Does UPMC Carlisle have an emergency room?

Yes. Medicare (CMS) data lists emergency services at UPMC Carlisle. In a medical emergency, call 911.

Where is UPMC Carlisle?

361 Alexander Spring Road, Carlisle, PA 17015, in Cumberland County, Pennsylvania.

What is the phone number of UPMC Carlisle?

(717) 249-1212, as listed by Medicare (CMS).

What is the Medicare star rating of UPMC Carlisle?

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

Does Medicare reduce its payments to UPMC Carlisle for hospital-acquired conditions?

No. For fiscal year 2026, CMS lists no Medicare payment reduction for UPMC Carlisle under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 0.2942; 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).

UPMC Carlisle — Phone, Address, ER & Ratings

Quick answers

Does UPMC Carlisle have an emergency room?: Yes. Medicare (CMS) data lists emergency services at UPMC Carlisle. In a medical emergency, call 911.
Where is UPMC Carlisle?: 361 Alexander Spring Road, Carlisle, PA 17015, in Cumberland County, Pennsylvania.
What is the phone number of UPMC Carlisle?: (717) 249-1212, as listed by Medicare (CMS).
What is the Medicare star rating of UPMC Carlisle?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to UPMC Carlisle for hospital-acquired conditions?: No. For fiscal year 2026, CMS lists no Medicare payment reduction for UPMC Carlisle under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 0.2942; 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][8]

Anesthesia
Cancer
Critical Care Medicine
Emergency
Heart and Vascular
Imaging
Orthopaedics
Pulmonary Medicine
Surgery
Urology
Women's Health
Stroke Center
Nutrition

Treatments^[5][11]

Physical therapy and rehabilitation
Wound healing
Nutrition
Veteran care
Pre-admission testing

Procedures^[5]

Outpatient laboratory
Blood donation
Sleep center

Programs and centers^[4][5][8][9]

Hospitalist Program
Women's Center
Hillman Cancer Center at the Stuart Pavilion
Stroke Center
Safe Haven Program
Walk-in care
Sleep Center
Veteran Care
Wound Healing
Physical Therapy and Rehabilitation
Outpatient Laboratory
Blood Donation

Emergency care (hospital website)^[5][9]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	General visiting hours 9 a.m. to 9 p.m^[7]
Parking	Parking is free and available outside of the hospital^[7]

Doctors and clinicians (635)

635 doctors and other clinicians list UPMC Carlisle 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 611 more: the button below opens the full list.

Other emergency rooms nearby

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

Penn State Health Hampden Medical Center15 mi · Enola, PA · Acute Care Hospital
Penn State Health Holy Spirit Medical Center17 mi · Camp Hill, PA · Acute Care Hospital
Pennsylvania Psychiatric Institute19 mi · Harrisburg, PA · Psychiatric Hospital
UPMC Pinnacle Hospitals19 mi · Harrisburg, PA · Acute Care Hospital
Gettysburg Hospital25 mi · Gettysburg, PA · Acute Care Hospital

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

Other hospitals near Carlisle

Encompass Health Rehabilitation Hospital of Mechanicsburg13 mi · Mechanicsburg, PA · Inpatient Rehabilitation Hospital
Select Specialty Hospital - Central PA Harrisburg19 mi · Harrisburg, PA · Long-Term Acute Care Hospital
Roxbury Treatment Center19 mi · Shippensburg, PA · Psychiatric Hospital

Hospitals in Cumberland 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

Carlisle Skilled Nursing and Rehabilitation Center1.0 mi · Carlisle, PA · 1 of 5 stars
Forest Park Nursing and Rehabilitation1.2 mi · Carlisle, PA · 1 of 5 stars
Thornwald Home1.3 mi · Carlisle, PA · 4 of 5 stars

All nursing homes in the state →

Hospice providers

Residential Hospice of Carlisle, LLC11 mi · Mechanicsburg, PA · 4 of 5 stars
Adoration Hospice16 mi · Camp Hill, PA · 3 of 5 stars
Gentiva16 mi · Camp Hill, PA · 3 of 5 stars

All hospice providers in the state →

Home health agencies

Medstaffers LLC0.4 mi · Carlisle, PA
Community Home Nursing and Therapy Services, Inc4.5 mi · Carlisle, PA
Residential Home Health of Carlisle, LLC11 mi · Mechanicsburg, PA · 3 of 5 stars

All home health agencies in the state →

Dialysis facilities

DaVita Carlisle Regional Dialysis0.4 mi · Carlisle, PA · 2 of 5 stars
USRC Carlisle0.4 mi · Carlisle, PA · 3 of 5 stars
FKC Cumberland County4.5 mi · Carlisle, PA · 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.

Ophthalmology & Surgical Institute of Central PA0.4 mi · Carlisle, PA
Carlisle Endoscopy Center4.5 mi · Carlisle, PA
West Shore Pain and Spine Institute, LLC11 mi · Mechanicsburg, PA

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

Sadler Health Center Corporation2.3 mi · Carlisle, PA · Community health center
Keystone Agricultural Worker Program - Adams Co.12 mi · Gardners, PA · Community health center
Mobile Van113 mi · Mechanicsburg, PA · Community health center

Clinics and urgent care

Pinnacle Health Abc LLC0.4 mi · Carlisle, PA · Urgent care center
Urgent Care Travel, Inc0.4 mi · Carlisle, PA · Urgent care center
American Current Care P.A.4.5 mi · Carlisle, PA · Urgent care center

Pharmacies

The Giant Company, LLC0.4 mi · Carlisle, PA · Community/retail pharmacy
Giant Food Stores, LLC4.5 mi · Carlisle, PA · Community/retail pharmacy
KPR Pharmaceuticals Inc4.5 mi · Carlisle, PA · Community/retail pharmacy

Assisted living nearby

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

Evertrue Cumberland Crossings0.4 mi · Carlisle, PA
Chapel Pointe at Carlisle4.5 mi · Carlisle, PA
The Residence at Carlisle4.5 mi · Carlisle, PA
Thornwald Home4.5 mi · Carlisle, PA

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

What patients said (patient survey)

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

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	3 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	3 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	3 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Restfulness of Environment	2 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	69%National average: 72%
Would definitely recommend the hospital	65%National average: 71%
Nurses “always” communicated well	79%National average: 80%
Doctors “always” communicated well	76%National average: 80%
“Always” got help as soon as they wanted	65%National average: 64%
Staff “always” explained medicines before giving them	61%National average: 62%
Were given information about recovery at home	86%National average: 86%
Room and bathroom “always” clean	78%National average: 73%
Completed surveys	422Response rate: 26%

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.

Central line bloodstream infections (CLABSI)	0No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.751No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.19Better than the national benchmark
Not reported to Medicare	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 attack patients	13.4%
Deaths within 30 days: heart failure patients	10.3%
Deaths within 30 days: pneumonia patients	16.4%
Deaths within 30 days: COPD patients	7.8%
Deaths within 30 days: stroke patients	10.6%
Serious complications (patient safety indicator PSI-90)	0.9No different from the national rate
Complications after hip or knee replacement	4.3%
Not reported to Medicare	Deaths within 30 days: coronary bypass surgery (CABG)

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)	16.9%
Readmitted within 30 days: heart failure	23.3%
Readmitted within 30 days: pneumonia	17.1%
Readmitted within 30 days: COPD	21%
Readmitted within 30 days: hip or knee replacement	5.3%
Not reported to Medicare	Readmitted within 30 days: coronary bypass surgery
Too few cases to report	Readmitted within 30 days: heart attack

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)	Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	215 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)	82%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 UPMC Carlisle, 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	0.2942Lower 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	1.0531More readmissions than expected
Pneumonia	0.9385Fewer readmissions than expected
COPD (chronic lung disease)	0.9972Fewer readmissions than expected
Hip or knee replacement	0.9313Fewer readmissions than expected
No result published	Heart attack; 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	28.50 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)	10.00 out of 100
Person and community engagement (patient survey)	34.00 out of 100
Safety (infections and sepsis care)	60.00 out of 100
Efficiency and cost reduction (Medicare spending)	10.00 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	1.01Above the national median hospital (1.00): Medicare spent more

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 Pennsylvania Best hospitals in Pennsylvania

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 64 common services exactly as UPMC Carlisle 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 64 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ED VISIT IV-SAFE PROGRAM	$1,479	$887.40	$45.50 – $1,257.15
Emergency room visit (moderate): 10 of 40 insurance plan rates Aetna — ACO: $581.25 Aetna — Commercial: $692.17 Aetna — Medicare: $276.27 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $45.50 Capital Blue Cross — CHIP: $809.01 Capital Blue Cross — Commercial: $809.01 Capital Blue Cross — Medicare Advantage: $295.80 Cigna — Commercial: $1,250 Cigna — Medicare: $278.12 Geisinger — Commercial: $968.45
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 3	$1,479	$887.40	$45.50 – $1,257.15
Emergency room visit (moderate): 10 of 40 insurance plan rates Aetna — ACO: $581.25 Aetna — Commercial: $692.17 Aetna — Medicare: $276.27 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $45.50 Capital Blue Cross — CHIP: $809.01 Capital Blue Cross — Commercial: $809.01 Capital Blue Cross — Medicare Advantage: $295.80 Cigna — Commercial: $1,250 Cigna — Medicare: $278.12 Geisinger — Commercial: $968.45
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC ED VISIT IV-SAFE PROGRAM	$1,479	$887.40	$603.43 – $1,257.15
Emergency room visit (moderate): rates for 10 insurance plans Aetna — ACO: $607.87 Aetna — Commercial: $723.23 Geisinger — Commercial: $1,068.28 Multiplan — PPO (Includes PHCS and Humana as Payers): $1,257.15 Prime Net — ACO: $607.87 Prime Net — FH-Medical Rental: $1,118.12 Prime Net — GateKeeper: $723.23 Prime Net — Legacy Commercial: $603.43 Prime Net — NonGateKeeper: $718.79 Wellspan Population Health — PPO: $1,183.20
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 4	$2,200	$1,320	$65 – $1,870
Emergency room visit (moderately high): 10 of 40 insurance plan rates Aetna — ACO: $864.60 Aetna — Commercial: $1,029.60 Aetna — Medicare: $424.87 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $65 Capital Blue Cross — CHIP: $1,203.40 Capital Blue Cross — Commercial: $1,203.40 Capital Blue Cross — Medicare Advantage: $440 Cigna — Commercial: $1,850 Cigna — Medicare: $427.72 Geisinger — Commercial: $1,440.56
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 4	$2,200	$1,320	$897.60 – $1,870
Emergency room visit (moderately high): rates for 10 insurance plans Aetna — ACO: $904.20 Aetna — Commercial: $1,075.80 Geisinger — Commercial: $1,589.06 Multiplan — PPO (Includes PHCS and Humana as Payers): $1,870 Prime Net — ACO: $904.20 Prime Net — FH-Medical Rental: $1,663.20 Prime Net — GateKeeper: $1,075.80 Prime Net — Legacy Commercial: $897.60 Prime Net — NonGateKeeper: $1,069.20 Wellspan Population Health — PPO: $1,760
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 5	$3,048	$1,828.80	$65 – $2,590.80
Emergency room visit (high): 10 of 40 insurance plan rates Aetna — ACO: $1,197.86 Aetna — Commercial: $1,426.46 Aetna — Medicare: $611.72 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $65 Capital Blue Cross — CHIP: $1,667.26 Capital Blue Cross — Commercial: $1,667.26 Capital Blue Cross — Medicare Advantage: $609.60 Cigna — Commercial: $1,850 Cigna — Medicare: $615.83 Geisinger — Commercial: $1,995.83
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 5	$3,048	$1,828.80	$1,243.58 – $2,590.80
Emergency room visit (high): rates for 10 insurance plans Aetna — ACO: $1,252.73 Aetna — Commercial: $1,490.47 Geisinger — Commercial: $2,201.57 Multiplan — PPO (Includes PHCS and Humana as Payers): $2,590.80 Prime Net — ACO: $1,252.73 Prime Net — FH-Medical Rental: $2,304.29 Prime Net — GateKeeper: $1,490.47 Prime Net — Legacy Commercial: $1,243.58 Prime Net — NonGateKeeper: $1,481.33 Wellspan Population Health — PPO: $2,438.40

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$92	$55.20	$8.38 – $78.20
Basic metabolic panel (blood test): 10 of 40 insurance plan rates Aetna — ACO: $36.16 Aetna — Commercial: $43.06 Aetna — Medicare: $8.82 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $9.36 Capital Blue Cross — CHIP: $50.32 Capital Blue Cross — Commercial: $50.32 Capital Blue Cross — Medicare Advantage: $18.40 Cigna — Commercial: $22 Cigna — Medicare: $8.88 Geisinger — Commercial: $60.24
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$92	$55.20	$37.54 – $78.20
Basic metabolic panel (blood test): rates for 10 insurance plans Aetna — ACO: $37.81 Aetna — Commercial: $44.99 Geisinger — Commercial: $66.45 Multiplan — PPO (Includes PHCS and Humana as Payers): $78.20 Prime Net — ACO: $37.81 Prime Net — FH-Medical Rental: $69.55 Prime Net — GateKeeper: $44.99 Prime Net — Legacy Commercial: $37.54 Prime Net — NonGateKeeper: $44.71 Wellspan Population Health — PPO: $73.60
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$114	$68.40	$10.39 – $96.90
Comprehensive metabolic panel (blood test): 10 of 40 insurance plan rates Aetna — ACO: $44.80 Aetna — Commercial: $53.35 Aetna — Medicare: $11.01 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $11.69 Capital Blue Cross — CHIP: $62.36 Capital Blue Cross — Commercial: $62.36 Capital Blue Cross — Medicare Advantage: $22.80 Cigna — Commercial: $27.44 Cigna — Medicare: $11.09 Geisinger — Commercial: $74.65
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$114	$68.40	$46.51 – $96.90
Comprehensive metabolic panel (blood test): rates for 10 insurance plans Aetna — ACO: $46.85 Aetna — Commercial: $55.75 Geisinger — Commercial: $82.34 Multiplan — PPO (Includes PHCS and Humana as Payers): $96.90 Prime Net — ACO: $46.85 Prime Net — FH-Medical Rental: $86.18 Prime Net — GateKeeper: $55.75 Prime Net — Legacy Commercial: $46.51 Prime Net — NonGateKeeper: $55.40 Wellspan Population Health — PPO: $91.20
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL WITHOUT HIV SCREEN	$518	$310.80	$12 – $440.30
Obstetric blood test panel: 10 of 40 insurance plan rates Aetna — ACO: $203.57 Aetna — Commercial: $242.42 Aetna — Medicare: $49.87 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $12 Capital Blue Cross — CHIP: $283.35 Capital Blue Cross — Commercial: $283.35 Capital Blue Cross — Medicare Advantage: $103.60 Cigna — Commercial: $124.32 Cigna — Medicare: $50.20 Geisinger — Commercial: $339.19
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL WITHOUT HIV SCREEN	$518	$310.80	$211.34 – $440.30
Obstetric blood test panel: rates for 10 insurance plans Aetna — ACO: $212.90 Aetna — Commercial: $253.30 Geisinger — Commercial: $374.15 Multiplan — PPO (Includes PHCS and Humana as Payers): $440.30 Prime Net — ACO: $212.90 Prime Net — FH-Medical Rental: $391.61 Prime Net — GateKeeper: $253.30 Prime Net — Legacy Commercial: $211.34 Prime Net — NonGateKeeper: $251.75 Wellspan Population Health — PPO: $414.40
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$146	$87.60	$13.26 – $124.10
Cholesterol panel (lipid panel): 10 of 40 insurance plan rates Aetna — ACO: $57.38 Aetna — Commercial: $68.33 Aetna — Medicare: $13.97 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $14 Capital Blue Cross — CHIP: $79.86 Capital Blue Cross — Commercial: $79.86 Capital Blue Cross — Medicare Advantage: $29.20 Cigna — Commercial: $34.80 Cigna — Medicare: $14.06 Geisinger — Commercial: $95.60
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ADV LIPID PN INFLAM, CARDIO IQ - A	$146	$87.60	$13.26 – $124.10
Cholesterol panel (lipid panel): 10 of 40 insurance plan rates Aetna — ACO: $57.38 Aetna — Commercial: $68.33 Aetna — Medicare: $13.97 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $14 Capital Blue Cross — CHIP: $79.86 Capital Blue Cross — Commercial: $79.86 Capital Blue Cross — Medicare Advantage: $29.20 Cigna — Commercial: $34.80 Cigna — Medicare: $14.06 Geisinger — Commercial: $95.60
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ADVANCED LIPID PANEL W/ INFLAMMATION, CARDIO IQ A	$146	$87.60	$13.26 – $124.10
Cholesterol panel (lipid panel): 10 of 40 insurance plan rates Aetna — ACO: $57.38 Aetna — Commercial: $68.33 Aetna — Medicare: $13.97 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $14 Capital Blue Cross — CHIP: $79.86 Capital Blue Cross — Commercial: $79.86 Capital Blue Cross — Medicare Advantage: $29.20 Cigna — Commercial: $34.80 Cigna — Medicare: $14.06 Geisinger — Commercial: $95.60
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$94	$56.40	$8.59 – $79.90
Kidney function panel: 10 of 40 insurance plan rates Aetna — ACO: $36.94 Aetna — Commercial: $43.99 Aetna — Medicare: $9.05 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $9.60 Capital Blue Cross — CHIP: $51.42 Capital Blue Cross — Commercial: $51.42 Capital Blue Cross — Medicare Advantage: $18.80 Cigna — Commercial: $22.56 Cigna — Medicare: $9.11 Geisinger — Commercial: $61.55
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$94	$56.40	$38.35 – $79.90
Kidney function panel: rates for 10 insurance plans Aetna — ACO: $38.63 Aetna — Commercial: $45.97 Geisinger — Commercial: $67.90 Multiplan — PPO (Includes PHCS and Humana as Payers): $79.90 Prime Net — ACO: $38.63 Prime Net — FH-Medical Rental: $71.06 Prime Net — GateKeeper: $45.97 Prime Net — Legacy Commercial: $38.35 Prime Net — NonGateKeeper: $45.68 Wellspan Population Health — PPO: $75.20
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$90	$54	$8.09 – $76.50
Liver function panel: 10 of 40 insurance plan rates Aetna — ACO: $35.37 Aetna — Commercial: $42.12 Aetna — Medicare: $8.52 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $9.03 Capital Blue Cross — CHIP: $49.23 Capital Blue Cross — Commercial: $49.23 Capital Blue Cross — Medicare Advantage: $18 Cigna — Commercial: $21.24 Cigna — Medicare: $8.58 Geisinger — Commercial: $58.93
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$90	$54	$36.72 – $76.50
Liver function panel: rates for 10 insurance plans Aetna — ACO: $36.99 Aetna — Commercial: $44.01 Geisinger — Commercial: $65.01 Multiplan — PPO (Includes PHCS and Humana as Payers): $76.50 Prime Net — ACO: $36.99 Prime Net — FH-Medical Rental: $68.04 Prime Net — GateKeeper: $44.01 Prime Net — Legacy Commercial: $36.72 Prime Net — NonGateKeeper: $43.74 Wellspan Population Health — PPO: $72
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS W/MICRO	$39	$23.40	$3 – $33.15
Urine test (automated, with microscope): 10 of 40 insurance plan rates Aetna — ACO: $15.33 Aetna — Commercial: $18.25 Aetna — Medicare: $3.31 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3 Capital Blue Cross — CHIP: $21.33 Capital Blue Cross — Commercial: $21.33 Capital Blue Cross — Medicare Advantage: $7.80 Cigna — Commercial: $8.24 Cigna — Medicare: $3.33 Geisinger — Commercial: $25.54
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/MICRO	$39	$23.40	$15.91 – $33.15
Urine test (automated, with microscope): rates for 10 insurance plans Aetna — ACO: $16.03 Aetna — Commercial: $19.07 Geisinger — Commercial: $28.17 Multiplan — PPO (Includes PHCS and Humana as Payers): $33.15 Prime Net — ACO: $16.03 Prime Net — FH-Medical Rental: $29.48 Prime Net — GateKeeper: $19.07 Prime Net — Legacy Commercial: $15.91 Prime Net — NonGateKeeper: $18.95 Wellspan Population Health — PPO: $31.20
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PH URINE	$42	$25.20	$3.45 – $35.70
Urine test (manual, without microscope): 10 of 40 insurance plan rates Aetna — ACO: $16.51 Aetna — Commercial: $19.66 Aetna — Medicare: $3.63 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3.57 Capital Blue Cross — CHIP: $22.97 Capital Blue Cross — Commercial: $22.97 Capital Blue Cross — Medicare Advantage: $8.40 Cigna — Commercial: $9.04 Cigna — Medicare: $3.65 Geisinger — Commercial: $27.50
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEMOGLOBIN URINE	$42	$25.20	$3.45 – $35.70
Urine test (manual, without microscope): 10 of 40 insurance plan rates Aetna — ACO: $16.51 Aetna — Commercial: $19.66 Aetna — Medicare: $3.63 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3.57 Capital Blue Cross — CHIP: $22.97 Capital Blue Cross — Commercial: $22.97 Capital Blue Cross — Medicare Advantage: $8.40 Cigna — Commercial: $9.04 Cigna — Medicare: $3.65 Geisinger — Commercial: $27.50
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PH URINE	$42	$25.20	$17.14 – $35.70
Urine test (manual, without microscope): rates for 10 insurance plans Aetna — ACO: $17.26 Aetna — Commercial: $20.54 Geisinger — Commercial: $30.34 Multiplan — PPO (Includes PHCS and Humana as Payers): $35.70 Prime Net — ACO: $17.26 Prime Net — FH-Medical Rental: $31.75 Prime Net — GateKeeper: $20.54 Prime Net — Legacy Commercial: $17.14 Prime Net — NonGateKeeper: $20.41 Wellspan Population Health — PPO: $33.60
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINE DIP W/RFX TO MICROSCOPIC IF IND	$29	$17.40	$2.23 – $24.65
Urine test (automated, without microscope): 10 of 40 insurance plan rates Aetna — ACO: $11.40 Aetna — Commercial: $13.57 Aetna — Medicare: $2.35 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3.10 Capital Blue Cross — CHIP: $15.86 Capital Blue Cross — Commercial: $15.86 Capital Blue Cross — Medicare Advantage: $5.80 Cigna — Commercial: $5.84 Cigna — Medicare: $2.36 Geisinger — Commercial: $18.99
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SPEC GRAV URINE	$29	$17.40	$2.23 – $24.65
Urine test (automated, without microscope): 10 of 40 insurance plan rates Aetna — ACO: $11.40 Aetna — Commercial: $13.57 Aetna — Medicare: $2.35 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3.10 Capital Blue Cross — CHIP: $15.86 Capital Blue Cross — Commercial: $15.86 Capital Blue Cross — Medicare Advantage: $5.80 Cigna — Commercial: $5.84 Cigna — Medicare: $2.36 Geisinger — Commercial: $18.99
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS AUTO W/O MICRO	$29	$17.40	$2.23 – $24.65
Urine test (automated, without microscope): 10 of 40 insurance plan rates Aetna — ACO: $11.40 Aetna — Commercial: $13.57 Aetna — Medicare: $2.35 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3.10 Capital Blue Cross — CHIP: $15.86 Capital Blue Cross — Commercial: $15.86 Capital Blue Cross — Medicare Advantage: $5.80 Cigna — Commercial: $5.84 Cigna — Medicare: $2.36 Geisinger — Commercial: $18.99
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE SPECIFIC ANTIGEN	$183	$109.80	$18.21 – $155.55
PSA (prostate specific antigen) blood test: 10 of 40 insurance plan rates Aetna — ACO: $71.92 Aetna — Commercial: $85.64 Aetna — Medicare: $19.18 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $24.36 Capital Blue Cross — CHIP: $100.10 Capital Blue Cross — Commercial: $100.10 Capital Blue Cross — Medicare Advantage: $36.60 Cigna — Commercial: $47.80 Cigna — Medicare: $19.31 Geisinger — Commercial: $119.83
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSA % FREE & TOTAL - A	$183	$109.80	$18.21 – $155.55
PSA (prostate specific antigen) blood test: 10 of 40 insurance plan rates Aetna — ACO: $71.92 Aetna — Commercial: $85.64 Aetna — Medicare: $19.18 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $24.36 Capital Blue Cross — CHIP: $100.10 Capital Blue Cross — Commercial: $100.10 Capital Blue Cross — Medicare Advantage: $36.60 Cigna — Commercial: $47.80 Cigna — Medicare: $19.31 Geisinger — Commercial: $119.83
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE HEALTH INDEX (PHI) W/REF, SERUM	$183	$109.80	$18.21 – $155.55
PSA (prostate specific antigen) blood test: 10 of 40 insurance plan rates Aetna — ACO: $71.92 Aetna — Commercial: $85.64 Aetna — Medicare: $19.18 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $24.36 Capital Blue Cross — CHIP: $100.10 Capital Blue Cross — Commercial: $100.10 Capital Blue Cross — Medicare Advantage: $36.60 Cigna — Commercial: $47.80 Cigna — Medicare: $19.31 Geisinger — Commercial: $119.83
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TSH T/F	$143	$85.80	$16.63 – $121.55
Thyroid stimulating hormone (TSH) test: 10 of 40 insurance plan rates Aetna — ACO: $56.20 Aetna — Commercial: $66.92 Aetna — Medicare: $17.52 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $23.21 Capital Blue Cross — CHIP: $78.22 Capital Blue Cross — Commercial: $78.22 Capital Blue Cross — Medicare Advantage: $28.60 Cigna — Commercial: $43.68 Cigna — Medicare: $17.64 Geisinger — Commercial: $93.64
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC TSH T/F	$143	$85.80	$58.34 – $121.55
Thyroid stimulating hormone (TSH) test: rates for 10 insurance plans Aetna — ACO: $58.77 Aetna — Commercial: $69.93 Geisinger — Commercial: $103.29 Multiplan — PPO (Includes PHCS and Humana as Payers): $121.55 Prime Net — ACO: $58.77 Prime Net — FH-Medical Rental: $108.11 Prime Net — GateKeeper: $69.93 Prime Net — Legacy Commercial: $58.34 Prime Net — NonGateKeeper: $69.50 Wellspan Population Health — PPO: $114.40
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC & AUTO DIFFERENTIAL	$67	$40.20	$3.52 – $56.95
Complete blood count (CBC) with differential: 10 of 40 insurance plan rates Aetna — ACO: $26.33 Aetna — Commercial: $31.36 Aetna — Medicare: $8.10 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $6 Capital Blue Cross — CHIP: $36.65 Capital Blue Cross — Commercial: $36.65 Capital Blue Cross — Medicare Advantage: $13.40 Cigna — Commercial: $20.20 Cigna — Medicare: $8.16 Geisinger — Commercial: $43.87
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC & AUTO DIFFERENTIAL	$67	$40.20	$27.34 – $56.95
Complete blood count (CBC) with differential: rates for 10 insurance plans Aetna — ACO: $27.54 Aetna — Commercial: $32.76 Geisinger — Commercial: $48.39 Multiplan — PPO (Includes PHCS and Humana as Payers): $56.95 Prime Net — ACO: $27.54 Prime Net — FH-Medical Rental: $50.65 Prime Net — GateKeeper: $32.76 Prime Net — Legacy Commercial: $27.34 Prime Net — NonGateKeeper: $32.56 Wellspan Population Health — PPO: $53.60
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC (HEMOGRAM)	$54	$32.40	$6.41 – $45.90
Complete blood count (CBC), automated: 10 of 40 insurance plan rates Aetna — ACO: $21.22 Aetna — Commercial: $25.27 Aetna — Medicare: $6.75 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $7.52 Capital Blue Cross — CHIP: $29.54 Capital Blue Cross — Commercial: $29.54 Capital Blue Cross — Medicare Advantage: $10.80 Cigna — Commercial: $16.84 Cigna — Medicare: $6.79 Geisinger — Commercial: $35.36
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC AND BUFFY COAT DIFF A	$54	$32.40	$6.41 – $45.90
Complete blood count (CBC), automated: 10 of 40 insurance plan rates Aetna — ACO: $21.22 Aetna — Commercial: $25.27 Aetna — Medicare: $6.75 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $7.52 Capital Blue Cross — CHIP: $29.54 Capital Blue Cross — Commercial: $29.54 Capital Blue Cross — Medicare Advantage: $10.80 Cigna — Commercial: $16.84 Cigna — Medicare: $6.79 Geisinger — Commercial: $35.36
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC AND MANUAL DIFF A	$54	$32.40	$6.41 – $45.90
Complete blood count (CBC), automated: 10 of 40 insurance plan rates Aetna — ACO: $21.22 Aetna — Commercial: $25.27 Aetna — Medicare: $6.75 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $7.52 Capital Blue Cross — CHIP: $29.54 Capital Blue Cross — Commercial: $29.54 Capital Blue Cross — Medicare Advantage: $10.80 Cigna — Commercial: $16.84 Cigna — Medicare: $6.79 Geisinger — Commercial: $35.36
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME	$37	$22.20	$4 – $31.45
Blood clotting time test (prothrombin time, PT): 10 of 40 insurance plan rates Aetna — ACO: $14.54 Aetna — Commercial: $17.32 Aetna — Medicare: $4.47 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4 Capital Blue Cross — CHIP: $20.24 Capital Blue Cross — Commercial: $20.24 Capital Blue Cross — Medicare Advantage: $7.40 Cigna — Commercial: $11.16 Cigna — Medicare: $4.50 Geisinger — Commercial: $24.23
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LUPUS ANTICOAG SCRN PROFILE A	$37	$22.20	$4 – $31.45
Blood clotting time test (prothrombin time, PT): 10 of 40 insurance plan rates Aetna — ACO: $14.54 Aetna — Commercial: $17.32 Aetna — Medicare: $4.47 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4 Capital Blue Cross — CHIP: $20.24 Capital Blue Cross — Commercial: $20.24 Capital Blue Cross — Medicare Advantage: $7.40 Cigna — Commercial: $11.16 Cigna — Medicare: $4.50 Geisinger — Commercial: $24.23
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ISTAT PT INR POC	$37	$22.20	$4 – $31.45
Blood clotting time test (prothrombin time, PT): 10 of 40 insurance plan rates Aetna — ACO: $14.54 Aetna — Commercial: $17.32 Aetna — Medicare: $4.47 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4 Capital Blue Cross — CHIP: $20.24 Capital Blue Cross — Commercial: $20.24 Capital Blue Cross — Medicare Advantage: $7.40 Cigna — Commercial: $11.16 Cigna — Medicare: $4.50 Geisinger — Commercial: $24.23
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PTT	$51	$30.60	$5.95 – $43.35
Blood clotting test (partial thromboplastin time, PTT): 10 of 40 insurance plan rates Aetna — ACO: $20.04 Aetna — Commercial: $23.87 Aetna — Medicare: $6.27 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $7.50 Capital Blue Cross — CHIP: $27.90 Capital Blue Cross — Commercial: $27.90 Capital Blue Cross — Medicare Advantage: $10.20 Cigna — Commercial: $15.64 Cigna — Medicare: $6.31 Geisinger — Commercial: $33.39
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VON WILLEBRAND'S PANEL - D	$51	$30.60	$5.95 – $43.35
Blood clotting test (partial thromboplastin time, PTT): 10 of 40 insurance plan rates Aetna — ACO: $20.04 Aetna — Commercial: $23.87 Aetna — Medicare: $6.27 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $7.50 Capital Blue Cross — CHIP: $27.90 Capital Blue Cross — Commercial: $27.90 Capital Blue Cross — Medicare Advantage: $10.20 Cigna — Commercial: $15.64 Cigna — Medicare: $6.31 Geisinger — Commercial: $33.39
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LUPUS ANTICOAG SCRN PROFILE D	$51	$30.60	$5.95 – $43.35
Blood clotting test (partial thromboplastin time, PTT): 10 of 40 insurance plan rates Aetna — ACO: $20.04 Aetna — Commercial: $23.87 Aetna — Medicare: $6.27 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $7.50 Capital Blue Cross — CHIP: $27.90 Capital Blue Cross — Commercial: $27.90 Capital Blue Cross — Medicare Advantage: $10.20 Cigna — Commercial: $15.64 Cigna — Medicare: $6.31 Geisinger — Commercial: $33.39

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 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT BRAIN W/O CONTRAST	$1,328	$796.80	$100.71 – $1,128.80
CT scan of the head or brain, without contrast: 10 of 42 insurance plan rates Aetna — ACO: $521.90 Aetna — Commercial: $621.50 Aetna — Medicare: $106.10 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $148.27 Capital Blue Cross — CHIP: $726.42 Capital Blue Cross — Commercial: $726.42 Capital Blue Cross — Medicare Advantage: $265.60 Cigna — Commercial: $589.04 Cigna — Medicare: $106.82 Geisinger — Commercial: $869.57
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT BRAIN W/O CONTRAST	$1,328	$796.80	$541.82 – $1,128.80
CT scan of the head or brain, without contrast: rates for 10 insurance plans Aetna — ACO: $545.81 Aetna — Commercial: $649.39 Geisinger — Commercial: $959.21 Multiplan — PPO (Includes PHCS and Humana as Payers): $1,128.80 Prime Net — ACO: $545.81 Prime Net — FH-Medical Rental: $1,003.97 Prime Net — GateKeeper: $649.39 Prime Net — Legacy Commercial: $541.82 Prime Net — NonGateKeeper: $645.41 Wellspan Population Health — PPO: $1,062.40
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI Brain W/Wo Contrast	$4,758	$2,854.80	$338.22 – $4,044.30
MRI of the brain, before and after contrast: 10 of 42 insurance plan rates Aetna — ACO: $1,869.89 Aetna — Commercial: $2,226.74 Aetna — Medicare: $356.33 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $430.53 Capital Blue Cross — CHIP: $2,602.63 Capital Blue Cross — Commercial: $2,602.63 Capital Blue Cross — Medicare Advantage: $951.60 Cigna — Commercial: $2,006.79 Cigna — Medicare: $358.72 Geisinger — Commercial: $3,115.54
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI Brain W/Wo Contrast	$4,758	$2,854.80	$1,941.26 – $4,044.30
MRI of the brain, before and after contrast: rates for 10 insurance plans Aetna — ACO: $1,955.54 Aetna — Commercial: $2,326.66 Geisinger — Commercial: $3,436.70 Multiplan — PPO (Includes PHCS and Humana as Payers): $4,044.30 Prime Net — ACO: $1,955.54 Prime Net — FH-Medical Rental: $3,597.05 Prime Net — GateKeeper: $2,326.66 Prime Net — Legacy Commercial: $1,941.26 Prime Net — NonGateKeeper: $2,312.39 Wellspan Population Health — PPO: $3,806.40
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CHEST 2 VIEWS	$314	$188.40	$19.45 – $419.44
Chest X-ray, 2 views: 10 of 41 insurance plan rates Aetna — ACO: $123.40 Aetna — Commercial: $146.95 Aetna — Medicare: $87.85 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $30.02 Capital Blue Cross — CHIP: $171.76 Capital Blue Cross — Commercial: $171.76 Capital Blue Cross — Medicare Advantage: $62.80 Cigna — Commercial: $419.44 Cigna — Medicare: $88.44 Geisinger — Commercial: $205.61
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC XRAY CHEST 2 VIEWS MD	$39	$23.40	$5.34 – $419.44
Chest X-ray, 2 views: 10 of 41 insurance plan rates Aetna — ACO: $15.33 Aetna — Commercial: $18.25 Aetna — Medicare: $87.85 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $30.02 Capital Blue Cross — CHIP: $21.33 Capital Blue Cross — Commercial: $21.33 Capital Blue Cross — Medicare Advantage: $7.80 Cigna — Commercial: $419.44 Cigna — Medicare: $88.44 Geisinger — Commercial: $25.54
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CHEST 2 VIEWS	$314	$188.40	$128.11 – $266.90
Chest X-ray, 2 views: rates for 10 insurance plans Aetna — ACO: $129.05 Aetna — Commercial: $153.55 Geisinger — Commercial: $226.80 Multiplan — PPO (Includes PHCS and Humana as Payers): $266.90 Prime Net — ACO: $129.05 Prime Net — FH-Medical Rental: $237.38 Prime Net — GateKeeper: $153.55 Prime Net — Legacy Commercial: $128.11 Prime Net — NonGateKeeper: $152.60 Wellspan Population Health — PPO: $251.20
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LUMBAR SPINE MIN 4 VIEWS	$438	$262.80	$29.48 – $589.04
X-ray of the lower spine, at least 4 views: 10 of 41 insurance plan rates Aetna — ACO: $172.13 Aetna — Commercial: $204.98 Aetna — Medicare: $106.10 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $46.51 Capital Blue Cross — CHIP: $239.59 Capital Blue Cross — Commercial: $239.59 Capital Blue Cross — Medicare Advantage: $87.60 Cigna — Commercial: $589.04 Cigna — Medicare: $106.82 Geisinger — Commercial: $286.80
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LUMBAR SPINE MIN 4 VIEWS	$438	$262.80	$178.70 – $372.30
X-ray of the lower spine, at least 4 views: rates for 10 insurance plans Aetna — ACO: $180.02 Aetna — Commercial: $214.18 Geisinger — Commercial: $316.37 Multiplan — PPO (Includes PHCS and Humana as Payers): $372.30 Prime Net — ACO: $180.02 Prime Net — FH-Medical Rental: $331.13 Prime Net — GateKeeper: $214.18 Prime Net — Legacy Commercial: $178.70 Prime Net — NonGateKeeper: $212.87 Wellspan Population Health — PPO: $350.40
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI Lumbar W/O Contrast	$2,760	$1,656	$228.92 – $2,346
MRI of the lower back (lumbar spine), without contrast: 10 of 42 insurance plan rates Aetna — ACO: $1,084.68 Aetna — Commercial: $1,291.68 Aetna — Medicare: $241.17 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $325.31 Capital Blue Cross — CHIP: $1,509.72 Capital Blue Cross — Commercial: $1,509.72 Capital Blue Cross — Medicare Advantage: $552 Cigna — Commercial: $1,224.77 Cigna — Medicare: $242.79 Geisinger — Commercial: $1,807.25
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI Lumbar W/O Contrast	$2,760	$1,656	$1,126.08 – $2,346
MRI of the lower back (lumbar spine), without contrast: rates for 10 insurance plans Aetna — ACO: $1,134.36 Aetna — Commercial: $1,349.64 Geisinger — Commercial: $1,993.55 Multiplan — PPO (Includes PHCS and Humana as Payers): $2,346 Prime Net — ACO: $1,134.36 Prime Net — FH-Medical Rental: $2,086.56 Prime Net — GateKeeper: $1,349.64 Prime Net — Legacy Commercial: $1,126.08 Prime Net — NonGateKeeper: $1,341.36 Wellspan Population Health — PPO: $2,208
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT PELVIS W/CONTRAST	$2,374	$1,424.40	$113.31 – $2,017.90
CT scan of the pelvis, with contrast: 10 of 42 insurance plan rates Aetna — ACO: $932.98 Aetna — Commercial: $1,111.03 Aetna — Medicare: $177.62 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $177.91 Capital Blue Cross — CHIP: $1,298.58 Capital Blue Cross — Commercial: $1,298.58 Capital Blue Cross — Medicare Advantage: $474.80 Cigna — Commercial: $957.68 Cigna — Medicare: $178.81 Geisinger — Commercial: $1,554.50
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT PELVIS W/CONTRAST	$2,374	$1,424.40	$968.59 – $2,017.90
CT scan of the pelvis, with contrast: rates for 10 insurance plans Aetna — ACO: $975.71 Aetna — Commercial: $1,160.89 Geisinger — Commercial: $1,714.74 Multiplan — PPO (Includes PHCS and Humana as Payers): $2,017.90 Prime Net — ACO: $975.71 Prime Net — FH-Medical Rental: $1,794.74 Prime Net — GateKeeper: $1,160.89 Prime Net — Legacy Commercial: $968.59 Prime Net — NonGateKeeper: $1,153.76 Wellspan Population Health — PPO: $1,899.20
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: HC MRI LOW EXT JT W/O CNTRST - RT	$2,760	$1,656	$352.39 – $2,346
MRI of a leg joint (such as the knee), without contrast: 10 of 31 insurance plan rates Aetna — ACO: $1,084.68 Aetna — Commercial: $1,291.68 Aetna — Medicare: $455.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $420.87 Capital Blue Cross — CHIP: $1,509.72 Capital Blue Cross — Commercial: $1,509.72 Capital Blue Cross — Medicare Advantage: $552 Cigna — Commercial: $1,224.77 Geisinger — Commercial: $1,807.25 Geisinger — Medicaid/CHIP: $482.70
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: HC MRI LOW EXT JT W/O CNTRST - LT	$2,760	$1,656	$352.39 – $2,346
MRI of a leg joint (such as the knee), without contrast: 10 of 31 insurance plan rates Aetna — ACO: $1,084.68 Aetna — Commercial: $1,291.68 Aetna — Medicare: $455.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $420.87 Capital Blue Cross — CHIP: $1,509.72 Capital Blue Cross — Commercial: $1,509.72 Capital Blue Cross — Medicare Advantage: $552 Cigna — Commercial: $1,224.77 Geisinger — Commercial: $1,807.25 Geisinger — Medicaid/CHIP: $482.70
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee · modifier RT In the file: HC MRI LOW EXT JT W/O CNTRST - RT	$2,760	$1,656	$1,126.08 – $2,346
MRI of a leg joint (such as the knee), without contrast: rates for 10 insurance plans Aetna — ACO: $1,134.36 Aetna — Commercial: $1,349.64 Geisinger — Commercial: $1,993.55 Multiplan — PPO (Includes PHCS and Humana as Payers): $2,346 Prime Net — ACO: $1,134.36 Prime Net — FH-Medical Rental: $2,086.56 Prime Net — GateKeeper: $1,349.64 Prime Net — Legacy Commercial: $1,126.08 Prime Net — NonGateKeeper: $1,341.36 Wellspan Population Health — PPO: $2,208
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT ABDOMEN / PELVIS W/CNTRST	$4,976	$2,985.60	$252.48 – $4,229.60
CT scan of the abdomen and pelvis, with contrast: 10 of 41 insurance plan rates Aetna — ACO: $1,955.57 Aetna — Commercial: $2,328.77 Aetna — Medicare: $356.33 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $334.21 Capital Blue Cross — CHIP: $2,721.87 Capital Blue Cross — Commercial: $2,721.87 Capital Blue Cross — Medicare Advantage: $995.20 Cigna — Commercial: $2,006.79 Cigna — Medicare: $358.72 Geisinger — Commercial: $3,258.28
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT ABDOMEN / PELVIS W/CNTRST	$4,976	$2,985.60	$2,030.21 – $4,229.60
CT scan of the abdomen and pelvis, with contrast: rates for 10 insurance plans Aetna — ACO: $2,045.14 Aetna — Commercial: $2,433.26 Geisinger — Commercial: $3,594.16 Multiplan — PPO (Includes PHCS and Humana as Payers): $4,229.60 Prime Net — ACO: $2,045.14 Prime Net — FH-Medical Rental: $3,761.86 Prime Net — GateKeeper: $2,433.26 Prime Net — Legacy Commercial: $2,030.21 Prime Net — NonGateKeeper: $2,418.34 Wellspan Population Health — PPO: $3,980.80
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US ABDOMEN COMPLETE	$657	$394.20	$75.33 – $589.04
Ultrasound of the abdomen, complete: 10 of 41 insurance plan rates Aetna — ACO: $258.20 Aetna — Commercial: $307.48 Aetna — Medicare: $106.10 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $120.99 Capital Blue Cross — CHIP: $359.38 Capital Blue Cross — Commercial: $359.38 Capital Blue Cross — Medicare Advantage: $131.40 Cigna — Commercial: $589.04 Cigna — Medicare: $106.82 Geisinger — Commercial: $430.20
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US ABDOMEN COMPLETE MD	$306	$183.60	$41.92 – $589.04
Ultrasound of the abdomen, complete: 10 of 41 insurance plan rates Aetna — ACO: $120.26 Aetna — Commercial: $143.21 Aetna — Medicare: $106.10 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $120.99 Capital Blue Cross — CHIP: $167.38 Capital Blue Cross — Commercial: $167.38 Capital Blue Cross — Medicare Advantage: $61.20 Cigna — Commercial: $589.04 Cigna — Medicare: $106.82 Geisinger — Commercial: $200.37
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US ABDOMEN COMPLETE	$657	$394.20	$268.06 – $558.45
Ultrasound of the abdomen, complete: rates for 10 insurance plans Aetna — ACO: $270.03 Aetna — Commercial: $321.27 Geisinger — Commercial: $474.55 Multiplan — PPO (Includes PHCS and Humana as Payers): $558.45 Prime Net — ACO: $270.03 Prime Net — FH-Medical Rental: $496.69 Prime Net — GateKeeper: $321.27 Prime Net — Legacy Commercial: $268.06 Prime Net — NonGateKeeper: $319.30 Wellspan Population Health — PPO: $525.60
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US OB >/=14 WKS SINGLE FETUS	$657	$394.20	$60.91 – $589.04
Pregnancy ultrasound (after the first trimester): 10 of 41 insurance plan rates Aetna — ACO: $258.20 Aetna — Commercial: $307.48 Aetna — Medicare: $106.10 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $98.42 Capital Blue Cross — CHIP: $359.38 Capital Blue Cross — Commercial: $359.38 Capital Blue Cross — Medicare Advantage: $131.40 Cigna — Commercial: $589.04 Cigna — Medicare: $106.82 Geisinger — Commercial: $430.20
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US OB >/=14 WKS SINGLE FETUS	$657	$394.20	$268.06 – $558.45
Pregnancy ultrasound (after the first trimester): rates for 10 insurance plans Aetna — ACO: $270.03 Aetna — Commercial: $321.27 Geisinger — Commercial: $474.55 Multiplan — PPO (Includes PHCS and Humana as Payers): $558.45 Prime Net — ACO: $270.03 Prime Net — FH-Medical Rental: $496.69 Prime Net — GateKeeper: $321.27 Prime Net — Legacy Commercial: $268.06 Prime Net — NonGateKeeper: $319.30 Wellspan Population Health — PPO: $525.60
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL	$657	$394.20	$60.91 – $589.04
Transvaginal ultrasound: 10 of 41 insurance plan rates Aetna — ACO: $258.20 Aetna — Commercial: $307.48 Aetna — Medicare: $106.10 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $97.16 Capital Blue Cross — CHIP: $359.38 Capital Blue Cross — Commercial: $359.38 Capital Blue Cross — Medicare Advantage: $131.40 Cigna — Commercial: $589.04 Cigna — Medicare: $106.82 Geisinger — Commercial: $430.20
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL MD	$123	$73.80	$16.85 – $589.04
Transvaginal ultrasound: 10 of 41 insurance plan rates Aetna — ACO: $48.34 Aetna — Commercial: $57.56 Aetna — Medicare: $106.10 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $97.16 Capital Blue Cross — CHIP: $67.28 Capital Blue Cross — Commercial: $67.28 Capital Blue Cross — Medicare Advantage: $24.60 Cigna — Commercial: $589.04 Cigna — Medicare: $106.82 Geisinger — Commercial: $80.54
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL	$657	$394.20	$268.06 – $558.45
Transvaginal ultrasound: rates for 10 insurance plans Aetna — ACO: $270.03 Aetna — Commercial: $321.27 Geisinger — Commercial: $474.55 Multiplan — PPO (Includes PHCS and Humana as Payers): $558.45 Prime Net — ACO: $270.03 Prime Net — FH-Medical Rental: $496.69 Prime Net — GateKeeper: $321.27 Prime Net — Legacy Commercial: $268.06 Prime Net — NonGateKeeper: $319.30 Wellspan Population Health — PPO: $525.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC MAMMOGRAPH DIG MD	$142	$85.20	$19.45 – $479.38
Diagnostic mammogram, one breast: 10 of 28 insurance plan rates Aetna — ACO: $55.81 Aetna — Commercial: $66.46 Aetna — Medicare: $23.43 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $130.06 Capital Blue Cross — CHIP: $77.67 Capital Blue Cross — Commercial: $77.67 Capital Blue Cross — Medicare Advantage: $28.40 Cigna — Commercial: $479.38 Geisinger — Commercial: $92.98 Geisinger — Medicaid/CHIP: $149.17
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC MAMMOGRAPH DIG MD	$142	$85.20	$57.94 – $120.70
Diagnostic mammogram, one breast: rates for 10 insurance plans Aetna — ACO: $58.36 Aetna — Commercial: $69.44 Geisinger — Commercial: $102.57 Multiplan — PPO (Includes PHCS and Humana as Payers): $120.70 Prime Net — ACO: $58.36 Prime Net — FH-Medical Rental: $107.35 Prime Net — GateKeeper: $69.44 Prime Net — Legacy Commercial: $57.94 Prime Net — NonGateKeeper: $69.01 Wellspan Population Health — PPO: $113.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: HC DIGITAL MAMMO - LT	$406	$243.60	$55.62 – $479.38
Diagnostic mammogram, one breast: 10 of 28 insurance plan rates Aetna — ACO: $159.56 Aetna — Commercial: $190.01 Aetna — Medicare: $66.99 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $130.06 Capital Blue Cross — CHIP: $222.08 Capital Blue Cross — Commercial: $222.08 Capital Blue Cross — Medicare Advantage: $81.20 Cigna — Commercial: $479.38 Geisinger — Commercial: $265.85 Geisinger — Medicaid/CHIP: $149.17
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BILAT DIGITAL MAMMOGRAPHY	$517	$310.20	$70.83 – $675.02
Diagnostic mammogram, both breasts: 10 of 28 insurance plan rates Aetna — ACO: $203.18 Aetna — Commercial: $241.96 Aetna — Medicare: $85.31 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $164.91 Capital Blue Cross — CHIP: $282.80 Capital Blue Cross — Commercial: $282.80 Capital Blue Cross — Medicare Advantage: $103.40 Cigna — Commercial: $611.06 Geisinger — Commercial: $338.53 Geisinger — Medicaid/CHIP: $189.14
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BI DIAG MAMMO BILAT W/CAD	$517	$310.20	$70.83 – $675.02
Diagnostic mammogram, both breasts: 10 of 28 insurance plan rates Aetna — ACO: $203.18 Aetna — Commercial: $241.96 Aetna — Medicare: $85.31 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $164.91 Capital Blue Cross — CHIP: $282.80 Capital Blue Cross — Commercial: $282.80 Capital Blue Cross — Medicare Advantage: $103.40 Cigna — Commercial: $611.06 Geisinger — Commercial: $338.53 Geisinger — Medicaid/CHIP: $189.14
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BILAT DIGITAL MAMMOGRAPHY	$517	$310.20	$210.94 – $439.45
Diagnostic mammogram, both breasts: rates for 10 insurance plans Aetna — ACO: $212.49 Aetna — Commercial: $252.81 Geisinger — Commercial: $373.43 Multiplan — PPO (Includes PHCS and Humana as Payers): $439.45 Prime Net — ACO: $212.49 Prime Net — FH-Medical Rental: $390.85 Prime Net — GateKeeper: $252.81 Prime Net — Legacy Commercial: $210.94 Prime Net — NonGateKeeper: $251.26 Wellspan Population Health — PPO: $413.60
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREENING DIG MAMMOGRAPHY	$429	$257.40	$58.77 – $551.43
Screening mammogram, both breasts: 10 of 28 insurance plan rates Aetna — ACO: $168.60 Aetna — Commercial: $200.77 Aetna — Medicare: $70.78 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $132.97 Capital Blue Cross — CHIP: $234.66 Capital Blue Cross — Commercial: $234.66 Capital Blue Cross — Medicare Advantage: $85.80 Cigna — Commercial: $506.81 Geisinger — Commercial: $280.91 Geisinger — Medicaid/CHIP: $152.51
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREENING DIGITAL MAMMO W/IMPL	$429	$257.40	$58.77 – $551.43
Screening mammogram, both breasts: 10 of 28 insurance plan rates Aetna — ACO: $168.60 Aetna — Commercial: $200.77 Aetna — Medicare: $70.78 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $132.97 Capital Blue Cross — CHIP: $234.66 Capital Blue Cross — Commercial: $234.66 Capital Blue Cross — Medicare Advantage: $85.80 Cigna — Commercial: $506.81 Geisinger — Commercial: $280.91 Geisinger — Medicaid/CHIP: $152.51
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BI SCRN MAMMO LEFT W/CAD	$429	$257.40	$58.77 – $551.43
Screening mammogram, both breasts: 10 of 28 insurance plan rates Aetna — ACO: $168.60 Aetna — Commercial: $200.77 Aetna — Medicare: $70.78 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $132.97 Capital Blue Cross — CHIP: $234.66 Capital Blue Cross — Commercial: $234.66 Capital Blue Cross — Medicare Advantage: $85.80 Cigna — Commercial: $506.81 Geisinger — Commercial: $280.91 Geisinger — Medicaid/CHIP: $152.51

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COR ANGIO OR LHC	$8,734	$5,240.40	$1,016.56 – $17,298
Left heart catheterization (diagnostic): 10 of 37 insurance plan rates Aetna — Medicare: $3,209.19 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $1,692.28 Capital Blue Cross — CHIP: $4,777.50 Capital Blue Cross — Commercial: $4,777.50 Capital Blue Cross — Medicare Advantage: $1,746.80 Cigna — Commercial: $17,298 Cigna — Medicare: $3,230.72 Geisinger — Commercial: $5,719.02 Geisinger — Medicaid/CHIP: $4,803.70 Geisinger — Medicare: $3,230.72
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COR ANGIO OR LHC	$8,734	$5,240.40	$3,563.47 – $7,423.90
Left heart catheterization (diagnostic): rates for 10 insurance plans Aetna — ACO: $3,589.67 Aetna — Commercial: $4,270.93 Geisinger — Commercial: $6,308.57 Multiplan — PPO (Includes PHCS and Humana as Payers): $7,423.90 Prime Net — ACO: $3,589.67 Prime Net — FH-Medical Rental: $6,602.90 Prime Net — GateKeeper: $4,270.93 Prime Net — Legacy Commercial: $3,563.47 Prime Net — NonGateKeeper: $4,244.72 Wellspan Population Health — PPO: $6,987.20
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TX ATRIAL FIB PULM VEIN ISOL	$51,625	$30,975	$1,016.56 – $73,340.13
Heart rhythm study with ablation for atrial fibrillation: 10 of 37 insurance plan rates Aetna — ACO: $20,288.62 Aetna — Commercial: $24,160.50 Aetna — Medicare: $24,477.22 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $12,907.45 Capital Blue Cross — CHIP: $28,238.88 Capital Blue Cross — Commercial: $28,238.88 Capital Blue Cross — Medicare Advantage: $10,325 Cigna — Commercial: $17,298 Cigna — Medicare: $24,641.49 Geisinger — Commercial: $33,804.05
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC TX ATRIAL FIB PULM VEIN ISOL	$51,625	$30,975	$21,063 – $43,881.25
Heart rhythm study with ablation for atrial fibrillation: rates for 10 insurance plans Aetna — ACO: $21,217.88 Aetna — Commercial: $25,244.62 Geisinger — Commercial: $37,288.74 Multiplan — PPO (Includes PHCS and Humana as Payers): $43,881.25 Prime Net — ACO: $21,217.88 Prime Net — FH-Medical Rental: $39,028.50 Prime Net — GateKeeper: $25,244.62 Prime Net — Legacy Commercial: $21,063 Prime Net — NonGateKeeper: $25,089.75 Wellspan Population Health — PPO: $41,300
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ALL NIGHT SLEEP	$7,132	$4,279.20	$354.12 – $6,062.20
Sleep study (overnight, in a sleep lab): 10 of 40 insurance plan rates Aetna — ACO: $2,802.88 Aetna — Commercial: $3,337.78 Aetna — Medicare: $1,015.11 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $440.13 Capital Blue Cross — CHIP: $3,901.20 Capital Blue Cross — Commercial: $3,901.20 Capital Blue Cross — Medicare Advantage: $1,426.40 Cigna — Commercial: $5,562.96 Cigna — Medicare: $1,021.92 Geisinger — Commercial: $4,670.03
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DISCON SLEEP STUDY - NON DIAG	$6,259	$3,755.40	$354.12 – $5,320.15
Sleep study (overnight, in a sleep lab): 10 of 40 insurance plan rates Aetna — ACO: $2,459.79 Aetna — Commercial: $2,929.21 Aetna — Medicare: $1,015.11 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $440.13 Capital Blue Cross — CHIP: $3,423.67 Capital Blue Cross — Commercial: $3,423.67 Capital Blue Cross — Medicare Advantage: $1,251.80 Cigna — Commercial: $4,882.02 Cigna — Medicare: $1,021.92 Geisinger — Commercial: $4,098.39
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PEDIATRIC SLEEP STUDY AGE 6-20	$7,132	$4,279.20	$354.12 – $6,062.20
Sleep study (overnight, in a sleep lab): 10 of 40 insurance plan rates Aetna — ACO: $2,802.88 Aetna — Commercial: $3,337.78 Aetna — Medicare: $1,015.11 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $440.13 Capital Blue Cross — CHIP: $3,901.20 Capital Blue Cross — Commercial: $3,901.20 Capital Blue Cross — Medicare Advantage: $1,426.40 Cigna — Commercial: $5,562.96 Cigna — Medicare: $1,021.92 Geisinger — Commercial: $4,670.03

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC EXERCISE PT 15 MIN	$74	$44.40	$10.14 – $387
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 29 insurance plan rates Aetna — ACO: $29.08 Aetna — Commercial: $34.63 Aetna — Medicare: $12.21 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $10.64 Capital Blue Cross — CHIP: $40.48 Capital Blue Cross — Commercial: $40.48 Capital Blue Cross — Medicare Advantage: $14.80 Cigna — Commercial: $387 Geisinger — Commercial: $48.46 Geisinger — Medicaid/CHIP: $12.21
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GO In the file: HC THERAP EXER OT 15 MIN	$123	$73.80	$10.64 – $387
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 29 insurance plan rates Aetna — ACO: $48.34 Aetna — Commercial: $57.56 Aetna — Medicare: $20.30 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $10.64 Capital Blue Cross — CHIP: $67.28 Capital Blue Cross — Commercial: $67.28 Capital Blue Cross — Medicare Advantage: $24.60 Cigna — Commercial: $387 Geisinger — Commercial: $80.54 Geisinger — Medicaid/CHIP: $12.21
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: HC EXERCISE PT 15 MIN	$74	$44.40	$30.19 – $62.90
Physical therapy: therapeutic exercise (each 15 minutes): rates for 10 insurance plans Aetna — ACO: $30.41 Aetna — Commercial: $36.19 Geisinger — Commercial: $53.45 Multiplan — PPO (Includes PHCS and Humana as Payers): $62.90 Prime Net — ACO: $30.41 Prime Net — FH-Medical Rental: $55.94 Prime Net — GateKeeper: $36.19 Prime Net — Legacy Commercial: $30.19 Prime Net — NonGateKeeper: $35.96 Wellspan Population Health — PPO: $59.20
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: LOW COMPLEXITY	$378	$226.80	$51.79 – $387
Physical therapy evaluation (low complexity): 10 of 25 insurance plan rates Aetna — ACO: $148.55 Aetna — Commercial: $176.90 Aetna — Medicare: $62.37 Capital Blue Cross — CHIP: $206.77 Capital Blue Cross — Commercial: $206.77 Capital Blue Cross — Medicare Advantage: $75.60 Cigna — Commercial: $387 Geisinger — Commercial: $247.51 Geisinger — Medicaid/CHIP: $207.90 Keystone Health Plan — Commercial: $206.77
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: LOW COMPLEXITY	$378	$226.80	$154.22 – $321.30
Physical therapy evaluation (low complexity): rates for 10 insurance plans Aetna — ACO: $155.36 Aetna — Commercial: $184.84 Geisinger — Commercial: $273.03 Multiplan — PPO (Includes PHCS and Humana as Payers): $321.30 Prime Net — ACO: $155.36 Prime Net — FH-Medical Rental: $285.77 Prime Net — GateKeeper: $184.84 Prime Net — Legacy Commercial: $154.22 Prime Net — NonGateKeeper: $183.71 Wellspan Population Health — PPO: $302.40
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: MODERATE COMPLEXITY	$506	$303.60	$33.18 – $430.10
Physical therapy evaluation (moderate complexity): 10 of 25 insurance plan rates Aetna — ACO: $198.86 Aetna — Commercial: $236.81 Aetna — Medicare: $83.49 Capital Blue Cross — CHIP: $276.78 Capital Blue Cross — Commercial: $276.78 Capital Blue Cross — Medicare Advantage: $101.20 Cigna — Commercial: $387 Geisinger — Commercial: $331.33 Geisinger — Medicaid/CHIP: $278.30 Keystone Health Plan — Commercial: $276.78
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: MODERATE COMPLEXITY	$506	$303.60	$206.45 – $430.10
Physical therapy evaluation (moderate complexity): rates for 10 insurance plans Aetna — ACO: $207.97 Aetna — Commercial: $247.43 Geisinger — Commercial: $365.48 Multiplan — PPO (Includes PHCS and Humana as Payers): $430.10 Prime Net — ACO: $207.97 Prime Net — FH-Medical Rental: $382.54 Prime Net — GateKeeper: $247.43 Prime Net — Legacy Commercial: $206.45 Prime Net — NonGateKeeper: $245.92 Wellspan Population Health — PPO: $404.80
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: HIGH COMPLEXITY	$605	$363	$82.89 – $514.25
Physical therapy evaluation (high complexity): 10 of 25 insurance plan rates Aetna — ACO: $237.76 Aetna — Commercial: $283.14 Aetna — Medicare: $99.83 Capital Blue Cross — CHIP: $330.94 Capital Blue Cross — Commercial: $330.94 Capital Blue Cross — Medicare Advantage: $121 Cigna — Commercial: $387 Geisinger — Commercial: $396.15 Geisinger — Medicaid/CHIP: $332.75 Keystone Health Plan — Commercial: $330.94
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: HIGH COMPLEXITY	$605	$363	$246.84 – $514.25
Physical therapy evaluation (high complexity): rates for 10 insurance plans Aetna — ACO: $248.66 Aetna — Commercial: $295.85 Geisinger — Commercial: $436.99 Multiplan — PPO (Includes PHCS and Humana as Payers): $514.25 Prime Net — ACO: $248.66 Prime Net — FH-Medical Rental: $457.38 Prime Net — GateKeeper: $295.85 Prime Net — Legacy Commercial: $246.84 Prime Net — NonGateKeeper: $294.03 Wellspan Population Health — PPO: $484
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INDIVID PSYCHO 60MIN MD	$504	$302.40	$66.04 – $480.33
Psychotherapy, 60 minutes: 10 of 38 insurance plan rates Aetna — ACO: $198.07 Aetna — Commercial: $235.87 Aetna — Medicare: $160.31 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $66.04 Capital Blue Cross — CHIP: $275.69 Capital Blue Cross — Commercial: $275.69 Capital Blue Cross — Medicare Advantage: $100.80 Cigna — Commercial: $393.12 Cigna — Medicare: $161.38 Geisinger — Commercial: $330.02
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INDIVID PSYCHO 60MIN MD	$504	$302.40	$205.63 – $428.40
Psychotherapy, 60 minutes: rates for 10 insurance plans Aetna — ACO: $207.14 Aetna — Commercial: $246.46 Geisinger — Commercial: $364.04 Multiplan — PPO (Includes PHCS and Humana as Payers): $428.40 Prime Net — ACO: $207.14 Prime Net — FH-Medical Rental: $381.02 Prime Net — GateKeeper: $246.46 Prime Net — Legacy Commercial: $205.63 Prime Net — NonGateKeeper: $244.94 Wellspan Population Health — PPO: $403.20

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19	Not listed in the file	Not listed in the file	$219.71 – $11,447.77
Removal of breast growth (open surgery): 10 of 23 insurance plan rates Aetna — Medicare: $3,820.69 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $233.55 Cigna — Commercial: $6,413 Cigna — Medicare: $3,846.33 Geisinger — Medicaid/CHIP: $251.99 Geisinger — Medicare: $3,846.33 Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $235.63 Highmark BCBS of PA — CHIP - Managed Care: $10,738.95 Highmark BCBS of PA — Commercial: $11,447.77 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3,626.54
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT	Not listed in the file	Not listed in the file	$1,016.56 – $38,465.79
Total hip replacement: 10 of 18 insurance plan rates Aetna — Medicare: $12,837.93 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $6,769.76 Cigna — Commercial: $25,000 Cigna — Medicare: $12,924.09 Geisinger — Medicare: $12,924.09 Highmark BCBS of PA — CHIP - Managed Care: $36,084.07 Highmark BCBS of PA — Commercial: $38,465.79 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $12,185.57 Highmark BCBS of PA — Community Blue PPO: $34,619.34 Highmark BCBS of PA — Freedom Blue Medicare Advantage: $12,185.57
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY)	Not listed in the file	Not listed in the file	$1,016.56 – $38,465.79
Total knee replacement: 10 of 19 insurance plan rates Aetna — Medicare: $12,837.93 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $6,769.76 Cigna — Commercial: $25,000 Cigna — Medicare: $12,924.09 Geisinger — Medicare: $12,924.09 Highmark BCBS of PA — CHIP - Managed Care: $36,084.07 Highmark BCBS of PA — Commercial: $38,465.79 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $12,185.57 Highmark BCBS of PA — Community Blue PPO: $34,619.34 Highmark BCBS of PA — Freedom Blue Medicare Advantage: $12,185.57
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLASTY, WITH CORACOACROMIAL LIGAMENT (IE, ARCH) RELE	Not listed in the file	Not listed in the file	$711.99 – $6,413
Shoulder arthroscopy: shaving of shoulder bone: rates for 5 insurance plans Cigna — Commercial: $6,413 United Healthcare Community Plan for Families — PA Medicaid: $711.99 UPMC Health Plan — CHIP: $2,655.58 UPMC Work Partners — Workers Comp: $2,238.66 United Healthcare — Commercial: 76.9% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULA	Not listed in the file	Not listed in the file	$690.25 – $9,699.87
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 23 insurance plan rates Aetna — Medicare: $3,237.33 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $733.73 Cigna — Commercial: $6,971 Cigna — Medicare: $3,259.05 Geisinger — Medicaid/CHIP: $791.66 Geisinger — Medicare: $3,259.05 Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $740.25 Highmark BCBS of PA — CHIP - Managed Care: $9,099.28 Highmark BCBS of PA — Commercial: $9,699.87 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3,072.82
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC UPPER GI ENDOSCOPY EGD/EGJ	$2,515	$1,509	$159.03 – $2,802.87
Upper GI endoscopy (diagnostic): 10 of 40 insurance plan rates Aetna — ACO: $988.39 Aetna — Commercial: $1,177.02 Aetna — Medicare: $935.46 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $159.03 Capital Blue Cross — CHIP: $1,375.70 Capital Blue Cross — Commercial: $1,375.70 Capital Blue Cross — Medicare Advantage: $503 Cigna — Commercial: $1,961.70 Cigna — Medicare: $941.73 Geisinger — Commercial: $1,646.82
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC UPPER GI ENDOSCOPY EGD/EGJ	$2,515	$1,509	$1,026.12 – $2,137.75
Upper GI endoscopy (diagnostic): rates for 10 insurance plans Aetna — ACO: $1,033.66 Aetna — Commercial: $1,229.84 Geisinger — Commercial: $1,816.58 Multiplan — PPO (Includes PHCS and Humana as Payers): $2,137.75 Prime Net — ACO: $1,033.66 Prime Net — FH-Medical Rental: $1,901.34 Prime Net — GateKeeper: $1,229.84 Prime Net — Legacy Commercial: $1,026.12 Prime Net — NonGateKeeper: $1,222.29 Wellspan Population Health — PPO: $2,012
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEP	Not listed in the file	Not listed in the file	$159.03 – $3,397
Upper GI endoscopy (diagnostic): 10 of 23 insurance plan rates Aetna — Medicare: $935.46 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $169.05 Cigna — Commercial: $3,397 Cigna — Medicare: $941.73 Geisinger — Medicaid/CHIP: $182.40 Geisinger — Medicare: $941.73 Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $170.55 Highmark BCBS of PA — CHIP - Managed Care: $2,629.32 Highmark BCBS of PA — Commercial: $2,802.87 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $887.92
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC UPPER GI ENDOSCOPY W/BIOPSY	$3,366	$2,019.60	$188.70 – $2,861.10
Upper GI endoscopy with biopsy: 10 of 40 insurance plan rates Aetna — ACO: $1,322.84 Aetna — Commercial: $1,575.29 Aetna — Medicare: $935.46 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $188.70 Capital Blue Cross — CHIP: $1,841.20 Capital Blue Cross — Commercial: $1,841.20 Capital Blue Cross — Medicare Advantage: $673.20 Cigna — Commercial: $2,625.48 Cigna — Medicare: $941.73 Geisinger — Commercial: $2,204.06
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC UPPER GI ENDOSCOPY W/BIOPSY	$3,366	$2,019.60	$1,373.33 – $2,861.10
Upper GI endoscopy with biopsy: rates for 10 insurance plans Aetna — ACO: $1,383.43 Aetna — Commercial: $1,645.97 Geisinger — Commercial: $2,431.26 Multiplan — PPO (Includes PHCS and Humana as Payers): $2,861.10 Prime Net — ACO: $1,383.43 Prime Net — FH-Medical Rental: $2,544.70 Prime Net — GateKeeper: $1,645.97 Prime Net — Legacy Commercial: $1,373.33 Prime Net — NonGateKeeper: $1,635.88 Wellspan Population Health — PPO: $2,692.80
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE	Not listed in the file	Not listed in the file	$188.70 – $5,035
Upper GI endoscopy with biopsy: 10 of 23 insurance plan rates Aetna — Medicare: $935.46 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $200.58 Cigna — Commercial: $5,035 Cigna — Medicare: $941.73 Geisinger — Medicaid/CHIP: $216.42 Geisinger — Medicare: $941.73 Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $202.37 Highmark BCBS of PA — CHIP - Managed Care: $2,629.32 Highmark BCBS of PA — Commercial: $2,802.87 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $887.92
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)	Not listed in the file	Not listed in the file	$229.24 – $5,035
Colonoscopy (diagnostic): 10 of 23 insurance plan rates Aetna — Medicare: $909.66 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $243.68 Cigna — Commercial: $5,035 Cigna — Medicare: $915.77 Geisinger — Medicaid/CHIP: $262.92 Geisinger — Medicare: $915.77 Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $245.84 Highmark BCBS of PA — CHIP - Managed Care: $2,556.82 Highmark BCBS of PA — Commercial: $2,725.59 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $863.44
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE	Not listed in the file	Not listed in the file	$286.28 – $5,035
Colonoscopy with biopsy: 10 of 23 insurance plan rates Aetna — Medicare: $1,176.43 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $304.32 Cigna — Commercial: $5,035 Cigna — Medicare: $1,184.33 Geisinger — Medicaid/CHIP: $328.35 Geisinger — Medicare: $1,184.33 Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $307.02 Highmark BCBS of PA — CHIP - Managed Care: $3,306.64 Highmark BCBS of PA — Commercial: $3,524.89 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $1,116.65
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE	Not listed in the file	Not listed in the file	$340.46 – $5,035
Colonoscopy with removal of polyps (snare): 10 of 23 insurance plan rates Aetna — Medicare: $1,176.43 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $361.91 Cigna — Commercial: $5,035 Cigna — Medicare: $1,184.33 Geisinger — Medicaid/CHIP: $390.49 Geisinger — Medicare: $1,184.33 Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $365.12 Highmark BCBS of PA — CHIP - Managed Care: $3,306.64 Highmark BCBS of PA — Commercial: $3,524.89 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $1,116.65
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK	Not listed in the file	Not listed in the file	$479.69 – $5,035
Screening colonoscopy (not high risk): 10 of 17 insurance plan rates Aetna — Medicare: $909.66 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $479.69 Cigna — Commercial: $5,035 Cigna — Medicare: $915.77 Geisinger — Medicare: $915.77 Highmark BCBS of PA — CHIP - Managed Care: $2,556.82 Highmark BCBS of PA — Commercial: $2,725.59 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $863.44 Highmark BCBS of PA — Community Blue PPO: $2,453.04 Highmark BCBS of PA — Freedom Blue Medicare Advantage: $863.44
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$1,016.56 – $17,442.03
Gallbladder removal by laparoscope: 10 of 18 insurance plan rates Aetna — Medicare: $5,821.26 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3,069.70 Cigna — Commercial: $16,693 Cigna — Medicare: $5,860.33 Geisinger — Medicare: $5,860.33 Highmark BCBS of PA — CHIP - Managed Care: $16,362.05 Highmark BCBS of PA — Commercial: $17,442.03 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $5,525.46 Highmark BCBS of PA — Community Blue PPO: $15,697.88 Highmark BCBS of PA — Freedom Blue Medicare Advantage: $5,525.46
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NEEDLE BX PROSTATE	$5,493	$3,295.80	$113.67 – $6,124.10
Prostate biopsy: 10 of 40 insurance plan rates Aetna — ACO: $2,158.75 Aetna — Commercial: $2,570.72 Aetna — Medicare: $2,043.91 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $120.83 Capital Blue Cross — CHIP: $3,004.67 Capital Blue Cross — Commercial: $3,004.67 Capital Blue Cross — Medicare Advantage: $1,098.60 Cigna — Commercial: $5,035 Cigna — Medicare: $2,057.63 Geisinger — Commercial: $3,596.82
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NEEDLE BX PROSTATE	$5,493	$3,295.80	$2,241.14 – $4,669.05
Prostate biopsy: rates for 10 insurance plans Aetna — ACO: $2,257.62 Aetna — Commercial: $2,686.08 Geisinger — Commercial: $3,967.59 Multiplan — PPO (Includes PHCS and Humana as Payers): $4,669.05 Prime Net — ACO: $2,257.62 Prime Net — FH-Medical Rental: $4,152.71 Prime Net — GateKeeper: $2,686.08 Prime Net — Legacy Commercial: $2,241.14 Prime Net — NonGateKeeper: $2,669.60 Wellspan Population Health — PPO: $4,394.40
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH	Not listed in the file	Not listed in the file	$113.67 – $6,124.10
Prostate biopsy: 10 of 23 insurance plan rates Aetna — Medicare: $2,043.91 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $120.83 Cigna — Commercial: $5,035 Cigna — Medicare: $2,057.63 Geisinger — Medicaid/CHIP: $130.37 Geisinger — Medicare: $2,057.63 Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $121.90 Highmark BCBS of PA — CHIP - Managed Care: $5,744.91 Highmark BCBS of PA — Commercial: $6,124.10 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $1,940.05
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C	Not listed in the file	Not listed in the file	$604.75 – $9,505.30
Hysteroscopy with biopsy of the uterus lining: 10 of 18 insurance plan rates Aetna — Medicare: $3,172.39 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $1,672.88 Cigna — Commercial: $6,413 Cigna — Medicare: $3,193.68 Geisinger — Medicare: $3,193.68 Highmark BCBS of PA — CHIP - Managed Care: $8,916.75 Highmark BCBS of PA — Commercial: $9,505.30 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3,011.18 Highmark BCBS of PA — Community Blue PPO: $8,554.80 Highmark BCBS of PA — Freedom Blue Medicare Advantage: $3,011.18
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NJX INTERLUML LMBR/SAC W/IMG INJ	$3,414	$2,048.40	$103.28 – $2,901.90
Spinal injection, lower back (epidural), with imaging guidance: 10 of 41 insurance plan rates Aetna — ACO: $1,341.70 Aetna — Commercial: $1,597.75 Aetna — Medicare: $690.97 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $103.28 Capital Blue Cross — CHIP: $1,867.46 Capital Blue Cross — Commercial: $1,867.46 Capital Blue Cross — Medicare Advantage: $682.80 Cigna — Commercial: $2,662.92 Cigna — Medicare: $695.60 Geisinger — Commercial: $2,235.49
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NJX INTERLUML LMBR/SAC W/IMG INJ	$3,414	$2,048.40	$1,392.91 – $2,901.90
Spinal injection, lower back (epidural), with imaging guidance: rates for 10 insurance plans Aetna — ACO: $1,403.15 Aetna — Commercial: $1,669.45 Geisinger — Commercial: $2,465.93 Multiplan — PPO (Includes PHCS and Humana as Payers): $2,901.90 Prime Net — ACO: $1,403.15 Prime Net — FH-Medical Rental: $2,580.98 Prime Net — GateKeeper: $1,669.45 Prime Net — Legacy Commercial: $1,392.91 Prime Net — NonGateKeeper: $1,659.20 Wellspan Population Health — PPO: $2,731.20
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ EPIDURAL L/S SINGLE	$4,412	$2,647.20	$120.70 – $3,750.20
Nerve root injection, lower back, with imaging guidance: 10 of 40 insurance plan rates Aetna — ACO: $1,733.92 Aetna — Commercial: $2,064.82 Aetna — Medicare: $888.29 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $128.30 Capital Blue Cross — CHIP: $2,413.36 Capital Blue Cross — Commercial: $2,413.36 Capital Blue Cross — Medicare Advantage: $882.40 Cigna — Commercial: $3,397 Cigna — Medicare: $894.25 Geisinger — Commercial: $2,888.98
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ EPIDURAL L/S SINGLE	$4,412	$2,647.20	$1,800.10 – $3,750.20
Nerve root injection, lower back, with imaging guidance: rates for 10 insurance plans Aetna — ACO: $1,813.33 Aetna — Commercial: $2,157.47 Geisinger — Commercial: $3,186.79 Multiplan — PPO (Includes PHCS and Humana as Payers): $3,750.20 Prime Net — ACO: $1,813.33 Prime Net — FH-Medical Rental: $3,335.47 Prime Net — GateKeeper: $2,157.47 Prime Net — Legacy Commercial: $1,800.10 Prime Net — NonGateKeeper: $2,144.23 Wellspan Population Health — PPO: $3,529.60
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL	Not listed in the file	Not listed in the file	$381 – $5,837.87
Carpal tunnel release: 10 of 23 insurance plan rates Aetna — Medicare: $1,948.39 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $405 Cigna — Commercial: $5,035 Cigna — Medicare: $1,961.46 Geisinger — Medicaid/CHIP: $436.98 Geisinger — Medicare: $1,961.46 Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $408.60 Highmark BCBS of PA — CHIP - Managed Care: $5,476.40 Highmark BCBS of PA — Commercial: $5,837.87 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $1,849.38
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGA	Not listed in the file	Not listed in the file	$765.21 – $9,812
Cataract removal with lens implant: 10 of 23 insurance plan rates Aetna — Medicare: $2,275.61 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $813.42 Cigna — Commercial: $9,812 Cigna — Medicare: $2,290.88 Geisinger — Medicaid/CHIP: $877.65 Geisinger — Medicare: $2,290.88 Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $820.65 Highmark BCBS of PA — CHIP - Managed Care: $6,396.14 Highmark BCBS of PA — Commercial: $6,818.31 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $2,159.97

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC C/SECTION	$16,724	$10,034.40	$471 – $14,215.40
Cesarean delivery (C-section), with care before and after: 10 of 25 insurance plan rates Aetna — ACO: $6,572.53 Aetna — Commercial: $7,826.83 Aetna — Medicare: $2,759.46 Capital Blue Cross — CHIP: $9,148.03 Capital Blue Cross — Commercial: $9,148.03 Capital Blue Cross — Medicare Advantage: $3,344.80 Cigna — Commercial: $13,044.72 Geisinger — Commercial: $10,950.88 Geisinger — Medicaid/CHIP: $9,198.20 Keystone Health Plan — Commercial: $9,148.03
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC C/SECTION	$16,724	$10,034.40	$6,823.39 – $14,215.40
Cesarean delivery (C-section), with care before and after: rates for 10 insurance plans Aetna — ACO: $6,873.56 Aetna — Commercial: $8,178.04 Geisinger — Commercial: $12,079.75 Multiplan — PPO (Includes PHCS and Humana as Payers): $14,215.40 Prime Net — ACO: $6,873.56 Prime Net — FH-Medical Rental: $12,643.34 Prime Net — GateKeeper: $8,178.04 Prime Net — Legacy Commercial: $6,823.39 Prime Net — NonGateKeeper: $8,127.86 Wellspan Population Health — PPO: $13,379.20

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$12,917.95 – $235,470.59
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 21 insurance plan rates Aetna — Medicare: $71,961.39 Capital Blue Cross — CHIP: $188,205.33 Capital Blue Cross — Commercial: $188,205.33 Capital Blue Cross — Medicare Advantage: $68,994.62 Cigna — Commercial: $229,895.80 Cigna — Medicare: $72,444.35 Geisinger — Medicare: $72,444.35 Highmark BCBS of PA — CHIP - Managed Care: $12,917.95 Highmark BCBS of PA — Commercial: $235,470.59 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $68,304.67
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: DRG Grouper 12 (10/1/1994): DRG 216: BIOPSIES OF MUSCULOSKELETAL SYSTEM	Not listed in the file	Not listed in the file	$21,250.42
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 1 insurance plan UPMC Work Partners — Workers Comp: $21,250.42
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) · Hospital (facility) fee In the file: SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	Not listed in the file	Not listed in the file	$4,993.79 – $91,027.65
Spinal fusion (not neck), without major complications: rates for 3 insurance plans Highmark BCBS of PA — CHIP - Managed Care: $4,993.79 Highmark BCBS of PA — Commercial: $91,027.65 Highmark BCBS of PA — Community Blue PPO: $81,924.89
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) · Hospital (facility) fee In the file: DRG Grouper 12 (10/1/1994): DRG 460: NON-EXTENSIVE BURNS W/O O.R.	Not listed in the file	Not listed in the file	$10,120.35
Spinal fusion (not neck), without major complications: rates for 1 insurance plan UPMC Work Partners — Workers Comp: $10,120.35
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$2,535.22 – $46,212.36
Hip or knee replacement (major joint of the leg), without major complications: 10 of 21 insurance plan rates Aetna — Medicare: $14,496.63 Capital Blue Cross — CHIP: $41,427.34 Capital Blue Cross — Commercial: $41,427.34 Capital Blue Cross — Medicare Advantage: $13,898.97 Cigna — Commercial: $45,329.15 Cigna — Medicare: $14,593.92 Geisinger — Medicare: $14,593.92 Highmark BCBS of PA — CHIP - Managed Care: $2,535.22 Highmark BCBS of PA — Commercial: $46,212.36 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $13,759.98
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$3,361.59 – $61,275.67
Neck (cervical) spinal fusion, without complications: 10 of 21 insurance plan rates Aetna — Medicare: $18,245.71 Capital Blue Cross — CHIP: $42,022.45 Capital Blue Cross — Commercial: $42,022.45 Capital Blue Cross — Medicare Advantage: $17,493.49 Cigna — Commercial: $57,370.55 Cigna — Medicare: $18,368.16 Geisinger — Medicare: $18,368.16 Highmark BCBS of PA — CHIP - Managed Care: $3,361.59 Highmark BCBS of PA — Commercial: $61,275.67 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $17,318.56
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: DRG Grouper 12 (10/1/1994): DRG 473: ACUTE LEUKEMIA W/O MAJOR O.R.	Not listed in the file	Not listed in the file	$36,470.83
Neck (cervical) spinal fusion, without complications: rates for 1 insurance plan UPMC Work Partners — Workers Comp: $36,470.83
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$1,552.24 – $29,156.45
Uterus and ovary surgery (not for cancer), without complications: 10 of 21 insurance plan rates Aetna — Medicare: $9,461.24 Capital Blue Cross — CHIP: $19,085.49 Capital Blue Cross — Commercial: $19,085.49 Capital Blue Cross — Medicare Advantage: $9,071.18 Cigna — Commercial: $29,156.45 Cigna — Medicare: $9,524.74 Geisinger — Medicare: $9,524.74 Highmark BCBS of PA — CHIP - Managed Care: $1,552.24 Highmark BCBS of PA — Commercial: $28,294.47 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $8,980.47

Source: UPMC Carlisle’s standard charges file (dam.upmc.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on March 6, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	361 Alexander Spring Road, Carlisle, PA 17015
County	Cumberland County
State	Pennsylvania
Phone	(717) 249‑1212
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	390058
Name in Medicare records	UPMC CARLISLE
Profile level	Medicare data + hospital website
Official website	upmc.com
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.

About UPMC Carlisle — upmc.com
Clinical Services at UPMC Carlisle — upmc.com
Patients & Visitors — upmc.com
UPMC Carlisle | Carlisle, PA — upmc.com
Emergency Room at UPMC Carlisle - Carlisle, PA — upmc.com
Before Your Stay | UPMC Carlisle — upmc.com

UPMC Carlisle

Summary

Profile from official sources

At a glance