — Medicare Advantage: $8.46
  • Amerigroup — Managed Medicaid: $37.35
  • Amerigroup — Medicare Advantage: $8.63
  • Amida Care — Managed Medicaid: $37.35
  • Amida Care — Medicare Advantage: $9.31
  • ArchCare — Medicare Advantage: $8.88
  • Beacon Health — Medicare Emblem & VNS: $203.50
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE PANEL $714 Not listed in the file $307.02 – $699.72
Comprehensive metabolic panel (blood test): 10 of 41 insurance plan rates
  • Aetna — All Products: $13.20
  • Aetna — High Performance: $357
  • Aetna — Medicare Advantage: $307.02
  • Affinity — Medicare Advantage: $10.56
  • Amerigroup — Managed Medicaid: $37.35
  • Amerigroup — Medicare Advantage: $10.77
  • Amida Care — Managed Medicaid: $37.35
  • Amida Care — Medicare Advantage: $11.62
  • ArchCare — Medicare Advantage: $11.09
  • Beacon Health — Medicare Emblem & VNS: $357
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL Not listed in the file Not listed in the file $23.01 – $59.76
Obstetric blood test panel: 10 of 22 insurance plan rates
  • Aetna — All Products: $59.76
  • Affinity — Medicare Advantage: $47.81
  • Amerigroup — Medicare Advantage: $48.77
  • Amida Care — Medicare Advantage: $52.59
  • ArchCare — Medicare Advantage: $50.20
  • Centerlight Healthcare — Medicare Advantage: $47.81
  • Cigna — All Products: $47.81
  • Elderplan — Medicare Advantage: $47.81
  • Empire — HMO: $23.01
  • Empire — Indemnity: $23.01
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric panel Not listed in the file Not listed in the file $37.35 – $52.59
Obstetric blood test panel: 10 of 11 insurance plan rates
  • Amerigroup — Managed Medicaid: $37.35
  • Amida Care — Managed Medicaid: $37.35
  • Emblem — Managed Medicaid - HIP & GHI: $37.35
  • Empire — HealthPlus ALIESSA: $38.23
  • Empire — HealthPlus Medicaid: $37.35
  • Fidelis — Managed Medicaid: $37.35
  • Healthfirst — Managed Medicaid: $37.35
  • UHC — Essential Plans: $41.83
  • UHC — Managed Medicaid: $41.83
  • VNS — Managed Medicaid: $37.35
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PROFILE $609 Not listed in the file $261.87 – $596.82
Cholesterol panel (lipid panel): 10 of 41 insurance plan rates
  • Aetna — All Products: $16.74
  • Aetna — High Performance: $304.50
  • Aetna — Medicare Advantage: $261.87
  • Affinity — Medicare Advantage: $13.39
  • Amerigroup — Managed Medicaid: $37.35
  • Amerigroup — Medicare Advantage: $13.66
  • Amida Care — Managed Medicaid: $37.35
  • Amida Care — Medicare Advantage: $14.73
  • ArchCare — Medicare Advantage: $14.06
  • Beacon Health — Medicare Emblem & VNS: $304.50
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL Not listed in the file Not listed in the file $4.92 – $37.35
Kidney function panel: 10 of 23 insurance plan rates
  • Aetna — All Products: $10.85
  • Affinity — Medicare Advantage: $8.68
  • Amerigroup — Medicare Advantage: $8.85
  • Amida Care — Medicare Advantage: $9.55
  • ArchCare — Medicare Advantage: $9.11
  • Centerlight Healthcare — Medicare Advantage: $8.68
  • Cigna — All Products: $8.68
  • Elderplan — Medicare Advantage: $8.68
  • Empire — HMO: $4.92
  • Empire — Indemnity: $4.92
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal function panel Not listed in the file Not listed in the file $8.51 – $41.83
Kidney function panel: rates for 10 insurance plans
  • Amerigroup — Managed Medicaid: $37.35
  • Amida Care — Managed Medicaid: $37.35
  • Emblem — Managed Medicaid - HIP & GHI: $37.35
  • Empire — HealthPlus ALIESSA: $38.23
  • Empire — HealthPlus Medicaid: $37.35
  • Fidelis — Managed Medicaid: $37.35
  • UHC — Essential Plans: $41.83
  • UHC — Managed Medicaid: $41.83
  • VNS — Managed Medicaid: $37.35
  • Wellcare — Managed Medicaid: $38.21
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL $423 Not listed in the file $181.89 – $414.54
Liver function panel: 10 of 41 insurance plan rates
  • Aetna — All Products: $10.21
  • Aetna — High Performance: $211.50
  • Aetna — Medicare Advantage: $181.89
  • Affinity — Medicare Advantage: $8.17
  • Amerigroup — Managed Medicaid: $37.35
  • Amerigroup — Medicare Advantage: $8.33
  • Amida Care — Managed Medicaid: $37.35
  • Amida Care — Medicare Advantage: $8.99
  • ArchCare — Medicare Advantage: $8.58
  • Beacon Health — Medicare Emblem & VNS: $211.50
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/SCOPE Not listed in the file Not listed in the file $1.79 – $15.24
Urine test (automated, with microscope): 10 of 23 insurance plan rates
  • Aetna — All Products: $3.96
  • Affinity — Medicare Advantage: $3.17
  • Amerigroup — Medicare Advantage: $3.23
  • Amida Care — Medicare Advantage: $3.49
  • ArchCare — Medicare Advantage: $3.33
  • Centerlight Healthcare — Medicare Advantage: $3.17
  • Cigna — All Products: $3.17
  • Elderplan — Medicare Advantage: $3.17
  • Empire — HMO: $1.79
  • Empire — Indemnity: $1.79
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/scope Not listed in the file Not listed in the file $3.11 – $17.07
Urine test (automated, with microscope): rates for 10 insurance plans
  • Amerigroup — Managed Medicaid: $15.24
  • Amida Care — Managed Medicaid: $15.24
  • Emblem — Managed Medicaid - HIP & GHI: $15.24
  • Empire — HealthPlus ALIESSA: $15.60
  • Empire — HealthPlus Medicaid: $15.24
  • Fidelis — Managed Medicaid: $15.24
  • UHC — Essential Plans: $17.07
  • UHC — Managed Medicaid: $17.07
  • VNS — Managed Medicaid: $15.24
  • Wellcare — Managed Medicaid: $15.59
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: N-AUTOM URINALYS WO MICRO $28 Not listed in the file $12.04 – $27.44
Urine test (manual, without microscope): 10 of 41 insurance plan rates
  • Aetna — All Products: $4.35
  • Aetna — High Performance: $14
  • Aetna — Medicare Advantage: $12.04
  • Affinity — Medicare Advantage: $3.48
  • Amerigroup — Managed Medicaid: $15.24
  • Amerigroup — Medicare Advantage: $3.55
  • Amida Care — Managed Medicaid: $15.24
  • Amida Care — Medicare Advantage: $3.83
  • ArchCare — Medicare Advantage: $3.65
  • Beacon Health — Medicare Emblem & VNS: $14
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UA W/O MICRO NON-AUTOMATED $72 Not listed in the file $1 – $15.24
Urine test (manual, without microscope): 10 of 41 insurance plan rates
  • Aetna — All Products: $4.35
  • Aetna — High Performance: $36
  • Aetna — Medicare Advantage: $30.96
  • Affinity — Medicare Advantage: $3.48
  • Amerigroup — Managed Medicaid: $15.24
  • Amerigroup — Medicare Advantage: $3.55
  • Amida Care — Managed Medicaid: $15.24
  • Amida Care — Medicare Advantage: $3.83
  • ArchCare — Medicare Advantage: $3.65
  • Beacon Health — Medicare Emblem & VNS: $36
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS(AUTO NO MICRO $125 Not listed in the file $53.75 – $122.50
Urine test (automated, without microscope): 10 of 41 insurance plan rates
  • Aetna — All Products: $2.81
  • Aetna — High Performance: $62.50
  • Aetna — Medicare Advantage: $53.75
  • Affinity — Medicare Advantage: $2.25
  • Amerigroup — Managed Medicaid: $15.24
  • Amerigroup — Medicare Advantage: $2.30
  • Amida Care — Managed Medicaid: $15.24
  • Amida Care — Medicare Advantage: $2.48
  • ArchCare — Medicare Advantage: $2.36
  • Beacon Health — Medicare Emblem & VNS: $62.50
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA TOTAL $714 Not listed in the file $307.02 – $699.72
PSA (prostate specific antigen) blood test: 10 of 41 insurance plan rates
  • Aetna — All Products: $22.99
  • Aetna — High Performance: $357
  • Aetna — Medicare Advantage: $307.02
  • Affinity — Medicare Advantage: $18.39
  • Amerigroup — Managed Medicaid: $15.54
  • Amerigroup — Medicare Advantage: $18.76
  • Amida Care — Managed Medicaid: $15.54
  • Amida Care — Medicare Advantage: $20.23
  • ArchCare — Medicare Advantage: $19.31
  • Beacon Health — Medicare Emblem & VNS: $357
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THYROID STIM HORMONE $670 Not listed in the file $288.10 – $656.60
Thyroid stimulating hormone (TSH) test: 10 of 41 insurance plan rates
  • Aetna — All Products: $21
  • Aetna — High Performance: $335
  • Aetna — Medicare Advantage: $288.10
  • Affinity — Medicare Advantage: $16.80
  • Amerigroup — Managed Medicaid: $36.49
  • Amerigroup — Medicare Advantage: $17.14
  • Amida Care — Managed Medicaid: $36.49
  • Amida Care — Medicare Advantage: $18.48
  • ArchCare — Medicare Advantage: $17.64
  • Beacon Health — Medicare Emblem & VNS: $335
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC W/AUTO DIFF WBC Not listed in the file Not listed in the file $3.20 – $16
Complete blood count (CBC) with differential: 10 of 23 insurance plan rates
  • Aetna — All Products: $9.71
  • Affinity — Medicare Advantage: $7.77
  • Amerigroup — Medicare Advantage: $7.93
  • Amida Care — Medicare Advantage: $8.55
  • ArchCare — Medicare Advantage: $8.16
  • Centerlight Healthcare — Medicare Advantage: $7.77
  • Cigna — All Products: $7.77
  • Elderplan — Medicare Advantage: $7.77
  • Empire — HMO: $4.41
  • Empire — Indemnity: $4.41
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc w/auto diff wbc Not listed in the file Not listed in the file $7.61 – $17.91
Complete blood count (CBC) with differential: rates for 10 insurance plans
  • Amerigroup — Managed Medicaid: $15.99
  • Amida Care — Managed Medicaid: $15.99
  • Emblem — Managed Medicaid - HIP & GHI: $15.99
  • Empire — HealthPlus ALIESSA: $16.37
  • Empire — HealthPlus Medicaid: $15.99
  • Fidelis — Managed Medicaid: $15.99
  • UHC — Essential Plans: $17.91
  • UHC — Managed Medicaid: $17.91
  • VNS — Managed Medicaid: $15.99
  • Wellcare — Managed Medicaid: $16.36
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC AUTOMATED $90 Not listed in the file $38.70 – $88.20
Complete blood count (CBC), automated: 10 of 41 insurance plan rates
  • Aetna — All Products: $8.09
  • Aetna — High Performance: $45
  • Aetna — Medicare Advantage: $38.70
  • Affinity — Medicare Advantage: $6.47
  • Amerigroup — Managed Medicaid: $15.99
  • Amerigroup — Medicare Advantage: $6.60
  • Amida Care — Managed Medicaid: $15.99
  • Amida Care — Medicare Advantage: $7.12
  • ArchCare — Medicare Advantage: $6.79
  • Beacon Health — Medicare Emblem & VNS: $45
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME $97 Not listed in the file $1 – $19.24
Blood clotting time test (prothrombin time, PT): 10 of 41 insurance plan rates
  • Aetna — All Products: $5.36
  • Aetna — High Performance: $48.50
  • Aetna — Medicare Advantage: $41.71
  • Affinity — Medicare Advantage: $4.29
  • Amerigroup — Managed Medicaid: $19.23
  • Amerigroup — Medicare Advantage: $4.38
  • Amida Care — Managed Medicaid: $19.23
  • Amida Care — Medicare Advantage: $4.72
  • ArchCare — Medicare Advantage: $4.50
  • Beacon Health — Medicare Emblem & VNS: $48.50
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME ROUTINE $205 Not listed in the file $88.15 – $200.90
Blood clotting time test (prothrombin time, PT): 10 of 41 insurance plan rates
  • Aetna — All Products: $5.36
  • Aetna — High Performance: $102.50
  • Aetna — Medicare Advantage: $88.15
  • Affinity — Medicare Advantage: $4.29
  • Amerigroup — Managed Medicaid: $19.23
  • Amerigroup — Medicare Advantage: $4.38
  • Amida Care — Managed Medicaid: $19.23
  • Amida Care — Medicare Advantage: $4.72
  • ArchCare — Medicare Advantage: $4.50
  • Beacon Health — Medicare Emblem & VNS: $102.50
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTIAL $88 Not listed in the file $37.84 – $86.24
Blood clotting test (partial thromboplastin time, PTT): 10 of 41 insurance plan rates
  • Aetna — All Products: $7.51
  • Aetna — High Performance: $44
  • Aetna — Medicare Advantage: $37.84
  • Affinity — Medicare Advantage: $6.01
  • Amerigroup — Managed Medicaid: $19.23
  • Amerigroup — Medicare Advantage: $6.13
  • Amida Care — Managed Medicaid: $19.23
  • Amida Care — Medicare Advantage: $6.61
  • ArchCare — Medicare Advantage: $6.31
  • Beacon Health — Medicare Emblem & VNS: $44

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

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEAD CT W/O CONTRAST $3,550 Not listed in the file $1,775 – $1,959.60
CT scan of the head or brain, without contrast: 10 of 45 insurance plan rates
  • Aetna — All Products: $1,959.60
  • Aetna — High Performance: $1,775
  • Aetna — Medicare Advantage: $130.50
  • Affinity — Medicare Advantage: $130.50
  • Amerigroup — Managed Medicaid: $450.11
  • Amerigroup — Medicare Advantage: $133.11
  • Amida Care — Managed Medicaid: $450.11
  • Amida Care — Medicare Advantage: $143.55
  • ArchCare — Medicare Advantage: $137.03
  • Beacon Health — Managed Medicaid: $124.56
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 Not listed in the file Not listed in the file $70.34 – $241
CT scan of the head or brain, without contrast: 10 of 12 insurance plan rates
  • Aetna — High Performance: $88.31
  • Beacon Health — Managed Medicaid: $80.05
  • Beacon Health — Medicare Advantage/ Health Exchange: $80.05
  • Emblem — GHI PPO EPO HMO: $163.59
  • Emblem — HIP PPO EPO HMO: $163.59
  • Empire — HealthPlus Medicaid: $71.82
  • Empire — HMO: $72.70
  • Empire — Indemnity: $72.70
  • Healthfirst — Managed Medicaid: $72.05
  • Healthfirst — Medicare Advantage: $78.21
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: CT HEAD/BRAIN W/O DYE Not listed in the file Not listed in the file $39.41 – $89.76
CT scan of the head or brain, without contrast: rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $44.51
  • Beacon Health — Medicare Advantage/ Health Exchange: $44.51
  • Emblem — GHI PPO EPO HMO: $89.76
  • Emblem — HIP PPO EPO HMO: $89.76
  • Empire — HealthPlus Medicaid: $39.41
  • Empire — HMO: $42.50
  • Empire — Indemnity: $42.50
  • Healthfirst — Managed Medicaid: $40.06
  • Healthfirst — Medicare Advantage: $42.91
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI BRAIN W/O & WITH CON $12,817 Not listed in the file $6,408.50 – $7,074.98
MRI of the brain, before and after contrast: 10 of 45 insurance plan rates
  • Aetna — All Products: $7,074.98
  • Aetna — High Performance: $6,408.50
  • Aetna — Medicare Advantage: $435.49
  • Affinity — Medicare Advantage: $435.49
  • Amerigroup — Managed Medicaid: $831.32
  • Amerigroup — Medicare Advantage: $444.20
  • Amida Care — Managed Medicaid: $831.32
  • Amida Care — Medicare Advantage: $479.04
  • ArchCare — Medicare Advantage: $457.27
  • Beacon Health — Managed Medicaid: $371.14
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 Not listed in the file Not listed in the file $221.84 – $1,268
MRI of the brain, before and after contrast: 10 of 12 insurance plan rates
  • Aetna — High Performance: $278.53
  • Beacon Health — Managed Medicaid: $252.45
  • Beacon Health — Medicare Advantage/ Health Exchange: $252.45
  • Emblem — GHI PPO EPO HMO: $516.25
  • Emblem — HIP PPO EPO HMO: $516.25
  • Empire — HealthPlus Medicaid: $226.65
  • Empire — HMO: $262
  • Empire — Indemnity: $262
  • Healthfirst — Managed Medicaid: $227.21
  • Healthfirst — Medicare Advantage: $246.79
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: MRI BRAIN STEM W/O & W/DYE Not listed in the file Not listed in the file $106.82 – $243.44
MRI of the brain, before and after contrast: rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $118.69
  • Beacon Health — Medicare Advantage/ Health Exchange: $118.69
  • Emblem — GHI PPO EPO HMO: $243.44
  • Emblem — HIP PPO EPO HMO: $243.44
  • Empire — HealthPlus Medicaid: $106.88
  • Empire — HMO: $114.14
  • Empire — Indemnity: $114.14
  • Healthfirst — Managed Medicaid: $106.82
  • Healthfirst — Medicare Advantage: $116.38
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CHEST X-RAY 2 VIE $1,416 Not listed in the file $43.89 – $119.50
Chest X-ray, 2 views: 10 of 45 insurance plan rates
  • Aetna — All Products: $781.63
  • Aetna — High Performance: $708
  • Aetna — Medicare Advantage: $108.63
  • Affinity — Medicare Advantage: $108.63
  • Amerigroup — Managed Medicaid: $43.89
  • Amerigroup — Medicare Advantage: $110.80
  • Amida Care — Managed Medicaid: $43.89
  • Amida Care — Medicare Advantage: $119.50
  • ArchCare — Medicare Advantage: $114.06
  • Beacon Health — Managed Medicaid: $38.89
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-RAY EXAM CHEST 2 VIEWS $1,416 Not listed in the file $708 – $781.63
Chest X-ray, 2 views: 10 of 45 insurance plan rates
  • Aetna — All Products: $781.63
  • Aetna — High Performance: $708
  • Aetna — Medicare Advantage: $108.63
  • Affinity — Medicare Advantage: $108.63
  • Amerigroup — Managed Medicaid: $43.89
  • Amerigroup — Medicare Advantage: $110.80
  • Amida Care — Managed Medicaid: $43.89
  • Amida Care — Medicare Advantage: $119.50
  • ArchCare — Medicare Advantage: $114.06
  • Beacon Health — Managed Medicaid: $38.89
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CHEST (2VIEW)FRONTAL LAT $1,416 Not listed in the file $708 – $781.63
Chest X-ray, 2 views: 10 of 45 insurance plan rates
  • Aetna — All Products: $781.63
  • Aetna — High Performance: $708
  • Aetna — Medicare Advantage: $108.63
  • Affinity — Medicare Advantage: $108.63
  • Amerigroup — Managed Medicaid: $43.89
  • Amerigroup — Medicare Advantage: $110.80
  • Amida Care — Managed Medicaid: $43.89
  • Amida Care — Medicare Advantage: $119.50
  • ArchCare — Medicare Advantage: $114.06
  • Beacon Health — Managed Medicaid: $38.89
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LUMBAR SPINE W/OBLIQUES $1,820 Not listed in the file $910 – $1,004.64
X-ray of the lower spine, at least 4 views: 10 of 45 insurance plan rates
  • Aetna — All Products: $1,004.64
  • Aetna — High Performance: $910
  • Aetna — Medicare Advantage: $130.50
  • Affinity — Medicare Advantage: $130.50
  • Amerigroup — Managed Medicaid: $43.89
  • Amerigroup — Medicare Advantage: $133.11
  • Amida Care — Managed Medicaid: $43.89
  • Amida Care — Medicare Advantage: $143.55
  • ArchCare — Medicare Advantage: $137.03
  • Beacon Health — Managed Medicaid: $63.17
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 Not listed in the file Not listed in the file $32.19 – $94.37
X-ray of the lower spine, at least 4 views: 10 of 12 insurance plan rates
  • Aetna — High Performance: $53.66
  • Beacon Health — Managed Medicaid: $48.67
  • Beacon Health — Medicare Advantage/ Health Exchange: $48.67
  • Emblem — GHI PPO EPO HMO: $94.37
  • Emblem — HIP PPO EPO HMO: $94.37
  • Empire — HealthPlus Medicaid: $41.43
  • Empire — HMO: $32.19
  • Empire — Indemnity: $32.19
  • Healthfirst — Managed Medicaid: $43.80
  • Healthfirst — Medicare Advantage: $45.11
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: X-RAY EXAM L-2 SPINE 4/>VWS Not listed in the file Not listed in the file $12.46 – $28.38
X-ray of the lower spine, at least 4 views: rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $14.49
  • Beacon Health — Medicare Advantage/ Health Exchange: $14.49
  • Emblem — GHI PPO EPO HMO: $28.38
  • Emblem — HIP PPO EPO HMO: $28.38
  • Empire — HealthPlus Medicaid: $12.46
  • Empire — HMO: $15.57
  • Empire — Indemnity: $15.57
  • Healthfirst — Managed Medicaid: $13.04
  • Healthfirst — Medicare Advantage: $13.57
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LUMBAR SPINE WO CONTRAST $9,594 Not listed in the file $4,797 – $5,295.89
MRI of the lower back (lumbar spine), without contrast: 10 of 45 insurance plan rates
  • Aetna — All Products: $5,295.89
  • Aetna — High Performance: $4,797
  • Aetna — Medicare Advantage: $297.84
  • Affinity — Medicare Advantage: $297.84
  • Amerigroup — Managed Medicaid: $551.19
  • Amerigroup — Medicare Advantage: $303.80
  • Amida Care — Managed Medicaid: $551.19
  • Amida Care — Medicare Advantage: $327.63
  • ArchCare — Medicare Advantage: $312.74
  • Beacon Health — Managed Medicaid: $224.18
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 Not listed in the file Not listed in the file $129.15 – $634
MRI of the lower back (lumbar spine), without contrast: 10 of 12 insurance plan rates
  • Aetna — High Performance: $162.16
  • Beacon Health — Managed Medicaid: $146.99
  • Beacon Health — Medicare Advantage/ Health Exchange: $146.99
  • Emblem — GHI PPO EPO HMO: $297.75
  • Emblem — HIP PPO EPO HMO: $297.75
  • Empire — HealthPlus Medicaid: $130.72
  • Empire — HMO: $149.26
  • Empire — Indemnity: $149.26
  • Healthfirst — Managed Medicaid: $132.29
  • Healthfirst — Medicare Advantage: $142.34
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: MRI LUMBAR SPINE W/O DYE Not listed in the file Not listed in the file $68.64 – $156.36
MRI of the lower back (lumbar spine), without contrast: rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $77.19
  • Beacon Health — Medicare Advantage/ Health Exchange: $77.19
  • Emblem — GHI PPO EPO HMO: $156.36
  • Emblem — HIP PPO EPO HMO: $156.36
  • Empire — HealthPlus Medicaid: $68.64
  • Empire — HMO: $74.45
  • Empire — Indemnity: $74.45
  • Healthfirst — Managed Medicaid: $69.47
  • Healthfirst — Medicare Advantage: $74.75
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PELVIS CT W/CONTRAST $3,379 Not listed in the file $1,689.50 – $1,865.21
CT scan of the pelvis, with contrast: 10 of 45 insurance plan rates
  • Aetna — All Products: $1,865.21
  • Aetna — High Performance: $1,689.50
  • Aetna — Medicare Advantage: $218.95
  • Affinity — Medicare Advantage: $218.95
  • Amerigroup — Managed Medicaid: $450.11
  • Amerigroup — Medicare Advantage: $223.33
  • Amida Care — Managed Medicaid: $450.11
  • Amida Care — Medicare Advantage: $240.85
  • ArchCare — Medicare Advantage: $229.90
  • Beacon Health — Managed Medicaid: $265.75
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 Not listed in the file Not listed in the file $166.12 – $420.29
CT scan of the pelvis, with contrast: 10 of 12 insurance plan rates
  • Aetna — High Performance: $226.62
  • Beacon Health — Managed Medicaid: $205.37
  • Beacon Health — Medicare Advantage/ Health Exchange: $205.37
  • Emblem — GHI PPO EPO HMO: $420.29
  • Emblem — HIP PPO EPO HMO: $420.29
  • Empire — HealthPlus Medicaid: $184.52
  • Empire — HMO: $166.12
  • Empire — Indemnity: $166.12
  • Healthfirst — Managed Medicaid: $184.83
  • Healthfirst — Medicare Advantage: $200.92
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: CT PELVIS W/DYE Not listed in the file Not listed in the file $53.42 – $121.68
CT scan of the pelvis, with contrast: rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $60.39
  • Beacon Health — Medicare Advantage/ Health Exchange: $60.39
  • Emblem — GHI PPO EPO HMO: $121.68
  • Emblem — HIP PPO EPO HMO: $121.68
  • Empire — HealthPlus Medicaid: $53.42
  • Empire — HMO: $58.30
  • Empire — Indemnity: $58.30
  • Healthfirst — Managed Medicaid: $54.35
  • Healthfirst — Medicare Advantage: $58.17
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LWR EXT ANY JOINT WO CONTR $8,879 Not listed in the file $4,439.50 – $4,901.21
MRI of a leg joint (such as the knee), without contrast: 10 of 45 insurance plan rates
  • Aetna — All Products: $4,901.21
  • Aetna — High Performance: $4,439.50
  • Aetna — Medicare Advantage: $297.84
  • Affinity — Medicare Advantage: $297.84
  • Amerigroup — Managed Medicaid: $551.19
  • Amerigroup — Medicare Advantage: $303.80
  • Amida Care — Managed Medicaid: $551.19
  • Amida Care — Medicare Advantage: $327.63
  • ArchCare — Medicare Advantage: $312.74
  • Beacon Health — Managed Medicaid: $239.54
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI JNT OF LWR EXTRE W/O DYE Not listed in the file Not listed in the file $148.37 – $571
MRI of a leg joint (such as the knee), without contrast: 10 of 12 insurance plan rates
  • Aetna — High Performance: $186.28
  • Beacon Health — Managed Medicaid: $168.83
  • Beacon Health — Medicare Advantage/ Health Exchange: $168.83
  • Emblem — GHI PPO EPO HMO: $341.98
  • Emblem — HIP PPO EPO HMO: $341.98
  • Empire — HealthPlus Medicaid: $150.14
  • Empire — HMO: $168.22
  • Empire — Indemnity: $168.22
  • Healthfirst — Managed Medicaid: $151.95
  • Healthfirst — Medicare Advantage: $163.49
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: MRI JNT OF LWR EXTRE W/O DYE Not listed in the file Not listed in the file $62.66 – $142.73
MRI of a leg joint (such as the knee), without contrast: rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $70.71
  • Beacon Health — Medicare Advantage/ Health Exchange: $70.71
  • Emblem — GHI PPO EPO HMO: $142.73
  • Emblem — HIP PPO EPO HMO: $142.73
  • Empire — HealthPlus Medicaid: $62.66
  • Empire — HMO: $68.13
  • Empire — Indemnity: $68.13
  • Healthfirst — Managed Medicaid: $63.64
  • Healthfirst — Medicare Advantage: $68.23
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT ABD & PEL W CONTRAST $4,669 Not listed in the file $414.16 – $504.12
CT scan of the abdomen and pelvis, with contrast: 10 of 45 insurance plan rates
  • Aetna — All Products: $2,577.29
  • Aetna — High Performance: $2,334.50
  • Aetna — Medicare Advantage: $435.49
  • Affinity — Medicare Advantage: $435.49
  • Amerigroup — Managed Medicaid: $450.11
  • Amerigroup — Medicare Advantage: $444.20
  • Amida Care — Managed Medicaid: $450.11
  • Amida Care — Medicare Advantage: $479.04
  • ArchCare — Medicare Advantage: $457.27
  • Beacon Health — Managed Medicaid: $352.54
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 Not listed in the file Not listed in the file $218.45 – $526.92
CT scan of the abdomen and pelvis, with contrast: 10 of 11 insurance plan rates
  • Aetna — High Performance: $284.51
  • Beacon Health — Managed Medicaid: $257.79
  • Beacon Health — Medicare Advantage/ Health Exchange: $257.79
  • Emblem — GHI PPO EPO HMO: $526.92
  • Emblem — HIP PPO EPO HMO: $526.92
  • Empire — HealthPlus Medicaid: $231.33
  • Empire — HMO: $218.45
  • Empire — Indemnity: $218.45
  • Healthfirst — Managed Medicaid: $232.01
  • Healthfirst — Medicare Advantage: $251.89
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: CT ABD & PELVIS W/CONTRAST Not listed in the file Not listed in the file $85.05 – $193.72
CT scan of the abdomen and pelvis, with contrast: rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $94.75
  • Beacon Health — Medicare Advantage/ Health Exchange: $94.75
  • Emblem — GHI PPO EPO HMO: $193.72
  • Emblem — HIP PPO EPO HMO: $193.72
  • Empire — HealthPlus Medicaid: $85.05
  • Empire — HMO: $91.31
  • Empire — Indemnity: $91.31
  • Healthfirst — Managed Medicaid: $85.28
  • Healthfirst — Medicare Advantage: $92.61
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US - ABDOMEN $2,803 Not listed in the file $123.32 – $905.08
Ultrasound of the abdomen, complete: 10 of 45 insurance plan rates
  • Aetna — All Products: $1,547.26
  • Aetna — High Performance: $1,401.50
  • Aetna — Medicare Advantage: $130.50
  • Affinity — Medicare Advantage: $130.50
  • Amerigroup — Managed Medicaid: $808.11
  • Amerigroup — Medicare Advantage: $133.11
  • Amida Care — Managed Medicaid: $808.11
  • Amida Care — Medicare Advantage: $143.55
  • ArchCare — Medicare Advantage: $137.03
  • Beacon Health — Managed Medicaid: $133.86
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US EXAM ABDOM COMPLETE Not listed in the file Not listed in the file $79.79 – $185.55
Ultrasound of the abdomen, complete: 10 of 12 insurance plan rates
  • Aetna — High Performance: $101.19
  • Beacon Health — Managed Medicaid: $91.79
  • Beacon Health — Medicare Advantage/ Health Exchange: $91.79
  • Emblem — GHI PPO EPO HMO: $185.55
  • Emblem — HIP PPO EPO HMO: $185.55
  • Empire — HealthPlus Medicaid: $81.46
  • Empire — HMO: $79.79
  • Empire — Indemnity: $79.79
  • Healthfirst — Managed Medicaid: $82.61
  • Healthfirst — Medicare Advantage: $88.70
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: US EXAM ABDOM COMPLETE Not listed in the file Not listed in the file $37.47 – $85.35
Ultrasound of the abdomen, complete: rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $42.07
  • Beacon Health — Medicare Advantage/ Health Exchange: $42.07
  • Emblem — GHI PPO EPO HMO: $85.35
  • Emblem — HIP PPO EPO HMO: $85.35
  • Empire — HealthPlus Medicaid: $37.47
  • Empire — HMO: $39.22
  • Empire — Indemnity: $39.22
  • Healthfirst — Managed Medicaid: $37.86
  • Healthfirst — Medicare Advantage: $40.80
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US - FETAL/MATERN AFT 1ST TRI $2,122 Not listed in the file $123.32 – $180.31
Pregnancy ultrasound (after the first trimester): 10 of 45 insurance plan rates
  • Aetna — All Products: $1,171.34
  • Aetna — High Performance: $1,061
  • Aetna — Medicare Advantage: $130.50
  • Affinity — Medicare Advantage: $130.50
  • Amerigroup — Managed Medicaid: $160.99
  • Amerigroup — Medicare Advantage: $133.11
  • Amida Care — Managed Medicaid: $160.99
  • Amida Care — Medicare Advantage: $143.55
  • ArchCare — Medicare Advantage: $137.03
  • Beacon Health — Managed Medicaid: $159.15
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 $555 Not listed in the file $2.35 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $455
Pregnancy ultrasound (after the first trimester): 10 of 32 insurance plan rates
  • Aetna — All Products: $306.36
  • Aetna — High Performance: $130.44
  • Aetna — Medicare Advantage: $238.65
  • Amerigroup — Managed Medicaid: $160.99
  • Amida Care — Managed Medicaid: $160.99
  • Beacon Health — Managed Medicaid: $106.08
  • Beacon Health — Medicare Advantage/ Health Exchange: $106.08
  • Beacon Health — Medicare Emblem & VNS: $277.50
  • Cigna — All Products: $249.75
  • Elderplan — Medicare Advantage: $388.50
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: OB US >/= 14 WKS SNGL FETUS Not listed in the file Not listed in the file $46.19 – $105.22
Pregnancy ultrasound (after the first trimester): rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $53.06
  • Beacon Health — Medicare Advantage/ Health Exchange: $53.06
  • Emblem — GHI PPO EPO HMO: $105.22
  • Emblem — HIP PPO EPO HMO: $105.22
  • Empire — HealthPlus Medicaid: $46.19
  • Empire — HMO: $49.10
  • Empire — Indemnity: $49.10
  • Healthfirst — Managed Medicaid: $47.75
  • Healthfirst — Medicare Advantage: $50.30
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US - ECHOGRAPHY TRANSVAGINAL $2,021 Not listed in the file $123.32 – $208.66
Transvaginal ultrasound: 10 of 45 insurance plan rates
  • Aetna — All Products: $1,115.59
  • Aetna — High Performance: $1,010.50
  • Aetna — Medicare Advantage: $130.50
  • Affinity — Medicare Advantage: $130.50
  • Amerigroup — Managed Medicaid: $186.30
  • Amerigroup — Medicare Advantage: $133.11
  • Amida Care — Managed Medicaid: $186.30
  • Amida Care — Medicare Advantage: $143.55
  • ArchCare — Medicare Advantage: $137.03
  • Beacon Health — Managed Medicaid: $138.33
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: TRANSVAGINAL US NON-OB $555 Not listed in the file $238.65 – $567.77
Transvaginal ultrasound: 10 of 32 insurance plan rates
  • Aetna — All Products: $306.36
  • Aetna — High Performance: $125.06
  • Aetna — Medicare Advantage: $238.65
  • Amerigroup — Managed Medicaid: $186.30
  • Amida Care — Managed Medicaid: $186.30
  • Beacon Health — Managed Medicaid: $101.72
  • Beacon Health — Medicare Advantage/ Health Exchange: $101.72
  • Beacon Health — Medicare Emblem & VNS: $277.50
  • Cigna — All Products: $249.75
  • Elderplan — Medicare Advantage: $388.50
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: TRANSVAGINAL US NON-OB Not listed in the file Not listed in the file $32.14 – $73.22
Transvaginal ultrasound: rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $36.62
  • Beacon Health — Medicare Advantage/ Health Exchange: $36.62
  • Emblem — GHI PPO EPO HMO: $73.22
  • Emblem — HIP PPO EPO HMO: $73.22
  • Empire — HealthPlus Medicaid: $32.14
  • Empire — HMO: $33.82
  • Empire — Indemnity: $33.82
  • Healthfirst — Managed Medicaid: $32.96
  • Healthfirst — Medicare Advantage: $35
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DX MAMMO INCL CAD UNI Not listed in the file Not listed in the file $141.30 – $283.49
Diagnostic mammogram, one breast: 10 of 30 insurance plan rates
  • Aetna — All Products: $145.38
  • Aetna — High Performance: $283.49
  • Aetna — Medicare Advantage: $145.38
  • Affinity — Medicare Advantage: $145.38
  • Amerigroup — Medicare Advantage: $148.29
  • Amida Care — Medicare Advantage: $159.92
  • ArchCare — Medicare Advantage: $152.65
  • Beacon Health — Managed Medicaid: $145.38
  • Beacon Health — Medicare Advantage/ Health Exchange: $145.38
  • Centerlight Healthcare — Medicare Advantage: $145.38
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: MAM DIAG-UNI LT DIG WCAD $673 Not listed in the file $289.39 – $688.48
Diagnostic mammogram, one breast: 10 of 28 insurance plan rates
  • Aetna — All Products: $371.50
  • Aetna — High Performance: $336.50
  • Aetna — Medicare Advantage: $289.39
  • Amerigroup — Managed Medicaid: $154.77
  • Amida Care — Managed Medicaid: $154.77
  • Beacon Health — Medicare Emblem & VNS: $336.50
  • Cigna — All Products: $302.85
  • Elderplan — Medicare Advantage: $471.10
  • Emblem — GHI PPO EPO HMO: $336.50
  • Emblem — HIP PPO EPO HMO: $336.50
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: MAM DIAG-UNI RT DIG WCAD $673 Not listed in the file $289.39 – $688.48
Diagnostic mammogram, one breast: 10 of 28 insurance plan rates
  • Aetna — All Products: $371.50
  • Aetna — High Performance: $336.50
  • Aetna — Medicare Advantage: $289.39
  • Amerigroup — Managed Medicaid: $154.77
  • Amida Care — Managed Medicaid: $154.77
  • Beacon Health — Medicare Emblem & VNS: $336.50
  • Cigna — All Products: $302.85
  • Elderplan — Medicare Advantage: $471.10
  • Emblem — GHI PPO EPO HMO: $336.50
  • Emblem — HIP PPO EPO HMO: $336.50
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DX MAMMO INCL CAD BI Not listed in the file Not listed in the file $154.77 – $359.48
Diagnostic mammogram, both breasts: 10 of 30 insurance plan rates
  • Aetna — All Products: $184.35
  • Aetna — High Performance: $359.48
  • Aetna — Medicare Advantage: $184.35
  • Affinity — Medicare Advantage: $184.35
  • Amerigroup — Medicare Advantage: $188.04
  • Amida Care — Medicare Advantage: $202.79
  • ArchCare — Medicare Advantage: $193.57
  • Beacon Health — Managed Medicaid: $184.35
  • Beacon Health — Medicare Advantage/ Health Exchange: $184.35
  • Centerlight Healthcare — Medicare Advantage: $184.35
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad bi Not listed in the file Not listed in the file $154.77 – $359.48
Diagnostic mammogram, both breasts: rates for 7 insurance plans
  • Amerigroup — Managed Medicaid: $154.77
  • Amida Care — Managed Medicaid: $154.77
  • Emblem — Managed Medicaid - HIP & GHI: $154.77
  • Empire — HealthPlus ALIESSA: $158.42
  • UHC — Essential Plans: $173.34
  • VNS — Managed Medicaid: $154.77
  • Wellcare — Managed Medicaid: $158.33
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DX MAMMO INCL CAD BI Not listed in the file Not listed in the file $92.79 – $267.51
Diagnostic mammogram, both breasts: 10 of 12 insurance plan rates
  • Aetna — High Performance: $145.49
  • Beacon Health — Managed Medicaid: $131.90
  • Beacon Health — Medicare Advantage/ Health Exchange: $131.90
  • Emblem — GHI PPO EPO HMO: $267.51
  • Emblem — HIP PPO EPO HMO: $267.51
  • Empire — HealthPlus Medicaid: $117.44
  • Empire — HMO: $92.79
  • Empire — Indemnity: $92.79
  • Healthfirst — Managed Medicaid: $118.71
  • Healthfirst — Medicare Advantage: $127.88
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SCR MAMMO BI INCL CAD Not listed in the file Not listed in the file $144.32 – $288.87
Screening mammogram, both breasts: 10 of 30 insurance plan rates
  • Aetna — All Products: $148.14
  • Aetna — High Performance: $288.87
  • Aetna — Medicare Advantage: $148.14
  • Affinity — Medicare Advantage: $148.14
  • Amerigroup — Medicare Advantage: $151.10
  • Amida Care — Medicare Advantage: $162.95
  • ArchCare — Medicare Advantage: $155.55
  • Beacon Health — Managed Medicaid: $148.14
  • Beacon Health — Medicare Advantage/ Health Exchange: $148.14
  • Centerlight Healthcare — Medicare Advantage: $148.14
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Scr mammo bi incl cad Not listed in the file Not listed in the file $144.32 – $288.87
Screening mammogram, both breasts: rates for 7 insurance plans
  • Amerigroup — Managed Medicaid: $154.77
  • Amida Care — Managed Medicaid: $154.77
  • Emblem — Managed Medicaid - HIP & GHI: $154.77
  • Empire — HealthPlus ALIESSA: $158.42
  • UHC — Essential Plans: $173.34
  • VNS — Managed Medicaid: $154.77
  • Wellcare — Managed Medicaid: $158.33
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: SCR MAMMO BI INCL CAD Not listed in the file Not listed in the file $76.73 – $220.89
Screening mammogram, both breasts: 10 of 12 insurance plan rates
  • Aetna — High Performance: $119.89
  • Beacon Health — Managed Medicaid: $108.64
  • Beacon Health — Medicare Advantage/ Health Exchange: $108.64
  • Emblem — GHI PPO EPO HMO: $220.89
  • Emblem — HIP PPO EPO HMO: $220.89
  • Empire — HealthPlus Medicaid: $96.97
  • Empire — HMO: $76.73
  • Empire — Indemnity: $76.73
  • Healthfirst — Managed Medicaid: $97.78
  • Healthfirst — Medicare Advantage: $105.59

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 Not listed in the file Not listed in the file $14.77 – $52.98
Electrocardiogram (ECG/EKG) with reading: 10 of 13 insurance plan rates
  • Beacon Health — Managed Medicaid: $18
  • Beacon Health — Medicare Advantage/ Health Exchange: $18
  • Emblem — GHI PPO EPO HMO: $33.64
  • Emblem — HIP PPO EPO HMO: $33.64
  • Empire — HealthPlus Medicaid: $14.77
  • Empire — HMO: $16.41
  • Empire — Indemnity: $16.41
  • Fidelis — Managed Medicaid: $15.15
  • Healthfirst — Managed Medicaid: $15.15
  • Healthfirst — Medicare Advantage: $16.08
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Electrocardiogram complete Not listed in the file Not listed in the file $52.97 – $59.33
Electrocardiogram (ECG/EKG) with reading: rates for 7 insurance plans
  • Amerigroup — Managed Medicaid: $52.97
  • Amida Care — Managed Medicaid: $52.97
  • Emblem — Managed Medicaid - HIP & GHI: $52.97
  • Empire — HealthPlus ALIESSA: $54.22
  • UHC — Essential Plans: $59.33
  • VNS — Managed Medicaid: $52.97
  • Wellcare — Managed Medicaid: $54.19
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HEART CATH $24,561 Not listed in the file $1,990 – $12,136
Left heart catheterization (diagnostic): 10 of 45 insurance plan rates
  • Aetna — All Products: $11,363
  • Aetna — High Performance: $10,227
  • Aetna — Medicare Advantage: $4,046.85
  • Affinity — Medicare Advantage: $4,046.85
  • Amerigroup — Managed Medicaid: $2,272.73
  • Amerigroup — Medicare Advantage: $4,127.79
  • Amida Care — Managed Medicaid: $2,272.73
  • Amida Care — Medicare Advantage: $4,451.54
  • ArchCare — Medicare Advantage: $4,249.19
  • Beacon Health — Managed Medicaid: $1,043.44
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY $24,561 Not listed in the file $1,990 – $12,136
Left heart catheterization (diagnostic): 10 of 45 insurance plan rates
  • Aetna — All Products: $11,363
  • Aetna — High Performance: $10,227
  • Aetna — Medicare Advantage: $4,046.85
  • Affinity — Medicare Advantage: $4,046.85
  • Amerigroup — Managed Medicaid: $2,272.73
  • Amerigroup — Medicare Advantage: $4,127.79
  • Amida Care — Managed Medicaid: $2,272.73
  • Amida Care — Medicare Advantage: $4,451.54
  • ArchCare — Medicare Advantage: $4,249.19
  • Beacon Health — Managed Medicaid: $1,043.44
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: LEFT HRT CATH W/VENTRCLGRPHY Not listed in the file Not listed in the file $583.51 – $1,495.46
Left heart catheterization (diagnostic): 10 of 11 insurance plan rates
  • Aetna — High Performance: $847.68
  • Beacon Health — Managed Medicaid: $767.99
  • Beacon Health — Medicare Advantage/ Health Exchange: $767.99
  • Emblem — GHI PPO EPO HMO: $1,495.46
  • Emblem — HIP PPO EPO HMO: $1,495.46
  • Empire — HealthPlus Medicaid: $656.54
  • Empire — HMO: $583.51
  • Empire — Indemnity: $583.51
  • Healthfirst — Managed Medicaid: $691.19
  • Healthfirst — Medicare Advantage: $714.90
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE EP EVALUATION Not listed in the file Not listed in the file $677.07 – $10,709.81
Heart rhythm study (electrophysiology evaluation): 10 of 23 insurance plan rates
  • Aetna — Medicare Advantage: $9,736.19
  • Affinity — Medicare Advantage: $9,736.19
  • Amerigroup — Medicare Advantage: $9,930.92
  • Amida Care — Medicare Advantage: $10,709.81
  • ArchCare — Medicare Advantage: $10,223
  • Centerlight Healthcare — Medicare Advantage: $9,736.19
  • Cigna — All Products: $15,268.61
  • Elderplan — Medicare Advantage: $9,736.19
  • Emblem — Medicare Advantage - HIP & GHI: $9,736.19
  • Empire — Medicare Advantage: $9,736.19
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive ep evaluation Not listed in the file Not listed in the file $677.07 – $10,709.81
Heart rhythm study (electrophysiology evaluation): rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $677.07
  • Amida Care — Managed Medicaid: $677.07
  • Emblem — Managed Medicaid - HIP & GHI: $677.07
  • Empire — HealthPlus ALIESSA: $693.04
  • UHC — Essential Plans: $758.32
  • UHC — Managed Medicaid: $758.32
  • VNS — Managed Medicaid: $677.07
  • Wellcare — Managed Medicaid: $692.64
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: COMPREHENSIVE EP EVALUATION Not listed in the file Not listed in the file $389.52 – $887.24
Heart rhythm study (electrophysiology evaluation): rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $447.73
  • Beacon Health — Medicare Advantage/ Health Exchange: $447.73
  • Emblem — GHI PPO EPO HMO: $887.24
  • Emblem — HIP PPO EPO HMO: $887.24
  • Empire — HealthPlus Medicaid: $389.52
  • Empire — HMO: $399.43
  • Empire — Indemnity: $399.43
  • Healthfirst — Managed Medicaid: $402.96
  • Healthfirst — Medicare Advantage: $424.14
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPRE EP EVAL ABLTJ ATR FIB Not listed in the file Not listed in the file $1,163.99 – $35,890.22
Heart rhythm study with ablation for atrial fibrillation: 10 of 28 insurance plan rates
  • Aetna — Medicare Advantage: $32,627.47
  • Affinity — Medicare Advantage: $32,627.47
  • Amerigroup — Medicare Advantage: $33,280.02
  • Amida Care — Medicare Advantage: $35,890.22
  • ArchCare — Medicare Advantage: $34,258.84
  • Beacon Health — Managed Medicaid: $977.10
  • Beacon Health — Medicare Advantage/ Health Exchange: $977.10
  • Centerlight Healthcare — Medicare Advantage: $32,627.47
  • Cigna — All Products: $51,167.42
  • Elderplan — Medicare Advantage: $32,627.47
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Compre ep eval abltj atr fib Not listed in the file Not listed in the file $1,163.99 – $35,890.22
Heart rhythm study with ablation for atrial fibrillation: rates for 9 insurance plans
  • Amerigroup — Managed Medicaid: $1,163.99
  • Amida Care — Managed Medicaid: $1,163.99
  • Emblem — Managed Medicaid - HIP & GHI: $1,163.99
  • Empire — HealthPlus ALIESSA: $1,191.46
  • Fidelis — Managed Medicaid: $1,163.99
  • UHC — Essential Plans: $1,303.67
  • UHC — Managed Medicaid: $1,303.67
  • VNS — Managed Medicaid: $1,163.99
  • Wellcare — Managed Medicaid: $1,190.76
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POLYSOM 6/> YRS 4/> PARAM Not listed in the file Not listed in the file $1,050.51 – $1,179.86
Sleep study (overnight, in a sleep lab): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $1,071.95
  • Affinity — Medicare Advantage: $1,071.95
  • Amerigroup — Medicare Advantage: $1,093.39
  • Amida Care — Medicare Advantage: $1,179.15
  • ArchCare — Medicare Advantage: $1,125.55
  • Beacon Health — Managed Medicaid: $796.64
  • Beacon Health — Medicare Advantage/ Health Exchange: $796.64
  • Centerlight Healthcare — Medicare Advantage: $1,071.95
  • Cigna — All Products: $1,681.06
  • Elderplan — Medicare Advantage: $1,071.95
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: SLEEP STUDY 4+PARAM ATTENDED $8,601 Not listed in the file $3,698.43 – $8,798.82
Sleep study (overnight, in a sleep lab): 10 of 31 insurance plan rates
  • Aetna — All Products: $3,973
  • Aetna — High Performance: $3,576
  • Aetna — Medicare Advantage: $3,698.43
  • Amerigroup — Managed Medicaid: $1,082.84
  • Amida Care — Managed Medicaid: $1,082.84
  • Beacon Health — Managed Medicaid: $662.20
  • Beacon Health — Medicare Advantage/ Health Exchange: $662.20
  • Beacon Health — Medicare Emblem & VNS: $4,300.50
  • Cigna — All Products: $3,870.45
  • Elderplan — Medicare Advantage: $6,020.70
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: POLYSOM 6/> YRS 4/> PARAM Not listed in the file Not listed in the file $84.77 – $257.51
Sleep study (overnight, in a sleep lab): rates for 9 insurance plans
  • Beacon Health — Managed Medicaid: $134.44
  • Beacon Health — Medicare Advantage/ Health Exchange: $134.44
  • Emblem — GHI PPO EPO HMO: $257.51
  • Emblem — HIP PPO EPO HMO: $257.51
  • Empire — HealthPlus Medicaid: $113.05
  • Empire — HMO: $84.77
  • Empire — Indemnity: $84.77
  • Healthfirst — Managed Medicaid: $121
  • Healthfirst — Medicare Advantage: $123.10

Physical therapy and mental health

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THERAPEUTIC EXERCISES Not listed in the file Not listed in the file $32.15 – $64.16
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 27 insurance plan rates
  • Aetna — All Products: $32.90
  • Aetna — High Performance: $64.16
  • Aetna — Medicare Advantage: $32.90
  • Affinity — Medicare Advantage: $32.90
  • Amerigroup — Medicare Advantage: $33.56
  • Amida Care — Medicare Advantage: $36.19
  • ArchCare — Medicare Advantage: $34.55
  • Beacon Health — Managed Medicaid: $32.90
  • Beacon Health — Medicare Advantage/ Health Exchange: $32.90
  • Centerlight Healthcare — Medicare Advantage: $32.90
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT THERAPEUTIC EXERCISE 15M $409 Not listed in the file $2.35 – $344
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 29 insurance plan rates
  • Aetna — All Products: $271
  • Aetna — High Performance: $244
  • Aetna — Medicare Advantage: $175.87
  • Amerigroup — Managed Medicaid: $89.97
  • Amida Care — Managed Medicaid: $89.97
  • ArchCare — Medicare Advantage: $145
  • Beacon Health — Medicare Emblem & VNS: $204.50
  • Cigna — All Products: $306
  • Elderplan — Medicare Advantage: $286.30
  • Emblem — GHI PPO EPO HMO: $204.50
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GO In the file: OT THERAPEUTIC EXER 15 MIN $409 Not listed in the file $2.35 – $344
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 29 insurance plan rates
  • Aetna — All Products: $271
  • Aetna — High Performance: $244
  • Aetna — Medicare Advantage: $175.87
  • Amerigroup — Managed Medicaid: $89.97
  • Amida Care — Managed Medicaid: $89.97
  • ArchCare — Medicare Advantage: $145
  • Beacon Health — Medicare Emblem & VNS: $204.50
  • Cigna — All Products: $184.05
  • Elderplan — Medicare Advantage: $286.30
  • Emblem — GHI PPO EPO HMO: $204.50
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT EVAL LOW COMPLEX 20 MIN Not listed in the file Not listed in the file $109.57 – $214.79
Physical therapy evaluation (low complexity): 10 of 27 insurance plan rates
  • Aetna — All Products: $110.15
  • Aetna — High Performance: $214.79
  • Aetna — Medicare Advantage: $110.15
  • Affinity — Medicare Advantage: $110.15
  • Amerigroup — Medicare Advantage: $112.35
  • Amida Care — Medicare Advantage: $121.17
  • ArchCare — Medicare Advantage: $115.66
  • Beacon Health — Managed Medicaid: $110.15
  • Beacon Health — Medicare Advantage/ Health Exchange: $110.15
  • Centerlight Healthcare — Medicare Advantage: $110.15
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL LOW COMPLEX $751 Not listed in the file $2.35 – $344
Physical therapy evaluation (low complexity): 10 of 29 insurance plan rates
  • Aetna — All Products: $271
  • Aetna — High Performance: $244
  • Aetna — Medicare Advantage: $322.93
  • Amerigroup — Managed Medicaid: $157.99
  • Amida Care — Managed Medicaid: $157.99
  • ArchCare — Medicare Advantage: $145
  • Beacon Health — Medicare Emblem & VNS: $375.50
  • Cigna — All Products: $306
  • Elderplan — Medicare Advantage: $525.70
  • Emblem — GHI PPO EPO HMO: $375.50
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT EVAL MOD COMPLEX 30 MIN Not listed in the file Not listed in the file $109.57 – $214.79
Physical therapy evaluation (moderate complexity): 10 of 27 insurance plan rates
  • Aetna — All Products: $110.15
  • Aetna — High Performance: $214.79
  • Aetna — Medicare Advantage: $110.15
  • Affinity — Medicare Advantage: $110.15
  • Amerigroup — Medicare Advantage: $112.35
  • Amida Care — Medicare Advantage: $121.17
  • ArchCare — Medicare Advantage: $115.66
  • Beacon Health — Managed Medicaid: $110.15
  • Beacon Health — Medicare Advantage/ Health Exchange: $110.15
  • Centerlight Healthcare — Medicare Advantage: $110.15
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL MOD COMPLEX $1,491 Not listed in the file $641.13 – $1,525.29
Physical therapy evaluation (moderate complexity): 10 of 29 insurance plan rates
  • Aetna — All Products: $271
  • Aetna — High Performance: $244
  • Aetna — Medicare Advantage: $641.13
  • Amerigroup — Managed Medicaid: $157.99
  • Amida Care — Managed Medicaid: $157.99
  • ArchCare — Medicare Advantage: $145
  • Beacon Health — Medicare Emblem & VNS: $745.50
  • Cigna — All Products: $306
  • Elderplan — Medicare Advantage: $1,043.70
  • Emblem — GHI PPO EPO HMO: $745.50
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT EVAL HIGH COMPLEX 45 MIN Not listed in the file Not listed in the file $109.57 – $214.79
Physical therapy evaluation (high complexity): 10 of 27 insurance plan rates
  • Aetna — All Products: $110.15
  • Aetna — High Performance: $214.79
  • Aetna — Medicare Advantage: $110.15
  • Affinity — Medicare Advantage: $110.15
  • Amerigroup — Medicare Advantage: $112.35
  • Amida Care — Medicare Advantage: $121.17
  • ArchCare — Medicare Advantage: $115.66
  • Beacon Health — Managed Medicaid: $110.15
  • Beacon Health — Medicare Advantage/ Health Exchange: $110.15
  • Centerlight Healthcare — Medicare Advantage: $110.15
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL HIGH COMPLEX $1,121 Not listed in the file $482.03 – $1,146.78
Physical therapy evaluation (high complexity): 10 of 29 insurance plan rates
  • Aetna — All Products: $271
  • Aetna — High Performance: $244
  • Aetna — Medicare Advantage: $482.03
  • Amerigroup — Managed Medicaid: $157.99
  • Amida Care — Managed Medicaid: $157.99
  • ArchCare — Medicare Advantage: $145
  • Beacon Health — Medicare Emblem & VNS: $560.50
  • Cigna — All Products: $306
  • Elderplan — Medicare Advantage: $784.70
  • Emblem — GHI PPO EPO HMO: $560.50
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INDIVIDUAL THERAPY 30 MIN PHP $745 Not listed in the file $143.63 – $243.72
Psychotherapy, 30 minutes: 10 of 43 insurance plan rates
  • Aetna — All Products: $162.16
  • Aetna — High Performance: $145.72
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $143.63
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $143.63
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $74.73
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYTX W PT 30 MINUTES $523 Not listed in the file $143.63 – $243.72
Psychotherapy, 30 minutes: 10 of 43 insurance plan rates
  • Aetna — All Products: $162.16
  • Aetna — High Performance: $145.72
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $143.63
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $143.63
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $74.73
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INDIVIDUAL THERAPY 30 MIN $745 Not listed in the file $143.63 – $243.72
Psychotherapy, 30 minutes: 10 of 43 insurance plan rates
  • Aetna — All Products: $162.16
  • Aetna — High Performance: $145.72
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $143.63
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $143.63
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $74.73
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INDIVIDUAL THERAPY 45 MIN PHP $983 Not listed in the file $186.33 – $243.72
Psychotherapy, 45 minutes: 10 of 43 insurance plan rates
  • Aetna — All Products: $214.76
  • Aetna — High Performance: $192.99
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $191.51
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $191.51
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $98.97
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYTX W PT 45 MINUTES $556 Not listed in the file $186.33 – $243.72
Psychotherapy, 45 minutes: 10 of 43 insurance plan rates
  • Aetna — All Products: $214.76
  • Aetna — High Performance: $192.99
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $191.51
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $191.51
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $98.97
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INDIVIDUAL THERAPY 45 MIN $983 Not listed in the file $186.33 – $243.72
Psychotherapy, 45 minutes: 10 of 43 insurance plan rates
  • Aetna — All Products: $214.76
  • Aetna — High Performance: $192.99
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $191.51
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $191.51
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $98.97
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INDIVIDUAL THERAPY 60 MIN PHP $743 Not listed in the file $186.33 – $315.74
Psychotherapy, 60 minutes: 10 of 43 insurance plan rates
  • Aetna — All Products: $315.74
  • Aetna — High Performance: $283.73
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $191.51
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $191.51
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $145.50
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHP COLLATERAL W/O PT $983 Not listed in the file $143.63 – $243.72
Family psychotherapy, without the patient: 10 of 43 insurance plan rates
  • Aetna — All Products: $232.58
  • Aetna — High Performance: $209
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $143.63
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $143.63
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $107.18
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLLATERAL $983 Not listed in the file $143.63 – $243.72
Family psychotherapy, without the patient: 10 of 43 insurance plan rates
  • Aetna — All Products: $232.58
  • Aetna — High Performance: $209
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $143.63
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $143.63
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $107.18
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLLATERAL W/O PT 50 MIN $983 Not listed in the file $143.63 – $243.72
Family psychotherapy, without the patient: 10 of 43 insurance plan rates
  • Aetna — All Products: $232.58
  • Aetna — High Performance: $209
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $143.63
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $143.63
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $107.18
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLLATERAL W/ PT PHP $983 Not listed in the file $143.63 – $243.72
Family psychotherapy, with the patient: 10 of 43 insurance plan rates
  • Aetna — All Products: $240.48
  • Aetna — High Performance: $216.10
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $143.63
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $143.63
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $110.82
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/PT 50 MIN $581 Not listed in the file $143.63 – $243.72
Family psychotherapy, with the patient: 10 of 43 insurance plan rates
  • Aetna — All Products: $240.48
  • Aetna — High Performance: $216.10
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $143.63
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $143.63
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $110.82
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY THERAPY $983 Not listed in the file $143.63 – $243.72
Family psychotherapy, with the patient: 10 of 43 insurance plan rates
  • Aetna — All Products: $240.48
  • Aetna — High Performance: $216.10
  • Aetna — Medicare Advantage: $221.56
  • Affinity — Medicare Advantage: $221.56
  • Amerigroup — Managed Medicaid: $143.63
  • Amerigroup — Medicare Advantage: $226
  • Amida Care — Managed Medicaid: $143.63
  • Amida Care — Medicare Advantage: $243.72
  • ArchCare — Medicare Advantage: $232.64
  • Beacon Health — Managed Medicaid: $110.82
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: WELLNESS SELF MGT GRP PHP $376 Not listed in the file $51.52 – $139.49
Group psychotherapy: 10 of 43 insurance plan rates
  • Aetna — All Products: $57.33
  • Aetna — High Performance: $51.52
  • Aetna — Medicare Advantage: $126.81
  • Affinity — Medicare Advantage: $126.81
  • Amerigroup — Managed Medicaid: $74.21
  • Amerigroup — Medicare Advantage: $129.35
  • Amida Care — Managed Medicaid: $74.21
  • Amida Care — Medicare Advantage: $139.49
  • ArchCare — Medicare Advantage: $133.15
  • Beacon Health — Managed Medicaid: $26.42
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SAFETY PLANNING GRP PHP $376 Not listed in the file $51.52 – $139.49
Group psychotherapy: 10 of 43 insurance plan rates
  • Aetna — All Products: $57.33
  • Aetna — High Performance: $51.52
  • Aetna — Medicare Advantage: $126.81
  • Affinity — Medicare Advantage: $126.81
  • Amerigroup — Managed Medicaid: $74.21
  • Amerigroup — Medicare Advantage: $129.35
  • Amida Care — Managed Medicaid: $74.21
  • Amida Care — Medicare Advantage: $139.49
  • ArchCare — Medicare Advantage: $133.15
  • Beacon Health — Managed Medicaid: $26.42
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MOOD MGT GRP PHP $376 Not listed in the file $51.52 – $139.49
Group psychotherapy: 10 of 43 insurance plan rates
  • Aetna — All Products: $57.33
  • Aetna — High Performance: $51.52
  • Aetna — Medicare Advantage: $126.81
  • Affinity — Medicare Advantage: $126.81
  • Amerigroup — Managed Medicaid: $74.21
  • Amerigroup — Medicare Advantage: $129.35
  • Amida Care — Managed Medicaid: $74.21
  • Amida Care — Medicare Advantage: $139.49
  • ArchCare — Medicare Advantage: $133.15
  • Beacon Health — Managed Medicaid: $26.42

Procedures and surgery

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF BREAST LESION Not listed in the file Not listed in the file $1,782 – $6,928
Removal of breast growth (open surgery): 10 of 36 insurance plan rates
  • Aetna — All Products: $6,928
  • Aetna — High Performance: $6,235
  • Aetna — Medicare Advantage: $4,887.57
  • Affinity — Medicare Advantage: $4,887.57
  • Amerigroup — Medicare Advantage: $4,985.32
  • Amida Care — Medicare Advantage: $5,376.33
  • ArchCare — Medicare Advantage: $5,131.95
  • Beacon Health — Managed Medicaid: $493.17
  • Beacon Health — Medicare Advantage/ Health Exchange: $493.17
  • Centerlight Healthcare — Medicare Advantage: $4,887.57
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Removal of breast lesion Not listed in the file Not listed in the file $1,782 – $6,928
Removal of breast growth (open surgery): rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $1,983.84
  • Amida Care — Managed Medicaid: $1,983.84
  • Emblem — Managed Medicaid - HIP & GHI: $1,983.84
  • Empire — HealthPlus ALIESSA: $2,030.64
  • UHC — Essential Plans: $2,221.90
  • UHC — Managed Medicaid: $2,221.90
  • VNS — Managed Medicaid: $1,983.84
  • Wellcare — Managed Medicaid: $2,029.47
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: REMOVAL OF BREAST LESION Not listed in the file Not listed in the file $578
Removal of breast growth (open surgery): rates for 1 insurance plan
  • Local 1199 — Local 1199: $578
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL HIP ARTHROPLASTY Not listed in the file Not listed in the file $2,196 – $17,628.95
Total hip replacement: 10 of 35 insurance plan rates
  • Aetna — All Products: $9,363
  • Aetna — High Performance: $8,426
  • Aetna — Medicare Advantage: $16,026.32
  • Affinity — Medicare Advantage: $16,026.32
  • Amerigroup — Medicare Advantage: $16,346.85
  • Amida Care — Medicare Advantage: $17,628.95
  • ArchCare — Medicare Advantage: $16,827.64
  • Beacon Health — Managed Medicaid: $1,392.21
  • Beacon Health — Medicare Advantage/ Health Exchange: $1,392.21
  • Centerlight Healthcare — Medicare Advantage: $16,026.32
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total hip arthroplasty Not listed in the file Not listed in the file $2,196 – $17,628.95
Total hip replacement: rates for 9 insurance plans
  • Amerigroup — Managed Medicaid: $4,412.21
  • Amida Care — Managed Medicaid: $4,412.21
  • Emblem — Managed Medicaid - HIP & GHI: $4,412.21
  • Empire — HealthPlus ALIESSA: $4,516.31
  • Fidelis — Managed Medicaid: $4,412.21
  • UHC — Essential Plans: $4,941.68
  • UHC — Managed Medicaid: $4,941.68
  • VNS — Managed Medicaid: $4,412.21
  • Wellcare — Managed Medicaid: $4,513.69
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: TOTAL HIP ARTHROPLASTY Not listed in the file Not listed in the file $2,338.50
Total hip replacement: rates for 1 insurance plan
  • Local 1199 — Local 1199: $2,338.50
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL KNEE ARTHROPLASTY Not listed in the file Not listed in the file $2,196 – $47,998
Total knee replacement: 10 of 35 insurance plan rates
  • Aetna — All Products: $9,363
  • Aetna — High Performance: $8,426
  • Aetna — Medicare Advantage: $16,026.32
  • Affinity — Medicare Advantage: $16,026.32
  • Amerigroup — Medicare Advantage: $16,346.85
  • Amida Care — Medicare Advantage: $17,628.95
  • ArchCare — Medicare Advantage: $16,827.64
  • Beacon Health — Managed Medicaid: $1,388.37
  • Beacon Health — Medicare Advantage/ Health Exchange: $1,388.37
  • Centerlight Healthcare — Medicare Advantage: $16,026.32
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total knee arthroplasty Not listed in the file Not listed in the file $2,196 – $47,998
Total knee replacement: rates for 9 insurance plans
  • Amerigroup — Managed Medicaid: $4,412.21
  • Amida Care — Managed Medicaid: $4,412.21
  • Emblem — Managed Medicaid - HIP & GHI: $4,412.21
  • Empire — HealthPlus ALIESSA: $4,516.31
  • Fidelis — Managed Medicaid: $4,412.21
  • UHC — Essential Plans: $4,941.68
  • UHC — Managed Medicaid: $4,941.68
  • VNS — Managed Medicaid: $4,412.21
  • Wellcare — Managed Medicaid: $4,513.69
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: TOTAL KNEE ARTHROPLASTY Not listed in the file Not listed in the file $2,518.50
Total knee replacement: rates for 1 insurance plan
  • Local 1199 — Local 1199: $2,518.50
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SHO ARTHRS SRG DECOMPRESSION Not listed in the file Not listed in the file $1,480 – $6,928
Shoulder arthroscopy: shaving of shoulder bone: 10 of 17 insurance plan rates
  • Aetna — All Products: $6,928
  • Aetna — High Performance: $6,235
  • Beacon Health — Managed Medicaid: $176.24
  • Beacon Health — Medicare Advantage/ Health Exchange: $176.24
  • Emblem — GHI PPO EPO HMO: $410.76
  • Emblem — HIP PPO EPO HMO: $410.76
  • Empire — EPO PPO: $5,991
  • Empire — HealthPlus Medicaid: $180.33
  • Empire — HMO: $5,463
  • Empire — Indemnity: $6,592
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Sho arthrs srg decompression Not listed in the file Not listed in the file $1,480 – $6,928
Shoulder arthroscopy: shaving of shoulder bone: rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $2,302.93
  • Amida Care — Managed Medicaid: $2,302.93
  • Emblem — Managed Medicaid - HIP & GHI: $2,302.93
  • Empire — HealthPlus ALIESSA: $2,357.26
  • UHC — Essential Plans: $2,579.28
  • UHC — Managed Medicaid: $2,579.28
  • VNS — Managed Medicaid: $2,302.93
  • Wellcare — Managed Medicaid: $2,355.90
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: SHO ARTHRS SRG DECOMPRESSION Not listed in the file Not listed in the file $1,153.50
Shoulder arthroscopy: shaving of shoulder bone: rates for 1 insurance plan
  • Local 1199 — Local 1199: $1,153.50
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHRS KNE SRG MNISECTMY M/L Not listed in the file Not listed in the file $1,889 – $9,259
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 36 insurance plan rates
  • Aetna — All Products: $9,259
  • Aetna — High Performance: $8,333
  • Aetna — Medicare Advantage: $4,084.39
  • Affinity — Medicare Advantage: $4,084.39
  • Amerigroup — Medicare Advantage: $4,166.07
  • Amida Care — Medicare Advantage: $4,492.82
  • ArchCare — Medicare Advantage: $4,288.60
  • Beacon Health — Managed Medicaid: $615.82
  • Beacon Health — Medicare Advantage/ Health Exchange: $615.82
  • Centerlight Healthcare — Medicare Advantage: $4,084.39
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Knee arthroscopy/surgery Not listed in the file Not listed in the file $1,889 – $9,259
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $2,302.93
  • Amida Care — Managed Medicaid: $2,302.93
  • Emblem — Managed Medicaid - HIP & GHI: $2,302.93
  • Empire — HealthPlus ALIESSA: $2,357.26
  • UHC — Essential Plans: $2,579.28
  • UHC — Managed Medicaid: $2,579.28
  • VNS — Managed Medicaid: $2,302.93
  • Wellcare — Managed Medicaid: $2,355.90
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: ARTHRS KNE SRG MNISECTMY M/L Not listed in the file Not listed in the file $1,029
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 1 insurance plan
  • Local 1199 — Local 1199: $1,029
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVE TONSILS AND ADENOIDS Not listed in the file Not listed in the file $1,782 – $8,128.59
Removal of tonsils and adenoids (under age 12): 10 of 36 insurance plan rates
  • Aetna — All Products: $6,928
  • Aetna — High Performance: $6,235
  • Aetna — Medicare Advantage: $7,389.63
  • Affinity — Medicare Advantage: $7,389.63
  • Amerigroup — Medicare Advantage: $7,537.42
  • Amida Care — Medicare Advantage: $8,128.59
  • ArchCare — Medicare Advantage: $7,759.11
  • Beacon Health — Managed Medicaid: $306.17
  • Beacon Health — Medicare Advantage/ Health Exchange: $306.17
  • Centerlight Healthcare — Medicare Advantage: $7,389.63
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Remove tonsils and adenoids Not listed in the file Not listed in the file $1,782 – $8,128.59
Removal of tonsils and adenoids (under age 12): rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $1,821.70
  • Amida Care — Managed Medicaid: $1,821.70
  • Emblem — Managed Medicaid - HIP & GHI: $1,821.70
  • Empire — HealthPlus ALIESSA: $1,864.68
  • UHC — Essential Plans: $2,040.30
  • UHC — Managed Medicaid: $2,040.30
  • VNS — Managed Medicaid: $1,821.70
  • Wellcare — Managed Medicaid: $1,863.60
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD DIAGNOSTIC BRUSH WASH $5,250 Not listed in the file $957 – $3,059
Upper GI endoscopy (diagnostic): 10 of 45 insurance plan rates
  • Aetna — All Products: $1,910
  • Aetna — High Performance: $3,059
  • Aetna — Medicare Advantage: $1,132.18
  • Affinity — Medicare Advantage: $1,132.18
  • Amerigroup — Managed Medicaid: $1,017.26
  • Amerigroup — Medicare Advantage: $1,154.82
  • Amida Care — Managed Medicaid: $1,017.26
  • Amida Care — Medicare Advantage: $1,245.39
  • ArchCare — Medicare Advantage: $1,188.78
  • Beacon Health — Managed Medicaid: $128.29
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD WITH BIOPSY $5,441 Not listed in the file $957 – $3,059
Upper GI endoscopy with biopsy: 10 of 45 insurance plan rates
  • Aetna — All Products: $1,910
  • Aetna — High Performance: $3,059
  • Aetna — Medicare Advantage: $1,132.18
  • Affinity — Medicare Advantage: $1,132.18
  • Amerigroup — Managed Medicaid: $1,017.26
  • Amerigroup — Medicare Advantage: $1,154.82
  • Amida Care — Managed Medicaid: $1,017.26
  • Amida Care — Medicare Advantage: $1,245.39
  • ArchCare — Medicare Advantage: $1,188.78
  • Beacon Health — Managed Medicaid: $143.24
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UPPER GI ENDO BIOPSY $5,441 Not listed in the file $1,017.26 – $6,528
Upper GI endoscopy with biopsy: 10 of 45 insurance plan rates
  • Aetna — All Products: $5,296
  • Aetna — High Performance: $3,059
  • Aetna — Medicare Advantage: $1,132.18
  • Affinity — Medicare Advantage: $1,132.18
  • Amerigroup — Managed Medicaid: $1,017.26
  • Amerigroup — Medicare Advantage: $1,154.82
  • Amida Care — Managed Medicaid: $1,017.26
  • Amida Care — Medicare Advantage: $1,245.39
  • ArchCare — Medicare Advantage: $1,188.78
  • Beacon Health — Managed Medicaid: $143.24
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC COLONOSCOPY $6,680 Not listed in the file $977.20 – $6,528
Colonoscopy (diagnostic): 10 of 45 insurance plan rates
  • Aetna — All Products: $5,296
  • Aetna — High Performance: $3,059
  • Aetna — Medicare Advantage: $1,160.85
  • Affinity — Medicare Advantage: $1,160.85
  • Amerigroup — Managed Medicaid: $977.20
  • Amerigroup — Medicare Advantage: $1,184.07
  • Amida Care — Managed Medicaid: $977.20
  • Amida Care — Medicare Advantage: $1,276.94
  • ArchCare — Medicare Advantage: $1,218.89
  • Beacon Health — Managed Medicaid: $191.66
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY SCRN; NOT HI RISK; $6,680 Not listed in the file $977.20 – $6,528
Colonoscopy (diagnostic): 10 of 45 insurance plan rates
  • Aetna — All Products: $5,296
  • Aetna — High Performance: $3,059
  • Aetna — Medicare Advantage: $1,160.85
  • Affinity — Medicare Advantage: $1,160.85
  • Amerigroup — Managed Medicaid: $977.20
  • Amerigroup — Medicare Advantage: $1,184.07
  • Amida Care — Managed Medicaid: $977.20
  • Amida Care — Medicare Advantage: $1,276.94
  • ArchCare — Medicare Advantage: $1,218.89
  • Beacon Health — Managed Medicaid: $191.66
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY SCRN; HI RISK PT $6,680 Not listed in the file $977.20 – $6,528
Colonoscopy (diagnostic): 10 of 45 insurance plan rates
  • Aetna — All Products: $5,296
  • Aetna — High Performance: $3,059
  • Aetna — Medicare Advantage: $1,160.85
  • Affinity — Medicare Advantage: $1,160.85
  • Amerigroup — Managed Medicaid: $977.20
  • Amerigroup — Medicare Advantage: $1,184.07
  • Amida Care — Managed Medicaid: $977.20
  • Amida Care — Medicare Advantage: $1,276.94
  • ArchCare — Medicare Advantage: $1,218.89
  • Beacon Health — Managed Medicaid: $191.66
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONSCOPY AND BIOPSY $6,680 Not listed in the file $977.20 – $6,528
Colonoscopy with biopsy: 10 of 45 insurance plan rates
  • Aetna — All Products: $5,296
  • Aetna — High Performance: $3,059
  • Aetna — Medicare Advantage: $1,493.75
  • Affinity — Medicare Advantage: $1,493.75
  • Amerigroup — Managed Medicaid: $977.20
  • Amerigroup — Medicare Advantage: $1,523.62
  • Amida Care — Managed Medicaid: $977.20
  • Amida Care — Medicare Advantage: $1,643.12
  • ArchCare — Medicare Advantage: $1,568.44
  • Beacon Health — Managed Medicaid: $206.16
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/LESION REMOVAL $6,680 Not listed in the file $977.20 – $6,528
Colonoscopy with removal of polyps (snare): 10 of 45 insurance plan rates
  • Aetna — All Products: $5,296
  • Aetna — High Performance: $3,059
  • Aetna — Medicare Advantage: $1,493.75
  • Affinity — Medicare Advantage: $1,493.75
  • Amerigroup — Managed Medicaid: $977.20
  • Amerigroup — Medicare Advantage: $1,523.62
  • Amida Care — Managed Medicaid: $977.20
  • Amida Care — Medicare Advantage: $1,643.12
  • ArchCare — Medicare Advantage: $1,568.44
  • Beacon Health — Managed Medicaid: $258.44
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/ENDOSCOPE US Not listed in the file Not listed in the file $977.20 – $1,643.12
Ultrasound of the lower bowel by endoscope: 10 of 28 insurance plan rates
  • Aetna — Medicare Advantage: $1,493.75
  • Affinity — Medicare Advantage: $1,493.75
  • Amerigroup — Medicare Advantage: $1,523.62
  • Amida Care — Medicare Advantage: $1,643.12
  • ArchCare — Medicare Advantage: $1,568.44
  • Beacon Health — Managed Medicaid: $260.92
  • Beacon Health — Medicare Advantage/ Health Exchange: $260.92
  • Centerlight Healthcare — Medicare Advantage: $1,493.75
  • Cigna — All Products: $2,342.54
  • Elderplan — Medicare Advantage: $1,493.75
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/endoscope us Not listed in the file Not listed in the file $977.20 – $1,643.12
Ultrasound of the lower bowel by endoscope: rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $977.20
  • Amida Care — Managed Medicaid: $977.20
  • Emblem — Managed Medicaid - HIP & GHI: $977.20
  • Empire — HealthPlus ALIESSA: $1,000.25
  • UHC — Essential Plans: $1,094.46
  • UHC — Managed Medicaid: $1,094.46
  • VNS — Managed Medicaid: $977.20
  • Wellcare — Managed Medicaid: $999.68
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind Not listed in the file Not listed in the file $874 – $5,296
Screening colonoscopy (not high risk): 10 of 44 insurance plan rates
  • Aetna — All Products: $5,296
  • Aetna — High Performance: $4,767
  • Aetna — Medicare Advantage: $1,160.85
  • Affinity — Medicare Advantage: $1,160.85
  • Amerigroup — Managed Medicaid: $977.20
  • Amerigroup — Medicare Advantage: $1,184.07
  • Amida Care — Managed Medicaid: $977.20
  • Amida Care — Medicare Advantage: $1,276.94
  • ArchCare — Medicare Advantage: $1,218.89
  • Beacon Health — Managed Medicaid: $192.28
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 53 In the file: Colon ca scrn not hi rsk ind Not listed in the file Not listed in the file $86.53 – $214.60
Screening colonoscopy (not high risk): rates for 7 insurance plans
  • Beacon Health — Managed Medicaid: $96.14
  • Beacon Health — Medicare Advantage/ Health Exchange: $96.14
  • Emblem — GHI PPO EPO HMO: $214.60
  • Emblem — HIP PPO EPO HMO: $214.60
  • Empire — HealthPlus Medicaid: $94.22
  • Healthfirst — Managed Medicaid: $86.53
  • Healthfirst — Medicare Advantage: $102.59
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPIC CHOLECYSTECTOMY Not listed in the file Not listed in the file $2,091 – $13,272
Gallbladder removal by laparoscope: 10 of 36 insurance plan rates
  • Aetna — All Products: $9,874
  • Aetna — High Performance: $8,887
  • Aetna — Medicare Advantage: $7,546.53
  • Affinity — Medicare Advantage: $7,546.53
  • Amerigroup — Medicare Advantage: $7,697.47
  • Amida Care — Medicare Advantage: $8,301.19
  • ArchCare — Medicare Advantage: $7,923.86
  • Beacon Health — Managed Medicaid: $768.33
  • Beacon Health — Medicare Advantage/ Health Exchange: $768.33
  • Centerlight Healthcare — Medicare Advantage: $7,546.53
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laparoscopic cholecystectomy Not listed in the file Not listed in the file $2,091 – $13,272
Gallbladder removal by laparoscope: rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $3,404.35
  • Amida Care — Managed Medicaid: $3,404.35
  • Emblem — Managed Medicaid - HIP & GHI: $3,404.35
  • Empire — HealthPlus ALIESSA: $3,484.67
  • UHC — Essential Plans: $3,812.87
  • UHC — Managed Medicaid: $3,812.87
  • VNS — Managed Medicaid: $3,404.35
  • Wellcare — Managed Medicaid: $3,482.65
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PRP I/HERN INIT REDUC >5 YR Not listed in the file Not listed in the file $1,889 – $9,259
Groin (inguinal) hernia repair, age 5 or older: 10 of 36 insurance plan rates
  • Aetna — All Products: $9,259
  • Aetna — High Performance: $8,333
  • Aetna — Medicare Advantage: $4,469.36
  • Affinity — Medicare Advantage: $4,469.36
  • Amerigroup — Medicare Advantage: $4,558.74
  • Amida Care — Medicare Advantage: $4,916.29
  • ArchCare — Medicare Advantage: $4,692.82
  • Beacon Health — Managed Medicaid: $617.39
  • Beacon Health — Medicare Advantage/ Health Exchange: $617.39
  • Centerlight Healthcare — Medicare Advantage: $4,469.36
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prp i/hern init reduc >5 yr Not listed in the file Not listed in the file $1,889 – $9,259
Groin (inguinal) hernia repair, age 5 or older: rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $2,631.49
  • Amida Care — Managed Medicaid: $2,631.49
  • Emblem — Managed Medicaid - HIP & GHI: $2,631.49
  • Empire — HealthPlus ALIESSA: $2,693.58
  • UHC — Essential Plans: $2,947.27
  • UHC — Managed Medicaid: $2,947.27
  • VNS — Managed Medicaid: $2,631.49
  • Wellcare — Managed Medicaid: $2,692.01
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: PRP I/HERN INIT REDUC >5 YR Not listed in the file Not listed in the file $1,035
Groin (inguinal) hernia repair, age 5 or older: rates for 1 insurance plan
  • Local 1199 — Local 1199: $1,035
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF PROSTATE Not listed in the file Not listed in the file $2,375.64 – $6,193
Prostate biopsy: 10 of 13 insurance plan rates
  • Aetna — All Products: $5,296
  • Aetna — High Performance: $4,767
  • Emblem — GHI PPO EPO HMO: $298.44
  • Emblem — HIP PPO EPO HMO: $298.44
  • Empire — EPO PPO: $5,619
  • Empire — HealthPlus Medicaid: $131.02
  • Empire — HMO: $5,136
  • Empire — Indemnity: $6,193
  • Fidelis — Managed Medicaid: $2,574.19
  • Healthfirst — Medicare Advantage: $142.67
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Biopsy of prostate Not listed in the file Not listed in the file $2,375.64 – $6,193
Prostate biopsy: rates for 9 insurance plans
  • Amerigroup — Managed Medicaid: $2,514.85
  • Amida Care — Managed Medicaid: $2,514.85
  • Emblem — Managed Medicaid - HIP & GHI: $2,514.85
  • Empire — HealthPlus ALIESSA: $2,574.18
  • Healthfirst — Managed Medicaid: $2,514.85
  • UHC — Essential Plans: $2,816.63
  • UHC — Managed Medicaid: $2,816.63
  • VNS — Managed Medicaid: $2,514.85
  • Wellcare — Managed Medicaid: $2,572.69
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD Not listed in the file Not listed in the file $2,196 – $47,998
Prostate removal by laparoscope (radical prostatectomy): 10 of 36 insurance plan rates
  • Aetna — All Products: $9,874
  • Aetna — High Performance: $8,887
  • Aetna — Medicare Advantage: $13,269.05
  • Affinity — Medicare Advantage: $13,269.05
  • Amerigroup — Medicare Advantage: $13,534.43
  • Amida Care — Medicare Advantage: $14,595.96
  • ArchCare — Medicare Advantage: $13,932.50
  • Beacon Health — Managed Medicaid: $1,258.03
  • Beacon Health — Medicare Advantage/ Health Exchange: $1,258.03
  • Centerlight Healthcare — Medicare Advantage: $13,269.05
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laps surg prst8ect rpbic rad Not listed in the file Not listed in the file $2,196 – $47,998
Prostate removal by laparoscope (radical prostatectomy): rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $3,401.81
  • Amida Care — Managed Medicaid: $3,401.81
  • Emblem — Managed Medicaid - HIP & GHI: $3,401.81
  • Empire — HealthPlus ALIESSA: $3,482.07
  • UHC — Essential Plans: $3,810.03
  • UHC — Managed Medicaid: $3,810.03
  • VNS — Managed Medicaid: $3,401.81
  • Wellcare — Managed Medicaid: $3,480.05
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY BIOPSY Not listed in the file Not listed in the file $1,763.86 – $6,928
Hysteroscopy with biopsy of the uterus lining: 10 of 36 insurance plan rates
  • Aetna — All Products: $6,928
  • Aetna — High Performance: $6,235
  • Aetna — Medicare Advantage: $4,040.85
  • Affinity — Medicare Advantage: $4,040.85
  • Amerigroup — Medicare Advantage: $4,121.67
  • Amida Care — Medicare Advantage: $4,444.94
  • ArchCare — Medicare Advantage: $4,242.89
  • Beacon Health — Managed Medicaid: $242.12
  • Beacon Health — Medicare Advantage/ Health Exchange: $242.12
  • Centerlight Healthcare — Medicare Advantage: $4,040.85
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy biopsy Not listed in the file Not listed in the file $1,763.86 – $6,928
Hysteroscopy with biopsy of the uterus lining: rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $1,763.86
  • Amida Care — Managed Medicaid: $1,763.86
  • Emblem — Managed Medicaid - HIP & GHI: $1,763.86
  • Empire — HealthPlus ALIESSA: $1,805.48
  • UHC — Essential Plans: $1,975.52
  • UHC — Managed Medicaid: $1,975.52
  • VNS — Managed Medicaid: $1,763.86
  • Wellcare — Managed Medicaid: $1,804.43
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX INTERLAMINAR LMBR/SAC Not listed in the file Not listed in the file $699.91 – $4,170
Spinal injection, lower back (epidural), with imaging guidance: 10 of 35 insurance plan rates
  • Aetna — All Products: $3,859
  • Aetna — High Performance: $3,473
  • Aetna — Medicare Advantage: $881.14
  • Affinity — Medicare Advantage: $881.14
  • Amerigroup — Medicare Advantage: $898.76
  • Amida Care — Medicare Advantage: $969.25
  • ArchCare — Medicare Advantage: $925.20
  • Beacon Health — Managed Medicaid: $102.48
  • Beacon Health — Medicare Advantage/ Health Exchange: $102.48
  • Centerlight Healthcare — Medicare Advantage: $881.14
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx interlaminar lmbr/sac Not listed in the file Not listed in the file $699.91 – $4,170
Spinal injection, lower back (epidural), with imaging guidance: rates for 9 insurance plans
  • Amerigroup — Managed Medicaid: $699.91
  • Amida Care — Managed Medicaid: $699.91
  • Emblem — Managed Medicaid - HIP & GHI: $699.91
  • Empire — HealthPlus ALIESSA: $716.42
  • Fidelis — Managed Medicaid: $699.91
  • UHC — Essential Plans: $783.90
  • UHC — Managed Medicaid: $783.90
  • VNS — Managed Medicaid: $699.91
  • Wellcare — Managed Medicaid: $716.01
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX AA&/STRD TFRM EPI L/S 1 $4,464 Not listed in the file $699.91 – $6,528
Nerve root injection, lower back, with imaging guidance: 10 of 45 insurance plan rates
  • Aetna — All Products: $3,859
  • Aetna — High Performance: $3,059
  • Aetna — Medicare Advantage: $1,104.07
  • Affinity — Medicare Advantage: $1,104.07
  • Amerigroup — Managed Medicaid: $699.91
  • Amerigroup — Medicare Advantage: $1,126.15
  • Amida Care — Managed Medicaid: $699.91
  • Amida Care — Medicare Advantage: $1,214.48
  • ArchCare — Medicare Advantage: $1,159.28
  • Beacon Health — Managed Medicaid: $114.42
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: NJX AA&/STRD TFRM EPI L/S 1 Not listed in the file Not listed in the file $165
Nerve root injection, lower back, with imaging guidance: rates for 1 insurance plan
  • Local 1199 — Local 1199: $165
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CARPAL TUNNEL SURGERY Not listed in the file Not listed in the file $1,675.93 – $6,193
Carpal tunnel release: 10 of 36 insurance plan rates
  • Aetna — All Products: $5,296
  • Aetna — High Performance: $4,767
  • Aetna — Medicare Advantage: $2,437.56
  • Affinity — Medicare Advantage: $2,437.56
  • Amerigroup — Medicare Advantage: $2,486.31
  • Amida Care — Medicare Advantage: $2,681.31
  • ArchCare — Medicare Advantage: $2,559.43
  • Beacon Health — Managed Medicaid: $505.01
  • Beacon Health — Medicare Advantage/ Health Exchange: $505.01
  • Centerlight Healthcare — Medicare Advantage: $2,437.56
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Carpal tunnel surgery Not listed in the file Not listed in the file $1,675.93 – $6,193
Carpal tunnel release: rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $1,675.93
  • Amida Care — Managed Medicaid: $1,675.93
  • Emblem — Managed Medicaid - HIP & GHI: $1,675.93
  • Empire — HealthPlus ALIESSA: $1,715.47
  • UHC — Essential Plans: $1,877.04
  • UHC — Managed Medicaid: $1,877.04
  • VNS — Managed Medicaid: $1,675.93
  • Wellcare — Managed Medicaid: $1,714.48
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: CARPAL TUNNEL SURGERY Not listed in the file Not listed in the file $690
Carpal tunnel release: rates for 1 insurance plan
  • Local 1199 — Local 1199: $690
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: YAG CAPSULOTOMY $3,872 Not listed in the file $1,936 – $2,137.34
Laser treatment of clouding after cataract surgery: 10 of 43 insurance plan rates
  • Aetna — All Products: $2,137.34
  • Aetna — High Performance: $3,059
  • Aetna — Medicare Advantage: $686.55
  • Affinity — Medicare Advantage: $686.55
  • Amerigroup — Managed Medicaid: $2,034.47
  • Amerigroup — Medicare Advantage: $700.28
  • Amida Care — Managed Medicaid: $2,034.47
  • Amida Care — Medicare Advantage: $755.21
  • ArchCare — Medicare Advantage: $720.88
  • Beacon Health — Managed Medicaid: $318.92
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: AFTER CATARACT LASER SURGERY Not listed in the file Not listed in the file $376.50
Laser treatment of clouding after cataract surgery: rates for 1 insurance plan
  • Local 1199 — Local 1199: $376.50
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XCAPSL CTRC RMVL W/O ECP Not listed in the file Not listed in the file $1,782 – $9,874
Cataract removal with lens implant: 10 of 36 insurance plan rates
  • Aetna — All Products: $9,874
  • Aetna — High Performance: $8,887
  • Aetna — Medicare Advantage: $2,880.82
  • Affinity — Medicare Advantage: $2,880.82
  • Amerigroup — Medicare Advantage: $2,938.44
  • Amida Care — Medicare Advantage: $3,168.90
  • ArchCare — Medicare Advantage: $3,024.86
  • Beacon Health — Managed Medicaid: $532.15
  • Beacon Health — Medicare Advantage/ Health Exchange: $532.15
  • Centerlight Healthcare — Medicare Advantage: $2,880.82
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xcapsl ctrc rmvl w/o ecp Not listed in the file Not listed in the file $1,782 – $9,874
Cataract removal with lens implant: rates for 8 insurance plans
  • Amerigroup — Managed Medicaid: $2,573.88
  • Amida Care — Managed Medicaid: $2,573.88
  • Emblem — Managed Medicaid - HIP & GHI: $2,573.88
  • Empire — HealthPlus ALIESSA: $2,634.61
  • UHC — Essential Plans: $2,882.75
  • UHC — Managed Medicaid: $2,882.75
  • VNS — Managed Medicaid: $2,573.88
  • Wellcare — Managed Medicaid: $2,633.08
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: XCAPSL CTRC RMVL W/O ECP Not listed in the file Not listed in the file $1,149
Cataract removal with lens implant: rates for 1 insurance plan
  • Local 1199 — Local 1199: $1,149

Pregnancy and childbirth

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRICAL CARE Not listed in the file Not listed in the file $2,442.33 – $5,937.54
Vaginal delivery, with care before and after: 10 of 11 insurance plan rates
  • Beacon Health — Managed Medicaid: $2,713.70
  • Beacon Health — Medicare Advantage/ Health Exchange: $2,713.70
  • Emblem — GHI PPO EPO HMO: $5,937.54
  • Emblem — HIP PPO EPO HMO: $5,937.54
  • Empire — HealthPlus Medicaid: $2,606.72
  • Empire — HMO: $3,634
  • Empire — Indemnity: $3,634
  • Healthfirst — Managed Medicaid: $2,442.33
  • Healthfirst — Medicare Advantage: $2,838.43
  • Local 1199 — Local 1199: $3,000
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetrical care Not listed in the file Not listed in the file $2,524.69 – $2,827.65
Vaginal delivery, with care before and after: rates for 9 insurance plans
  • Amerigroup — Managed Medicaid: $2,524.69
  • Amida Care — Managed Medicaid: $2,524.69
  • Emblem — Managed Medicaid - HIP & GHI: $2,524.69
  • Empire — HealthPlus ALIESSA: $2,584.25
  • Fidelis — Managed Medicaid: $2,524.69
  • UHC — Essential Plans: $2,827.65
  • UHC — Managed Medicaid: $2,827.65
  • VNS — Managed Medicaid: $2,524.69
  • Wellcare — Managed Medicaid: $2,582.76
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 22 In the file: OBSTETRICAL CARE Not listed in the file Not listed in the file $3,000
Vaginal delivery, with care before and after: rates for 1 insurance plan
  • Local 1199 — Local 1199: $3,000
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CESAREAN DELIVERY Not listed in the file Not listed in the file $2,753.51 – $6,649.04
Cesarean delivery (C-section), with care before and after: rates for 10 insurance plans
  • Beacon Health — Managed Medicaid: $3,059.46
  • Beacon Health — Medicare Advantage/ Health Exchange: $3,059.46
  • Emblem — GHI PPO EPO HMO: $6,649.04
  • Emblem — HIP PPO EPO HMO: $6,649.04
  • Empire — HealthPlus Medicaid: $2,919.09
  • Empire — HMO: $3,634
  • Empire — Indemnity: $3,634
  • Healthfirst — Managed Medicaid: $2,753.51
  • Healthfirst — Medicare Advantage: $3,178.56
  • Local 1199 — Local 1199: $3,000
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 22 In the file: CESAREAN DELIVERY Not listed in the file Not listed in the file $3,000
Cesarean delivery (C-section), with care before and after: rates for 1 insurance plan
  • Local 1199 — Local 1199: $3,000
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VBAC DELIVERY Not listed in the file Not listed in the file $2,524.69 – $6,276.76
Vaginal delivery after a previous C-section, with care before and after: 10 of 11 insurance plan rates
  • Beacon Health — Managed Medicaid: $2,887.16
  • Beacon Health — Medicare Advantage/ Health Exchange: $2,887.16
  • Emblem — GHI PPO EPO HMO: $6,276.76
  • Emblem — HIP PPO EPO HMO: $6,276.76
  • Empire — HealthPlus Medicaid: $2,755.65
  • Empire — HMO: $3,634
  • Empire — Indemnity: $3,634
  • Healthfirst — Managed Medicaid: $2,598.44
  • Healthfirst — Medicare Advantage: $3,000.60
  • Local 1199 — Local 1199: $3,000
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Vbac delivery Not listed in the file Not listed in the file $2,524.69 – $2,827.65
Vaginal delivery after a previous C-section, with care before and after: rates for 9 insurance plans
  • Amerigroup — Managed Medicaid: $2,524.69
  • Amida Care — Managed Medicaid: $2,524.69
  • Emblem — Managed Medicaid - HIP & GHI: $2,524.69
  • Empire — HealthPlus ALIESSA: $2,584.25
  • Fidelis — Managed Medicaid: $2,524.69
  • UHC — Essential Plans: $2,827.65
  • UHC — Managed Medicaid: $2,827.65
  • VNS — Managed Medicaid: $2,524.69
  • Wellcare — Managed Medicaid: $2,582.76

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 $88,426.73 – $271,844.45
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 27 insurance plan rates
  • Aetna — All Products: $234,366.54
  • Aetna — High Performance: $210,926.95
  • Aetna — Medicare Advantage: $119,814.99
  • Affinity — Medicare Advantage: $119,814.99
  • Amerigroup — Medicare Advantage: $122,211.29
  • Amida Care — Medicare Advantage: $131,796.49
  • ArchCare — Medicare Advantage: $125,805.74
  • Centerlight Healthcare — Medicare Advantage: $119,814.99
  • Cigna — All Products: $159,488.99
  • Elderplan — Medicare Advantage: $119,814.99
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC Not listed in the file Not listed in the file $17,435.33 – $53,600.27
Hip or knee replacement (major joint of the leg), without major complications: 10 of 19 insurance plan rates
  • Aetna — Medicare Advantage: $24,362.65
  • Affinity — Medicare Advantage: $24,362.65
  • Amerigroup — Medicare Advantage: $24,849.90
  • Amida Care — Medicare Advantage: $26,798.92
  • ArchCare — Medicare Advantage: $25,580.78
  • Centerlight Healthcare — Medicare Advantage: $24,362.65
  • Elderplan — Medicare Advantage: $24,362.65
  • Emblem — Medicare Advantage - HIP & GHI: $24,362.65
  • Empire — Medicare Advantage: $24,362.65
  • Fidelis — Medicare Advantage: $24,362.65
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Major joint replacement or reattachment of lower extremity w/o MCC Not listed in the file Not listed in the file $17,435.33 – $53,600.27
Hip or knee replacement (major joint of the leg), without major complications: rates for 8 insurance plans
  • Aetna — All Products: $46,210.66
  • Aetna — High Performance: $41,589.01
  • Cigna — All Products: $31,446.86
  • Emblem — GHI PPO EPO HMO: $53,600.27
  • Emblem — HIP PPO EPO HMO: $47,767.28
  • Local 1199 — Local 1199: $31,346.55
  • UHC — All Products: $40,695.93
  • UHC — Oxford: $17,435.33
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC Not listed in the file Not listed in the file $22,066.91 – $67,838.84
Neck (cervical) spinal fusion, without complications: 10 of 27 insurance plan rates
  • Aetna — All Products: $58,486.22
  • Aetna — High Performance: $52,636.87
  • Aetna — Medicare Advantage: $30,590.11
  • Affinity — Medicare Advantage: $30,590.11
  • Amerigroup — Medicare Advantage: $31,201.91
  • Amida Care — Medicare Advantage: $33,649.12
  • ArchCare — Medicare Advantage: $32,119.62
  • Centerlight Healthcare — Medicare Advantage: $30,590.11
  • Cigna — All Products: $39,800.51
  • Elderplan — Medicare Advantage: $30,590.11
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC Not listed in the file Not listed in the file $11,214.69 – $34,476.57
Uterus and ovary surgery (not for cancer), without complications: 10 of 27 insurance plan rates
  • Aetna — All Products: $29,723.45
  • Aetna — High Performance: $26,750.73
  • Aetna — Medicare Advantage: $15,998.62
  • Affinity — Medicare Advantage: $15,998.62
  • Amerigroup — Medicare Advantage: $16,318.59
  • Amida Care — Medicare Advantage: $17,598.48
  • ArchCare — Medicare Advantage: $16,798.55
  • Centerlight Healthcare — Medicare Advantage: $15,998.62
  • Cigna — All Products: $20,227.13
  • Elderplan — Medicare Advantage: $15,998.62

Source: Richmond University Medical Center’s standard charges file (rumcsi.pt.panaceainc.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on August 6, 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
Address355 Bard Avenue, Staten Island, NY 10310
CountyRichmond County
StateNew York
Phone(718) 354‑5047
Emergency servicesYes
OwnershipVoluntary non-profit - Private
Medicare overall rating1 of 5 stars
Birthing-friendly designationYes (meets CMS criteria)
CMS Certification Number330028
Name in Medicare recordsRICHMOND UNIVERSITY MEDICAL CENTER
Profile levelMedicare data + hospital website
Main phone on the hospital’s website(718) 818‑1234[4]
Official websiterumcsi.org
CorrectionsReport an error or suggest an update →

Sources

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

From the hospital’s website

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

  1. Richmond University Medical Center: Main Hospital — rumcsi.org
  2. Services — rumcsi.org
  3. Awards and Recognitions — rumcsi.org
  4. Visitation Policy — rumcsi.org
  5. Emergency Services - Richmond University Medical Center — rumcsi.org
  6. New Emergency Department – Richmond University Medical Center — rumcsi.org
  7. Behavioral Health – Psychiatric Emergency Services - Richmond University Medical Center — rumcsi.org
  8. Surgery Procedures on Staten Island, NY – Richmond University Medical Center — rumcsi.org
  9. Trauma - Richmond University Medical Center — rumcsi.org
  10. Neurosurgery Services in Staten Island, NY — rumcsi.org
  11. Traumatic Brain Injury Care on Staten Island, NY – Richmond University Medical Center — rumcsi.org
  12. Orthopedic Surgery and Care Near You in Staten Island, NY — rumcsi.org
  13. VIP Program for US Military – Richmond University Medical Center — rumcsi.org
  14. Pediatric Oncology Services in Staten Island, NY — rumcsi.org
  15. Cancer Rehabilitation Services - Richmond University Medical Center — rumcsi.org
  16. Cardiopulmonary Rehabilitation - Richmond University Medical Center — rumcsi.org
  17. Neurological Rehabilitation Services in Staten Island, NY — rumcsi.org
  18. Pediatric Surgery on Staten Island, NY – Richmond University Medical Center — rumcsi.org