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Acute Care Hospital

Southern Ocean Medical Center

Manahawkin, New Jersey · Ocean County · Emergency services listed

Summary

Southern Ocean Medical Center is an acute care hospital in Manahawkin, New Jersey. Medicare data lists emergency services. CMS overall star rating: 4 of 5 stars. Its official website lists 66 services, specialties and programs. Medicare lists 640 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(609) 597‑6011 Directions Website Medicare profile
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Profile from official sources

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

In a medical emergency, call 911.

At a glance

YesEmergency services
4 of 5 stars4 of 5 stars · Medicare rating
YesBirthing-friendly (CMS)
640Doctors and clinicians
66Services listed

Quick answers

Does Southern Ocean Medical Center have an emergency room?
Yes. Medicare (CMS) data lists emergency services at Southern Ocean Medical Center. In a medical emergency, call 911.
Where is Southern Ocean Medical Center?
1140 RT 72 W, Manahawkin, NJ 08050, in Ocean County, New Jersey.
What is the phone number of Southern Ocean Medical Center?
(609) 597-6011, as listed by Medicare (CMS).
What is the Medicare star rating of Southern Ocean Medical Center?
4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas[4][6]

Conditions treated[7]

Treatments[4]

Procedures[4][5][6]

Programs and centers[4]

  • Center for Weight Loss
  • Cancer Center
  • Chest pain center
  • Cancer clinical trials
  • Diabetes Program
  • Wound Care Program
  • Rehabilitation services

Emergency care (hospital website)[4][7]

Emergency roomYes
Open 24/7Yes
Stroke designationPrimary Stroke Center (Joint Commission and NJDOHSS)

Visiting and practical information

ParkingFree parking for patients and visitors[4]

Recognition[4][7]

  • U.S. News & World Report high performing in leukemia, lymphoma and myeloma (2026-2027)
  • High performing in Leukemia, lymphoma & myeloma (U.S. News & World Report) 2026
  • Primary Stroke Center (Joint Commission and NJDOHSS)

Doctors and clinicians (640)

640 doctors and other clinicians list Southern Ocean 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 (640)

And 616 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

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 Southern Ocean 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) 3 of 5 stars
Overall rating of the hospital3 of 5 stars
Would recommend the hospital3 of 5 stars
Nurses communicated well3 of 5 stars
Doctors communicated well2 of 5 stars
Staff explained medicines2 of 5 stars
Information about recovery at home3 of 5 stars
Room and bathroom kept clean3 of 5 stars
Quiet at night2 of 5 stars
Rated the hospital 9 or 10 out of 1064%National average: 72%
Would definitely recommend the hospital63%National average: 71%
Nurses “always” communicated well78%National average: 80%
Doctors “always” communicated well73%National average: 80%
Staff “always” explained medicines before giving them60%National average: 62%
Were given information about recovery at home83%National average: 86%
Room and bathroom “always” clean70%National average: 74%
Area around the room “always” quiet at night41%National average: 60%
Completed surveys1,438Response rate: 24%

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)0.922No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)0.395No different from the national benchmark
Surgical site infections after colon surgery0.347No different from the national benchmark
Surgical site infections after abdominal hysterectomyNot reported to Medicare
MRSA bloodstream infections1.164No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections0.177Better 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 patients10.1%
Deaths within 30 days: heart failure patients10.4%
Deaths within 30 days: pneumonia patients14.5%
Deaths within 30 days: COPD patients7.9%
Deaths within 30 days: stroke patients10.3%
Deaths within 30 days: coronary bypass surgery (CABG)Not reported to Medicare
Serious complications (patient safety indicator PSI-90)0.92No different from the national rate
Complications after hip or knee replacementToo few cases to report

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)Not reported to Medicare
Readmitted within 30 days: heart attack14.6%
Readmitted within 30 days: heart failure22%
Readmitted within 30 days: pneumonia18.2%
Readmitted within 30 days: COPD21.7%
Readmitted within 30 days: coronary bypass surgeryNot reported to Medicare
Readmitted within 30 days: hip or knee replacementToo few cases to report

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)163 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)71%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 New JerseyBest hospitals in New Jersey

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 87 common services exactly as Southern Ocean 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 →

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: NMDP OFFICE OUTPATIENT NEW 30 MINUTES $1,870 Not listed in the file $336.60 – $1,839.33
New patient office visit (about 30–44 minutes): 10 of 30 insurance plan rates
  • AETNA — ASA: $1,464.21
  • AETNA — HMO: $1,683.37
  • AETNA — MANAGED MEDICAID: $121.57
  • AETNA — MEDICARE ADVANTAGE: $390.83
  • AETNA — PPO: $1,683.37
  • AMERIHEALTH — LOCAL HMO: $1,623.91
  • AMERIHEALTH — REGIONAL HMO: $1,839.33
  • BERGEN RISK — ALL PRODUCTS: $1,402.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $1,683
  • CIGNA — BH: $1,496
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES $523 Not listed in the file $64.24 – $134.29
New patient office visit (about 30–44 minutes): 10 of 29 insurance plan rates
  • AETNA — ASA: $409.51
  • AETNA — HMO: $470.80
  • AETNA — MANAGED MEDICAID: $121.57
  • AETNA — MEDICARE ADVANTAGE: $109.31
  • AETNA — PPO: $470.80
  • AMERIHEALTH — LOCAL HMO: $454.17
  • AMERIHEALTH — REGIONAL HMO: $514.42
  • BERGEN RISK — ALL PRODUCTS: $392.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $470.70
  • CIGNA — BH: $418.40
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier HF In the file: OFFICE O/P NEW LOW 30 MIN Not listed in the file Not listed in the file $130.01
New patient office visit (about 30–44 minutes): rates for 1 insurance plan
  • HORIZON — BH: $130.01
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NMDP OFFICE OUTPATIENT NEW 45 MINUTES $2,057 Not listed in the file $370.26 – $2,023.27
New patient office visit (about 45–59 minutes): 10 of 30 insurance plan rates
  • AETNA — ASA: $1,610.63
  • AETNA — HMO: $1,851.71
  • AETNA — MANAGED MEDICAID: $380.55
  • AETNA — MEDICARE ADVANTAGE: $429.91
  • AETNA — PPO: $1,851.71
  • AMERIHEALTH — LOCAL HMO: $1,786.30
  • AMERIHEALTH — REGIONAL HMO: $2,023.27
  • BERGEN RISK — ALL PRODUCTS: $1,542.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $1,851.30
  • CIGNA — BH: $1,645.60
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES $605 Not listed in the file $108.90 – $595.08
New patient office visit (about 45–59 minutes): 10 of 29 insurance plan rates
  • AETNA — ASA: $473.72
  • AETNA — HMO: $544.62
  • AETNA — MANAGED MEDICAID: $111.93
  • AETNA — MEDICARE ADVANTAGE: $126.45
  • AETNA — PPO: $544.62
  • AMERIHEALTH — LOCAL HMO: $525.38
  • AMERIHEALTH — REGIONAL HMO: $595.08
  • BERGEN RISK — ALL PRODUCTS: $453.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $544.50
  • CIGNA — BH: $484
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier HF In the file: OFFICE O/P NEW MOD 45 MIN Not listed in the file Not listed in the file $197.44
New patient office visit (about 45–59 minutes): rates for 1 insurance plan
  • HORIZON — BH: $197.44
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES $770 Not listed in the file $111 – $297.38
New patient office visit (about 60–74 minutes): 10 of 29 insurance plan rates
  • AETNA — ASA: $602.91
  • AETNA — HMO: $693.15
  • AETNA — MANAGED MEDICAID: $232.21
  • AETNA — MEDICARE ADVANTAGE: $160.93
  • AETNA — PPO: $693.15
  • AMERIHEALTH — LOCAL HMO: $668.67
  • AMERIHEALTH — REGIONAL HMO: $757.37
  • BERGEN RISK — ALL PRODUCTS: $577.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $693
  • CIGNA — BH: $616
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier HF In the file: OFFICE O/P NEW HI 60 MIN Not listed in the file Not listed in the file $249.05
New patient office visit (about 60–74 minutes): rates for 1 insurance plan
  • HORIZON — BH: $249.05
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier UC In the file: OFFICE O/P NEW HI 60 MIN Not listed in the file Not listed in the file $126.02
New patient office visit (about 60–74 minutes): rates for 1 insurance plan
  • HORIZON — BH: $126.02
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN $374 Not listed in the file $67.32 – $367.87
Established patient office visit (about 20–29 minutes): 10 of 29 insurance plan rates
  • AETNA — ASA: $292.84
  • AETNA — HMO: $336.67
  • AETNA — MANAGED MEDICAID: $84.85
  • AETNA — MEDICARE ADVANTAGE: $78.17
  • AETNA — PPO: $336.67
  • AMERIHEALTH — LOCAL HMO: $324.78
  • AMERIHEALTH — REGIONAL HMO: $367.87
  • BERGEN RISK — ALL PRODUCTS: $280.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $336.60
  • CIGNA — BH: $299.20
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier HF In the file: OFFICE O/P EST LOW 20 MIN Not listed in the file Not listed in the file $90.69
Established patient office visit (about 20–29 minutes): rates for 1 insurance plan
  • HORIZON — BH: $90.69
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier SA In the file: OFFICE O/P EST LOW 20 MIN Not listed in the file Not listed in the file $90.69
Established patient office visit (about 20–29 minutes): rates for 1 insurance plan
  • HORIZON — BH: $90.69
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN $495 Not listed in the file $89.10 – $486.88
Established patient office visit (about 30–39 minutes): 10 of 29 insurance plan rates
  • AETNA — ASA: $387.59
  • AETNA — HMO: $445.60
  • AETNA — MANAGED MEDICAID: $122.61
  • AETNA — MEDICARE ADVANTAGE: $103.46
  • AETNA — PPO: $445.60
  • AMERIHEALTH — LOCAL HMO: $429.86
  • AMERIHEALTH — REGIONAL HMO: $486.88
  • BERGEN RISK — ALL PRODUCTS: $371.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $445.50
  • CIGNA — BH: $396
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier HF In the file: OFFICE O/P EST MOD 30 MIN Not listed in the file Not listed in the file $131.17
Established patient office visit (about 30–39 minutes): rates for 1 insurance plan
  • HORIZON — BH: $131.17
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier SA In the file: OFFICE O/P EST MOD 30 MIN Not listed in the file Not listed in the file $131.17
Established patient office visit (about 30–39 minutes): rates for 1 insurance plan
  • HORIZON — BH: $131.17
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES $550 Not listed in the file $99 – $540.98
Office consultation with a specialist (moderate): 10 of 29 insurance plan rates
  • AETNA — ASA: $430.65
  • AETNA — HMO: $495.11
  • AETNA — MANAGED MEDICAID: $101.75
  • AETNA — MEDICARE ADVANTAGE: $114.95
  • AETNA — PPO: $495.11
  • AMERIHEALTH — LOCAL HMO: $477.62
  • AMERIHEALTH — REGIONAL HMO: $540.98
  • BERGEN RISK — ALL PRODUCTS: $412.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $495
  • CIGNA — BH: $440
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES $825 Not listed in the file $148.50 – $811.47
Office consultation with a specialist (moderate to high): 10 of 29 insurance plan rates
  • AETNA — ASA: $645.98
  • AETNA — HMO: $742.67
  • AETNA — MANAGED MEDICAID: $152.63
  • AETNA — MEDICARE ADVANTAGE: $172.43
  • AETNA — PPO: $742.67
  • AMERIHEALTH — LOCAL HMO: $716.43
  • AMERIHEALTH — REGIONAL HMO: $811.47
  • BERGEN RISK — ALL PRODUCTS: $618.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $742.50
  • CIGNA — BH: $660
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS $173 Not listed in the file $31.14 – $170.16
Preventive checkup, new patient, age 18–39: 10 of 28 insurance plan rates
  • AETNA — ASA: $135.46
  • AETNA — HMO: $155.73
  • AETNA — MANAGED MEDICAID: $32.01
  • AETNA — MEDICARE ADVANTAGE: $36.16
  • AETNA — PPO: $155.73
  • AMERIHEALTH — LOCAL HMO: $150.23
  • AMERIHEALTH — REGIONAL HMO: $170.16
  • BERGEN RISK — ALL PRODUCTS: $129.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $155.70
  • CIGNA — BH: $138.40
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS $132 Not listed in the file $23.76 – $129.84
Preventive checkup, new patient, age 40–64: 10 of 28 insurance plan rates
  • AETNA — ASA: $103.36
  • AETNA — HMO: $118.83
  • AETNA — MANAGED MEDICAID: $24.42
  • AETNA — MEDICARE ADVANTAGE: $27.59
  • AETNA — PPO: $118.83
  • AMERIHEALTH — LOCAL HMO: $114.63
  • AMERIHEALTH — REGIONAL HMO: $129.84
  • BERGEN RISK — ALL PRODUCTS: $99
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $118.80
  • CIGNA — BH: $105.60
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT LOW MDM (LEVEL 3) $2,090 $302.61 $268 – $3,841
Emergency room visit (moderate): 10 of 37 insurance plan rates
  • AETNA — ASA: $1,636.47
  • AETNA — HMO: $2,881
  • AETNA — MANAGED MEDICAID: $386.65
  • AETNA — MEDICARE ADVANTAGE: $329.84
  • AETNA — PPO: $2,881
  • AMERIGROUP — MANAGED MEDICAID: $140
  • AMERIHEALTH — LOCAL HMO: $1,416
  • AMERIHEALTH — REGIONAL HMO: $1,599
  • BERGEN RISK — ALL PRODUCTS: $1,522
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $3,539
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED VISIT MODERATE SEVERITY MOD 25 (LEVEL 3) $2,090 $302.61 $268 – $3,841
Emergency room visit (moderate): 10 of 37 insurance plan rates
  • AETNA — ASA: $1,636.47
  • AETNA — HMO: $2,881
  • AETNA — MANAGED MEDICAID: $386.65
  • AETNA — MEDICARE ADVANTAGE: $329.84
  • AETNA — PPO: $2,881
  • AMERIGROUP — MANAGED MEDICAID: $140
  • AMERIHEALTH — LOCAL HMO: $1,416
  • AMERIHEALTH — REGIONAL HMO: $1,599
  • BERGEN RISK — ALL PRODUCTS: $1,522
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $3,539
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT MODERATE MDM (LEVEL 4) $3,025 $465.37 $358 – $4,374
Emergency room visit (moderately high): 10 of 37 insurance plan rates
  • AETNA — ASA: $2,368.58
  • AETNA — HMO: $3,174
  • AETNA — MANAGED MEDICAID: $559.63
  • AETNA — MEDICARE ADVANTAGE: $507.25
  • AETNA — PPO: $3,174
  • AMERIGROUP — MANAGED MEDICAID: $140
  • AMERIHEALTH — LOCAL HMO: $1,416
  • AMERIHEALTH — REGIONAL HMO: $1,599
  • BERGEN RISK — ALL PRODUCTS: $1,522
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $3,539
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED VISIT HIGH/URGENT SEVERITY MOD 25 (LEVEL 4) $3,025 $465.37 $544.50 – $2,746.70
Emergency room visit (moderately high): 10 of 37 insurance plan rates
  • AETNA — ASA: $2,368.58
  • AETNA — HMO: $3,174
  • AETNA — MANAGED MEDICAID: $559.63
  • AETNA — MEDICARE ADVANTAGE: $507.25
  • AETNA — PPO: $3,174
  • AMERIGROUP — MANAGED MEDICAID: $140
  • AMERIHEALTH — LOCAL HMO: $1,416
  • AMERIHEALTH — REGIONAL HMO: $1,599
  • BERGEN RISK — ALL PRODUCTS: $1,522
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $3,539
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPARTMENT VISIT HIGH MDM (LEVEL 5) $4,125 $670.04 $742.50 – $3,745.50
Emergency room visit (high): 10 of 37 insurance plan rates
  • AETNA — ASA: $3,229.88
  • AETNA — HMO: $3,478
  • AETNA — MANAGED MEDICAID: $763.13
  • AETNA — MEDICARE ADVANTAGE: $730.35
  • AETNA — PPO: $3,478
  • AMERIGROUP — MANAGED MEDICAID: $140
  • AMERIHEALTH — LOCAL HMO: $1,416
  • AMERIHEALTH — REGIONAL HMO: $1,599
  • BERGEN RISK — ALL PRODUCTS: $1,522
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $3,539
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED VISIT HIGH SEVERITY&THREAT FUNCJ MOD 25 (LEVEL 5) $4,125 $670.04 $742.50 – $3,745.50
Emergency room visit (high): 10 of 37 insurance plan rates
  • AETNA — ASA: $3,229.88
  • AETNA — HMO: $3,478
  • AETNA — MANAGED MEDICAID: $763.13
  • AETNA — MEDICARE ADVANTAGE: $730.35
  • AETNA — PPO: $3,478
  • AMERIGROUP — MANAGED MEDICAID: $140
  • AMERIHEALTH — LOCAL HMO: $1,416
  • AMERIHEALTH — REGIONAL HMO: $1,599
  • BERGEN RISK — ALL PRODUCTS: $1,522
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $3,539

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: I-STAT CHEM 8 PANEL $187 $8.46 $34.60 – $183.93
Basic metabolic panel (blood test): 10 of 36 insurance plan rates
  • AETNA — ASA: $146.42
  • AETNA — HMO: $159.32
  • AETNA — MANAGED MEDICAID: $34.60
  • AETNA — MEDICARE ADVANTAGE: $9.22
  • AETNA — PPO: $159.32
  • AMERIGROUP — MANAGED MEDICAID: $8.46
  • AMERIHEALTH — LOCAL HMO: $162.39
  • AMERIHEALTH — REGIONAL HMO: $183.93
  • BERGEN RISK — ALL PRODUCTS: $140.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $149.60
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL $187 $8.46 $34.60 – $183.93
Basic metabolic panel (blood test): 10 of 36 insurance plan rates
  • AETNA — ASA: $146.42
  • AETNA — HMO: $159.32
  • AETNA — MANAGED MEDICAID: $34.60
  • AETNA — MEDICARE ADVANTAGE: $9.22
  • AETNA — PPO: $159.32
  • AMERIGROUP — MANAGED MEDICAID: $8.46
  • AMERIHEALTH — LOCAL HMO: $162.39
  • AMERIHEALTH — REGIONAL HMO: $183.93
  • BERGEN RISK — ALL PRODUCTS: $140.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $149.60
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL DIABETIC $187 $8.46 $34.60 – $183.93
Basic metabolic panel (blood test): 10 of 36 insurance plan rates
  • AETNA — ASA: $146.42
  • AETNA — HMO: $159.32
  • AETNA — MANAGED MEDICAID: $34.60
  • AETNA — MEDICARE ADVANTAGE: $9.22
  • AETNA — PPO: $159.32
  • AMERIGROUP — MANAGED MEDICAID: $8.46
  • AMERIHEALTH — LOCAL HMO: $162.39
  • AMERIHEALTH — REGIONAL HMO: $183.93
  • BERGEN RISK — ALL PRODUCTS: $140.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $149.60
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC PANEL $341 $10.56 $63.09 – $335.41
Comprehensive metabolic panel (blood test): 10 of 36 insurance plan rates
  • AETNA — ASA: $267
  • AETNA — HMO: $290.53
  • AETNA — MANAGED MEDICAID: $63.09
  • AETNA — MEDICARE ADVANTAGE: $11.51
  • AETNA — PPO: $290.53
  • AMERIGROUP — MANAGED MEDICAID: $10.56
  • AMERIHEALTH — LOCAL HMO: $296.12
  • AMERIHEALTH — REGIONAL HMO: $335.41
  • BERGEN RISK — ALL PRODUCTS: $255.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $272.80
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC PANEL DIABETIC $341 $10.56 $63.09 – $335.41
Comprehensive metabolic panel (blood test): 10 of 36 insurance plan rates
  • AETNA — ASA: $267
  • AETNA — HMO: $290.53
  • AETNA — MANAGED MEDICAID: $63.09
  • AETNA — MEDICARE ADVANTAGE: $11.51
  • AETNA — PPO: $290.53
  • AMERIGROUP — MANAGED MEDICAID: $10.56
  • AMERIHEALTH — LOCAL HMO: $296.12
  • AMERIHEALTH — REGIONAL HMO: $335.41
  • BERGEN RISK — ALL PRODUCTS: $255.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $272.80
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMP METABOLIC CMP $341 $10.56 $63.09 – $335.41
Comprehensive metabolic panel (blood test): 10 of 36 insurance plan rates
  • AETNA — ASA: $267
  • AETNA — HMO: $290.53
  • AETNA — MANAGED MEDICAID: $63.09
  • AETNA — MEDICARE ADVANTAGE: $11.51
  • AETNA — PPO: $290.53
  • AMERIGROUP — MANAGED MEDICAID: $10.56
  • AMERIHEALTH — LOCAL HMO: $296.12
  • AMERIHEALTH — REGIONAL HMO: $335.41
  • BERGEN RISK — ALL PRODUCTS: $255.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $272.80
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL PRENATAL PROFILE $326 $47.81 $60.31 – $320.65
Obstetric blood test panel: 10 of 36 insurance plan rates
  • AETNA — ASA: $255.26
  • AETNA — HMO: $277.75
  • AETNA — MANAGED MEDICAID: $60.31
  • AETNA — MEDICARE ADVANTAGE: $52.11
  • AETNA — PPO: $277.75
  • AMERIGROUP — MANAGED MEDICAID: $47.81
  • AMERIHEALTH — LOCAL HMO: $283.10
  • AMERIHEALTH — REGIONAL HMO: $320.65
  • BERGEN RISK — ALL PRODUCTS: $244.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $260.80
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL. $255 $13.39 $13.39 – $16.07
Cholesterol panel (lipid panel): 10 of 36 insurance plan rates
  • AETNA — ASA: $199.67
  • AETNA — HMO: $217.26
  • AETNA — MANAGED MEDICAID: $47.18
  • AETNA — MEDICARE ADVANTAGE: $14.60
  • AETNA — PPO: $217.26
  • AMERIGROUP — MANAGED MEDICAID: $13.39
  • AMERIHEALTH — LOCAL HMO: $221.44
  • AMERIHEALTH — REGIONAL HMO: $250.82
  • BERGEN RISK — ALL PRODUCTS: $191.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $204
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL $260 $13.39 $48.10 – $255.74
Cholesterol panel (lipid panel): 10 of 36 insurance plan rates
  • AETNA — ASA: $203.58
  • AETNA — HMO: $221.52
  • AETNA — MANAGED MEDICAID: $48.10
  • AETNA — MEDICARE ADVANTAGE: $14.60
  • AETNA — PPO: $221.52
  • AMERIGROUP — MANAGED MEDICAID: $13.39
  • AMERIHEALTH — LOCAL HMO: $225.78
  • AMERIHEALTH — REGIONAL HMO: $255.74
  • BERGEN RISK — ALL PRODUCTS: $195
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $208
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL ARUP $255 $13.39 $47.18 – $250.82
Cholesterol panel (lipid panel): 10 of 36 insurance plan rates
  • AETNA — ASA: $199.67
  • AETNA — HMO: $217.26
  • AETNA — MANAGED MEDICAID: $47.18
  • AETNA — MEDICARE ADVANTAGE: $14.60
  • AETNA — PPO: $217.26
  • AMERIGROUP — MANAGED MEDICAID: $13.39
  • AMERIHEALTH — LOCAL HMO: $221.44
  • AMERIHEALTH — REGIONAL HMO: $250.82
  • BERGEN RISK — ALL PRODUCTS: $191.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $204
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUCTION PANEL $197 $8.68 $36.45 – $193.77
Kidney function panel: 10 of 36 insurance plan rates
  • AETNA — ASA: $154.25
  • AETNA — HMO: $167.84
  • AETNA — MANAGED MEDICAID: $36.45
  • AETNA — MEDICARE ADVANTAGE: $9.46
  • AETNA — PPO: $167.84
  • AMERIGROUP — MANAGED MEDICAID: $8.68
  • AMERIHEALTH — LOCAL HMO: $171.07
  • AMERIHEALTH — REGIONAL HMO: $193.77
  • BERGEN RISK — ALL PRODUCTS: $147.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $157.60
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUCTION PANEL DIABETIC $197 $8.68 $36.45 – $193.77
Kidney function panel: 10 of 36 insurance plan rates
  • AETNA — ASA: $154.25
  • AETNA — HMO: $167.84
  • AETNA — MANAGED MEDICAID: $36.45
  • AETNA — MEDICARE ADVANTAGE: $9.46
  • AETNA — PPO: $167.84
  • AMERIGROUP — MANAGED MEDICAID: $8.68
  • AMERIHEALTH — LOCAL HMO: $171.07
  • AMERIHEALTH — REGIONAL HMO: $193.77
  • BERGEN RISK — ALL PRODUCTS: $147.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $157.60
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL QST $197 $8.68 $36.45 – $193.77
Kidney function panel: 10 of 36 insurance plan rates
  • AETNA — ASA: $154.25
  • AETNA — HMO: $167.84
  • AETNA — MANAGED MEDICAID: $36.45
  • AETNA — MEDICARE ADVANTAGE: $9.46
  • AETNA — PPO: $167.84
  • AMERIGROUP — MANAGED MEDICAID: $8.68
  • AMERIHEALTH — LOCAL HMO: $171.07
  • AMERIHEALTH — REGIONAL HMO: $193.77
  • BERGEN RISK — ALL PRODUCTS: $147.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $157.60
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL. $167 $8.17 $30.90 – $164.26
Liver function panel: 10 of 37 insurance plan rates
  • AETNA — ASA: $130.76
  • AETNA — HMO: $142.28
  • AETNA — MANAGED MEDICAID: $30.90
  • AETNA — MEDICARE ADVANTAGE: $8.91
  • AETNA — PPO: $142.28
  • AMERIGROUP — MANAGED MEDICAID: $8.17
  • AMERIHEALTH — LOCAL HMO: $145.02
  • AMERIHEALTH — REGIONAL HMO: $164.26
  • BERGEN RISK — ALL PRODUCTS: $125.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $133.60
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL QST $167 $8.17 $8.17 – $9.80
Liver function panel: 10 of 37 insurance plan rates
  • AETNA — ASA: $130.76
  • AETNA — HMO: $142.28
  • AETNA — MANAGED MEDICAID: $30.90
  • AETNA — MEDICARE ADVANTAGE: $8.91
  • AETNA — PPO: $142.28
  • AMERIGROUP — MANAGED MEDICAID: $8.17
  • AMERIHEALTH — LOCAL HMO: $145.02
  • AMERIHEALTH — REGIONAL HMO: $164.26
  • BERGEN RISK — ALL PRODUCTS: $125.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $133.60
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL $167 $8.17 $30.90 – $164.26
Liver function panel: 10 of 37 insurance plan rates
  • AETNA — ASA: $130.76
  • AETNA — HMO: $142.28
  • AETNA — MANAGED MEDICAID: $30.90
  • AETNA — MEDICARE ADVANTAGE: $8.91
  • AETNA — PPO: $142.28
  • AMERIGROUP — MANAGED MEDICAID: $8.17
  • AMERIHEALTH — LOCAL HMO: $145.02
  • AMERIHEALTH — REGIONAL HMO: $164.26
  • BERGEN RISK — ALL PRODUCTS: $125.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $133.60
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W MICRO $107 $3.17 $3.17 – $3.80
Urine test (automated, with microscope): 10 of 36 insurance plan rates
  • AETNA — ASA: $83.78
  • AETNA — HMO: $91.16
  • AETNA — MANAGED MEDICAID: $19.80
  • AETNA — MEDICARE ADVANTAGE: $3.46
  • AETNA — PPO: $91.16
  • AMERIGROUP — MANAGED MEDICAID: $3.17
  • AMERIHEALTH — LOCAL HMO: $92.92
  • AMERIHEALTH — REGIONAL HMO: $105.25
  • BERGEN RISK — ALL PRODUCTS: $80.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $85.60
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS COMPLETE QST $107 $3.17 $3.17 – $3.80
Urine test (automated, with microscope): 10 of 36 insurance plan rates
  • AETNA — ASA: $83.78
  • AETNA — HMO: $91.16
  • AETNA — MANAGED MEDICAID: $19.80
  • AETNA — MEDICARE ADVANTAGE: $3.46
  • AETNA — PPO: $91.16
  • AMERIGROUP — MANAGED MEDICAID: $3.17
  • AMERIHEALTH — LOCAL HMO: $92.92
  • AMERIHEALTH — REGIONAL HMO: $105.25
  • BERGEN RISK — ALL PRODUCTS: $80.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $85.60
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS COMPLETE W/REFLEX TO CULTURE QST $107 $3.17 $3.17 – $3.80
Urine test (automated, with microscope): 10 of 36 insurance plan rates
  • AETNA — ASA: $83.78
  • AETNA — HMO: $91.16
  • AETNA — MANAGED MEDICAID: $19.80
  • AETNA — MEDICARE ADVANTAGE: $3.46
  • AETNA — PPO: $91.16
  • AMERIGROUP — MANAGED MEDICAID: $3.17
  • AMERIHEALTH — LOCAL HMO: $92.92
  • AMERIHEALTH — REGIONAL HMO: $105.25
  • BERGEN RISK — ALL PRODUCTS: $80.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $85.60
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP $45 $3.48 $8.33 – $44.26
Urine test (manual, without microscope): 10 of 36 insurance plan rates
  • AETNA — ASA: $35.24
  • AETNA — HMO: $38.34
  • AETNA — MANAGED MEDICAID: $8.33
  • AETNA — MEDICARE ADVANTAGE: $3.79
  • AETNA — PPO: $38.34
  • AMERIGROUP — MANAGED MEDICAID: $3.48
  • AMERIHEALTH — LOCAL HMO: $39.08
  • AMERIHEALTH — REGIONAL HMO: $44.26
  • BERGEN RISK — ALL PRODUCTS: $33.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $36
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS SING COMP $80 $2.25 $14.80 – $78.69
Urine test (automated, without microscope): 10 of 36 insurance plan rates
  • AETNA — ASA: $62.64
  • AETNA — HMO: $68.16
  • AETNA — MANAGED MEDICAID: $14.80
  • AETNA — MEDICARE ADVANTAGE: $2.45
  • AETNA — PPO: $68.16
  • AMERIGROUP — MANAGED MEDICAID: $2.25
  • AMERIHEALTH — LOCAL HMO: $69.47
  • AMERIHEALTH — REGIONAL HMO: $78.69
  • BERGEN RISK — ALL PRODUCTS: $60
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $64
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO WO MICRO $80 $2.25 $14.80 – $78.69
Urine test (automated, without microscope): 10 of 36 insurance plan rates
  • AETNA — ASA: $62.64
  • AETNA — HMO: $68.16
  • AETNA — MANAGED MEDICAID: $14.80
  • AETNA — MEDICARE ADVANTAGE: $2.45
  • AETNA — PPO: $68.16
  • AMERIGROUP — MANAGED MEDICAID: $2.25
  • AMERIHEALTH — LOCAL HMO: $69.47
  • AMERIHEALTH — REGIONAL HMO: $78.69
  • BERGEN RISK — ALL PRODUCTS: $60
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $64
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINE PH $80 $2.25 $14.80 – $78.69
Urine test (automated, without microscope): 10 of 36 insurance plan rates
  • AETNA — ASA: $62.64
  • AETNA — HMO: $68.16
  • AETNA — MANAGED MEDICAID: $14.80
  • AETNA — MEDICARE ADVANTAGE: $2.45
  • AETNA — PPO: $68.16
  • AMERIGROUP — MANAGED MEDICAID: $2.25
  • AMERIHEALTH — LOCAL HMO: $69.47
  • AMERIHEALTH — REGIONAL HMO: $78.69
  • BERGEN RISK — ALL PRODUCTS: $60
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $64
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA TOTAL $328 $18.39 $60.68 – $322.62
PSA (prostate specific antigen) blood test: 10 of 36 insurance plan rates
  • AETNA — ASA: $256.82
  • AETNA — HMO: $279.46
  • AETNA — MANAGED MEDICAID: $60.68
  • AETNA — MEDICARE ADVANTAGE: $20.05
  • AETNA — PPO: $279.46
  • AMERIGROUP — MANAGED MEDICAID: $18.39
  • AMERIHEALTH — LOCAL HMO: $284.84
  • AMERIHEALTH — REGIONAL HMO: $322.62
  • BERGEN RISK — ALL PRODUCTS: $246
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $262.40
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA DIAGNOSTIC $328 $18.39 $60.68 – $322.62
PSA (prostate specific antigen) blood test: 10 of 36 insurance plan rates
  • AETNA — ASA: $256.82
  • AETNA — HMO: $279.46
  • AETNA — MANAGED MEDICAID: $60.68
  • AETNA — MEDICARE ADVANTAGE: $20.05
  • AETNA — PPO: $279.46
  • AMERIGROUP — MANAGED MEDICAID: $18.39
  • AMERIHEALTH — LOCAL HMO: $284.84
  • AMERIHEALTH — REGIONAL HMO: $322.62
  • BERGEN RISK — ALL PRODUCTS: $246
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $262.40
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA ULTRASENSITIVE ARUP $328 $18.39 $60.68 – $322.62
PSA (prostate specific antigen) blood test: 10 of 36 insurance plan rates
  • AETNA — ASA: $256.82
  • AETNA — HMO: $279.46
  • AETNA — MANAGED MEDICAID: $60.68
  • AETNA — MEDICARE ADVANTAGE: $20.05
  • AETNA — PPO: $279.46
  • AMERIGROUP — MANAGED MEDICAID: $18.39
  • AMERIHEALTH — LOCAL HMO: $284.84
  • AMERIHEALTH — REGIONAL HMO: $322.62
  • BERGEN RISK — ALL PRODUCTS: $246
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $262.40
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THYROID STIMULATING HORMONE $266 $16.80 $49.21 – $261.64
Thyroid stimulating hormone (TSH) test: 10 of 36 insurance plan rates
  • AETNA — ASA: $208.28
  • AETNA — HMO: $226.63
  • AETNA — MANAGED MEDICAID: $49.21
  • AETNA — MEDICARE ADVANTAGE: $18.31
  • AETNA — PPO: $226.63
  • AMERIGROUP — MANAGED MEDICAID: $16.80
  • AMERIHEALTH — LOCAL HMO: $230.99
  • AMERIHEALTH — REGIONAL HMO: $261.64
  • BERGEN RISK — ALL PRODUCTS: $199.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $212.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH SENSITIVE $72 $16.80 $13.32 – $70.82
Thyroid stimulating hormone (TSH) test: 10 of 36 insurance plan rates
  • AETNA — ASA: $56.38
  • AETNA — HMO: $61.34
  • AETNA — MANAGED MEDICAID: $13.32
  • AETNA — MEDICARE ADVANTAGE: $18.31
  • AETNA — PPO: $61.34
  • AMERIGROUP — MANAGED MEDICAID: $16.80
  • AMERIHEALTH — LOCAL HMO: $62.52
  • AMERIHEALTH — REGIONAL HMO: $70.82
  • BERGEN RISK — ALL PRODUCTS: $54
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $57.60
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH $266 $16.80 $49.21 – $261.64
Thyroid stimulating hormone (TSH) test: 10 of 36 insurance plan rates
  • AETNA — ASA: $208.28
  • AETNA — HMO: $226.63
  • AETNA — MANAGED MEDICAID: $49.21
  • AETNA — MEDICARE ADVANTAGE: $18.31
  • AETNA — PPO: $226.63
  • AMERIGROUP — MANAGED MEDICAID: $16.80
  • AMERIHEALTH — LOCAL HMO: $230.99
  • AMERIHEALTH — REGIONAL HMO: $261.64
  • BERGEN RISK — ALL PRODUCTS: $199.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $212.80
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC AUTO WITH DIFF $149 $7.77 $27.57 – $146.56
Complete blood count (CBC) with differential: 10 of 36 insurance plan rates
  • AETNA — ASA: $116.67
  • AETNA — HMO: $126.95
  • AETNA — MANAGED MEDICAID: $27.57
  • AETNA — MEDICARE ADVANTAGE: $8.47
  • AETNA — PPO: $126.95
  • AMERIGROUP — MANAGED MEDICAID: $7.77
  • AMERIHEALTH — LOCAL HMO: $129.39
  • AMERIHEALTH — REGIONAL HMO: $146.56
  • BERGEN RISK — ALL PRODUCTS: $111.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $119.20
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC WITH DIFF $165 $7.77 $30.53 – $162.29
Complete blood count (CBC) with differential: 10 of 36 insurance plan rates
  • AETNA — ASA: $129.20
  • AETNA — HMO: $140.58
  • AETNA — MANAGED MEDICAID: $30.53
  • AETNA — MEDICARE ADVANTAGE: $8.47
  • AETNA — PPO: $140.58
  • AMERIGROUP — MANAGED MEDICAID: $7.77
  • AMERIHEALTH — LOCAL HMO: $143.29
  • AMERIHEALTH — REGIONAL HMO: $162.29
  • BERGEN RISK — ALL PRODUCTS: $123.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $132
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC INCLUDES DIFF AND PLT QST $149 $7.77 $7.77 – $9.32
Complete blood count (CBC) with differential: 10 of 36 insurance plan rates
  • AETNA — ASA: $116.67
  • AETNA — HMO: $126.95
  • AETNA — MANAGED MEDICAID: $27.57
  • AETNA — MEDICARE ADVANTAGE: $8.47
  • AETNA — PPO: $126.95
  • AMERIGROUP — MANAGED MEDICAID: $7.77
  • AMERIHEALTH — LOCAL HMO: $129.39
  • AMERIHEALTH — REGIONAL HMO: $146.56
  • BERGEN RISK — ALL PRODUCTS: $111.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $119.20
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC AUTO $106 $6.47 $19.61 – $104.26
Complete blood count (CBC), automated: 10 of 36 insurance plan rates
  • AETNA — ASA: $83
  • AETNA — HMO: $90.31
  • AETNA — MANAGED MEDICAID: $19.61
  • AETNA — MEDICARE ADVANTAGE: $7.05
  • AETNA — PPO: $90.31
  • AMERIGROUP — MANAGED MEDICAID: $6.47
  • AMERIHEALTH — LOCAL HMO: $92.05
  • AMERIHEALTH — REGIONAL HMO: $104.26
  • BERGEN RISK — ALL PRODUCTS: $79.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $84.80
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLD CNTHEMOGRAM PLT CT AUTO $106 $6.47 $19.61 – $104.26
Complete blood count (CBC), automated: 10 of 36 insurance plan rates
  • AETNA — ASA: $83
  • AETNA — HMO: $90.31
  • AETNA — MANAGED MEDICAID: $19.61
  • AETNA — MEDICARE ADVANTAGE: $7.05
  • AETNA — PPO: $90.31
  • AMERIGROUP — MANAGED MEDICAID: $6.47
  • AMERIHEALTH — LOCAL HMO: $92.05
  • AMERIHEALTH — REGIONAL HMO: $104.26
  • BERGEN RISK — ALL PRODUCTS: $79.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $84.80
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC WITH PLATELET COUNT ARUP $106 $6.47 $19.61 – $104.26
Complete blood count (CBC), automated: 10 of 36 insurance plan rates
  • AETNA — ASA: $83
  • AETNA — HMO: $90.31
  • AETNA — MANAGED MEDICAID: $19.61
  • AETNA — MEDICARE ADVANTAGE: $7.05
  • AETNA — PPO: $90.31
  • AMERIGROUP — MANAGED MEDICAID: $6.47
  • AMERIHEALTH — LOCAL HMO: $92.05
  • AMERIHEALTH — REGIONAL HMO: $104.26
  • BERGEN RISK — ALL PRODUCTS: $79.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $84.80
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME- . $97 $4.29 $4.29 – $5.15
Blood clotting time test (prothrombin time, PT): 10 of 36 insurance plan rates
  • AETNA — ASA: $75.95
  • AETNA — HMO: $82.64
  • AETNA — MANAGED MEDICAID: $17.95
  • AETNA — MEDICARE ADVANTAGE: $4.68
  • AETNA — PPO: $82.64
  • AMERIGROUP — MANAGED MEDICAID: $4.29
  • AMERIHEALTH — LOCAL HMO: $84.23
  • AMERIHEALTH — REGIONAL HMO: $95.41
  • BERGEN RISK — ALL PRODUCTS: $72.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $77.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME-INR QST $97 $4.29 $17.95 – $95.41
Blood clotting time test (prothrombin time, PT): 10 of 36 insurance plan rates
  • AETNA — ASA: $75.95
  • AETNA — HMO: $82.64
  • AETNA — MANAGED MEDICAID: $17.95
  • AETNA — MEDICARE ADVANTAGE: $4.68
  • AETNA — PPO: $82.64
  • AMERIGROUP — MANAGED MEDICAID: $4.29
  • AMERIHEALTH — LOCAL HMO: $84.23
  • AMERIHEALTH — REGIONAL HMO: $95.41
  • BERGEN RISK — ALL PRODUCTS: $72.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $77.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME $97 $4.29 $17.95 – $95.41
Blood clotting time test (prothrombin time, PT): 10 of 36 insurance plan rates
  • AETNA — ASA: $75.95
  • AETNA — HMO: $82.64
  • AETNA — MANAGED MEDICAID: $17.95
  • AETNA — MEDICARE ADVANTAGE: $4.68
  • AETNA — PPO: $82.64
  • AMERIGROUP — MANAGED MEDICAID: $4.29
  • AMERIHEALTH — LOCAL HMO: $84.23
  • AMERIHEALTH — REGIONAL HMO: $95.41
  • BERGEN RISK — ALL PRODUCTS: $72.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $77.60
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBPLASTN TIME(PTT)POST HEP $132 $6.01 $24.42 – $129.84
Blood clotting test (partial thromboplastin time, PTT): 10 of 36 insurance plan rates
  • AETNA — ASA: $103.36
  • AETNA — HMO: $112.46
  • AETNA — MANAGED MEDICAID: $24.42
  • AETNA — MEDICARE ADVANTAGE: $6.55
  • AETNA — PPO: $112.46
  • AMERIGROUP — MANAGED MEDICAID: $6.01
  • AMERIHEALTH — LOCAL HMO: $114.63
  • AMERIHEALTH — REGIONAL HMO: $129.84
  • BERGEN RISK — ALL PRODUCTS: $99
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $105.60
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ACTIVATED PARTIAL THROMBOPLASTIN TIME $132 $6.01 $24.42 – $129.84
Blood clotting test (partial thromboplastin time, PTT): 10 of 36 insurance plan rates
  • AETNA — ASA: $103.36
  • AETNA — HMO: $112.46
  • AETNA — MANAGED MEDICAID: $24.42
  • AETNA — MEDICARE ADVANTAGE: $6.55
  • AETNA — PPO: $112.46
  • AMERIGROUP — MANAGED MEDICAID: $6.01
  • AMERIHEALTH — LOCAL HMO: $114.63
  • AMERIHEALTH — REGIONAL HMO: $129.84
  • BERGEN RISK — ALL PRODUCTS: $99
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $105.60
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD $46 $6.01 $8.51 – $45.25
Blood clotting test (partial thromboplastin time, PTT): 10 of 36 insurance plan rates
  • AETNA — ASA: $36.02
  • AETNA — HMO: $39.19
  • AETNA — MANAGED MEDICAID: $8.51
  • AETNA — MEDICARE ADVANTAGE: $6.55
  • AETNA — PPO: $39.19
  • AMERIGROUP — MANAGED MEDICAID: $6.01
  • AMERIHEALTH — LOCAL HMO: $39.95
  • AMERIHEALTH — REGIONAL HMO: $45.25
  • BERGEN RISK — ALL PRODUCTS: $34.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $36.80

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: CT HEAD/BRAIN W/O CONTRAST MATERIAL $2,504 $116.22 $450.72 – $2,289.16
CT scan of the head or brain, without contrast: 10 of 35 insurance plan rates
  • AETNA — ASA: $1,960.63
  • AETNA — HMO: $227.90
  • AETNA — MANAGED MEDICAID: $463.24
  • AETNA — MEDICARE ADVANTAGE: $126.68
  • AETNA — PPO: $227.90
  • AMERIHEALTH — LOCAL HMO: $439.59
  • AMERIHEALTH — REGIONAL HMO: $447.19
  • BERGEN RISK — ALL PRODUCTS: $1,878
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $1,727.76
  • CIGNA — BH: $2,003.20
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 $116.22 $128.36 – $265.07
CT scan of the head or brain, without contrast: rates for 5 insurance plans
  • AETNA — HMO: $227.90
  • AETNA — PPO: $227.90
  • KARNA — MEDICARE ADVANTAGE: $128.36
  • OXFORD — ALL PRODUCTS: $265.07
  • UNITED HEALTHCARE — HMO: $265.07
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 $116.22 $70.67
CT scan of the head or brain, without contrast: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $70.67
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI BRAIN BRAIN STEM W/O &W/CONTRAST MATERIAL $5,631 $390.30 $600.50 – $4,332
MRI of the brain, before and after contrast: 10 of 35 insurance plan rates
  • AETNA — ASA: $4,409.07
  • AETNA — HMO: $817.82
  • AETNA — MANAGED MEDICAID: $1,041.74
  • AETNA — MEDICARE ADVANTAGE: $425.43
  • AETNA — PPO: $817.82
  • AMERIHEALTH — LOCAL HMO: $1,531.59
  • AMERIHEALTH — REGIONAL HMO: $1,558.09
  • BERGEN RISK — ALL PRODUCTS: $4,332
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $3,885.39
  • CIGNA — BH: $4,504.80
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 $390.30 $409.88 – $895.45
MRI of the brain, before and after contrast: rates for 5 insurance plans
  • AETNA — HMO: $817.82
  • AETNA — PPO: $817.82
  • KARNA — MEDICARE ADVANTAGE: $409.88
  • OXFORD — ALL PRODUCTS: $895.45
  • UNITED HEALTHCARE — HMO: $895.45
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 $390.30 $190.61
MRI of the brain, before and after contrast: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $190.61
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RADIOLOGIC EXAM CHEST 2 VIEWS $497 $96.23 $89.46 – $454.36
Chest X-ray, 2 views: 10 of 35 insurance plan rates
  • AETNA — ASA: $389.15
  • AETNA — HMO: $60.81
  • AETNA — MANAGED MEDICAID: $91.95
  • AETNA — MEDICARE ADVANTAGE: $104.89
  • AETNA — PPO: $60.81
  • AMERIHEALTH — LOCAL HMO: $67.63
  • AMERIHEALTH — REGIONAL HMO: $68.80
  • BERGEN RISK — ALL PRODUCTS: $372.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $397.60
  • CIGNA — BH: $397.60
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NMDP RADIOLOGIC EXAM CHEST 2 VIEWS $497 $96.23 $89.46 – $454.36
Chest X-ray, 2 views: 10 of 35 insurance plan rates
  • AETNA — ASA: $389.15
  • AETNA — HMO: $60.81
  • AETNA — MANAGED MEDICAID: $91.95
  • AETNA — MEDICARE ADVANTAGE: $104.89
  • AETNA — PPO: $60.81
  • AMERIHEALTH — LOCAL HMO: $67.63
  • AMERIHEALTH — REGIONAL HMO: $68.80
  • BERGEN RISK — ALL PRODUCTS: $372.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $447.30
  • CIGNA — BH: $397.60
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: X-RAY EXAM CHEST 2 VIEWS Not listed in the file $96.23 $43.39 – $219.04
Chest X-ray, 2 views: rates for 5 insurance plans
  • AETNA — HMO: $60.81
  • AETNA — PPO: $60.81
  • KARNA — MEDICARE ADVANTAGE: $43.39
  • OXFORD — ALL PRODUCTS: $219.04
  • UNITED HEALTHCARE — HMO: $219.04
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS $1,019 $116.22 $183.42 – $931.57
X-ray of the lower spine, at least 4 views: 10 of 35 insurance plan rates
  • AETNA — ASA: $797.88
  • AETNA — HMO: $102.81
  • AETNA — MANAGED MEDICAID: $188.52
  • AETNA — MEDICARE ADVANTAGE: $126.68
  • AETNA — PPO: $102.81
  • AMERIHEALTH — LOCAL HMO: $99.45
  • AMERIHEALTH — REGIONAL HMO: $101.17
  • BERGEN RISK — ALL PRODUCTS: $764.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $815.20
  • CIGNA — BH: $815.20
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 $116.22 $73.78 – $295.04
X-ray of the lower spine, at least 4 views: rates for 5 insurance plans
  • AETNA — HMO: $102.81
  • AETNA — PPO: $102.81
  • KARNA — MEDICARE ADVANTAGE: $73.78
  • OXFORD — ALL PRODUCTS: $295.04
  • UNITED HEALTHCARE — HMO: $295.04
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 $116.22 $21.99
X-ray of the lower spine, at least 4 views: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $21.99
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL $4,439 $264.17 $799.02 – $4,058.13
MRI of the lower back (lumbar spine), without contrast: 10 of 35 insurance plan rates
  • AETNA — ASA: $3,475.74
  • AETNA — HMO: $463.71
  • AETNA — MANAGED MEDICAID: $821.22
  • AETNA — MEDICARE ADVANTAGE: $287.95
  • AETNA — PPO: $463.71
  • AMERIHEALTH — LOCAL HMO: $944.81
  • AMERIHEALTH — REGIONAL HMO: $961.16
  • BERGEN RISK — ALL PRODUCTS: $4,332
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $3,062.91
  • CIGNA — BH: $3,551.20
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 $264.17 $236.25 – $559.79
MRI of the lower back (lumbar spine), without contrast: rates for 5 insurance plans
  • AETNA — HMO: $463.71
  • AETNA — PPO: $463.71
  • KARNA — MEDICARE ADVANTAGE: $236.25
  • OXFORD — ALL PRODUCTS: $559.79
  • UNITED HEALTHCARE — HMO: $559.79
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 $264.17 $124.14
MRI of the lower back (lumbar spine), without contrast: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $124.14
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT PELVIS W/CONTRAST MATERIAL $3,245 $194.55 $584.10 – $2,966.58
CT scan of the pelvis, with contrast: 10 of 35 insurance plan rates
  • AETNA — ASA: $2,540.84
  • AETNA — HMO: $522.40
  • AETNA — MANAGED MEDICAID: $600.33
  • AETNA — MEDICARE ADVANTAGE: $212.06
  • AETNA — PPO: $522.40
  • AMERIHEALTH — LOCAL HMO: $618.61
  • AMERIHEALTH — REGIONAL HMO: $629.31
  • BERGEN RISK — ALL PRODUCTS: $2,433.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $2,239.05
  • CIGNA — BH: $2,596
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 $194.55 $336.10 – $522.40
CT scan of the pelvis, with contrast: rates for 5 insurance plans
  • AETNA — HMO: $522.40
  • AETNA — PPO: $522.40
  • KARNA — MEDICARE ADVANTAGE: $336.10
  • OXFORD — ALL PRODUCTS: $434.32
  • UNITED HEALTHCARE — HMO: $434.32
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 $194.55 $96.80
CT scan of the pelvis, with contrast: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $96.80
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL $4,290 $264.17 $772.20 – $3,921.92
MRI of a leg joint (such as the knee), without contrast: 10 of 35 insurance plan rates
  • AETNA — ASA: $3,359.07
  • AETNA — HMO: $525.56
  • AETNA — MANAGED MEDICAID: $793.65
  • AETNA — MEDICARE ADVANTAGE: $287.95
  • AETNA — PPO: $525.56
  • AMERIHEALTH — LOCAL HMO: $944.81
  • AMERIHEALTH — REGIONAL HMO: $961.16
  • BERGEN RISK — ALL PRODUCTS: $4,332
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $2,960.10
  • CIGNA — BH: $3,432
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 $264.17 $269.12 – $559.79
MRI of a leg joint (such as the knee), without contrast: rates for 5 insurance plans
  • AETNA — HMO: $525.56
  • AETNA — PPO: $525.56
  • KARNA — MEDICARE ADVANTAGE: $269.12
  • OXFORD — ALL PRODUCTS: $559.79
  • UNITED HEALTHCARE — HMO: $559.79
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 $264.17 $113.47
MRI of a leg joint (such as the knee), without contrast: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $113.47
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT ABDOMEN & PELVIS WITH CONTRAST MATERIAL $4,650 $390.30 $837 – $4,251.03
CT scan of the abdomen and pelvis, with contrast: 10 of 35 insurance plan rates
  • AETNA — ASA: $3,640.95
  • AETNA — HMO: $685.13
  • AETNA — MANAGED MEDICAID: $860.25
  • AETNA — MEDICARE ADVANTAGE: $425.43
  • AETNA — PPO: $685.13
  • AMERIHEALTH — LOCAL HMO: $630.54
  • AMERIHEALTH — REGIONAL HMO: $641.45
  • BERGEN RISK — ALL PRODUCTS: $3,487.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $3,208.50
  • CIGNA — BH: $3,720
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 $390.30 $421.07 – $895.45
CT scan of the abdomen and pelvis, with contrast: rates for 5 insurance plans
  • AETNA — HMO: $685.13
  • AETNA — PPO: $685.13
  • KARNA — MEDICARE ADVANTAGE: $421.07
  • OXFORD — ALL PRODUCTS: $895.45
  • UNITED HEALTHCARE — HMO: $895.45
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: CT ABD & PELVIS W/CONTRAST Not listed in the file $390.30 $151.43
CT scan of the abdomen and pelvis, with contrast: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $151.43
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION $1,362 $116.22 $147.94 – $299.87
Ultrasound of the abdomen, complete: 10 of 35 insurance plan rates
  • AETNA — ASA: $1,066.45
  • AETNA — HMO: $257.80
  • AETNA — MANAGED MEDICAID: $251.97
  • AETNA — MEDICARE ADVANTAGE: $126.68
  • AETNA — PPO: $257.80
  • AMERIHEALTH — LOCAL HMO: $226.76
  • AMERIHEALTH — REGIONAL HMO: $230.68
  • BERGEN RISK — ALL PRODUCTS: $1,021.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $1,225.80
  • CIGNA — BH: $1,089.60
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 $116.22 $146.32 – $295.04
Ultrasound of the abdomen, complete: rates for 5 insurance plans
  • AETNA — HMO: $257.80
  • AETNA — PPO: $257.80
  • KARNA — MEDICARE ADVANTAGE: $146.32
  • OXFORD — ALL PRODUCTS: $295.04
  • UNITED HEALTHCARE — HMO: $295.04
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 $116.22 $67.09
Ultrasound of the abdomen, complete: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $67.09
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION $825 $116.22 $148.50 – $754.22
Pregnancy ultrasound (after the first trimester): 10 of 35 insurance plan rates
  • AETNA — ASA: $645.98
  • AETNA — HMO: $289.91
  • AETNA — MANAGED MEDICAID: $152.63
  • AETNA — MEDICARE ADVANTAGE: $126.68
  • AETNA — PPO: $289.91
  • AMERIHEALTH — LOCAL HMO: $198.91
  • AMERIHEALTH — REGIONAL HMO: $202.35
  • BERGEN RISK — ALL PRODUCTS: $618.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $742.50
  • CIGNA — BH: $660
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 Not listed in the file $116.22 $165.55 – $295.04
Pregnancy ultrasound (after the first trimester): rates for 5 insurance plans
  • AETNA — HMO: $289.91
  • AETNA — PPO: $289.91
  • KARNA — MEDICARE ADVANTAGE: $165.55
  • OXFORD — ALL PRODUCTS: $295.04
  • UNITED HEALTHCARE — HMO: $295.04
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 $116.22 $83.19
Pregnancy ultrasound (after the first trimester): rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $83.19
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ULTRASOUND TRANSVAGINAL $1,255 $116.22 $115.03 – $328.28
Transvaginal ultrasound: 10 of 35 insurance plan rates
  • AETNA — ASA: $982.67
  • AETNA — HMO: $275.51
  • AETNA — MANAGED MEDICAID: $232.18
  • AETNA — MEDICARE ADVANTAGE: $126.68
  • AETNA — PPO: $275.51
  • AMERIHEALTH — LOCAL HMO: $184.98
  • AMERIHEALTH — REGIONAL HMO: $188.18
  • BERGEN RISK — ALL PRODUCTS: $941.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $1,129.50
  • CIGNA — BH: $1,004
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: TRANSVAGINAL US NON-OB Not listed in the file $116.22 $161.83 – $295.04
Transvaginal ultrasound: rates for 5 insurance plans
  • AETNA — HMO: $275.51
  • AETNA — PPO: $275.51
  • KARNA — MEDICARE ADVANTAGE: $161.83
  • OXFORD — ALL PRODUCTS: $295.04
  • UNITED HEALTHCARE — HMO: $295.04
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 $116.22 $57.62
Transvaginal ultrasound: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $57.62
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI $737 $164.52 $164.52 – $197.42
Diagnostic mammogram, one breast: 10 of 35 insurance plan rates
  • AETNA — ASA: $577.07
  • AETNA — HMO: $293.22
  • AETNA — MANAGED MEDICAID: $136.35
  • AETNA — MEDICARE ADVANTAGE: $179.33
  • AETNA — PPO: $293.22
  • AMERIGROUP — MANAGED MEDICAID: $164.52
  • AMERIHEALTH — LOCAL HMO: $123.32
  • AMERIHEALTH — REGIONAL HMO: $125.46
  • BERGEN RISK — ALL PRODUCTS: $552.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $663.30
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DX MAMMO INCL CAD UNI Not listed in the file $164.52 $162.47 – $293.22
Diagnostic mammogram, one breast: rates for 5 insurance plans
  • AETNA — HMO: $293.22
  • AETNA — PPO: $293.22
  • KARNA — MEDICARE ADVANTAGE: $162.47
  • OXFORD — ALL PRODUCTS: $247.52
  • UNITED HEALTHCARE — HMO: $247.52
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: DX MAMMO INCL CAD UNI Not listed in the file $164.52 $67.71
Diagnostic mammogram, one breast: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $67.71
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI $1,045 $207.95 $207.95 – $249.54
Diagnostic mammogram, both breasts: 10 of 35 insurance plan rates
  • AETNA — ASA: $818.24
  • AETNA — HMO: $375.14
  • AETNA — MANAGED MEDICAID: $193.33
  • AETNA — MEDICARE ADVANTAGE: $226.67
  • AETNA — PPO: $375.14
  • AMERIGROUP — MANAGED MEDICAID: $207.95
  • AMERIHEALTH — LOCAL HMO: $157.14
  • AMERIHEALTH — REGIONAL HMO: $159.86
  • BERGEN RISK — ALL PRODUCTS: $783.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $940.50
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 $207.95 $208.34 – $375.14
Diagnostic mammogram, both breasts: rates for 5 insurance plans
  • AETNA — HMO: $375.14
  • AETNA — PPO: $375.14
  • KARNA — MEDICARE ADVANTAGE: $208.34
  • OXFORD — ALL PRODUCTS: $316.48
  • UNITED HEALTHCARE — HMO: $316.48
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: DX MAMMO INCL CAD BI Not listed in the file $207.95 $83.13
Diagnostic mammogram, both breasts: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $83.13
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD $748 $169.06 $169.06 – $202.87
Screening mammogram, both breasts: 10 of 35 insurance plan rates
  • AETNA — ASA: $585.68
  • AETNA — HMO: $309.84
  • AETNA — MANAGED MEDICAID: $138.38
  • AETNA — MEDICARE ADVANTAGE: $184.28
  • AETNA — PPO: $309.84
  • AMERIGROUP — MANAGED MEDICAID: $169.06
  • AMERIHEALTH — LOCAL HMO: $119.35
  • AMERIHEALTH — REGIONAL HMO: $121.41
  • BERGEN RISK — ALL PRODUCTS: $561
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $673.20
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 $169.06 $171.77 – $309.84
Screening mammogram, both breasts: rates for 5 insurance plans
  • AETNA — HMO: $309.84
  • AETNA — PPO: $309.84
  • KARNA — MEDICARE ADVANTAGE: $171.77
  • OXFORD — ALL PRODUCTS: $261.68
  • UNITED HEALTHCARE — HMO: $261.68
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: SCR MAMMO BI INCL CAD Not listed in the file $169.06 $63.55
Screening mammogram, both breasts: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $63.55

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 $24.05 – $49.09
Electrocardiogram (ECG/EKG) with reading: rates for 2 insurance plans
  • KARNA — MEDICARE ADVANTAGE: $24.05
  • UNITED HEALTHCARE — MANAGED MEDICAID: $49.09
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I $15,597 $3,515.15 $2,379 – $22,114
Left heart catheterization (diagnostic): 10 of 36 insurance plan rates
  • AETNA — ASA: $12,212.45
  • AETNA — HMO: $9,960
  • AETNA — MANAGED MEDICAID: $2,885.45
  • AETNA — MEDICARE ADVANTAGE: $3,831.51
  • AETNA — PPO: $9,960
  • AMERIHEALTH — LOCAL HMO: $19,565
  • AMERIHEALTH — REGIONAL HMO: $22,114
  • BERGEN RISK — ALL PRODUCTS: $11,697.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $11,920
  • CIGNA — BH: $12,477.60
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: LEFT HRT CATH W/VENTRCLGRPHY Not listed in the file $3,515.15 $378.50
Left heart catheterization (diagnostic): rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $378.50
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 $3,515.15 $1,125.45
Left heart catheterization (diagnostic): rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $1,125.45
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION $13,433 $8,292.88 $2,417.94 – $13,212.70
Heart rhythm study (electrophysiology evaluation): 10 of 36 insurance plan rates
  • AETNA — ASA: $10,518.04
  • AETNA — HMO: $12,092.39
  • AETNA — MANAGED MEDICAID: $2,485.11
  • AETNA — MEDICARE ADVANTAGE: $9,039.24
  • AETNA — PPO: $12,092.39
  • AMERIHEALTH — LOCAL HMO: $11,665.22
  • AMERIHEALTH — REGIONAL HMO: $13,212.70
  • BERGEN RISK — ALL PRODUCTS: $10,074.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $12,089.70
  • CIGNA — BH: $10,746.40
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 $8,292.88 $616.21
Heart rhythm study (electrophysiology evaluation): rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $616.21
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: COMPREHENSIVE EP EVALUATION Not listed in the file $8,292.88 $1,334.31
Heart rhythm study (electrophysiology evaluation): rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $1,334.31
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 PULM VEIN ISOLATION $42,264 $26,810.86 $21,850 – $35,713
Heart rhythm study with ablation for atrial fibrillation: 10 of 36 insurance plan rates
  • AETNA — ASA: $33,092.71
  • AETNA — HMO: $38,046.05
  • AETNA — MANAGED MEDICAID: $7,818.84
  • AETNA — MEDICARE ADVANTAGE: $29,223.84
  • AETNA — PPO: $38,046.05
  • AMERIHEALTH — LOCAL HMO: $36,702.06
  • AMERIHEALTH — REGIONAL HMO: $41,570.87
  • BERGEN RISK — ALL PRODUCTS: $31,698
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $21,850
  • CIGNA — BH: $33,811.20
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POLYSOMNOGRAPHY SLEEP STAGING 4/> ADDL PARAM $9,011 $1,111.89 $1,111.89 – $1,580
Sleep study (overnight, in a sleep lab): 10 of 36 insurance plan rates
  • AETNA — ASA: $7,055.61
  • AETNA — HMO: $7,659.35
  • AETNA — MANAGED MEDICAID: $1,667.04
  • AETNA — MEDICARE ADVANTAGE: $1,211.95
  • AETNA — PPO: $7,659.35
  • AMERIHEALTH — LOCAL HMO: $5,843.63
  • AMERIHEALTH — REGIONAL HMO: $6,506.84
  • BERGEN RISK — ALL PRODUCTS: $6,758.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $8,109.90
  • CIGNA — BH: $7,208.80
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 $1,111.89 $190.50
Sleep study (overnight, in a sleep lab): rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $190.50
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: POLYSOM 6/> YRS 4/> PARAM Not listed in the file $1,111.89 $874.12
Sleep study (overnight, in a sleep lab): rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $874.12

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 PX 1/> AREAS EACH 15 MIN EXERCISES $231 $37.06 $41.58 – $227.21
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 36 insurance plan rates
  • AETNA — ASA: $180.87
  • AETNA — HMO: $213.44
  • AETNA — MANAGED MEDICAID: $42.74
  • AETNA — MEDICARE ADVANTAGE: $40.40
  • AETNA — PPO: $213.44
  • AMERIGROUP — MANAGED MEDICAID: $37.06
  • AMERIHEALTH — LOCAL HMO: $200.60
  • AMERIHEALTH — REGIONAL HMO: $227.21
  • BERGEN RISK — ALL PRODUCTS: $291
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $355
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS $396 $126.19 $71.28 – $389.51
Physical therapy evaluation (low complexity): 10 of 36 insurance plan rates
  • AETNA — ASA: $310.07
  • AETNA — HMO: $365.90
  • AETNA — MANAGED MEDICAID: $73.26
  • AETNA — MEDICARE ADVANTAGE: $137.55
  • AETNA — PPO: $365.90
  • AMERIGROUP — MANAGED MEDICAID: $126.19
  • AMERIHEALTH — LOCAL HMO: $343.89
  • AMERIHEALTH — REGIONAL HMO: $389.51
  • BERGEN RISK — ALL PRODUCTS: $349
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $517
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS $453 $126.19 $81.54 – $445.57
Physical therapy evaluation (moderate complexity): 10 of 36 insurance plan rates
  • AETNA — ASA: $354.70
  • AETNA — HMO: $418.57
  • AETNA — MANAGED MEDICAID: $83.81
  • AETNA — MEDICARE ADVANTAGE: $137.55
  • AETNA — PPO: $418.57
  • AMERIGROUP — MANAGED MEDICAID: $126.19
  • AMERIHEALTH — LOCAL HMO: $393.39
  • AMERIHEALTH — REGIONAL HMO: $445.57
  • BERGEN RISK — ALL PRODUCTS: $349
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $517
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS $611 $126.19 $109.98 – $600.98
Physical therapy evaluation (high complexity): 10 of 36 insurance plan rates
  • AETNA — ASA: $478.41
  • AETNA — HMO: $564.56
  • AETNA — MANAGED MEDICAID: $113.04
  • AETNA — MEDICARE ADVANTAGE: $137.55
  • AETNA — PPO: $564.56
  • AMERIGROUP — MANAGED MEDICAID: $126.19
  • AMERIHEALTH — LOCAL HMO: $530.59
  • AMERIHEALTH — REGIONAL HMO: $600.98
  • BERGEN RISK — ALL PRODUCTS: $349
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $517
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY W/PATIENT 30 MINUTES $452 $175.59 $81.36 – $444.59
Psychotherapy, 30 minutes: 10 of 37 insurance plan rates
  • AETNA — ASA: $353.92
  • AETNA — HMO: $406.89
  • AETNA — MANAGED MEDICAID: $83.62
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $406.89
  • AMERIHEALTH — LOCAL HMO: $392.52
  • AMERIHEALTH — REGIONAL HMO: $444.59
  • BERGEN RISK — ALL PRODUCTS: $339
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $406.80
  • CIGNA — BH: $361.60
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DOC PSYCHOTHERAPY W/PATIENT 30 MINUTES $452 $175.59 $81.36 – $444.59
Psychotherapy, 30 minutes: 10 of 37 insurance plan rates
  • AETNA — ASA: $353.92
  • AETNA — HMO: $406.89
  • AETNA — MANAGED MEDICAID: $83.62
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $406.89
  • AMERIHEALTH — LOCAL HMO: $392.52
  • AMERIHEALTH — REGIONAL HMO: $444.59
  • BERGEN RISK — ALL PRODUCTS: $339
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $406.80
  • CIGNA — BH: $361.60
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MS PSYCHOTHERAPY W/PATIENT 30 MINUTES $452 $175.59 $81.36 – $444.59
Psychotherapy, 30 minutes: 10 of 37 insurance plan rates
  • AETNA — ASA: $353.92
  • AETNA — HMO: $406.89
  • AETNA — MANAGED MEDICAID: $83.62
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $406.89
  • AMERIHEALTH — LOCAL HMO: $392.52
  • AMERIHEALTH — REGIONAL HMO: $444.59
  • BERGEN RISK — ALL PRODUCTS: $339
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $406.80
  • CIGNA — BH: $361.60
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY W/PATIENT 45 MINUTES $539 $175.59 $97.02 – $530.16
Psychotherapy, 45 minutes: 10 of 37 insurance plan rates
  • AETNA — ASA: $422.04
  • AETNA — HMO: $485.21
  • AETNA — MANAGED MEDICAID: $99.72
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $485.21
  • AMERIHEALTH — LOCAL HMO: $468.07
  • AMERIHEALTH — REGIONAL HMO: $530.16
  • BERGEN RISK — ALL PRODUCTS: $404.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $485.10
  • CIGNA — BH: $431.20
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DOC PSYCHOTHERAPY W/PATIENT 45 MINUTES $539 $175.59 $97.02 – $530.16
Psychotherapy, 45 minutes: 10 of 37 insurance plan rates
  • AETNA — ASA: $422.04
  • AETNA — HMO: $485.21
  • AETNA — MANAGED MEDICAID: $99.72
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $485.21
  • AMERIHEALTH — LOCAL HMO: $468.07
  • AMERIHEALTH — REGIONAL HMO: $530.16
  • BERGEN RISK — ALL PRODUCTS: $404.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $485.10
  • CIGNA — BH: $431.20
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MS PSYCHOTHERAPY W/PATIENT 45 MINUTES $539 $175.59 $97.02 – $530.16
Psychotherapy, 45 minutes: 10 of 37 insurance plan rates
  • AETNA — ASA: $422.04
  • AETNA — HMO: $485.21
  • AETNA — MANAGED MEDICAID: $99.72
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $485.21
  • AMERIHEALTH — LOCAL HMO: $468.07
  • AMERIHEALTH — REGIONAL HMO: $530.16
  • BERGEN RISK — ALL PRODUCTS: $404.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $485.10
  • CIGNA — BH: $431.20
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY W/PATIENT 60 MINUTES $605 $175.59 $108.90 – $595.08
Psychotherapy, 60 minutes: 10 of 37 insurance plan rates
  • AETNA — ASA: $473.72
  • AETNA — HMO: $544.62
  • AETNA — MANAGED MEDICAID: $111.93
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $544.62
  • AMERIHEALTH — LOCAL HMO: $525.38
  • AMERIHEALTH — REGIONAL HMO: $595.08
  • BERGEN RISK — ALL PRODUCTS: $453.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $544.50
  • CIGNA — BH: $484
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DOC PSYCHOTHERAPY W/PATIENT 60 MINUTES $605 $175.59 $175.59 – $210.71
Psychotherapy, 60 minutes: 10 of 37 insurance plan rates
  • AETNA — ASA: $473.72
  • AETNA — HMO: $544.62
  • AETNA — MANAGED MEDICAID: $111.93
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $544.62
  • AMERIHEALTH — LOCAL HMO: $525.38
  • AMERIHEALTH — REGIONAL HMO: $595.08
  • BERGEN RISK — ALL PRODUCTS: $453.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $544.50
  • CIGNA — BH: $484
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MS PSYCHOTHERAPY W/PATIENT 60 MINUTES $605 $175.59 $175.59 – $210.71
Psychotherapy, 60 minutes: 10 of 37 insurance plan rates
  • AETNA — ASA: $473.72
  • AETNA — HMO: $544.62
  • AETNA — MANAGED MEDICAID: $111.93
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $544.62
  • AMERIHEALTH — LOCAL HMO: $525.38
  • AMERIHEALTH — REGIONAL HMO: $595.08
  • BERGEN RISK — ALL PRODUCTS: $453.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $544.50
  • CIGNA — BH: $484
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS $385 $175.59 $69.30 – $378.69
Family psychotherapy, without the patient: 10 of 37 insurance plan rates
  • AETNA — ASA: $301.46
  • AETNA — HMO: $346.58
  • AETNA — MANAGED MEDICAID: $71.23
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $346.58
  • AMERIHEALTH — LOCAL HMO: $334.33
  • AMERIHEALTH — REGIONAL HMO: $378.69
  • BERGEN RISK — ALL PRODUCTS: $288.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $346.50
  • CIGNA — BH: $308
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier HF In the file: FAMILY PSYTX W/O PT 50 MIN Not listed in the file $175.59 $113.94
Family psychotherapy, without the patient: rates for 1 insurance plan
  • HORIZON — BH: $113.94
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS $497 $175.59 $89.46 – $488.85
Family psychotherapy, with the patient: 10 of 37 insurance plan rates
  • AETNA — ASA: $389.15
  • AETNA — HMO: $447.40
  • AETNA — MANAGED MEDICAID: $91.95
  • AETNA — MEDICARE ADVANTAGE: $191.40
  • AETNA — PPO: $447.40
  • AMERIHEALTH — LOCAL HMO: $431.59
  • AMERIHEALTH — REGIONAL HMO: $488.85
  • BERGEN RISK — ALL PRODUCTS: $372.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $447.30
  • CIGNA — BH: $397.60
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier HF In the file: FAMILY PSYTX W/PT 50 MIN Not listed in the file $175.59 $126.46
Family psychotherapy, with the patient: rates for 1 insurance plan
  • HORIZON — BH: $126.46
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier UC In the file: FAMILY PSYTX W/PT 50 MIN Not listed in the file $175.59 $126.46
Family psychotherapy, with the patient: rates for 1 insurance plan
  • HORIZON — BH: $126.46
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP PSYCHOTHERAPY $413 $101.09 $74.34 – $406.23
Group psychotherapy: 10 of 37 insurance plan rates
  • AETNA — ASA: $323.38
  • AETNA — HMO: $371.78
  • AETNA — MANAGED MEDICAID: $76.41
  • AETNA — MEDICARE ADVANTAGE: $110.19
  • AETNA — PPO: $371.78
  • AMERIHEALTH — LOCAL HMO: $358.65
  • AMERIHEALTH — REGIONAL HMO: $406.23
  • BERGEN RISK — ALL PRODUCTS: $309.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $371.70
  • CIGNA — BH: $330.40
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DOC GROUP PSYCHOTHERAPY $413 $101.09 $74.34 – $406.23
Group psychotherapy: 10 of 37 insurance plan rates
  • AETNA — ASA: $323.38
  • AETNA — HMO: $371.78
  • AETNA — MANAGED MEDICAID: $76.41
  • AETNA — MEDICARE ADVANTAGE: $110.19
  • AETNA — PPO: $371.78
  • AMERIHEALTH — LOCAL HMO: $358.65
  • AMERIHEALTH — REGIONAL HMO: $406.23
  • BERGEN RISK — ALL PRODUCTS: $309.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $371.70
  • CIGNA — BH: $330.40
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MS GROUP PSYCHOTHERAPY $413 $101.09 $74.34 – $406.23
Group psychotherapy: 10 of 37 insurance plan rates
  • AETNA — ASA: $323.38
  • AETNA — HMO: $371.78
  • AETNA — MANAGED MEDICAID: $76.41
  • AETNA — MEDICARE ADVANTAGE: $110.19
  • AETNA — PPO: $371.78
  • AMERIHEALTH — LOCAL HMO: $358.65
  • AMERIHEALTH — REGIONAL HMO: $406.23
  • BERGEN RISK — ALL PRODUCTS: $309.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $371.70
  • CIGNA — BH: $330.40

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 $4,184.94 $4,184.94 – $5,021.93
Removal of breast growth (open surgery): rates for 8 insurance plans
  • AETNA — MEDICARE ADVANTAGE: $4,561.59
  • HORIZON BCBS BRAVEN — MEDICARE ADVANTAGE: $4,184.94
  • KARNA — MEDICARE ADVANTAGE: $874.93
  • UNITED COMMUNITY/AMERICHOICE — MEDICARE ADVANTAGE: $4,394.19
  • UNITED HEALTHCARE — DSNP: $5,021.93
  • VACCN — ALL PRODUCTS: $4,184.94
  • WELLCARE — MANAGED MEDICAID: $4,184.94
  • WELLCARE — MEDICARE ADVANTAGE: $4,184.94
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESIONS $7,014 Not listed in the file $1,189 – $10,216
Removal of breast growth (open surgery): 10 of 29 insurance plan rates
  • AETNA — ASA: $5,491.96
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $1,297.59
  • AETNA — MEDICARE ADVANTAGE: $1,465.93
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $6,090.96
  • AMERIHEALTH — REGIONAL HMO: $6,898.97
  • BERGEN RISK — ALL PRODUCTS: $5,260.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $5,611.20
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL HIP ARTHROPLASTY Not listed in the file $14,061.89 $14,061.89 – $16,874.27
Total hip replacement: rates for 8 insurance plans
  • AETNA — MEDICARE ADVANTAGE: $15,327.46
  • HORIZON BCBS BRAVEN — MEDICARE ADVANTAGE: $14,061.89
  • KARNA — MEDICARE ADVANTAGE: $2,664.47
  • UNITED COMMUNITY/AMERICHOICE — MEDICARE ADVANTAGE: $14,764.98
  • UNITED HEALTHCARE — DSNP: $16,874.27
  • VACCN — ALL PRODUCTS: $14,061.89
  • WELLCARE — MANAGED MEDICAID: $14,061.89
  • WELLCARE — MEDICARE ADVANTAGE: $14,061.89
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT $16,225 Not listed in the file $2,920.50 – $15,795
Total hip replacement: 10 of 29 insurance plan rates
  • AETNA — ASA: $12,704.18
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $3,001.63
  • AETNA — MEDICARE ADVANTAGE: $3,391.03
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $13,972
  • AMERIHEALTH — REGIONAL HMO: $15,795
  • BERGEN RISK — ALL PRODUCTS: $12,168.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $12,980
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL KNEE ARTHROPLASTY Not listed in the file $14,061.89 $14,061.89 – $16,874.27
Total knee replacement: rates for 8 insurance plans
  • AETNA — MEDICARE ADVANTAGE: $15,327.46
  • HORIZON BCBS BRAVEN — MEDICARE ADVANTAGE: $14,061.89
  • KARNA — MEDICARE ADVANTAGE: $2,660.24
  • UNITED COMMUNITY/AMERICHOICE — MEDICARE ADVANTAGE: $14,764.98
  • UNITED HEALTHCARE — DSNP: $16,874.27
  • VACCN — ALL PRODUCTS: $14,061.89
  • WELLCARE — MANAGED MEDICAID: $14,061.89
  • WELLCARE — MEDICARE ADVANTAGE: $14,061.89
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS $17,531 Not listed in the file $3,155.58 – $15,795
Total knee replacement: 10 of 29 insurance plan rates
  • AETNA — ASA: $13,726.77
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $3,243.24
  • AETNA — MEDICARE ADVANTAGE: $3,663.98
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $13,972
  • AMERIHEALTH — REGIONAL HMO: $15,795
  • BERGEN RISK — ALL PRODUCTS: $13,148.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $14,024.80
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 $349.95
Shoulder arthroscopy: shaving of shoulder bone: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $349.95
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: SHOULDER SCOPE BONE SHAVING $5,304 Not listed in the file $954.72 – $5,217.01
Shoulder arthroscopy: shaving of shoulder bone: 10 of 29 insurance plan rates
  • AETNA — ASA: $4,153.03
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $981.24
  • AETNA — MEDICARE ADVANTAGE: $1,108.54
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $4,605.99
  • AMERIHEALTH — REGIONAL HMO: $5,217.01
  • BERGEN RISK — ALL PRODUCTS: $3,978
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $15,984
  • CIGNA — BH: $4,243.20
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 $3,545.97 $3,545.97 – $4,255.16
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 8 insurance plans
  • AETNA — MEDICARE ADVANTAGE: $3,865.11
  • HORIZON BCBS BRAVEN — MEDICARE ADVANTAGE: $3,545.97
  • KARNA — MEDICARE ADVANTAGE: $1,144.38
  • UNITED COMMUNITY/AMERICHOICE — MEDICARE ADVANTAGE: $3,723.27
  • UNITED HEALTHCARE — DSNP: $4,255.16
  • VACCN — ALL PRODUCTS: $3,545.97
  • WELLCARE — MANAGED MEDICAID: $3,545.97
  • WELLCARE — MEDICARE ADVANTAGE: $3,545.97
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG $7,673 Not listed in the file $1,189 – $14,007
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 29 insurance plan rates
  • AETNA — ASA: $6,007.96
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $1,419.51
  • AETNA — MEDICARE ADVANTAGE: $1,603.66
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $6,663.23
  • AMERIHEALTH — REGIONAL HMO: $7,547.16
  • BERGEN RISK — ALL PRODUCTS: $5,754.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $15,984
  • CIGNA — BH: $6,138.40
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TONSILLECTOMY & ADENOIDECTOMY <AGE 12 $9,176 $6,465.11 $1,189 – $10,216
Removal of tonsils and adenoids (under age 12): 10 of 36 insurance plan rates
  • AETNA — ASA: $7,184.81
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $1,697.56
  • AETNA — MEDICARE ADVANTAGE: $7,046.97
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $7,968.44
  • AMERIHEALTH — REGIONAL HMO: $9,025.51
  • BERGEN RISK — ALL PRODUCTS: $6,882
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $7,340.80
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC $4,476 $1,024.64 $903 – $9,933
Upper GI endoscopy (diagnostic): 10 of 36 insurance plan rates
  • AETNA — ASA: $3,504.71
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $828.06
  • AETNA — MEDICARE ADVANTAGE: $1,116.86
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $3,886.96
  • AMERIHEALTH — REGIONAL HMO: $4,402.59
  • BERGEN RISK — ALL PRODUCTS: $3,357
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $3,580.80
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UPPER NDSC BIOPSY SINGLE/MULTIPLE $4,106 $1,024.64 $1,024.64 – $9,933
Upper GI endoscopy with biopsy: 10 of 36 insurance plan rates
  • AETNA — ASA: $3,215
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $759.61
  • AETNA — MEDICARE ADVANTAGE: $1,116.86
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $3,565.65
  • AMERIHEALTH — REGIONAL HMO: $4,038.66
  • BERGEN RISK — ALL PRODUCTS: $3,079.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $3,284.80
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD $4,235 $996.39 $762.30 – $4,165.55
Colonoscopy (diagnostic): 10 of 36 insurance plan rates
  • AETNA — ASA: $3,316.01
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $783.48
  • AETNA — MEDICARE ADVANTAGE: $1,086.06
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $3,677.67
  • AMERIHEALTH — REGIONAL HMO: $4,165.55
  • BERGEN RISK — ALL PRODUCTS: $3,176.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $3,388
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 53 In the file: DIAGNOSTIC COLONOSCOPY Not listed in the file $996.39 $187.47
Colonoscopy (diagnostic): rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $187.47
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE $4,294 $1,288.59 $772.92 – $4,223.58
Colonoscopy with biopsy: 10 of 36 insurance plan rates
  • AETNA — ASA: $3,362.20
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $794.39
  • AETNA — MEDICARE ADVANTAGE: $1,404.57
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $3,728.91
  • AMERIHEALTH — REGIONAL HMO: $4,223.58
  • BERGEN RISK — ALL PRODUCTS: $3,220.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $3,435.20
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ $4,235 $1,288.59 $762.30 – $4,165.55
Colonoscopy with removal of polyps (snare): 10 of 36 insurance plan rates
  • AETNA — ASA: $3,316.01
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $783.48
  • AETNA — MEDICARE ADVANTAGE: $1,404.57
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $3,677.67
  • AMERIHEALTH — REGIONAL HMO: $4,165.55
  • BERGEN RISK — ALL PRODUCTS: $3,176.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $3,388
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX $4,490 $1,288.59 $808.20 – $4,416.36
Ultrasound of the lower bowel by endoscope: 10 of 36 insurance plan rates
  • AETNA — ASA: $3,515.67
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $830.65
  • AETNA — MEDICARE ADVANTAGE: $1,404.57
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $3,899.12
  • AMERIHEALTH — REGIONAL HMO: $4,416.36
  • BERGEN RISK — ALL PRODUCTS: $3,367.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $3,592
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SCREENING COLONOSCOPY $4,023 $996.39 $724.14 – $3,957.02
Screening colonoscopy (not high risk): 10 of 36 insurance plan rates
  • AETNA — ASA: $3,150.01
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $744.26
  • AETNA — MEDICARE ADVANTAGE: $1,086.06
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $3,493.57
  • AMERIHEALTH — REGIONAL HMO: $3,957.02
  • BERGEN RISK — ALL PRODUCTS: $3,017.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $3,218.40
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 $996.39 $158.85
Screening colonoscopy (not high risk): rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $158.85
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPY SURG CHOLECYSTECTOMY $10,973 $6,376.26 $2,379 – $24,016
Gallbladder removal by laparoscope: 10 of 36 insurance plan rates
  • AETNA — ASA: $8,591.86
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $2,030.01
  • AETNA — MEDICARE ADVANTAGE: $6,950.12
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $21,245
  • AMERIHEALTH — REGIONAL HMO: $24,016
  • BERGEN RISK — ALL PRODUCTS: $8,229.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $15,984
  • CIGNA — BH: $8,778.40
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 $3,856.84 $3,856.84 – $4,628.21
Groin (inguinal) hernia repair, age 5 or older: rates for 8 insurance plans
  • AETNA — MEDICARE ADVANTAGE: $4,203.95
  • HORIZON BCBS BRAVEN — MEDICARE ADVANTAGE: $3,856.84
  • KARNA — MEDICARE ADVANTAGE: $1,090.59
  • UNITED COMMUNITY/AMERICHOICE — MEDICARE ADVANTAGE: $4,049.68
  • UNITED HEALTHCARE — DSNP: $4,628.21
  • VACCN — ALL PRODUCTS: $3,856.84
  • WELLCARE — MANAGED MEDICAID: $3,856.84
  • WELLCARE — MEDICARE ADVANTAGE: $3,856.84
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE $9,680 Not listed in the file $1,742.40 – $9,521.25
Groin (inguinal) hernia repair, age 5 or older: 10 of 29 insurance plan rates
  • AETNA — ASA: $7,579.44
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $1,790.80
  • AETNA — MEDICARE ADVANTAGE: $2,023.12
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $8,406.11
  • AMERIHEALTH — REGIONAL HMO: $9,521.25
  • BERGEN RISK — ALL PRODUCTS: $7,260
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $7,744
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROSTATE NEEDLE BIOPSY ANY APPROACH $6,930 $2,238.78 $1,188 – $9,933
Prostate biopsy: 10 of 36 insurance plan rates
  • AETNA — ASA: $5,426.19
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $1,282.05
  • AETNA — MEDICARE ADVANTAGE: $2,440.27
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $6,018.01
  • AMERIHEALTH — REGIONAL HMO: $6,816.35
  • BERGEN RISK — ALL PRODUCTS: $5,197.50
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $5,544
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT $14,441 $11,378.21 $2,599.38 – $14,204.17
Prostate removal by laparoscope (radical prostatectomy): 10 of 36 insurance plan rates
  • AETNA — ASA: $11,307.30
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $2,671.59
  • AETNA — MEDICARE ADVANTAGE: $12,402.25
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $12,540.56
  • AMERIHEALTH — REGIONAL HMO: $14,204.17
  • BERGEN RISK — ALL PRODUCTS: $10,830.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $11,552.80
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C $7,159 $3,474.84 $1,189 – $10,216
Hysteroscopy with biopsy of the uterus lining: 10 of 36 insurance plan rates
  • AETNA — ASA: $5,605.50
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $1,324.42
  • AETNA — MEDICARE ADVANTAGE: $3,787.58
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $6,216.88
  • AMERIHEALTH — REGIONAL HMO: $7,041.59
  • BERGEN RISK — ALL PRODUCTS: $5,369.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $5,727.20
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN $4,620 $756.84 $756.84 – $9,933
Spinal injection, lower back (epidural), with imaging guidance: 10 of 36 insurance plan rates
  • AETNA — ASA: $3,617.46
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $854.70
  • AETNA — MEDICARE ADVANTAGE: $824.96
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $4,012.01
  • AMERIHEALTH — REGIONAL HMO: $4,544.23
  • BERGEN RISK — ALL PRODUCTS: $3,465
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $3,696
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX AA&/STRD TFRM EPI L/S 1 Not listed in the file $972.98 $972.98 – $1,167.58
Nerve root injection, lower back, with imaging guidance: rates for 8 insurance plans
  • AETNA — MEDICARE ADVANTAGE: $1,060.55
  • HORIZON BCBS BRAVEN — MEDICARE ADVANTAGE: $972.98
  • KARNA — MEDICARE ADVANTAGE: $228.50
  • UNITED COMMUNITY/AMERICHOICE — MEDICARE ADVANTAGE: $1,021.63
  • UNITED HEALTHCARE — DSNP: $1,167.58
  • VACCN — ALL PRODUCTS: $972.98
  • WELLCARE — MANAGED MEDICAID: $972.98
  • WELLCARE — MEDICARE ADVANTAGE: $972.98
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL $4,349 Not listed in the file $903 – $9,933
Nerve root injection, lower back, with imaging guidance: 10 of 29 insurance plan rates
  • AETNA — ASA: $3,405.27
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $804.57
  • AETNA — MEDICARE ADVANTAGE: $908.94
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $3,776.67
  • AMERIHEALTH — REGIONAL HMO: $4,277.68
  • BERGEN RISK — ALL PRODUCTS: $3,261.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $3,479.20
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNEL $5,972 $2,134.14 $1,188 – $10,216
Carpal tunnel release: 10 of 36 insurance plan rates
  • AETNA — ASA: $4,676.08
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $1,104.82
  • AETNA — MEDICARE ADVANTAGE: $2,326.22
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $5,186.08
  • AMERIHEALTH — REGIONAL HMO: $5,874.06
  • BERGEN RISK — ALL PRODUCTS: $4,479
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $4,777.60
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POST-CATARACT LASER SURGERY $2,869 $599.55 $516.42 – $2,821.95
Laser treatment of clouding after cataract surgery: 10 of 36 insurance plan rates
  • AETNA — ASA: $2,246.43
  • AETNA — HMO: $2,582.67
  • AETNA — MANAGED MEDICAID: $530.77
  • AETNA — MEDICARE ADVANTAGE: $653.51
  • AETNA — PPO: $2,582.67
  • AMERIHEALTH — LOCAL HMO: $2,491.44
  • AMERIHEALTH — REGIONAL HMO: $2,821.95
  • BERGEN RISK — ALL PRODUCTS: $2,151.75
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $2,582.10
  • CIGNA — BH: $2,295.20
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CATARACT REMOVAL INSERTION OF LENS $7,351 $2,492.56 $1,189 – $10,216
Cataract removal with lens implant: 10 of 36 insurance plan rates
  • AETNA — ASA: $5,755.83
  • AETNA — HMO: $9,383
  • AETNA — MANAGED MEDICAID: $1,359.94
  • AETNA — MEDICARE ADVANTAGE: $2,716.89
  • AETNA — PPO: $9,383
  • AMERIHEALTH — LOCAL HMO: $6,383.61
  • AMERIHEALTH — REGIONAL HMO: $7,230.44
  • BERGEN RISK — ALL PRODUCTS: $5,513.25
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $9,933
  • CIGNA — BH: $5,880.80

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: OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM $5,834 Not listed in the file $1,050.12 – $5,297.27
Vaginal delivery, with care before and after: 10 of 19 insurance plan rates
  • AETNA — ASA: $4,568.02
  • AETNA — MANAGED MEDICAID: $1,079.29
  • AETNA — MEDICARE ADVANTAGE: $1,219.31
  • CIGNA — BH: $4,667.20
  • CLOVER — MEDICARE ADVANTAGE: $1,050.12
  • HORIZON — HMO: $7,869
  • HORIZON — INDEMNITY: $7,867
  • HORIZON — PIP: $3,797.93
  • HORIZON — PPO: $8,077
  • HORIZON — SHP: $7,264
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 $5,589.58
Cesarean delivery (C-section), with care before and after: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $5,589.58
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 $5,269.74
Vaginal delivery after a previous C-section, with care before and after: rates for 1 insurance plan
  • KARNA — MEDICARE ADVANTAGE: $5,269.74

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 $69,982.73 $6,542 – $367,735.86
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 24 insurance plan rates
  • AETNA — HMO: $306,065.33
  • AETNA — MANAGED MEDICAID: $76,064.09
  • AETNA — MEDICARE ADVANTAGE: $82,909.86
  • AETNA — PPO: $306,065.33
  • AMERIGROUP — MANAGED MEDICAID: $76,064.09
  • AMERIHEALTH — LOCAL HMO: $77,115.99
  • AMERIHEALTH — REGIONAL HMO: $77,115.99
  • CIGNA — HMO: $322,182.67
  • CIGNA — PPO: $280,557.48
  • CLOVER — MEDICARE ADVANTAGE: $83,670.50
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 & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC Not listed in the file $69,982.73 $6,542 – $367,735.86
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 7 insurance plans
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $333,940.06
  • HORIZON — HMO: $204,324
  • HORIZON — INDEMNITY: $312,472
  • HORIZON — MANAGED MEDICAID: $71,569
  • HORIZON — OMNIA: $165,453
  • HORIZON — PPO: $242,311
  • HORIZON — SHP: $191,282
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) · Hospital (facility) fee In the file: SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC Not listed in the file Not listed in the file $29,076.81
Spinal fusion (not neck), without major complications: rates for 2 insurance plans
  • AMERIHEALTH — LOCAL HMO: $29,076.81
  • AMERIHEALTH — REGIONAL HMO: $29,076.81
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 $13,672.27 $6,542 – $71,843.21
Hip or knee replacement (major joint of the leg), without major complications: 10 of 17 insurance plan rates
  • AETNA — HMO: $59,794.86
  • AETNA — MANAGED MEDICAID: $14,860.36
  • AETNA — MEDICARE ADVANTAGE: $16,197.79
  • AETNA — PPO: $59,794.86
  • AMERIGROUP — MANAGED MEDICAID: $14,860.36
  • CIGNA — HMO: $62,943.65
  • CIGNA — PPO: $54,811.49
  • CLOVER — MEDICARE ADVANTAGE: $16,346.40
  • HORIZON BCBS BRAVEN — MEDICARE ADVANTAGE: $14,860.36
  • KARNA — MEDICARE ADVANTAGE: $21,489.77
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC Not listed in the file $13,672.27 $6,542 – $71,843.21
Hip or knee replacement (major joint of the leg), without major complications: rates for 7 insurance plans
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $67,659.17
  • HORIZON — HMO: $41,398
  • HORIZON — INDEMNITY: $63,309
  • HORIZON — MANAGED MEDICAID: $14,028
  • HORIZON — OMNIA: $33,522
  • HORIZON — PPO: $49,094
  • HORIZON — SHP: $38,755
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 $13,672.27 $6,542 – $71,843.21
Hip or knee replacement (major joint of the leg), without major complications: rates for 6 insurance plans
  • AMERIHEALTH — LOCAL HMO: $14,047.10
  • AMERIHEALTH — REGIONAL HMO: $14,047.10
  • HORIZON — PIP: $8,719
  • HORIZON — WORKERS COMP: $6,542
  • VACCN — ALL PRODUCTS: $13,672.27
  • MULTIPLAN - PHCS — ALL PRODUCTS: 85% (a percentage in the contract, not a dollar amount)
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 $17,166.66 $6,542 – $90,205.04
Neck (cervical) spinal fusion, without complications: 10 of 23 insurance plan rates
  • AETNA — HMO: $75,077.36
  • AETNA — MANAGED MEDICAID: $18,658.40
  • AETNA — MEDICARE ADVANTAGE: $20,337.66
  • AETNA — PPO: $75,077.36
  • AMERIGROUP — MANAGED MEDICAID: $18,658.40
  • AMERIHEALTH — LOCAL HMO: $18,781.22
  • AMERIHEALTH — REGIONAL HMO: $18,781.22
  • CIGNA — HMO: $79,030.91
  • CIGNA — PPO: $68,820.32
  • CLOVER — MEDICARE ADVANTAGE: $20,524.24
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION W/O CC/MCC Not listed in the file $17,166.66 $6,542 – $90,205.04
Neck (cervical) spinal fusion, without complications: rates for 7 insurance plans
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $80,685.72
  • HORIZON — HMO: $49,368
  • HORIZON — INDEMNITY: $75,499
  • HORIZON — MANAGED MEDICAID: $17,905
  • HORIZON — OMNIA: $39,976
  • HORIZON — PPO: $58,547
  • HORIZON — SHP: $46,217
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 $8,692.10 $6,542 – $45,674.07
Uterus and ovary surgery (not for cancer), without complications: 10 of 23 insurance plan rates
  • AETNA — HMO: $38,014.37
  • AETNA — MANAGED MEDICAID: $9,447.42
  • AETNA — MEDICARE ADVANTAGE: $10,297.69
  • AETNA — PPO: $38,014.37
  • AMERIGROUP — MANAGED MEDICAID: $9,447.42
  • AMERIHEALTH — LOCAL HMO: $8,371.77
  • AMERIHEALTH — REGIONAL HMO: $8,371.77
  • CIGNA — HMO: $40,016.20
  • CIGNA — PPO: $34,846.21
  • CLOVER — MEDICARE ADVANTAGE: $10,392.16
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC Not listed in the file $8,692.10 $6,542 – $45,674.07
Uterus and ovary surgery (not for cancer), without complications: rates for 7 insurance plans
  • BRIGHTON HEALTH PLAN — ALL PRODUCTS: $37,933.75
  • HORIZON — HMO: $23,210
  • HORIZON — INDEMNITY: $35,495
  • HORIZON — MANAGED MEDICAID: $8,185
  • HORIZON — OMNIA: $18,795
  • HORIZON — PPO: $27,525
  • HORIZON — SHP: $21,729

Source: Southern Ocean Medical Center’s standard charges file (hackensackmeridianhealth.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on December 31, 2025; 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
Address1140 RT 72 W, Manahawkin, NJ 08050
CountyOcean County
StateNew Jersey
Phone(609) 597‑6011
Emergency servicesYes
OwnershipVoluntary non-profit - Private
Medicare overall rating4 of 5 stars
Birthing-friendly designationYes (meets CMS criteria)
CMS Certification Number310113
Name in Medicare recordsSOUTHERN OCEAN MEDICAL CENTER
Profile levelMedicare data + hospital website
Official websitehackensackmeridianhealth.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. Southern Ocean Medical Center | Hackensack Meridian Health — hackensackmeridianhealth.org
  2. Southern Ocean Medical Center Imaging Services | Hackensack Meridian Health — hackensackmeridianhealth.org
  3. Southern Ocean Medical Center-Laboratory Services | Hackensack Meridian Health — hackensackmeridianhealth.org
  4. Specialized Stroke Centers & Care in NJ | Hackensack Meridian Health — hackensackmeridianhealth.org