Does St Nicholas Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at St Nicholas Hospital. In a medical emergency, call 911.

Where is St Nicholas Hospital?

3100 Superior Ave, Sheboygan, WI 53081, in Sheboygan County, Wisconsin.

What is the phone number of St Nicholas Hospital?

(920) 459-8300, as listed by Medicare (CMS).

What is the Medicare star rating of St Nicholas Hospital?

3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).

Does Medicare reduce its payments to St Nicholas Hospital for hospital-acquired conditions?

No. For fiscal year 2026, CMS lists no Medicare payment reduction for St Nicholas Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.4431; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

St Nicholas Hospital — Phone, Address & ER

Quick answers

Does St Nicholas Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at St Nicholas Hospital. In a medical emergency, call 911.
Where is St Nicholas Hospital?: 3100 Superior Ave, Sheboygan, WI 53081, in Sheboygan County, Wisconsin.
What is the phone number of St Nicholas Hospital?: (920) 459-8300, as listed by Medicare (CMS).
What is the Medicare star rating of St Nicholas Hospital?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to St Nicholas Hospital for hospital-acquired conditions?: No. For fiscal year 2026, CMS lists no Medicare payment reduction for St Nicholas Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.4431; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas^{[5][6][11][14][17][18]}

Cancer care
Digestive health
Heart care
Orthopedics
Pregnancy and birth
Women's health
Respiratory care
Surgery
Therapy
Imaging and laboratory
Intensive care
Infusion services
Wound care
Sleep disorders center
Mammogram
Emergency medicine
Cardiology
Medical oncology
Hematology
Radiation oncology
Sleep medicine
Obstetrics and gynecology

Conditions treated^{[6][8][12][14][17]}

Stroke
Heart attack
Chest pain
Heart disease
Heart failure
Transient ischemic attack (TIA)
Shortness of breath
Broken bones
Abdominal pain
Lacerations
Mental health issues
Motor vehicle accident injuries
Insomnia
Narcolepsy
Sleep apnea

Treatments^{[5][8][9][11][12][13][14][15][17][18]}

Thrombolytic (clot-busting) medicine
Telestroke
Stress testing
Echocardiography
Electrocardiogram (ECG)
Holter and event heart monitoring
Continuous blood pressure monitoring
CPAP referral
Epidural anesthesia for labor
Nitrous oxide pain relief in labor
Radiation therapy
Mammography
Ultrasound imaging
MRI
Inpatient physical and occupational therapy
Intensive care
Respiratory care
Wound care
Infusion services

Procedures^[9][16]

Total knee replacement
Total hip replacement
Hip resurfacing
Same-day (outpatient) joint replacement
Shoulder replacement
Shoulder reconstruction
Arthroscopic shoulder surgery
Arthroscopic rotator cuff repair
Knee arthroscopy
ACL knee surgery
Hamstring surgery
Patellar tendon surgery
Spine surgery
Carpal tunnel release
Trigger finger release
Hand surgery
Foot arthroscopy
Ankle arthroscopy
Hammertoe surgery
Tendon and ligament repair
Fracture care
Robotic surgery (da Vinci)
ROSA robot-assisted joint replacement
Colonoscopy
EGD (upper gastroscopy)
Colorectal surgery
Breast surgery
Laser cataract surgery
Urology surgery
Vascular surgery
Ear, nose and throat surgery
General surgery
Pain management injections (epidural steroid, trigger point)

Programs and centers^{[5][8][10][15][17]}

Stroke Center
Joints inMotion
TelePediatric Critical Care (Tele-PICU)
TeleNeonatology (Tele-NICU)
Women and Infants Center
Sleep Disorders Center
Milk donation and dispensary

Emergency care (hospital website)^[4][6][12]

Emergency room	Yes
Open 24/7	Yes
Trauma designation	Level IV
Stroke designation	Primary Stroke Center certification (page 2 says The Joint Commission; page 10 says DNV Healthcare)

Recognition^[6][12]

Level IV trauma center, designated by the Wisconsin Trauma Care System
Primary Stroke Center certification (certifier conflicts between pages)

Doctors and clinicians (224)

224 doctors and other clinicians list St Nicholas Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 200 more: the button below opens the full list.

Other emergency rooms nearby

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

Aurora Medical Center Sheboygan County1.9 mi · Sheboygan, WI · Acute Care Hospital
Holy Family Memorial23 mi · Manitowoc, WI · Acute Care Hospital
Aurora Medical Center Manitowoc County26 mi · Two Rivers, WI · Acute Care Hospital
Ascension Calumet Hospital27 mi · Chilton, WI · Critical Access Hospital
Aurora Medical Center31 mi · Grafton, WI · Acute Care Hospital

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

Other hospitals near Sheboygan

Clearsky Rehabilitation Hospital Lakeshore10 mi · Cleveland, WI · Inpatient Rehabilitation Hospital

All hospitals in Sheboygan · Hospitals in Sheboygan County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Sheboygan Health Services0.2 mi · Sheboygan, WI · 3 of 5 stars
Edenbrook Sheboygan0.6 mi · Sheboygan, WI · 1 of 5 stars
Morningside Health Services1.9 mi · Sheboygan, WI · 3 of 5 stars

All nursing homes in the state →

Hospice providers

Compassus Milwaukee3.6 mi · Sheboygan, WI · 3 of 5 stars
Moments Hospice of Sheboygan3.6 mi · Sheboygan, WI
Sharon S Richardson Community Hospice5.7 mi · Sheboygan Falls, WI · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Homecare Health Services23 mi · Manitowoc, WI · 2 of 5 stars

All home health agencies in the state →

Dialysis facilities

DaVita Sheboygan Dialysis3.6 mi · Sheboygan, WI · 3 of 5 stars
Fresenius Kidney Care Sheboygan3.6 mi · Sheboygan, WI · 2 of 5 stars
DaVita Manitowoc Dialysis23 mi · Manitowoc, WI · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

Spine Solutions of Sheboygan LLC3.6 mi · Sheboygan, WI
Third Coast Vascular ASC LLC3.6 mi · Sheboygan, WI

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

LCHC @ Cooper Elem0.9 mi · Sheboygan, WI · Community health center
Lakeshore Community Health Care, Inc. - Main Facility0.9 mi · Sheboygan, WI · Community health center
LCHC @ Jefferson Elementary1.1 mi · Sheboygan, WI · Community health center

Pharmacies

Walgreen Co2.4 mi · Kohler, WI · Pharmacy
Aurora Health Care Central, Inc.3.6 mi · Sheboygan, WI · Clinic pharmacy
Aurora Pharmacy Inc3.6 mi · Sheboygan, WI · Pharmacy

Assisted living nearby

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

Calm Harbor Sheboygan3.6 mi · Sheboygan, WI
Dimensions Living Sheboygan I3.6 mi · Sheboygan, WI
Dimensions Living Sheboygan II3.6 mi · Sheboygan, WI
Golden Harbor3.6 mi · Sheboygan, WI

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

What patients said (patient survey)

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

Summary star rating (all survey topics)	4 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	4 of 5 stars
Patients got help quickly from staff	4 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Restfulness of Environment	3 of 5 stars
Care Coordination	3 of 5 stars
Symptoms After Stay	3 of 5 stars
Rated the hospital 9 or 10 out of 10	70%National average: 72%
Would definitely recommend the hospital	70%National average: 71%
Nurses “always” communicated well	81%National average: 80%
Doctors “always” communicated well	81%National average: 80%
“Always” got help as soon as they wanted	64%National average: 64%
Staff “always” explained medicines before giving them	61%National average: 62%
Were given information about recovery at home	87%National average: 86%
Room and bathroom “always” clean	71%National average: 73%
Completed surveys	393Response rate: 33%

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

Infections caught in the hospital

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

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

Source: Healthcare Associated Infections - Hospital — CMS, released October 19, 2026; data from January 2025 to December 2025.

Complications and deaths

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

Deaths within 30 days: heart failure patients	11.5%
Deaths within 30 days: pneumonia patients	17.3%
Deaths within 30 days: stroke patients	11.8%
Serious complications (patient safety indicator PSI-90)	0.96No different from the national rate
Not reported to Medicare	Deaths within 30 days: coronary bypass surgery (CABG)
Too few cases to report	Deaths within 30 days: heart attack patients; Deaths within 30 days: COPD patients; Complications after hip or knee replacement

Source: Complications and Deaths - Hospital — CMS, released October 20, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	15.1%
Readmitted within 30 days: heart failure	21.3%
Readmitted within 30 days: pneumonia	19.1%
Readmitted within 30 days: COPD	18.8%
Not reported to Medicare	Readmitted within 30 days: coronary bypass surgery
Too few cases to report	Readmitted within 30 days: heart attack; Readmitted within 30 days: hip or knee replacement

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	124 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	0%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	74%National average: 66%

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

See every measure on Medicare Care Compare →

Medicare payment programs

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

Show the Medicare payment program results

Hospital-Acquired Condition Reduction Program

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

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

Medicare payment reduction, fiscal year 2026	NoCMS lists no payment reduction for this hospital.
Total HAC Score	-0.4431Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

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

Hospital Readmissions Reduction Program

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

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

Heart failure	0.9789Fewer readmissions than expected
Pneumonia	1.0072More readmissions than expected
No result published	Heart attack; COPD (chronic lung disease); Hip or knee replacement; Coronary bypass surgery (CABG) (not reported, or too few cases)

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

Hospital Value-Based Purchasing Program

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

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

Total Performance Score	40.50 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)	15.00 out of 100
Person and community engagement (patient survey)	47.00 out of 100
Safety (infections and sepsis care)	20.00 out of 100
Efficiency and cost reduction (Medicare spending)	80.00 out of 100

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

Medicare spending per patient (MSPB)

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

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

Medicare spending per patient, ratio	0.87Below the national median hospital (1.00): Medicare spent less

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

ER wait times and Medicare ratings nearby

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

ER wait times in Sheboygan Best hospitals in Wisconsin

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 68 common services exactly as St Nicholas Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

Show the prices of 68 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: HC CLINIC VISIT INTERM NEW	$382	$252.12	$95.40 – $382
New patient office visit (about 30–44 minutes): 10 of 37 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $382 ANTHEM — ANTHEM POS/HMO: $154 ANTHEM — ANTHEM PPO: $154 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $229.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $382 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $324.70 CIGNA — ALL COMMERCIAL CIGNA: $267.40 COFINITY — COFINITY: $382 FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: $362.90 HEALTH CARE ALLIANCE — THE ALLIANCE: $320.88
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: HC CLINIC VISIT COMPLEX NEW	$435	$287.10	$95.40 – $435
New patient office visit (about 45–59 minutes): 10 of 37 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $435 ANTHEM — ANTHEM POS/HMO: $154 ANTHEM — ANTHEM PPO: $154 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $261 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $435 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $369.75 CIGNA — ALL COMMERCIAL CIGNA: $304.50 COFINITY — COFINITY: $435 FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: $413.25 HEALTH CARE ALLIANCE — THE ALLIANCE: $365.40
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: HC CLINIC VISIT COMPREH NEW	$527	$347.82	$95.40 – $527
New patient office visit (about 60–74 minutes): 10 of 37 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $527 ANTHEM — ANTHEM POS/HMO: $154 ANTHEM — ANTHEM PPO: $154 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $316.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $527 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $447.95 CIGNA — ALL COMMERCIAL CIGNA: $368.90 COFINITY — COFINITY: $527 FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: $500.65 HEALTH CARE ALLIANCE — THE ALLIANCE: $442.68
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: HC CLINIC VISIT INTERM EST	$369	$243.54	$95.40 – $369
Established patient office visit (about 20–29 minutes): 10 of 37 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $369 ANTHEM — ANTHEM POS/HMO: $154 ANTHEM — ANTHEM PPO: $154 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $221.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $369 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $313.65 CIGNA — ALL COMMERCIAL CIGNA: $258.30 COFINITY — COFINITY: $369 FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: $350.55 HEALTH CARE ALLIANCE — THE ALLIANCE: $309.96
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: OFFICE O/P EST LOW 20 MIN	$369	$243.54	$95.40 – $369
Established patient office visit (about 20–29 minutes): 10 of 37 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $369 ANTHEM — ANTHEM POS/HMO: $154 ANTHEM — ANTHEM PPO: $154 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $221.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $369 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $313.65 CIGNA — ALL COMMERCIAL CIGNA: $258.30 COFINITY — COFINITY: $369 FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: $350.55 HEALTH CARE ALLIANCE — THE ALLIANCE: $309.96
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · modifier 27 In the file: HC CLINIC VISIT INTERM EST	$369	$243.54	$95.40 – $369
Established patient office visit (about 20–29 minutes): 10 of 37 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $369 ANTHEM — ANTHEM POS/HMO: $154 ANTHEM — ANTHEM PPO: $154 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $221.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $369 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $313.65 CIGNA — ALL COMMERCIAL CIGNA: $258.30 COFINITY — COFINITY: $369 FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: $350.55 HEALTH CARE ALLIANCE — THE ALLIANCE: $309.96
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: HC LACTATION EST PAT-COMPLEX	$407	$268.62	$95.40 – $407
Established patient office visit (about 30–39 minutes): 10 of 37 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $407 ANTHEM — ANTHEM POS/HMO: $154 ANTHEM — ANTHEM PPO: $154 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $244.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $407 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $345.95 CIGNA — ALL COMMERCIAL CIGNA: $284.90 COFINITY — COFINITY: $407 FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: $386.65 HEALTH CARE ALLIANCE — THE ALLIANCE: $341.88
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: HC CLINIC VISIT COMPLX EST	$407	$268.62	$95.40 – $407
Established patient office visit (about 30–39 minutes): 10 of 37 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $407 ANTHEM — ANTHEM POS/HMO: $154 ANTHEM — ANTHEM PPO: $154 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $244.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $407 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $345.95 CIGNA — ALL COMMERCIAL CIGNA: $284.90 COFINITY — COFINITY: $407 FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: $386.65 HEALTH CARE ALLIANCE — THE ALLIANCE: $341.88
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · modifier 59 In the file: HC CLINIC VISIT COMPLX EST	$407	$268.62	$95.40 – $407
Established patient office visit (about 30–39 minutes): 10 of 37 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $407 ANTHEM — ANTHEM POS/HMO: $154 ANTHEM — ANTHEM PPO: $154 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $244.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $407 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $345.95 CIGNA — ALL COMMERCIAL CIGNA: $284.90 COFINITY — COFINITY: $407 FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: $386.65 HEALTH CARE ALLIANCE — THE ALLIANCE: $341.88
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: HC ER LEVEL 3	$1,272	$839.52	$266.96 – $1,272
Emergency room visit (moderate): 10 of 46 insurance plan rates AETNA — AETNA MEDICARE: $266.96 AETNA — ALL COMMERCIAL AETNA: $1,272 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $266.96 ANTHEM — ANTHEM POS/HMO: $1,272 ANTHEM — ANTHEM PPO: $1,272 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $763.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,272 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,081.20 CIGNA — ALL COMMERCIAL CIGNA: $890.40 COFINITY — COFINITY: $1,272
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · modifier 24 In the file: HC ER LEVEL 3	$1,272	$839.52	$266.96 – $1,272
Emergency room visit (moderate): 10 of 46 insurance plan rates AETNA — AETNA MEDICARE: $266.96 AETNA — ALL COMMERCIAL AETNA: $1,272 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $266.96 ANTHEM — ANTHEM POS/HMO: $1,272 ANTHEM — ANTHEM PPO: $1,272 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $763.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,272 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,081.20 CIGNA — ALL COMMERCIAL CIGNA: $890.40 COFINITY — COFINITY: $1,272
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · modifier 27 In the file: HC ER LEVEL 3	$1,272	$839.52	$266.96 – $1,272
Emergency room visit (moderate): 10 of 46 insurance plan rates AETNA — AETNA MEDICARE: $266.96 AETNA — ALL COMMERCIAL AETNA: $1,272 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $266.96 ANTHEM — ANTHEM POS/HMO: $1,272 ANTHEM — ANTHEM PPO: $1,272 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $763.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,272 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,081.20 CIGNA — ALL COMMERCIAL CIGNA: $890.40 COFINITY — COFINITY: $1,272
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: HC ER LEVEL 4	$1,908	$1,259.28	$408.06 – $1,908
Emergency room visit (moderately high): 10 of 46 insurance plan rates AETNA — AETNA MEDICARE: $408.06 AETNA — ALL COMMERCIAL AETNA: $1,908 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $408.06 ANTHEM — ANTHEM POS/HMO: $1,908 ANTHEM — ANTHEM PPO: $1,908 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,144.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,908 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,621.80 CIGNA — ALL COMMERCIAL CIGNA: $1,335.60 COFINITY — COFINITY: $1,908
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · modifier XU In the file: HC ER LEVEL 4	$1,908	$1,259.28	$408.06 – $1,908
Emergency room visit (moderately high): 10 of 46 insurance plan rates AETNA — AETNA MEDICARE: $408.06 AETNA — ALL COMMERCIAL AETNA: $1,908 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $408.06 ANTHEM — ANTHEM POS/HMO: $1,908 ANTHEM — ANTHEM PPO: $1,908 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,144.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,908 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,621.80 CIGNA — ALL COMMERCIAL CIGNA: $1,335.60 COFINITY — COFINITY: $1,908
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · modifier 27 In the file: HC ER LEVEL 4	$1,908	$1,259.28	$408.06 – $1,908
Emergency room visit (moderately high): 10 of 46 insurance plan rates AETNA — AETNA MEDICARE: $408.06 AETNA — ALL COMMERCIAL AETNA: $1,908 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $408.06 ANTHEM — ANTHEM POS/HMO: $1,908 ANTHEM — ANTHEM PPO: $1,908 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,144.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,908 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,621.80 CIGNA — ALL COMMERCIAL CIGNA: $1,335.60 COFINITY — COFINITY: $1,908
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: EMERGENCY DEPT VISIT HI MDM	$2,612	$1,723.92	$582.40 – $2,612
Emergency room visit (high): 10 of 46 insurance plan rates AETNA — AETNA MEDICARE: $582.40 AETNA — ALL COMMERCIAL AETNA: $2,612 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $582.40 ANTHEM — ANTHEM POS/HMO: $2,612 ANTHEM — ANTHEM PPO: $2,612 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,567.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $2,612 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $2,220.20 CIGNA — ALL COMMERCIAL CIGNA: $1,828.40 COFINITY — COFINITY: $2,612
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · modifier 27 In the file: EMERGENCY DEPT VISIT HI MDM	$2,612	$1,723.92	$582.40 – $2,612
Emergency room visit (high): 10 of 46 insurance plan rates AETNA — AETNA MEDICARE: $582.40 AETNA — ALL COMMERCIAL AETNA: $2,612 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $582.40 ANTHEM — ANTHEM POS/HMO: $2,612 ANTHEM — ANTHEM PPO: $2,612 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,567.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $2,612 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $2,220.20 CIGNA — ALL COMMERCIAL CIGNA: $1,828.40 COFINITY — COFINITY: $2,612
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · modifier XU In the file: EMERGENCY DEPT VISIT HI MDM	$2,612	$1,723.92	$582.40 – $2,612
Emergency room visit (high): 10 of 46 insurance plan rates AETNA — AETNA MEDICARE: $582.40 AETNA — ALL COMMERCIAL AETNA: $2,612 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $582.40 ANTHEM — ANTHEM POS/HMO: $2,612 ANTHEM — ANTHEM PPO: $2,612 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,567.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $2,612 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $2,220.20 CIGNA — ALL COMMERCIAL CIGNA: $1,828.40 COFINITY — COFINITY: $2,612

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: HC SURGICAL VET PANEL	$12	$7.92	$5.83 – $19.04
Basic metabolic panel (blood test): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $8.46 AETNA — ALL COMMERCIAL AETNA: $12 ANTHEM — ANTEHM MEDICAID: $8.74 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $8.46 ANTHEM — ANTHEM POS/HMO: $12 ANTHEM — ANTHEM PPO: $12 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $7.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $12 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $10.20 CIGNA — ALL COMMERCIAL CIGNA: $8.40
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: HC BASIC METABOLIC PANEL	$130	$85.80	$8.46 – $130
Basic metabolic panel (blood test): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $8.46 AETNA — ALL COMMERCIAL AETNA: $130 ANTHEM — ANTEHM MEDICAID: $8.74 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $8.46 ANTHEM — ANTHEM POS/HMO: $29.61 ANTHEM — ANTHEM PPO: $29.61 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $78 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $130 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $110.50 CIGNA — ALL COMMERCIAL CIGNA: $91
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · modifier 91 In the file: HC SURGICAL VET PANEL	$12	$7.92	$5.83 – $19.04
Basic metabolic panel (blood test): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $8.46 AETNA — ALL COMMERCIAL AETNA: $12 ANTHEM — ANTEHM MEDICAID: $8.74 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $8.46 ANTHEM — ANTHEM POS/HMO: $12 ANTHEM — ANTHEM PPO: $12 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $7.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $12 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $10.20 CIGNA — ALL COMMERCIAL CIGNA: $8.40
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: HC COMPREHENSIVE METABOL PANEL	$180	$118.80	$10.56 – $180
Comprehensive metabolic panel (blood test): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $10.56 AETNA — ALL COMMERCIAL AETNA: $180 ANTHEM — ANTEHM MEDICAID: $10.91 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $10.56 ANTHEM — ANTHEM POS/HMO: $36.96 ANTHEM — ANTHEM PPO: $36.96 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $108 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $180 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $153 CIGNA — ALL COMMERCIAL CIGNA: $126
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: HC COMPREHENSIVE METABOL PANEL VET	$24	$15.84	$10.56 – $24
Comprehensive metabolic panel (blood test): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $10.56 AETNA — ALL COMMERCIAL AETNA: $24 ANTHEM — ANTEHM MEDICAID: $10.91 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $10.56 ANTHEM — ANTHEM POS/HMO: $24 ANTHEM — ANTHEM PPO: $24 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $14.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $24 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $20.40 CIGNA — ALL COMMERCIAL CIGNA: $16.80
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · modifier PN In the file: HC COMPREHENSIVE METABOL PANEL	$180	$118.80	$10.56 – $180
Comprehensive metabolic panel (blood test): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $10.56 AETNA — ALL COMMERCIAL AETNA: $180 ANTHEM — ANTEHM MEDICAID: $10.91 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $10.56 ANTHEM — ANTHEM POS/HMO: $36.96 ANTHEM — ANTHEM PPO: $36.96 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $108 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $180 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $153 CIGNA — ALL COMMERCIAL CIGNA: $126
Obstetric blood test panel CPT 80055 · Inpatient or outpatient In the file: HC PRENATAL PANEL	$389	$256.74	$18.84 – $389
Obstetric blood test panel: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $47.81 AETNA — ALL COMMERCIAL AETNA: $389 ANTHEM — ANTEHM MEDICAID: $18.84 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $47.81 ANTHEM — ANTHEM POS/HMO: $167.34 ANTHEM — ANTHEM PPO: $167.34 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $233.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $389 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $330.65 CIGNA — ALL COMMERCIAL CIGNA: $272.30
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: HC LIPID PANEL	$135	$89.10	$13.39 – $135
Cholesterol panel (lipid panel): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $13.39 AETNA — ALL COMMERCIAL AETNA: $135 ANTHEM — ANTEHM MEDICAID: $13.84 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $13.39 ANTHEM — ANTHEM POS/HMO: $46.87 ANTHEM — ANTHEM PPO: $46.87 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $81 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $135 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $114.75 CIGNA — ALL COMMERCIAL CIGNA: $94.50
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · modifier PN In the file: HC LIPID PANEL	$135	$89.10	$13.39 – $135
Cholesterol panel (lipid panel): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $13.39 AETNA — ALL COMMERCIAL AETNA: $135 ANTHEM — ANTEHM MEDICAID: $13.84 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $13.39 ANTHEM — ANTHEM POS/HMO: $46.87 ANTHEM — ANTHEM PPO: $46.87 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $81 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $135 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $114.75 CIGNA — ALL COMMERCIAL CIGNA: $94.50
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · modifier PO In the file: HC LIPID PANEL	$135	$89.10	$13.39 – $135
Cholesterol panel (lipid panel): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $13.39 AETNA — ALL COMMERCIAL AETNA: $135 ANTHEM — ANTEHM MEDICAID: $13.84 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $13.39 ANTHEM — ANTHEM POS/HMO: $46.87 ANTHEM — ANTHEM PPO: $46.87 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $81 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $135 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $114.75 CIGNA — ALL COMMERCIAL CIGNA: $94.50
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: HC RENAL PANEL	$172	$113.52	$8.68 – $172
Kidney function panel: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $8.68 AETNA — ALL COMMERCIAL AETNA: $172 ANTHEM — ANTEHM MEDICAID: $8.97 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $8.68 ANTHEM — ANTHEM POS/HMO: $30.38 ANTHEM — ANTHEM PPO: $30.38 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $103.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $172 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $146.20 CIGNA — ALL COMMERCIAL CIGNA: $120.40
Kidney function panel CPT 80069 · Inpatient or outpatient · modifier PN In the file: HC RENAL PANEL	$172	$113.52	$8.68 – $172
Kidney function panel: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $8.68 AETNA — ALL COMMERCIAL AETNA: $172 ANTHEM — ANTEHM MEDICAID: $8.97 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $8.68 ANTHEM — ANTHEM POS/HMO: $30.38 ANTHEM — ANTHEM PPO: $30.38 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $103.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $172 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $146.20 CIGNA — ALL COMMERCIAL CIGNA: $120.40
Kidney function panel CPT 80069 · Inpatient or outpatient · modifier 59 In the file: HC RENAL PANEL	$172	$113.52	$8.68 – $172
Kidney function panel: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $8.68 AETNA — ALL COMMERCIAL AETNA: $172 ANTHEM — ANTEHM MEDICAID: $8.97 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $8.68 ANTHEM — ANTHEM POS/HMO: $30.38 ANTHEM — ANTHEM PPO: $30.38 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $103.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $172 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $146.20 CIGNA — ALL COMMERCIAL CIGNA: $120.40
Liver function panel CPT 80076 · Inpatient or outpatient In the file: HC LIVER (HEPATIC) PANEL	$104	$68.64	$8.17 – $104
Liver function panel: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $8.17 AETNA — ALL COMMERCIAL AETNA: $104 ANTHEM — ANTEHM MEDICAID: $8.44 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $8.17 ANTHEM — ANTHEM POS/HMO: $28.60 ANTHEM — ANTHEM PPO: $28.60 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $62.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $104 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $88.40 CIGNA — ALL COMMERCIAL CIGNA: $72.80
Liver function panel CPT 80076 · Inpatient or outpatient · modifier 59 In the file: HC LIVER (HEPATIC) PANEL	$104	$68.64	$8.17 – $104
Liver function panel: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $8.17 AETNA — ALL COMMERCIAL AETNA: $104 ANTHEM — ANTEHM MEDICAID: $8.44 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $8.17 ANTHEM — ANTHEM POS/HMO: $28.60 ANTHEM — ANTHEM PPO: $28.60 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $62.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $104 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $88.40 CIGNA — ALL COMMERCIAL CIGNA: $72.80
Liver function panel CPT 80076 · Inpatient or outpatient · modifier XU In the file: HC LIVER (HEPATIC) PANEL	$104	$68.64	$8.17 – $104
Liver function panel: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $8.17 AETNA — ALL COMMERCIAL AETNA: $104 ANTHEM — ANTEHM MEDICAID: $8.44 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $8.17 ANTHEM — ANTHEM POS/HMO: $28.60 ANTHEM — ANTHEM PPO: $28.60 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $62.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $104 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $88.40 CIGNA — ALL COMMERCIAL CIGNA: $72.80
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: HC URINALYSIS AUTO W/MICRO	$58	$38.28	$3.17 – $58
Urine test (automated, with microscope): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $3.17 AETNA — ALL COMMERCIAL AETNA: $58 ANTHEM — ANTEHM MEDICAID: $3.28 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $3.17 ANTHEM — ANTHEM POS/HMO: $11.10 ANTHEM — ANTHEM PPO: $11.10 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $34.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $58 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $49.30 CIGNA — ALL COMMERCIAL CIGNA: $40.60
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · modifier XE In the file: HC URINALYSIS AUTO W/MICRO	$58	$38.28	$3.17 – $58
Urine test (automated, with microscope): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $3.17 AETNA — ALL COMMERCIAL AETNA: $58 ANTHEM — ANTEHM MEDICAID: $3.28 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $3.17 ANTHEM — ANTHEM POS/HMO: $11.10 ANTHEM — ANTHEM PPO: $11.10 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $34.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $58 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $49.30 CIGNA — ALL COMMERCIAL CIGNA: $40.60
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · modifier XP In the file: HC URINALYSIS AUTO W/MICRO	$58	$38.28	$3.17 – $58
Urine test (automated, with microscope): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $3.17 AETNA — ALL COMMERCIAL AETNA: $58 ANTHEM — ANTEHM MEDICAID: $3.28 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $3.17 ANTHEM — ANTHEM POS/HMO: $11.10 ANTHEM — ANTHEM PPO: $11.10 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $34.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $58 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $49.30 CIGNA — ALL COMMERCIAL CIGNA: $40.60
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · modifier QW In the file: HC URINALYSIS AUTO W/O MICRO	$42	$27.72	$2.25 – $42
Urine test (automated, without microscope): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $2.25 AETNA — ALL COMMERCIAL AETNA: $42 ANTHEM — ANTEHM MEDICAID: $2.32 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $2.25 ANTHEM — ANTHEM POS/HMO: $7.88 ANTHEM — ANTHEM PPO: $7.88 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $25.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $42 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $35.70 CIGNA — ALL COMMERCIAL CIGNA: $29.40
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · modifier QW In the file: URINALYSIS AUTO W/O SCOPE	$26	$17.16	$2.25 – $26
Urine test (automated, without microscope): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $2.25 AETNA — ALL COMMERCIAL AETNA: $26 ANTHEM — ANTEHM MEDICAID: $2.32 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $2.25 ANTHEM — ANTHEM POS/HMO: $7.88 ANTHEM — ANTHEM PPO: $7.88 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $15.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $26 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $22.10 CIGNA — ALL COMMERCIAL CIGNA: $18.20
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · modifier QW In the file: HC URINALYSIS DIP STICK	$35	$23.10	$2.25 – $35
Urine test (automated, without microscope): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $2.25 AETNA — ALL COMMERCIAL AETNA: $35 ANTHEM — ANTEHM MEDICAID: $2.32 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $2.25 ANTHEM — ANTHEM POS/HMO: $7.88 ANTHEM — ANTHEM PPO: $7.88 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $21 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $35 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $29.75 CIGNA — ALL COMMERCIAL CIGNA: $24.50
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: HC PSA TOTAL	$178	$117.48	$18.39 – $178
PSA (prostate specific antigen) blood test: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $18.39 AETNA — ALL COMMERCIAL AETNA: $178 ANTHEM — ANTEHM MEDICAID: $19 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $18.39 ANTHEM — ANTHEM POS/HMO: $64.37 ANTHEM — ANTHEM PPO: $64.37 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $106.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $178 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $151.30 CIGNA — ALL COMMERCIAL CIGNA: $124.60
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · modifier 91 In the file: HC PSA TOTAL	$178	$117.48	$18.39 – $178
PSA (prostate specific antigen) blood test: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $18.39 AETNA — ALL COMMERCIAL AETNA: $178 ANTHEM — ANTEHM MEDICAID: $19 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $18.39 ANTHEM — ANTHEM POS/HMO: $64.37 ANTHEM — ANTHEM PPO: $64.37 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $106.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $178 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $151.30 CIGNA — ALL COMMERCIAL CIGNA: $124.60
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · modifier PO In the file: HC PSA TOTAL	$178	$117.48	$18.39 – $178
PSA (prostate specific antigen) blood test: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $18.39 AETNA — ALL COMMERCIAL AETNA: $178 ANTHEM — ANTEHM MEDICAID: $19 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $18.39 ANTHEM — ANTHEM POS/HMO: $64.37 ANTHEM — ANTHEM PPO: $64.37 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $106.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $178 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $151.30 CIGNA — ALL COMMERCIAL CIGNA: $124.60
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: ASSAY THYROID STIM HORMONE	$150	$99	$16.80 – $150
Thyroid stimulating hormone (TSH) test: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $16.80 AETNA — ALL COMMERCIAL AETNA: $150 ANTHEM — ANTEHM MEDICAID: $17.36 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $16.80 ANTHEM — ANTHEM POS/HMO: $58.80 ANTHEM — ANTHEM PPO: $58.80 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $90 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $150 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $127.50 CIGNA — ALL COMMERCIAL CIGNA: $105
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · modifier PN In the file: ASSAY THYROID STIM HORMONE	$150	$99	$16.80 – $150
Thyroid stimulating hormone (TSH) test: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $16.80 AETNA — ALL COMMERCIAL AETNA: $150 ANTHEM — ANTEHM MEDICAID: $17.36 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $16.80 ANTHEM — ANTHEM POS/HMO: $58.80 ANTHEM — ANTHEM PPO: $58.80 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $90 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $150 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $127.50 CIGNA — ALL COMMERCIAL CIGNA: $105
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · modifier PO In the file: ASSAY THYROID STIM HORMONE	$150	$99	$16.80 – $150
Thyroid stimulating hormone (TSH) test: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $16.80 AETNA — ALL COMMERCIAL AETNA: $150 ANTHEM — ANTEHM MEDICAID: $17.36 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $16.80 ANTHEM — ANTHEM POS/HMO: $58.80 ANTHEM — ANTHEM PPO: $58.80 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $90 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $150 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $127.50 CIGNA — ALL COMMERCIAL CIGNA: $105
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: HC CBC AUTO W/AUTO DIFF	$90	$59.40	$7.77 – $90
Complete blood count (CBC) with differential: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $7.77 AETNA — ALL COMMERCIAL AETNA: $90 ANTHEM — ANTEHM MEDICAID: $8.03 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $7.77 ANTHEM — ANTHEM POS/HMO: $27.20 ANTHEM — ANTHEM PPO: $27.20 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $54 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $90 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $76.50 CIGNA — ALL COMMERCIAL CIGNA: $63
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · modifier 91 In the file: HC CBC AUTO W/AUTO DIFF	$90	$59.40	$7.77 – $90
Complete blood count (CBC) with differential: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $7.77 AETNA — ALL COMMERCIAL AETNA: $90 ANTHEM — ANTEHM MEDICAID: $8.03 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $7.77 ANTHEM — ANTHEM POS/HMO: $27.20 ANTHEM — ANTHEM PPO: $27.20 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $54 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $90 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $76.50 CIGNA — ALL COMMERCIAL CIGNA: $63
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · modifier EC In the file: HC CBC AUTO W/AUTO DIFF	$90	$59.40	$7.77 – $90
Complete blood count (CBC) with differential: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $7.77 AETNA — ALL COMMERCIAL AETNA: $90 ANTHEM — ANTEHM MEDICAID: $8.03 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $7.77 ANTHEM — ANTHEM POS/HMO: $27.20 ANTHEM — ANTHEM PPO: $27.20 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $54 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $90 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $76.50 CIGNA — ALL COMMERCIAL CIGNA: $63
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: COMPLETE CBC AUTOMATED	$66	$43.56	$6.47 – $66
Complete blood count (CBC), automated: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $6.47 AETNA — ALL COMMERCIAL AETNA: $66 ANTHEM — ANTEHM MEDICAID: $6.69 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $6.47 ANTHEM — ANTHEM POS/HMO: $22.65 ANTHEM — ANTHEM PPO: $22.65 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $39.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $66 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $56.10 CIGNA — ALL COMMERCIAL CIGNA: $46.20
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · modifier 91 In the file: COMPLETE CBC AUTOMATED	$66	$43.56	$6.47 – $66
Complete blood count (CBC), automated: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $6.47 AETNA — ALL COMMERCIAL AETNA: $66 ANTHEM — ANTEHM MEDICAID: $6.69 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $6.47 ANTHEM — ANTHEM POS/HMO: $22.65 ANTHEM — ANTHEM PPO: $22.65 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $39.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $66 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $56.10 CIGNA — ALL COMMERCIAL CIGNA: $46.20
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · modifier AY In the file: COMPLETE CBC AUTOMATED	$66	$43.56	$6.47 – $66
Complete blood count (CBC), automated: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $6.47 AETNA — ALL COMMERCIAL AETNA: $66 ANTHEM — ANTEHM MEDICAID: $6.69 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $6.47 ANTHEM — ANTHEM POS/HMO: $22.65 ANTHEM — ANTHEM PPO: $22.65 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $39.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $66 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $56.10 CIGNA — ALL COMMERCIAL CIGNA: $46.20
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: HC PROTHROMBIN TIME (PT)	$48	$31.68	$4.29 – $48
Blood clotting time test (prothrombin time, PT): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $4.29 AETNA — ALL COMMERCIAL AETNA: $48 ANTHEM — ANTEHM MEDICAID: $4.43 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $4.29 ANTHEM — ANTHEM POS/HMO: $15.02 ANTHEM — ANTHEM PPO: $15.02 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $28.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $48 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $40.80 CIGNA — ALL COMMERCIAL CIGNA: $33.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · modifier 91 In the file: HC PROTHROMBIN TIME (PT)	$48	$31.68	$4.29 – $48
Blood clotting time test (prothrombin time, PT): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $4.29 AETNA — ALL COMMERCIAL AETNA: $48 ANTHEM — ANTEHM MEDICAID: $4.43 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $4.29 ANTHEM — ANTHEM POS/HMO: $15.02 ANTHEM — ANTHEM PPO: $15.02 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $28.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $48 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $40.80 CIGNA — ALL COMMERCIAL CIGNA: $33.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · modifier GA In the file: HC PROTHROMBIN TIME (PT)	$48	$31.68	$4.29 – $108
Blood clotting time test (prothrombin time, PT): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $4.29 AETNA — ALL COMMERCIAL AETNA: $48 ANTHEM — ANTEHM MEDICAID: $4.43 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $48 ANTHEM — ANTHEM POS/HMO: $15.02 ANTHEM — ANTHEM PPO: $15.02 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $28.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $48 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $40.80 CIGNA — ALL COMMERCIAL CIGNA: $33.60
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: THROMBOPLASTIN TIME PARTIAL	$71	$46.86	$6.01 – $71
Blood clotting test (partial thromboplastin time, PTT): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $6.01 AETNA — ALL COMMERCIAL AETNA: $71 ANTHEM — ANTEHM MEDICAID: $6.21 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $6.01 ANTHEM — ANTHEM POS/HMO: $21.04 ANTHEM — ANTHEM PPO: $21.04 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $42.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $71 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $60.35 CIGNA — ALL COMMERCIAL CIGNA: $49.70
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: HC APTT	$138	$91.08	$6.01 – $138
Blood clotting test (partial thromboplastin time, PTT): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $6.01 AETNA — ALL COMMERCIAL AETNA: $138 ANTHEM — ANTEHM MEDICAID: $6.21 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $6.01 ANTHEM — ANTHEM POS/HMO: $21.04 ANTHEM — ANTHEM PPO: $21.04 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $82.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $138 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $117.30 CIGNA — ALL COMMERCIAL CIGNA: $96.60
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: HC PTT	$75	$49.50	$6.01 – $75
Blood clotting test (partial thromboplastin time, PTT): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $6.01 AETNA — ALL COMMERCIAL AETNA: $75 ANTHEM — ANTEHM MEDICAID: $6.21 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $6.01 ANTHEM — ANTHEM POS/HMO: $21.04 ANTHEM — ANTHEM PPO: $21.04 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $45 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $75 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $63.75 CIGNA — ALL COMMERCIAL CIGNA: $52.50

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: HC CT HEAD/BRAIN W/O CONTRAST	$1,908	$1,259.28	$102.24 – $1,908
CT scan of the head or brain, without contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $1,908 ANTHEM — ANTEHM MEDICAID: $134.40 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $1,239 ANTHEM — ANTHEM PPO: $1,239 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,144.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,908 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,621.80 CIGNA — ALL COMMERCIAL CIGNA: $1,335.60
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · modifier 76 In the file: HC CT HEAD/BRAIN W/O CONTRAST	$1,908	$1,259.28	$102.24 – $1,908
CT scan of the head or brain, without contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $1,908 ANTHEM — ANTEHM MEDICAID: $134.40 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $1,239 ANTHEM — ANTHEM PPO: $1,239 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,144.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,908 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,621.80 CIGNA — ALL COMMERCIAL CIGNA: $1,335.60
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · modifier 77 In the file: HC CT HEAD/BRAIN W/O CONTRAST	$1,908	$1,259.28	$102.24 – $1,908
CT scan of the head or brain, without contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $1,908 ANTHEM — ANTEHM MEDICAID: $134.40 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $1,239 ANTHEM — ANTHEM PPO: $1,239 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,144.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,908 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,621.80 CIGNA — ALL COMMERCIAL CIGNA: $1,335.60
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: HC MRI BRAIN W&W/O CONTRAST	$4,123	$2,721.18	$179.97 – $4,123
MRI of the brain, before and after contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $341.18 AETNA — ALL COMMERCIAL AETNA: $4,123 ANTHEM — ANTEHM MEDICAID: $179.97 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $341.18 ANTHEM — ANTHEM POS/HMO: $1,430 ANTHEM — ANTHEM PPO: $1,430 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,473.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $4,123 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,504.55 CIGNA — ALL COMMERCIAL CIGNA: $2,886.10
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: HC MRI BRAIN W&W/O CONTRAST PITUITARY	$4,330	$2,857.80	$179.97 – $4,330
MRI of the brain, before and after contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $341.18 AETNA — ALL COMMERCIAL AETNA: $4,330 ANTHEM — ANTEHM MEDICAID: $179.97 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $341.18 ANTHEM — ANTHEM POS/HMO: $1,430 ANTHEM — ANTHEM PPO: $1,430 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,598 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $4,330 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,680.50 CIGNA — ALL COMMERCIAL CIGNA: $3,031
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · modifier XU In the file: HC MRI BRAIN W&W/O CONTRAST	$4,123	$2,721.18	$179.97 – $4,123
MRI of the brain, before and after contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $341.18 AETNA — ALL COMMERCIAL AETNA: $4,123 ANTHEM — ANTEHM MEDICAID: $179.97 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $341.18 ANTHEM — ANTHEM POS/HMO: $1,430 ANTHEM — ANTHEM PPO: $1,430 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,473.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $4,123 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,504.55 CIGNA — ALL COMMERCIAL CIGNA: $2,886.10
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: X-RAY EXAM CHEST 2 VIEWS	$418	$275.88	$24.82 – $418
Chest X-ray, 2 views: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $85.11 AETNA — ALL COMMERCIAL AETNA: $418 ANTHEM — ANTEHM MEDICAID: $24.82 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $85.11 ANTHEM — ANTHEM POS/HMO: $94.65 ANTHEM — ANTHEM PPO: $94.65 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $250.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $418 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $355.30 CIGNA — ALL COMMERCIAL CIGNA: $292.60
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · modifier XU In the file: X-RAY EXAM CHEST 2 VIEWS	$418	$275.88	$24.82 – $418
Chest X-ray, 2 views: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $85.11 AETNA — ALL COMMERCIAL AETNA: $418 ANTHEM — ANTEHM MEDICAID: $24.82 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $85.11 ANTHEM — ANTHEM POS/HMO: $94.65 ANTHEM — ANTHEM PPO: $94.65 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $250.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $418 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $355.30 CIGNA — ALL COMMERCIAL CIGNA: $292.60
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · modifier 77 In the file: X-RAY EXAM CHEST 2 VIEWS	$418	$275.88	$24.82 – $418
Chest X-ray, 2 views: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $85.11 AETNA — ALL COMMERCIAL AETNA: $418 ANTHEM — ANTEHM MEDICAID: $24.82 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $85.11 ANTHEM — ANTHEM POS/HMO: $94.65 ANTHEM — ANTHEM PPO: $94.65 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $250.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $418 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $355.30 CIGNA — ALL COMMERCIAL CIGNA: $292.60
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: X-RAY EXAM L-2 SPINE 4/>VWS	$883	$582.78	$24.82 – $883
X-ray of the lower spine, at least 4 views: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $883 ANTHEM — ANTEHM MEDICAID: $24.82 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $159.76 ANTHEM — ANTHEM PPO: $159.76 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $529.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $883 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $750.55 CIGNA — ALL COMMERCIAL CIGNA: $618.10
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · modifier XU In the file: X-RAY EXAM L-2 SPINE 4/>VWS	$883	$582.78	$24.82 – $883
X-ray of the lower spine, at least 4 views: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $883 ANTHEM — ANTEHM MEDICAID: $24.82 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $159.76 ANTHEM — ANTHEM PPO: $159.76 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $529.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $883 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $750.55 CIGNA — ALL COMMERCIAL CIGNA: $618.10
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · modifier PN In the file: X-RAY EXAM L-2 SPINE 4/>VWS	$883	$582.78	$24.82 – $883
X-ray of the lower spine, at least 4 views: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $883 ANTHEM — ANTEHM MEDICAID: $24.82 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $159.76 ANTHEM — ANTHEM PPO: $159.76 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $529.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $883 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $750.55 CIGNA — ALL COMMERCIAL CIGNA: $618.10
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: HC MRI L-SPINE W/O CONTRAST	$3,542	$2,337.72	$106.68 – $3,542
MRI of the lower back (lumbar spine), without contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $233.34 AETNA — ALL COMMERCIAL AETNA: $3,542 ANTHEM — ANTEHM MEDICAID: $106.68 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $233.34 ANTHEM — ANTHEM POS/HMO: $1,430 ANTHEM — ANTHEM PPO: $1,430 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,125.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $3,542 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,010.70 CIGNA — ALL COMMERCIAL CIGNA: $2,479.40
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · modifier PN In the file: HC MRI L-SPINE W/O CONTRAST	$3,542	$2,337.72	$93.34 – $3,542
MRI of the lower back (lumbar spine), without contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $233.34 AETNA — ALL COMMERCIAL AETNA: $3,542 ANTHEM — ANTEHM MEDICAID: $106.68 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $233.34 ANTHEM — ANTHEM POS/HMO: $1,430 ANTHEM — ANTHEM PPO: $1,430 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,125.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $3,542 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,010.70 CIGNA — ALL COMMERCIAL CIGNA: $2,479.40
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · modifier UA In the file: HC MRI L-SPINE W/O CONTRAST	$3,542	$2,337.72	$106.68 – $3,542
MRI of the lower back (lumbar spine), without contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $233.34 AETNA — ALL COMMERCIAL AETNA: $3,542 ANTHEM — ANTEHM MEDICAID: $106.68 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $233.34 ANTHEM — ANTHEM POS/HMO: $1,430 ANTHEM — ANTHEM PPO: $1,430 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,125.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $3,542 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,010.70 CIGNA — ALL COMMERCIAL CIGNA: $2,479.40
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: HC CT PELVIS W/CONTRAST	$2,332	$1,539.12	$134.40 – $2,332
CT scan of the pelvis, with contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $171.53 AETNA — ALL COMMERCIAL AETNA: $2,332 ANTHEM — ANTEHM MEDICAID: $134.40 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $171.53 ANTHEM — ANTHEM POS/HMO: $1,239 ANTHEM — ANTHEM PPO: $1,239 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,399.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $2,332 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,982.20 CIGNA — ALL COMMERCIAL CIGNA: $1,632.40
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · modifier UA In the file: HC CT PELVIS W/CONTRAST	$2,332	$1,539.12	$134.40 – $2,332
CT scan of the pelvis, with contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $171.53 AETNA — ALL COMMERCIAL AETNA: $2,332 ANTHEM — ANTEHM MEDICAID: $134.40 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $171.53 ANTHEM — ANTHEM POS/HMO: $1,239 ANTHEM — ANTHEM PPO: $1,239 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,399.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $2,332 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $1,982.20 CIGNA — ALL COMMERCIAL CIGNA: $1,632.40
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: HC MRI LWR EXT JOINT W/O CONTRAST	$3,668	$2,420.88	$106.68 – $3,668
MRI of a leg joint (such as the knee), without contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $233.34 AETNA — ALL COMMERCIAL AETNA: $3,668 ANTHEM — ANTEHM MEDICAID: $106.68 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $233.34 ANTHEM — ANTHEM POS/HMO: $1,430 ANTHEM — ANTHEM PPO: $1,430 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,200.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $3,668 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,117.80 CIGNA — ALL COMMERCIAL CIGNA: $2,567.60
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: HC CT ABDOMEN/PELVIS W/CONTRAST	$4,571	$3,016.86	$134.40 – $4,571
CT scan of the abdomen and pelvis, with contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $341.18 AETNA — ALL COMMERCIAL AETNA: $4,571 ANTHEM — ANTEHM MEDICAID: $134.40 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $341.18 ANTHEM — ANTHEM POS/HMO: $1,239 ANTHEM — ANTHEM PPO: $1,239 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,742.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $4,571 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,885.35 CIGNA — ALL COMMERCIAL CIGNA: $3,199.70
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · modifier XU In the file: HC CT ABDOMEN/PELVIS W/CONTRAST	$4,571	$3,016.86	$134.40 – $4,571
CT scan of the abdomen and pelvis, with contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $341.18 AETNA — ALL COMMERCIAL AETNA: $4,571 ANTHEM — ANTEHM MEDICAID: $134.40 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $341.18 ANTHEM — ANTHEM POS/HMO: $1,239 ANTHEM — ANTHEM PPO: $1,239 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,742.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $4,571 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,885.35 CIGNA — ALL COMMERCIAL CIGNA: $3,199.70
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · modifier MA In the file: HC CT ABDOMEN/PELVIS W/CONTRAST	$4,571	$3,016.86	$134.40 – $4,571
CT scan of the abdomen and pelvis, with contrast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $341.18 AETNA — ALL COMMERCIAL AETNA: $4,571 ANTHEM — ANTEHM MEDICAID: $134.40 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $341.18 ANTHEM — ANTHEM POS/HMO: $1,239 ANTHEM — ANTHEM PPO: $1,239 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,742.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $4,571 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,885.35 CIGNA — ALL COMMERCIAL CIGNA: $3,199.70
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: HC US ABDOMEN CMPL	$1,166	$769.56	$74.44 – $1,166
Ultrasound of the abdomen, complete: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $1,166 ANTHEM — ANTEHM MEDICAID: $74.44 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $500 ANTHEM — ANTHEM PPO: $500 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $699.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,166 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $991.10 CIGNA — ALL COMMERCIAL CIGNA: $816.20
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · modifier PO In the file: HC US ABDOMEN CMPL	$1,166	$769.56	$74.44 – $1,166
Ultrasound of the abdomen, complete: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $1,166 ANTHEM — ANTEHM MEDICAID: $74.44 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $500 ANTHEM — ANTHEM PPO: $500 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $699.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,166 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $991.10 CIGNA — ALL COMMERCIAL CIGNA: $816.20
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · modifier 59 In the file: HC US ABDOMEN CMPL	$1,166	$769.56	$74.44 – $1,166
Ultrasound of the abdomen, complete: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $1,166 ANTHEM — ANTEHM MEDICAID: $74.44 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $500 ANTHEM — ANTHEM PPO: $500 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $699.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $1,166 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $991.10 CIGNA — ALL COMMERCIAL CIGNA: $816.20
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: HC US PREGNANCY >14 WEEKS SGL	$869	$573.54	$44.52 – $869
Pregnancy ultrasound (after the first trimester): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $869 ANTHEM — ANTEHM MEDICAID: $44.52 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $500 ANTHEM — ANTHEM PPO: $500 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $521.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $869 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $738.65 CIGNA — ALL COMMERCIAL CIGNA: $608.30
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · modifier 59 In the file: HC US PREGNANCY >14 WEEKS SGL	$869	$573.54	$44.52 – $869
Pregnancy ultrasound (after the first trimester): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $869 ANTHEM — ANTEHM MEDICAID: $44.52 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $500 ANTHEM — ANTHEM PPO: $500 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $521.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $869 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $738.65 CIGNA — ALL COMMERCIAL CIGNA: $608.30
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: HC US TRANSVAGINAL	$805	$531.30	$48.32 – $805
Transvaginal ultrasound: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $805 ANTHEM — ANTEHM MEDICAID: $48.32 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $500 ANTHEM — ANTHEM PPO: $500 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $483 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $805 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $684.25 CIGNA — ALL COMMERCIAL CIGNA: $563.50
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · modifier PO In the file: HC US TRANSVAGINAL	$805	$531.30	$48.32 – $805
Transvaginal ultrasound: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $805 ANTHEM — ANTEHM MEDICAID: $48.32 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $500 ANTHEM — ANTHEM PPO: $500 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $483 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $805 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $684.25 CIGNA — ALL COMMERCIAL CIGNA: $563.50
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · modifier PN In the file: HC US TRANSVAGINAL	$805	$531.30	$40.90 – $805
Transvaginal ultrasound: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $102.24 AETNA — ALL COMMERCIAL AETNA: $805 ANTHEM — ANTEHM MEDICAID: $48.32 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $102.24 ANTHEM — ANTHEM POS/HMO: $500 ANTHEM — ANTHEM PPO: $500 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $483 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $805 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $684.25 CIGNA — ALL COMMERCIAL CIGNA: $563.50
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient In the file: DX MAMMO INCL CAD UNI	$470	$310.20	$21.09 – $470
Diagnostic mammogram, one breast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $82.34 AETNA — ALL COMMERCIAL AETNA: $470 ANTHEM — ANTEHM MEDICAID: $21.09 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $82.34 ANTHEM — ANTHEM POS/HMO: $350 ANTHEM — ANTHEM PPO: $350 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $282 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $470 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $399.50 CIGNA — ALL COMMERCIAL CIGNA: $329
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · modifier FY In the file: DX MAMMO INCL CAD UNI	$470	$310.20	$21.09 – $470
Diagnostic mammogram, one breast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $74.11 AETNA — ALL COMMERCIAL AETNA: $470 ANTHEM — ANTEHM MEDICAID: $21.09 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $74.11 ANTHEM — ANTHEM POS/HMO: $350 ANTHEM — ANTHEM PPO: $350 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $282 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $470 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $399.50 CIGNA — ALL COMMERCIAL CIGNA: $329
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · modifier GA In the file: DX MAMMO INCL CAD UNI	$470	$310.20	$21.09 – $474.70
Diagnostic mammogram, one breast: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $82.34 AETNA — ALL COMMERCIAL AETNA: $470 ANTHEM — ANTEHM MEDICAID: $21.09 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $82.34 ANTHEM — ANTHEM POS/HMO: $350 ANTHEM — ANTHEM PPO: $350 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $282 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $470 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $399.50 CIGNA — ALL COMMERCIAL CIGNA: $329
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient In the file: DX MAMMO INCL CAD BI	$560	$369.60	$21.09 – $560
Diagnostic mammogram, both breasts: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $105.48 AETNA — ALL COMMERCIAL AETNA: $560 ANTHEM — ANTEHM MEDICAID: $21.09 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $105.48 ANTHEM — ANTHEM POS/HMO: $350 ANTHEM — ANTHEM PPO: $350 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $336 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $560 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $476 CIGNA — ALL COMMERCIAL CIGNA: $392
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · modifier GG In the file: HC MAMMOGRAM DIAG W/CAD UPGRADE BIL	$560	$369.60	$21.09 – $560
Diagnostic mammogram, both breasts: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $105.48 AETNA — ALL COMMERCIAL AETNA: $560 ANTHEM — ANTEHM MEDICAID: $21.09 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $105.48 ANTHEM — ANTHEM POS/HMO: $350 ANTHEM — ANTHEM PPO: $350 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $336 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $560 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $476 CIGNA — ALL COMMERCIAL CIGNA: $392
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · modifier FY In the file: DX MAMMO INCL CAD BI	$560	$369.60	$21.09 – $560
Diagnostic mammogram, both breasts: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $94.93 AETNA — ALL COMMERCIAL AETNA: $560 ANTHEM — ANTEHM MEDICAID: $21.09 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $94.93 ANTHEM — ANTHEM POS/HMO: $350 ANTHEM — ANTHEM PPO: $350 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $336 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $560 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $476 CIGNA — ALL COMMERCIAL CIGNA: $392
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: HC MAMM SCREEN BI W/CAD SELF REFERRAL	$360	$237.60	$21.09 – $360
Screening mammogram, both breasts: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $87.14 AETNA — ALL COMMERCIAL AETNA: $360 ANTHEM — ANTEHM MEDICAID: $21.09 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $87.14 ANTHEM — ANTHEM POS/HMO: $350 ANTHEM — ANTHEM PPO: $350 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $216 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $360 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $306 CIGNA — ALL COMMERCIAL CIGNA: $252
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: HC MAMM SCREEN BI W/CAD CORPORATE	$163	$107.58	$21.09 – $196.07
Screening mammogram, both breasts: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $87.14 AETNA — ALL COMMERCIAL AETNA: $163 ANTHEM — ANTEHM MEDICAID: $21.09 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $87.14 ANTHEM — ANTHEM POS/HMO: $163 ANTHEM — ANTHEM PPO: $163 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $97.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $163 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $138.55 CIGNA — ALL COMMERCIAL CIGNA: $114.10
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: SCR MAMMO BI INCL CAD	$470	$310.20	$21.09 – $470
Screening mammogram, both breasts: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $87.14 AETNA — ALL COMMERCIAL AETNA: $470 ANTHEM — ANTEHM MEDICAID: $21.09 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $87.14 ANTHEM — ANTHEM POS/HMO: $350 ANTHEM — ANTHEM PPO: $350 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $282 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $470 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $399.50 CIGNA — ALL COMMERCIAL CIGNA: $329

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient In the file: HC LHC ONLY NO COROS 93452	$7,939	$5,239.74	$1,066.54 – $7,939
Left heart catheterization (diagnostic): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $3,170.46 AETNA — ALL COMMERCIAL AETNA: $7,939 ANTHEM — ANTEHM MEDICAID: $1,066.54 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $3,170.46 ANTHEM — ANTHEM POS/HMO: $7,939 ANTHEM — ANTHEM PPO: $7,939 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $4,763.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $7,939 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $6,748.15 CIGNA — ALL COMMERCIAL CIGNA: $5,557.30
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient In the file: HC EP COMPREHENSIVE W/O ARRHYTHMI 93619	$13,279	$8,764.14	$1,209 – $17,162.33
Heart rhythm study (electrophysiology evaluation): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $7,627.70 AETNA — ALL COMMERCIAL AETNA: $13,279 ANTHEM — ANTEHM MEDICAID: $2,816.70 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $7,627.70 ANTHEM — ANTHEM POS/HMO: $9,029.72 ANTHEM — ANTHEM PPO: $9,029.72 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $7,967.40 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $13,279 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $11,287.15 CIGNA — ALL COMMERCIAL CIGNA: $9,295.30
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient In the file: HC EP STUDY PLUS AFIB ABLATION 93656	$26,767	$17,666.22	$7,726.98 – $57,513.58
Heart rhythm study with ablation for atrial fibrillation: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $25,561.59 AETNA — ALL COMMERCIAL AETNA: $26,767 ANTHEM — ANTEHM MEDICAID: $7,726.98 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $25,561.59 ANTHEM — ANTHEM POS/HMO: $26,767 ANTHEM — ANTHEM PPO: $26,767 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $16,060.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $26,767 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $22,751.95 CIGNA — ALL COMMERCIAL CIGNA: $18,736.90
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · modifier XU In the file: HC EP STUDY PLUS AFIB ABLATION 93656	$26,767	$17,666.22	$7,726.98 – $57,513.58
Heart rhythm study with ablation for atrial fibrillation: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $25,561.59 AETNA — ALL COMMERCIAL AETNA: $26,767 ANTHEM — ANTEHM MEDICAID: $7,726.98 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $25,561.59 ANTHEM — ANTHEM POS/HMO: $26,767 ANTHEM — ANTHEM PPO: $26,767 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $16,060.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $26,767 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $22,751.95 CIGNA — ALL COMMERCIAL CIGNA: $18,736.90
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · modifier 59 In the file: HC EP STUDY PLUS AFIB ABLATION 93656	$26,767	$17,666.22	$7,726.98 – $57,513.58
Heart rhythm study with ablation for atrial fibrillation: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $25,561.59 AETNA — ALL COMMERCIAL AETNA: $26,767 ANTHEM — ANTEHM MEDICAID: $7,726.98 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $25,561.59 ANTHEM — ANTHEM POS/HMO: $26,767 ANTHEM — ANTHEM PPO: $26,767 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $16,060.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $26,767 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $22,751.95 CIGNA — ALL COMMERCIAL CIGNA: $18,736.90
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: HC SLEEP STUDY	$5,776	$3,812.16	$349.46 – $5,776
Sleep study (overnight, in a sleep lab): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $839.81 AETNA — ALL COMMERCIAL AETNA: $5,776 ANTHEM — ANTEHM MEDICAID: $349.46 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $839.81 ANTHEM — ANTHEM POS/HMO: $3,500 ANTHEM — ANTHEM PPO: $3,719 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $3,465.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $5,776 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $4,909.60 CIGNA — ALL COMMERCIAL CIGNA: $4,043.20
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: HC SLEEP STUDY ONE ON ONE	$6,121	$4,039.86	$349.46 – $6,121
Sleep study (overnight, in a sleep lab): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $839.81 AETNA — ALL COMMERCIAL AETNA: $6,121 ANTHEM — ANTEHM MEDICAID: $349.46 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $839.81 ANTHEM — ANTHEM POS/HMO: $3,500 ANTHEM — ANTHEM PPO: $3,719 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $3,672.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $6,121 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $5,202.85 CIGNA — ALL COMMERCIAL CIGNA: $4,284.70
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · modifier PO In the file: HC SLEEP STUDY	$5,776	$3,812.16	$349.46 – $5,776
Sleep study (overnight, in a sleep lab): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $839.81 AETNA — ALL COMMERCIAL AETNA: $5,776 ANTHEM — ANTEHM MEDICAID: $349.46 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $839.81 ANTHEM — ANTHEM POS/HMO: $3,500 ANTHEM — ANTHEM PPO: $3,719 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $3,465.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $5,776 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $4,909.60 CIGNA — ALL COMMERCIAL CIGNA: $4,043.20

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: HC THERA EXER; EA 15 MIN	$122	$80.52	$16.89 – $122
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $28.25 AETNA — ALL COMMERCIAL AETNA: $122 ANTHEM — ANTEHM MEDICAID: $31.38 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $28.25 ANTHEM — ANTHEM POS/HMO: $122 ANTHEM — ANTHEM PPO: $122 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $73.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $122 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $103.70 CIGNA — ALL COMMERCIAL CIGNA: $85.40
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · modifier GO In the file: HC THERA EXER; EA 15 MIN	$122	$80.52	$16.89 – $122
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $28.25 AETNA — ALL COMMERCIAL AETNA: $122 ANTHEM — ANTEHM MEDICAID: $31.38 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $28.25 ANTHEM — ANTHEM POS/HMO: $122 ANTHEM — ANTHEM PPO: $122 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $73.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $122 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $103.70 CIGNA — ALL COMMERCIAL CIGNA: $85.40
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · modifier GP In the file: HC THERA EXER; EA 15 MIN	$122	$80.52	$16.89 – $122
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $28.25 AETNA — ALL COMMERCIAL AETNA: $122 ANTHEM — ANTEHM MEDICAID: $31.38 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $28.25 ANTHEM — ANTHEM POS/HMO: $122 ANTHEM — ANTHEM PPO: $122 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $73.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $122 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $103.70 CIGNA — ALL COMMERCIAL CIGNA: $85.40
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: HC PT EVAL LOW COMPLEXITY 15MIN	$145	$95.70	$70.47 – $215.33
Physical therapy evaluation (low complexity): 10 of 47 insurance plan rates AETNA — AETNA MEDICARE: $95.70 AETNA — ALL COMMERCIAL AETNA: $145 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $95.70 ANTHEM — ANTHEM POS/HMO: $145 ANTHEM — ANTHEM PPO: $145 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $87 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $145 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $123.25 CIGNA — ALL COMMERCIAL CIGNA: $101.50 COFINITY — COFINITY: $145
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: HC PT EVAL LOW COMPLEXITY 30MIN	$172	$113.52	$83.59 – $215.33
Physical therapy evaluation (low complexity): 10 of 47 insurance plan rates AETNA — AETNA MEDICARE: $95.70 AETNA — ALL COMMERCIAL AETNA: $172 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $95.70 ANTHEM — ANTHEM POS/HMO: $172 ANTHEM — ANTHEM PPO: $172 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $103.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $172 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $146.20 CIGNA — ALL COMMERCIAL CIGNA: $120.40 COFINITY — COFINITY: $172
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: HC PT EVAL LOW COMPLEXITY 60MIN	$235	$155.10	$88.79 – $235
Physical therapy evaluation (low complexity): 10 of 47 insurance plan rates AETNA — AETNA MEDICARE: $95.70 AETNA — ALL COMMERCIAL AETNA: $235 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $95.70 ANTHEM — ANTHEM POS/HMO: $235 ANTHEM — ANTHEM PPO: $235 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $141 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $235 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $199.75 CIGNA — ALL COMMERCIAL CIGNA: $164.50 COFINITY — COFINITY: $235
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: HC PT EVAL MOD COMPLEXITY 15MIN	$145	$95.70	$70.47 – $215.33
Physical therapy evaluation (moderate complexity): 10 of 47 insurance plan rates AETNA — AETNA MEDICARE: $95.70 AETNA — ALL COMMERCIAL AETNA: $145 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $95.70 ANTHEM — ANTHEM POS/HMO: $145 ANTHEM — ANTHEM PPO: $145 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $87 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $145 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $123.25 CIGNA — ALL COMMERCIAL CIGNA: $101.50 COFINITY — COFINITY: $145
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: HC PT EVAL MOD COMPLEXITY 60MIN	$235	$155.10	$88.79 – $235
Physical therapy evaluation (moderate complexity): 10 of 47 insurance plan rates AETNA — AETNA MEDICARE: $95.70 AETNA — ALL COMMERCIAL AETNA: $235 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $95.70 ANTHEM — ANTHEM POS/HMO: $235 ANTHEM — ANTHEM PPO: $235 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $141 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $235 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $199.75 CIGNA — ALL COMMERCIAL CIGNA: $164.50 COFINITY — COFINITY: $235
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: HC PT EVAL MOD COMPLEXITY 30MIN	$172	$113.52	$83.59 – $215.33
Physical therapy evaluation (moderate complexity): 10 of 47 insurance plan rates AETNA — AETNA MEDICARE: $95.70 AETNA — ALL COMMERCIAL AETNA: $172 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $95.70 ANTHEM — ANTHEM POS/HMO: $172 ANTHEM — ANTHEM PPO: $172 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $103.20 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $172 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $146.20 CIGNA — ALL COMMERCIAL CIGNA: $120.40 COFINITY — COFINITY: $172
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: HC PT EVAL HIGH COMPLEXITY 15MIN	$145	$95.70	$70.47 – $215.33
Physical therapy evaluation (high complexity): 10 of 47 insurance plan rates AETNA — AETNA MEDICARE: $95.70 AETNA — ALL COMMERCIAL AETNA: $145 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $95.70 ANTHEM — ANTHEM POS/HMO: $145 ANTHEM — ANTHEM PPO: $145 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $87 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $145 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $123.25 CIGNA — ALL COMMERCIAL CIGNA: $101.50 COFINITY — COFINITY: $145
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: HC PT EVAL HIGH COMPLEXITY 45MIN	$188	$124.08	$88.79 – $215.33
Physical therapy evaluation (high complexity): 10 of 47 insurance plan rates AETNA — AETNA MEDICARE: $95.70 AETNA — ALL COMMERCIAL AETNA: $188 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $95.70 ANTHEM — ANTHEM POS/HMO: $188 ANTHEM — ANTHEM PPO: $188 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $112.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $188 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $159.80 CIGNA — ALL COMMERCIAL CIGNA: $131.60 COFINITY — COFINITY: $188
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: HC PT EVAL HIGH COMPLEXITY	$150	$99	$72.90 – $215.33
Physical therapy evaluation (high complexity): 10 of 47 insurance plan rates AETNA — AETNA MEDICARE: $95.70 AETNA — ALL COMMERCIAL AETNA: $150 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $95.70 ANTHEM — ANTHEM POS/HMO: $150 ANTHEM — ANTHEM PPO: $150 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $90 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $150 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $127.50 CIGNA — ALL COMMERCIAL CIGNA: $105 COFINITY — COFINITY: $150

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$588.15 – $9,178
Removal of breast growth (open surgery): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · modifier 50 In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$882.22 – $9,178
Removal of breast growth (open surgery): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$4,194.59 – $31,233.17
Total hip replacement: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$4,194.59 – $30,827.61
Total knee replacement: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · modifier 50 In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$6,291.89 – $30,827.61
Total knee replacement: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$945.70 – $8,738.27
Shoulder arthroscopy: shaving of shoulder bone: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · modifier XS In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$945.70 – $8,738.27
Shoulder arthroscopy: shaving of shoulder bone: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · modifier XU In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$945.70 – $8,738.27
Shoulder arthroscopy: shaving of shoulder bone: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$945.70 – $12,479.04
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · modifier 50 In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$1,418.56 – $12,479.04
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · modifier 59 In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$945.70 – $12,479.04
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$877.49 – $13,025.96
Removal of tonsils and adenoids (under age 12): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$426.39 – $10,374.48
Upper GI endoscopy (diagnostic): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · modifier XU In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$426.39 – $4,048.07
Upper GI endoscopy (diagnostic): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · modifier XS In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$426.39 – $4,048.07
Upper GI endoscopy (diagnostic): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$426.39 – $6,443
Upper GI endoscopy with biopsy: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · modifier XU In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$426.39 – $6,443
Upper GI endoscopy with biopsy: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · modifier XS In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$426.39 – $6,443
Upper GI endoscopy with biopsy: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$435.70 – $4,205.05
Colonoscopy (diagnostic): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · modifier KX In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$435.70 – $4,205.05
Colonoscopy (diagnostic): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · modifier 33 In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$435.70 – $4,205.05
Colonoscopy (diagnostic): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$435.70 – $4,086.81
Colonoscopy with biopsy: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · modifier XU In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$435.70 – $4,086.81
Colonoscopy with biopsy: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · modifier XP In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$435.70 – $4,086.81
Colonoscopy with biopsy: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$435.70 – $4,955.03
Colonoscopy with removal of polyps (snare): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · modifier XU In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$435.70 – $4,955.03
Colonoscopy with removal of polyps (snare): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · modifier XS In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$435.70 – $4,955.03
Colonoscopy with removal of polyps (snare): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: COLON CA SCRN NOT HI RSK IND	Not listed in the file	Not listed in the file	$435.70 – $4,238.82
Screening colonoscopy (not high risk): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · modifier KX In the file: COLON CA SCRN NOT HI RSK IND	Not listed in the file	Not listed in the file	$435.70 – $4,238.82
Screening colonoscopy (not high risk): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · modifier 52 In the file: COLON CA SCRN NOT HI RSK IND	Not listed in the file	Not listed in the file	$217.85 – $4,238.82
Screening colonoscopy (not high risk): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$1,517.97 – $22,276.69
Gallbladder removal by laparoscope: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · modifier 50 In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$2,276.95 – $22,276.69
Gallbladder removal by laparoscope: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$1,557.87 – $13,061.39
Groin (inguinal) hernia repair, age 5 or older: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · modifier 50 In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$2,336.81 – $13,358.37
Groin (inguinal) hernia repair, age 5 or older: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Prostate biopsy CPT 55700 · Inpatient or outpatient In the file: HC BX PROSTATE NEEDLE/PUNCH	$3,585	$2,366.10	$752.65 – $3,585
Prostate biopsy: 10 of 41 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $3,585 ANTHEM — ANTEHM MEDICAID: $752.65 ANTHEM — ANTHEM POS/HMO: $3,585 ANTHEM — ANTHEM PPO: $3,585 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,151 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $3,585 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,047.25 CIGNA — ALL COMMERCIAL CIGNA: $2,509.50 COFINITY — COFINITY: $3,585 COMMUNITY CARE FAMILY CARE — COMMUNITY CARE FAMILY CARE MEDICAID MANAGED: $752.65
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$752.65 – $13,353.01
Prostate biopsy: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Prostate biopsy CPT 55700 · Inpatient or outpatient · modifier XU In the file: HC BX PROSTATE NEEDLE/PUNCH	$3,585	$2,366.10	$752.65 – $3,585
Prostate biopsy: 10 of 41 insurance plan rates AETNA — ALL COMMERCIAL AETNA: $3,585 ANTHEM — ANTEHM MEDICAID: $752.65 ANTHEM — ANTHEM POS/HMO: $3,585 ANTHEM — ANTHEM PPO: $3,585 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $2,151 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $3,585 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $3,047.25 CIGNA — ALL COMMERCIAL CIGNA: $2,509.50 COFINITY — COFINITY: $3,585 COMMUNITY CARE FAMILY CARE — COMMUNITY CARE FAMILY CARE MEDICAID MANAGED: $752.65
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$1,945.59 – $33,124.70
Prostate removal by laparoscope (radical prostatectomy): 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$1,027.53 – $9,206.41
Hysteroscopy with biopsy of the uterus lining: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · modifier 74 In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$1,027.53 – $9,206.41
Hysteroscopy with biopsy of the uterus lining: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · modifier XP In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$1,027.53 – $9,206.41
Hysteroscopy with biopsy of the uterus lining: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: HC INJ INTRLAMNR LUM/SAC W/GUIDE	$2,583	$1,704.78	$337.74 – $2,583
Spinal injection, lower back (epidural), with imaging guidance: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $690.32 AETNA — ALL COMMERCIAL AETNA: $2,583 ANTHEM — ANTEHM MEDICAID: $337.74 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $690.32 ANTHEM — ANTHEM POS/HMO: $2,583 ANTHEM — ANTHEM PPO: $2,583 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,549.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $2,583 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $2,195.55 CIGNA — ALL COMMERCIAL CIGNA: $1,808.10
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$337.74 – $3,090.02
Spinal injection, lower back (epidural), with imaging guidance: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · modifier 50 In the file: HC INJ INTRLAMNR LUM/SAC W/GUIDE	$2,583	$1,704.78	$337.74 – $2,583
Spinal injection, lower back (epidural), with imaging guidance: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $690.32 AETNA — ALL COMMERCIAL AETNA: $2,583 ANTHEM — ANTEHM MEDICAID: $337.74 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $690.32 ANTHEM — ANTHEM POS/HMO: $2,583 ANTHEM — ANTHEM PPO: $2,583 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,549.80 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $2,583 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $2,195.55 CIGNA — ALL COMMERCIAL CIGNA: $1,808.10
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient In the file: HC INJ TRANSF LUMBAR SACRAL SINGLE	$2,696	$1,779.36	$337.74 – $2,696
Nerve root injection, lower back, with imaging guidance: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $864.97 AETNA — ALL COMMERCIAL AETNA: $2,696 ANTHEM — ANTEHM MEDICAID: $337.74 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $864.97 ANTHEM — ANTHEM POS/HMO: $2,696 ANTHEM — ANTHEM PPO: $2,696 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,617.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $2,696 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $2,291.60 CIGNA — ALL COMMERCIAL CIGNA: $1,887.20
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$337.74 – $3,333.50
Nerve root injection, lower back, with imaging guidance: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · modifier XS In the file: HC INJ TRANSF LUMBAR SACRAL SINGLE	$2,696	$1,779.36	$337.74 – $2,696
Nerve root injection, lower back, with imaging guidance: 10 of 53 insurance plan rates AETNA — AETNA MEDICARE: $864.97 AETNA — ALL COMMERCIAL AETNA: $2,696 ANTHEM — ANTEHM MEDICAID: $337.74 ANTHEM — ANTHEM MEDICARE ADVANTAGE HMO: $864.97 ANTHEM — ANTHEM POS/HMO: $2,696 ANTHEM — ANTHEM PPO: $2,696 ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: $1,617.60 CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: $2,696 CHOICECARE — ALL COMMERCIAL CHOICE CARE: $2,291.60 CIGNA — ALL COMMERCIAL CIGNA: $1,887.20
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$595.28 – $7,040.84
Carpal tunnel release: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · modifier XS In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$595.28 – $7,040.84
Carpal tunnel release: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · modifier 50 In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$892.92 – $7,040.84
Carpal tunnel release: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$754.59 – $6,552.59
Cataract removal with lens implant: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · modifier PO In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$754.59 – $6,552.59
Cataract removal with lens implant: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · modifier 50 In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$1,131.89 – $6,552.59
Cataract removal with lens implant: 10 of 25 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) ARISE HEALTH PLAN — ALL COMMERCIAL ARISE HEALTH PLAN: 60% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount)

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$14,590.99 – $52,803.75
Hip or knee replacement (major joint of the leg), without major complications: 10 of 24 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount) HSHS EMPLOYEES — HSHS EMPLOYEES: 48.6% (a percentage in the contract, not a dollar amount)
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$18,205.06 – $63,024.36
Neck (cervical) spinal fusion, without complications: 10 of 24 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount) HSHS EMPLOYEES — HSHS EMPLOYEES: 48.6% (a percentage in the contract, not a dollar amount)
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$9,736.95 – $36,625.34
Uterus and ovary surgery (not for cancer), without complications: 10 of 24 insurance plan rates AETNA — ALL COMMERCIAL AETNA: 100% (a percentage in the contract, not a dollar amount) CATERPILLAR, INC. — UHC CATERPILLAR EMPLOYER GROUP: 100% (a percentage in the contract, not a dollar amount) CHOICECARE — ALL COMMERCIAL CHOICE CARE: 85% (a percentage in the contract, not a dollar amount) CIGNA — ALL COMMERCIAL CIGNA: 70% (a percentage in the contract, not a dollar amount) COFINITY — COFINITY: 100% (a percentage in the contract, not a dollar amount) FIRST HEALTH — ALL COMMERCIAL FIRST HEALTH NETWORK: 95% (a percentage in the contract, not a dollar amount) HEALTH CARE ALLIANCE — THE ALLIANCE: 84% (a percentage in the contract, not a dollar amount) HEALTH EOS — ALL COMMERCIAL HEALTH EOS: 75% (a percentage in the contract, not a dollar amount) HEALTHSMART — ALL COMMERCIAL HEALTHSMART: 75% (a percentage in the contract, not a dollar amount) HSHS EMPLOYEES — HSHS EMPLOYEES: 48.6% (a percentage in the contract, not a dollar amount)

Source: St Nicholas Hospital’s standard charges file (hshs.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on March 24, 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 type	Acute Care Hospital
Address	3100 Superior Ave, Sheboygan, WI 53081
County	Sheboygan County
State	Wisconsin
Phone	(920) 459‑8300
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	3 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	520044
Name in Medicare records	ST NICHOLAS HOSPITAL
Profile level	Medicare data + hospital website
Name on the hospital’s website	HSHS St. Nicholas Hospital
Official website	hshs.org
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

HSHS St. Nicholas Hospital — hshs.org
Services — hshs.org
Emergency Care — hshs.org
Telehealth Technology at HSHS St. Nicholas Hospital — hshs.org
Orthopedic Center at HSHS St. Nicholas Hospital — hshs.org
Joints inMotion at HSHS St. Nicholas Hospital — hshs.org
Cancer Care at HSHS St. Nicholas Hospital — hshs.org
Stroke Care at HSHS St. Nicholas Hospital — hshs.org
Imaging & Laboratory Testing at HSHS St. Nicholas Hospital — hshs.org
Heart Care at HSHS St. Nicholas Hospital — hshs.org
Pregnancy & Birth at HSHS St. Nicholas Hospital — hshs.org
Surgery Center at HSHS St. Nicholas Hospital — hshs.org
Sleep Disorders Center at HSHS St. Nicholas Hospital — hshs.org
Women's Health at HSHS St. Nicholas — hshs.org

St Nicholas Hospital

Summary

Profile from official sources

At a glance