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Acute Care Hospital

UPMC Presbyterian Shadyside

Pittsburgh, Pennsylvania · Allegheny County · Emergency services listed

Summary

UPMC Presbyterian Shadyside is an acute care hospital in Pittsburgh, Pennsylvania. Medicare data lists emergency services. CMS overall star rating: 4 of 5 stars. Its official website lists 41 services, specialties and programs. Medicare lists 2,633 affiliated clinicians. Source: CMS Hospital General Information, data updated 2026-07-22.

What is an acute care hospital?

A general hospital for short-term care: emergencies, surgery, illness and injury. Most patients stay a few days. More about hospital types

Call(412) 647‑2345 Directions Website Medicare profile
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Profile from official sources

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

In a medical emergency, call 911.

At a glance

YesEmergency services
4 of 5 stars4 of 5 stars · Medicare rating
2,633Doctors and clinicians
41Services listed

Quick answers

Does UPMC Presbyterian Shadyside have an emergency room?
Yes. Medicare (CMS) data lists emergency services at UPMC Presbyterian Shadyside. In a medical emergency, call 911.
Where is UPMC Presbyterian Shadyside?
200 Lothrop Street, Pittsburgh, PA 15213, in Allegheny County, Pennsylvania.
What is the phone number of UPMC Presbyterian Shadyside?
(412) 647-2345, as listed by Medicare (CMS).
What is the Medicare star rating of UPMC Presbyterian Shadyside?
4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas[5]

Conditions treated[4][8]

Programs and centers[4][6][8]

  • UPMC Heart and Vascular Institute
  • UPMC Esophageal and Lung Surgery Institute
  • UPMC Neurological Institute
  • UPMC Stroke Institute
  • Trauma in Pregnancy Center
  • Safe Haven Program

Emergency care (hospital website)[4][6][8]

Emergency roomYes
Open 24/7Yes
Trauma designationLevel I
Stroke designationComprehensive Stroke Center

Visiting and practical information

VisitingMost inpatient units and ICU: visitors 9 a.m.-9 p.m. daily; med-surg hours vary, ask the nurse[7]
ParkingParking tickets validated at main information desk; attendant on duty 24 hours a day[9]
Interpreters and languagesLanguage interpreters/translators and sign language interpreters offered on request[10]
Patient portalMyUPMC

Recognition[6][8]

  • Comprehensive Stroke Center (Joint Commission)
  • Level I Trauma Center

Doctors and clinicians (2,633)

2,633 doctors and other clinicians list UPMC Presbyterian Shadyside as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

Doctors with a page on this site (2,633)

And 2,609 more: the button below opens the full list.

Other emergency rooms nearby

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

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

All nursing homes in the state →

Hospice providers

All hospice providers in the state →

Home health agencies

All home health agencies in the state →

Dialysis facilities

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Clinics and urgent care

Pharmacies

Assisted living nearby

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

About the Medicare star rating

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

Medicare quality data

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

What patients said (patient survey)

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

Summary star rating (all survey topics) 3 of 5 stars
Overall rating of the hospital3 of 5 stars
Would recommend the hospital4 of 5 stars
Nurses communicated well4 of 5 stars
Doctors communicated well3 of 5 stars
Staff explained medicines3 of 5 stars
Information about recovery at home4 of 5 stars
Room and bathroom kept clean3 of 5 stars
Quiet at night2 of 5 stars
Rated the hospital 9 or 10 out of 1071%National average: 72%
Would definitely recommend the hospital72%National average: 71%
Nurses “always” communicated well80%National average: 80%
Doctors “always” communicated well78%National average: 80%
Staff “always” explained medicines before giving them61%National average: 62%
Were given information about recovery at home88%National average: 86%
Room and bathroom “always” clean65%National average: 74%
Area around the room “always” quiet at night47%National average: 60%
Completed surveys612Response rate: 26%

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)0.755Better than the national benchmark
Catheter-associated urinary tract infections (CAUTI)0.481Better than the national benchmark
Surgical site infections after colon surgery0.355Better than the national benchmark
Surgical site infections after abdominal hysterectomyNot reported to Medicare
MRSA bloodstream infections0.86No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections0.597Better than the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

Complications and deaths

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

Deaths within 30 days: heart attack patients11%
Deaths within 30 days: heart failure patients7.6%
Deaths within 30 days: pneumonia patients12%
Deaths within 30 days: COPD patients7%
Deaths within 30 days: stroke patients8.7%
Deaths within 30 days: coronary bypass surgery (CABG)1.6%
Serious complications (patient safety indicator PSI-90)1.4Worse than the national rate
Complications after hip or knee replacement4.6%

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)Not reported to Medicare
Readmitted within 30 days: heart attack15.2%
Readmitted within 30 days: heart failure23.1%
Readmitted within 30 days: pneumonia19.7%
Readmitted within 30 days: COPD19.1%
Readmitted within 30 days: coronary bypass surgery13.7%
Readmitted within 30 days: hip or knee replacement4.6%

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)Very high (60,000 or more)
Average (median) time patients spent in the emergency room before leaving (OP-18b)234 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)52%National average: 65%

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in PittsburghBest hospitals in Pittsburgh

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 74 common services exactly as UPMC Presbyterian Shadyside lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

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

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

Office and emergency visits

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CLINIC VISIT NEW 99203 $426 $255.60 $36.08 – $511.74
New patient office visit (about 30–44 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $70.53
  • Aetna — Medicare: $106.50
  • Aetna of PA — Medicare: $36.08
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $85.85
  • Coventry/First Health — Commercial: $298.20
  • Fidelis — Medicare: $319.50
  • Geisinger — Medicaid/CHIP: $84.45
  • Health Coalition Partners — Intergroup: $340.80
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $81.81
  • Health Payors Organization — Commercial: $362.10
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEW OP VISIT LEVEL 3 $426 $255.60 $36.08 – $511.74
New patient office visit (about 30–44 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $70.53
  • Aetna — Medicare: $106.50
  • Aetna of PA — Medicare: $36.08
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $85.85
  • Coventry/First Health — Commercial: $298.20
  • Fidelis — Medicare: $319.50
  • Geisinger — Medicaid/CHIP: $84.45
  • Health Coalition Partners — Intergroup: $340.80
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $81.81
  • Health Payors Organization — Commercial: $362.10
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CLINIC VISIT NEW 99203 $426 $255.60 $276.90 – $362.10
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $298.20
  • Fidelis — Medicare: $319.50
  • Health Coalition Partners — Intergroup: $340.80
  • Health Payors Organization — Commercial: $362.10
  • Humana — Commercial: $362.10
  • InterGroup — Approved National Affiliated PPO Business: $362.10
  • InterGroup — InterGroup Services Corporation: $319.50
  • Multiplan — PPO: $340.80
  • Preferred Healthcare System — PPO: $276.90
  • Private Health Care Systems — PPO: $340.80
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CLINIC VISIT NEW 99204 $500 $300 $36.08 – $636.41
New patient office visit (about 45–59 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $117.48
  • Aetna — Medicare: $125
  • Aetna of PA — Medicare: $36.08
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $143
  • Coventry/First Health — Commercial: $350
  • Fidelis — Medicare: $375
  • Geisinger — Medicaid/CHIP: $140.68
  • Health Coalition Partners — Intergroup: $400
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $136.28
  • Health Payors Organization — Commercial: $425
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEW OP VISIT LEVEL 4 $500 $300 $36.08 – $636.41
New patient office visit (about 45–59 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $117.48
  • Aetna — Medicare: $125
  • Aetna of PA — Medicare: $36.08
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $143
  • Coventry/First Health — Commercial: $350
  • Fidelis — Medicare: $375
  • Geisinger — Medicaid/CHIP: $140.68
  • Health Coalition Partners — Intergroup: $400
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $136.28
  • Health Payors Organization — Commercial: $425
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CLINIC VISIT NEW 99204 $500 $300 $325 – $425
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $350
  • Fidelis — Medicare: $375
  • Health Coalition Partners — Intergroup: $400
  • Health Payors Organization — Commercial: $425
  • Humana — Commercial: $425
  • InterGroup — Approved National Affiliated PPO Business: $425
  • InterGroup — InterGroup Services Corporation: $375
  • Multiplan — PPO: $400
  • Preferred Healthcare System — PPO: $325
  • Private Health Care Systems — PPO: $400
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CLINIC VISIT NEW 99205 $604 $362.40 $36.08 – $756.20
New patient office visit (about 60–74 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $152.80
  • Aetna — Medicare: $151
  • Aetna of PA — Medicare: $36.08
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $186
  • Coventry/First Health — Commercial: $422.80
  • Fidelis — Medicare: $453
  • Geisinger — Medicaid/CHIP: $182.97
  • Health Coalition Partners — Intergroup: $483.20
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $177.25
  • Health Payors Organization — Commercial: $513.40
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEW OP VISIT LEVEL 5 $604 $362.40 $36.08 – $756.20
New patient office visit (about 60–74 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $152.80
  • Aetna — Medicare: $151
  • Aetna of PA — Medicare: $36.08
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $186
  • Coventry/First Health — Commercial: $422.80
  • Fidelis — Medicare: $453
  • Geisinger — Medicaid/CHIP: $182.97
  • Health Coalition Partners — Intergroup: $483.20
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $177.25
  • Health Payors Organization — Commercial: $513.40
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CLINIC VISIT NEW 99205 $604 $362.40 $392.60 – $513.40
New patient office visit (about 60–74 minutes): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $422.80
  • Fidelis — Medicare: $453
  • Health Coalition Partners — Intergroup: $483.20
  • Health Payors Organization — Commercial: $513.40
  • Humana — Commercial: $513.40
  • InterGroup — Approved National Affiliated PPO Business: $513.40
  • InterGroup — InterGroup Services Corporation: $453
  • Multiplan — PPO: $483.20
  • Preferred Healthcare System — PPO: $392.60
  • Private Health Care Systems — PPO: $483.20
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CLINIC VISIT EST 99213 $246 $147.60 $36.08 – $302.38
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $45.50
  • Aetna — Medicare: $61.50
  • Aetna of PA — Medicare: $36.08
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $55.38
  • Coventry/First Health — Commercial: $172.20
  • Fidelis — Medicare: $184.50
  • Geisinger — Medicaid/CHIP: $54.48
  • Health Coalition Partners — Intergroup: $196.80
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $52.78
  • Health Payors Organization — Commercial: $209.10
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EST OP VISIT LEVEL 3 $246 $147.60 $36.08 – $302.38
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $45.50
  • Aetna — Medicare: $61.50
  • Aetna of PA — Medicare: $36.08
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $55.38
  • Coventry/First Health — Commercial: $172.20
  • Fidelis — Medicare: $184.50
  • Geisinger — Medicaid/CHIP: $54.48
  • Health Coalition Partners — Intergroup: $196.80
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $52.78
  • Health Payors Organization — Commercial: $209.10
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CLINIC VISIT EST 99213 $246 $147.60 $159.90 – $209.10
Established patient office visit (about 20–29 minutes): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $172.20
  • Fidelis — Medicare: $184.50
  • Health Coalition Partners — Intergroup: $196.80
  • Health Payors Organization — Commercial: $209.10
  • Humana — Commercial: $209.10
  • InterGroup — Approved National Affiliated PPO Business: $209.10
  • InterGroup — InterGroup Services Corporation: $184.50
  • Multiplan — PPO: $196.80
  • Preferred Healthcare System — PPO: $159.90
  • Private Health Care Systems — PPO: $196.80
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CLINIC VISIT EST 99214 $280 $168 $36.08 – $364.09
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $70.75
  • Aetna — Medicare: $70
  • Aetna of PA — Medicare: $36.08
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $86.11
  • Coventry/First Health — Commercial: $196
  • Fidelis — Medicare: $210
  • Geisinger — Medicaid/CHIP: $84.72
  • Health Coalition Partners — Intergroup: $224
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $82.07
  • Health Payors Organization — Commercial: $238
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EST OP VISIT LEVEL 4 $280 $168 $36.08 – $364.09
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $70.75
  • Aetna — Medicare: $70
  • Aetna of PA — Medicare: $36.08
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $86.11
  • Coventry/First Health — Commercial: $196
  • Fidelis — Medicare: $210
  • Geisinger — Medicaid/CHIP: $84.72
  • Health Coalition Partners — Intergroup: $224
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $82.07
  • Health Payors Organization — Commercial: $238
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CLINIC VISIT EST 99214 $280 $168 $182 – $238
Established patient office visit (about 30–39 minutes): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $196
  • Fidelis — Medicare: $210
  • Health Coalition Partners — Intergroup: $224
  • Health Payors Organization — Commercial: $238
  • Humana — Commercial: $238
  • InterGroup — Approved National Affiliated PPO Business: $238
  • InterGroup — InterGroup Services Corporation: $210
  • Multiplan — PPO: $224
  • Preferred Healthcare System — PPO: $182
  • Private Health Care Systems — PPO: $224
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ACUITY LEVEL 3 $2,240 $1,344 $62.31 – $1,904
Emergency room visit (moderate): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $73.64
  • Aetna — Medicare: $290.38
  • Aetna of PA — Medicare: $290.38
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $89.64
  • AmeriHealth Caritas — Medicare: $285.10
  • Cigna Lifesource — Medicare Transplant: $285.10
  • Coventry/First Health — Commercial: $1,568
  • Fidelis — Medicare: $1,680
  • Geisinger — Medicaid/CHIP: $88.19
  • Health Coalition Partners — Intergroup: $1,792
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ACUITY LEVEL 3 $2,240 $1,344 $1,456 – $1,904
Emergency room visit (moderate): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $1,568
  • Fidelis — Medicare: $1,680
  • Health Coalition Partners — Intergroup: $1,792
  • Health Payors Organization — Commercial: $1,904
  • Humana — Commercial: $1,904
  • InterGroup — Approved National Affiliated PPO Business: $1,904
  • InterGroup — InterGroup Services Corporation: $1,680
  • Multiplan — PPO: $1,792
  • Preferred Healthcare System — PPO: $1,456
  • Private Health Care Systems — PPO: $1,792
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ACUITY LEVEL 4 $3,257 $1,954.20 $104.86 – $2,768.45
Emergency room visit (moderately high): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $123.93
  • Aetna — Medicare: $446.57
  • Aetna of PA — Medicare: $446.57
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $150.85
  • AmeriHealth Caritas — Medicare: $438.45
  • Cigna Lifesource — Medicare Transplant: $438.45
  • Coventry/First Health — Commercial: $2,279.90
  • Fidelis — Medicare: $2,442.75
  • Geisinger — Medicaid/CHIP: $148.40
  • Health Coalition Partners — Intergroup: $2,605.60
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ACUITY LEVEL 4 $3,257 $1,954.20 $2,117.05 – $2,768.45
Emergency room visit (moderately high): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $2,279.90
  • Fidelis — Medicare: $2,442.75
  • Health Coalition Partners — Intergroup: $2,605.60
  • Health Payors Organization — Commercial: $2,768.45
  • Humana — Commercial: $2,768.45
  • InterGroup — Approved National Affiliated PPO Business: $2,768.45
  • InterGroup — InterGroup Services Corporation: $2,442.75
  • Multiplan — PPO: $2,605.60
  • Preferred Healthcare System — PPO: $2,117.05
  • Private Health Care Systems — PPO: $2,605.60
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ACUITY LEVEL 5 $6,053 $3,631.80 $152.61 – $5,145.05
Emergency room visit (high): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $180.36
  • Aetna — Medicare: $642.97
  • Aetna of PA — Medicare: $642.97
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $219.54
  • AmeriHealth Caritas — Medicare: $631.28
  • Cigna Lifesource — Medicare Transplant: $631.28
  • Coventry/First Health — Commercial: $4,237.10
  • Fidelis — Medicare: $4,539.75
  • Geisinger — Medicaid/CHIP: $215.98
  • Health Coalition Partners — Intergroup: $4,842.40
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ACUITY LEVEL 5 $6,053 $3,631.80 $3,934.45 – $5,145.05
Emergency room visit (high): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $4,237.10
  • Fidelis — Medicare: $4,539.75
  • Health Coalition Partners — Intergroup: $4,842.40
  • Health Payors Organization — Commercial: $5,145.05
  • Humana — Commercial: $5,145.05
  • InterGroup — Approved National Affiliated PPO Business: $5,145.05
  • InterGroup — InterGroup Services Corporation: $4,539.75
  • Multiplan — PPO: $4,842.40
  • Preferred Healthcare System — PPO: $3,934.45
  • Private Health Care Systems — PPO: $4,842.40

Lab tests

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL $350 $210 $8.36 – $297.50
Basic metabolic panel (blood test): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $12.17
  • Aetna — Medicare: $9.31
  • Aetna of PA — Medicare: $9.31
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $14.81
  • AmeriHealth Caritas — Medicare: $9.14
  • Cigna Lifesource — Medicare Transplant: $9.14
  • Coventry/First Health — Commercial: $245
  • Fidelis — Medicare: $262.50
  • Geisinger — Medicaid/CHIP: $14.57
  • Health Coalition Partners — Intergroup: $280
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: WHOLE BLOOD BASIC METABOLIC PN $350 $210 $8.36 – $297.50
Basic metabolic panel (blood test): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $12.17
  • Aetna — Medicare: $9.31
  • Aetna of PA — Medicare: $9.31
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $14.81
  • AmeriHealth Caritas — Medicare: $9.14
  • Cigna Lifesource — Medicare Transplant: $9.14
  • Coventry/First Health — Commercial: $245
  • Fidelis — Medicare: $262.50
  • Geisinger — Medicaid/CHIP: $14.57
  • Health Coalition Partners — Intergroup: $280
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL $350 $210 $227.50 – $297.50
Basic metabolic panel (blood test): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $245
  • Fidelis — Medicare: $262.50
  • Health Coalition Partners — Intergroup: $280
  • Health Payors Organization — Commercial: $297.50
  • Humana — Commercial: $297.50
  • InterGroup — Approved National Affiliated PPO Business: $297.50
  • InterGroup — InterGroup Services Corporation: $262.50
  • Multiplan — PPO: $280
  • Preferred Healthcare System — PPO: $227.50
  • Private Health Care Systems — PPO: $280
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC PANEL $1,031 $618.60 $10.43 – $876.35
Comprehensive metabolic panel (blood test): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $15.20
  • Aetna — Medicare: $11.62
  • Aetna of PA — Medicare: $11.62
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $18.50
  • AmeriHealth Caritas — Medicare: $11.40
  • Cigna Lifesource — Medicare Transplant: $11.40
  • Coventry/First Health — Commercial: $721.70
  • Fidelis — Medicare: $773.25
  • Geisinger — Medicaid/CHIP: $18.20
  • Health Coalition Partners — Intergroup: $824.80
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOL PN P5147 $1,031 $618.60 $10.43 – $876.35
Comprehensive metabolic panel (blood test): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $15.20
  • Aetna — Medicare: $11.62
  • Aetna of PA — Medicare: $11.62
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $18.50
  • AmeriHealth Caritas — Medicare: $11.40
  • Cigna Lifesource — Medicare Transplant: $11.40
  • Coventry/First Health — Commercial: $721.70
  • Fidelis — Medicare: $773.25
  • Geisinger — Medicaid/CHIP: $18.20
  • Health Coalition Partners — Intergroup: $824.80
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC PANEL $1,031 $618.60 $670.15 – $876.35
Comprehensive metabolic panel (blood test): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $721.70
  • Fidelis — Medicare: $773.25
  • Health Coalition Partners — Intergroup: $824.80
  • Health Payors Organization — Commercial: $876.35
  • Humana — Commercial: $876.35
  • InterGroup — Approved National Affiliated PPO Business: $876.35
  • InterGroup — InterGroup Services Corporation: $773.25
  • Multiplan — PPO: $824.80
  • Preferred Healthcare System — PPO: $670.15
  • Private Health Care Systems — PPO: $824.80
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRICS PANEL $1,494 $896.40 $12 – $1,269.90
Obstetric blood test panel: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $15.60
  • Aetna — Medicare: $52.59
  • Aetna of PA — Medicare: $52.59
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $18.99
  • AmeriHealth Caritas — Medicare: $51.63
  • Cigna Lifesource — Medicare Transplant: $51.63
  • Coventry/First Health — Commercial: $1,045.80
  • Fidelis — Medicare: $1,120.50
  • Geisinger — Medicaid/CHIP: $18.68
  • Health Coalition Partners — Intergroup: $1,195.20
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OBSTETRICS PANEL $1,494 $896.40 $971.10 – $1,269.90
Obstetric blood test panel: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $1,045.80
  • Fidelis — Medicare: $1,120.50
  • Health Coalition Partners — Intergroup: $1,195.20
  • Health Payors Organization — Commercial: $1,269.90
  • Humana — Commercial: $1,269.90
  • InterGroup — Approved National Affiliated PPO Business: $1,269.90
  • InterGroup — InterGroup Services Corporation: $1,120.50
  • Multiplan — PPO: $1,195.20
  • Preferred Healthcare System — PPO: $971.10
  • Private Health Care Systems — PPO: $1,195.20
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PROFILE $1,200 $720 $13.24 – $1,020
Cholesterol panel (lipid panel): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $18.20
  • Aetna — Medicare: $14.73
  • Aetna of PA — Medicare: $14.73
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $22.15
  • AmeriHealth Caritas — Medicare: $14.46
  • Cigna Lifesource — Medicare Transplant: $14.46
  • Coventry/First Health — Commercial: $840
  • Fidelis — Medicare: $900
  • Geisinger — Medicaid/CHIP: $21.79
  • Health Coalition Partners — Intergroup: $960
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL W/RFX LDL $1,200 $720 $13.24 – $1,020
Cholesterol panel (lipid panel): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $18.20
  • Aetna — Medicare: $14.73
  • Aetna of PA — Medicare: $14.73
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $22.15
  • AmeriHealth Caritas — Medicare: $14.46
  • Cigna Lifesource — Medicare Transplant: $14.46
  • Coventry/First Health — Commercial: $840
  • Fidelis — Medicare: $900
  • Geisinger — Medicaid/CHIP: $21.79
  • Health Coalition Partners — Intergroup: $960
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CARDIO IQ LIPID PANEL $1,200 $720 $13.24 – $1,020
Cholesterol panel (lipid panel): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $18.20
  • Aetna — Medicare: $14.73
  • Aetna of PA — Medicare: $14.73
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $22.15
  • AmeriHealth Caritas — Medicare: $14.46
  • Cigna Lifesource — Medicare Transplant: $14.46
  • Coventry/First Health — Commercial: $840
  • Fidelis — Medicare: $900
  • Geisinger — Medicaid/CHIP: $21.79
  • Health Coalition Partners — Intergroup: $960
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL $707 $424.20 $8.58 – $600.95
Kidney function panel: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $12.48
  • Aetna — Medicare: $9.55
  • Aetna of PA — Medicare: $9.55
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $15.19
  • AmeriHealth Caritas — Medicare: $9.37
  • Cigna Lifesource — Medicare Transplant: $9.37
  • Coventry/First Health — Commercial: $494.90
  • Fidelis — Medicare: $530.25
  • Geisinger — Medicaid/CHIP: $14.94
  • Health Coalition Partners — Intergroup: $565.60
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL P1635 $707 $424.20 $8.58 – $600.95
Kidney function panel: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $12.48
  • Aetna — Medicare: $9.55
  • Aetna of PA — Medicare: $9.55
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $15.19
  • AmeriHealth Caritas — Medicare: $9.37
  • Cigna Lifesource — Medicare Transplant: $9.37
  • Coventry/First Health — Commercial: $494.90
  • Fidelis — Medicare: $530.25
  • Geisinger — Medicaid/CHIP: $14.94
  • Health Coalition Partners — Intergroup: $565.60
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL $707 $424.20 $459.55 – $600.95
Kidney function panel: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $494.90
  • Fidelis — Medicare: $530.25
  • Health Coalition Partners — Intergroup: $565.60
  • Health Payors Organization — Commercial: $600.95
  • Humana — Commercial: $600.95
  • InterGroup — Approved National Affiliated PPO Business: $600.95
  • InterGroup — InterGroup Services Corporation: $530.25
  • Multiplan — PPO: $565.60
  • Preferred Healthcare System — PPO: $459.55
  • Private Health Care Systems — PPO: $565.60
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL $727 $436.20 $8.08 – $617.95
Liver function panel: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $11.74
  • Aetna — Medicare: $8.99
  • Aetna of PA — Medicare: $8.99
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $14.29
  • AmeriHealth Caritas — Medicare: $8.82
  • Cigna Lifesource — Medicare Transplant: $8.82
  • Coventry/First Health — Commercial: $508.90
  • Fidelis — Medicare: $545.25
  • Geisinger — Medicaid/CHIP: $14.06
  • Health Coalition Partners — Intergroup: $581.60
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION - PANEL A $727 $436.20 $8.08 – $617.95
Liver function panel: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $11.74
  • Aetna — Medicare: $8.99
  • Aetna of PA — Medicare: $8.99
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $14.29
  • AmeriHealth Caritas — Medicare: $8.82
  • Cigna Lifesource — Medicare Transplant: $8.82
  • Coventry/First Health — Commercial: $508.90
  • Fidelis — Medicare: $545.25
  • Geisinger — Medicaid/CHIP: $14.06
  • Health Coalition Partners — Intergroup: $581.60
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNC PN PLASMA OR SER $727 $436.20 $8.08 – $617.95
Liver function panel: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $11.74
  • Aetna — Medicare: $8.99
  • Aetna of PA — Medicare: $8.99
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $14.29
  • AmeriHealth Caritas — Medicare: $8.82
  • Cigna Lifesource — Medicare Transplant: $8.82
  • Coventry/First Health — Commercial: $508.90
  • Fidelis — Medicare: $545.25
  • Geisinger — Medicaid/CHIP: $14.06
  • Health Coalition Partners — Intergroup: $581.60
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS R & M $781 $468.60 $3 – $663.85
Urine test (automated, with microscope): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $3.90
  • Aetna — Medicare: $3.49
  • Aetna of PA — Medicare: $3.49
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.75
  • AmeriHealth Caritas — Medicare: $3.42
  • Cigna Lifesource — Medicare Transplant: $3.42
  • Coventry/First Health — Commercial: $546.70
  • Fidelis — Medicare: $585.75
  • Geisinger — Medicaid/CHIP: $4.67
  • Health Coalition Partners — Intergroup: $624.80
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UR COMPL W/REFLEX TO CULTURE $781 $468.60 $3 – $663.85
Urine test (automated, with microscope): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $3.90
  • Aetna — Medicare: $3.49
  • Aetna of PA — Medicare: $3.49
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.75
  • AmeriHealth Caritas — Medicare: $3.42
  • Cigna Lifesource — Medicare Transplant: $3.42
  • Coventry/First Health — Commercial: $546.70
  • Fidelis — Medicare: $585.75
  • Geisinger — Medicaid/CHIP: $4.67
  • Health Coalition Partners — Intergroup: $624.80
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS R & M $781 $468.60 $507.65 – $663.85
Urine test (automated, with microscope): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $546.70
  • Fidelis — Medicare: $585.75
  • Health Coalition Partners — Intergroup: $624.80
  • Health Payors Organization — Commercial: $663.85
  • Humana — Commercial: $663.85
  • InterGroup — Approved National Affiliated PPO Business: $663.85
  • InterGroup — InterGroup Services Corporation: $585.75
  • Multiplan — PPO: $624.80
  • Preferred Healthcare System — PPO: $507.65
  • Private Health Care Systems — PPO: $624.80
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS DIPSTICK $36 $21.60 $3.44 – $31.24
Urine test (manual, without microscope): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $4.64
  • Aetna — Medicare: $3.83
  • Aetna of PA — Medicare: $3.83
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $5.65
  • AmeriHealth Caritas — Medicare: $3.76
  • Cigna Lifesource — Medicare Transplant: $3.76
  • Coventry/First Health — Commercial: $25.20
  • Fidelis — Medicare: $27
  • Geisinger — Medicaid/CHIP: $5.56
  • Health Coalition Partners — Intergroup: $28.80
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINANALYSIS DIPSTICK WO MICRO $36 $21.60 $3.44 – $31.24
Urine test (manual, without microscope): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $4.64
  • Aetna — Medicare: $3.83
  • Aetna of PA — Medicare: $3.83
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $5.65
  • AmeriHealth Caritas — Medicare: $3.76
  • Cigna Lifesource — Medicare Transplant: $3.76
  • Coventry/First Health — Commercial: $25.20
  • Fidelis — Medicare: $27
  • Geisinger — Medicaid/CHIP: $5.56
  • Health Coalition Partners — Intergroup: $28.80
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NON AUTOMATED W/O MICRO P3632 $36 $21.60 $3.44 – $31.24
Urine test (manual, without microscope): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $4.64
  • Aetna — Medicare: $3.83
  • Aetna of PA — Medicare: $3.83
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $5.65
  • AmeriHealth Caritas — Medicare: $3.76
  • Cigna Lifesource — Medicare Transplant: $3.76
  • Coventry/First Health — Commercial: $25.20
  • Fidelis — Medicare: $27
  • Geisinger — Medicaid/CHIP: $5.56
  • Health Coalition Partners — Intergroup: $28.80
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PH URINE-C $82 $49.20 $2.22 – $69.70
Urine test (automated, without microscope): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $4.03
  • Aetna — Medicare: $2.48
  • Aetna of PA — Medicare: $2.48
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.91
  • AmeriHealth Caritas — Medicare: $2.43
  • Cigna Lifesource — Medicare Transplant: $2.43
  • Coventry/First Health — Commercial: $57.40
  • Fidelis — Medicare: $61.50
  • Geisinger — Medicaid/CHIP: $4.83
  • Health Coalition Partners — Intergroup: $65.60
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SPECIFIC GRAVITY URINE-C $82 $49.20 $2.22 – $69.70
Urine test (automated, without microscope): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $4.03
  • Aetna — Medicare: $2.48
  • Aetna of PA — Medicare: $2.48
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.91
  • AmeriHealth Caritas — Medicare: $2.43
  • Cigna Lifesource — Medicare Transplant: $2.43
  • Coventry/First Health — Commercial: $57.40
  • Fidelis — Medicare: $61.50
  • Geisinger — Medicaid/CHIP: $4.83
  • Health Coalition Partners — Intergroup: $65.60
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINE MACRO $82 $49.20 $2.22 – $69.70
Urine test (automated, without microscope): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $4.03
  • Aetna — Medicare: $2.48
  • Aetna of PA — Medicare: $2.48
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.91
  • AmeriHealth Caritas — Medicare: $2.43
  • Cigna Lifesource — Medicare Transplant: $2.43
  • Coventry/First Health — Commercial: $57.40
  • Fidelis — Medicare: $61.50
  • Geisinger — Medicaid/CHIP: $4.83
  • Health Coalition Partners — Intergroup: $65.60
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA DIAGNOSTIC $719 $431.40 $18.17 – $611.15
PSA (prostate specific antigen) blood test: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $31.67
  • Aetna — Medicare: $20.23
  • Aetna of PA — Medicare: $20.23
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $38.55
  • AmeriHealth Caritas — Medicare: $19.86
  • Cigna Lifesource — Medicare Transplant: $19.86
  • Coventry/First Health — Commercial: $503.30
  • Fidelis — Medicare: $539.25
  • Geisinger — Medicaid/CHIP: $37.92
  • Health Coalition Partners — Intergroup: $575.20
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL PSA PNL 2770 $719 $431.40 $18.17 – $611.15
PSA (prostate specific antigen) blood test: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $31.67
  • Aetna — Medicare: $20.23
  • Aetna of PA — Medicare: $20.23
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $38.55
  • AmeriHealth Caritas — Medicare: $19.86
  • Cigna Lifesource — Medicare Transplant: $19.86
  • Coventry/First Health — Commercial: $503.30
  • Fidelis — Medicare: $539.25
  • Geisinger — Medicaid/CHIP: $37.92
  • Health Coalition Partners — Intergroup: $575.20
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSA ULTRA-SENSITIVE $719 $431.40 $18.17 – $611.15
PSA (prostate specific antigen) blood test: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $31.67
  • Aetna — Medicare: $20.23
  • Aetna of PA — Medicare: $20.23
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $38.55
  • AmeriHealth Caritas — Medicare: $19.86
  • Cigna Lifesource — Medicare Transplant: $19.86
  • Coventry/First Health — Commercial: $503.30
  • Fidelis — Medicare: $539.25
  • Geisinger — Medicaid/CHIP: $37.92
  • Health Coalition Partners — Intergroup: $575.20
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH THIRD GENERATION $158 $94.80 $16.60 – $145.94
Thyroid stimulating hormone (TSH) test: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $30.17
  • Aetna — Medicare: $18.48
  • Aetna of PA — Medicare: $18.48
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $36.73
  • AmeriHealth Caritas — Medicare: $18.14
  • Cigna Lifesource — Medicare Transplant: $18.14
  • Coventry/First Health — Commercial: $110.60
  • Fidelis — Medicare: $118.50
  • Geisinger — Medicaid/CHIP: $36.13
  • Health Coalition Partners — Intergroup: $126.40
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH W/FREE T4 RFX $364 $218.40 $16.60 – $309.40
Thyroid stimulating hormone (TSH) test: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $30.17
  • Aetna — Medicare: $18.48
  • Aetna of PA — Medicare: $18.48
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $36.73
  • AmeriHealth Caritas — Medicare: $18.14
  • Cigna Lifesource — Medicare Transplant: $18.14
  • Coventry/First Health — Commercial: $254.80
  • Fidelis — Medicare: $273
  • Geisinger — Medicaid/CHIP: $36.13
  • Health Coalition Partners — Intergroup: $291.20
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THYROID STIMULATING HORMONE $364 $218.40 $16.60 – $309.40
Thyroid stimulating hormone (TSH) test: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $30.17
  • Aetna — Medicare: $18.48
  • Aetna of PA — Medicare: $18.48
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $36.73
  • AmeriHealth Caritas — Medicare: $18.14
  • Cigna Lifesource — Medicare Transplant: $18.14
  • Coventry/First Health — Commercial: $254.80
  • Fidelis — Medicare: $273
  • Geisinger — Medicaid/CHIP: $36.13
  • Health Coalition Partners — Intergroup: $291.20
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC & PLT & AUTO COMP DIFF $402 $241.20 $6 – $341.70
Complete blood count (CBC) with differential: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $7.80
  • Aetna — Medicare: $8.55
  • Aetna of PA — Medicare: $8.55
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $9.49
  • AmeriHealth Caritas — Medicare: $8.39
  • Cigna Lifesource — Medicare Transplant: $8.39
  • Coventry/First Health — Commercial: $281.40
  • Fidelis — Medicare: $301.50
  • Geisinger — Medicaid/CHIP: $9.34
  • Health Coalition Partners — Intergroup: $321.60
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC W/DIFF & PLATELETS $402 $241.20 $6 – $341.70
Complete blood count (CBC) with differential: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $7.80
  • Aetna — Medicare: $8.55
  • Aetna of PA — Medicare: $8.55
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $9.49
  • AmeriHealth Caritas — Medicare: $8.39
  • Cigna Lifesource — Medicare Transplant: $8.39
  • Coventry/First Health — Commercial: $281.40
  • Fidelis — Medicare: $301.50
  • Geisinger — Medicaid/CHIP: $9.34
  • Health Coalition Partners — Intergroup: $321.60
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OXLDL $402 $241.20 $6 – $341.70
Complete blood count (CBC) with differential: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $7.80
  • Aetna — Medicare: $8.55
  • Aetna of PA — Medicare: $8.55
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $9.49
  • AmeriHealth Caritas — Medicare: $8.39
  • Cigna Lifesource — Medicare Transplant: $8.39
  • Coventry/First Health — Commercial: $281.40
  • Fidelis — Medicare: $301.50
  • Geisinger — Medicaid/CHIP: $9.34
  • Health Coalition Partners — Intergroup: $321.60
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CBC & PLT ONLY $350 $210 $6.39 – $297.50
Complete blood count (CBC), automated: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $9.78
  • Aetna — Medicare: $7.12
  • Aetna of PA — Medicare: $7.12
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $11.90
  • AmeriHealth Caritas — Medicare: $6.99
  • Cigna Lifesource — Medicare Transplant: $6.99
  • Coventry/First Health — Commercial: $245
  • Fidelis — Medicare: $262.50
  • Geisinger — Medicaid/CHIP: $11.71
  • Health Coalition Partners — Intergroup: $280
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CBC & PLT ONLY $350 $210 $227.50 – $297.50
Complete blood count (CBC), automated: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $245
  • Fidelis — Medicare: $262.50
  • Health Coalition Partners — Intergroup: $280
  • Health Payors Organization — Commercial: $297.50
  • Humana — Commercial: $297.50
  • InterGroup — Approved National Affiliated PPO Business: $297.50
  • InterGroup — InterGroup Services Corporation: $262.50
  • Multiplan — PPO: $280
  • Preferred Healthcare System — PPO: $227.50
  • Private Health Care Systems — PPO: $280
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME P0070 $514 $308.40 $3.80 – $436.90
Blood clotting time test (prothrombin time, PT): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $5.20
  • Aetna — Medicare: $4.72
  • Aetna of PA — Medicare: $4.72
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $6.33
  • AmeriHealth Caritas — Medicare: $4.63
  • Cigna Lifesource — Medicare Transplant: $4.63
  • Coventry/First Health — Commercial: $359.80
  • Fidelis — Medicare: $385.50
  • Geisinger — Medicaid/CHIP: $6.23
  • Health Coalition Partners — Intergroup: $411.20
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT PROTHROMBIN TIME $514 $308.40 $3.80 – $436.90
Blood clotting time test (prothrombin time, PT): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $5.20
  • Aetna — Medicare: $4.72
  • Aetna of PA — Medicare: $4.72
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $6.33
  • AmeriHealth Caritas — Medicare: $4.63
  • Cigna Lifesource — Medicare Transplant: $4.63
  • Coventry/First Health — Commercial: $359.80
  • Fidelis — Medicare: $385.50
  • Geisinger — Medicaid/CHIP: $6.23
  • Health Coalition Partners — Intergroup: $411.20
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME PNL 2848 $514 $308.40 $3.80 – $436.90
Blood clotting time test (prothrombin time, PT): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $5.20
  • Aetna — Medicare: $4.72
  • Aetna of PA — Medicare: $4.72
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $6.33
  • AmeriHealth Caritas — Medicare: $4.63
  • Cigna Lifesource — Medicare Transplant: $4.63
  • Coventry/First Health — Commercial: $359.80
  • Fidelis — Medicare: $385.50
  • Geisinger — Medicaid/CHIP: $6.23
  • Health Coalition Partners — Intergroup: $411.20
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBO TIME PTT P0070 $502 $301.20 $5.94 – $426.70
Blood clotting test (partial thromboplastin time, PTT): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $9.75
  • Aetna — Medicare: $6.61
  • Aetna of PA — Medicare: $6.61
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $11.87
  • AmeriHealth Caritas — Medicare: $6.49
  • Cigna Lifesource — Medicare Transplant: $6.49
  • Coventry/First Health — Commercial: $351.40
  • Fidelis — Medicare: $376.50
  • Geisinger — Medicaid/CHIP: $11.68
  • Health Coalition Partners — Intergroup: $401.60
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PTT ACTIVATED $502 $301.20 $5.94 – $426.70
Blood clotting test (partial thromboplastin time, PTT): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $9.75
  • Aetna — Medicare: $6.61
  • Aetna of PA — Medicare: $6.61
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $11.87
  • AmeriHealth Caritas — Medicare: $6.49
  • Cigna Lifesource — Medicare Transplant: $6.49
  • Coventry/First Health — Commercial: $351.40
  • Fidelis — Medicare: $376.50
  • Geisinger — Medicaid/CHIP: $11.68
  • Health Coalition Partners — Intergroup: $401.60
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ACTIVATED PTT $502 $301.20 $5.94 – $426.70
Blood clotting test (partial thromboplastin time, PTT): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $9.75
  • Aetna — Medicare: $6.61
  • Aetna of PA — Medicare: $6.61
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $11.87
  • AmeriHealth Caritas — Medicare: $6.49
  • Cigna Lifesource — Medicare Transplant: $6.49
  • Coventry/First Health — Commercial: $351.40
  • Fidelis — Medicare: $376.50
  • Geisinger — Medicaid/CHIP: $11.68
  • Health Coalition Partners — Intergroup: $401.60

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

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT HEAD WO CONTRAST $4,895 $2,937 $93 – $4,160.75
CT scan of the head or brain, without contrast: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $151.78
  • Aetna — Medicare: $111.52
  • Aetna of PA — Medicare: $111.52
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $184.75
  • AmeriHealth Caritas — Medicare: $109.49
  • Cigna Lifesource — Medicare Transplant: $109.49
  • Coventry/First Health — Commercial: $3,426.50
  • Fidelis — Medicare: $3,671.25
  • Geisinger — Medicaid/CHIP: $181.74
  • Health Coalition Partners — Intergroup: $3,916
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT HEAD WO CONTRAST $4,895 $2,937 $3,181.75 – $4,160.75
CT scan of the head or brain, without contrast: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $3,426.50
  • Fidelis — Medicare: $3,671.25
  • Health Coalition Partners — Intergroup: $3,916
  • Health Payors Organization — Commercial: $4,160.75
  • Humana — Commercial: $4,160.75
  • InterGroup — Approved National Affiliated PPO Business: $4,160.75
  • InterGroup — InterGroup Services Corporation: $3,671.25
  • Multiplan — PPO: $3,916
  • Preferred Healthcare System — PPO: $3,181.75
  • Private Health Care Systems — PPO: $3,916
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: CT HEAD WO CONTRAST $4,895 $2,937 $93 – $4,160.75
CT scan of the head or brain, without contrast: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $151.78
  • Aetna — Medicare: $1,223.75
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $184.75
  • Coventry/First Health — Commercial: $3,426.50
  • Fidelis — Medicare: $3,671.25
  • Geisinger — Medicaid/CHIP: $181.74
  • Health Coalition Partners — Intergroup: $3,916
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $176.06
  • Health Payors Organization — Commercial: $4,160.75
  • Highmark BCBS of PA — Commercial - Indemnity: $1,627.73
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR BRAIN W WO CON $16,347 $9,808.20 $322.80 – $13,894.95
MRI of the brain, before and after contrast: 10 of 36 insurance plan rates
  • Aetna — CHIP/Medicaid: $440.70
  • Aetna — Medicare: $374.53
  • Aetna of PA — Medicare: $374.53
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $536.43
  • AmeriHealth Caritas — Medicare: $367.72
  • Cigna Lifesource — Medicare Transplant: $367.72
  • Coventry/First Health — Commercial: $11,442.90
  • Fidelis — Medicare: $12,260.25
  • Geisinger — Medicaid/CHIP: $527.72
  • Health Coalition Partners — Intergroup: $13,077.60
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR BRAIN WWO CON DONE IN PET $16,347 $9,808.20 $322.80 – $13,894.95
MRI of the brain, before and after contrast: 10 of 36 insurance plan rates
  • Aetna — CHIP/Medicaid: $440.70
  • Aetna — Medicare: $374.53
  • Aetna of PA — Medicare: $374.53
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $536.43
  • AmeriHealth Caritas — Medicare: $367.72
  • Cigna Lifesource — Medicare Transplant: $367.72
  • Coventry/First Health — Commercial: $11,442.90
  • Fidelis — Medicare: $12,260.25
  • Geisinger — Medicaid/CHIP: $527.72
  • Health Coalition Partners — Intergroup: $13,077.60
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MR BRAIN W WO CON $16,347 $9,808.20 $10,625.55 – $13,894.95
MRI of the brain, before and after contrast: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $11,442.90
  • Fidelis — Medicare: $12,260.25
  • Health Coalition Partners — Intergroup: $13,077.60
  • Health Payors Organization — Commercial: $13,894.95
  • Humana — Commercial: $13,894.95
  • InterGroup — Approved National Affiliated PPO Business: $13,894.95
  • InterGroup — InterGroup Services Corporation: $12,260.25
  • Multiplan — PPO: $13,077.60
  • Preferred Healthcare System — PPO: $10,625.55
  • Private Health Care Systems — PPO: $13,077.60
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CHEST 2 VIEWS $1,144 $686.40 $11.90 – $972.40
Chest X-ray, 2 views: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $30.73
  • Aetna — Medicare: $92.34
  • Aetna of PA — Medicare: $92.34
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $37.41
  • AmeriHealth Caritas — Medicare: $90.67
  • Cigna Lifesource — Medicare Transplant: $90.67
  • Coventry/First Health — Commercial: $800.80
  • Fidelis — Medicare: $858
  • Geisinger — Medicaid/CHIP: $36.80
  • Health Coalition Partners — Intergroup: $915.20
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CHEST 2 VIEWS $1,144 $686.40 $743.60 – $972.40
Chest X-ray, 2 views: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $800.80
  • Fidelis — Medicare: $858
  • Health Coalition Partners — Intergroup: $915.20
  • Health Payors Organization — Commercial: $972.40
  • Humana — Commercial: $972.40
  • InterGroup — Approved National Affiliated PPO Business: $972.40
  • InterGroup — InterGroup Services Corporation: $858
  • Multiplan — PPO: $915.20
  • Preferred Healthcare System — PPO: $743.60
  • Private Health Care Systems — PPO: $915.20
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PN In the file: CHEST 2 VIEWS $1,144 $686.40 $11.90 – $972.40
Chest X-ray, 2 views: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $30.73
  • Aetna — Medicare: $286
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $37.41
  • Coventry/First Health — Commercial: $800.80
  • Fidelis — Medicare: $858
  • Geisinger — Medicaid/CHIP: $36.80
  • Health Coalition Partners — Intergroup: $915.20
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $35.65
  • Health Payors Organization — Commercial: $972.40
  • Highmark BCBS of PA — Commercial - Indemnity: $74.50
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SPINE LUMBOSAC MIN 4 VWS $1,924 $1,154.40 $27 – $1,635.40
X-ray of the lower spine, at least 4 views: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $47.61
  • Aetna — Medicare: $111.52
  • Aetna of PA — Medicare: $111.52
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $57.95
  • AmeriHealth Caritas — Medicare: $109.49
  • Cigna Lifesource — Medicare Transplant: $109.49
  • Coventry/First Health — Commercial: $1,346.80
  • Fidelis — Medicare: $1,443
  • Geisinger — Medicaid/CHIP: $57.01
  • Health Coalition Partners — Intergroup: $1,539.20
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: SPINE LUMBOSAC MIN 4 VWS $1,924 $1,154.40 $1,250.60 – $1,635.40
X-ray of the lower spine, at least 4 views: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $1,346.80
  • Fidelis — Medicare: $1,443
  • Health Coalition Partners — Intergroup: $1,539.20
  • Health Payors Organization — Commercial: $1,635.40
  • Humana — Commercial: $1,635.40
  • InterGroup — Approved National Affiliated PPO Business: $1,635.40
  • InterGroup — InterGroup Services Corporation: $1,443
  • Multiplan — PPO: $1,539.20
  • Preferred Healthcare System — PPO: $1,250.60
  • Private Health Care Systems — PPO: $1,539.20
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: SPINE LUMBOSAC MIN 4 VWS $1,924 $1,154.40 $27 – $1,635.40
X-ray of the lower spine, at least 4 views: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $47.61
  • Aetna — Medicare: $481
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $57.95
  • Coventry/First Health — Commercial: $1,346.80
  • Fidelis — Medicare: $1,443
  • Geisinger — Medicaid/CHIP: $57.01
  • Health Coalition Partners — Intergroup: $1,539.20
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $55.22
  • Health Payors Organization — Commercial: $1,635.40
  • Highmark BCBS of PA — Commercial - Indemnity: $369.19
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR SP CANAL LUMBAR WO $10,357 $6,214.20 $224.64 – $8,803.45
MRI of the lower back (lumbar spine), without contrast: 10 of 36 insurance plan rates
  • Aetna — CHIP/Medicaid: $333
  • Aetna — Medicare: $253.50
  • Aetna of PA — Medicare: $253.50
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $405.33
  • AmeriHealth Caritas — Medicare: $248.89
  • Cigna Lifesource — Medicare Transplant: $248.89
  • Coventry/First Health — Commercial: $7,249.90
  • Fidelis — Medicare: $7,767.75
  • Geisinger — Medicaid/CHIP: $398.75
  • Health Coalition Partners — Intergroup: $8,285.60
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MR SP CANAL LUMBAR WO $10,357 $6,214.20 $6,732.05 – $8,803.45
MRI of the lower back (lumbar spine), without contrast: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $7,249.90
  • Fidelis — Medicare: $7,767.75
  • Health Coalition Partners — Intergroup: $8,285.60
  • Health Payors Organization — Commercial: $8,803.45
  • Humana — Commercial: $8,803.45
  • InterGroup — Approved National Affiliated PPO Business: $8,803.45
  • InterGroup — InterGroup Services Corporation: $7,767.75
  • Multiplan — PPO: $8,285.60
  • Preferred Healthcare System — PPO: $6,732.05
  • Private Health Care Systems — PPO: $8,285.60
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: MR SP CANAL LUMBAR WO $10,357 $6,214.20 $224.64 – $8,803.45
MRI of the lower back (lumbar spine), without contrast: 10 of 31 insurance plan rates
  • Aetna — CHIP/Medicaid: $333
  • Aetna — Medicare: $2,589.25
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $405.33
  • Coventry/First Health — Commercial: $7,249.90
  • Fidelis — Medicare: $7,767.75
  • Geisinger — Medicaid/CHIP: $398.75
  • Health Coalition Partners — Intergroup: $8,285.60
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $386.27
  • Health Payors Organization — Commercial: $8,803.45
  • Highmark BCBS of PA — Commercial - Indemnity: $3,915.92
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT PELVIS W CON $7,666 $4,599.60 $103.80 – $6,516.10
CT scan of the pelvis, with contrast: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $182.12
  • Aetna — Medicare: $186.69
  • Aetna of PA — Medicare: $186.69
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $221.68
  • AmeriHealth Caritas — Medicare: $183.30
  • Cigna Lifesource — Medicare Transplant: $183.30
  • Coventry/First Health — Commercial: $5,366.20
  • Fidelis — Medicare: $5,749.50
  • Geisinger — Medicaid/CHIP: $218.08
  • Health Coalition Partners — Intergroup: $6,132.80
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT PELVIS W CON $7,666 $4,599.60 $4,982.90 – $6,516.10
CT scan of the pelvis, with contrast: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $5,366.20
  • Fidelis — Medicare: $5,749.50
  • Health Coalition Partners — Intergroup: $6,132.80
  • Health Payors Organization — Commercial: $6,516.10
  • Humana — Commercial: $6,516.10
  • InterGroup — Approved National Affiliated PPO Business: $6,516.10
  • InterGroup — InterGroup Services Corporation: $5,749.50
  • Multiplan — PPO: $6,132.80
  • Preferred Healthcare System — PPO: $4,982.90
  • Private Health Care Systems — PPO: $6,132.80
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: CT PELVIS W CON $7,666 $4,599.60 $103.80 – $6,516.10
CT scan of the pelvis, with contrast: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $182.12
  • Aetna — Medicare: $1,916.50
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $221.68
  • Coventry/First Health — Commercial: $5,366.20
  • Fidelis — Medicare: $5,749.50
  • Geisinger — Medicaid/CHIP: $218.08
  • Health Coalition Partners — Intergroup: $6,132.80
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $211.26
  • Health Payors Organization — Commercial: $6,516.10
  • Highmark BCBS of PA — Commercial - Indemnity: $2,289.72
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MR LOW EXTREM ANY JNT WO $10,357 $6,214.20 $248.89 – $8,803.45
MRI of a leg joint (such as the knee), without contrast: 10 of 31 insurance plan rates
  • Aetna — CHIP/Medicaid: $1,864.26
  • Aetna — Medicare: $253.50
  • Aetna of PA — Medicare: $253.50
  • AmeriHealth Caritas — Medicare: $248.89
  • Cigna Lifesource — Medicare Transplant: $248.89
  • Coventry/First Health — Commercial: $7,249.90
  • Fidelis — Medicare: $7,767.75
  • Geisinger — Medicaid/CHIP: $5,696.35
  • Health Coalition Partners — Intergroup: $8,285.60
  • Health Payors Organization — Commercial: $8,803.45
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MR LOW EXTREM ANY JNT WO $10,357 $6,214.20 $6,732.05 – $8,803.45
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $7,249.90
  • Fidelis — Medicare: $7,767.75
  • Health Coalition Partners — Intergroup: $8,285.60
  • Health Payors Organization — Commercial: $8,803.45
  • Humana — Commercial: $8,803.45
  • InterGroup — Approved National Affiliated PPO Business: $8,803.45
  • InterGroup — InterGroup Services Corporation: $7,767.75
  • Multiplan — PPO: $8,285.60
  • Preferred Healthcare System — PPO: $6,732.05
  • Private Health Care Systems — PPO: $8,285.60
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: MR LOW EXTREM ANY JNT WO $10,357 $6,214.20 $322.80 – $8,803.45
MRI of a leg joint (such as the knee), without contrast: 10 of 26 insurance plan rates
  • Aetna — CHIP/Medicaid: $1,864.26
  • Aetna — Medicare: $2,589.25
  • Coventry/First Health — Commercial: $7,249.90
  • Fidelis — Medicare: $7,767.75
  • Geisinger — Medicaid/CHIP: $5,696.35
  • Health Coalition Partners — Intergroup: $8,285.60
  • Health Payors Organization — Commercial: $8,803.45
  • Highmark BCBS of PA — Commercial - Indemnity: $3,376.01
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $2,520.83
  • Highmark BCBS of PA — Managed Care: $1,789.75
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT ABD & PLVS W CONTRAST $14,808 $8,884.80 $231.28 – $12,586.80
CT scan of the abdomen and pelvis, with contrast: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $342.11
  • Aetna — Medicare: $374.53
  • Aetna of PA — Medicare: $374.53
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $416.42
  • AmeriHealth Caritas — Medicare: $367.72
  • Cigna Lifesource — Medicare Transplant: $367.72
  • Coventry/First Health — Commercial: $10,365.60
  • Fidelis — Medicare: $11,106
  • Geisinger — Medicaid/CHIP: $409.66
  • Health Coalition Partners — Intergroup: $11,846.40
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT ABD & PLVS W CONTRAST $14,808 $8,884.80 $9,625.20 – $12,586.80
CT scan of the abdomen and pelvis, with contrast: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $10,365.60
  • Fidelis — Medicare: $11,106
  • Health Coalition Partners — Intergroup: $11,846.40
  • Health Payors Organization — Commercial: $12,586.80
  • Humana — Commercial: $12,586.80
  • InterGroup — Approved National Affiliated PPO Business: $12,586.80
  • InterGroup — InterGroup Services Corporation: $11,106
  • Multiplan — PPO: $11,846.40
  • Preferred Healthcare System — PPO: $9,625.20
  • Private Health Care Systems — PPO: $11,846.40
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: CT ABD & PLVS W CONTRAST $14,808 $8,884.80 $231.28 – $12,586.80
CT scan of the abdomen and pelvis, with contrast: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $342.11
  • Aetna — Medicare: $3,702
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $416.42
  • Coventry/First Health — Commercial: $10,365.60
  • Fidelis — Medicare: $11,106
  • Geisinger — Medicaid/CHIP: $409.66
  • Health Coalition Partners — Intergroup: $11,846.40
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $396.85
  • Health Payors Organization — Commercial: $12,586.80
  • Highmark BCBS of PA — Commercial - Indemnity: $3,468.13
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US ABDOMINAL COMPLETE $2,124 $1,274.40 $69 – $1,805.40
Ultrasound of the abdomen, complete: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $123.85
  • Aetna — Medicare: $111.52
  • Aetna of PA — Medicare: $111.52
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $150.76
  • AmeriHealth Caritas — Medicare: $109.49
  • Cigna Lifesource — Medicare Transplant: $109.49
  • Coventry/First Health — Commercial: $1,486.80
  • Fidelis — Medicare: $1,593
  • Geisinger — Medicaid/CHIP: $148.31
  • Health Coalition Partners — Intergroup: $1,699.20
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US ABDOMINAL COMPLETE $2,124 $1,274.40 $1,380.60 – $1,805.40
Ultrasound of the abdomen, complete: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $1,486.80
  • Fidelis — Medicare: $1,593
  • Health Coalition Partners — Intergroup: $1,699.20
  • Health Payors Organization — Commercial: $1,805.40
  • Humana — Commercial: $1,805.40
  • InterGroup — Approved National Affiliated PPO Business: $1,805.40
  • InterGroup — InterGroup Services Corporation: $1,593
  • Multiplan — PPO: $1,699.20
  • Preferred Healthcare System — PPO: $1,380.60
  • Private Health Care Systems — PPO: $1,699.20
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: US ABDOMINAL COMPLETE $2,124 $1,274.40 $69 – $1,805.40
Ultrasound of the abdomen, complete: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $123.85
  • Aetna — Medicare: $531
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $150.76
  • Coventry/First Health — Commercial: $1,486.80
  • Fidelis — Medicare: $1,593
  • Geisinger — Medicaid/CHIP: $148.31
  • Health Coalition Partners — Intergroup: $1,699.20
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $143.67
  • Health Payors Organization — Commercial: $1,805.40
  • Highmark BCBS of PA — Commercial - Indemnity: $850.23
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US PREGNANT UTERUS>14WKS $3,033 $1,819.80 $55.80 – $2,578.05
Pregnancy ultrasound (after the first trimester): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $100.75
  • Aetna — Medicare: $111.52
  • Aetna of PA — Medicare: $111.52
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $122.64
  • AmeriHealth Caritas — Medicare: $109.49
  • Cigna Lifesource — Medicare Transplant: $109.49
  • Coventry/First Health — Commercial: $2,123.10
  • Fidelis — Medicare: $2,274.75
  • Geisinger — Medicaid/CHIP: $120.64
  • Health Coalition Partners — Intergroup: $2,426.40
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US PREGNANT UTERUS>14WKS $3,033 $1,819.80 $1,971.45 – $2,578.05
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $2,123.10
  • Fidelis — Medicare: $2,274.75
  • Health Coalition Partners — Intergroup: $2,426.40
  • Health Payors Organization — Commercial: $2,578.05
  • Humana — Commercial: $2,578.05
  • InterGroup — Approved National Affiliated PPO Business: $2,578.05
  • InterGroup — InterGroup Services Corporation: $2,274.75
  • Multiplan — PPO: $2,426.40
  • Preferred Healthcare System — PPO: $1,971.45
  • Private Health Care Systems — PPO: $2,426.40
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US TRANSVAGINAL $3,855 $2,313 $55.80 – $3,276.75
Transvaginal ultrasound: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $99.45
  • Aetna — Medicare: $111.52
  • Aetna of PA — Medicare: $111.52
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $121.05
  • AmeriHealth Caritas — Medicare: $109.49
  • Cigna Lifesource — Medicare Transplant: $109.49
  • Coventry/First Health — Commercial: $2,698.50
  • Fidelis — Medicare: $2,891.25
  • Geisinger — Medicaid/CHIP: $119.09
  • Health Coalition Partners — Intergroup: $3,084
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US TRANSVAGINAL $3,855 $2,313 $2,505.75 – $3,276.75
Transvaginal ultrasound: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $2,698.50
  • Fidelis — Medicare: $2,891.25
  • Health Coalition Partners — Intergroup: $3,084
  • Health Payors Organization — Commercial: $3,276.75
  • Humana — Commercial: $3,276.75
  • InterGroup — Approved National Affiliated PPO Business: $3,276.75
  • InterGroup — InterGroup Services Corporation: $2,891.25
  • Multiplan — PPO: $3,084
  • Preferred Healthcare System — PPO: $2,505.75
  • Private Health Care Systems — PPO: $3,084
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: US TRANSVAGINAL $3,855 $2,313 $55.80 – $3,276.75
Transvaginal ultrasound: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $99.45
  • Aetna — Medicare: $963.75
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $121.05
  • Coventry/First Health — Commercial: $2,698.50
  • Fidelis — Medicare: $2,891.25
  • Geisinger — Medicaid/CHIP: $119.09
  • Health Coalition Partners — Intergroup: $3,084
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $115.36
  • Health Payors Organization — Commercial: $3,276.75
  • Highmark BCBS of PA — Commercial - Indemnity: $688.08
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MAMMO DIGITAL DX UNI WWO CAD $905 $543 $58.27 – $769.25
Diagnostic mammogram, one breast: 10 of 28 insurance plan rates
  • Aetna — CHIP/Medicaid: $133.13
  • Aetna — Medicare: $226.25
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $162.05
  • Coventry/First Health — Commercial: $633.50
  • Fidelis — Medicare: $678.75
  • Geisinger — Medicaid/CHIP: $159.42
  • Health Coalition Partners — Intergroup: $724
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $154.43
  • Health Payors Organization — Commercial: $769.25
  • Highmark BCBS of PA — Commercial - Indemnity: $364.84
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAMMO DIGITAL DX UNI WWO CAD $905 $543 $588.25 – $769.25
Diagnostic mammogram, one breast: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $633.50
  • Fidelis — Medicare: $678.75
  • Health Coalition Partners — Intergroup: $724
  • Health Payors Organization — Commercial: $769.25
  • Humana — Commercial: $769.25
  • InterGroup — Approved National Affiliated PPO Business: $769.25
  • InterGroup — InterGroup Services Corporation: $678.75
  • Multiplan — PPO: $724
  • Preferred Healthcare System — PPO: $588.25
  • Private Health Care Systems — PPO: $724

Heart tests and sleep study

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HRT CATH W VENTRCLGRPHY $19,097 $11,458.20 $931.20 – $16,232.45
Left heart catheterization (diagnostic): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $3,437.46
  • Aetna — Medicare: $3,373.11
  • Aetna of PA — Medicare: $3,373.11
  • AmeriHealth Caritas — Medicare: $3,311.78
  • Cigna Lifesource — Medicare Transplant: $3,311.78
  • Coventry/First Health — Commercial: $13,367.90
  • Fidelis — Medicare: $14,322.75
  • Geisinger — Medicaid/CHIP: $10,503.35
  • Health Coalition Partners — Intergroup: $15,277.60
  • Health Payors Organization — Commercial: $16,232.45
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LEFT HRT CATH W VENTRCLGRPHY $19,097 $11,458.20 $12,413.05 – $16,232.45
Left heart catheterization (diagnostic): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $13,367.90
  • Fidelis — Medicare: $14,322.75
  • Health Coalition Partners — Intergroup: $15,277.60
  • Health Payors Organization — Commercial: $16,232.45
  • Humana — Commercial: $16,232.45
  • InterGroup — Approved National Affiliated PPO Business: $16,232.45
  • InterGroup — InterGroup Services Corporation: $14,322.75
  • Multiplan — PPO: $15,277.60
  • Preferred Healthcare System — PPO: $12,413.05
  • Private Health Care Systems — PPO: $15,277.60
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPRE EP EVAL WO INDUCTION $15,146 $9,087.60 $730.54 – $12,874.10
Heart rhythm study (electrophysiology evaluation): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $2,726.28
  • Aetna — Medicare: $7,957.77
  • Aetna of PA — Medicare: $7,957.77
  • AmeriHealth Caritas — Medicare: $7,813.09
  • Cigna Lifesource — Medicare Transplant: $7,813.09
  • Coventry/First Health — Commercial: $10,602.20
  • Fidelis — Medicare: $11,359.50
  • Geisinger — Medicaid/CHIP: $8,330.30
  • Health Coalition Partners — Intergroup: $12,116.80
  • Health Payors Organization — Commercial: $12,874.10
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPRE EP EVAL WO INDUCTION $15,146 $9,087.60 $9,844.90 – $12,874.10
Heart rhythm study (electrophysiology evaluation): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $10,602.20
  • Fidelis — Medicare: $11,359.50
  • Health Coalition Partners — Intergroup: $12,116.80
  • Health Payors Organization — Commercial: $12,874.10
  • Humana — Commercial: $12,874.10
  • InterGroup — Approved National Affiliated PPO Business: $12,874.10
  • InterGroup — InterGroup Services Corporation: $11,359.50
  • Multiplan — PPO: $12,116.80
  • Preferred Healthcare System — PPO: $9,844.90
  • Private Health Care Systems — PPO: $12,116.80
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TX ATRIAL FIB PULM VEN ISOL $98,950 $59,370 $931.20 – $84,107.50
Heart rhythm study with ablation for atrial fibrillation: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $17,811
  • Aetna — Medicare: $25,727.46
  • Aetna of PA — Medicare: $25,727.46
  • AmeriHealth Caritas — Medicare: $25,259.69
  • Cigna Lifesource — Medicare Transplant: $25,259.69
  • Coventry/First Health — Commercial: $69,265
  • Fidelis — Medicare: $74,212.50
  • Geisinger — Medicaid/CHIP: $54,422.50
  • Health Coalition Partners — Intergroup: $79,160
  • Health Payors Organization — Commercial: $84,107.50
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: TX ATRIAL FIB PULM VEN ISOL $98,950 $59,370 $64,317.50 – $84,107.50
Heart rhythm study with ablation for atrial fibrillation: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $69,265
  • Fidelis — Medicare: $74,212.50
  • Health Coalition Partners — Intergroup: $79,160
  • Health Payors Organization — Commercial: $84,107.50
  • Humana — Commercial: $84,107.50
  • InterGroup — Approved National Affiliated PPO Business: $84,107.50
  • InterGroup — InterGroup Services Corporation: $74,212.50
  • Multiplan — PPO: $79,160
  • Preferred Healthcare System — PPO: $64,317.50
  • Private Health Care Systems — PPO: $79,160
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSG 9+PARAM ATTENDED $13,103 $7,861.80 $324.38 – $11,137.55
Sleep study (overnight, in a sleep lab): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $450.53
  • Aetna — Medicare: $1,066.96
  • Aetna of PA — Medicare: $1,066.96
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $548.40
  • AmeriHealth Caritas — Medicare: $1,047.56
  • Cigna Lifesource — Medicare Transplant: $1,047.56
  • Coventry/First Health — Commercial: $9,172.10
  • Fidelis — Medicare: $9,827.25
  • Geisinger — Medicaid/CHIP: $539.49
  • Health Coalition Partners — Intergroup: $10,482.40
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSG 9+PARAM ATTENDED $13,103 $7,861.80 $8,516.95 – $11,137.55
Sleep study (overnight, in a sleep lab): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $9,172.10
  • Fidelis — Medicare: $9,827.25
  • Health Coalition Partners — Intergroup: $10,482.40
  • Health Payors Organization — Commercial: $11,137.55
  • Humana — Commercial: $11,137.55
  • InterGroup — Approved National Affiliated PPO Business: $11,137.55
  • InterGroup — InterGroup Services Corporation: $9,827.25
  • Multiplan — PPO: $10,482.40
  • Preferred Healthcare System — PPO: $8,516.95
  • Private Health Care Systems — PPO: $10,482.40
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: PSG 9+PARAM ATTENDED $13,103 $7,861.80 $324.38 – $11,137.55
Sleep study (overnight, in a sleep lab): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $450.53
  • Aetna — Medicare: $3,275.75
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $548.40
  • Coventry/First Health — Commercial: $9,172.10
  • Fidelis — Medicare: $9,827.25
  • Geisinger — Medicaid/CHIP: $539.49
  • Health Coalition Partners — Intergroup: $10,482.40
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $522.61
  • Health Payors Organization — Commercial: $11,137.55
  • Highmark BCBS of PA — Commercial - Indemnity: $3,179.13

Physical therapy and mental health

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GO In the file: THERAPEUTIC EXERCISE P/15M $297 $178.20 $9.22 – $252.45
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $10.89
  • Aetna — Medicare: $74.25
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $13.26
  • Coventry/First Health — Commercial: $207.90
  • Fidelis — Medicare: $222.75
  • Geisinger — Medicaid/CHIP: $13.05
  • Health Coalition Partners — Intergroup: $237.60
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $12.64
  • Health Payors Organization — Commercial: $252.45
  • Highmark BCBS of PA — Commercial - Indemnity: $58.30
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GO,CO In the file: CO THERAPEUTIC EXERCISE P/15M $297 $178.20 $9.22 – $252.45
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $10.89
  • Aetna — Medicare: $74.25
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $13.26
  • Coventry/First Health — Commercial: $207.90
  • Fidelis — Medicare: $222.75
  • Geisinger — Medicaid/CHIP: $13.05
  • Health Coalition Partners — Intergroup: $237.60
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $12.64
  • Health Payors Organization — Commercial: $252.45
  • Highmark BCBS of PA — Commercial - Indemnity: $58.30
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: THERAPEUTIC EXERCISE P/15M $297 $178.20 $9.22 – $252.45
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $10.89
  • Aetna — Medicare: $74.25
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $13.26
  • Coventry/First Health — Commercial: $207.90
  • Fidelis — Medicare: $222.75
  • Geisinger — Medicaid/CHIP: $13.05
  • Health Coalition Partners — Intergroup: $237.60
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $12.64
  • Health Payors Organization — Commercial: $252.45
  • Highmark BCBS of PA — Commercial - Indemnity: $58.30
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL LOW COMPLEX $1,154 $692.40 $52.05 – $980.90
Physical therapy evaluation (low complexity): 10 of 25 insurance plan rates
  • Aetna — CHIP/Medicaid: $207.72
  • Aetna — Medicare: $288.50
  • Coventry/First Health — Commercial: $807.80
  • Fidelis — Medicare: $865.50
  • Geisinger — Medicaid/CHIP: $634.70
  • Health Coalition Partners — Intergroup: $923.20
  • Health Payors Organization — Commercial: $980.90
  • Highmark BCBS of PA — Commercial - Indemnity: $117.97
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $88.09
  • Highmark BCBS of PA — Managed Care: $115.87
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL LOW COMPLEX $1,154 $692.40 $750.10 – $980.90
Physical therapy evaluation (low complexity): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $807.80
  • Fidelis — Medicare: $865.50
  • Health Coalition Partners — Intergroup: $923.20
  • Health Payors Organization — Commercial: $980.90
  • Humana — Commercial: $980.90
  • InterGroup — Approved National Affiliated PPO Business: $980.90
  • InterGroup — InterGroup Services Corporation: $865.50
  • Multiplan — PPO: $923.20
  • Preferred Healthcare System — PPO: $750.10
  • Private Health Care Systems — PPO: $923.20
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL MOD COMPLEX $1,154 $692.40 $30.40 – $980.90
Physical therapy evaluation (moderate complexity): 10 of 25 insurance plan rates
  • Aetna — CHIP/Medicaid: $207.72
  • Aetna — Medicare: $288.50
  • Coventry/First Health — Commercial: $807.80
  • Fidelis — Medicare: $865.50
  • Geisinger — Medicaid/CHIP: $634.70
  • Health Coalition Partners — Intergroup: $923.20
  • Health Payors Organization — Commercial: $980.90
  • Highmark BCBS of PA — Commercial - Indemnity: $117.97
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $88.09
  • Highmark BCBS of PA — Managed Care: $115.87
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL MOD COMPLEX $1,154 $692.40 $750.10 – $980.90
Physical therapy evaluation (moderate complexity): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $807.80
  • Fidelis — Medicare: $865.50
  • Health Coalition Partners — Intergroup: $923.20
  • Health Payors Organization — Commercial: $980.90
  • Humana — Commercial: $980.90
  • InterGroup — Approved National Affiliated PPO Business: $980.90
  • InterGroup — InterGroup Services Corporation: $865.50
  • Multiplan — PPO: $923.20
  • Preferred Healthcare System — PPO: $750.10
  • Private Health Care Systems — PPO: $923.20
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL HIGH COMPLEX $1,154 $692.40 $52.05 – $980.90
Physical therapy evaluation (high complexity): 10 of 25 insurance plan rates
  • Aetna — CHIP/Medicaid: $207.72
  • Aetna — Medicare: $288.50
  • Coventry/First Health — Commercial: $807.80
  • Fidelis — Medicare: $865.50
  • Geisinger — Medicaid/CHIP: $634.70
  • Health Coalition Partners — Intergroup: $923.20
  • Health Payors Organization — Commercial: $980.90
  • Highmark BCBS of PA — Commercial - Indemnity: $117.97
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $88.09
  • Highmark BCBS of PA — Managed Care: $115.87
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL HIGH COMPLEX $1,154 $692.40 $750.10 – $980.90
Physical therapy evaluation (high complexity): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $807.80
  • Fidelis — Medicare: $865.50
  • Health Coalition Partners — Intergroup: $923.20
  • Health Payors Organization — Commercial: $980.90
  • Humana — Commercial: $980.90
  • InterGroup — Approved National Affiliated PPO Business: $980.90
  • InterGroup — InterGroup Services Corporation: $865.50
  • Multiplan — PPO: $923.20
  • Preferred Healthcare System — PPO: $750.10
  • Private Health Care Systems — PPO: $923.20
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY 30 MINUTES $292 $175.20 $28.60 – $797.32
Psychotherapy, 30 minutes: 10 of 34 insurance plan rates
  • Aetna — CHIP/Medicaid: $33.80
  • Aetna — Medicare: $168.50
  • Aetna of PA — Medicare: $168.50
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $41.14
  • AmeriHealth Caritas — Medicare: $165.43
  • Cigna Lifesource — Medicare Transplant: $165.43
  • Coventry/First Health — Commercial: $204.40
  • Fidelis — Medicare: $219
  • Geisinger — Medicaid/CHIP: $40.47
  • Health Coalition Partners — Intergroup: $233.60
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY 30 MINUTES $292 $175.20 $189.80 – $248.20
Psychotherapy, 30 minutes: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $204.40
  • Fidelis — Medicare: $219
  • Health Coalition Partners — Intergroup: $233.60
  • Health Payors Organization — Commercial: $248.20
  • Humana — Commercial: $248.20
  • InterGroup — Approved National Affiliated PPO Business: $248.20
  • InterGroup — InterGroup Services Corporation: $219
  • Multiplan — PPO: $233.60
  • Preferred Healthcare System — PPO: $189.80
  • Private Health Care Systems — PPO: $233.60
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: PSYCHOTHERAPY 30 MINUTES $292 $175.20 $28.60 – $797.32
Psychotherapy, 30 minutes: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $33.80
  • Aetna — Medicare: $73
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $41.14
  • Coventry/First Health — Commercial: $204.40
  • Fidelis — Medicare: $219
  • Geisinger — Medicaid/CHIP: $40.47
  • Health Coalition Partners — Intergroup: $233.60
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $39.21
  • Health Payors Organization — Commercial: $248.20
  • Highmark BCBS of PA — Commercial - Indemnity: $749.57
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY 45 MINUTES $392 $235.20 $42.90 – $1,177.30
Psychotherapy, 45 minutes: 10 of 34 insurance plan rates
  • Aetna — CHIP/Medicaid: $50.70
  • Aetna — Medicare: $168.50
  • Aetna of PA — Medicare: $168.50
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $61.71
  • AmeriHealth Caritas — Medicare: $165.43
  • Cigna Lifesource — Medicare Transplant: $165.43
  • Coventry/First Health — Commercial: $274.40
  • Fidelis — Medicare: $294
  • Geisinger — Medicaid/CHIP: $60.71
  • Health Coalition Partners — Intergroup: $313.60
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY 45 MINUTES $392 $235.20 $254.80 – $333.20
Psychotherapy, 45 minutes: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $274.40
  • Fidelis — Medicare: $294
  • Health Coalition Partners — Intergroup: $313.60
  • Health Payors Organization — Commercial: $333.20
  • Humana — Commercial: $333.20
  • InterGroup — Approved National Affiliated PPO Business: $333.20
  • InterGroup — InterGroup Services Corporation: $294
  • Multiplan — PPO: $313.60
  • Preferred Healthcare System — PPO: $254.80
  • Private Health Care Systems — PPO: $313.60
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: PSYCHOTHERAPY 45 MINUTES $392 $235.20 $42.90 – $1,177.30
Psychotherapy, 45 minutes: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $50.70
  • Aetna — Medicare: $98
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $61.71
  • Coventry/First Health — Commercial: $274.40
  • Fidelis — Medicare: $294
  • Geisinger — Medicaid/CHIP: $60.71
  • Health Coalition Partners — Intergroup: $313.60
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $58.81
  • Health Payors Organization — Commercial: $333.20
  • Highmark BCBS of PA — Commercial - Indemnity: $1,106.79
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY 60 MINUTES $424 $254.40 $57.20 – $1,719.23
Psychotherapy, 60 minutes: 10 of 34 insurance plan rates
  • Aetna — CHIP/Medicaid: $67.60
  • Aetna — Medicare: $168.50
  • Aetna of PA — Medicare: $168.50
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $82.28
  • AmeriHealth Caritas — Medicare: $165.43
  • Cigna Lifesource — Medicare Transplant: $165.43
  • Coventry/First Health — Commercial: $296.80
  • Fidelis — Medicare: $318
  • Geisinger — Medicaid/CHIP: $80.95
  • Health Coalition Partners — Intergroup: $339.20
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY 60 MINUTES $424 $254.40 $275.60 – $360.40
Psychotherapy, 60 minutes: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $296.80
  • Fidelis — Medicare: $318
  • Health Coalition Partners — Intergroup: $339.20
  • Health Payors Organization — Commercial: $360.40
  • Humana — Commercial: $360.40
  • InterGroup — Approved National Affiliated PPO Business: $360.40
  • InterGroup — InterGroup Services Corporation: $318
  • Multiplan — PPO: $339.20
  • Preferred Healthcare System — PPO: $275.60
  • Private Health Care Systems — PPO: $339.20
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: PSYCHOTHERAPY 60 MINUTES $424 $254.40 $57.20 – $1,719.23
Psychotherapy, 60 minutes: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $67.60
  • Aetna — Medicare: $106
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $82.28
  • Coventry/First Health — Commercial: $296.80
  • Fidelis — Medicare: $318
  • Geisinger — Medicaid/CHIP: $80.95
  • Health Coalition Partners — Intergroup: $339.20
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $78.42
  • Health Payors Organization — Commercial: $360.40
  • Highmark BCBS of PA — Commercial - Indemnity: $1,616.27
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP FAMILY W/O PT $678 $406.80 $15.60 – $576.30
Family psychotherapy, without the patient: 10 of 29 insurance plan rates
  • Aetna — CHIP/Medicaid: $122.04
  • Aetna — Medicare: $168.50
  • Aetna of PA — Medicare: $168.50
  • AmeriHealth Caritas — Medicare: $165.43
  • Cigna Lifesource — Medicare Transplant: $165.43
  • Coventry/First Health — Commercial: $474.60
  • Fidelis — Medicare: $508.50
  • Geisinger — Medicaid/CHIP: $372.90
  • Health Coalition Partners — Intergroup: $542.40
  • Health Payors Organization — Commercial: $576.30
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OP FAMILY W/O PT $678 $406.80 $440.70 – $576.30
Family psychotherapy, without the patient: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $474.60
  • Fidelis — Medicare: $508.50
  • Health Coalition Partners — Intergroup: $542.40
  • Health Payors Organization — Commercial: $576.30
  • Humana — Commercial: $576.30
  • InterGroup — Approved National Affiliated PPO Business: $576.30
  • InterGroup — InterGroup Services Corporation: $508.50
  • Multiplan — PPO: $542.40
  • Preferred Healthcare System — PPO: $440.70
  • Private Health Care Systems — PPO: $542.40
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP FAMILY W/PT $678 $406.80 $15.60 – $576.30
Family psychotherapy, with the patient: 10 of 29 insurance plan rates
  • Aetna — CHIP/Medicaid: $122.04
  • Aetna — Medicare: $168.50
  • Aetna of PA — Medicare: $168.50
  • AmeriHealth Caritas — Medicare: $165.43
  • Cigna Lifesource — Medicare Transplant: $165.43
  • Coventry/First Health — Commercial: $474.60
  • Fidelis — Medicare: $508.50
  • Geisinger — Medicaid/CHIP: $372.90
  • Health Coalition Partners — Intergroup: $542.40
  • Health Payors Organization — Commercial: $576.30
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OP FAMILY W/PT $678 $406.80 $440.70 – $576.30
Family psychotherapy, with the patient: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $474.60
  • Fidelis — Medicare: $508.50
  • Health Coalition Partners — Intergroup: $542.40
  • Health Payors Organization — Commercial: $576.30
  • Humana — Commercial: $576.30
  • InterGroup — Approved National Affiliated PPO Business: $576.30
  • InterGroup — InterGroup Services Corporation: $508.50
  • Multiplan — PPO: $542.40
  • Preferred Healthcare System — PPO: $440.70
  • Private Health Care Systems — PPO: $542.40
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP THERAPY SESSION $78 $46.80 $14.04 – $721.21
Group psychotherapy: 10 of 29 insurance plan rates
  • Aetna — CHIP/Medicaid: $14.04
  • Aetna — Medicare: $97.01
  • Aetna of PA — Medicare: $97.01
  • AmeriHealth Caritas — Medicare: $95.25
  • Cigna Lifesource — Medicare Transplant: $95.25
  • Coventry/First Health — Commercial: $54.60
  • Fidelis — Medicare: $58.50
  • Geisinger — Medicaid/CHIP: $42.90
  • Health Coalition Partners — Intergroup: $62.40
  • Health Payors Organization — Commercial: $66.30
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: IP GROUP THERAPY $78 $46.80 $14.04 – $721.21
Group psychotherapy: 10 of 29 insurance plan rates
  • Aetna — CHIP/Medicaid: $14.04
  • Aetna — Medicare: $97.01
  • Aetna of PA — Medicare: $97.01
  • AmeriHealth Caritas — Medicare: $95.25
  • Cigna Lifesource — Medicare Transplant: $95.25
  • Coventry/First Health — Commercial: $54.60
  • Fidelis — Medicare: $58.50
  • Geisinger — Medicaid/CHIP: $42.90
  • Health Coalition Partners — Intergroup: $62.40
  • Health Payors Organization — Commercial: $66.30
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Hospital (facility) fee In the file: GROUP THERAPY SESSION $78 $46.80 $50.70 – $66.30
Group psychotherapy: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $54.60
  • Fidelis — Medicare: $58.50
  • Health Coalition Partners — Intergroup: $62.40
  • Health Payors Organization — Commercial: $66.30
  • Humana — Commercial: $66.30
  • InterGroup — Approved National Affiliated PPO Business: $66.30
  • InterGroup — InterGroup Services Corporation: $58.50
  • Multiplan — PPO: $62.40
  • Preferred Healthcare System — PPO: $50.70
  • Private Health Care Systems — PPO: $62.40

Procedures and surgery

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 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 $190.30 – $5,760.66
Removal of breast growth (open surgery): 10 of 24 insurance plan rates
  • Aetna — CHIP/Medicaid: $224.90
  • Aetna — Medicare: $4,015.84
  • Aetna of PA — Medicare: $4,015.84
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $273.76
  • AmeriHealth Caritas — Medicare: $3,942.82
  • Cigna Lifesource — Medicare Transplant: $3,942.82
  • Geisinger — Medicaid/CHIP: $269.31
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $260.88
  • Highmark BCBS of PA — Commercial - Indemnity: $5,760.66
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $4,301.52
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 $931.20 – $23,214.77
Total hip replacement: 10 of 17 insurance plan rates
  • Aetna — Medicare: $13,493.67
  • Aetna of PA — Medicare: $13,493.67
  • AmeriHealth Caritas — Medicare: $13,248.33
  • Cigna Lifesource — Medicare Transplant: $13,248.33
  • Highmark BCBS of PA — Commercial - Indemnity: $16,995.80
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $12,690.85
  • Highmark BCBS of PA — Managed Care: $8,274.99
  • Highmark BCBS of PA — Managed Care - Social Mission: $6,179.37
  • Highmark BCBS of PA — Medicare Advantage: $2,492.82
  • Highmark BCBS of PA — UPMC Emergent: $16,549.97
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 $931.20 – $23,214.77
Total knee replacement: 10 of 17 insurance plan rates
  • Aetna — Medicare: $13,493.67
  • Aetna of PA — Medicare: $13,493.67
  • AmeriHealth Caritas — Medicare: $13,248.33
  • Cigna Lifesource — Medicare Transplant: $13,248.33
  • Highmark BCBS of PA — Commercial - Indemnity: $18,345.93
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $13,699
  • Highmark BCBS of PA — Managed Care: $8,932.34
  • Highmark BCBS of PA — Managed Care - Social Mission: $6,670.25
  • Highmark BCBS of PA — Medicare Advantage: $2,690.84
  • Highmark BCBS of PA — UPMC Emergent: $17,864.69
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 $652.20 – $5,760.66
Shoulder arthroscopy: shaving of shoulder bone: rates for 10 insurance plans
  • Highmark BCBS of PA — Commercial - Indemnity: $5,760.66
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $4,301.52
  • Highmark BCBS of PA — Managed Care: $2,804.78
  • Highmark BCBS of PA — Managed Care - Social Mission: $2,094.48
  • Highmark BCBS of PA — Medicare Advantage: $844.93
  • Highmark BCBS of PA — UPMC Emergent: $5,609.55
  • Multiplan — Worker's Compensation: $2,888.21
  • United Healthcare Community Plan for Families — PA CHIP/PA Medicaid: $652.20
  • UPMC Health Plan — Commercial: $1,010.30
  • UPMC Work Partners — Workers Comp: $2,483.86
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 $597.85 – $7,095.95
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 24 insurance plan rates
  • Aetna — CHIP/Medicaid: $706.55
  • Aetna — Medicare: $3,402.68
  • Aetna of PA — Medicare: $3,402.68
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $860.03
  • AmeriHealth Caritas — Medicare: $3,340.82
  • Cigna Lifesource — Medicare Transplant: $3,340.82
  • Geisinger — Medicaid/CHIP: $846.07
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $819.60
  • Highmark BCBS of PA — Commercial - Indemnity: $7,095.95
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $5,298.59
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD W/WO BRUSHINGS $5,393 $3,235.80 $137.74 – $4,584.05
Upper GI endoscopy (diagnostic): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $162.79
  • Aetna — Medicare: $983.24
  • Aetna of PA — Medicare: $983.24
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $198.15
  • AmeriHealth Caritas — Medicare: $965.36
  • Cigna Lifesource — Medicare Transplant: $965.36
  • Coventry/First Health — Commercial: $3,775.10
  • Fidelis — Medicare: $4,044.75
  • Geisinger — Medicaid/CHIP: $194.93
  • Health Coalition Partners — Intergroup: $4,314.40
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EGD W/WO BRUSHINGS $5,393 $3,235.80 $3,505.45 – $4,584.05
Upper GI endoscopy (diagnostic): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $3,775.10
  • Fidelis — Medicare: $4,044.75
  • Health Coalition Partners — Intergroup: $4,314.40
  • Health Payors Organization — Commercial: $4,584.05
  • Humana — Commercial: $4,584.05
  • InterGroup — Approved National Affiliated PPO Business: $4,584.05
  • InterGroup — InterGroup Services Corporation: $4,044.75
  • Multiplan — PPO: $4,314.40
  • Preferred Healthcare System — PPO: $3,505.45
  • Private Health Care Systems — PPO: $4,314.40
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 $137.74 – $3,751.40
Upper GI endoscopy (diagnostic): 10 of 24 insurance plan rates
  • Aetna — CHIP/Medicaid: $162.79
  • Aetna — Medicare: $983.24
  • Aetna of PA — Medicare: $983.24
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $198.15
  • AmeriHealth Caritas — Medicare: $965.36
  • Cigna Lifesource — Medicare Transplant: $965.36
  • Geisinger — Medicaid/CHIP: $194.93
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $188.83
  • Highmark BCBS of PA — Commercial - Indemnity: $3,751.40
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $2,801.19
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD W/BIOPSY SINGLE/MULT $7,218 $4,330.80 $163.44 – $6,135.30
Upper GI endoscopy with biopsy: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $193.15
  • Aetna — Medicare: $983.24
  • Aetna of PA — Medicare: $983.24
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $235.11
  • AmeriHealth Caritas — Medicare: $965.36
  • Cigna Lifesource — Medicare Transplant: $965.36
  • Coventry/First Health — Commercial: $5,052.60
  • Fidelis — Medicare: $5,413.50
  • Geisinger — Medicaid/CHIP: $231.29
  • Health Coalition Partners — Intergroup: $5,774.40
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EGD W/BIOPSY SINGLE/MULT $7,218 $4,330.80 $4,691.70 – $6,135.30
Upper GI endoscopy with biopsy: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $5,052.60
  • Fidelis — Medicare: $5,413.50
  • Health Coalition Partners — Intergroup: $5,774.40
  • Health Payors Organization — Commercial: $6,135.30
  • Humana — Commercial: $6,135.30
  • InterGroup — Approved National Affiliated PPO Business: $6,135.30
  • InterGroup — InterGroup Services Corporation: $5,413.50
  • Multiplan — PPO: $5,774.40
  • Preferred Healthcare System — PPO: $4,691.70
  • Private Health Care Systems — PPO: $5,774.40
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 $163.44 – $5,023.10
Upper GI endoscopy with biopsy: 10 of 24 insurance plan rates
  • Aetna — CHIP/Medicaid: $193.15
  • Aetna — Medicare: $983.24
  • Aetna of PA — Medicare: $983.24
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $235.11
  • AmeriHealth Caritas — Medicare: $965.36
  • Cigna Lifesource — Medicare Transplant: $965.36
  • Geisinger — Medicaid/CHIP: $231.29
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $224.06
  • Highmark BCBS of PA — Commercial - Indemnity: $5,023.10
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $3,750.78
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY DIAG W/WO BRUSHING $2,500 $1,500 $198.55 – $5,023.10
Colonoscopy (diagnostic): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $234.65
  • Aetna — Medicare: $956.13
  • Aetna of PA — Medicare: $956.13
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $285.62
  • AmeriHealth Caritas — Medicare: $938.75
  • Cigna Lifesource — Medicare Transplant: $938.75
  • Coventry/First Health — Commercial: $1,750
  • Fidelis — Medicare: $1,875
  • Geisinger — Medicaid/CHIP: $280.98
  • Health Coalition Partners — Intergroup: $2,000
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY DIAG W/WO BRUSHING $2,500 $1,500 $1,625 – $2,125
Colonoscopy (diagnostic): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $1,750
  • Fidelis — Medicare: $1,875
  • Health Coalition Partners — Intergroup: $2,000
  • Health Payors Organization — Commercial: $2,125
  • Humana — Commercial: $2,125
  • InterGroup — Approved National Affiliated PPO Business: $2,125
  • InterGroup — InterGroup Services Corporation: $1,875
  • Multiplan — PPO: $2,000
  • Preferred Healthcare System — PPO: $1,625
  • Private Health Care Systems — PPO: $2,000
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: COLONOSCOPY DIAG W/WO BRUSHING $2,500 $1,500 $198.55 – $5,023.10
Colonoscopy (diagnostic): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $234.65
  • Aetna — Medicare: $625
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $285.62
  • Coventry/First Health — Commercial: $1,750
  • Fidelis — Medicare: $1,875
  • Geisinger — Medicaid/CHIP: $280.98
  • Health Coalition Partners — Intergroup: $2,000
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $272.19
  • Health Payors Organization — Commercial: $2,125
  • Highmark BCBS of PA — Commercial - Indemnity: $5,023.10
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/BX SINGLE/MULT $7,218 $4,330.80 $247.96 – $6,135.30
Colonoscopy with biopsy: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $293.05
  • Aetna — Medicare: $1,236.52
  • Aetna of PA — Medicare: $1,236.52
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $356.70
  • AmeriHealth Caritas — Medicare: $1,214.04
  • Cigna Lifesource — Medicare Transplant: $1,214.04
  • Coventry/First Health — Commercial: $5,052.60
  • Fidelis — Medicare: $5,413.50
  • Geisinger — Medicaid/CHIP: $350.91
  • Health Coalition Partners — Intergroup: $5,774.40
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY W/BX SINGLE/MULT $7,218 $4,330.80 $4,691.70 – $6,135.30
Colonoscopy with biopsy: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $5,052.60
  • Fidelis — Medicare: $5,413.50
  • Health Coalition Partners — Intergroup: $5,774.40
  • Health Payors Organization — Commercial: $6,135.30
  • Humana — Commercial: $6,135.30
  • InterGroup — Approved National Affiliated PPO Business: $6,135.30
  • InterGroup — InterGroup Services Corporation: $5,413.50
  • Multiplan — PPO: $5,774.40
  • Preferred Healthcare System — PPO: $4,691.70
  • Private Health Care Systems — PPO: $5,774.40
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: COLONOSCOPY W/BX SINGLE/MULT $7,218 $4,330.80 $247.96 – $6,135.30
Colonoscopy with biopsy: 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $293.05
  • Aetna — Medicare: $1,804.50
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $356.70
  • Coventry/First Health — Commercial: $5,052.60
  • Fidelis — Medicare: $5,413.50
  • Geisinger — Medicaid/CHIP: $350.91
  • Health Coalition Partners — Intergroup: $5,774.40
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $339.93
  • Health Payors Organization — Commercial: $6,135.30
  • Highmark BCBS of PA — Commercial - Indemnity: $5,023.10
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/SNARE TECHNIQUE $7,218 $4,330.80 $294.89 – $6,135.30
Colonoscopy with removal of polyps (snare): 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $348.50
  • Aetna — Medicare: $1,236.52
  • Aetna of PA — Medicare: $1,236.52
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $424.21
  • AmeriHealth Caritas — Medicare: $1,214.04
  • Cigna Lifesource — Medicare Transplant: $1,214.04
  • Coventry/First Health — Commercial: $5,052.60
  • Fidelis — Medicare: $5,413.50
  • Geisinger — Medicaid/CHIP: $417.32
  • Health Coalition Partners — Intergroup: $5,774.40
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY W/SNARE TECHNIQUE $7,218 $4,330.80 $4,691.70 – $6,135.30
Colonoscopy with removal of polyps (snare): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $5,052.60
  • Fidelis — Medicare: $5,413.50
  • Health Coalition Partners — Intergroup: $5,774.40
  • Health Payors Organization — Commercial: $6,135.30
  • Humana — Commercial: $6,135.30
  • InterGroup — Approved National Affiliated PPO Business: $6,135.30
  • InterGroup — InterGroup Services Corporation: $5,413.50
  • Multiplan — PPO: $5,774.40
  • Preferred Healthcare System — PPO: $4,691.70
  • Private Health Care Systems — PPO: $5,774.40
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier PO In the file: COLONOSCOPY W/SNARE TECHNIQUE $7,218 $4,330.80 $294.89 – $6,135.30
Colonoscopy with removal of polyps (snare): 10 of 30 insurance plan rates
  • Aetna — CHIP/Medicaid: $348.50
  • Aetna — Medicare: $1,804.50
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $424.21
  • Coventry/First Health — Commercial: $5,052.60
  • Fidelis — Medicare: $5,413.50
  • Geisinger — Medicaid/CHIP: $417.32
  • Health Coalition Partners — Intergroup: $5,774.40
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $404.26
  • Health Payors Organization — Commercial: $6,135.30
  • Highmark BCBS of PA — Commercial - Indemnity: $5,023.10
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY WITH USN $6,872 $4,123.20 $241.22 – $5,841.20
Ultrasound of the lower bowel by endoscope: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $285.08
  • Aetna — Medicare: $1,236.52
  • Aetna of PA — Medicare: $1,236.52
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $347
  • AmeriHealth Caritas — Medicare: $1,214.04
  • Cigna Lifesource — Medicare Transplant: $1,214.04
  • Coventry/First Health — Commercial: $4,810.40
  • Fidelis — Medicare: $5,154
  • Geisinger — Medicaid/CHIP: $341.37
  • Health Coalition Partners — Intergroup: $5,497.60
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY WITH USN $6,872 $4,123.20 $4,466.80 – $5,841.20
Ultrasound of the lower bowel by endoscope: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $4,810.40
  • Fidelis — Medicare: $5,154
  • Health Coalition Partners — Intergroup: $5,497.60
  • Health Payors Organization — Commercial: $5,841.20
  • Humana — Commercial: $5,841.20
  • InterGroup — Approved National Affiliated PPO Business: $5,841.20
  • InterGroup — InterGroup Services Corporation: $5,154
  • Multiplan — PPO: $5,497.60
  • Preferred Healthcare System — PPO: $4,466.80
  • Private Health Care Systems — PPO: $5,497.60
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY SCREEN AVG RISK $2,400 $1,440 $432 – $4,271.08
Screening colonoscopy (not high risk): 10 of 28 insurance plan rates
  • Aetna — CHIP/Medicaid: $432
  • Aetna — Medicare: $956.13
  • Aetna of PA — Medicare: $956.13
  • AmeriHealth Caritas — Medicare: $938.75
  • Cigna Lifesource — Medicare Transplant: $938.75
  • Coventry/First Health — Commercial: $1,680
  • Fidelis — Medicare: $1,800
  • Geisinger — Medicaid/CHIP: $1,320
  • Health Coalition Partners — Intergroup: $1,920
  • Health Payors Organization — Commercial: $2,040
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY SCREEN AVG RISK $2,400 $1,440 $1,560 – $2,040
Screening colonoscopy (not high risk): 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $1,680
  • Fidelis — Medicare: $1,800
  • Health Coalition Partners — Intergroup: $1,920
  • Health Payors Organization — Commercial: $2,040
  • Humana — Commercial: $2,040
  • InterGroup — Approved National Affiliated PPO Business: $2,040
  • InterGroup — InterGroup Services Corporation: $1,800
  • Multiplan — PPO: $1,920
  • Preferred Healthcare System — PPO: $1,560
  • Private Health Care Systems — PPO: $1,920
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 $931.20 – $11,228.86
Gallbladder removal by laparoscope: 10 of 17 insurance plan rates
  • Aetna — Medicare: $6,118.60
  • Aetna of PA — Medicare: $6,118.60
  • AmeriHealth Caritas — Medicare: $6,007.35
  • Cigna Lifesource — Medicare Transplant: $6,007.35
  • Highmark BCBS of PA — Commercial - Indemnity: $11,228.86
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $8,384.65
  • Highmark BCBS of PA — Managed Care: $5,467.16
  • Highmark BCBS of PA — Managed Care - Social Mission: $4,082.62
  • Highmark BCBS of PA — Medicare Advantage: $1,646.97
  • Highmark BCBS of PA — UPMC Emergent: $10,934.31
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RPR INIT ING HERNIA >5YRS/RE $14,084 $8,450.40 $349.25 – $11,971.40
Groin (inguinal) hernia repair, age 5 or older: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $412.75
  • Aetna — Medicare: $3,700.99
  • Aetna of PA — Medicare: $3,700.99
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $502.41
  • AmeriHealth Caritas — Medicare: $3,633.70
  • Cigna Lifesource — Medicare Transplant: $3,633.70
  • Coventry/First Health — Commercial: $9,858.80
  • Fidelis — Medicare: $10,563
  • Geisinger — Medicaid/CHIP: $494.25
  • Health Coalition Partners — Intergroup: $11,267.20
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient (hospital stay) · Hospital (facility) fee In the file: RPR INIT ING HERNIA >5YRS/RE $14,084 $8,450.40 $9,154.60 – $11,971.40
Groin (inguinal) hernia repair, age 5 or older: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $9,858.80
  • Fidelis — Medicare: $10,563
  • Health Coalition Partners — Intergroup: $11,267.20
  • Health Payors Organization — Commercial: $11,971.40
  • Humana — Commercial: $11,971.40
  • InterGroup — Approved National Affiliated PPO Business: $11,971.40
  • InterGroup — InterGroup Services Corporation: $10,563
  • Multiplan — PPO: $11,267.20
  • Preferred Healthcare System — PPO: $9,154.60
  • Private Health Care Systems — PPO: $11,267.20
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE Not listed in the file Not listed in the file $349.25 – $7,095.95
Groin (inguinal) hernia repair, age 5 or older: 10 of 24 insurance plan rates
  • Aetna — CHIP/Medicaid: $412.75
  • Aetna — Medicare: $3,700.99
  • Aetna of PA — Medicare: $3,700.99
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $502.41
  • AmeriHealth Caritas — Medicare: $3,633.70
  • Cigna Lifesource — Medicare Transplant: $3,633.70
  • Geisinger — Medicaid/CHIP: $494.25
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $478.79
  • Highmark BCBS of PA — Commercial - Indemnity: $7,095.95
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $5,298.59
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BX PROSTATE NDL/PNCH SGL/MULT $7,283 $4,369.80 $98.45 – $6,190.55
Prostate biopsy: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $116.35
  • Aetna — Medicare: $2,148.31
  • Aetna of PA — Medicare: $2,148.31
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $141.62
  • AmeriHealth Caritas — Medicare: $2,109.25
  • Cigna Lifesource — Medicare Transplant: $2,109.25
  • Coventry/First Health — Commercial: $5,098.10
  • Fidelis — Medicare: $5,462.25
  • Geisinger — Medicaid/CHIP: $139.32
  • Health Coalition Partners — Intergroup: $5,826.40
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: BX PROSTATE NDL/PNCH SGL/MULT $7,283 $4,369.80 $4,733.95 – $6,190.55
Prostate biopsy: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $5,098.10
  • Fidelis — Medicare: $5,462.25
  • Health Coalition Partners — Intergroup: $5,826.40
  • Health Payors Organization — Commercial: $6,190.55
  • Humana — Commercial: $6,190.55
  • InterGroup — Approved National Affiliated PPO Business: $6,190.55
  • InterGroup — InterGroup Services Corporation: $5,462.25
  • Multiplan — PPO: $5,826.40
  • Preferred Healthcare System — PPO: $4,733.95
  • Private Health Care Systems — PPO: $5,826.40
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 $98.45 – $5,023.10
Prostate biopsy: 10 of 24 insurance plan rates
  • Aetna — CHIP/Medicaid: $116.35
  • Aetna — Medicare: $2,148.31
  • Aetna of PA — Medicare: $2,148.31
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $141.62
  • AmeriHealth Caritas — Medicare: $2,109.25
  • Cigna Lifesource — Medicare Transplant: $2,109.25
  • Geisinger — Medicaid/CHIP: $139.32
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $134.97
  • Highmark BCBS of PA — Commercial - Indemnity: $5,023.10
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $3,750.78
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 $508.32 – $6,179.28
Hysteroscopy with biopsy of the uterus lining: 10 of 17 insurance plan rates
  • Aetna — Medicare: $3,334.43
  • Aetna of PA — Medicare: $3,334.43
  • AmeriHealth Caritas — Medicare: $3,273.80
  • Cigna Lifesource — Medicare Transplant: $3,273.80
  • Highmark BCBS of PA — Commercial - Indemnity: $6,179.28
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $4,614.10
  • Highmark BCBS of PA — Managed Care: $3,008.59
  • Highmark BCBS of PA — Managed Care - Social Mission: $2,246.68
  • Highmark BCBS of PA — Medicare Advantage: $906.33
  • Highmark BCBS of PA — UPMC Emergent: $6,017.19
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX INTRLMNR LUM/SAC W/IMG GDE $5,992 $3,595.20 $89.45 – $5,093.20
Spinal injection, lower back (epidural), with imaging guidance: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $105.72
  • Aetna — Medicare: $726.25
  • Aetna of PA — Medicare: $726.25
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $128.68
  • AmeriHealth Caritas — Medicare: $713.05
  • Cigna Lifesource — Medicare Transplant: $713.05
  • Coventry/First Health — Commercial: $4,194.40
  • Fidelis — Medicare: $4,494
  • Geisinger — Medicaid/CHIP: $126.59
  • Health Coalition Partners — Intergroup: $4,793.60
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEURAXIAL L/S INJ-W/ IMG GUIDE $5,992 $3,595.20 $89.45 – $5,093.20
Spinal injection, lower back (epidural), with imaging guidance: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $105.72
  • Aetna — Medicare: $726.25
  • Aetna of PA — Medicare: $726.25
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $128.68
  • AmeriHealth Caritas — Medicare: $713.05
  • Cigna Lifesource — Medicare Transplant: $713.05
  • Coventry/First Health — Commercial: $4,194.40
  • Fidelis — Medicare: $4,494
  • Geisinger — Medicaid/CHIP: $126.59
  • Health Coalition Partners — Intergroup: $4,793.60
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: NJX INTRLMNR LUM/SAC W/IMG GDE $5,992 $3,595.20 $3,894.80 – $5,093.20
Spinal injection, lower back (epidural), with imaging guidance: 10 of 11 insurance plan rates
  • Coventry/First Health — Commercial: $4,194.40
  • Fidelis — Medicare: $4,494
  • Health Coalition Partners — Intergroup: $4,793.60
  • Health Payors Organization — Commercial: $5,093.20
  • Humana — Commercial: $5,093.20
  • InterGroup — Approved National Affiliated PPO Business: $5,093.20
  • InterGroup — InterGroup Services Corporation: $4,494
  • Multiplan — PPO: $4,793.60
  • Preferred Healthcare System — PPO: $3,894.80
  • Private Health Care Systems — PPO: $4,793.60
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ ANES/STEROID EPI L/S SGL $4,506 $2,703.60 $104.54 – $4,034.65
Nerve root injection, lower back, with imaging guidance: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $123.55
  • Aetna — Medicare: $933.66
  • Aetna of PA — Medicare: $933.66
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $150.39
  • AmeriHealth Caritas — Medicare: $916.68
  • Cigna Lifesource — Medicare Transplant: $916.68
  • Coventry/First Health — Commercial: $3,154.20
  • Fidelis — Medicare: $3,379.50
  • Geisinger — Medicaid/CHIP: $147.95
  • Health Coalition Partners — Intergroup: $3,604.80
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ EPIDURAL LUMB PLEX SINGLE $4,506 $2,703.60 $104.54 – $4,034.65
Nerve root injection, lower back, with imaging guidance: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $123.55
  • Aetna — Medicare: $933.66
  • Aetna of PA — Medicare: $933.66
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $150.39
  • AmeriHealth Caritas — Medicare: $916.68
  • Cigna Lifesource — Medicare Transplant: $916.68
  • Coventry/First Health — Commercial: $3,154.20
  • Fidelis — Medicare: $3,379.50
  • Geisinger — Medicaid/CHIP: $147.95
  • Health Coalition Partners — Intergroup: $3,604.80
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ ANES LUM/SA TRANSF SNG LEV $4,506 $2,703.60 $104.54 – $4,034.65
Nerve root injection, lower back, with imaging guidance: 10 of 35 insurance plan rates
  • Aetna — CHIP/Medicaid: $123.55
  • Aetna — Medicare: $933.66
  • Aetna of PA — Medicare: $933.66
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $150.39
  • AmeriHealth Caritas — Medicare: $916.68
  • Cigna Lifesource — Medicare Transplant: $916.68
  • Coventry/First Health — Commercial: $3,154.20
  • Fidelis — Medicare: $3,379.50
  • Geisinger — Medicaid/CHIP: $147.95
  • Health Coalition Partners — Intergroup: $3,604.80
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 $330 – $5,023.10
Carpal tunnel release: 10 of 24 insurance plan rates
  • Aetna — CHIP/Medicaid: $390
  • Aetna — Medicare: $2,047.90
  • Aetna of PA — Medicare: $2,047.90
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $474.72
  • AmeriHealth Caritas — Medicare: $2,010.67
  • Cigna Lifesource — Medicare Transplant: $2,010.67
  • Geisinger — Medicaid/CHIP: $467.01
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $452.40
  • Highmark BCBS of PA — Commercial - Indemnity: $5,023.10
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $3,750.78
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 $662.78 – $9,940.91
Cataract removal with lens implant: 10 of 24 insurance plan rates
  • Aetna — CHIP/Medicaid: $783.29
  • Aetna — Medicare: $2,391.84
  • Aetna of PA — Medicare: $2,391.84
  • AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $953.44
  • AmeriHealth Caritas — Medicare: $2,348.35
  • Cigna Lifesource — Medicare Transplant: $2,348.35
  • Geisinger — Medicaid/CHIP: $937.96
  • Health Partners Plans (Jefferson Health Plan) — Medicaid/CHIP: $908.62
  • Highmark BCBS of PA — Commercial - Indemnity: $9,940.91
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $7,422.93

Hospital stays (whole stay, MS-DRG)

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC Not listed in the file Not listed in the file $91,337.90 – $366,691.98
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 13 insurance plan rates
  • Aetna — Medicare: $100,471.69
  • Aetna of PA — Medicare: $100,471.69
  • AmeriHealth Caritas — Medicare: $98,644.93
  • Highmark BCBS of PA — Commercial - Indemnity: $228,902.76
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $171,166.76
  • Highmark BCBS of PA — Managed Care: $183,346.02
  • Highmark BCBS of PA — Managed Care - Social Mission: $137,100.61
  • Highmark BCBS of PA — Medicare Advantage: $91,337.90
  • Highmark BCBS of PA — UPMC Emergent: $366,691.98
  • Highmark Wholecare (prev Gateway) — Medicare: $98,644.93
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 $10,292.55 – $25,188.02
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 2 insurance plans
  • Multiplan — Worker's Compensation: $25,188.02
  • UPMC Work Partners — Workers Comp: $10,292.55
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 $10,292.55 – $11,995.61
Spinal fusion (not neck), without major complications: rates for 2 insurance plans
  • Multiplan — Worker's Compensation: $11,995.61
  • UPMC Work Partners — Workers Comp: $10,292.55
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 $18,408.44 – $65,432.31
Hip or knee replacement (major joint of the leg), without major complications: 10 of 13 insurance plan rates
  • Aetna — Medicare: $20,249.28
  • Aetna of PA — Medicare: $20,249.28
  • AmeriHealth Caritas — Medicare: $19,881.12
  • Highmark BCBS of PA — Commercial - Indemnity: $37,623.20
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $28,160.76
  • Highmark BCBS of PA — Managed Care: $32,716.15
  • Highmark BCBS of PA — Managed Care - Social Mission: $24,487.83
  • Highmark BCBS of PA — Medicare Advantage: $18,408.44
  • Highmark BCBS of PA — UPMC Emergent: $65,432.31
  • Highmark Wholecare (prev Gateway) — Medicare: $19,881.12
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: DRG Grouper 12 (10/1/1994): DRG 470: **UNGROUPABLE Not listed in the file Not listed in the file $10,292.55
Hip or knee replacement (major joint of the leg), without major complications: rates for 1 insurance plan
  • UPMC Work Partners — Workers Comp: $10,292.55
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 $23,166.45 – $84,204.77
Neck (cervical) spinal fusion, without complications: 10 of 13 insurance plan rates
  • Aetna — Medicare: $25,483.10
  • Aetna of PA — Medicare: $25,483.10
  • AmeriHealth Caritas — Medicare: $25,019.77
  • Highmark BCBS of PA — Commercial - Indemnity: $48,417.25
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $36,240.05
  • Highmark BCBS of PA — Managed Care: $42,102.38
  • Highmark BCBS of PA — Managed Care - Social Mission: $31,513.36
  • Highmark BCBS of PA — Medicare Advantage: $23,166.45
  • Highmark BCBS of PA — UPMC Emergent: $84,204.77
  • Highmark Wholecare (prev Gateway) — Medicare: $25,019.77
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 $10,292.55 – $43,228.70
Neck (cervical) spinal fusion, without complications: rates for 2 insurance plans
  • Multiplan — Worker's Compensation: $43,228.70
  • UPMC Work Partners — Workers Comp: $10,292.55
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 $12,017.96 – $47,365.18
Uterus and ovary surgery (not for cancer), without complications: 10 of 13 insurance plan rates
  • Aetna — Medicare: $13,219.76
  • Aetna of PA — Medicare: $13,219.76
  • AmeriHealth Caritas — Medicare: $12,979.40
  • Highmark BCBS of PA — Commercial - Indemnity: $27,234.70
  • Highmark BCBS of PA — Commercial - Social Mission Indemnity: $20,385.03
  • Highmark BCBS of PA — Managed Care: $23,682.59
  • Highmark BCBS of PA — Managed Care - Social Mission: $17,726.26
  • Highmark BCBS of PA — Medicare Advantage: $12,017.96
  • Highmark BCBS of PA — UPMC Emergent: $47,365.18
  • Highmark Wholecare (prev Gateway) — Medicare: $12,979.40

Source: UPMC Presbyterian Shadyside’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 typeAcute Care Hospital
Address200 Lothrop Street, Pittsburgh, PA 15213
CountyAllegheny County
StatePennsylvania
Phone(412) 647‑2345
Emergency servicesYes
OwnershipVoluntary non-profit - Private
Medicare overall rating4 of 5 stars
CMS Certification Number390164
Name in Medicare recordsUPMC PRESBYTERIAN SHADYSIDE
Profile levelMedicare data + hospital website
Name on the hospital’s websiteUPMC Presbyterian
Official websiteupmc.com
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Sources

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

From the hospital’s website

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

  1. UPMC Presbyterian — upmc.com
  2. UPMC Presbyterian Services — upmc.com
  3. UPMC Presbyterian Trauma — upmc.com
  4. Visitor Information — upmc.com
  5. Emergency Department | UPMC Presbyterian | Pittsburgh, Pa — upmc.com
  6. Patient and Visitor Resources for UPMC Presbyterian — upmc.com
  7. During Your Stay | UPMC Presbyterian | Oakland – Pittsburgh, Pa — upmc.com