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Acute Care Hospital

Spotsylvania Regional Medical Center

Fredericksburg, Virginia · Spotsylvania County · Emergency services listed

Summary

Spotsylvania Regional Medical Center is an acute care hospital in Fredericksburg, Virginia. Medicare data lists emergency services. CMS overall star rating: 3 of 5 stars. Its official website lists 151 services, specialties and programs. Medicare lists 240 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(540) 498‑4000 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
3 of 5 stars3 of 5 stars · Medicare rating
YesBirthing-friendly (CMS)
133Beds (hospital website)
240Doctors and clinicians
151Services listed

Quick answers

Does Spotsylvania Regional Medical Center have an emergency room?
Yes. Medicare (CMS) data lists emergency services at Spotsylvania Regional Medical Center. In a medical emergency, call 911.
Where is Spotsylvania Regional Medical Center?
4600 Spotsylvania Parkway, Fredericksburg, VA 22408, in Spotsylvania County, Virginia.
What is the phone number of Spotsylvania Regional Medical Center?
(540) 498-4000, as listed by Medicare (CMS).
What is the Medicare star rating of Spotsylvania Regional Medical Center?
3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

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

Conditions treated[5][8][10][14][15][16][17]

Treatments[5][10][12][13][14][15][16][17]

Procedures[4][5][7][8][10][11][13][14][17]

Programs and centers[4][6][7][8][13][16][17]

  • Chest Pain Center with Primary PCI (ACC accredited)
  • Certified Primary Stroke Center
  • Level 3 NICU
  • FastTrack emergency program
  • Accredited Chest Pain Center with Primary PCI
  • Level III NICU
  • OB emergency room (OB ER)
  • FastTrack ER for minor emergencies
  • Pediatric-friendly emergency care
  • askSARAH cancer nurse helpline
  • Oncology nurse navigator program
  • Behavioral health unit (28 beds)

Emergency care (hospital website)[4][6]

Emergency roomYes
Open 24/7Yes
Stroke designationCertified Primary Stroke Center (The Joint Commission)

Visiting and practical information

VisitingOpen visiting hours, some overnight visits restricted; public entrances locked 9pm to 5:30am; unit-specific rules apply[9]
Interpreters and languagesFree sign language and oral interpreters for deaf or hard of hearing; free interpreter for limited English on request[9]

Recognition[4]

  • ACC Accredited Chest Pain Center with Primary PCI
  • ACR accredited mammography and CT facility
  • Joint Commission Certified Primary Stroke Center
  • Accredited Chest Pain Center with Primary Percutaneous Coronary Intervention (American College of Cardiology)
  • Accredited mammography and CT scan facility (American College of Radiology)
  • Certified Primary Stroke Center (The Joint Commission)

Doctors and clinicians (240)

240 doctors and other clinicians list Spotsylvania Regional 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 (240)

And 216 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 Spotsylvania Regional Medical Center reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

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

Summary star rating (all survey topics) 2 of 5 stars
Overall rating of the hospital2 of 5 stars
Would recommend the hospital2 of 5 stars
Nurses communicated well2 of 5 stars
Doctors communicated well2 of 5 stars
Staff explained medicines1 of 5 stars
Information about recovery at home1 of 5 stars
Room and bathroom kept clean3 of 5 stars
Quiet at night3 of 5 stars
Rated the hospital 9 or 10 out of 1063%National average: 72%
Would definitely recommend the hospital63%National average: 71%
Nurses “always” communicated well73%National average: 80%
Doctors “always” communicated well70%National average: 80%
Staff “always” explained medicines before giving them51%National average: 62%
Were given information about recovery at home76%National average: 86%
Room and bathroom “always” clean69%National average: 74%
Area around the room “always” quiet at night57%National average: 60%
Completed surveys489Response rate: 17%

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)0.64No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)0No different from the national benchmark
Surgical site infections after colon surgeryNot reported to Medicare
Surgical site infections after abdominal hysterectomyNot reported to Medicare
MRSA bloodstream infectionsNot reported to Medicare
Clostridioides difficile (C. diff) intestinal infections0.192Better 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 patients12.7%
Deaths within 30 days: heart failure patients9.7%
Deaths within 30 days: pneumonia patients15.9%
Deaths within 30 days: COPD patients8.3%
Deaths within 30 days: stroke patients10.8%
Deaths within 30 days: coronary bypass surgery (CABG)Not reported to Medicare
Serious complications (patient safety indicator PSI-90)0.84No 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 attack15.5%
Readmitted within 30 days: heart failure23.2%
Readmitted within 30 days: pneumonia19.3%
Readmitted within 30 days: COPD20.8%
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)120 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)49%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 FredericksburgBest hospitals in Virginia

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 Spotsylvania Regional 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) In the file: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or e Not listed in the file Not listed in the file Not listed in the file
New patient office visit (about 30–44 minutes): rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or e Not listed in the file Not listed in the file Not listed in the file
New patient office visit (about 45–59 minutes): rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or e Not listed in the file Not listed in the file Not listed in the file
New patient office visit (about 60–74 minutes): rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: OP VISIT LEVEL 3 EST $488.16 $488.16 $73.22 – $488.16
Established patient office visit (about 20–29 minutes): 10 of 18 insurance plan rates
  • 4Most Health Nework — COMM: $439.34
  • Aetna — Broad: $170.86
  • Aetna — MGMCR: $73.22
  • CorVel — WorkersComp: $351.48
  • Greenvbrier Sporting Club — COMM: $292.90
  • Kaiser — COMM: $263.61
  • Lifeworks — MCR: $92.75
  • Multiplan — MPI: $312.42
  • Multiplan — PHCS: $312.42
  • OccuNet Workers Comp — WorkersComp: $390.53
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history $488.16 $488.16 Not listed in the file
Established patient office visit (about 20–29 minutes): rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history Not listed in the file Not listed in the file Not listed in the file
Established patient office visit (about 30–39 minutes): rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination Not listed in the file Not listed in the file Not listed in the file
Office consultation with a specialist (moderate): rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination Not listed in the file Not listed in the file Not listed in the file
Office consultation with a specialist (moderate to high): rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) In the file: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examin Not listed in the file Not listed in the file $66.58 – $68.64
Preventive checkup, new patient, age 18–39: rates for 5 insurance plans
  • Humana Military — TRCR: $66.58
  • Johns Hopkins — UniformedServicesFamilyHealthPlan: $68.64
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) In the file: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examin Not listed in the file Not listed in the file $80.89 – $83.39
Preventive checkup, new patient, age 40–64: rates for 5 insurance plans
  • Humana Military — TRCR: $80.89
  • Johns Hopkins — UniformedServicesFamilyHealthPlan: $83.39
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: LVL 3 EMER DEPT $2,784.24 $2,784.24 $779.59 – $2,505.82
Emergency room visit (moderate): 10 of 14 insurance plan rates
  • 4Most Health Nework — COMM: $2,505.82
  • CorVel — WorkersComp: $2,004.65
  • Greenvbrier Sporting Club — COMM: $1,670.54
  • Kaiser — COMM: $1,503.49
  • Multiplan — MPI: $1,781.91
  • Multiplan — PHCS: $1,781.91
  • OccuNet Workers Comp — WorkersComp: $2,227.39
  • Three Rivers Provider Network — COMM: $2,505.82
  • Three Rivers Provider Network — WorkersComp: $2,505.82
  • United — GlobalBenefitPlan: $1,252.91
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination Not listed in the file Not listed in the file $500 – $2,647
Emergency room visit (moderate): 10 of 14 insurance plan rates
  • Aetna — Broad: $2,019
  • Anthem — HIX: $611
  • Anthem — HMO: $839
  • Anthem — HPN: $835
  • Anthem — PPO: $839
  • Bright Health — COMM: $705
  • Cigna — HMO: $2,071
  • Cigna — IFP: $1,606
  • Cigna — PPO: $2,071
  • Johns Hopkins — UniformedServicesFamilyHealthPlan: $500
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · modifier ER In the file: LVL 3 FREE STD EMER DEPT $2,784.24 $2,784.24 $779.59 – $2,505.82
Emergency room visit (moderate): 10 of 14 insurance plan rates
  • 4Most Health Nework — COMM: $2,505.82
  • CorVel — WorkersComp: $2,004.65
  • Greenvbrier Sporting Club — COMM: $1,670.54
  • Kaiser — COMM: $1,503.49
  • Multiplan — MPI: $1,781.91
  • Multiplan — PHCS: $1,781.91
  • OccuNet Workers Comp — WorkersComp: $2,227.39
  • Three Rivers Provider Network — COMM: $2,505.82
  • Three Rivers Provider Network — WorkersComp: $2,505.82
  • United — GlobalBenefitPlan: $1,252.91
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: LVL 4 EMER DEPT $3,814.56 $3,814.56 $1,068.08 – $3,433.10
Emergency room visit (moderately high): 10 of 14 insurance plan rates
  • 4Most Health Nework — COMM: $3,433.10
  • CorVel — WorkersComp: $2,746.48
  • Greenvbrier Sporting Club — COMM: $2,288.74
  • Kaiser — COMM: $2,059.86
  • Multiplan — MPI: $2,441.32
  • Multiplan — PHCS: $2,441.32
  • OccuNet Workers Comp — WorkersComp: $3,051.65
  • Three Rivers Provider Network — COMM: $3,433.10
  • Three Rivers Provider Network — WorkersComp: $3,433.10
  • United — GlobalBenefitPlan: $1,716.55
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination Not listed in the file Not listed in the file $1,790 – $3,614
Emergency room visit (moderately high): 10 of 14 insurance plan rates
  • Aetna — Broad: $4,000
  • Anthem — HIX: $1,790
  • Anthem — HMO: $2,462
  • Anthem — HPN: $2,451
  • Anthem — PPO: $2,462
  • Bright Health — COMM: $1,961
  • Cigna — HMO: $3,488
  • Cigna — IFP: $2,640
  • Cigna — PPO: $3,488
  • Johns Hopkins — UniformedServicesFamilyHealthPlan: $500
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · modifier ER In the file: LVL 4 FREE STD EMER DEPT $3,814.56 $3,814.56 $1,068.08 – $3,433.10
Emergency room visit (moderately high): 10 of 14 insurance plan rates
  • 4Most Health Nework — COMM: $3,433.10
  • CorVel — WorkersComp: $2,746.48
  • Greenvbrier Sporting Club — COMM: $2,288.74
  • Kaiser — COMM: $2,059.86
  • Multiplan — MPI: $2,441.32
  • Multiplan — PHCS: $2,441.32
  • OccuNet Workers Comp — WorkersComp: $3,051.65
  • Three Rivers Provider Network — COMM: $3,433.10
  • Three Rivers Provider Network — WorkersComp: $3,433.10
  • United — GlobalBenefitPlan: $1,716.55
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: LVL 5 EMER DEPT $4,986.36 $4,986.36 $1,396.18 – $4,487.72
Emergency room visit (high): 10 of 14 insurance plan rates
  • 4Most Health Nework — COMM: $4,487.72
  • CorVel — WorkersComp: $3,590.18
  • Greenvbrier Sporting Club — COMM: $2,991.82
  • Kaiser — COMM: $2,692.63
  • Multiplan — MPI: $3,191.27
  • Multiplan — PHCS: $3,191.27
  • OccuNet Workers Comp — WorkersComp: $3,989.09
  • Three Rivers Provider Network — COMM: $4,487.72
  • Three Rivers Provider Network — WorkersComp: $4,487.72
  • United — GlobalBenefitPlan: $2,243.86
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination Not listed in the file Not listed in the file $4,060
Emergency room visit (high): 10 of 14 insurance plan rates
  • Aetna — Broad: $4,060
  • Anthem — HIX: $2,642
  • Anthem — HMO: $3,634
  • Anthem — HPN: $3,618
  • Anthem — PPO: $3,634
  • Bright Health — COMM: $2,329
  • Cigna — HMO: $4,392
  • Cigna — IFP: $3,731
  • Cigna — PPO: $4,392
  • Johns Hopkins — UniformedServicesFamilyHealthPlan: $500
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · modifier ER In the file: LVL 5 FREE STD EMER DEPT $4,986.36 $4,986.36 $1,396.18 – $4,487.72
Emergency room visit (high): 10 of 14 insurance plan rates
  • 4Most Health Nework — COMM: $4,487.72
  • CorVel — WorkersComp: $3,590.18
  • Greenvbrier Sporting Club — COMM: $2,991.82
  • Kaiser — COMM: $2,692.63
  • Multiplan — MPI: $3,191.27
  • Multiplan — PHCS: $3,191.27
  • OccuNet Workers Comp — WorkersComp: $3,989.09
  • Three Rivers Provider Network — COMM: $4,487.72
  • Three Rivers Provider Network — WorkersComp: $4,487.72
  • United — GlobalBenefitPlan: $2,243.86

Lab tests

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Ch $749.52 $749.52 $8.40 – $42
Basic metabolic panel (blood test): 10 of 26 insurance plan rates
  • Aetna — MGMCR: $8.56
  • Align Senior Care — MGMCR: $9.05
  • Anthem — HIX: $32.27
  • Anthem — HMO: $44.40
  • Anthem — HPN: $44.20
  • Anthem — MGMCR: $8.71
  • Anthem — PPO: $44.40
  • Bright Health — COMM: $18.10
  • Cigna — HMO: $34.22
  • Cigna — IFP: $42
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: BMP TOTAL CALCIUM $749.52 $749.52 $142.41 – $674.57
Basic metabolic panel (blood test): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $674.57
  • Aetna — Broad: $262.33
  • CorVel — WorkersComp: $539.65
  • Greenvbrier Sporting Club — COMM: $449.71
  • Kaiser — COMM: $404.74
  • Lifeworks — MCR: $142.41
  • Multiplan — MPI: $479.69
  • Multiplan — PHCS: $479.69
  • OccuNet Workers Comp — WorkersComp: $599.62
  • Three Rivers Provider Network — COMM: $674.57
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: COMP METABOLIC PANEL $1,158.84 $1,158.84 $220.18 – $1,042.96
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $1,042.96
  • Aetna — Broad: $405.59
  • CorVel — WorkersComp: $834.36
  • Greenvbrier Sporting Club — COMM: $695.30
  • Kaiser — COMM: $625.77
  • Lifeworks — MCR: $220.18
  • Multiplan — MPI: $741.66
  • Multiplan — PHCS: $741.66
  • OccuNet Workers Comp — WorkersComp: $927.07
  • Three Rivers Provider Network — COMM: $1,042.96
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon Not listed in the file Not listed in the file $10.56 – $55.42
Comprehensive metabolic panel (blood test): 10 of 26 insurance plan rates
  • Aetna — MGMCR: $10.68
  • Align Senior Care — MGMCR: $11.30
  • Anthem — HIX: $40.29
  • Anthem — HMO: $55.42
  • Anthem — HPN: $55.17
  • Anthem — MGMCR: $10.88
  • Anthem — PPO: $55.42
  • Bright Health — COMM: $22.60
  • Cigna — HMO: $42.66
  • Cigna — IFP: $52.36
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or Not listed in the file Not listed in the file $47.81 – $250.91
Obstetric blood test panel: 10 of 26 insurance plan rates
  • Aetna — MGMCR: $48.36
  • Align Senior Care — MGMCR: $51.16
  • Anthem — HIX: $182.40
  • Anthem — HMO: $250.91
  • Anthem — HPN: $249.76
  • Anthem — MGMCR: $49.24
  • Anthem — PPO: $250.91
  • Bright Health — COMM: $102.31
  • Cigna — HMO: $193.31
  • Cigna — IFP: $237.24
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholester $867.24 $867.24 $13.39 – $70.27
Cholesterol panel (lipid panel): 10 of 26 insurance plan rates
  • Aetna — MGMCR: $13.54
  • Align Senior Care — MGMCR: $14.33
  • Anthem — HIX: $51.08
  • Anthem — HMO: $70.27
  • Anthem — HPN: $69.95
  • Anthem — MGMCR: $13.79
  • Anthem — PPO: $70.27
  • Bright Health — COMM: $28.65
  • Cigna — HMO: $54.11
  • Cigna — IFP: $66.41
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: LIPID PANEL $867.24 $867.24 $164.78 – $780.52
Cholesterol panel (lipid panel): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $780.52
  • Aetna — Broad: $303.53
  • CorVel — WorkersComp: $624.41
  • Greenvbrier Sporting Club — COMM: $520.34
  • Kaiser — COMM: $468.31
  • Lifeworks — MCR: $164.78
  • Multiplan — MPI: $555.03
  • Multiplan — PHCS: $555.03
  • OccuNet Workers Comp — WorkersComp: $693.79
  • Three Rivers Provider Network — COMM: $780.52
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chlo $867.24 $867.24 $9.03
Kidney function panel: 10 of 26 insurance plan rates
  • Aetna — MGMCR: $8.78
  • Align Senior Care — MGMCR: $9.29
  • Anthem — HIX: $33.11
  • Anthem — HMO: $45.55
  • Anthem — HPN: $45.34
  • Anthem — MGMCR: $8.94
  • Anthem — PPO: $45.55
  • Bright Health — COMM: $18.58
  • Cigna — HMO: $35.07
  • Cigna — IFP: $43.04
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL FUNCTION PANEL $867.24 $867.24 $164.78 – $780.52
Kidney function panel: 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $780.52
  • Aetna — Broad: $303.53
  • CorVel — WorkersComp: $624.41
  • Greenvbrier Sporting Club — COMM: $520.34
  • Kaiser — COMM: $468.31
  • Lifeworks — MCR: $164.78
  • Multiplan — MPI: $555.03
  • Multiplan — PHCS: $555.03
  • OccuNet Workers Comp — WorkersComp: $693.79
  • Three Rivers Provider Network — COMM: $780.52
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase $654.48 $654.48 $8.17 – $42.88
Liver function panel: 10 of 26 insurance plan rates
  • Aetna — MGMCR: $8.26
  • Align Senior Care — MGMCR: $8.74
  • Anthem — HIX: $31.17
  • Anthem — HMO: $42.88
  • Anthem — HPN: $42.68
  • Anthem — MGMCR: $8.42
  • Anthem — PPO: $42.88
  • Bright Health — COMM: $17.48
  • Cigna — HMO: $33.03
  • Cigna — IFP: $40.54
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HEPATIC FUNCTION PANEL $654.48 $654.48 $124.35 – $589.03
Liver function panel: 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $589.03
  • Aetna — Broad: $229.07
  • CorVel — WorkersComp: $471.23
  • Greenvbrier Sporting Club — COMM: $392.69
  • Kaiser — COMM: $353.42
  • Lifeworks — MCR: $124.35
  • Multiplan — MPI: $418.87
  • Multiplan — PHCS: $418.87
  • OccuNet Workers Comp — WorkersComp: $523.58
  • Three Rivers Provider Network — COMM: $589.03
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, $270 $270 $3.17 – $16.64
Urine test (automated, with microscope): 10 of 26 insurance plan rates
  • Aetna — MGMCR: $3.21
  • Align Senior Care — MGMCR: $3.39
  • Anthem — HIX: $12.09
  • Anthem — HMO: $16.64
  • Anthem — HPN: $16.56
  • Anthem — MGMCR: $3.27
  • Anthem — PPO: $16.64
  • Bright Health — COMM: $6.78
  • Cigna — HMO: $12.80
  • Cigna — IFP: $15.71
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: UA W MICRO AUTO $270 $270 $51.30 – $243
Urine test (automated, with microscope): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $243
  • Aetna — Broad: $94.50
  • CorVel — WorkersComp: $194.40
  • Greenvbrier Sporting Club — COMM: $162
  • Kaiser — COMM: $145.80
  • Lifeworks — MCR: $51.30
  • Multiplan — MPI: $172.80
  • Multiplan — PHCS: $172.80
  • OccuNet Workers Comp — WorkersComp: $216
  • Three Rivers Provider Network — COMM: $243
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, Not listed in the file Not listed in the file $3.48 – $18.26
Urine test (manual, without microscope): 10 of 26 insurance plan rates
  • Aetna — MGMCR: $3.52
  • Align Senior Care — MGMCR: $3.72
  • Anthem — HIX: $13.28
  • Anthem — HMO: $18.26
  • Anthem — HPN: $18.18
  • Anthem — MGMCR: $3.58
  • Anthem — PPO: $18.26
  • Bright Health — COMM: $7.45
  • Cigna — HMO: $14.06
  • Cigna — IFP: $17.26
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: UA W O MICRO AUTO $131.76 $131.76 $25.03 – $118.58
Urine test (automated, without microscope): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $118.58
  • Aetna — Broad: $46.12
  • CorVel — WorkersComp: $94.87
  • Greenvbrier Sporting Club — COMM: $79.06
  • Kaiser — COMM: $71.15
  • Lifeworks — MCR: $25.03
  • Multiplan — MPI: $84.33
  • Multiplan — PHCS: $84.33
  • OccuNet Workers Comp — WorkersComp: $105.41
  • Three Rivers Provider Network — COMM: $118.58
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, Not listed in the file Not listed in the file $2.25 – $11.81
Urine test (automated, without microscope): 10 of 26 insurance plan rates
  • Aetna — MGMCR: $2.28
  • Align Senior Care — MGMCR: $2.41
  • Anthem — HIX: $8.58
  • Anthem — HMO: $11.81
  • Anthem — HPN: $11.75
  • Anthem — MGMCR: $2.32
  • Anthem — PPO: $11.81
  • Bright Health — COMM: $4.82
  • Cigna — HMO: $9.07
  • Cigna — IFP: $11.14
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: Prostate specific antigen (PSA); total $608.04 $608.04 $18.39 – $96.51
PSA (prostate specific antigen) blood test: 10 of 26 insurance plan rates
  • Aetna — MGMCR: $18.60
  • Align Senior Care — MGMCR: $19.68
  • Anthem — HIX: $70.16
  • Anthem — HMO: $96.51
  • Anthem — HPN: $96.07
  • Anthem — MGMCR: $18.94
  • Anthem — PPO: $96.51
  • Bright Health — COMM: $39.35
  • Cigna — HMO: $74.32
  • Cigna — IFP: $91.21
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PROS SPEC AG (PSA) TOTAL $608.04 $608.04 $115.53 – $547.24
PSA (prostate specific antigen) blood test: 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $547.24
  • Aetna — Broad: $212.81
  • CorVel — WorkersComp: $437.79
  • Greenvbrier Sporting Club — COMM: $364.82
  • Kaiser — COMM: $328.34
  • Lifeworks — MCR: $115.53
  • Multiplan — MPI: $389.15
  • Multiplan — PHCS: $389.15
  • OccuNet Workers Comp — WorkersComp: $486.43
  • Three Rivers Provider Network — COMM: $547.24
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: Thyroid stimulating hormone (TSH) $832.68 $832.68 $16.80 – $88.17
Thyroid stimulating hormone (TSH) test: 10 of 26 insurance plan rates
  • Aetna — MGMCR: $16.99
  • Align Senior Care — MGMCR: $17.98
  • Anthem — HIX: $64.09
  • Anthem — HMO: $88.17
  • Anthem — HPN: $87.76
  • Anthem — MGMCR: $17.30
  • Anthem — PPO: $88.17
  • Bright Health — COMM: $35.95
  • Cigna — HMO: $67.91
  • Cigna — IFP: $83.34
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: TSH $832.68 $832.68 $158.21 – $749.41
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $749.41
  • Aetna — Broad: $291.44
  • CorVel — WorkersComp: $599.53
  • Greenvbrier Sporting Club — COMM: $499.61
  • Kaiser — COMM: $449.65
  • Lifeworks — MCR: $158.21
  • Multiplan — MPI: $532.92
  • Multiplan — PHCS: $532.92
  • OccuNet Workers Comp — WorkersComp: $666.14
  • Three Rivers Provider Network — COMM: $749.41
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count Not listed in the file Not listed in the file $7.77 – $40.78
Complete blood count (CBC) with differential: 10 of 26 insurance plan rates
  • Aetna — MGMCR: $7.86
  • Align Senior Care — MGMCR: $8.31
  • Anthem — HIX: $29.64
  • Anthem — HMO: $40.78
  • Anthem — HPN: $40.59
  • Anthem — MGMCR: $8
  • Anthem — PPO: $40.78
  • Bright Health — COMM: $16.63
  • Cigna — HMO: $31.41
  • Cigna — IFP: $38.55
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: CBC AUTOMATED $245.16 $245.16 $46.58 – $220.64
Complete blood count (CBC), automated: 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $220.64
  • Aetna — Broad: $85.81
  • CorVel — WorkersComp: $176.52
  • Greenvbrier Sporting Club — COMM: $147.10
  • Kaiser — COMM: $132.39
  • Lifeworks — MCR: $46.58
  • Multiplan — MPI: $156.90
  • Multiplan — PHCS: $156.90
  • OccuNet Workers Comp — WorkersComp: $196.13
  • Three Rivers Provider Network — COMM: $220.64
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) Not listed in the file Not listed in the file $6.47 – $33.95
Complete blood count (CBC), automated: 10 of 26 insurance plan rates
  • Aetna — MGMCR: $6.54
  • Align Senior Care — MGMCR: $6.92
  • Anthem — HIX: $24.68
  • Anthem — HMO: $33.95
  • Anthem — HPN: $33.80
  • Anthem — MGMCR: $6.66
  • Anthem — PPO: $33.95
  • Bright Health — COMM: $13.85
  • Cigna — HMO: $26.18
  • Cigna — IFP: $32.14
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PROTIME $287.28 $287.28 $54.58 – $258.55
Blood clotting time test (prothrombin time, PT): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $258.55
  • Aetna — Broad: $100.55
  • CorVel — WorkersComp: $206.84
  • Greenvbrier Sporting Club — COMM: $172.37
  • Kaiser — COMM: $155.13
  • Lifeworks — MCR: $54.58
  • Multiplan — MPI: $183.86
  • Multiplan — PHCS: $183.86
  • OccuNet Workers Comp — WorkersComp: $229.82
  • Three Rivers Provider Network — COMM: $258.55
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: Prothrombin time; Not listed in the file Not listed in the file $4.29 – $22.51
Blood clotting time test (prothrombin time, PT): 10 of 26 insurance plan rates
  • Aetna — MGMCR: $4.34
  • Align Senior Care — MGMCR: $4.59
  • Anthem — HIX: $16.37
  • Anthem — HMO: $22.51
  • Anthem — HPN: $22.41
  • Anthem — MGMCR: $4.42
  • Anthem — PPO: $22.51
  • Bright Health — COMM: $9.18
  • Cigna — HMO: $17.35
  • Cigna — IFP: $21.29
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: PTT $287.28 $287.28 $54.58 – $258.55
Blood clotting test (partial thromboplastin time, PTT): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $258.55
  • Aetna — Broad: $100.55
  • CorVel — WorkersComp: $206.84
  • Greenvbrier Sporting Club — COMM: $172.37
  • Kaiser — COMM: $155.13
  • Lifeworks — MCR: $54.58
  • Multiplan — MPI: $183.86
  • Multiplan — PHCS: $183.86
  • OccuNet Workers Comp — WorkersComp: $229.82
  • Three Rivers Provider Network — COMM: $258.55
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: Thromboplastin time, partial (PTT); plasma or whole blood Not listed in the file Not listed in the file $6.01 – $31.54
Blood clotting test (partial thromboplastin time, PTT): 10 of 26 insurance plan rates
  • Aetna — MGMCR: $6.08
  • Align Senior Care — MGMCR: $6.43
  • Anthem — HIX: $22.93
  • Anthem — HMO: $31.54
  • Anthem — HPN: $31.40
  • Anthem — MGMCR: $6.19
  • Anthem — PPO: $31.54
  • Bright Health — COMM: $12.86
  • Cigna — HMO: $24.32
  • Cigna — IFP: $29.85

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) In the file: CT HEAD/BRAIN W/O CONT $3,669.12 $3,669.12 $697.13 – $3,302.21
CT scan of the head or brain, without contrast: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $3,302.21
  • CorVel — WorkersComp: $2,641.77
  • Greenvbrier Sporting Club — COMM: $2,201.47
  • Kaiser — COMM: $1,981.32
  • Lifeworks — MCR: $697.13
  • Multiplan — MPI: $2,348.24
  • Multiplan — PHCS: $2,348.24
  • OccuNet Workers Comp — WorkersComp: $2,935.30
  • Three Rivers Provider Network — COMM: $3,302.21
  • Three Rivers Provider Network — WorkersComp: $3,302.21
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: Computed tomography, head or brain; without contrast material $3,669.12 $3,669.12 $283.08 – $389.54
CT scan of the head or brain, without contrast: rates for 9 insurance plans
  • Aetna — Broad: $1,892
  • Anthem — HIX: $283.08
  • Anthem — HMO: $389.54
  • Anthem — HPN: $387.76
  • Anthem — PPO: $389.54
  • United — AllPayerAppendix: $245.18
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · modifier 26 In the file: Computed tomography, head or brain; without contrast material Not listed in the file Not listed in the file $101.73 – $139.99
CT scan of the head or brain, without contrast: rates for 4 insurance plans
  • Anthem — HIX: $101.73
  • Anthem — HMO: $139.99
  • Anthem — HPN: $139.35
  • Anthem — PPO: $139.99
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN W&WO CONT $7,782.60 $7,782.60 $1,478.69 – $7,004.34
MRI of the brain, before and after contrast: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $7,004.34
  • CorVel — WorkersComp: $5,603.47
  • Greenvbrier Sporting Club — COMM: $4,669.56
  • Kaiser — COMM: $4,202.60
  • Lifeworks — MCR: $1,478.69
  • Multiplan — MPI: $4,980.86
  • Multiplan — PHCS: $4,980.86
  • OccuNet Workers Comp — WorkersComp: $6,226.08
  • Three Rivers Provider Network — COMM: $7,004.34
  • Three Rivers Provider Network — WorkersComp: $7,004.34
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and furth $7,782.60 $7,782.60 $843.64 – $1,160.92
MRI of the brain, before and after contrast: rates for 9 insurance plans
  • Aetna — Broad: $1,992
  • Anthem — HIX: $843.64
  • Anthem — HMO: $1,160.92
  • Anthem — HPN: $1,155.61
  • Anthem — PPO: $1,160.92
  • United — AllPayerAppendix: $828.27
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · modifier 26 In the file: Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and furth Not listed in the file Not listed in the file $271.59 – $373.73
MRI of the brain, before and after contrast: rates for 4 insurance plans
  • Anthem — HIX: $271.59
  • Anthem — HMO: $373.73
  • Anthem — HPN: $372.02
  • Anthem — PPO: $373.73
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: CHEST XRAY 2 V $933.92 $933.92 $177.44 – $840.53
Chest X-ray, 2 views: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $840.53
  • CorVel — WorkersComp: $672.42
  • Greenvbrier Sporting Club — COMM: $560.35
  • Kaiser — COMM: $504.32
  • Lifeworks — MCR: $177.44
  • Multiplan — MPI: $597.71
  • Multiplan — PHCS: $597.71
  • OccuNet Workers Comp — WorkersComp: $747.14
  • Three Rivers Provider Network — COMM: $840.53
  • Three Rivers Provider Network — WorkersComp: $840.53
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: Radiologic examination, chest; 2 views $933.92 $933.92 $88.03 – $182.03
Chest X-ray, 2 views: 10 of 12 insurance plan rates
  • Anthem — HIX: $88.03
  • Anthem — HMO: $121.14
  • Anthem — HPN: $120.58
  • Anthem — PPO: $121.14
  • Cigna — HMO: $142.13
  • Cigna — IFP: $174.43
  • Cigna — PPO: $142.13
  • United — AllPayerAppendix: $182.03
  • Aetna — Broad: 35% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · modifier TC In the file: Radiologic examination, chest; 2 views $933.92 $933.92 $62.10 – $85.46
Chest X-ray, 2 views: rates for 4 insurance plans
  • Anthem — HIX: $62.10
  • Anthem — HMO: $85.46
  • Anthem — HPN: $85.07
  • Anthem — PPO: $85.46
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: XR L-SPINE 4 + VIEWS $1,333.28 $1,333.28 $253.32 – $1,199.95
X-ray of the lower spine, at least 4 views: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $1,199.95
  • CorVel — WorkersComp: $959.96
  • Greenvbrier Sporting Club — COMM: $799.97
  • Kaiser — COMM: $719.97
  • Lifeworks — MCR: $253.32
  • Multiplan — MPI: $853.30
  • Multiplan — PHCS: $853.30
  • OccuNet Workers Comp — WorkersComp: $1,066.62
  • Three Rivers Provider Network — COMM: $1,199.95
  • Three Rivers Provider Network — WorkersComp: $1,199.95
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: Radiologic examination, spine, lumbosacral; minimum of 4 views $1,333.28 $1,333.28 $142.71 – $245.18
X-ray of the lower spine, at least 4 views: 10 of 12 insurance plan rates
  • Anthem — HIX: $142.71
  • Anthem — HMO: $196.38
  • Anthem — HPN: $195.48
  • Anthem — PPO: $196.38
  • Cigna — HMO: $241.95
  • Cigna — IFP: $296.94
  • Cigna — PPO: $241.95
  • United — AllPayerAppendix: $245.18
  • Aetna — Broad: 35% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · modifier TC In the file: Radiologic examination, spine, lumbosacral; minimum of 4 views $1,333.28 $1,333.28 $109.97 – $151.32
X-ray of the lower spine, at least 4 views: rates for 4 insurance plans
  • Anthem — HIX: $109.97
  • Anthem — HMO: $151.32
  • Anthem — HPN: $150.63
  • Anthem — PPO: $151.32
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI L-SPINE W/O CONT $7,983.16 $7,983.16 $1,516.80 – $7,184.84
MRI of the lower back (lumbar spine), without contrast: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $7,184.84
  • CorVel — WorkersComp: $5,747.88
  • Greenvbrier Sporting Club — COMM: $4,789.90
  • Kaiser — COMM: $4,310.91
  • Lifeworks — MCR: $1,516.80
  • Multiplan — MPI: $5,109.22
  • Multiplan — PHCS: $5,109.22
  • OccuNet Workers Comp — WorkersComp: $6,386.53
  • Three Rivers Provider Network — COMM: $7,184.84
  • Three Rivers Provider Network — WorkersComp: $7,184.84
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material $7,983.16 $7,983.16 $1,992
MRI of the lower back (lumbar spine), without contrast: rates for 9 insurance plans
  • Aetna — Broad: $1,992
  • Anthem — HIX: $509.80
  • Anthem — HMO: $701.52
  • Anthem — HPN: $698.32
  • Anthem — PPO: $701.52
  • United — AllPayerAppendix: $517.79
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · modifier TC In the file: Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material Not listed in the file Not listed in the file $332.87 – $458.06
MRI of the lower back (lumbar spine), without contrast: rates for 4 insurance plans
  • Anthem — HIX: $332.87
  • Anthem — HMO: $458.06
  • Anthem — HPN: $455.97
  • Anthem — PPO: $458.06
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W/CONTRAST $4,235.92 $4,235.92 $804.82 – $3,812.33
CT scan of the pelvis, with contrast: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $3,812.33
  • CorVel — WorkersComp: $3,049.86
  • Greenvbrier Sporting Club — COMM: $2,541.55
  • Kaiser — COMM: $2,287.40
  • Lifeworks — MCR: $804.82
  • Multiplan — MPI: $2,710.99
  • Multiplan — PHCS: $2,710.99
  • OccuNet Workers Comp — WorkersComp: $3,388.74
  • Three Rivers Provider Network — COMM: $3,812.33
  • Three Rivers Provider Network — WorkersComp: $3,812.33
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: Computed tomography, pelvis; with contrast material(s) $4,235.92 $4,235.92 $401.74
CT scan of the pelvis, with contrast: rates for 9 insurance plans
  • Aetna — Broad: $1,892
  • Anthem — HIX: $603.55
  • Anthem — HMO: $830.53
  • Anthem — HPN: $826.73
  • Anthem — PPO: $830.53
  • United — AllPayerAppendix: $401.74
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · modifier TC In the file: Computed tomography, pelvis; with contrast material(s) Not listed in the file Not listed in the file $465.67 – $640.80
CT scan of the pelvis, with contrast: rates for 4 insurance plans
  • Anthem — HIX: $465.67
  • Anthem — HMO: $640.80
  • Anthem — HPN: $637.87
  • Anthem — PPO: $640.80
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material Not listed in the file Not listed in the file $517.79
MRI of a leg joint (such as the knee), without contrast: rates for 9 insurance plans
  • Aetna — Broad: $1,992
  • Anthem — HIX: $544.88
  • Anthem — HMO: $749.80
  • Anthem — HPN: $746.37
  • Anthem — PPO: $749.80
  • United — AllPayerAppendix: $517.79
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier RT In the file: MRI LW JNT W/O CONT RT $10,051.98 $10,051.98 $1,909.88 – $9,046.78
MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $9,046.78
  • CorVel — WorkersComp: $7,237.43
  • Greenvbrier Sporting Club — COMM: $6,031.19
  • Kaiser — COMM: $5,428.07
  • Lifeworks — MCR: $1,909.88
  • Multiplan — MPI: $6,433.27
  • Multiplan — PHCS: $6,433.27
  • OccuNet Workers Comp — WorkersComp: $8,041.58
  • Three Rivers Provider Network — COMM: $9,046.78
  • Three Rivers Provider Network — WorkersComp: $9,046.78
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier LT In the file: MRI LW JNT W/O CONT LT $10,051.98 $10,051.98 $1,909.88 – $9,046.78
MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $9,046.78
  • CorVel — WorkersComp: $7,237.43
  • Greenvbrier Sporting Club — COMM: $6,031.19
  • Kaiser — COMM: $5,428.07
  • Lifeworks — MCR: $1,909.88
  • Multiplan — MPI: $6,433.27
  • Multiplan — PHCS: $6,433.27
  • OccuNet Workers Comp — WorkersComp: $8,041.58
  • Three Rivers Provider Network — COMM: $9,046.78
  • Three Rivers Provider Network — WorkersComp: $9,046.78
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABD&PELVIS W/CONT $5,869.76 $5,869.76 $1,115.25 – $5,282.78
CT scan of the abdomen and pelvis, with contrast: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $5,282.78
  • CorVel — WorkersComp: $4,226.23
  • Greenvbrier Sporting Club — COMM: $3,521.86
  • Kaiser — COMM: $3,169.67
  • Lifeworks — MCR: $1,115.25
  • Multiplan — MPI: $3,756.65
  • Multiplan — PHCS: $3,756.65
  • OccuNet Workers Comp — WorkersComp: $4,695.81
  • Three Rivers Provider Network — COMM: $5,282.78
  • Three Rivers Provider Network — WorkersComp: $5,282.78
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: Computed tomography, abdomen and pelvis; with contrast material(s) $5,869.76 $5,869.76 $828.27
CT scan of the abdomen and pelvis, with contrast: rates for 9 insurance plans
  • Aetna — Broad: $1,892
  • Anthem — HIX: $801.21
  • Anthem — HMO: $1,102.53
  • Anthem — HPN: $1,097.49
  • Anthem — PPO: $1,102.53
  • United — AllPayerAppendix: $828.27
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · modifier TC In the file: Computed tomography, abdomen and pelvis; with contrast material(s) Not listed in the file Not listed in the file $584.91 – $804.89
CT scan of the abdomen and pelvis, with contrast: rates for 4 insurance plans
  • Anthem — HIX: $584.91
  • Anthem — HMO: $804.89
  • Anthem — HPN: $801.21
  • Anthem — PPO: $804.89
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US ABDOMEN COMPLETE $2,920.32 $2,920.32 $554.86 – $2,628.29
Ultrasound of the abdomen, complete: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $2,628.29
  • CorVel — WorkersComp: $2,102.63
  • Greenvbrier Sporting Club — COMM: $1,752.19
  • Kaiser — COMM: $1,576.97
  • Lifeworks — MCR: $554.86
  • Multiplan — MPI: $1,869
  • Multiplan — PHCS: $1,869
  • OccuNet Workers Comp — WorkersComp: $2,336.26
  • Three Rivers Provider Network — COMM: $2,628.29
  • Three Rivers Provider Network — WorkersComp: $2,628.29
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: Ultrasound, abdominal, real time with image documentation; complete $2,920.32 $2,920.32 $304.02 – $418.36
Ultrasound of the abdomen, complete: 10 of 12 insurance plan rates
  • Anthem — HIX: $304.02
  • Anthem — HMO: $418.36
  • Anthem — HPN: $416.45
  • Anthem — PPO: $418.36
  • Cigna — HMO: $479.81
  • Cigna — IFP: $588.86
  • Cigna — PPO: $479.81
  • United — AllPayerAppendix: $245.18
  • Aetna — Broad: 35% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · modifier TC In the file: Ultrasound, abdominal, real time with image documentation; complete $2,920.32 $2,920.32 $207.30 – $285.26
Ultrasound of the abdomen, complete: rates for 4 insurance plans
  • Anthem — HIX: $207.30
  • Anthem — HMO: $285.26
  • Anthem — HPN: $283.96
  • Anthem — PPO: $285.26
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: US PREG AFTER 1ST TRI $1,823.22 $1,823.22 $346.41 – $1,640.90
Pregnancy ultrasound (after the first trimester): 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $1,640.90
  • CorVel — WorkersComp: $1,312.72
  • Greenvbrier Sporting Club — COMM: $1,093.93
  • Kaiser — COMM: $984.54
  • Lifeworks — MCR: $346.41
  • Multiplan — MPI: $1,166.86
  • Multiplan — PHCS: $1,166.86
  • OccuNet Workers Comp — WorkersComp: $1,458.58
  • Three Rivers Provider Network — COMM: $1,640.90
  • Three Rivers Provider Network — WorkersComp: $1,640.90
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 day Not listed in the file Not listed in the file $361.73 – $497.77
Pregnancy ultrasound (after the first trimester): 10 of 12 insurance plan rates
  • Anthem — HIX: $361.73
  • Anthem — HMO: $497.77
  • Anthem — HPN: $495.49
  • Anthem — PPO: $497.77
  • Cigna — HMO: $542.98
  • Cigna — IFP: $666.38
  • Cigna — PPO: $542.98
  • United — AllPayerAppendix: $245.18
  • Aetna — Broad: 35% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · modifier TC In the file: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 day Not listed in the file Not listed in the file $239.81 – $330
Pregnancy ultrasound (after the first trimester): rates for 4 insurance plans
  • Anthem — HIX: $239.81
  • Anthem — HMO: $330
  • Anthem — HPN: $328.49
  • Anthem — PPO: $330
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: US TRANSVAGINAL $937.04 $937.04 $178.04 – $843.34
Transvaginal ultrasound: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $843.34
  • CorVel — WorkersComp: $674.67
  • Greenvbrier Sporting Club — COMM: $562.22
  • Kaiser — COMM: $506
  • Lifeworks — MCR: $178.04
  • Multiplan — MPI: $599.71
  • Multiplan — PHCS: $599.71
  • OccuNet Workers Comp — WorkersComp: $749.63
  • Three Rivers Provider Network — COMM: $843.34
  • Three Rivers Provider Network — WorkersComp: $843.34
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: Ultrasound, transvaginal Not listed in the file Not listed in the file $245.18 – $431.51
Transvaginal ultrasound: 10 of 12 insurance plan rates
  • Anthem — HIX: $313.58
  • Anthem — HMO: $431.51
  • Anthem — HPN: $429.54
  • Anthem — PPO: $431.51
  • Cigna — HMO: $530.75
  • Cigna — IFP: $651.38
  • Cigna — PPO: $530.75
  • United — AllPayerAppendix: $245.18
  • Aetna — Broad: 35% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · modifier 26 In the file: Ultrasound, transvaginal Not listed in the file Not listed in the file $83.71 – $115.19
Transvaginal ultrasound: rates for 4 insurance plans
  • Anthem — HIX: $83.71
  • Anthem — HMO: $115.19
  • Anthem — HPN: $114.66
  • Anthem — PPO: $115.19
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral Not listed in the file Not listed in the file $88
Diagnostic mammogram, one breast: 10 of 26 insurance plan rates
  • Aetna — MGMCR: $85.58
  • Align Senior Care — MGMCR: $90.54
  • Anthem — HIX: $330.23
  • Anthem — HMO: $454.43
  • Anthem — HPN: $452.35
  • Anthem — MGMCR: $87.16
  • Anthem — PPO: $454.43
  • Cigna — HMO: $533.27
  • Cigna — IFP: $654.47
  • Cigna — PPO: $533.27
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · modifier RT In the file: MAMMO DIAG CAD UNI RT $614.64 $614.64 $116.78 – $553.18
Diagnostic mammogram, one breast: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $553.18
  • CorVel — WorkersComp: $442.54
  • Greenvbrier Sporting Club — COMM: $368.78
  • Kaiser — COMM: $331.91
  • Lifeworks — MCR: $116.78
  • Multiplan — MPI: $393.37
  • Multiplan — PHCS: $393.37
  • OccuNet Workers Comp — WorkersComp: $491.71
  • Three Rivers Provider Network — COMM: $553.18
  • Three Rivers Provider Network — WorkersComp: $553.18
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · modifier LT In the file: MAMMO DIAG CAD UNI LT $614.64 $614.64 $116.78 – $553.18
Diagnostic mammogram, one breast: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $553.18
  • CorVel — WorkersComp: $442.54
  • Greenvbrier Sporting Club — COMM: $368.78
  • Kaiser — COMM: $331.91
  • Lifeworks — MCR: $116.78
  • Multiplan — MPI: $393.37
  • Multiplan — PHCS: $393.37
  • OccuNet Workers Comp — WorkersComp: $491.71
  • Three Rivers Provider Network — COMM: $553.18
  • Three Rivers Provider Network — WorkersComp: $553.18
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral $684.32 $684.32 $112.83
Diagnostic mammogram, both breasts: 10 of 26 insurance plan rates
  • Aetna — MGMCR: $109.73
  • Align Senior Care — MGMCR: $116.08
  • Anthem — HIX: $418.34
  • Anthem — HMO: $575.67
  • Anthem — HPN: $573.03
  • Anthem — MGMCR: $111.74
  • Anthem — PPO: $575.67
  • Cigna — HMO: $683.53
  • Cigna — IFP: $838.88
  • Cigna — PPO: $683.53
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: MAMMO DIAG CAD BI $684.32 $684.32 $130.02 – $615.89
Diagnostic mammogram, both breasts: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $615.89
  • CorVel — WorkersComp: $492.71
  • Greenvbrier Sporting Club — COMM: $410.59
  • Kaiser — COMM: $369.53
  • Lifeworks — MCR: $130.02
  • Multiplan — MPI: $437.96
  • Multiplan — PHCS: $437.96
  • OccuNet Workers Comp — WorkersComp: $547.46
  • Three Rivers Provider Network — COMM: $615.89
  • Three Rivers Provider Network — WorkersComp: $615.89
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · modifier 26 In the file: Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral Not listed in the file Not listed in the file $119.80 – $164.86
Diagnostic mammogram, both breasts: rates for 4 insurance plans
  • Anthem — HIX: $119.80
  • Anthem — HMO: $164.86
  • Anthem — HPN: $164.11
  • Anthem — PPO: $164.86
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: MAMMO SCR CAD BI $684.32 $684.32 $130.02 – $615.89
Screening mammogram, both breasts: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $615.89
  • CorVel — WorkersComp: $492.71
  • Greenvbrier Sporting Club — COMM: $410.59
  • Kaiser — COMM: $369.53
  • Lifeworks — MCR: $130.02
  • Multiplan — MPI: $437.96
  • Multiplan — PHCS: $437.96
  • OccuNet Workers Comp — WorkersComp: $547.46
  • Three Rivers Provider Network — COMM: $615.89
  • Three Rivers Provider Network — WorkersComp: $615.89
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed Not listed in the file Not listed in the file $337.02 – $463.76
Screening mammogram, both breasts: 10 of 26 insurance plan rates
  • Aetna — MGMCR: $90.56
  • Align Senior Care — MGMCR: $95.81
  • Anthem — HIX: $337.02
  • Anthem — HMO: $463.76
  • Anthem — HPN: $461.64
  • Anthem — MGMCR: $92.23
  • Anthem — PPO: $463.76
  • Cigna — HMO: $563.81
  • Cigna — IFP: $691.95
  • Cigna — PPO: $563.81
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · modifier 52 In the file: MAMMO SCR CAD 1BRST $684.32 $684.32 $130.02 – $615.89
Screening mammogram, both breasts: 10 of 15 insurance plan rates
  • 4Most Health Nework — COMM: $615.89
  • CorVel — WorkersComp: $492.71
  • Greenvbrier Sporting Club — COMM: $410.59
  • Kaiser — COMM: $369.53
  • Lifeworks — MCR: $130.02
  • Multiplan — MPI: $437.96
  • Multiplan — PHCS: $437.96
  • OccuNet Workers Comp — WorkersComp: $547.46
  • Three Rivers Provider Network — COMM: $615.89
  • Three Rivers Provider Network — WorkersComp: $615.89

Heart tests and sleep study

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) In the file: Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report Not listed in the file Not listed in the file $12.38 – $12.76
Electrocardiogram (ECG/EKG) with reading: rates for 5 insurance plans
  • Humana Military — TRCR: $12.38
  • Johns Hopkins — UniformedServicesFamilyHealthPlan: $12.76
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when pe Not listed in the file Not listed in the file $9,315 – $13,359
Left heart catheterization (diagnostic): 10 of 14 insurance plan rates
  • Aetna — Broad: $12,626
  • Anthem — HIX: $9,712
  • Anthem — HMO: $13,359
  • Anthem — HPN: $13,299
  • Anthem — PPO: $13,359
  • Bright Health — COMM: $14,915
  • Cigna — HMO: $8,310
  • Cigna — IFP: $6,102
  • Cigna — PPO: $8,310
  • Lifeworks — MCR: $3,850
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recor Not listed in the file Not listed in the file $15,743 – $25,615
Heart rhythm study (electrophysiology evaluation): 10 of 11 insurance plan rates
  • Aetna — Broad: $4,327
  • Anthem — HIX: $18,622
  • Anthem — HMO: $25,615
  • Anthem — HPN: $15,743
  • Anthem — PPO: $25,615
  • Bright Health — COMM: $12,386
  • Lifeworks — MCR: $7,650
  • United — AllPayerAppendix: $17,057
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: COM EP REPO CTH TX AFIB $68,938.10 $68,938.10 $19,302.67 – $62,044.29
Heart rhythm study with ablation for atrial fibrillation: 10 of 14 insurance plan rates
  • 4Most Health Nework — COMM: $62,044.29
  • CorVel — WorkersComp: $49,635.43
  • Greenvbrier Sporting Club — COMM: $41,362.86
  • Kaiser — COMM: $37,226.57
  • Multiplan — MPI: $44,120.38
  • Multiplan — PHCS: $44,120.38
  • OccuNet Workers Comp — WorkersComp: $55,150.48
  • Three Rivers Provider Network — COMM: $62,044.29
  • Three Rivers Provider Network — WorkersComp: $62,044.29
  • United — GlobalBenefitPlan: $31,022.15
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, $68,938.10 $68,938.10 $4,943
Heart rhythm study with ablation for atrial fibrillation: 10 of 11 insurance plan rates
  • Aetna — Broad: $4,327
  • Anthem — HIX: $18,257
  • Anthem — HMO: $25,113
  • Anthem — HPN: $10,018
  • Anthem — PPO: $25,113
  • Bright Health — COMM: $4,943
  • Lifeworks — MCR: $7,650
  • United — AllPayerAppendix: $10,981
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist Not listed in the file Not listed in the file $692 – $2,747
Sleep study (overnight, in a sleep lab): rates for 9 insurance plans
  • Anthem — HIX: $1,997
  • Anthem — HMO: $2,747
  • Anthem — HPN: $2,735
  • Anthem — PPO: $2,747
  • United — AllPayerAppendix: $692
  • Aetna — Broad: 35% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)

Physical therapy and mental health

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexib Not listed in the file Not listed in the file $29.88
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 18 insurance plan rates
  • Aetna — MGMCR: $29.06
  • Align Senior Care — MGMCR: $30.74
  • Anthem — MGMCR: $29.59
  • Cigna HealthSpring — MCR: $29.88
  • Devoted — MCR: $28.73
  • Evernorth Behavioral Health — MCR: $29.88
  • Humana — MCR: $28.73
  • Humana Military — TRCR: $27.87
  • Johns Hopkins — UniformedServicesFamilyHealthPlan: $28.73
  • Sentara Health — MCR: $28.73
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier GP|CQ In the file: THER EXERCIS 15 MIN PTCQ $172.80 $172.80 $27.92 – $155.52
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $155.52
  • Bright Health — COMM: $27.92
  • CorVel — WorkersComp: $124.42
  • Greenvbrier Sporting Club — COMM: $103.68
  • Kaiser — COMM: $93.31
  • Lifeworks — MCR: $32.83
  • Multiplan — MPI: $110.59
  • Multiplan — PHCS: $110.59
  • OccuNet Workers Comp — WorkersComp: $138.24
  • Three Rivers Provider Network — COMM: $155.52
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier GP In the file: THER EXERCISES 15 MIN PT $172.80 $172.80 $27.92 – $155.52
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $155.52
  • Bright Health — COMM: $27.92
  • CorVel — WorkersComp: $124.42
  • Greenvbrier Sporting Club — COMM: $103.68
  • Kaiser — COMM: $93.31
  • Lifeworks — MCR: $32.83
  • Multiplan — MPI: $110.59
  • Multiplan — PHCS: $110.59
  • OccuNet Workers Comp — WorkersComp: $138.24
  • Three Rivers Provider Network — COMM: $155.52
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact $690.12 $690.12 $100.86
Physical therapy evaluation (low complexity): 10 of 18 insurance plan rates
  • Aetna — MGMCR: $98.09
  • Align Senior Care — MGMCR: $103.77
  • Anthem — MGMCR: $99.89
  • Cigna HealthSpring — MCR: $100.86
  • Devoted — MCR: $96.98
  • Evernorth Behavioral Health — MCR: $100.86
  • Humana — MCR: $96.98
  • Humana Military — TRCR: $94.07
  • Johns Hopkins — UniformedServicesFamilyHealthPlan: $96.98
  • Sentara Health — MCR: $96.98
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · modifier GP In the file: EVAL PT LOW COMPLEX $690.12 $690.12 $111.52 – $621.11
Physical therapy evaluation (low complexity): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $621.11
  • Bright Health — COMM: $111.52
  • CorVel — WorkersComp: $496.89
  • Greenvbrier Sporting Club — COMM: $414.07
  • Kaiser — COMM: $372.66
  • Lifeworks — MCR: $131.12
  • Multiplan — MPI: $441.68
  • Multiplan — PHCS: $441.68
  • OccuNet Workers Comp — WorkersComp: $552.10
  • Three Rivers Provider Network — COMM: $621.11
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · modifier GP|CQ In the file: Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact $690.12 $690.12 $88.76
Physical therapy evaluation (low complexity): 10 of 12 insurance plan rates
  • Aetna — MGMCR: $86.31
  • Align Senior Care — MGMCR: $91.32
  • Anthem — MGMCR: $87.90
  • Cigna HealthSpring — MCR: $88.76
  • Devoted — MCR: $85.34
  • Evernorth Behavioral Health — MCR: $88.76
  • Humana — MCR: $85.34
  • Sentara Health — MCR: $85.34
  • United — MGMCR: $85.77
  • United — VACCN: $85.34
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or $710.64 $710.64 $100.86
Physical therapy evaluation (moderate complexity): 10 of 18 insurance plan rates
  • Aetna — MGMCR: $98.09
  • Align Senior Care — MGMCR: $103.77
  • Anthem — MGMCR: $99.89
  • Cigna HealthSpring — MCR: $100.86
  • Devoted — MCR: $96.98
  • Evernorth Behavioral Health — MCR: $100.86
  • Humana — MCR: $96.98
  • Humana Military — TRCR: $94.07
  • Johns Hopkins — UniformedServicesFamilyHealthPlan: $96.98
  • Sentara Health — MCR: $96.98
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · modifier GP In the file: EVAL PT MOD COMPLEX $710.64 $710.64 $114.84 – $639.58
Physical therapy evaluation (moderate complexity): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $639.58
  • Bright Health — COMM: $114.84
  • CorVel — WorkersComp: $511.66
  • Greenvbrier Sporting Club — COMM: $426.38
  • Kaiser — COMM: $383.75
  • Lifeworks — MCR: $135.02
  • Multiplan — MPI: $454.81
  • Multiplan — PHCS: $454.81
  • OccuNet Workers Comp — WorkersComp: $568.51
  • Three Rivers Provider Network — COMM: $639.58
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · modifier GP|CQ In the file: Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or $710.64 $710.64 $88.76
Physical therapy evaluation (moderate complexity): 10 of 12 insurance plan rates
  • Aetna — MGMCR: $86.31
  • Align Senior Care — MGMCR: $91.32
  • Anthem — MGMCR: $87.90
  • Cigna HealthSpring — MCR: $88.76
  • Devoted — MCR: $85.34
  • Evernorth Behavioral Health — MCR: $88.76
  • Humana — MCR: $85.34
  • Sentara Health — MCR: $85.34
  • United — MGMCR: $85.77
  • United — VACCN: $85.34
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/o $732.24 $732.24 $100.86
Physical therapy evaluation (high complexity): 10 of 18 insurance plan rates
  • Aetna — MGMCR: $98.09
  • Align Senior Care — MGMCR: $103.77
  • Anthem — MGMCR: $99.89
  • Cigna HealthSpring — MCR: $100.86
  • Devoted — MCR: $96.98
  • Evernorth Behavioral Health — MCR: $100.86
  • Humana — MCR: $96.98
  • Humana Military — TRCR: $94.07
  • Johns Hopkins — UniformedServicesFamilyHealthPlan: $96.98
  • Sentara Health — MCR: $96.98
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · modifier GP In the file: EVAL PT HIGH COMPLEX $732.24 $732.24 $118.33 – $659.02
Physical therapy evaluation (high complexity): 10 of 16 insurance plan rates
  • 4Most Health Nework — COMM: $659.02
  • Bright Health — COMM: $118.33
  • CorVel — WorkersComp: $527.21
  • Greenvbrier Sporting Club — COMM: $439.34
  • Kaiser — COMM: $395.41
  • Lifeworks — MCR: $139.13
  • Multiplan — MPI: $468.63
  • Multiplan — PHCS: $468.63
  • OccuNet Workers Comp — WorkersComp: $585.79
  • Three Rivers Provider Network — COMM: $659.02
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · modifier GP|CQ In the file: Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/o $732.24 $732.24 $88.76
Physical therapy evaluation (high complexity): 10 of 12 insurance plan rates
  • Aetna — MGMCR: $86.31
  • Align Senior Care — MGMCR: $91.32
  • Anthem — MGMCR: $87.90
  • Cigna HealthSpring — MCR: $88.76
  • Devoted — MCR: $85.34
  • Evernorth Behavioral Health — MCR: $88.76
  • Humana — MCR: $85.34
  • Sentara Health — MCR: $85.34
  • United — MGMCR: $85.77
  • United — VACCN: $85.34
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: Psychotherapy, 30 minutes with patient Not listed in the file Not listed in the file Not listed in the file
Psychotherapy, 30 minutes: rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: Psychotherapy, 45 minutes with patient Not listed in the file Not listed in the file Not listed in the file
Psychotherapy, 45 minutes: rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: Psychotherapy, 60 minutes with patient Not listed in the file Not listed in the file Not listed in the file
Psychotherapy, 60 minutes: rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: Family psychotherapy (without the patient present), 50 minutes Not listed in the file Not listed in the file Not listed in the file
Family psychotherapy, without the patient: rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes Not listed in the file Not listed in the file Not listed in the file
Family psychotherapy, with the patient: rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: Group psychotherapy (other than of a multiple-family group) Not listed in the file Not listed in the file Not listed in the file
Group psychotherapy: rates for 3 insurance plans
  • Sentara Optima Health — HMO: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — POS: 21.4% (a percentage in the contract, not a dollar amount)
  • Sentara Optima Health — PPO: 21.4% (a percentage in the contract, not a dollar amount)

Procedures and surgery

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19 Not listed in the file Not listed in the file $3,140 – $7,208
Removal of breast growth (open surgery): 10 of 14 insurance plan rates
  • Aetna — Broad: $9,256
  • Anthem — HIX: $4,287
  • Anthem — HMO: $5,897
  • Anthem — HPN: $5,871
  • Anthem — PPO: $5,897
  • Bright Health — COMM: $3,993
  • Cigna — HMO: $4,625
  • Cigna — IFP: $3,140
  • Cigna — PPO: $4,625
  • Lifeworks — MCR: $4,950
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft Not listed in the file Not listed in the file $21,128 – $29,061
Total hip replacement: 10 of 17 insurance plan rates
  • Aetna — Broad: $46,898
  • Align Senior Care — MGMCR: $12,000
  • Anthem — HIX: $21,128
  • Anthem — HMO: $29,061
  • Anthem — HPN: $28,931
  • Anthem — PPO: $29,061
  • Bright Health — COMM: $10,932
  • Cigna — HMO: $30,393
  • Cigna — IFP: $18,695
  • Cigna — PPO: $30,393
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) Not listed in the file Not listed in the file $21,128 – $29,061
Total knee replacement: 10 of 17 insurance plan rates
  • Aetna — Broad: $46,898
  • Align Senior Care — MGMCR: $12,000
  • Anthem — HIX: $21,128
  • Anthem — HMO: $29,061
  • Anthem — HPN: $28,931
  • Anthem — PPO: $29,061
  • Bright Health — COMM: $10,932
  • Cigna — HMO: $30,393
  • Cigna — IFP: $18,695
  • Cigna — PPO: $30,393
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) rele Not listed in the file Not listed in the file $1,373 – $7,208
Shoulder arthroscopy: shaving of shoulder bone: rates for 10 insurance plans
  • Aetna — Broad: $9,256
  • Bright Health — COMM: $3,993
  • Cigna — HMO: $4,625
  • Cigna — IFP: $3,140
  • Cigna — PPO: $4,625
  • Lifeworks — MCR: $4,950
  • Sentara Optima Health — HMO: $7,208
  • Sentara Optima Health — POS: $7,208
  • Sentara Optima Health — PPO: $7,208
  • United — AllPayerAppendix: $1,373
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articula Not listed in the file Not listed in the file $4,278 – $8,403
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 14 insurance plan rates
  • Aetna — Broad: $9,256
  • Anthem — HIX: $4,287
  • Anthem — HMO: $5,897
  • Anthem — HPN: $5,871
  • Anthem — PPO: $5,897
  • Bright Health — COMM: $4,278
  • Cigna — HMO: $15,207
  • Cigna — IFP: $12,194
  • Cigna — PPO: $15,207
  • Lifeworks — MCR: $4,950
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: Tonsillectomy and adenoidectomy; younger than age 12 Not listed in the file Not listed in the file $3,993 – $7,208
Removal of tonsils and adenoids (under age 12): 10 of 13 insurance plan rates
  • Anthem — HIX: $4,960
  • Anthem — HMO: $6,822
  • Anthem — HPN: $6,791
  • Anthem — PPO: $6,822
  • Bright Health — COMM: $3,993
  • Cigna — HMO: $4,625
  • Cigna — IFP: $3,140
  • Cigna — PPO: $4,625
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $7,208
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (sep Not listed in the file Not listed in the file $1,573 – $3,701
Upper GI endoscopy (diagnostic): 10 of 13 insurance plan rates
  • Anthem — HIX: $1,743
  • Anthem — HMO: $2,396
  • Anthem — HPN: $2,385
  • Anthem — PPO: $2,396
  • Bright Health — COMM: $1,687
  • Cigna — HMO: $2,685
  • Cigna — IFP: $1,573
  • Cigna — PPO: $2,685
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $3,701
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple Not listed in the file Not listed in the file $1,743 – $5,051
Upper GI endoscopy with biopsy: 10 of 13 insurance plan rates
  • Anthem — HIX: $1,743
  • Anthem — HMO: $2,396
  • Anthem — HPN: $2,385
  • Anthem — PPO: $2,396
  • Bright Health — COMM: $2,377
  • Cigna — HMO: $3,273
  • Cigna — IFP: $2,217
  • Cigna — PPO: $3,273
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $5,051
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Not listed in the file Not listed in the file $2,377 – $5,051
Colonoscopy (diagnostic): 10 of 13 insurance plan rates
  • Anthem — HIX: $1,743
  • Anthem — HMO: $2,396
  • Anthem — HPN: $2,385
  • Anthem — PPO: $2,396
  • Bright Health — COMM: $2,377
  • Cigna — HMO: $3,273
  • Cigna — IFP: $2,217
  • Cigna — PPO: $3,273
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $5,051
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: Colonoscopy, flexible; with biopsy, single or multiple Not listed in the file Not listed in the file $2,217 – $5,051
Colonoscopy with biopsy: 10 of 13 insurance plan rates
  • Anthem — HIX: $2,235
  • Anthem — HMO: $3,074
  • Anthem — HPN: $3,060
  • Anthem — PPO: $3,074
  • Bright Health — COMM: $2,377
  • Cigna — HMO: $3,273
  • Cigna — IFP: $2,217
  • Cigna — PPO: $3,273
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $5,051
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique Not listed in the file Not listed in the file $2,217 – $5,051
Colonoscopy with removal of polyps (snare): 10 of 13 insurance plan rates
  • Anthem — HIX: $2,235
  • Anthem — HMO: $3,074
  • Anthem — HPN: $3,060
  • Anthem — PPO: $3,074
  • Bright Health — COMM: $2,377
  • Cigna — HMO: $3,273
  • Cigna — IFP: $2,217
  • Cigna — PPO: $3,273
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $5,051
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) In the file: Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and Not listed in the file Not listed in the file $2,217 – $5,051
Ultrasound of the lower bowel by endoscope: 10 of 13 insurance plan rates
  • Anthem — HIX: $2,235
  • Anthem — HMO: $3,074
  • Anthem — HPN: $3,060
  • Anthem — PPO: $3,074
  • Bright Health — COMM: $2,377
  • Cigna — HMO: $3,273
  • Cigna — IFP: $2,217
  • Cigna — PPO: $3,273
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $5,051
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk Not listed in the file Not listed in the file $1,743 – $3,273
Screening colonoscopy (not high risk): rates for 9 insurance plans
  • Anthem — HIX: $1,743
  • Anthem — HMO: $2,396
  • Anthem — HPN: $2,385
  • Anthem — PPO: $2,396
  • Bright Health — COMM: $2,377
  • Cigna — HMO: $3,273
  • Cigna — IFP: $2,217
  • Cigna — PPO: $3,273
  • United — AllPayerAppendix: $2,114
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: Laparoscopy, surgical; cholecystectomy Not listed in the file Not listed in the file $4,278 – $9,722
Gallbladder removal by laparoscope: 10 of 14 insurance plan rates
  • Aetna — Broad: $7,480
  • Anthem — HIX: $7,068
  • Anthem — HMO: $9,722
  • Anthem — HPN: $9,678
  • Anthem — PPO: $9,722
  • Bright Health — COMM: $4,278
  • Cigna — HMO: $5,943
  • Cigna — IFP: $4,474
  • Cigna — PPO: $5,943
  • Lifeworks — MCR: $4,950
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: Repair initial inguinal hernia, age 5 years or older; reducible Not listed in the file Not listed in the file $4,950
Groin (inguinal) hernia repair, age 5 or older: 10 of 13 insurance plan rates
  • Anthem — HIX: $4,287
  • Anthem — HMO: $5,897
  • Anthem — HPN: $5,871
  • Anthem — PPO: $5,897
  • Bright Health — COMM: $4,278
  • Cigna — HMO: $6,288
  • Cigna — IFP: $3,454
  • Cigna — PPO: $6,288
  • Lifeworks — MCR: $4,950
  • Sentara Optima Health — HMO: $8,403
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: Biopsy, prostate; needle or punch, single or multiple, any approach Not listed in the file Not listed in the file $2,235 – $3,074
Prostate biopsy: rates for 5 insurance plans
  • Anthem — HIX: $2,235
  • Anthem — HMO: $3,074
  • Anthem — HPN: $3,060
  • Anthem — PPO: $3,074
  • Bright Health — COMM: $2,377
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) In the file: Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed; Not listed in the file Not listed in the file $10,172 – $13,992
Prostate removal by laparoscope (radical prostatectomy): 10 of 13 insurance plan rates
  • Anthem — HIX: $10,172
  • Anthem — HMO: $13,992
  • Anthem — HPN: $13,929
  • Anthem — PPO: $13,992
  • Bright Health — COMM: $8,609
  • Cigna — HMO: $16,704
  • Cigna — IFP: $16,294
  • Cigna — PPO: $16,704
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $21,382
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C Not listed in the file Not listed in the file $2,235 – $7,208
Hysteroscopy with biopsy of the uterus lining: 10 of 14 insurance plan rates
  • Aetna — Broad: $9,256
  • Anthem — HIX: $2,235
  • Anthem — HMO: $3,074
  • Anthem — HPN: $3,060
  • Anthem — PPO: $3,074
  • Bright Health — COMM: $3,993
  • Cigna — HMO: $4,625
  • Cigna — IFP: $3,140
  • Cigna — PPO: $4,625
  • Lifeworks — MCR: $4,950
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neur Not listed in the file Not listed in the file $1,573 – $2,685
Spinal injection, lower back (epidural), with imaging guidance: rates for 10 insurance plans
  • Anthem — HIX: $1,743
  • Anthem — HMO: $2,396
  • Anthem — HPN: $2,385
  • Anthem — PPO: $2,396
  • Bright Health — COMM: $1,687
  • Cigna — HMO: $2,685
  • Cigna — IFP: $1,573
  • Cigna — PPO: $2,685
  • Lifeworks — MCR: $2,550
  • United — AllPayerAppendix: $2,114
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, sing Not listed in the file Not listed in the file $1,687 – $3,701
Nerve root injection, lower back, with imaging guidance: 10 of 13 insurance plan rates
  • Anthem — HIX: $1,743
  • Anthem — HMO: $2,396
  • Anthem — HPN: $2,385
  • Anthem — PPO: $2,396
  • Bright Health — COMM: $1,687
  • Cigna — HMO: $2,685
  • Cigna — IFP: $1,573
  • Cigna — PPO: $2,685
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $3,701
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: Neuroplasty and/or transposition; median nerve at carpal tunnel Not listed in the file Not listed in the file $2,377 – $5,051
Carpal tunnel release: 10 of 13 insurance plan rates
  • Anthem — HIX: $2,235
  • Anthem — HMO: $3,074
  • Anthem — HPN: $3,060
  • Anthem — PPO: $3,074
  • Bright Health — COMM: $2,377
  • Cigna — HMO: $3,273
  • Cigna — IFP: $2,217
  • Cigna — PPO: $3,273
  • Lifeworks — MCR: $4,950
  • Sentara Optima Health — HMO: $5,051
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) In the file: Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or Not listed in the file Not listed in the file $1,743 – $5,051
Laser treatment of clouding after cataract surgery: 10 of 13 insurance plan rates
  • Anthem — HIX: $1,743
  • Anthem — HMO: $2,396
  • Anthem — HPN: $2,385
  • Anthem — PPO: $2,396
  • Bright Health — COMM: $2,377
  • Cigna — HMO: $3,273
  • Cigna — IFP: $2,217
  • Cigna — PPO: $3,273
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $5,051
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) In the file: Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irriga Not listed in the file Not listed in the file $2,235 – $10,433
Cataract removal with lens implant: 10 of 13 insurance plan rates
  • Anthem — HIX: $2,235
  • Anthem — HMO: $3,074
  • Anthem — HPN: $3,060
  • Anthem — PPO: $3,074
  • Bright Health — COMM: $6,880
  • Cigna — HMO: $7,920
  • Cigna — IFP: $5,961
  • Cigna — PPO: $7,920
  • Lifeworks — MCR: $2,550
  • Sentara Optima Health — HMO: $10,433

Pregnancy and childbirth

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) In the file: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care Not listed in the file Not listed in the file $4,287 – $6,230
Vaginal delivery, with care before and after: rates for 8 insurance plans
  • Anthem — HIX: $4,287
  • Anthem — HMO: $5,897
  • Anthem — HPN: $5,871
  • Anthem — PPO: $5,897
  • Cigna — HMO: $6,230
  • Cigna — IFP: $4,474
  • Cigna — PPO: $6,230
  • Lifeworks — MCR: $2,550
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) In the file: Routine obstetric care including antepartum care, cesarean delivery, and postpartum care Not listed in the file Not listed in the file $4,287 – $6,230
Cesarean delivery (C-section), with care before and after: rates for 8 insurance plans
  • Anthem — HIX: $4,287
  • Anthem — HMO: $5,897
  • Anthem — HPN: $5,871
  • Anthem — PPO: $5,897
  • Cigna — HMO: $6,230
  • Cigna — IFP: $4,474
  • Cigna — PPO: $6,230
  • Lifeworks — MCR: $2,550
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) In the file: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after p Not listed in the file Not listed in the file $4,287 – $6,230
Vaginal delivery after a previous C-section, with care before and after: rates for 8 insurance plans
  • Anthem — HIX: $4,287
  • Anthem — HMO: $5,897
  • Anthem — HPN: $5,871
  • Anthem — PPO: $5,897
  • Cigna — HMO: $6,230
  • Cigna — IFP: $4,474
  • Cigna — PPO: $6,230
  • Lifeworks — MCR: $2,550

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) In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZA Not listed in the file Not listed in the file $103,254.40
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 38 insurance plan rates
  • Aetna — Broad: $111,336
  • Aetna — MGMCR: $75,745.90
  • Align Senior Care — MGMCR: $75,642.08
  • Anthem — HIX: $89,639.80
  • Anthem — HMO: $123,292.63
  • Anthem — HPN: $133,085.21
  • Anthem — MGMCR: $76,383.67
  • Anthem — PPO: $123,292.63
  • Bright Health — COMM: $103,254.40
  • Cigna — HMO: $88,474
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) In the file: SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC Not listed in the file Not listed in the file $29,421.08
Spinal fusion (not neck), without major complications: rates for 1 insurance plan
  • Bright Health — COMM: $29,421.08
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT Not listed in the file Not listed in the file $20,264.23
Hip or knee replacement (major joint of the leg), without major complications: 10 of 38 insurance plan rates
  • Aetna — Broad: $49,242
  • Aetna — MGMCR: $15,506.34
  • Align Senior Care — MGMCR: $1,275
  • Anthem — HIX: $2,313
  • Anthem — HMO: $3,183
  • Anthem — HPN: $3,169
  • Anthem — MGMCR: $15,636.90
  • Anthem — PPO: $3,183
  • Bright Health — COMM: $20,264.23
  • Cigna — HMO: $25,224
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC Not listed in the file Not listed in the file $26,869.52
Neck (cervical) spinal fusion, without complications: 10 of 38 insurance plan rates
  • Aetna — Broad: $39,381
  • Aetna — MGMCR: $19,436.46
  • Align Senior Care — MGMCR: $19,409.81
  • Anthem — HIX: $21,908
  • Anthem — HMO: $30,135
  • Anthem — HPN: $25,683
  • Anthem — MGMCR: $19,600.11
  • Anthem — PPO: $30,135
  • Bright Health — COMM: $26,869.52
  • Cigna — HMO: $37,850
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC Not listed in the file Not listed in the file $12,407.19
Uterus and ovary surgery (not for cancer), without complications: 10 of 38 insurance plan rates
  • Aetna — Broad: $16,750
  • Aetna — MGMCR: $10,227.83
  • Align Senior Care — MGMCR: $1,275
  • Anthem — HIX: $11,368.53
  • Anthem — HMO: $15,636.54
  • Anthem — HPN: $16,878.48
  • Anthem — MGMCR: $10,313.95
  • Anthem — PPO: $15,636.54
  • Bright Health — COMM: $12,407.19
  • Cigna — HMO: $20,636

Source: Spotsylvania Regional Medical Center’s standard charges file (stctrprodsnsvc00455826e6.blob.core.windows.net, JSON, CMS template 3.0.0; it can be a very large file), last updated by the hospital on September 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital typeAcute Care Hospital
Address4600 Spotsylvania Parkway, Fredericksburg, VA 22408
CountySpotsylvania County
StateVirginia
Phone(540) 498‑4000
Emergency servicesYes
OwnershipProprietary
Medicare overall rating3 of 5 stars
Birthing-friendly designationYes (meets CMS criteria)
CMS Certification Number490141
Name in Medicare recordsSPOTSYLVANIA REGIONAL MEDICAL CENTER
Profile levelMedicare data + hospital website
Official websitehcavirginia.com
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. Spotsylvania Regional Medical Center — hcavirginia.com
  2. Specialties — hcavirginia.com
  3. Emergency Care | Spotsylvania Regional Medical Center — hcavirginia.com
  4. Labor and Delivery | Spotsylvania Regional Medical Center — hcavirginia.com
  5. Cardiology | Spotsylvania Regional Medical Center — hcavirginia.com
  6. For Visitors | Spotsylvania Regional Medical Center — hcavirginia.com
  7. Orthopedics | Spotsylvania Regional Medical Center — hcavirginia.com
  8. Surgical Specialists | Spotsylvania Regional Medical Center | Spotsylvania Regional Medical Center — hcavirginia.com
  9. Physical Therapy | Spotsylvania Regional Medical Center — hcavirginia.com
  10. Women's Care | Spotsylvania Regional Medical Center — hcavirginia.com
  11. Spine Care | Spotsylvania Regional Medical Center — hcavirginia.com
  12. Gastroenterology | Spotsylvania Regional Medical Center — hcavirginia.com
  13. Mental Health Care | Spotsylvania Regional Medical Center — hcavirginia.com
  14. Cancer Treatment | Spotsylvania Regional Medical Center — hcavirginia.com