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Acute Care Hospital

St Joseph's Medical Center

Yonkers, New York · Westchester County · Emergency services listed

Summary

St Joseph's Medical Center is an acute care hospital in Yonkers, New York. Medicare data lists emergency services. CMS overall star rating: 1 of 5 stars. Its official website lists 29 services, specialties and programs. Medicare lists 187 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(914) 378‑7000 Directions Website Medicare profile
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Exterior of St Joseph's Medical Center
Photo: Jim.henderson, CC0, via Wikimedia Commons · source · licence

Profile from official sources

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

In a medical emergency, call 911.

At a glance

YesEmergency services
1 of 5 stars1 of 5 stars · Medicare rating
187Doctors and clinicians
29Services listed

Quick answers

Does St Joseph's Medical Center have an emergency room?
Yes. Medicare (CMS) data lists emergency services at St Joseph's Medical Center. In a medical emergency, call 911.
Where is St Joseph's Medical Center?
127 South Broadway, Yonkers, NY 10701, in Westchester County, New York.
What is the phone number of St Joseph's Medical Center?
(914) 378-7000, as listed by Medicare (CMS).
What is the Medicare star rating of St Joseph's Medical Center?
1 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas[5]

Treatments[5][12]

Procedures[5][11][12]

  • Orthopedic robotic-assisted surgery
  • Aquablation therapy
  • Mako robotic-arm assisted hip and knee replacement
  • Hand surgery
  • Sports medicine
  • Minimally invasive surgery

Programs and centers[10]

  • Fast Track emergency treatment

Emergency care (hospital website)[4][5][8][10]

Emergency roomYes
Open 24/7Yes
Stroke designationDesignated as a stroke center by the New York State Department of Health

Visiting and practical information

VisitingInpatient visitors age 12+ daily 9:00 a.m. to 8:30 p.m.; behavioral health halls 2-3 p.m. and 7-8:30 p.m[9]
ParkingHourly-fee hospital garage on Vark Street across from main entrance; handicapped parking available[9]
Interpreters and languagesFree qualified interpreters and written information in other languages; sign language interpreters for deaf or hard of hearing patients[6]

Recognition[7]

  • Accredited by The Joint Commission
  • Accredited by College of American Pathologists
  • Accredited by American Association of Blood Banks

Doctors and clinicians (187)

187 doctors and other clinicians list St Joseph's 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 (187)

And 163 more: the button below opens the full list.

Other emergency rooms nearby

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

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

All nursing homes in the state →

Hospice providers

All hospice providers in the state →

Home health agencies

All home health agencies in the state →

Dialysis facilities

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Clinics and urgent care

Pharmacies

Assisted living nearby

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

About the Medicare star rating

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

Medicare quality data

What St Joseph's 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) 1 of 5 stars
Overall rating of the hospital1 of 5 stars
Would recommend the hospital1 of 5 stars
Nurses communicated well1 of 5 stars
Doctors communicated well1 of 5 stars
Staff explained medicines2 of 5 stars
Information about recovery at home1 of 5 stars
Room and bathroom kept clean3 of 5 stars
Quiet at night2 of 5 stars
Rated the hospital 9 or 10 out of 1054%National average: 72%
Would definitely recommend the hospital46%National average: 71%
Nurses “always” communicated well63%National average: 80%
Doctors “always” communicated well66%National average: 80%
Staff “always” explained medicines before giving them56%National average: 62%
Were given information about recovery at home76%National average: 86%
Room and bathroom “always” clean67%National average: 74%
Area around the room “always” quiet at night45%National average: 60%
Completed surveys140Response rate: 9%

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)0No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)2.653No 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 infections0.607No different from 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 patientsToo few cases to report
Deaths within 30 days: heart failure patients9.8%
Deaths within 30 days: pneumonia patients14.9%
Deaths within 30 days: COPD patientsToo few cases to report
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)0.91No different from the national rate
Complications after hip or knee replacement4.2%

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)Not reported to Medicare
Readmitted within 30 days: heart attackToo few cases to report
Readmitted within 30 days: heart failure22%
Readmitted within 30 days: pneumonia18.1%
Readmitted within 30 days: COPD20.1%
Readmitted within 30 days: coronary bypass surgeryNot reported to Medicare
Readmitted within 30 days: hip or knee replacement6.5%

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)201 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)2%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)76%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 YonkersBest hospitals in New York

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 86 common services exactly as St Joseph's Medical Center lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean
Hospital charge
The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price
The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates
The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees
A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Office and emergency visits

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEVEL 3 INITIAL VISIT $1,036 $113.04 $67.83 – $828.80
New patient office visit (about 30–44 minutes): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $113.04
  • Aetna Gatekeeper — Commercial: $828.80
  • Aetna Non-Gatekeeper — Commercial: $828.80
  • Aetna Savings Plus — Exchange: $828.80
  • Affinity — Medicaid: $67.83
  • Affinity Essential Plans — Medicaid Managed Care: $67.83
  • Centerlight — Medicare Advantage: $113.04
  • Cigna — Commercial: $118.70
  • Elderplan — Medicare Advantage: $113.04
  • Emblem — Commercial: $146.96
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Visit Level 3 New 99203 $1,118 $113.04 $67.83 – $894.40
New patient office visit (about 30–44 minutes): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $113.04
  • Aetna Gatekeeper — Commercial: $894.40
  • Aetna Non-Gatekeeper — Commercial: $894.40
  • Aetna Savings Plus — Exchange: $894.40
  • Affinity — Medicaid: $67.83
  • Affinity Essential Plans — Medicaid Managed Care: $67.83
  • Centerlight — Medicare Advantage: $113.04
  • Cigna — Commercial: $118.70
  • Elderplan — Medicare Advantage: $113.04
  • Emblem — Commercial: $146.96
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee In the file: E&M New Low 30-44 min $81.88 $81.88 $35.74 – $137
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates
  • Elderplan — Medicare Advantage: $81.88
  • Evernorth Behavioral Health — Commercial: $137
  • Hamaspik — Medicaid Managed Care: $35.74
  • Hamaspik — Medicare Advantage: $85.97
  • Healthfirst — Medicaid: $81.88
  • Healthfirst — Medicare Advantage: $85.97
  • Healthfirst Essential Plans — Medicaid Managed Care: $85.97
  • Healthfirst QHP — Medicaid Managed Care: $85.97
  • MetroPlus Behavioral Health — Medicaid: $57.32
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $69.60
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Visit Level 4 New 99204 $1,485 $170.85 $102.51 – $1,188
New patient office visit (about 45–59 minutes): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $170.85
  • Aetna Gatekeeper — Commercial: $1,188
  • Aetna Non-Gatekeeper — Commercial: $1,188
  • Aetna Savings Plus — Exchange: $1,188
  • Affinity — Medicaid: $102.51
  • Affinity Essential Plans — Medicaid Managed Care: $102.51
  • Centerlight — Medicare Advantage: $170.85
  • Cigna — Commercial: $179.40
  • Elderplan — Medicare Advantage: $170.85
  • Emblem — Commercial: $222.11
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEVEL 4 INITIAL VISIT $1,559 $170.85 $102.51 – $1,247.20
New patient office visit (about 45–59 minutes): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $170.85
  • Aetna Gatekeeper — Commercial: $1,247.20
  • Aetna Non-Gatekeeper — Commercial: $1,247.20
  • Aetna Savings Plus — Exchange: $1,247.20
  • Affinity — Medicaid: $102.51
  • Affinity Essential Plans — Medicaid Managed Care: $102.51
  • Centerlight — Medicare Advantage: $170.85
  • Cigna — Commercial: $179.40
  • Elderplan — Medicare Advantage: $170.85
  • Emblem — Commercial: $222.11
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: E&M New Moderate 45-59 min $133.50 $133.50 $59.40 – $204
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates
  • Elderplan — Medicare Advantage: $133.50
  • Evernorth Behavioral Health — Commercial: $204
  • Hamaspik — Medicaid Managed Care: $59.40
  • Hamaspik — Medicare Advantage: $140.18
  • Healthfirst — Medicaid: $133.50
  • Healthfirst — Medicare Advantage: $140.18
  • Healthfirst Essential Plans — Medicaid Managed Care: $140.18
  • Healthfirst QHP — Medicaid Managed Care: $140.18
  • MetroPlus Behavioral Health — Medicaid: $93.45
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $113.48
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Visit Level 5 New 99205 $1,692 $227.85 $136.71 – $1,353.60
New patient office visit (about 60–74 minutes): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $227.85
  • Aetna Gatekeeper — Commercial: $1,353.60
  • Aetna Non-Gatekeeper — Commercial: $1,353.60
  • Aetna Savings Plus — Exchange: $1,353.60
  • Affinity — Medicaid: $136.71
  • Affinity Essential Plans — Medicaid Managed Care: $136.71
  • Centerlight — Medicare Advantage: $227.85
  • Cigna — Commercial: $239.24
  • Elderplan — Medicare Advantage: $227.85
  • Emblem — Commercial: $296.20
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEVEL 5 INITIAL VISIT $1,692 $227.85 $136.71 – $1,353.60
New patient office visit (about 60–74 minutes): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $227.85
  • Aetna Gatekeeper — Commercial: $1,353.60
  • Aetna Non-Gatekeeper — Commercial: $1,353.60
  • Aetna Savings Plus — Exchange: $1,353.60
  • Affinity — Medicaid: $136.71
  • Affinity Essential Plans — Medicaid Managed Care: $136.71
  • Centerlight — Medicare Advantage: $227.85
  • Cigna — Commercial: $239.24
  • Elderplan — Medicare Advantage: $227.85
  • Emblem — Commercial: $296.20
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: E&M New High 60-74 min $184.04 $184.04 $77.27 – $269
New patient office visit (about 60–74 minutes): 10 of 11 insurance plan rates
  • Elderplan — Medicare Advantage: $184.04
  • Evernorth Behavioral Health — Commercial: $269
  • Hamaspik — Medicaid Managed Care: $77.27
  • Hamaspik — Medicare Advantage: $193.24
  • Healthfirst — Medicaid: $184.04
  • Healthfirst — Medicare Advantage: $193.24
  • Healthfirst Essential Plans — Medicaid Managed Care: $193.24
  • Healthfirst QHP — Medicaid Managed Care: $193.24
  • MetroPlus Behavioral Health — Medicaid: $128.83
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $156.43
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEVEL 3 FOLLOW-UP VISIT $831 $91.86 $55.12 – $664.80
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $91.86
  • Aetna Gatekeeper — Commercial: $664.80
  • Aetna Non-Gatekeeper — Commercial: $664.80
  • Aetna Savings Plus — Exchange: $664.80
  • Affinity — Medicaid: $55.12
  • Affinity Essential Plans — Medicaid Managed Care: $55.12
  • Centerlight — Medicare Advantage: $91.86
  • Cigna — Commercial: $96.45
  • Elderplan — Medicare Advantage: $91.86
  • Emblem — Commercial: $119.42
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Visit Level 3 Est 99213 $847 $91.86 $55.12 – $677.60
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $91.86
  • Aetna Gatekeeper — Commercial: $677.60
  • Aetna Non-Gatekeeper — Commercial: $677.60
  • Aetna Savings Plus — Exchange: $677.60
  • Affinity — Medicaid: $55.12
  • Affinity Essential Plans — Medicaid Managed Care: $55.12
  • Centerlight — Medicare Advantage: $91.86
  • Cigna — Commercial: $96.45
  • Elderplan — Medicare Advantage: $91.86
  • Emblem — Commercial: $119.42
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Doctor (professional) fee In the file: E&M Established Low 20- 29 min $64.89 $64.89 $22.85 – $110
Established patient office visit (about 20–29 minutes): 10 of 11 insurance plan rates
  • Elderplan — Medicare Advantage: $64.89
  • Evernorth Behavioral Health — Commercial: $110
  • Hamaspik — Medicaid Managed Care: $22.85
  • Hamaspik — Medicare Advantage: $68.13
  • Healthfirst — Medicaid: $64.89
  • Healthfirst — Medicare Advantage: $68.13
  • Healthfirst Essential Plans — Medicaid Managed Care: $68.13
  • Healthfirst QHP — Medicaid Managed Care: $68.13
  • MetroPlus Behavioral Health — Medicaid: $45.42
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $55.16
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office Visit Level 4 Est 99214 $1,118 $130.88 $78.53 – $894.40
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $130.88
  • Aetna Gatekeeper — Commercial: $894.40
  • Aetna Non-Gatekeeper — Commercial: $894.40
  • Aetna Savings Plus — Exchange: $894.40
  • Affinity — Medicaid: $78.53
  • Affinity Essential Plans — Medicaid Managed Care: $78.53
  • Centerlight — Medicare Advantage: $130.88
  • Cigna — Commercial: $137.42
  • Elderplan — Medicare Advantage: $130.88
  • Emblem — Commercial: $170.14
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEVEL 4 FOLLOW-UP VISIT $1,118 $130.88 $78.53 – $894.40
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $130.88
  • Aetna Gatekeeper — Commercial: $894.40
  • Aetna Non-Gatekeeper — Commercial: $894.40
  • Aetna Savings Plus — Exchange: $894.40
  • Affinity — Medicaid: $78.53
  • Affinity Essential Plans — Medicaid Managed Care: $78.53
  • Centerlight — Medicare Advantage: $130.88
  • Cigna — Commercial: $137.42
  • Elderplan — Medicare Advantage: $130.88
  • Emblem — Commercial: $170.14
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: E&M Established Moderate 30-39 min $95.58 $95.58 $35.73 – $156
Established patient office visit (about 30–39 minutes): 10 of 11 insurance plan rates
  • Elderplan — Medicare Advantage: $95.58
  • Evernorth Behavioral Health — Commercial: $156
  • Hamaspik — Medicaid Managed Care: $35.73
  • Hamaspik — Medicare Advantage: $100.36
  • Healthfirst — Medicaid: $95.58
  • Healthfirst — Medicare Advantage: $100.36
  • Healthfirst Essential Plans — Medicaid Managed Care: $100.36
  • Healthfirst QHP — Medicaid Managed Care: $100.36
  • MetroPlus Behavioral Health — Medicaid: $66.91
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $81.24
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30 Not listed in the file $109.03 $82.34 – $109.03
Office consultation with a specialist (moderate): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $90.09
  • Aetna Non-Gatekeeper — Commercial: $90.09
  • Aetna Savings Plus — Exchange: $82.34
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE CONSULTATION Not listed in the file $109.03 $82.34 – $109.03
Office consultation with a specialist (moderate): rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $109.03
  • VA — Other: $109.03
  • VNS — Medicare Advantage: $109.03
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Doctor (professional) fee · modifier N/A In the file: OFFICE CONSULTATION Not listed in the file Not listed in the file $103.86
Office consultation with a specialist (moderate): rates for 1 insurance plan
  • VA — Other: $103.86
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40 Not listed in the file $156.03 $132.42 – $156.03
Office consultation with a specialist (moderate to high): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $144.87
  • Aetna Non-Gatekeeper — Commercial: $144.87
  • Aetna Savings Plus — Exchange: $132.42
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE CONSULTATION Not listed in the file $156.03 $132.42 – $156.03
Office consultation with a specialist (moderate to high): rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $156.03
  • VA — Other: $156.03
  • VNS — Medicare Advantage: $156.03
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee · modifier N/A In the file: OFFICE CONSULTATION Not listed in the file Not listed in the file $147.81
Office consultation with a specialist (moderate to high): rates for 1 insurance plan
  • VA — Other: $147.81
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Initial Comp Preventive Med 18 to 39 years New 99385 $1,894 $130.09 $78.06 – $1,515.20
Preventive checkup, new patient, age 18–39: 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $130.09
  • Aetna Gatekeeper — Commercial: $1,515.20
  • Aetna Non-Gatekeeper — Commercial: $1,515.20
  • Aetna Savings Plus — Exchange: $1,515.20
  • Affinity — Medicaid: $78.06
  • Affinity Essential Plans — Medicaid Managed Care: $78.06
  • Centerlight — Medicare Advantage: $130.09
  • Cigna — Commercial: $136.60
  • Elderplan — Medicare Advantage: $130.09
  • Emblem — Commercial: $169.12
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT, NEW, AGE 18-39 Not listed in the file $130.09 $84.91 – $92.89
Preventive checkup, new patient, age 18–39: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $92.89
  • Aetna Non-Gatekeeper — Commercial: $92.89
  • Aetna Savings Plus — Exchange: $84.91
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Initial Comp Preventive Med 18 to 39 years New 99385 $1,894 Not listed in the file Not listed in the file
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Initial Comp Preventive Med 40 to 64 years New 99386 $1,894 $150.52 $90.31 – $1,515.20
Preventive checkup, new patient, age 40–64: 10 of 30 insurance plan rates
  • Aetna — Medicare Advantage: $150.52
  • Aetna Gatekeeper — Commercial: $1,515.20
  • Aetna Non-Gatekeeper — Commercial: $1,515.20
  • Aetna Savings Plus — Exchange: $1,515.20
  • Affinity — Medicaid: $90.31
  • Affinity Essential Plans — Medicaid Managed Care: $90.31
  • Centerlight — Medicare Advantage: $150.52
  • Cigna — Commercial: $158.05
  • Elderplan — Medicare Advantage: $150.52
  • Emblem — Commercial: $195.68
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT, NEW, AGE 40-64 Not listed in the file $150.52 $103.50 – $113.23
Preventive checkup, new patient, age 40–64: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $113.23
  • Aetna Non-Gatekeeper — Commercial: $113.23
  • Aetna Savings Plus — Exchange: $103.50
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Initial Comp Preventive Med 40 to 64 years New 99386 $1,894 Not listed in the file Not listed in the file
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99283 - Level 3 $2,226 $278.89 $167.33 – $19,922.70
Emergency room visit (moderate): 10 of 34 insurance plan rates
  • 1199 Behavioral Health — Commercial: $618
  • Aetna — Medicare Advantage: $278.89
  • Aetna Gatekeeper — Commercial: $568
  • Aetna Non-Gatekeeper — Commercial: $568
  • Aetna Savings Plus — Exchange: $506
  • Affinity — Medicaid: $167.33
  • Affinity Essential Plans — Medicaid Managed Care: $167.33
  • Centerlight — Medicare Advantage: $278.89
  • Cigna — Commercial: $292.83
  • Elderplan — Medicare Advantage: $278.89
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit 99283 $2,226 $278.89 $167.33 – $19,922.70
Emergency room visit (moderate): 10 of 34 insurance plan rates
  • 1199 Behavioral Health — Commercial: $618
  • Aetna — Medicare Advantage: $278.89
  • Aetna Gatekeeper — Commercial: $568
  • Aetna Non-Gatekeeper — Commercial: $568
  • Aetna Savings Plus — Exchange: $506
  • Affinity — Medicaid: $167.33
  • Affinity Essential Plans — Medicaid Managed Care: $167.33
  • Centerlight — Medicare Advantage: $278.89
  • Cigna — Commercial: $292.83
  • Elderplan — Medicare Advantage: $278.89
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT LOW TO MODERATE MDM $80.39 $80.39 $56.27 – $84.41
Emergency room visit (moderate): rates for 10 insurance plans
  • Elderplan — Medicare Advantage: $80.39
  • Hamaspik — Medicaid Managed Care: $69.20
  • Hamaspik — Medicare Advantage: $84.41
  • Healthfirst — Medicaid: $80.39
  • Healthfirst — Medicare Advantage: $84.41
  • Healthfirst Essential Plans — Medicaid Managed Care: $84.41
  • Healthfirst QHP — Medicaid Managed Care: $84.41
  • MetroPlus Behavioral Health — Medicaid: $56.27
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $68.33
  • VA — Other: $80.39
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99284 - Level 4 $3,727 $426.30 $255.78 – $33,356.65
Emergency room visit (moderately high): 10 of 34 insurance plan rates
  • 1199 Behavioral Health — Commercial: $618
  • Aetna — Medicare Advantage: $426.30
  • Aetna Gatekeeper — Commercial: $568
  • Aetna Non-Gatekeeper — Commercial: $568
  • Aetna Savings Plus — Exchange: $506
  • Affinity — Medicaid: $255.78
  • Affinity Essential Plans — Medicaid Managed Care: $255.78
  • Centerlight — Medicare Advantage: $426.30
  • Cigna — Commercial: $447.62
  • Elderplan — Medicare Advantage: $426.30
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit 99284 $3,727 $426.30 $255.78 – $33,356.65
Emergency room visit (moderately high): 10 of 34 insurance plan rates
  • 1199 Behavioral Health — Commercial: $618
  • Aetna — Medicare Advantage: $426.30
  • Aetna Gatekeeper — Commercial: $568
  • Aetna Non-Gatekeeper — Commercial: $568
  • Aetna Savings Plus — Exchange: $506
  • Affinity — Medicaid: $255.78
  • Affinity Essential Plans — Medicaid Managed Care: $255.78
  • Centerlight — Medicare Advantage: $426.30
  • Cigna — Commercial: $447.62
  • Elderplan — Medicare Advantage: $426.30
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT MODERATE MDM $136.96 $136.96 $95.87 – $143.81
Emergency room visit (moderately high): rates for 10 insurance plans
  • Elderplan — Medicare Advantage: $136.96
  • Hamaspik — Medicaid Managed Care: $118.13
  • Hamaspik — Medicare Advantage: $143.81
  • Healthfirst — Medicaid: $136.96
  • Healthfirst — Medicare Advantage: $143.81
  • Healthfirst Essential Plans — Medicaid Managed Care: $143.81
  • Healthfirst QHP — Medicaid Managed Care: $143.81
  • MetroPlus Behavioral Health — Medicaid: $95.87
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $116.42
  • VA — Other: $136.96
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99285 - Level 5 $5,785 $608.43 $365.06 – $51,775.75
Emergency room visit (high): 10 of 34 insurance plan rates
  • 1199 Behavioral Health — Commercial: $618
  • Aetna — Medicare Advantage: $608.43
  • Aetna Gatekeeper — Commercial: $568
  • Aetna Non-Gatekeeper — Commercial: $568
  • Aetna Savings Plus — Exchange: $506
  • Affinity — Medicaid: $365.06
  • Affinity Essential Plans — Medicaid Managed Care: $365.06
  • Centerlight — Medicare Advantage: $608.43
  • Cigna — Commercial: $638.85
  • Elderplan — Medicare Advantage: $608.43
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit 99285 $5,785 $608.43 $365.06 – $51,775.75
Emergency room visit (high): 10 of 34 insurance plan rates
  • 1199 Behavioral Health — Commercial: $618
  • Aetna — Medicare Advantage: $608.43
  • Aetna Gatekeeper — Commercial: $568
  • Aetna Non-Gatekeeper — Commercial: $568
  • Aetna Savings Plus — Exchange: $506
  • Affinity — Medicaid: $365.06
  • Affinity Essential Plans — Medicaid Managed Care: $365.06
  • Centerlight — Medicare Advantage: $608.43
  • Cigna — Commercial: $638.85
  • Elderplan — Medicare Advantage: $608.43
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT HIGH MDM $197.74 $197.74 $138.42 – $207.63
Emergency room visit (high): rates for 10 insurance plans
  • Elderplan — Medicare Advantage: $197.74
  • Hamaspik — Medicaid Managed Care: $171.29
  • Hamaspik — Medicare Advantage: $207.63
  • Healthfirst — Medicaid: $197.74
  • Healthfirst — Medicare Advantage: $207.63
  • Healthfirst Essential Plans — Medicaid Managed Care: $207.63
  • Healthfirst QHP — Medicaid Managed Care: $207.63
  • MetroPlus Behavioral Health — Medicaid: $138.42
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $168.08
  • VA — Other: $197.74

Lab tests

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic Metabolic Panel $161 $8.46 $5.55 – $336.89
Basic metabolic panel (blood test): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $8.46
  • Aetna Gatekeeper — Commercial: $6.07
  • Aetna Non-Gatekeeper — Commercial: $6.07
  • Aetna Savings Plus — Exchange: $5.55
  • Affinity — Medicaid: $149.73
  • Affinity Essential Plans — Medicaid Managed Care: $336.89
  • Centerlight — Medicare Advantage: $8.46
  • Cigna — Commercial: $8.88
  • Elderplan — Medicaid: $149.73
  • Elderplan — Medicare Advantage: $8.46
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: METABOLIC PANEL TOTAL CA Not listed in the file $8.46 $5.55 – $172.19
Basic metabolic panel (blood test): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $6.07
  • Aetna Non-Gatekeeper — Commercial: $6.07
  • Aetna Savings Plus — Exchange: $5.55
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic metabolic pnl total ca Not listed in the file $8.46 $5.55 – $172.19
Basic metabolic panel (blood test): rates for 2 insurance plans
  • VNS — Medicare Advantage: $172.19
  • VNS Special Needs — Medicaid Managed Care: $152.72
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel $226 $10.56 $8.31 – $336.89
Comprehensive metabolic panel (blood test): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $10.56
  • Aetna Gatekeeper — Commercial: $9.09
  • Aetna Non-Gatekeeper — Commercial: $9.09
  • Aetna Savings Plus — Exchange: $8.31
  • Affinity — Medicaid: $149.73
  • Affinity Essential Plans — Medicaid Managed Care: $336.89
  • Centerlight — Medicare Advantage: $10.56
  • Cigna — Commercial: $11.09
  • Elderplan — Medicaid: $149.73
  • Elderplan — Medicare Advantage: $10.56
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHEN METABOLIC PANEL Not listed in the file $10.56 $8.31 – $172.19
Comprehensive metabolic panel (blood test): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $9.09
  • Aetna Non-Gatekeeper — Commercial: $9.09
  • Aetna Savings Plus — Exchange: $8.31
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehen metabolic panel Not listed in the file $10.56 $8.31 – $172.19
Comprehensive metabolic panel (blood test): rates for 2 insurance plans
  • VNS — Medicare Advantage: $172.19
  • VNS Special Needs — Medicaid Managed Care: $152.72
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL Not listed in the file $47.81 $41.52 – $336.89
Obstetric blood test panel: 10 of 14 insurance plan rates
  • Aetna Gatekeeper — Commercial: $45.43
  • Aetna Non-Gatekeeper — Commercial: $45.43
  • Aetna Savings Plus — Exchange: $41.52
  • Cigna — Commercial: $47.81
  • Empire — Commercial: $47.81
  • Empire Indemnity — Commercial: $47.81
  • Empire PPO — Commercial: $47.81
  • MetroPlus Behavioral Health — Medicare Advantage: $47.81
  • MVP — Commercial: $82.47
  • MVP — Medicare Advantage: $47.81
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric panel Not listed in the file $47.81 $41.52 – $336.89
Obstetric blood test panel: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $149.73
  • Empire HealthPlus CHP — Medicaid: $149.73
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $179.68
  • Empire HealthPlus Individual — Medicaid Managed Care: $179.68
  • Fidelis — Medicaid: $149.73
  • Fidelis CHP — Medicaid: $149.73
  • Fidelis Essential Plans — Medicaid Managed Care: $336.89
  • Healthfirst — Medicaid: $157.22
  • Healthfirst Essential Plans — Medicaid Managed Care: $336.89
  • Healthfirst QHP — Medicaid Managed Care: $157.22
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel $147 $13.39 $11.63 – $336.89
Cholesterol panel (lipid panel): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $13.39
  • Aetna Gatekeeper — Commercial: $12.72
  • Aetna Non-Gatekeeper — Commercial: $12.72
  • Aetna Savings Plus — Exchange: $11.63
  • Affinity — Medicaid: $149.73
  • Affinity Essential Plans — Medicaid Managed Care: $336.89
  • Centerlight — Medicare Advantage: $13.39
  • Cigna — Commercial: $14.06
  • Elderplan — Medicaid: $149.73
  • Elderplan — Medicare Advantage: $13.39
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PROFILE Not listed in the file $13.39 $11.63 – $172.19
Cholesterol panel (lipid panel): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $12.72
  • Aetna Non-Gatekeeper — Commercial: $12.72
  • Aetna Savings Plus — Exchange: $11.63
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid panel Not listed in the file $13.39 $11.63 – $172.19
Cholesterol panel (lipid panel): rates for 2 insurance plans
  • VNS — Medicare Advantage: $172.19
  • VNS Special Needs — Medicaid Managed Care: $152.72
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL Not listed in the file $8.68 $6.96 – $336.89
Kidney function panel: 10 of 18 insurance plan rates
  • Aetna Gatekeeper — Commercial: $7.62
  • Aetna Non-Gatekeeper — Commercial: $7.62
  • Aetna Savings Plus — Exchange: $6.96
  • Cigna — Commercial: $8.68
  • Empire — Commercial: $8.68
  • Empire Indemnity — Commercial: $8.68
  • Empire PPO — Commercial: $8.68
  • MetroPlus Behavioral Health — Medicare Advantage: $8.68
  • MVP — Commercial: $14.97
  • MVP — Medicaid: $8.68
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal function panel Not listed in the file $8.68 $6.96 – $336.89
Kidney function panel: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $149.73
  • Empire HealthPlus CHP — Medicaid: $149.73
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $179.68
  • Empire HealthPlus Individual — Medicaid Managed Care: $179.68
  • Fidelis — Medicaid: $149.73
  • Fidelis CHP — Medicaid: $149.73
  • Fidelis Essential Plans — Medicaid Managed Care: $336.89
  • Healthfirst — Medicaid: $157.22
  • Healthfirst Essential Plans — Medicaid Managed Care: $336.89
  • Healthfirst QHP — Medicaid Managed Care: $157.22
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel $255 $8.17 $5.55 – $336.89
Liver function panel: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $8.17
  • Aetna Gatekeeper — Commercial: $6.07
  • Aetna Non-Gatekeeper — Commercial: $6.07
  • Aetna Savings Plus — Exchange: $5.55
  • Affinity — Medicaid: $149.73
  • Affinity Essential Plans — Medicaid Managed Care: $336.89
  • Centerlight — Medicare Advantage: $8.17
  • Cigna — Commercial: $8.58
  • Elderplan — Medicaid: $149.73
  • Elderplan — Medicare Advantage: $8.17
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL Not listed in the file $8.17 $5.55 – $172.19
Liver function panel: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $6.07
  • Aetna Non-Gatekeeper — Commercial: $6.07
  • Aetna Savings Plus — Exchange: $5.55
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic function panel Not listed in the file $8.17 $5.55 – $172.19
Liver function panel: rates for 2 insurance plans
  • VNS — Medicare Advantage: $172.19
  • VNS Special Needs — Medicaid Managed Care: $152.72
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Urinalysis Dipstick $164 $3.17 $2.75 – $291.67
Urine test (automated, with microscope): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $3.17
  • Aetna Gatekeeper — Commercial: $3.01
  • Aetna Non-Gatekeeper — Commercial: $3.01
  • Aetna Savings Plus — Exchange: $2.75
  • Affinity — Medicaid: $129.63
  • Affinity Essential Plans — Medicaid Managed Care: $291.67
  • Centerlight — Medicare Advantage: $3.17
  • Cigna — Commercial: $3.33
  • Elderplan — Medicaid: $129.63
  • Elderplan — Medicare Advantage: $3.17
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis with Culture if Indicated (ED Only) $206 $3.17 $2.75 – $291.67
Urine test (automated, with microscope): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $3.17
  • Aetna Gatekeeper — Commercial: $3.01
  • Aetna Non-Gatekeeper — Commercial: $3.01
  • Aetna Savings Plus — Exchange: $2.75
  • Affinity — Medicaid: $129.63
  • Affinity Essential Plans — Medicaid Managed Care: $291.67
  • Centerlight — Medicare Advantage: $3.17
  • Cigna — Commercial: $3.33
  • Elderplan — Medicaid: $129.63
  • Elderplan — Medicare Advantage: $3.17
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis with Microscopic if Indicated $206 $3.17 $2.75 – $291.67
Urine test (automated, with microscope): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $3.17
  • Aetna Gatekeeper — Commercial: $3.01
  • Aetna Non-Gatekeeper — Commercial: $3.01
  • Aetna Savings Plus — Exchange: $2.75
  • Affinity — Medicaid: $129.63
  • Affinity Essential Plans — Medicaid Managed Care: $291.67
  • Centerlight — Medicare Advantage: $3.17
  • Cigna — Commercial: $3.33
  • Elderplan — Medicaid: $129.63
  • Elderplan — Medicare Advantage: $3.17
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis nonauto w/o scope Not listed in the file $3.48 $2.02 – $291.67
Urine test (manual, without microscope): 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $129.63
  • Empire HealthPlus CHP — Medicaid: $129.63
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $155.56
  • Empire HealthPlus Individual — Medicaid Managed Care: $155.56
  • Fidelis — Medicaid: $129.63
  • Fidelis CHP — Medicaid: $129.63
  • Fidelis Essential Plans — Medicaid Managed Care: $291.67
  • Healthfirst — Medicaid: $136.11
  • Healthfirst Essential Plans — Medicaid Managed Care: $291.67
  • Healthfirst QHP — Medicaid Managed Care: $136.11
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE Not listed in the file $3.48 $2.02 – $291.67
Urine test (manual, without microscope): 10 of 11 insurance plan rates
  • Cigna — Commercial: $3.48
  • Empire — Commercial: $3.48
  • Empire Indemnity — Commercial: $3.48
  • Empire PPO — Commercial: $3.48
  • MetroPlus Behavioral Health — Medicare Advantage: $3.48
  • MVP — Commercial: $6
  • MVP — Medicare Advantage: $3.48
  • Oxford — Commercial HMO: $4.19
  • Oxford — Commercial PPO: $4.19
  • United Healthcare — Commercial: $3.48
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, BY DIP STICK OR TABLET REAGE Not listed in the file $3.48 $2.02 – $291.67
Urine test (manual, without microscope): rates for 4 insurance plans
  • MVP — Medicaid: $2.02
  • MVP Essential Plans — Medicaid Managed Care: $4.55
  • United Healthcare — Medicaid: $2.02
  • United Healthcare — Medicaid Managed Care: $4.55
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/o scope Not listed in the file $2.25 $1.95 – $291.67
Urine test (automated, without microscope): 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $129.63
  • Empire HealthPlus CHP — Medicaid: $129.63
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $155.56
  • Empire HealthPlus Individual — Medicaid Managed Care: $155.56
  • Fidelis — Medicaid: $129.63
  • Fidelis CHP — Medicaid: $129.63
  • Fidelis Essential Plans — Medicaid Managed Care: $291.67
  • Healthfirst — Medicaid: $136.11
  • Healthfirst Essential Plans — Medicaid Managed Care: $291.67
  • Healthfirst QHP — Medicaid Managed Care: $136.11
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/O SCOPE Not listed in the file $2.25 $1.95 – $291.67
Urine test (automated, without microscope): 10 of 11 insurance plan rates
  • Cigna — Commercial: $2.25
  • Empire — Commercial: $2.25
  • Empire Indemnity — Commercial: $2.25
  • Empire PPO — Commercial: $2.25
  • MetroPlus Behavioral Health — Medicare Advantage: $2.25
  • MVP — Commercial: $3.88
  • MVP — Medicare Advantage: $2.25
  • Oxford — Commercial HMO: $3.67
  • Oxford — Commercial PPO: $3.67
  • United Healthcare — Commercial: $2.25
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, BY DIP STICK OR TABLET REAGE Not listed in the file $2.25 $1.95 – $291.67
Urine test (automated, without microscope): rates for 4 insurance plans
  • MVP — Medicaid: $2.02
  • MVP Essential Plans — Medicaid Managed Care: $4.55
  • United Healthcare — Medicaid: $2.02
  • United Healthcare — Medicaid Managed Care: $4.55
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA Total $118 $18.39 $15.98 – $292.28
PSA (prostate specific antigen) blood test: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $18.39
  • Aetna Gatekeeper — Commercial: $17.48
  • Aetna Non-Gatekeeper — Commercial: $17.48
  • Aetna Savings Plus — Exchange: $15.98
  • Affinity — Medicaid: $129.90
  • Affinity Essential Plans — Medicaid Managed Care: $292.28
  • Centerlight — Medicare Advantage: $18.39
  • Cigna — Commercial: $19.31
  • Elderplan — Medicaid: $129.90
  • Elderplan — Medicare Advantage: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA Free And Total $464 $18.39 $15.98 – $324.80
PSA (prostate specific antigen) blood test: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $18.39
  • Aetna Gatekeeper — Commercial: $17.48
  • Aetna Non-Gatekeeper — Commercial: $17.48
  • Aetna Savings Plus — Exchange: $15.98
  • Affinity — Medicaid: $129.90
  • Affinity Essential Plans — Medicaid Managed Care: $292.28
  • Centerlight — Medicare Advantage: $18.39
  • Cigna — Commercial: $19.31
  • Elderplan — Medicaid: $129.90
  • Elderplan — Medicare Advantage: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA TOTAL Not listed in the file $18.39 $15.98 – $149.39
PSA (prostate specific antigen) blood test: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $17.48
  • Aetna Non-Gatekeeper — Commercial: $17.48
  • Aetna Savings Plus — Exchange: $15.98
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TRAb (TSH Receptor Binding Antibody) $232 $16.80 $14.60 – $335.14
Thyroid stimulating hormone (TSH) test: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $16.80
  • Aetna Gatekeeper — Commercial: $15.97
  • Aetna Non-Gatekeeper — Commercial: $15.97
  • Aetna Savings Plus — Exchange: $14.60
  • Affinity — Medicaid: $148.95
  • Affinity Essential Plans — Medicaid Managed Care: $335.14
  • Centerlight — Medicare Advantage: $16.80
  • Cigna — Commercial: $17.64
  • Elderplan — Medicaid: $148.95
  • Elderplan — Medicare Advantage: $16.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thyroid Stimulating Hormone $245 $16.80 $14.60 – $335.14
Thyroid stimulating hormone (TSH) test: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $16.80
  • Aetna Gatekeeper — Commercial: $15.97
  • Aetna Non-Gatekeeper — Commercial: $15.97
  • Aetna Savings Plus — Exchange: $14.60
  • Affinity — Medicaid: $148.95
  • Affinity Essential Plans — Medicaid Managed Care: $335.14
  • Centerlight — Medicare Advantage: $16.80
  • Cigna — Commercial: $17.64
  • Elderplan — Medicaid: $148.95
  • Elderplan — Medicare Advantage: $16.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY THYROID STIM HORMONE Not listed in the file $16.80 $14.60 – $171.29
Thyroid stimulating hormone (TSH) test: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $15.97
  • Aetna Non-Gatekeeper — Commercial: $15.97
  • Aetna Savings Plus — Exchange: $14.60
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC without Differential $72 $7.77 $6.75 – $293.20
Complete blood count (CBC) with differential: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $7.77
  • Aetna Gatekeeper — Commercial: $7.39
  • Aetna Non-Gatekeeper — Commercial: $7.39
  • Aetna Savings Plus — Exchange: $6.75
  • Affinity — Medicaid: $130.31
  • Affinity Essential Plans — Medicaid Managed Care: $293.20
  • Centerlight — Medicare Advantage: $7.77
  • Cigna — Commercial: $8.16
  • Elderplan — Medicaid: $130.31
  • Elderplan — Medicare Advantage: $7.77
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC w/ Differential $106 $7.77 $6.75 – $293.20
Complete blood count (CBC) with differential: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $7.77
  • Aetna Gatekeeper — Commercial: $7.39
  • Aetna Non-Gatekeeper — Commercial: $7.39
  • Aetna Savings Plus — Exchange: $6.75
  • Affinity — Medicaid: $130.31
  • Affinity Essential Plans — Medicaid Managed Care: $293.20
  • Centerlight — Medicare Advantage: $7.77
  • Cigna — Commercial: $8.16
  • Elderplan — Medicaid: $130.31
  • Elderplan — Medicare Advantage: $7.77
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: AUTOMAT HEMOGRAM-COMPLET DIF Not listed in the file $7.77 $6.75 – $149.86
Complete blood count (CBC) with differential: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $7.39
  • Aetna Non-Gatekeeper — Commercial: $7.39
  • Aetna Savings Plus — Exchange: $6.75
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc automated Not listed in the file $6.47 $3.20 – $293.20
Complete blood count (CBC), automated: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $130.31
  • Empire HealthPlus CHP — Medicaid: $130.31
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $156.37
  • Empire HealthPlus Individual — Medicaid Managed Care: $156.37
  • Fidelis — Medicaid: $130.31
  • Fidelis CHP — Medicaid: $130.31
  • Fidelis Essential Plans — Medicaid Managed Care: $293.20
  • Healthfirst — Medicaid: $136.83
  • Healthfirst Essential Plans — Medicaid Managed Care: $293.20
  • Healthfirst QHP — Medicaid Managed Care: $136.83
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC AUTOMATED Not listed in the file $6.47 $3.20 – $293.20
Complete blood count (CBC), automated: 10 of 11 insurance plan rates
  • Cigna — Commercial: $6.47
  • Empire — Commercial: $6.47
  • Empire Indemnity — Commercial: $6.47
  • Empire PPO — Commercial: $6.47
  • MetroPlus Behavioral Health — Medicare Advantage: $6.47
  • MVP — Commercial: $11.16
  • MVP — Medicare Advantage: $6.47
  • Oxford — Commercial HMO: $10.60
  • Oxford — Commercial PPO: $10.60
  • United Healthcare — Commercial: $6.47
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD COUNT; COMPLETE (CBC), AUTOMATED ( Not listed in the file $6.47 $3.20 – $293.20
Complete blood count (CBC), automated: rates for 4 insurance plans
  • MVP — Medicaid: $3.20
  • MVP Essential Plans — Medicaid Managed Care: $7.20
  • United Healthcare — Medicaid: $3.20
  • United Healthcare — Medicaid Managed Care: $7.20
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INR POC $135 $4.29 $3.42 – $299.84
Blood clotting time test (prothrombin time, PT): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $4.29
  • Aetna Gatekeeper — Commercial: $3.74
  • Aetna Non-Gatekeeper — Commercial: $3.74
  • Aetna Savings Plus — Exchange: $3.42
  • Affinity — Medicaid: $133.26
  • Affinity Essential Plans — Medicaid Managed Care: $299.84
  • Centerlight — Medicare Advantage: $4.29
  • Cigna — Commercial: $4.50
  • Elderplan — Medicaid: $133.26
  • Elderplan — Medicare Advantage: $4.29
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time and INR $169 $4.29 $3.42 – $299.84
Blood clotting time test (prothrombin time, PT): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $4.29
  • Aetna Gatekeeper — Commercial: $3.74
  • Aetna Non-Gatekeeper — Commercial: $3.74
  • Aetna Savings Plus — Exchange: $3.42
  • Affinity — Medicaid: $133.26
  • Affinity Essential Plans — Medicaid Managed Care: $299.84
  • Centerlight — Medicare Advantage: $4.29
  • Cigna — Commercial: $4.50
  • Elderplan — Medicaid: $133.26
  • Elderplan — Medicare Advantage: $4.29
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME Not listed in the file $4.29 $3.42 – $153.25
Blood clotting time test (prothrombin time, PT): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $3.74
  • Aetna Non-Gatekeeper — Commercial: $3.74
  • Aetna Savings Plus — Exchange: $3.42
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Partial Thromboplastin Time $88 $6.01 $5.22 – $299.84
Blood clotting test (partial thromboplastin time, PTT): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $6.01
  • Aetna Gatekeeper — Commercial: $5.71
  • Aetna Non-Gatekeeper — Commercial: $5.71
  • Aetna Savings Plus — Exchange: $5.22
  • Affinity — Medicaid: $133.26
  • Affinity Essential Plans — Medicaid Managed Care: $299.84
  • Centerlight — Medicare Advantage: $6.01
  • Cigna — Commercial: $6.31
  • Elderplan — Medicaid: $133.26
  • Elderplan — Medicare Advantage: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME, PARTIAL Not listed in the file $6.01 $5.22 – $153.25
Blood clotting test (partial thromboplastin time, PTT): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $5.71
  • Aetna Non-Gatekeeper — Commercial: $5.71
  • Aetna Savings Plus — Exchange: $5.22
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin time partial Not listed in the file $6.01 $5.22 – $153.25
Blood clotting test (partial thromboplastin time, PTT): rates for 2 insurance plans
  • VNS — Medicare Advantage: $153.25
  • VNS Special Needs — Medicaid Managed Care: $135.93

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

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Brain/Head w/o Contrast $1,626 $106.81 $39.59 – $1,181.16
CT scan of the head or brain, without contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $106.81
  • Aetna Gatekeeper — Commercial: $153.22
  • Aetna Non-Gatekeeper — Commercial: $153.22
  • Aetna Savings Plus — Exchange: $140.05
  • Affinity — Medicaid: $524.96
  • Affinity Essential Plans — Medicaid Managed Care: $1,181.16
  • Centerlight — Medicare Advantage: $106.81
  • Cigna — Commercial: $112.15
  • Elderplan — Medicaid: $524.96
  • Elderplan — Medicare Advantage: $106.81
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CAT SCAN OF HEAD OR BRAIN Not listed in the file $106.81 $50.57 – $603.70
CT scan of the head or brain, without contrast: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $153.22
  • Aetna Non-Gatekeeper — Commercial: $153.22
  • Aetna Savings Plus — Exchange: $140.05
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct head/brain w/o dye Not listed in the file $106.81 $50.57 – $603.70
CT scan of the head or brain, without contrast: rates for 2 insurance plans
  • VNS — Medicare Advantage: $603.70
  • VNS Special Needs — Medicaid Managed Care: $535.46
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Brain w/ + w/o Contrast $4,582 $356.43 $110.84 – $3,207.40
MRI of the brain, before and after contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $356.43
  • Aetna Gatekeeper — Commercial: $1,046
  • Aetna Non-Gatekeeper — Commercial: $1,046
  • Aetna Savings Plus — Exchange: $942
  • Affinity — Medicaid: $871.52
  • Affinity Essential Plans — Medicaid Managed Care: $1,960.92
  • Centerlight — Medicare Advantage: $356.43
  • Cigna — Commercial: $374.25
  • Elderplan — Medicaid: $871.52
  • Elderplan — Medicare Advantage: $356.43
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Pituitary w/ + w/o Contrast $4,582 $356.43 $110.84 – $3,207.40
MRI of the brain, before and after contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $356.43
  • Aetna Gatekeeper — Commercial: $1,046
  • Aetna Non-Gatekeeper — Commercial: $1,046
  • Aetna Savings Plus — Exchange: $942
  • Affinity — Medicaid: $871.52
  • Affinity Essential Plans — Medicaid Managed Care: $1,960.92
  • Centerlight — Medicare Advantage: $356.43
  • Cigna — Commercial: $374.25
  • Elderplan — Medicaid: $871.52
  • Elderplan — Medicare Advantage: $356.43
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI OF BRAIN W/O & W/ CONTRA Not listed in the file $356.43 $130.05 – $1,002.25
MRI of the brain, before and after contrast: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $474.24
  • Aetna Non-Gatekeeper — Commercial: $474.24
  • Aetna Savings Plus — Exchange: $433.49
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XR Chest 2 Views $435 $88.91 $9.61 – $350.26
Chest X-ray, 2 views: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $88.91
  • Aetna Gatekeeper — Commercial: $30.59
  • Aetna Non-Gatekeeper — Commercial: $30.59
  • Aetna Savings Plus — Exchange: $27.96
  • Affinity — Medicaid: $155.67
  • Affinity Essential Plans — Medicaid Managed Care: $350.26
  • Centerlight — Medicare Advantage: $88.91
  • Cigna — Commercial: $93.36
  • Elderplan — Medicaid: $155.67
  • Elderplan — Medicare Advantage: $88.91
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XR Chest 2 Views w/ Fluoroscopy $435 $88.91 $9.61 – $350.26
Chest X-ray, 2 views: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $88.91
  • Aetna Gatekeeper — Commercial: $30.59
  • Aetna Non-Gatekeeper — Commercial: $30.59
  • Aetna Savings Plus — Exchange: $27.96
  • Affinity — Medicaid: $155.67
  • Affinity Essential Plans — Medicaid Managed Care: $350.26
  • Centerlight — Medicare Advantage: $88.91
  • Cigna — Commercial: $93.36
  • Elderplan — Medicaid: $155.67
  • Elderplan — Medicare Advantage: $88.91
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XR Chest 2 Views w/ Obliques $435 $88.91 $9.61 – $350.26
Chest X-ray, 2 views: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $88.91
  • Aetna Gatekeeper — Commercial: $30.59
  • Aetna Non-Gatekeeper — Commercial: $30.59
  • Aetna Savings Plus — Exchange: $27.96
  • Affinity — Medicaid: $155.67
  • Affinity Essential Plans — Medicaid Managed Care: $350.26
  • Centerlight — Medicare Advantage: $88.91
  • Cigna — Commercial: $93.36
  • Elderplan — Medicaid: $155.67
  • Elderplan — Medicare Advantage: $88.91
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XR Spine Lumbosacral 4+ Views $359 $106.81 $14.02 – $350.26
X-ray of the lower spine, at least 4 views: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $106.81
  • Aetna Gatekeeper — Commercial: $48.36
  • Aetna Non-Gatekeeper — Commercial: $48.36
  • Aetna Savings Plus — Exchange: $44.20
  • Affinity — Medicaid: $155.67
  • Affinity Essential Plans — Medicaid Managed Care: $350.26
  • Centerlight — Medicare Advantage: $106.81
  • Cigna — Commercial: $112.15
  • Elderplan — Medicaid: $155.67
  • Elderplan — Medicare Advantage: $106.81
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-RAY EXAM OF LOWER SPINE Not listed in the file $106.81 $14.02 – $179.02
X-ray of the lower spine, at least 4 views: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $48.36
  • Aetna Non-Gatekeeper — Commercial: $48.36
  • Aetna Savings Plus — Exchange: $44.20
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam l-2 spine 4/>vws Not listed in the file $106.81 $14.02 – $179.02
X-ray of the lower spine, at least 4 views: rates for 2 insurance plans
  • VNS — Medicare Advantage: $179.02
  • VNS Special Needs — Medicaid Managed Care: $158.78
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Spine Lumbar w/o Contrast $5,324 $243.77 $70.32 – $3,726.80
MRI of the lower back (lumbar spine), without contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $243.77
  • Aetna Gatekeeper — Commercial: $1,046
  • Aetna Non-Gatekeeper — Commercial: $1,046
  • Aetna Savings Plus — Exchange: $942
  • Affinity — Medicaid: $616.85
  • Affinity Essential Plans — Medicaid Managed Care: $1,387.91
  • Centerlight — Medicare Advantage: $243.77
  • Cigna — Commercial: $255.96
  • Elderplan — Medicaid: $616.85
  • Elderplan — Medicare Advantage: $243.77
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MAGNETIC RESONANCE IMAGING Not listed in the file $243.77 $130.05 – $709.38
MRI of the lower back (lumbar spine), without contrast: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $474.24
  • Aetna Non-Gatekeeper — Commercial: $474.24
  • Aetna Savings Plus — Exchange: $433.49
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri lumbar spine w/o dye Not listed in the file $243.77 $130.05 – $709.38
MRI of the lower back (lumbar spine), without contrast: rates for 2 insurance plans
  • VNS — Medicare Advantage: $709.38
  • VNS Special Needs — Medicaid Managed Care: $629.19
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Pelvis w/ IV Contrast $1,255 $179.20 $54.80 – $1,181.16
CT scan of the pelvis, with contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $179.20
  • Aetna Gatekeeper — Commercial: $299.46
  • Aetna Non-Gatekeeper — Commercial: $299.46
  • Aetna Savings Plus — Exchange: $273.72
  • Affinity — Medicaid: $524.96
  • Affinity Essential Plans — Medicaid Managed Care: $1,181.16
  • Centerlight — Medicare Advantage: $179.20
  • Cigna — Commercial: $188.16
  • Elderplan — Medicaid: $524.96
  • Elderplan — Medicare Advantage: $179.20
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Sacrum w/ Contrast $1,255 $179.20 $54.80 – $1,181.16
CT scan of the pelvis, with contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $179.20
  • Aetna Gatekeeper — Commercial: $299.46
  • Aetna Non-Gatekeeper — Commercial: $299.46
  • Aetna Savings Plus — Exchange: $273.72
  • Affinity — Medicaid: $524.96
  • Affinity Essential Plans — Medicaid Managed Care: $1,181.16
  • Centerlight — Medicare Advantage: $179.20
  • Cigna — Commercial: $188.16
  • Elderplan — Medicaid: $524.96
  • Elderplan — Medicare Advantage: $179.20
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CONTRAST CAT SCAN OF PELVIS Not listed in the file $179.20 $68.83 – $603.70
CT scan of the pelvis, with contrast: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $299.46
  • Aetna Non-Gatekeeper — Commercial: $299.46
  • Aetna Savings Plus — Exchange: $273.72
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Ankle w/o Contrast Left $2,218 $243.77 $64.85 – $1,552.60
MRI of a leg joint (such as the knee), without contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $243.77
  • Aetna Gatekeeper — Commercial: $1,046
  • Aetna Non-Gatekeeper — Commercial: $1,046
  • Aetna Savings Plus — Exchange: $942
  • Affinity — Medicaid: $616.85
  • Affinity Essential Plans — Medicaid Managed Care: $1,387.91
  • Centerlight — Medicare Advantage: $243.77
  • Cigna — Commercial: $255.96
  • Elderplan — Medicaid: $616.85
  • Elderplan — Medicare Advantage: $243.77
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Ankle w/o Contrast Right $2,218 $243.77 $64.85 – $1,552.60
MRI of a leg joint (such as the knee), without contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $243.77
  • Aetna Gatekeeper — Commercial: $1,046
  • Aetna Non-Gatekeeper — Commercial: $1,046
  • Aetna Savings Plus — Exchange: $942
  • Affinity — Medicaid: $616.85
  • Affinity Essential Plans — Medicaid Managed Care: $1,387.91
  • Centerlight — Medicare Advantage: $243.77
  • Cigna — Commercial: $255.96
  • Elderplan — Medicaid: $616.85
  • Elderplan — Medicare Advantage: $243.77
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRA Lower Extremity w/o Contrast Left $3,330 $243.77 $64.85 – $2,331
MRI of a leg joint (such as the knee), without contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $243.77
  • Aetna Gatekeeper — Commercial: $1,046
  • Aetna Non-Gatekeeper — Commercial: $1,046
  • Aetna Savings Plus — Exchange: $942
  • Affinity — Medicaid: $616.85
  • Affinity Essential Plans — Medicaid Managed Care: $1,387.91
  • Centerlight — Medicare Advantage: $243.77
  • Cigna — Commercial: $255.96
  • Elderplan — Medicaid: $616.85
  • Elderplan — Medicare Advantage: $243.77
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 74177 CT ABDOMEN & PELVIS-W/CONTRAST $3,015 $356.43 $83.75 – $2,110.50
CT scan of the abdomen and pelvis, with contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $356.43
  • Aetna Gatekeeper — Commercial: $410.92
  • Aetna Non-Gatekeeper — Commercial: $410.92
  • Aetna Savings Plus — Exchange: $375.61
  • Affinity — Medicaid: $524.96
  • Affinity Essential Plans — Medicaid Managed Care: $1,181.16
  • Centerlight — Medicare Advantage: $356.43
  • Cigna — Commercial: $374.25
  • Elderplan — Medicaid: $524.96
  • Elderplan — Medicare Advantage: $356.43
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Abdomen and Pelvis w/ IV Contrast $3,015 $356.43 $83.75 – $2,110.50
CT scan of the abdomen and pelvis, with contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $356.43
  • Aetna Gatekeeper — Commercial: $410.92
  • Aetna Non-Gatekeeper — Commercial: $410.92
  • Aetna Savings Plus — Exchange: $375.61
  • Affinity — Medicaid: $524.96
  • Affinity Essential Plans — Medicaid Managed Care: $1,181.16
  • Centerlight — Medicare Advantage: $356.43
  • Cigna — Commercial: $374.25
  • Elderplan — Medicaid: $524.96
  • Elderplan — Medicare Advantage: $356.43
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Enterography $3,015 $356.43 $83.75 – $2,110.50
CT scan of the abdomen and pelvis, with contrast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $356.43
  • Aetna Gatekeeper — Commercial: $410.92
  • Aetna Non-Gatekeeper — Commercial: $410.92
  • Aetna Savings Plus — Exchange: $375.61
  • Affinity — Medicaid: $524.96
  • Affinity Essential Plans — Medicaid Managed Care: $1,181.16
  • Centerlight — Medicare Advantage: $356.43
  • Cigna — Commercial: $374.25
  • Elderplan — Medicaid: $524.96
  • Elderplan — Medicare Advantage: $356.43
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Abdomen Complete $908 $106.81 $35.57 – $1,913.45
Ultrasound of the abdomen, complete: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $106.81
  • Aetna Gatekeeper — Commercial: $121.93
  • Aetna Non-Gatekeeper — Commercial: $121.93
  • Aetna Savings Plus — Exchange: $111.45
  • Affinity — Medicaid: $850.42
  • Affinity Essential Plans — Medicaid Managed Care: $1,913.45
  • Centerlight — Medicare Advantage: $106.81
  • Cigna — Commercial: $112.15
  • Elderplan — Medicaid: $850.42
  • Elderplan — Medicare Advantage: $106.81
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Abdomen Complete w/ Dopper $908 $106.81 $35.57 – $1,913.45
Ultrasound of the abdomen, complete: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $106.81
  • Aetna Gatekeeper — Commercial: $121.93
  • Aetna Non-Gatekeeper — Commercial: $121.93
  • Aetna Savings Plus — Exchange: $111.45
  • Affinity — Medicaid: $850.42
  • Affinity Essential Plans — Medicaid Managed Care: $1,913.45
  • Centerlight — Medicare Advantage: $106.81
  • Cigna — Commercial: $112.15
  • Elderplan — Medicaid: $850.42
  • Elderplan — Medicare Advantage: $106.81
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ULTRASOUND, ABDOMINAL Not listed in the file $106.81 $35.57 – $977.98
Ultrasound of the abdomen, complete: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $121.93
  • Aetna Non-Gatekeeper — Commercial: $121.93
  • Aetna Savings Plus — Exchange: $111.45
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US OB Greater Than 14 Weeks $532 $106.81 $44.95 – $589.79
Pregnancy ultrasound (after the first trimester): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $106.81
  • Aetna Gatekeeper — Commercial: $141.84
  • Aetna Non-Gatekeeper — Commercial: $141.84
  • Aetna Savings Plus — Exchange: $129.65
  • Affinity — Medicaid: $262.13
  • Affinity Essential Plans — Medicaid Managed Care: $589.79
  • Centerlight — Medicare Advantage: $106.81
  • Cigna — Commercial: $112.15
  • Elderplan — Medicaid: $262.13
  • Elderplan — Medicare Advantage: $106.81
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US EXAM, PG UTERUS, COMPL Not listed in the file $106.81 $44.95 – $301.45
Pregnancy ultrasound (after the first trimester): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $141.84
  • Aetna Non-Gatekeeper — Commercial: $141.84
  • Aetna Savings Plus — Exchange: $129.65
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ob us >/= 14 wks sngl fetus Not listed in the file $106.81 $44.95 – $301.45
Pregnancy ultrasound (after the first trimester): rates for 2 insurance plans
  • VNS — Medicare Advantage: $301.45
  • VNS Special Needs — Medicaid Managed Care: $267.37
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Transvaginal Non-OB $532 $106.81 $30.74 – $641.54
Transvaginal ultrasound: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $106.81
  • Aetna Gatekeeper — Commercial: $122
  • Aetna Non-Gatekeeper — Commercial: $122
  • Aetna Savings Plus — Exchange: $111.51
  • Affinity — Medicaid: $285.13
  • Affinity Essential Plans — Medicaid Managed Care: $641.54
  • Centerlight — Medicare Advantage: $106.81
  • Cigna — Commercial: $112.15
  • Elderplan — Medicaid: $285.13
  • Elderplan — Medicare Advantage: $106.81
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US EXAM, TRANSVAGINAL Not listed in the file $106.81 $30.74 – $327.90
Transvaginal ultrasound: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $122
  • Aetna Non-Gatekeeper — Commercial: $122
  • Aetna Savings Plus — Exchange: $111.51
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Transvaginal us non-ob Not listed in the file $106.81 $30.74 – $327.90
Transvaginal ultrasound: rates for 2 insurance plans
  • VNS — Medicare Advantage: $327.90
  • VNS Special Needs — Medicaid Managed Care: $290.83
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MG Breast 3D Digital Diag Left $988 $118.55 $34.15 – $691.60
Diagnostic mammogram, one breast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $118.55
  • Aetna Gatekeeper — Commercial: $133.17
  • Aetna Non-Gatekeeper — Commercial: $133.17
  • Aetna Savings Plus — Exchange: $121.73
  • Affinity — Medicaid: $256.47
  • Affinity Essential Plans — Medicaid Managed Care: $577.06
  • Centerlight — Medicare Advantage: $118.55
  • Cigna — Commercial: $124.47
  • Elderplan — Medicaid: $256.47
  • Elderplan — Medicare Advantage: $118.55
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MG Breast 3D Digital Diag Right $988 $118.55 $34.15 – $691.60
Diagnostic mammogram, one breast: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $118.55
  • Aetna Gatekeeper — Commercial: $133.17
  • Aetna Non-Gatekeeper — Commercial: $133.17
  • Aetna Savings Plus — Exchange: $121.73
  • Affinity — Medicaid: $256.47
  • Affinity Essential Plans — Medicaid Managed Care: $577.06
  • Centerlight — Medicare Advantage: $118.55
  • Cigna — Commercial: $124.47
  • Elderplan — Medicaid: $256.47
  • Elderplan — Medicare Advantage: $118.55
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DX MAMMO INCL CAD UNI Not listed in the file $118.55 $34.46 – $294.94
Diagnostic mammogram, one breast: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $133.17
  • Aetna Non-Gatekeeper — Commercial: $133.17
  • Aetna Savings Plus — Exchange: $121.73
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MG Breast 3D Digital Diag Bilateral $1,235 $150.11 $41.96 – $864.50
Diagnostic mammogram, both breasts: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $150.11
  • Aetna Gatekeeper — Commercial: $168.96
  • Aetna Non-Gatekeeper — Commercial: $168.96
  • Aetna Savings Plus — Exchange: $154.44
  • Affinity — Medicaid: $256.47
  • Affinity Essential Plans — Medicaid Managed Care: $577.06
  • Centerlight — Medicare Advantage: $150.11
  • Cigna — Commercial: $157.62
  • Elderplan — Medicaid: $256.47
  • Elderplan — Medicare Advantage: $150.11
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DX MAMMO INCL CAD BI Not listed in the file $150.11 $42.82 – $294.94
Diagnostic mammogram, both breasts: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $168.96
  • Aetna Non-Gatekeeper — Commercial: $168.96
  • Aetna Savings Plus — Exchange: $154.44
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad bi Not listed in the file $150.11 $42.82 – $294.94
Diagnostic mammogram, both breasts: rates for 2 insurance plans
  • VNS — Medicare Advantage: $294.94
  • VNS Special Needs — Medicaid Managed Care: $261.60
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MG Breast 3D Digital Screening Left $814 $120.77 $31.60 – $577.06
Screening mammogram, both breasts: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $120.77
  • Aetna Gatekeeper — Commercial: $136.44
  • Aetna Non-Gatekeeper — Commercial: $136.44
  • Aetna Savings Plus — Exchange: $124.71
  • Affinity — Medicaid: $256.47
  • Affinity Essential Plans — Medicaid Managed Care: $577.06
  • Centerlight — Medicare Advantage: $120.77
  • Cigna — Commercial: $126.80
  • Elderplan — Medicaid: $256.47
  • Elderplan — Medicare Advantage: $120.77
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MG Breast 3D Digital Screening Right $814 $120.77 $31.60 – $577.06
Screening mammogram, both breasts: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $120.77
  • Aetna Gatekeeper — Commercial: $136.44
  • Aetna Non-Gatekeeper — Commercial: $136.44
  • Aetna Savings Plus — Exchange: $124.71
  • Affinity — Medicaid: $256.47
  • Affinity Essential Plans — Medicaid Managed Care: $577.06
  • Centerlight — Medicare Advantage: $120.77
  • Cigna — Commercial: $126.80
  • Elderplan — Medicaid: $256.47
  • Elderplan — Medicare Advantage: $120.77
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MG Breast 3D Digital Screening Bilateral $864 $120.77 $31.60 – $604.80
Screening mammogram, both breasts: 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $120.77
  • Aetna Gatekeeper — Commercial: $136.44
  • Aetna Non-Gatekeeper — Commercial: $136.44
  • Aetna Savings Plus — Exchange: $124.71
  • Affinity — Medicaid: $256.47
  • Affinity Essential Plans — Medicaid Managed Care: $577.06
  • Centerlight — Medicare Advantage: $120.77
  • Cigna — Commercial: $126.80
  • Elderplan — Medicaid: $256.47
  • Elderplan — Medicare Advantage: $120.77

Heart tests and sleep study

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Electrocardiogram complete Not listed in the file $14.72 $14.72 – $368.84
Electrocardiogram (ECG/EKG) with reading: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $163.93
  • Empire HealthPlus CHP — Medicaid: $163.93
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $196.72
  • Empire HealthPlus Individual — Medicaid Managed Care: $196.72
  • Fidelis — Medicaid: $163.93
  • Fidelis CHP — Medicaid: $163.93
  • Fidelis Essential Plans — Medicaid Managed Care: $368.84
  • Healthfirst — Medicaid: $172.13
  • Healthfirst Essential Plans — Medicaid Managed Care: $368.84
  • Healthfirst QHP — Medicaid Managed Care: $172.13
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient · Doctor (professional) fee In the file: ELECTROCARDIOGRAM COMPLETE Not listed in the file $18 $12.60 – $18.90
Electrocardiogram (ECG/EKG) with reading: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $18
  • Hamaspik — Medicare Advantage: $18.90
  • Healthfirst — Medicaid: $18
  • Healthfirst — Medicare Advantage: $18.90
  • Healthfirst Essential Plans — Medicaid Managed Care: $18.90
  • Healthfirst QHP — Medicaid Managed Care: $18.90
  • MetroPlus Behavioral Health — Medicaid: $12.60
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $15.30
  • VA — Other: $18
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ELECTROCARDIOGRAM, COMPLETE Not listed in the file $14.72 $14.72 – $368.84
Electrocardiogram (ECG/EKG) with reading: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $19.25
  • Aetna Non-Gatekeeper — Commercial: $19.25
  • Aetna Savings Plus — Exchange: $17.60
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Left hrt cath w/ventrclgrphy Not listed in the file $3,312.15 $2,181.89 – $6,521.76
Left heart catheterization (diagnostic): 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $2,181.89
  • Empire HealthPlus CHP — Medicaid: $2,181.89
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $2,618.27
  • Empire HealthPlus Individual — Medicaid Managed Care: $2,618.27
  • Fidelis — Medicaid: $2,181.89
  • Fidelis CHP — Medicaid: $2,181.89
  • Fidelis Essential Plans — Medicaid Managed Care: $4,909.25
  • Healthfirst — Medicaid: $2,290.98
  • Healthfirst Essential Plans — Medicaid Managed Care: $4,909.25
  • Healthfirst QHP — Medicaid Managed Care: $2,290.98
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION, WHEN PE Not listed in the file $3,312.15 $2,181.89 – $6,521.76
Left heart catheterization (diagnostic): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $3,347
  • Aetna Non-Gatekeeper — Commercial: $3,347
  • Aetna Savings Plus — Exchange: $3,012
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY Not listed in the file $3,312.15 $2,181.89 – $6,521.76
Left heart catheterization (diagnostic): rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $3,312.15
  • United Healthcare — Commercial: $6,521.76
  • VA — Other: $3,312.15
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive ep evaluation Not listed in the file $7,968.60 $731.29 – $15,690.51
Heart rhythm study (electrophysiology evaluation): 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $731.29
  • Empire HealthPlus CHP — Medicaid: $731.29
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $877.55
  • Empire HealthPlus Individual — Medicaid Managed Care: $877.55
  • Fidelis — Medicaid: $731.29
  • Fidelis CHP — Medicaid: $731.29
  • Fidelis Essential Plans — Medicaid Managed Care: $1,645.40
  • Healthfirst — Medicaid: $767.85
  • Healthfirst Essential Plans — Medicaid Managed Care: $1,645.40
  • Healthfirst QHP — Medicaid Managed Care: $767.85
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee 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 $7,968.60 $731.29 – $15,690.51
Heart rhythm study (electrophysiology evaluation): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $3,347
  • Aetna Non-Gatekeeper — Commercial: $3,347
  • Aetna Savings Plus — Exchange: $3,012
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ELECTROPHYSIOLOGY EVALUATION Not listed in the file $7,968.60 $731.29 – $15,690.51
Heart rhythm study (electrophysiology evaluation): rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $7,968.60
  • United Healthcare — Commercial: $15,690.51
  • VA — Other: $7,968.60
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Compre ep eval abltj atr fib Not listed in the file $26,703.99 $1,173.95 – $52,581.28
Heart rhythm study with ablation for atrial fibrillation: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $1,173.95
  • Empire HealthPlus CHP — Medicaid: $1,173.95
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $1,408.74
  • Empire HealthPlus Individual — Medicaid Managed Care: $1,408.74
  • Fidelis — Medicaid: $1,173.95
  • Fidelis CHP — Medicaid: $1,173.95
  • Fidelis Essential Plans — Medicaid Managed Care: $2,641.39
  • Healthfirst — Medicaid: $1,232.65
  • Healthfirst Essential Plans — Medicaid Managed Care: $2,641.39
  • Healthfirst QHP — Medicaid Managed Care: $1,232.65
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPRE EP EVAL ABLTJ ATR FIB Not listed in the file $977.10 $683.97 – $1,025.96
Heart rhythm study with ablation for atrial fibrillation: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $977.10
  • Hamaspik — Medicare Advantage: $1,025.96
  • Healthfirst — Medicaid: $977.10
  • Healthfirst — Medicare Advantage: $1,025.96
  • Healthfirst Essential Plans — Medicaid Managed Care: $1,025.96
  • Healthfirst QHP — Medicaid Managed Care: $1,025.96
  • MetroPlus Behavioral Health — Medicaid: $683.97
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $830.54
  • VA — Other: $977.10
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TX ATRIAL FIB PULM VEIN ISOL Not listed in the file $26,703.99 $1,173.95 – $52,581.28
Heart rhythm study with ablation for atrial fibrillation: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $3,347
  • Aetna Non-Gatekeeper — Commercial: $3,347
  • Aetna Savings Plus — Exchange: $3,012
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom 6/> yrs 4/> param Not listed in the file $877.34 $121.52 – $2,475.38
Sleep study (overnight, in a sleep lab): 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $1,100.17
  • Empire HealthPlus CHP — Medicaid: $1,100.17
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $1,320.20
  • Empire HealthPlus Individual — Medicaid Managed Care: $1,320.20
  • Fidelis — Medicaid: $1,100.17
  • Fidelis CHP — Medicaid: $1,100.17
  • Fidelis Essential Plans — Medicaid Managed Care: $2,475.38
  • Healthfirst — Medicaid: $1,155.18
  • Healthfirst Essential Plans — Medicaid Managed Care: $2,475.38
  • Healthfirst QHP — Medicaid Managed Care: $1,155.18
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POLYSOM 6/> YRS 4/> PARAM Not listed in the file $877.34 $121.52 – $2,475.38
Sleep study (overnight, in a sleep lab): rates for 6 insurance plans
  • Aetna Gatekeeper — Commercial: $711.27
  • Aetna Non-Gatekeeper — Commercial: $711.27
  • Aetna Savings Plus — Exchange: $650.15
  • MetroPlus Behavioral Health — Medicare Advantage: $877.34
  • United Healthcare — Commercial: $1,727.51
  • VA — Other: $877.34
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: POLYSOM 6/> YRS 4/> PARAM Not listed in the file $134.44 $94.11 – $141.16
Sleep study (overnight, in a sleep lab): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $134.44
  • Hamaspik — Medicare Advantage: $141.16
  • Healthfirst — Medicaid: $134.44
  • Healthfirst — Medicare Advantage: $141.16
  • Healthfirst Essential Plans — Medicaid Managed Care: $141.16
  • Healthfirst QHP — Medicaid Managed Care: $141.16
  • MetroPlus Behavioral Health — Medicaid: $94.11
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $114.27
  • VA — Other: $134.44

Physical therapy and mental health

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OT Therapeutic Exercise Units $230 $28.27 $26.32 – $444.53
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $28.27
  • Aetna Gatekeeper — Commercial: $133
  • Aetna Non-Gatekeeper — Commercial: $133
  • Aetna Savings Plus — Exchange: $119
  • Affinity — Medicaid: $197.57
  • Affinity Essential Plans — Medicaid Managed Care: $444.53
  • Centerlight — Medicare Advantage: $28.27
  • Cigna — Commercial: $29.69
  • Elderplan — Medicaid: $197.57
  • Elderplan — Medicare Advantage: $28.27
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Therapeutic Exercise Units $230 $28.27 $26.32 – $444.53
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $28.27
  • Aetna Gatekeeper — Commercial: $133
  • Aetna Non-Gatekeeper — Commercial: $133
  • Aetna Savings Plus — Exchange: $119
  • Affinity — Medicaid: $197.57
  • Affinity Essential Plans — Medicaid Managed Care: $444.53
  • Centerlight — Medicare Advantage: $28.27
  • Cigna — Commercial: $29.69
  • Elderplan — Medicaid: $197.57
  • Elderplan — Medicare Advantage: $28.27
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Therapeutic Exercise Assistant Units $230 $28.27 $26.32 – $444.53
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $28.27
  • Aetna Gatekeeper — Commercial: $133
  • Aetna Non-Gatekeeper — Commercial: $133
  • Aetna Savings Plus — Exchange: $119
  • Affinity — Medicaid: $197.57
  • Affinity Essential Plans — Medicaid Managed Care: $444.53
  • Centerlight — Medicare Advantage: $28.27
  • Cigna — Commercial: $29.69
  • Elderplan — Medicaid: $197.57
  • Elderplan — Medicare Advantage: $28.27
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Evaluation Units, Low Complexity $606 $95.46 $88.12 – $583.67
Physical therapy evaluation (low complexity): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Aetna Gatekeeper — Commercial: $133
  • Aetna Non-Gatekeeper — Commercial: $133
  • Aetna Savings Plus — Exchange: $119
  • Affinity — Medicaid: $259.41
  • Affinity Essential Plans — Medicaid Managed Care: $583.67
  • Centerlight — Medicare Advantage: $95.46
  • Cigna — Commercial: $100.23
  • Elderplan — Medicaid: $259.41
  • Elderplan — Medicare Advantage: $95.46
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Doctor (professional) fee In the file: PT EVAL LOW COMPLEX 20 MIN Not listed in the file $110.15 $77.11 – $115.66
Physical therapy evaluation (low complexity): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $110.15
  • Hamaspik — Medicare Advantage: $115.66
  • Healthfirst — Medicaid: $110.15
  • Healthfirst — Medicare Advantage: $115.66
  • Healthfirst Essential Plans — Medicaid Managed Care: $115.66
  • Healthfirst QHP — Medicaid Managed Care: $115.66
  • MetroPlus Behavioral Health — Medicaid: $77.11
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $93.63
  • VA — Other: $110.15
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT EVAL LOW COMPLEX 20 MIN Not listed in the file $95.46 $57.46 – $298.32
Physical therapy evaluation (low complexity): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $62.86
  • Aetna Non-Gatekeeper — Commercial: $62.86
  • Aetna Savings Plus — Exchange: $57.46
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Evaluation Units, Moderate Complexity $669 $95.46 $88.12 – $583.67
Physical therapy evaluation (moderate complexity): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Aetna Gatekeeper — Commercial: $133
  • Aetna Non-Gatekeeper — Commercial: $133
  • Aetna Savings Plus — Exchange: $119
  • Affinity — Medicaid: $259.41
  • Affinity Essential Plans — Medicaid Managed Care: $583.67
  • Centerlight — Medicare Advantage: $95.46
  • Cigna — Commercial: $100.23
  • Elderplan — Medicaid: $259.41
  • Elderplan — Medicare Advantage: $95.46
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Doctor (professional) fee In the file: PT EVAL MOD COMPLEX 30 MIN Not listed in the file $110.15 $77.11 – $115.66
Physical therapy evaluation (moderate complexity): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $110.15
  • Hamaspik — Medicare Advantage: $115.66
  • Healthfirst — Medicaid: $110.15
  • Healthfirst — Medicare Advantage: $115.66
  • Healthfirst Essential Plans — Medicaid Managed Care: $115.66
  • Healthfirst QHP — Medicaid Managed Care: $115.66
  • MetroPlus Behavioral Health — Medicaid: $77.11
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $93.63
  • VA — Other: $110.15
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT EVAL MOD COMPLEX 30 MIN Not listed in the file $95.46 $57.46 – $298.32
Physical therapy evaluation (moderate complexity): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $62.86
  • Aetna Non-Gatekeeper — Commercial: $62.86
  • Aetna Savings Plus — Exchange: $57.46
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT Evaluation Units, High Complexity $708 $95.46 $88.12 – $583.67
Physical therapy evaluation (high complexity): 10 of 53 insurance plan rates
  • Aetna — Medicare Advantage: $95.46
  • Aetna Gatekeeper — Commercial: $133
  • Aetna Non-Gatekeeper — Commercial: $133
  • Aetna Savings Plus — Exchange: $119
  • Affinity — Medicaid: $259.41
  • Affinity Essential Plans — Medicaid Managed Care: $583.67
  • Centerlight — Medicare Advantage: $95.46
  • Cigna — Commercial: $100.23
  • Elderplan — Medicaid: $259.41
  • Elderplan — Medicare Advantage: $95.46
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Doctor (professional) fee In the file: PT EVAL HIGH COMPLEX 45 MIN Not listed in the file $110.15 $77.11 – $115.66
Physical therapy evaluation (high complexity): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $110.15
  • Hamaspik — Medicare Advantage: $115.66
  • Healthfirst — Medicaid: $110.15
  • Healthfirst — Medicare Advantage: $115.66
  • Healthfirst Essential Plans — Medicaid Managed Care: $115.66
  • Healthfirst QHP — Medicaid Managed Care: $115.66
  • MetroPlus Behavioral Health — Medicaid: $77.11
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $93.63
  • VA — Other: $110.15
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT EVAL HIGH COMPLEX 45 MIN Not listed in the file $95.46 $57.46 – $298.32
Physical therapy evaluation (high complexity): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $62.86
  • Aetna Non-Gatekeeper — Commercial: $62.86
  • Aetna Savings Plus — Exchange: $57.46
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psychotherapy, 30 Mins 90832 $585 $181.34 $49.25 – $554.29
Psychotherapy, 30 minutes: 10 of 53 insurance plan rates
  • 1199 Behavioral Health — Commercial: $78
  • Aetna — Medicare Advantage: $181.34
  • Aetna Gatekeeper — Commercial: $62
  • Aetna Non-Gatekeeper — Commercial: $62
  • Aetna Savings Plus — Exchange: $56
  • Affinity — Medicaid: $246.35
  • Affinity Essential Plans — Medicaid Managed Care: $554.29
  • Centerlight — Medicare Advantage: $181.34
  • Cigna — Commercial: $190.41
  • Elderplan — Medicaid: $246.35
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Doctor (professional) fee In the file: Psych Therapy 30 $74.73 $74.73 $26.47 – $91
Psychotherapy, 30 minutes: 10 of 11 insurance plan rates
  • Elderplan — Medicare Advantage: $74.73
  • Evernorth Behavioral Health — Commercial: $91
  • Hamaspik — Medicaid Managed Care: $26.47
  • Hamaspik — Medicare Advantage: $78.47
  • Healthfirst — Medicaid: $74.73
  • Healthfirst — Medicare Advantage: $78.47
  • Healthfirst Essential Plans — Medicaid Managed Care: $78.47
  • Healthfirst QHP — Medicaid Managed Care: $78.47
  • MetroPlus Behavioral Health — Medicaid: $52.31
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $63.52
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Crisis Triage Assessment $585 $181.34 $49.25 – $554.29
Psychotherapy, 30 minutes: rates for 1 insurance plan
  • Evernorth Behavioral Health — Commercial: $275
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psychotherapy, 45 Mins 90834 $789 $181.34 $74.25 – $652.21
Psychotherapy, 45 minutes: 10 of 52 insurance plan rates
  • Aetna — Medicare Advantage: $181.34
  • Aetna Gatekeeper — Commercial: $90
  • Aetna Non-Gatekeeper — Commercial: $90
  • Aetna Savings Plus — Exchange: $81
  • Affinity — Medicaid: $289.87
  • Affinity Essential Plans — Medicaid Managed Care: $652.21
  • Centerlight — Medicare Advantage: $181.34
  • Cigna — Commercial: $190.41
  • Elderplan — Medicaid: $289.87
  • Elderplan — Medicare Advantage: $181.34
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Doctor (professional) fee In the file: Psych Therapy 45 $98.97 $98.97 $39.68 – $117
Psychotherapy, 45 minutes: 10 of 11 insurance plan rates
  • Elderplan — Medicare Advantage: $98.97
  • Evernorth Behavioral Health — Commercial: $117
  • Hamaspik — Medicaid Managed Care: $39.68
  • Hamaspik — Medicare Advantage: $103.92
  • Healthfirst — Medicaid: $98.97
  • Healthfirst — Medicare Advantage: $103.92
  • Healthfirst Essential Plans — Medicaid Managed Care: $103.92
  • Healthfirst QHP — Medicaid Managed Care: $103.92
  • MetroPlus Behavioral Health — Medicaid: $69.28
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $84.12
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Crisis Triage Assessment $789 $181.34 $74.25 – $652.21
Psychotherapy, 45 minutes: rates for 1 insurance plan
  • Evernorth Behavioral Health — Commercial: $275
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psychotherapy, 60 Mins 90837 $824 $181.34 $81 – $652.21
Psychotherapy, 60 minutes: 10 of 50 insurance plan rates
  • Aetna — Medicare Advantage: $181.34
  • Aetna Gatekeeper — Commercial: $90
  • Aetna Non-Gatekeeper — Commercial: $90
  • Aetna Savings Plus — Exchange: $81
  • Affinity — Medicaid: $289.87
  • Affinity Essential Plans — Medicaid Managed Care: $652.21
  • Centerlight — Medicare Advantage: $181.34
  • Cigna — Commercial: $190.41
  • Elderplan — Medicaid: $289.87
  • Elderplan — Medicare Advantage: $181.34
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Doctor (professional) fee In the file: Psych Therapy 60 $145.50 $145.50 $59.90 – $173
Psychotherapy, 60 minutes: 10 of 11 insurance plan rates
  • Elderplan — Medicare Advantage: $145.50
  • Evernorth Behavioral Health — Commercial: $173
  • Hamaspik — Medicaid Managed Care: $59.90
  • Hamaspik — Medicare Advantage: $152.78
  • Healthfirst — Medicaid: $145.50
  • Healthfirst — Medicare Advantage: $152.78
  • Healthfirst Essential Plans — Medicaid Managed Care: $152.78
  • Healthfirst QHP — Medicaid Managed Care: $152.78
  • MetroPlus Behavioral Health — Medicaid: $101.85
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $123.68
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Crisis Triage Assessment $824 $181.34 $81 – $652.21
Psychotherapy, 60 minutes: rates for 1 insurance plan
  • Evernorth Behavioral Health — Commercial: $275
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family, Couples Psychotherapy W/O Patient 90846 $425 $181.34 $74.25 – $554.29
Family psychotherapy, without the patient: 10 of 54 insurance plan rates
  • 1199 Behavioral Health — Commercial: $114
  • Aetna — Medicare Advantage: $181.34
  • Aetna Gatekeeper — Commercial: $90
  • Aetna Non-Gatekeeper — Commercial: $90
  • Aetna Savings Plus — Exchange: $81
  • Affinity — Medicaid: $246.35
  • Affinity Essential Plans — Medicaid Managed Care: $554.29
  • Centerlight — Medicare Advantage: $181.34
  • Cigna — Commercial: $190.41
  • Elderplan — Medicaid: $246.35
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: zzBEH Family Therapy without Patient 863878 $425 $181.34 $74.25 – $554.29
Family psychotherapy, without the patient: 10 of 54 insurance plan rates
  • 1199 Behavioral Health — Commercial: $114
  • Aetna — Medicare Advantage: $181.34
  • Aetna Gatekeeper — Commercial: $90
  • Aetna Non-Gatekeeper — Commercial: $90
  • Aetna Savings Plus — Exchange: $81
  • Affinity — Medicaid: $246.35
  • Affinity Essential Plans — Medicaid Managed Care: $554.29
  • Centerlight — Medicare Advantage: $181.34
  • Cigna — Commercial: $190.41
  • Elderplan — Medicaid: $246.35
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family Therapy W/O Patient 90846 $773 $181.34 $74.25 – $554.29
Family psychotherapy, without the patient: 10 of 54 insurance plan rates
  • 1199 Behavioral Health — Commercial: $114
  • Aetna — Medicare Advantage: $181.34
  • Aetna Gatekeeper — Commercial: $90
  • Aetna Non-Gatekeeper — Commercial: $90
  • Aetna Savings Plus — Exchange: $81
  • Affinity — Medicaid: $246.35
  • Affinity Essential Plans — Medicaid Managed Care: $554.29
  • Centerlight — Medicare Advantage: $181.34
  • Cigna — Commercial: $190.41
  • Elderplan — Medicaid: $246.35
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family Therapy with Patient 90847 $1,172 $181.34 $74.25 – $820.40
Family psychotherapy, with the patient: 10 of 53 insurance plan rates
  • 1199 Behavioral Health — Commercial: $130
  • Aetna — Medicare Advantage: $181.34
  • Aetna Gatekeeper — Commercial: $90
  • Aetna Non-Gatekeeper — Commercial: $90
  • Aetna Savings Plus — Exchange: $81
  • Affinity — Medicaid: $246.35
  • Affinity Essential Plans — Medicaid Managed Care: $554.29
  • Centerlight — Medicare Advantage: $181.34
  • Cigna — Commercial: $190.41
  • Elderplan — Medicaid: $246.35
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Doctor (professional) fee In the file: Family Psych Therapy w/Patient 50 min $110.82 $110.82 $54.63 – $121
Family psychotherapy, with the patient: 10 of 11 insurance plan rates
  • Elderplan — Medicare Advantage: $110.82
  • Evernorth Behavioral Health — Commercial: $121
  • Hamaspik — Medicaid Managed Care: $54.63
  • Hamaspik — Medicare Advantage: $116.36
  • Healthfirst — Medicaid: $110.82
  • Healthfirst — Medicare Advantage: $116.36
  • Healthfirst Essential Plans — Medicaid Managed Care: $116.36
  • Healthfirst QHP — Medicaid Managed Care: $116.36
  • MetroPlus Behavioral Health — Medicaid: $77.57
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $94.20
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Crisis Triage Assessment $1,172 $181.34 $74.25 – $820.40
Family psychotherapy, with the patient: rates for 1 insurance plan
  • Evernorth Behavioral Health — Commercial: $275
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Group Therapy 90853 $418 $103.79 $45 – $412.29
Group psychotherapy: 10 of 54 insurance plan rates
  • 1199 Behavioral Health — Commercial: $70
  • Aetna — Medicare Advantage: $103.79
  • Aetna Gatekeeper — Commercial: $68
  • Aetna Non-Gatekeeper — Commercial: $68
  • Aetna Savings Plus — Exchange: $61
  • Affinity — Medicaid: $183.24
  • Affinity Essential Plans — Medicaid Managed Care: $412.29
  • Centerlight — Medicare Advantage: $103.79
  • Cigna — Commercial: $108.98
  • Elderplan — Medicaid: $183.24
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POS CHEMICAL DEP REHAB FULLDAY $1,321 $103.79 $45 – $924.70
Group psychotherapy: 10 of 54 insurance plan rates
  • 1199 Behavioral Health — Commercial: $70
  • Aetna — Medicare Advantage: $103.79
  • Aetna Gatekeeper — Commercial: $68
  • Aetna Non-Gatekeeper — Commercial: $68
  • Aetna Savings Plus — Exchange: $61
  • Affinity — Medicaid: $183.24
  • Affinity Essential Plans — Medicaid Managed Care: $412.29
  • Centerlight — Medicare Advantage: $103.79
  • Cigna — Commercial: $108.98
  • Elderplan — Medicaid: $183.24
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POS CHEMICAL DEP REHAB HALFDAY $1,013 $103.79 $45 – $709.10
Group psychotherapy: 10 of 54 insurance plan rates
  • 1199 Behavioral Health — Commercial: $70
  • Aetna — Medicare Advantage: $103.79
  • Aetna Gatekeeper — Commercial: $68
  • Aetna Non-Gatekeeper — Commercial: $68
  • Aetna Savings Plus — Exchange: $61
  • Affinity — Medicaid: $183.24
  • Affinity Essential Plans — Medicaid Managed Care: $412.29
  • Centerlight — Medicare Advantage: $103.79
  • Cigna — Commercial: $108.98
  • Elderplan — Medicaid: $183.24

Procedures and surgery

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Removal of breast lesion Not listed in the file $4,000.24 $1,544 – $7,876.64
Removal of breast growth (open surgery): 10 of 17 insurance plan rates
  • Aetna Gatekeeper — Commercial: $1,716
  • Aetna Non-Gatekeeper — Commercial: $1,716
  • Aetna Savings Plus — Exchange: $1,544
  • Empire HealthPlus — Medicaid: $1,919.26
  • Empire HealthPlus CHP — Medicaid: $1,919.26
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $2,303.11
  • Empire HealthPlus Individual — Medicaid Managed Care: $2,303.11
  • Fidelis — Medicaid: $1,919.26
  • Fidelis CHP — Medicaid: $1,919.26
  • Fidelis Essential Plans — Medicaid Managed Care: $4,318.34
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee In the file: REMOVAL OF BREAST LESION Not listed in the file $493.17 $345.22 – $517.83
Removal of breast growth (open surgery): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $493.17
  • Hamaspik — Medicare Advantage: $517.83
  • Healthfirst — Medicaid: $493.17
  • Healthfirst — Medicare Advantage: $517.83
  • Healthfirst Essential Plans — Medicaid Managed Care: $517.83
  • Healthfirst QHP — Medicaid Managed Care: $517.83
  • MetroPlus Behavioral Health — Medicaid: $345.22
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $419.19
  • VA — Other: $493.17
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF BREAST LESION Not listed in the file $4,000.24 $1,544 – $7,876.64
Removal of breast growth (open surgery): rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $4,000.24
  • United Healthcare — Commercial: $7,876.64
  • VA — Other: $4,000.24
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total hip arthroplasty Not listed in the file $13,116.76 $2,440 – $25,827.46
Total hip replacement: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $4,126.86
  • Empire HealthPlus CHP — Medicaid: $4,126.86
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $4,952.23
  • Empire HealthPlus Individual — Medicaid Managed Care: $4,952.23
  • Fidelis — Medicaid: $4,126.86
  • Fidelis CHP — Medicaid: $4,126.86
  • Fidelis Essential Plans — Medicaid Managed Care: $9,285.44
  • Healthfirst — Medicaid: $4,333.20
  • Healthfirst Essential Plans — Medicaid Managed Care: $9,285.44
  • Healthfirst QHP — Medicaid Managed Care: $4,333.20
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee In the file: TOTAL HIP ARTHROPLASTY Not listed in the file $1,392.21 $974.55 – $1,461.82
Total hip replacement: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $1,392.21
  • Hamaspik — Medicare Advantage: $1,461.82
  • Healthfirst — Medicaid: $1,392.21
  • Healthfirst — Medicare Advantage: $1,461.82
  • Healthfirst Essential Plans — Medicaid Managed Care: $1,461.82
  • Healthfirst QHP — Medicaid Managed Care: $1,461.82
  • MetroPlus Behavioral Health — Medicaid: $974.55
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $1,183.38
  • VA — Other: $1,392.21
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft Not listed in the file $13,116.76 $2,440 – $25,827.46
Total hip replacement: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $2,711
  • Aetna Non-Gatekeeper — Commercial: $2,711
  • Aetna Savings Plus — Exchange: $2,440
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total knee arthroplasty Not listed in the file $13,116.76 $2,440 – $25,827.46
Total knee replacement: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $4,126.86
  • Empire HealthPlus CHP — Medicaid: $4,126.86
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $4,952.23
  • Empire HealthPlus Individual — Medicaid Managed Care: $4,952.23
  • Fidelis — Medicaid: $4,126.86
  • Fidelis CHP — Medicaid: $4,126.86
  • Fidelis Essential Plans — Medicaid Managed Care: $9,285.44
  • Healthfirst — Medicaid: $4,333.20
  • Healthfirst Essential Plans — Medicaid Managed Care: $9,285.44
  • Healthfirst QHP — Medicaid Managed Care: $4,333.20
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee In the file: TOTAL KNEE ARTHROPLASTY Not listed in the file $1,388.37 $971.86 – $1,457.79
Total knee replacement: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $1,388.37
  • Hamaspik — Medicare Advantage: $1,457.79
  • Healthfirst — Medicaid: $1,388.37
  • Healthfirst — Medicare Advantage: $1,457.79
  • Healthfirst Essential Plans — Medicaid Managed Care: $1,457.79
  • Healthfirst QHP — Medicaid Managed Care: $1,457.79
  • MetroPlus Behavioral Health — Medicaid: $971.86
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $1,180.11
  • VA — Other: $1,388.37
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee 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 $13,116.76 $2,440 – $25,827.46
Total knee replacement: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $2,711
  • Aetna Non-Gatekeeper — Commercial: $2,711
  • Aetna Savings Plus — Exchange: $2,440
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Sho arthrs srg decompression Not listed in the file $140.36 $140.36 – $4,971.02
Shoulder arthroscopy: shaving of shoulder bone: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $2,209.34
  • Empire HealthPlus CHP — Medicaid: $2,209.34
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $2,651.21
  • Empire HealthPlus Individual — Medicaid Managed Care: $2,651.21
  • Fidelis — Medicaid: $2,209.34
  • Fidelis CHP — Medicaid: $2,209.34
  • Fidelis Essential Plans — Medicaid Managed Care: $4,971.02
  • Healthfirst — Medicaid: $2,319.81
  • Healthfirst Essential Plans — Medicaid Managed Care: $4,971.02
  • Healthfirst QHP — Medicaid Managed Care: $2,319.81
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee In the file: SHO ARTHRS SRG DECOMPRESSION Not listed in the file $176.24 $123.37 – $185.05
Shoulder arthroscopy: shaving of shoulder bone: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $176.24
  • Hamaspik — Medicare Advantage: $185.05
  • Healthfirst — Medicaid: $176.24
  • Healthfirst — Medicare Advantage: $185.05
  • Healthfirst Essential Plans — Medicaid Managed Care: $185.05
  • Healthfirst QHP — Medicaid Managed Care: $185.05
  • MetroPlus Behavioral Health — Medicaid: $123.37
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $149.80
  • VA — Other: $176.24
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Shoulder arthroscopy/surgery Not listed in the file $140.36 $140.36 – $4,971.02
Shoulder arthroscopy: shaving of shoulder bone: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $1,716
  • Aetna Non-Gatekeeper — Commercial: $1,716
  • Aetna Savings Plus — Exchange: $1,544
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Arthrs kne srg mnisectmy m/l Not listed in the file $3,342.87 $1,909 – $6,582.26
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $2,209.34
  • Empire HealthPlus CHP — Medicaid: $2,209.34
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $2,651.21
  • Empire HealthPlus Individual — Medicaid Managed Care: $2,651.21
  • Fidelis — Medicaid: $2,209.34
  • Fidelis CHP — Medicaid: $2,209.34
  • Fidelis Essential Plans — Medicaid Managed Care: $4,971.02
  • Healthfirst — Medicaid: $2,319.81
  • Healthfirst Essential Plans — Medicaid Managed Care: $4,971.02
  • Healthfirst QHP — Medicaid Managed Care: $2,319.81
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee In the file: KNEE ARTHROSCOPY/SURGERY Not listed in the file $615.82 $431.07 – $646.61
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $615.82
  • Hamaspik — Medicare Advantage: $646.61
  • Healthfirst — Medicaid: $615.82
  • Healthfirst — Medicare Advantage: $646.61
  • Healthfirst Essential Plans — Medicaid Managed Care: $646.61
  • Healthfirst QHP — Medicaid Managed Care: $646.61
  • MetroPlus Behavioral Health — Medicaid: $431.07
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $523.45
  • VA — Other: $615.82
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Knee arthroscopy/surgery Not listed in the file $3,342.87 $1,909 – $6,582.26
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $2,121
  • Aetna Non-Gatekeeper — Commercial: $2,121
  • Aetna Savings Plus — Exchange: $1,909
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Remove tonsils and adenoids Not listed in the file $6,048.05 $1,544 – $11,908.87
Removal of tonsils and adenoids (under age 12): 10 of 17 insurance plan rates
  • Aetna Gatekeeper — Commercial: $1,716
  • Aetna Non-Gatekeeper — Commercial: $1,716
  • Aetna Savings Plus — Exchange: $1,544
  • Empire HealthPlus — Medicaid: $1,771.86
  • Empire HealthPlus CHP — Medicaid: $1,771.86
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $2,126.23
  • Empire HealthPlus Individual — Medicaid Managed Care: $2,126.23
  • Fidelis — Medicaid: $1,771.86
  • Fidelis CHP — Medicaid: $1,771.86
  • Fidelis Essential Plans — Medicaid Managed Care: $3,986.69
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee In the file: REMOVE TONSILS AND ADENOIDS Not listed in the file $306.17 $214.32 – $321.48
Removal of tonsils and adenoids (under age 12): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $306.17
  • Hamaspik — Medicare Advantage: $321.48
  • Healthfirst — Medicaid: $306.17
  • Healthfirst — Medicare Advantage: $321.48
  • Healthfirst Essential Plans — Medicaid Managed Care: $321.48
  • Healthfirst QHP — Medicaid Managed Care: $321.48
  • MetroPlus Behavioral Health — Medicaid: $214.32
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $260.24
  • VA — Other: $306.17
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVE TONSILS AND ADENOIDS Not listed in the file $6,048.05 $1,544 – $11,908.87
Removal of tonsils and adenoids (under age 12): rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $6,048.05
  • United Healthcare — Commercial: $11,908.87
  • VA — Other: $6,048.05
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Egd diagnostic brush wash Not listed in the file $926.63 $926.63 – $2,341.24
Upper GI endoscopy (diagnostic): 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $1,040.55
  • Empire HealthPlus CHP — Medicaid: $1,040.55
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $1,248.66
  • Empire HealthPlus Individual — Medicaid Managed Care: $1,248.66
  • Fidelis — Medicaid: $1,040.55
  • Fidelis CHP — Medicaid: $1,040.55
  • Fidelis Essential Plans — Medicaid Managed Care: $2,341.24
  • Healthfirst — Medicaid: $1,092.58
  • Healthfirst Essential Plans — Medicaid Managed Care: $2,341.24
  • Healthfirst QHP — Medicaid Managed Care: $1,092.58
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee In the file: EGD DIAGNOSTIC BRUSH WASH Not listed in the file $128.29 $89.80 – $134.70
Upper GI endoscopy (diagnostic): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $128.29
  • Hamaspik — Medicare Advantage: $134.70
  • Healthfirst — Medicaid: $128.29
  • Healthfirst — Medicare Advantage: $134.70
  • Healthfirst Essential Plans — Medicaid Managed Care: $134.70
  • Healthfirst QHP — Medicaid Managed Care: $134.70
  • MetroPlus Behavioral Health — Medicaid: $89.80
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $109.05
  • VA — Other: $128.29
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Uppr gi endoscopy, diagnosis Not listed in the file $926.63 $926.63 – $2,341.24
Upper GI endoscopy (diagnostic): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $1,114
  • Aetna Non-Gatekeeper — Commercial: $1,114
  • Aetna Savings Plus — Exchange: $1,002
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Egd biopsy single/multiple Not listed in the file $926.63 $926.63 – $2,341.24
Upper GI endoscopy with biopsy: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $1,040.55
  • Empire HealthPlus CHP — Medicaid: $1,040.55
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $1,248.66
  • Empire HealthPlus Individual — Medicaid Managed Care: $1,248.66
  • Fidelis — Medicaid: $1,040.55
  • Fidelis CHP — Medicaid: $1,040.55
  • Fidelis Essential Plans — Medicaid Managed Care: $2,341.24
  • Healthfirst — Medicaid: $1,092.58
  • Healthfirst Essential Plans — Medicaid Managed Care: $2,341.24
  • Healthfirst QHP — Medicaid Managed Care: $1,092.58
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee In the file: EGD BIOPSY SINGLE/MULTIPLE Not listed in the file $143.24 $100.27 – $150.40
Upper GI endoscopy with biopsy: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $143.24
  • Hamaspik — Medicare Advantage: $150.40
  • Healthfirst — Medicaid: $143.24
  • Healthfirst — Medicare Advantage: $150.40
  • Healthfirst Essential Plans — Medicaid Managed Care: $150.40
  • Healthfirst QHP — Medicaid Managed Care: $150.40
  • MetroPlus Behavioral Health — Medicaid: $100.27
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $121.75
  • VA — Other: $143.24
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Upper GI endoscopy, biopsy Not listed in the file $926.63 $926.63 – $2,341.24
Upper GI endoscopy with biopsy: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $1,491
  • Aetna Non-Gatekeeper — Commercial: $1,491
  • Aetna Savings Plus — Exchange: $1,342
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Diagnostic colonoscopy Not listed in the file $950.10 $950.10 – $2,259.29
Colonoscopy (diagnostic): 10 of 17 insurance plan rates
  • Aetna Gatekeeper — Commercial: $1,491
  • Aetna Non-Gatekeeper — Commercial: $1,491
  • Aetna Savings Plus — Exchange: $1,342
  • Empire HealthPlus — Medicaid: $1,004.13
  • Empire HealthPlus CHP — Medicaid: $1,004.13
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $1,204.96
  • Empire HealthPlus Individual — Medicaid Managed Care: $1,204.96
  • Fidelis — Medicaid: $1,004.13
  • Fidelis CHP — Medicaid: $1,004.13
  • Fidelis Essential Plans — Medicaid Managed Care: $2,259.29
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee In the file: DIAGNOSTIC COLONOSCOPY Not listed in the file $96.14 $134.16 – $201.24
Colonoscopy (diagnostic): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $191.66
  • Hamaspik — Medicare Advantage: $201.24
  • Healthfirst — Medicaid: $191.66
  • Healthfirst — Medicare Advantage: $201.24
  • Healthfirst Essential Plans — Medicaid Managed Care: $201.24
  • Healthfirst QHP — Medicaid Managed Care: $201.24
  • MetroPlus Behavioral Health — Medicaid: $134.16
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $162.91
  • VA — Other: $191.66
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC COLONOSCOPY Not listed in the file $950.10 $950.10 – $2,259.29
Colonoscopy (diagnostic): rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $950.10
  • United Healthcare — Commercial: $1,870.79
  • VA — Other: $950.10
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy and biopsy Not listed in the file $1,222.56 $1,004.13 – $2,407.27
Colonoscopy with biopsy: 10 of 17 insurance plan rates
  • Aetna Gatekeeper — Commercial: $1,491
  • Aetna Non-Gatekeeper — Commercial: $1,491
  • Aetna Savings Plus — Exchange: $1,342
  • Empire HealthPlus — Medicaid: $1,004.13
  • Empire HealthPlus CHP — Medicaid: $1,004.13
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $1,204.96
  • Empire HealthPlus Individual — Medicaid Managed Care: $1,204.96
  • Fidelis — Medicaid: $1,004.13
  • Fidelis CHP — Medicaid: $1,004.13
  • Fidelis Essential Plans — Medicaid Managed Care: $2,259.29
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY AND BIOPSY Not listed in the file $206.16 $144.31 – $216.47
Colonoscopy with biopsy: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $206.16
  • Hamaspik — Medicare Advantage: $216.47
  • Healthfirst — Medicaid: $206.16
  • Healthfirst — Medicare Advantage: $216.47
  • Healthfirst Essential Plans — Medicaid Managed Care: $216.47
  • Healthfirst QHP — Medicaid Managed Care: $216.47
  • MetroPlus Behavioral Health — Medicaid: $144.31
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $175.24
  • VA — Other: $206.16
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY AND BIOPSY Not listed in the file $1,222.56 $1,004.13 – $2,407.27
Colonoscopy with biopsy: rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $1,222.56
  • United Healthcare — Commercial: $2,407.27
  • VA — Other: $1,222.56
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/lesion removal Not listed in the file $1,222.56 $1,004.13 – $2,407.27
Colonoscopy with removal of polyps (snare): 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $1,004.13
  • Empire HealthPlus CHP — Medicaid: $1,004.13
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $1,204.96
  • Empire HealthPlus Individual — Medicaid Managed Care: $1,204.96
  • Fidelis — Medicaid: $1,004.13
  • Fidelis CHP — Medicaid: $1,004.13
  • Fidelis Essential Plans — Medicaid Managed Care: $2,259.29
  • Healthfirst — Medicaid: $1,054.34
  • Healthfirst Essential Plans — Medicaid Managed Care: $2,259.29
  • Healthfirst QHP — Medicaid Managed Care: $1,054.34
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/LESION REMOVAL Not listed in the file $258.44 $180.91 – $271.36
Colonoscopy with removal of polyps (snare): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $258.44
  • Hamaspik — Medicare Advantage: $271.36
  • Healthfirst — Medicaid: $258.44
  • Healthfirst — Medicare Advantage: $271.36
  • Healthfirst Essential Plans — Medicaid Managed Care: $271.36
  • Healthfirst QHP — Medicaid Managed Care: $271.36
  • MetroPlus Behavioral Health — Medicaid: $180.91
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $219.67
  • VA — Other: $258.44
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lesion removal colonoscopy Not listed in the file $1,222.56 $1,004.13 – $2,407.27
Colonoscopy with removal of polyps (snare): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $1,491
  • Aetna Non-Gatekeeper — Commercial: $1,491
  • Aetna Savings Plus — Exchange: $1,342
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/endoscope us Not listed in the file $1,222.56 $1,004.13 – $2,407.27
Ultrasound of the lower bowel by endoscope: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $1,004.13
  • Empire HealthPlus CHP — Medicaid: $1,004.13
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $1,204.96
  • Empire HealthPlus Individual — Medicaid Managed Care: $1,204.96
  • Fidelis — Medicaid: $1,004.13
  • Fidelis CHP — Medicaid: $1,004.13
  • Fidelis Essential Plans — Medicaid Managed Care: $2,259.29
  • Healthfirst — Medicaid: $1,054.34
  • Healthfirst Essential Plans — Medicaid Managed Care: $2,259.29
  • Healthfirst QHP — Medicaid Managed Care: $1,054.34
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/ENDOSCOPE US Not listed in the file $260.92 $182.64 – $273.97
Ultrasound of the lower bowel by endoscope: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $260.92
  • Hamaspik — Medicare Advantage: $273.97
  • Healthfirst — Medicaid: $260.92
  • Healthfirst — Medicare Advantage: $273.97
  • Healthfirst Essential Plans — Medicaid Managed Care: $273.97
  • Healthfirst QHP — Medicaid Managed Care: $273.97
  • MetroPlus Behavioral Health — Medicaid: $182.64
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $221.78
  • VA — Other: $260.92
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/endoscope Not listed in the file $1,222.56 $1,004.13 – $2,407.27
Ultrasound of the lower bowel by endoscope: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $1,491
  • Aetna Non-Gatekeeper — Commercial: $1,491
  • Aetna Savings Plus — Exchange: $1,342
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind Not listed in the file $950.10 $950.10 – $2,259.29
Screening colonoscopy (not high risk): 10 of 17 insurance plan rates
  • Empire HealthPlus — Medicaid: $1,004.13
  • Empire HealthPlus CHP — Medicaid: $1,004.13
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $1,204.96
  • Empire HealthPlus Individual — Medicaid Managed Care: $1,204.96
  • Fidelis — Medicaid: $1,004.13
  • Fidelis CHP — Medicaid: $1,004.13
  • Fidelis Essential Plans — Medicaid Managed Care: $2,259.29
  • Healthfirst — Medicaid: $1,054.34
  • Healthfirst Essential Plans — Medicaid Managed Care: $2,259.29
  • Healthfirst QHP — Medicaid Managed Care: $1,054.34
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee In the file: Colon ca scrn not hi rsk ind Not listed in the file $96.14 $134.60 – $201.89
Screening colonoscopy (not high risk): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $192.28
  • Hamaspik — Medicare Advantage: $201.89
  • Healthfirst — Medicaid: $192.28
  • Healthfirst — Medicare Advantage: $201.89
  • Healthfirst Essential Plans — Medicaid Managed Care: $201.89
  • Healthfirst QHP — Medicaid Managed Care: $201.89
  • MetroPlus Behavioral Health — Medicaid: $134.60
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $163.44
  • VA — Other: $192.28
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK Not listed in the file $950.10 $950.10 – $2,259.29
Screening colonoscopy (not high risk): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $1,491
  • Aetna Non-Gatekeeper — Commercial: $1,491
  • Aetna Savings Plus — Exchange: $1,342
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laparoscopic cholecystectomy Not listed in the file $6,176.47 $2,167 – $12,161.74
Gallbladder removal by laparoscope: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $3,210.63
  • Empire HealthPlus CHP — Medicaid: $3,210.63
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $3,852.76
  • Empire HealthPlus Individual — Medicaid Managed Care: $3,852.76
  • Fidelis — Medicaid: $3,210.63
  • Fidelis CHP — Medicaid: $3,210.63
  • Fidelis Essential Plans — Medicaid Managed Care: $7,223.92
  • Healthfirst — Medicaid: $3,371.16
  • Healthfirst Essential Plans — Medicaid Managed Care: $7,223.92
  • Healthfirst QHP — Medicaid Managed Care: $3,371.16
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee In the file: LAPAROSCOPIC CHOLECYSTECTOMY Not listed in the file $768.33 $537.83 – $806.75
Gallbladder removal by laparoscope: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $768.33
  • Hamaspik — Medicare Advantage: $806.75
  • Healthfirst — Medicaid: $768.33
  • Healthfirst — Medicare Advantage: $806.75
  • Healthfirst Essential Plans — Medicaid Managed Care: $806.75
  • Healthfirst QHP — Medicaid Managed Care: $806.75
  • MetroPlus Behavioral Health — Medicaid: $537.83
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $653.08
  • VA — Other: $768.33
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY Not listed in the file $6,176.47 $2,167 – $12,161.74
Gallbladder removal by laparoscope: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $2,408
  • Aetna Non-Gatekeeper — Commercial: $2,408
  • Aetna Savings Plus — Exchange: $2,167
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prp i/hern init reduc >5 yr Not listed in the file $3,657.95 $1,909 – $7,202.66
Groin (inguinal) hernia repair, age 5 or older: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $2,508.03
  • Empire HealthPlus CHP — Medicaid: $2,508.03
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $3,009.64
  • Empire HealthPlus Individual — Medicaid Managed Care: $3,009.64
  • Fidelis — Medicaid: $2,508.03
  • Fidelis CHP — Medicaid: $2,508.03
  • Fidelis Essential Plans — Medicaid Managed Care: $5,643.07
  • Healthfirst — Medicaid: $2,633.43
  • Healthfirst Essential Plans — Medicaid Managed Care: $5,643.07
  • Healthfirst QHP — Medicaid Managed Care: $2,633.43
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee In the file: PRP I/HERN INIT REDUC >5 YR Not listed in the file $617.39 $432.17 – $648.26
Groin (inguinal) hernia repair, age 5 or older: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $617.39
  • Hamaspik — Medicare Advantage: $648.26
  • Healthfirst — Medicaid: $617.39
  • Healthfirst — Medicare Advantage: $648.26
  • Healthfirst Essential Plans — Medicaid Managed Care: $648.26
  • Healthfirst QHP — Medicaid Managed Care: $648.26
  • MetroPlus Behavioral Health — Medicaid: $432.17
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $524.78
  • VA — Other: $617.39
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Rpr i/hern init reduc>5 yr Not listed in the file $3,657.95 $1,909 – $7,202.66
Groin (inguinal) hernia repair, age 5 or older: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $2,121
  • Aetna Non-Gatekeeper — Commercial: $2,121
  • Aetna Savings Plus — Exchange: $1,909
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Biopsy Prostate $3,497 Not listed in the file $699.40 – $5,404.48
Prostate biopsy: 10 of 37 insurance plan rates
  • Aetna — Medicare Advantage: $1,888.38
  • Aetna Gatekeeper — Commercial: $2,559
  • Aetna Non-Gatekeeper — Commercial: $1,559
  • Aetna Savings Plus — Exchange: $2,303
  • Affinity — Medicaid: $2,401.99
  • Affinity Essential Plans — Medicaid Managed Care: $5,404.48
  • Elderplan — Medicaid: $2,401.99
  • Elderplan — Medicare Advantage: $699.40
  • Emblem — Commercial: $2,098.20
  • Emblem — Medicaid: $2,401.99
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Biopsy of prostate Not listed in the file Not listed in the file $2,450.03 – $2,762.29
Prostate biopsy: rates for 2 insurance plans
  • VNS — Medicare Advantage: $2,762.29
  • VNS Special Needs — Medicaid Managed Care: $2,450.03
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US Biopsy Prostate $3,497 Not listed in the file Not listed in the file
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laps surg prst8ect rpbic rad Not listed in the file $10,860.07 $2,167 – $21,383.95
Prostate removal by laparoscope (radical prostatectomy): 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $3,208.32
  • Empire HealthPlus CHP — Medicaid: $3,208.32
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $3,849.98
  • Empire HealthPlus Individual — Medicaid Managed Care: $3,849.98
  • Fidelis — Medicaid: $3,208.32
  • Fidelis CHP — Medicaid: $3,208.32
  • Fidelis Essential Plans — Medicaid Managed Care: $7,218.72
  • Healthfirst — Medicaid: $3,368.74
  • Healthfirst Essential Plans — Medicaid Managed Care: $7,218.72
  • Healthfirst QHP — Medicaid Managed Care: $3,368.74
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee In the file: LAPARO RADICAL PROSTATECTOMY Not listed in the file $1,258.03 $880.62 – $1,320.93
Prostate removal by laparoscope (radical prostatectomy): rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $1,258.03
  • Hamaspik — Medicare Advantage: $1,320.93
  • Healthfirst — Medicaid: $1,258.03
  • Healthfirst — Medicare Advantage: $1,320.93
  • Healthfirst Essential Plans — Medicaid Managed Care: $1,320.93
  • Healthfirst QHP — Medicaid Managed Care: $1,320.93
  • MetroPlus Behavioral Health — Medicaid: $880.62
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $1,069.33
  • VA — Other: $1,258.03
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED Not listed in the file $10,860.07 $2,167 – $21,383.95
Prostate removal by laparoscope (radical prostatectomy): rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $2,408
  • Aetna Non-Gatekeeper — Commercial: $2,408
  • Aetna Savings Plus — Exchange: $2,167
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy biopsy Not listed in the file $3,307.24 $1,544 – $6,512.09
Hysteroscopy with biopsy of the uterus lining: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $1,719.28
  • Empire HealthPlus CHP — Medicaid: $1,719.28
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $2,063.14
  • Empire HealthPlus Individual — Medicaid Managed Care: $2,063.14
  • Fidelis — Medicaid: $1,719.28
  • Fidelis CHP — Medicaid: $1,719.28
  • Fidelis Essential Plans — Medicaid Managed Care: $3,868.38
  • Healthfirst — Medicaid: $1,805.24
  • Healthfirst Essential Plans — Medicaid Managed Care: $3,868.38
  • Healthfirst QHP — Medicaid Managed Care: $1,805.24
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee In the file: HYSTEROSCOPY BIOPSY Not listed in the file $242.12 $169.48 – $254.23
Hysteroscopy with biopsy of the uterus lining: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $242.12
  • Hamaspik — Medicare Advantage: $254.23
  • Healthfirst — Medicaid: $242.12
  • Healthfirst — Medicare Advantage: $254.23
  • Healthfirst Essential Plans — Medicaid Managed Care: $254.23
  • Healthfirst QHP — Medicaid Managed Care: $254.23
  • MetroPlus Behavioral Health — Medicaid: $169.48
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $205.80
  • VA — Other: $242.12
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy, biopsy Not listed in the file $3,307.24 $1,544 – $6,512.09
Hysteroscopy with biopsy of the uterus lining: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $1,716
  • Aetna Non-Gatekeeper — Commercial: $1,716
  • Aetna Savings Plus — Exchange: $1,544
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx interlaminar lmbr/sac Not listed in the file $721.17 $721.17 – $1,692.11
Spinal injection, lower back (epidural), with imaging guidance: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $752.05
  • Empire HealthPlus CHP — Medicaid: $752.05
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $902.46
  • Empire HealthPlus Individual — Medicaid Managed Care: $902.46
  • Fidelis — Medicaid: $752.05
  • Fidelis CHP — Medicaid: $752.05
  • Fidelis Essential Plans — Medicaid Managed Care: $1,692.11
  • Healthfirst — Medicaid: $789.65
  • Healthfirst Essential Plans — Medicaid Managed Care: $1,692.11
  • Healthfirst QHP — Medicaid Managed Care: $789.65
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Doctor (professional) fee In the file: NJX INTERLAMINAR LMBR/SAC Not listed in the file $102.48 $71.74 – $107.60
Spinal injection, lower back (epidural), with imaging guidance: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $102.48
  • Hamaspik — Medicare Advantage: $107.60
  • Healthfirst — Medicaid: $102.48
  • Healthfirst — Medicare Advantage: $107.60
  • Healthfirst Essential Plans — Medicaid Managed Care: $107.60
  • Healthfirst QHP — Medicaid Managed Care: $107.60
  • MetroPlus Behavioral Health — Medicaid: $71.74
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $87.11
  • VA — Other: $102.48
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee 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 $721.17 $721.17 – $1,692.11
Spinal injection, lower back (epidural), with imaging guidance: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $1,114
  • Aetna Non-Gatekeeper — Commercial: $1,114
  • Aetna Savings Plus — Exchange: $1,002
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx aa&/strd tfrm epi l/s 1 Not listed in the file $903.63 $752.05 – $1,779.28
Nerve root injection, lower back, with imaging guidance: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $752.05
  • Empire HealthPlus CHP — Medicaid: $752.05
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $902.46
  • Empire HealthPlus Individual — Medicaid Managed Care: $902.46
  • Fidelis — Medicaid: $752.05
  • Fidelis CHP — Medicaid: $752.05
  • Fidelis Essential Plans — Medicaid Managed Care: $1,692.11
  • Healthfirst — Medicaid: $789.65
  • Healthfirst Essential Plans — Medicaid Managed Care: $1,692.11
  • Healthfirst QHP — Medicaid Managed Care: $789.65
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Doctor (professional) fee In the file: NJX AA&/STRD TFRM EPI L/S 1 Not listed in the file $114.42 $80.09 – $120.14
Nerve root injection, lower back, with imaging guidance: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $114.42
  • Hamaspik — Medicare Advantage: $120.14
  • Healthfirst — Medicaid: $114.42
  • Healthfirst — Medicare Advantage: $120.14
  • Healthfirst Essential Plans — Medicaid Managed Care: $120.14
  • Healthfirst QHP — Medicaid Managed Care: $120.14
  • MetroPlus Behavioral Health — Medicaid: $80.09
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $97.26
  • VA — Other: $114.42
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Inj foramen epidural l/s Not listed in the file $903.63 $752.05 – $1,779.28
Nerve root injection, lower back, with imaging guidance: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $1,114
  • Aetna Non-Gatekeeper — Commercial: $1,114
  • Aetna Savings Plus — Exchange: $1,002
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Carpal tunnel surgery Not listed in the file $1,995.02 $1,342 – $3,928.28
Carpal tunnel release: 10 of 17 insurance plan rates
  • Aetna Gatekeeper — Commercial: $1,491
  • Aetna Non-Gatekeeper — Commercial: $1,491
  • Aetna Savings Plus — Exchange: $1,342
  • Empire HealthPlus — Medicaid: $1,639.34
  • Empire HealthPlus CHP — Medicaid: $1,639.34
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $1,967.21
  • Empire HealthPlus Individual — Medicaid Managed Care: $1,967.21
  • Fidelis — Medicaid: $1,639.34
  • Fidelis CHP — Medicaid: $1,639.34
  • Fidelis Essential Plans — Medicaid Managed Care: $3,688.52
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee In the file: CARPAL TUNNEL SURGERY Not listed in the file $505.01 $353.51 – $530.26
Carpal tunnel release: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $505.01
  • Hamaspik — Medicare Advantage: $530.26
  • Healthfirst — Medicaid: $505.01
  • Healthfirst — Medicare Advantage: $530.26
  • Healthfirst Essential Plans — Medicaid Managed Care: $530.26
  • Healthfirst QHP — Medicaid Managed Care: $530.26
  • MetroPlus Behavioral Health — Medicaid: $353.51
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $429.26
  • VA — Other: $505.01
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CARPAL TUNNEL SURGERY Not listed in the file $1,995.02 $1,342 – $3,928.28
Carpal tunnel release: rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $1,995.02
  • United Healthcare — Commercial: $3,928.28
  • VA — Other: $1,995.02
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: After cataract laser surgery Not listed in the file $561.91 $561.91 – $4,421.90
Laser treatment of clouding after cataract surgery: 10 of 17 insurance plan rates
  • Aetna Gatekeeper — Commercial: $1,491
  • Aetna Non-Gatekeeper — Commercial: $1,491
  • Aetna Savings Plus — Exchange: $1,342
  • Empire HealthPlus — Medicaid: $1,965.29
  • Empire HealthPlus CHP — Medicaid: $1,965.29
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $2,358.35
  • Empire HealthPlus Individual — Medicaid Managed Care: $2,358.35
  • Fidelis — Medicaid: $1,965.29
  • Fidelis CHP — Medicaid: $1,965.29
  • Fidelis Essential Plans — Medicaid Managed Care: $4,421.90
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient · Doctor (professional) fee In the file: AFTER CATARACT LASER SURGERY Not listed in the file $318.92 $223.24 – $334.87
Laser treatment of clouding after cataract surgery: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $318.92
  • Hamaspik — Medicare Advantage: $334.87
  • Healthfirst — Medicaid: $318.92
  • Healthfirst — Medicare Advantage: $334.87
  • Healthfirst Essential Plans — Medicaid Managed Care: $334.87
  • Healthfirst QHP — Medicaid Managed Care: $334.87
  • MetroPlus Behavioral Health — Medicaid: $223.24
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $271.08
  • VA — Other: $318.92
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: AFTER CATARACT LASER SURGERY Not listed in the file $561.91 $561.91 – $4,421.90
Laser treatment of clouding after cataract surgery: rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $561.91
  • United Healthcare — Commercial: $1,106.42
  • VA — Other: $561.91
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xcapsl ctrc rmvl w/o ecp Not listed in the file $2,357.81 $2,167 – $5,525.24
Cataract removal with lens implant: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $2,455.66
  • Empire HealthPlus CHP — Medicaid: $2,455.66
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $2,946.79
  • Empire HealthPlus Individual — Medicaid Managed Care: $2,946.79
  • Fidelis — Medicaid: $2,455.66
  • Fidelis CHP — Medicaid: $2,455.66
  • Fidelis Essential Plans — Medicaid Managed Care: $5,525.24
  • Healthfirst — Medicaid: $2,578.44
  • Healthfirst Essential Plans — Medicaid Managed Care: $5,525.24
  • Healthfirst QHP — Medicaid Managed Care: $2,578.44
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Doctor (professional) fee In the file: XCAPSL CTRC RMVL W/O ECP Not listed in the file $532.15 $372.51 – $558.76
Cataract removal with lens implant: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $532.15
  • Hamaspik — Medicare Advantage: $558.76
  • Healthfirst — Medicaid: $532.15
  • Healthfirst — Medicare Advantage: $558.76
  • Healthfirst Essential Plans — Medicaid Managed Care: $558.76
  • Healthfirst QHP — Medicaid Managed Care: $558.76
  • MetroPlus Behavioral Health — Medicaid: $372.51
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $452.33
  • VA — Other: $532.15
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cataract surg w/iol, i stage Not listed in the file $2,357.81 $2,167 – $5,525.24
Cataract removal with lens implant: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $2,408
  • Aetna Non-Gatekeeper — Commercial: $2,408
  • Aetna Savings Plus — Exchange: $2,167

Pregnancy and childbirth

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetrical care Not listed in the file $2,078.59 $2,078.59 – $5,424.62
Vaginal delivery, with care before and after: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $2,410.94
  • Empire HealthPlus CHP — Medicaid: $2,410.94
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $2,893.13
  • Empire HealthPlus Individual — Medicaid Managed Care: $2,893.13
  • Fidelis — Medicaid: $2,410.94
  • Fidelis CHP — Medicaid: $2,410.94
  • Fidelis Essential Plans — Medicaid Managed Care: $5,424.62
  • Healthfirst — Medicaid: $2,531.49
  • Healthfirst Essential Plans — Medicaid Managed Care: $5,424.62
  • Healthfirst QHP — Medicaid Managed Care: $2,531.49
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient · Doctor (professional) fee In the file: OBSTETRICAL CARE Not listed in the file $2,713.70 $1,899.59 – $2,849.39
Vaginal delivery, with care before and after: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $2,713.70
  • Hamaspik — Medicare Advantage: $2,849.39
  • Healthfirst — Medicaid: $2,713.70
  • Healthfirst — Medicare Advantage: $2,849.39
  • Healthfirst Essential Plans — Medicaid Managed Care: $2,849.39
  • Healthfirst QHP — Medicaid Managed Care: $2,849.39
  • MetroPlus Behavioral Health — Medicaid: $1,899.59
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $2,306.65
  • VA — Other: $2,713.70
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL OBSTETRIC CARE Not listed in the file $2,078.59 $2,078.59 – $5,424.62
Vaginal delivery, with care before and after: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $3,165.44
  • Aetna Non-Gatekeeper — Commercial: $3,165.44
  • Aetna Savings Plus — Exchange: $2,893.41
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee In the file: CESAREAN DELIVERY Not listed in the file $3,059.46 $2,141.62 – $3,212.43
Cesarean delivery (C-section), with care before and after: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $3,059.46
  • Hamaspik — Medicare Advantage: $3,212.43
  • Healthfirst — Medicaid: $3,059.46
  • Healthfirst — Medicare Advantage: $3,212.43
  • Healthfirst Essential Plans — Medicaid Managed Care: $3,212.43
  • Healthfirst QHP — Medicaid Managed Care: $3,212.43
  • MetroPlus Behavioral Health — Medicaid: $2,141.62
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $2,600.54
  • VA — Other: $3,059.46
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRIC CARE/C-SECTION Not listed in the file $2,310.97 $2,310.97 – $2,937.60
Cesarean delivery (C-section), with care before and after: rates for 3 insurance plans
  • Aetna Gatekeeper — Commercial: $2,937.60
  • Aetna Non-Gatekeeper — Commercial: $2,937.60
  • Aetna Savings Plus — Exchange: $2,685.15
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CESAREAN DELIVERY Not listed in the file $2,310.97 $2,310.97 – $2,937.60
Cesarean delivery (C-section), with care before and after: rates for 3 insurance plans
  • MetroPlus Behavioral Health — Medicare Advantage: $2,310.97
  • VA — Other: $2,310.97
  • VNS — Medicare Advantage: $2,310.97
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Vbac delivery Not listed in the file $2,176.20 $2,176.20 – $5,424.62
Vaginal delivery after a previous C-section, with care before and after: 10 of 14 insurance plan rates
  • Empire HealthPlus — Medicaid: $2,410.94
  • Empire HealthPlus CHP — Medicaid: $2,410.94
  • Empire HealthPlus Essential Plan — Medicaid Managed Care: $2,893.13
  • Empire HealthPlus Individual — Medicaid Managed Care: $2,893.13
  • Fidelis — Medicaid: $2,410.94
  • Fidelis CHP — Medicaid: $2,410.94
  • Fidelis Essential Plans — Medicaid Managed Care: $5,424.62
  • Healthfirst — Medicaid: $2,531.49
  • Healthfirst Essential Plans — Medicaid Managed Care: $5,424.62
  • Healthfirst QHP — Medicaid Managed Care: $2,531.49
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient · Doctor (professional) fee In the file: VBAC DELIVERY Not listed in the file $2,887.16 $2,021.01 – $3,031.52
Vaginal delivery after a previous C-section, with care before and after: rates for 9 insurance plans
  • Elderplan — Medicare Advantage: $2,887.16
  • Hamaspik — Medicare Advantage: $3,031.52
  • Healthfirst — Medicaid: $2,887.16
  • Healthfirst — Medicare Advantage: $3,031.52
  • Healthfirst Essential Plans — Medicaid Managed Care: $3,031.52
  • Healthfirst QHP — Medicaid Managed Care: $3,031.52
  • MetroPlus Behavioral Health — Medicaid: $2,021.01
  • MetroPlus Behavioral Health Essential Plans — Medicaid Managed Care: $2,454.09
  • VA — Other: $2,887.16
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VBAC DELIVERY Not listed in the file $2,176.20 $2,176.20 – $5,424.62
Vaginal delivery after a previous C-section, with care before and after: rates for 5 insurance plans
  • Aetna Gatekeeper — Commercial: $3,229.44
  • Aetna Non-Gatekeeper — Commercial: $3,229.44
  • Aetna Savings Plus — Exchange: $2,951.91
  • MetroPlus Behavioral Health — Medicare Advantage: $2,176.20
  • VA — Other: $2,176.20

Hospital stays (whole stay, MS-DRG)

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC Not listed in the file $113,842.34 $95,822.53 – $147,995.04
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 20 insurance plan rates
  • 1199 Behavioral Health — Commercial: $95,822.53
  • Aetna — Medicare Advantage: $113,842.34
  • Centerlight — Medicare Advantage: $113,842.34
  • Cigna — Commercial: $115,877.27
  • Elderplan — Medicare Advantage: $113,842.34
  • Emblem — Commercial: $147,995.04
  • Emblem — Medicare Advantage: $113,842.34
  • Emblem Select Care — Exchange: $142,302.93
  • Empire — Medicare Advantage: $113,842.34
  • Fidelis — Medicaid Advantage Plus: $108,150.22
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC Not listed in the file $25,562.44 $18,893.58 – $39,602
Hip or knee replacement (major joint of the leg), without major complications: 10 of 22 insurance plan rates
  • 1199 Behavioral Health — Commercial: $18,893.58
  • Aetna — Medicare Advantage: $25,562.44
  • Centerlight — Medicare Advantage: $25,562.44
  • Cigna — Commercial: $22,847.82
  • Elderplan — Medicare Advantage: $25,562.44
  • Emblem — Commercial: $33,231.17
  • Emblem — Medicare Advantage: $25,562.44
  • Emblem Select Care — Exchange: $31,953.05
  • Empire — Medicare Advantage: $25,562.44
  • Fidelis — Medicaid Advantage Plus: $24,284.32
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC Not listed in the file $31,321.95 $23,912.53 – $40,718.54
Neck (cervical) spinal fusion, without complications: 10 of 20 insurance plan rates
  • 1199 Behavioral Health — Commercial: $23,912.53
  • Aetna — Medicare Advantage: $31,321.95
  • Centerlight — Medicare Advantage: $31,321.95
  • Cigna — Commercial: $28,917.20
  • Elderplan — Medicare Advantage: $31,321.95
  • Emblem — Commercial: $40,718.54
  • Emblem — Medicare Advantage: $31,321.95
  • Emblem Select Care — Exchange: $39,152.44
  • Empire — Medicare Advantage: $31,321.95
  • Fidelis — Medicaid Advantage Plus: $29,755.85
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC Not listed in the file $17,826.90 $12,152.66 – $23,174.97
Uterus and ovary surgery (not for cancer), without complications: 10 of 20 insurance plan rates
  • 1199 Behavioral Health — Commercial: $12,152.66
  • Aetna — Medicare Advantage: $17,826.90
  • Centerlight — Medicare Advantage: $17,826.90
  • Cigna — Commercial: $14,696.09
  • Elderplan — Medicare Advantage: $17,826.90
  • Emblem — Commercial: $23,174.97
  • Emblem — Medicare Advantage: $17,826.90
  • Emblem Select Care — Exchange: $22,283.63
  • Empire — Medicare Advantage: $17,826.90
  • Fidelis — Medicaid Advantage Plus: $16,935.56

Source: St Joseph's Medical Center’s standard charges file (sthpiprd.blob.core.windows.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on July 13, 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
Address127 South Broadway, Yonkers, NY 10701
CountyWestchester County
StateNew York
Phone(914) 378‑7000
Emergency servicesYes
OwnershipVoluntary non-profit - Private
Medicare overall rating1 of 5 stars
CMS Certification Number330006
Name in Medicare recordsST JOSEPH'S MEDICAL CENTER
Profile levelMedicare data + hospital website
Name on the hospital’s websiteSaint Joseph's Medical Center
Official websitesaintjosephs.org
CorrectionsReport an error or suggest an update →

Sources

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

From the hospital’s website

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

  1. About - Saint Joseph's Medical Center — saintjosephs.org
  2. Services — saintjosephs.org
  3. Language, Hearing, and Vision Services - Saint Joseph’s Medical Center — saintjosephs.org
  4. Accreditation & Awards - Saint Joseph’s Medical Center — saintjosephs.org
  5. Coming Soon: New Emergency Department - Saint Joseph’s Medical Center — saintjosephs.org
  6. Patient & Visitor Information - Saint Joseph’s Medical Center — saintjosephs.org
  7. Emergency Medicine - Saint Joseph’s Medical Center — saintjosephs.org
  8. Orthopedic Robotic-Assisted Surgery - Saint Joseph’s Medical Center — saintjosephs.org
  9. Orthopedic Surgery - Saint Joseph’s Medical Center — saintjosephs.org