Does UPMC Somerset have an emergency room?

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

Where is UPMC Somerset?

225 South Center Avenue, Somerset, PA 15501, in Somerset County, Pennsylvania.

What is the phone number of UPMC Somerset?

(814) 443-5000, as listed by Medicare (CMS).

What is the Medicare star rating of UPMC Somerset?

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

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

No. For fiscal year 2026, CMS lists no Medicare payment reduction for UPMC Somerset under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 0.1919; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

UPMC Somerset — Phone, Address, ER & Ratings

Quick answers

Does UPMC Somerset have an emergency room?: Yes. Medicare (CMS) data lists emergency services at UPMC Somerset. In a medical emergency, call 911.
Where is UPMC Somerset?: 225 South Center Avenue, Somerset, PA 15501, in Somerset County, Pennsylvania.
What is the phone number of UPMC Somerset?: (814) 443-5000, as listed by Medicare (CMS).
What is the Medicare star rating of UPMC Somerset?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to UPMC Somerset for hospital-acquired conditions?: No. For fiscal year 2026, CMS lists no Medicare payment reduction for UPMC Somerset under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 0.1919; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas^{[4][5][8][10]}

Behavioral health
Cancer care
Concussion - sports medicine
Diabetes education
Ear, nose, and throat
Emergency medicine
Heart and vascular
Home health
Hospice
Lab and pathology
Medical imaging
Neurology
Nutrition
Orthopaedics
Pain management
Primary care
Pulmonary medicine
Rehabilitation
Sleep lab
Surgery
Thoracic surgery
Urology
Women's specialty
Wound care
Pulmonology
Stroke Services
Surgical Services

Procedures^[10]

Gallbladder and common bile duct surgery
Colorectal surgery
Hernia repair
Treatment of ulcers
Pediatric surgery
Breast surgery
Vascular procedures
Colonoscopy
Gastroscopy
Thoracoscopy

Programs and centers^[5][12][15]

Primary stroke center
Telemedicine
Short procedures admissions
Adult behavioral health program
Senior behavioral health program
Meds-To-Beds

Emergency care (hospital website)^{[4][5][8][14][16]}

Emergency room	Yes
Stroke designation	Primary stroke center

Visiting and practical information

Visiting	Patient support persons may visit 9 a.m.-9 p.m., seven days a week^[7]
Parking	Patients may park in the parking lot at the main entrance^[17]
Patient portal	MyUPMC

Doctors and clinicians (212)

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

Main specialties

And 188 more: the button below opens the full list.

Other emergency rooms nearby

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

Conemaugh Meyersdale Medical Center14 mi · Meyersdale, PA · Critical Access Hospital
Chan Soon- Shiong Medical Center at Windber21 mi · Windber, PA · Acute Care Hospital
Conemaugh Memorial Medical Center22 mi · Johnstown, PA · Acute Care Hospital
Excela Health Latrobe Hospital25 mi · Latrobe, PA · Acute Care Hospital
Excela Health - Frick Hospital27 mi · Mount Pleasant, PA · Acute Care Hospital

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

Other hospitals near Somerset

Select Specialty Hospital - Johnstown24 mi · Johnstown, PA · Long-Term Acute Care Hospital
Select Specialty Hospital Laurel Highlands Inc25 mi · Latrobe, PA · Long-Term Acute Care Hospital

Hospitals in Somerset County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Patriot Village0.5 mi · Somerset, PA · 2 of 5 stars
Somerset Healthcare & Rehabilitation Center2.1 mi · Somerset, PA · 1 of 5 stars
Meadow View Nursing Center9.5 mi · Berlin, PA · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Concordia Hospice of Bethlen19 mi · Ligonier, PA
1 Laurel Highlands Hospice Care20 mi · Johnstown, PA
Interim Healthcare Hospice & Palliative Care20 mi · Johnstown, PA · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Concordia Home Health of Bethlen19 mi · Ligonier, PA · 3 of 5 stars
Interim Healthcare of Johnstown20 mi · Johnstown, PA · 3 of 5 stars
Windber Home Health Agency21 mi · Windber, PA · 3.5 of 5 stars

All home health agencies in the state →

Dialysis facilities

DaVita Somerset County Dialysis3.5 mi · Somerset, PA · 2 of 5 stars
Prodigy Dialysis Meyersdale16 mi · Meyersdale, PA
Prodigy-Home Dialysis Care20 mi · Johnstown, PA · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

Ophthalmic Associates Surgery & Laser Center25 mi · Johnstown, PA

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Highlands Health Somerset0.0 mi · Somerset, PA · Community health center
Mountain Laurel Medical Center Grantsville22 mi · Grantsville, MD · Community health center
Hyndman Area Health Center (Richland Township)22 mi · Johnstown, PA · Community health center

Clinics and urgent care

Medexpress Urgent Care, PC - Pennsylvania3.5 mi · Somerset, PA · Urgent care center
Medical Associates of Boswell12 mi · Boswell, PA · Rural health clinic
Conemaugh Health Inititatives Rural Health Clinic14 mi · Hollsoplle, PA · Rural health clinic

Pharmacies

Genmar.Eb Inc.3.5 mi · Somerset, PA · Community/retail pharmacy
Giant Eagle Inc3.5 mi · Somerset, PA · Community/retail pharmacy
SD Pharmacy Services LLC3.5 mi · Somerset, PA · Community/retail pharmacy

Assisted living nearby

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

Patriot Senior Living3.5 mi · Somerset, PA
Somerset Senior Living3.5 mi · Somerset, PA
Countryside Personal Care Home5.9 mi · Friedens, PA
Martin's Care Home9.2 mi · Rockwood, PA

About the Medicare star rating

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

Medicare quality data

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

What patients said (patient survey)

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

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	3 of 5 stars
Nurses communicated well	3 of 5 stars
Doctors communicated well	3 of 5 stars
Patients got help quickly from staff	4 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	5 of 5 stars
Restfulness of Environment	2 of 5 stars
Care Coordination	3 of 5 stars
Symptoms After Stay	4 of 5 stars
Rated the hospital 9 or 10 out of 10	67%National average: 72%
Would definitely recommend the hospital	61%National average: 71%
Nurses “always” communicated well	79%National average: 80%
Doctors “always” communicated well	77%National average: 80%
“Always” got help as soon as they wanted	64%National average: 64%
Staff “always” explained medicines before giving them	62%National average: 62%
Were given information about recovery at home	89%National average: 86%
Room and bathroom “always” clean	78%National average: 73%
Completed surveys	365Response rate: 31%

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

Infections caught in the hospital

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

Clostridioides difficile (C. diff) intestinal infections	0.46No different from the national benchmark
Not reported to Medicare	Central line bloodstream infections (CLABSI); Catheter-associated urinary tract infections (CAUTI); Surgical site infections after colon surgery; Surgical site infections after abdominal hysterectomy; MRSA bloodstream infections

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	11.8%
Deaths within 30 days: heart failure patients	12.2%
Deaths within 30 days: pneumonia patients	17.4%
Deaths within 30 days: stroke patients	12.8%
Serious complications (patient safety indicator PSI-90)	0.98No different from the national rate
Not reported to Medicare	Deaths within 30 days: coronary bypass surgery (CABG)
Too few cases to report	Deaths within 30 days: COPD patients; Complications after hip or knee replacement

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	16.9%
Readmitted within 30 days: heart attack	13.9%
Readmitted within 30 days: heart failure	20.3%
Readmitted within 30 days: pneumonia	16.2%
Readmitted within 30 days: COPD	20.7%
Not reported to Medicare	Readmitted within 30 days: coronary bypass surgery
Too few cases to report	Readmitted within 30 days: hip or knee replacement

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	215 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	2%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	39%National average: 66%

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

See every measure on Medicare Care Compare →

Medicare payment programs

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

Show the Medicare payment program results

Hospital-Acquired Condition Reduction Program

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

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

Medicare payment reduction, fiscal year 2026	NoCMS lists no payment reduction for this hospital.
Total HAC Score	0.1919Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

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

Hospital Readmissions Reduction Program

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

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

Heart attack	1.0273More readmissions than expected
Heart failure	0.9848Fewer readmissions than expected
Pneumonia	0.9681Fewer readmissions than expected
No result published	COPD (chronic lung disease); Hip or knee replacement; Coronary bypass surgery (CABG) (not reported, or too few cases)

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

Hospital Value-Based Purchasing Program

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

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

Total Performance Score	33.17 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)	30.00 out of 100
Person and community engagement (patient survey)	66.00 out of 100
Safety (infections and sepsis care)	16.67 out of 100
Efficiency and cost reduction (Medicare spending)	20.00 out of 100

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

Medicare spending per patient (MSPB)

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

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

Medicare spending per patient, ratio	0.95Below the national median hospital (1.00): Medicare spent less

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

ER wait times and Medicare ratings nearby

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

ER wait times in Pennsylvania Best hospitals in Pennsylvania

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 75 common services exactly as UPMC Somerset 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 →

$ 8 amounts are marked with “!”: they are more than 100 times higher or lower than what other hospitals list for the same service, which usually means an error or a different unit in the hospital’s file. They are shown exactly as listed; ask the hospital before relying on them.

Show the prices of 75 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DETAILED VISIT NP P/F	$196	$117.60	$24.60 – $289.24
New patient office visit (about 30–44 minutes): 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $78.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $62.28 Galaxy Health Plan — Commercial: $127.40 Geisinger — Commercial: $77.18 Geisinger — Medicaid: $75.40 Highmark BCBS of PA — Medicare Advantage: $24.60 Highmark Wholecare (prev Gateway) — Medicaid: $69.60 Highmark Wholecare (prev Gateway) — Medicare: $98 Humana — Commercial: $147 Multiplan — PPO (Includes PHCS as a Payer): $98
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VST DETAILED NEW PT MD	$735	$441	$24.60 – $551.25
New patient office visit (about 30–44 minutes): 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $294 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $62.28 Galaxy Health Plan — Commercial: $477.75 Geisinger — Commercial: $289.44 Geisinger — Medicaid: $75.40 Highmark BCBS of PA — Medicare Advantage: $24.60 Highmark Wholecare (prev Gateway) — Medicaid: $69.60 Highmark Wholecare (prev Gateway) — Medicare: $367.50 Humana — Commercial: $551.25 Multiplan — PPO (Includes PHCS as a Payer): $367.50
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DETAILED VISIT NP P/F	$196	$117.60	$127.40 – $147
New patient office visit (about 30–44 minutes): rates for 3 insurance plans Galaxy Health Plan — Commercial: $127.40 Humana — Commercial: $147 Multiplan — PPO (Includes PHCS as a Payer): $127.40
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPR MOD VISIT NP P/F	$210	$126	$26.90 – $371.06
New patient office visit (about 45–59 minutes): 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $84 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $103.74 Galaxy Health Plan — Commercial: $136.50 Geisinger — Commercial: $82.70 Geisinger — Medicaid: $125.61 Highmark BCBS of PA — Medicare Advantage: $26.90 Highmark Wholecare (prev Gateway) — Medicaid: $115.94 Highmark Wholecare (prev Gateway) — Medicare: $105 Humana — Commercial: $157.50 Multiplan — PPO (Includes PHCS as a Payer): $105
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT OP NEW PT	$533	$319.80	$26.90 – $399.75
New patient office visit (about 45–59 minutes): 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $213.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $103.74 Galaxy Health Plan — Commercial: $346.45 Geisinger — Commercial: $209.90 Geisinger — Medicaid: $125.61 Highmark BCBS of PA — Medicare Advantage: $26.90 Highmark Wholecare (prev Gateway) — Medicaid: $115.94 Highmark Wholecare (prev Gateway) — Medicare: $266.50 Humana — Commercial: $399.75 Multiplan — PPO (Includes PHCS as a Payer): $266.50
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT OP NEW PT MD	$1,018	$610.80	$26.90 – $763.50
New patient office visit (about 45–59 minutes): 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $407.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $103.74 Galaxy Health Plan — Commercial: $661.70 Geisinger — Commercial: $400.89 Geisinger — Medicaid: $125.61 Highmark BCBS of PA — Medicare Advantage: $26.90 Highmark Wholecare (prev Gateway) — Medicaid: $115.94 Highmark Wholecare (prev Gateway) — Medicare: $509 Humana — Commercial: $763.50 Multiplan — PPO (Includes PHCS as a Payer): $509
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VST COMP HIGH NEW PT MD	$1,333	$799.80	$28.87 – $999.75
New patient office visit (about 60–74 minutes): 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $533.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $134.94 Galaxy Health Plan — Commercial: $866.45 Geisinger — Commercial: $524.94 Geisinger — Medicaid: $163.37 Highmark BCBS of PA — Medicare Advantage: $28.87 Highmark Wholecare (prev Gateway) — Medicaid: $150.80 Highmark Wholecare (prev Gateway) — Medicare: $666.50 Humana — Commercial: $999.75 Multiplan — PPO (Includes PHCS as a Payer): $666.50
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC VST COMP HIGH NEW PT MD	$1,333	$799.80	$866.45 – $999.75
New patient office visit (about 60–74 minutes): rates for 3 insurance plans Galaxy Health Plan — Commercial: $866.45 Humana — Commercial: $999.75 Multiplan — PPO (Includes PHCS as a Payer): $866.45
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: HC VST COMP HIGH NEW PT P/F	$1,358	$814.80	$171.06 – $184.73
New patient office visit (about 60–74 minutes): rates for 2 insurance plans Highmark Wholecare (prev Gateway) — Medicare: $184.73 UPMC Health Plan — Managed Medicare: $171.06
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EHS F/U INTER P/F	$103	$61.80	$17.35 – $155.85
Established patient office visit (about 20–29 minutes): 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $41.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $40.18 Galaxy Health Plan — Commercial: $66.95 Geisinger — Commercial: $40.56 Geisinger — Medicaid: $48.65 Highmark BCBS of PA — Medicare Advantage: $17.35 Highmark Wholecare (prev Gateway) — Medicaid: $44.91 Highmark Wholecare (prev Gateway) — Medicare: $51.50 Humana — Commercial: $77.25 Multiplan — PPO (Includes PHCS as a Payer): $51.50
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VST EXP PROBFOC ESTPT MD	$401	$240.60	$17.35 – $300.75
Established patient office visit (about 20–29 minutes): 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $160.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $40.18 Galaxy Health Plan — Commercial: $260.65 Geisinger — Commercial: $157.91 Geisinger — Medicaid: $48.65 Highmark BCBS of PA — Medicare Advantage: $17.35 Highmark Wholecare (prev Gateway) — Medicaid: $44.91 Highmark Wholecare (prev Gateway) — Medicare: $200.50 Humana — Commercial: $300.75 Multiplan — PPO (Includes PHCS as a Payer): $200.50
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EHS F/U INTER P/F	$103	$61.80	$66.95 – $77.25
Established patient office visit (about 20–29 minutes): rates for 3 insurance plans Galaxy Health Plan — Commercial: $66.95 Humana — Commercial: $77.25 Multiplan — PPO (Includes PHCS as a Payer): $66.95
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EHS F/U EXT P/F	$155	$93	$22.63 – $185.08
Established patient office visit (about 30–39 minutes): 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $62 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $62.47 Galaxy Health Plan — Commercial: $100.75 Geisinger — Commercial: $61.04 Geisinger — Medicaid: $75.64 Highmark BCBS of PA — Medicare Advantage: $22.63 Highmark Wholecare (prev Gateway) — Medicaid: $69.82 Highmark Wholecare (prev Gateway) — Medicare: $77.50 Humana — Commercial: $116.25 Multiplan — PPO (Includes PHCS as a Payer): $77.50
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EHS F/U EXT P/F	$155	$93	$100.75 – $116.25
Established patient office visit (about 30–39 minutes): rates for 3 insurance plans Galaxy Health Plan — Commercial: $100.75 Humana — Commercial: $116.25 Multiplan — PPO (Includes PHCS as a Payer): $100.75
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: HC VST DETAILED EST PT P/F	$453	$271.80	$91.48 – $98.79
Established patient office visit (about 30–39 minutes): rates for 2 insurance plans Highmark Wholecare (prev Gateway) — Medicare: $98.79 UPMC Health Plan — Managed Medicare: $91.48
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CONSULT OUTPT D/LC	$815	$489	$21.25 – $611.25
Office consultation with a specialist (moderate): 10 of 12 insurance plan rates Aetna of PA — TPA/Carrier: $326 Galaxy Health Plan — Commercial: $529.75 Geisinger — Commercial: $320.95 Geisinger — Medicaid: $448.25 Highmark BCBS of PA — Medicare Advantage: $21.25 Highmark Wholecare (prev Gateway) — Medicare: $407.50 Humana — Commercial: $611.25 Multiplan — PPO (Includes PHCS as a Payer): $407.50 United Healthcare Community Plan for Families — PA Medicaid: $79.88 UPMC Health Plan — CHIP: $253.85
Office consultation with a specialist (moderate) CPT 99243 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CONSULT OUTPT D/LC	$815	$489	$529.75 – $611.25
Office consultation with a specialist (moderate): rates for 3 insurance plans Galaxy Health Plan — Commercial: $529.75 Humana — Commercial: $611.25 Multiplan — PPO (Includes PHCS as a Payer): $529.75
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CONSULT OUTPT C/MC	$1,156	$693.60	$22.91 – $867
Office consultation with a specialist (moderate to high): 10 of 12 insurance plan rates Aetna of PA — TPA/Carrier: $462.40 Galaxy Health Plan — Commercial: $751.40 Geisinger — Commercial: $455.23 Geisinger — Medicaid: $635.80 Highmark BCBS of PA — Medicare Advantage: $22.91 Highmark Wholecare (prev Gateway) — Medicare: $578 Humana — Commercial: $867 Multiplan — PPO (Includes PHCS as a Payer): $578 United Healthcare Community Plan for Families — PA Medicaid: $121.83 UPMC Health Plan — CHIP: $426.89
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CONSULT OUTPT C/MC	$1,156	$693.60	$751.40 – $867
Office consultation with a specialist (moderate to high): rates for 3 insurance plans Galaxy Health Plan — Commercial: $751.40 Humana — Commercial: $867 Multiplan — PPO (Includes PHCS as a Payer): $751.40
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee In the file: HC RAPE EXAM P/F	$642	$385.20	Not listed in the file
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PREV MED - NP 18-39 YR	$258	$154.80	$23 – $193.50
Preventive checkup, new patient, age 18–39: 10 of 11 insurance plan rates Aetna of PA — TPA/Carrier: $103.20 Galaxy Health Plan — Commercial: $167.70 Geisinger — Commercial: $101.60 Geisinger — Medicaid: $141.90 Highmark BCBS of PA — Medicare Advantage: $52.86 Highmark Wholecare (prev Gateway) — Medicare: $129 Humana — Commercial: $193.50 Multiplan — PPO (Includes PHCS as a Payer): $129 United Healthcare Community Plan for Families — PA Medicaid: $23 UPMC Health Plan — CHIP: $171.75
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PREV MED - NP 18-39 YR	$258	$154.80	$167.70 – $193.50
Preventive checkup, new patient, age 18–39: rates for 3 insurance plans Galaxy Health Plan — Commercial: $167.70 Humana — Commercial: $193.50 Multiplan — PPO (Includes PHCS as a Payer): $167.70
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PREV MED - NP 40-64 YR	$258	$154.80	$23 – $193.50
Preventive checkup, new patient, age 40–64: 10 of 11 insurance plan rates Aetna of PA — TPA/Carrier: $103.20 Galaxy Health Plan — Commercial: $167.70 Geisinger — Commercial: $101.60 Geisinger — Medicaid: $141.90 Highmark BCBS of PA — Medicare Advantage: $57.43 Highmark Wholecare (prev Gateway) — Medicare: $129 Humana — Commercial: $193.50 Multiplan — PPO (Includes PHCS as a Payer): $129 United Healthcare Community Plan for Families — PA Medicaid: $23 UPMC Health Plan — CHIP: $170.80
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PREV MED - NP 40-64 YR	$258	$154.80	$167.70 – $193.50
Preventive checkup, new patient, age 40–64: rates for 3 insurance plans Galaxy Health Plan — Commercial: $167.70 Humana — Commercial: $193.50 Multiplan — PPO (Includes PHCS as a Payer): $167.70
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ED VISIT IV-SAFE PROGRAM	$1,479	$887.40	$35.88 – $1,109.25
Emergency room visit (moderate): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $591.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $35.88 AmeriHealth Caritas — Medicare: $263.98 Galaxy Health Plan — Commercial: $961.35 Geisinger — Commercial: $582.43 Geisinger — Medicaid: $78.74 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $495.54 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $391.51 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $261.34 Highmark BCBS of PA — Medicare Advantage: $110.58
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 3 N/E	$1,479	$887.40	$35.88 – $1,109.25
Emergency room visit (moderate): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $591.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $35.88 AmeriHealth Caritas — Medicare: $263.98 Galaxy Health Plan — Commercial: $961.35 Geisinger — Commercial: $582.43 Geisinger — Medicaid: $78.74 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $495.54 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $391.51 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $261.34 Highmark BCBS of PA — Medicare Advantage: $110.58
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 3	$1,479	$887.40	$35.88 – $1,109.25
Emergency room visit (moderate): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $591.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $35.88 AmeriHealth Caritas — Medicare: $263.98 Galaxy Health Plan — Commercial: $961.35 Geisinger — Commercial: $582.43 Geisinger — Medicaid: $78.74 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $495.54 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $391.51 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $261.34 Highmark BCBS of PA — Medicare Advantage: $110.58
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 4 N/E	$2,200	$1,320	$51.25 – $1,650
Emergency room visit (moderately high): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $880 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $51.25 AmeriHealth Caritas — Medicare: $405.97 Galaxy Health Plan — Commercial: $1,430 Geisinger — Commercial: $866.36 Geisinger — Medicaid: $132.50 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $762.09 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $602.09 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $401.91 Highmark BCBS of PA — Medicare Advantage: $140.54
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 4	$2,200	$1,320	$51.25 – $1,650
Emergency room visit (moderately high): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $880 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $51.25 AmeriHealth Caritas — Medicare: $405.97 Galaxy Health Plan — Commercial: $1,430 Geisinger — Commercial: $866.36 Geisinger — Medicaid: $132.50 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $762.09 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $602.09 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $401.91 Highmark BCBS of PA — Medicare Advantage: $140.54
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY DEPT VISIT	$459	$275.40	$51.25 – $762.09
Emergency room visit (moderately high): 10 of 21 insurance plan rates Aetna of PA — TPA/Carrier: $183.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $51.25 AmeriHealth Caritas — Medicare: $405.97 Galaxy Health Plan — Commercial: $298.35 Geisinger — Commercial: $180.75 Geisinger — Medicaid: $132.50 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $762.09 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $602.09 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $401.91 Highmark BCBS of PA — Medicare Advantage: $140.54
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 5 N/E	$3,048	$1,828.80	$51.25 – $2,442.98
Emergency room visit (high): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $1,219.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $51.25 AmeriHealth Caritas — Medicare: $584.52 Galaxy Health Plan — Commercial: $1,981.20 Geisinger — Commercial: $1,200.30 Geisinger — Medicaid: $192.83 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,097.26 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $866.90 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $578.67 Highmark BCBS of PA — Medicare Advantage: $172.44
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VISIT LEVEL 5	$3,048	$1,828.80	$51.25 – $2,442.98
Emergency room visit (high): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $1,219.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $51.25 AmeriHealth Caritas — Medicare: $584.52 Galaxy Health Plan — Commercial: $1,981.20 Geisinger — Commercial: $1,200.30 Geisinger — Medicaid: $192.83 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,097.26 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $866.90 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $578.67 Highmark BCBS of PA — Medicare Advantage: $172.44
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ER COMP/HIGH COMP MD	$720	$432	$51.25 – $1,097.26
Emergency room visit (high): 10 of 21 insurance plan rates Aetna of PA — TPA/Carrier: $288 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $51.25 AmeriHealth Caritas — Medicare: $584.52 Galaxy Health Plan — Commercial: $468 Geisinger — Commercial: $283.54 Geisinger — Medicaid: $192.83 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,097.26 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $866.90 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $578.67 Highmark BCBS of PA — Medicare Advantage: $172.44

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$92	$55.20	$8.36 – $69
Basic metabolic panel (blood test): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $36.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $10.75 AmeriHealth Caritas — Medicare: $8.46 CBHNP — Commercial: $9.36 CCBHN — Commercial: $12.50 Galaxy Health Plan — Commercial: $59.80 Geisinger — Commercial: $36.23 Geisinger — Medicaid: $13.01 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $15.88 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $12.55
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$92	$55.20	$59.80 – $69
Basic metabolic panel (blood test): rates for 3 insurance plans Galaxy Health Plan — Commercial: $59.80 Humana — Commercial: $69 Multiplan — PPO (Includes PHCS as a Payer): $59.80
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$114	$68.40	$10.43 – $85.50
Comprehensive metabolic panel (blood test): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $45.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $13.42 AmeriHealth Caritas — Medicare: $10.56 CBHNP — Commercial: $11.69 CCBHN — Commercial: $11.69 Galaxy Health Plan — Commercial: $74.10 Geisinger — Commercial: $44.89 Geisinger — Medicaid: $16.25 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $19.82 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $15.66
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$114	$68.40	$74.10 – $85.50
Comprehensive metabolic panel (blood test): rates for 3 insurance plans Galaxy Health Plan — Commercial: $74.10 Humana — Commercial: $85.50 Multiplan — PPO (Includes PHCS as a Payer): $74.10
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL WITHOUT HIV SCREEN	$518	$310.80	$13.20 – $388.50
Obstetric blood test panel: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $207.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $13.78 AmeriHealth Caritas — Medicare: $47.81 Galaxy Health Plan — Commercial: $336.70 Geisinger — Commercial: $203.99 Geisinger — Medicaid: $16.68 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $89.75 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $70.91 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $47.33 Highmark BCBS of PA — Medicare Advantage: $36.05
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL WITHOUT HIV SCREEN	$518	$310.80	$336.70 – $388.50
Obstetric blood test panel: rates for 3 insurance plans Galaxy Health Plan — Commercial: $336.70 Humana — Commercial: $388.50 Multiplan — PPO (Includes PHCS as a Payer): $336.70
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$146	$87.60	$13.24 – $109.50
Cholesterol panel (lipid panel): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $58.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $16.07 AmeriHealth Caritas — Medicare: $13.39 CBHNP — Commercial: $14 CCBHN — Commercial: $14 Galaxy Health Plan — Commercial: $94.90 Geisinger — Commercial: $57.49 Geisinger — Medicaid: $19.46 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $25.14 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $19.86
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ADV LIPID PN INFLAM, CARDIO IQ - A	$146	$87.60	$13.24 – $109.50
Cholesterol panel (lipid panel): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $58.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $16.07 AmeriHealth Caritas — Medicare: $13.39 CBHNP — Commercial: $14 CCBHN — Commercial: $14 Galaxy Health Plan — Commercial: $94.90 Geisinger — Commercial: $57.49 Geisinger — Medicaid: $19.46 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $25.14 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $19.86
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ADVANCED LIPID PANEL W/ INFLAMMATION, CARDIO IQ A	$146	$87.60	$13.24 – $109.50
Cholesterol panel (lipid panel): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $58.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $16.07 AmeriHealth Caritas — Medicare: $13.39 CBHNP — Commercial: $14 CCBHN — Commercial: $14 Galaxy Health Plan — Commercial: $94.90 Geisinger — Commercial: $57.49 Geisinger — Medicaid: $19.46 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $25.14 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $19.86
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$94	$56.40	$8.58 – $73.64
Kidney function panel: 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $37.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $11.02 AmeriHealth Caritas — Medicare: $8.68 CBHNP — Commercial: $9.60 CCBHN — Commercial: $9.60 Galaxy Health Plan — Commercial: $61.10 Geisinger — Commercial: $37.02 Geisinger — Medicaid: $13.34 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $16.29 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $12.87
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$94	$56.40	$61.10 – $70.50
Kidney function panel: rates for 3 insurance plans Galaxy Health Plan — Commercial: $61.10 Humana — Commercial: $70.50 Multiplan — PPO (Includes PHCS as a Payer): $61.10
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$90	$54	$8.08 – $67.50
Liver function panel: 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $36 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $10.37 AmeriHealth Caritas — Medicare: $8.17 CBHNP — Commercial: $9.03 CCBHN — Commercial: $10 Galaxy Health Plan — Commercial: $58.50 Geisinger — Commercial: $35.44 Geisinger — Medicaid: $12.55 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $15.34 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $12.12
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$90	$54	$58.50 – $67.50
Liver function panel: rates for 3 insurance plans Galaxy Health Plan — Commercial: $58.50 Humana — Commercial: $67.50 Multiplan — PPO (Includes PHCS as a Payer): $58.50
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS W/MICRO	$39	$23.40	$3 – $29.25
Urine test (automated, with microscope): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $15.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3.44 AmeriHealth Caritas — Medicare: $3.17 CBHNP — Commercial: $3 CCBHN — Commercial: $4.37 Galaxy Health Plan — Commercial: $25.35 Geisinger — Commercial: $15.36 Geisinger — Medicaid: $4.17 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $5.95 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $4.70
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/MICRO	$39	$23.40	$25.35 – $29.25
Urine test (automated, with microscope): rates for 3 insurance plans Galaxy Health Plan — Commercial: $25.35 Humana — Commercial: $29.25 Multiplan — PPO (Includes PHCS as a Payer): $25.35
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PH URINE	$42	$25.20	$3.44 – $31.50
Urine test (manual, without microscope): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $16.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.10 AmeriHealth Caritas — Medicare: $3.48 Galaxy Health Plan — Commercial: $27.30 Geisinger — Commercial: $16.54 Geisinger — Medicaid: $4.96 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $6.53 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $5.16 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3.45 Highmark BCBS of PA — Medicare Advantage: $6.88
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEMOGLOBIN URINE	$42	$25.20	$3.44 – $31.50
Urine test (manual, without microscope): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $16.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.10 AmeriHealth Caritas — Medicare: $3.48 Galaxy Health Plan — Commercial: $27.30 Geisinger — Commercial: $16.54 Geisinger — Medicaid: $4.96 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $6.53 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $5.16 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3.45 Highmark BCBS of PA — Medicare Advantage: $6.88
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS	$12	$7.20	$3.44 – $26.26
Urine test (manual, without microscope): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $4.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.10 AmeriHealth Caritas — Medicare: $3.48 Galaxy Health Plan — Commercial: $7.80 Geisinger — Commercial: $4.73 Geisinger — Medicaid: $4.96 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $6.53 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $5.16 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3.45 Highmark BCBS of PA — Medicare Advantage: $6.88
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINE DIP W/RFX TO MICROSCOPIC IF IND	$29	$17.40	$2.22 – $24.08
Urine test (automated, without microscope): 10 of 24 insurance plan rates Aetna of PA — TPA/Carrier: $11.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3.56 AmeriHealth Caritas — Medicare: $2.25 CBHNP — Commercial: $4.37 Galaxy Health Plan — Commercial: $18.85 Geisinger — Commercial: $11.42 Geisinger — Medicaid: $4.31 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $4.22 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $3.34 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $2.23
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SPEC GRAV URINE	$29	$17.40	$2.22 – $24.08
Urine test (automated, without microscope): 10 of 24 insurance plan rates Aetna of PA — TPA/Carrier: $11.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3.56 AmeriHealth Caritas — Medicare: $2.25 CBHNP — Commercial: $4.37 Galaxy Health Plan — Commercial: $18.85 Geisinger — Commercial: $11.42 Geisinger — Medicaid: $4.31 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $4.22 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $3.34 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $2.23
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS AUTO W/O MICRO	$29	$17.40	$2.22 – $24.08
Urine test (automated, without microscope): 10 of 24 insurance plan rates Aetna of PA — TPA/Carrier: $11.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $3.56 AmeriHealth Caritas — Medicare: $2.25 CBHNP — Commercial: $4.37 Galaxy Health Plan — Commercial: $18.85 Geisinger — Commercial: $11.42 Geisinger — Medicaid: $4.31 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $4.22 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $3.34 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $2.23
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE SPECIFIC ANTIGEN	$183	$109.80	$18.17 – $137.25
PSA (prostate specific antigen) blood test: 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $73.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $27.97 AmeriHealth Caritas — Medicare: $18.39 CBHNP — Commercial: $24.36 CCBHN — Commercial: $24.36 Galaxy Health Plan — Commercial: $118.95 Geisinger — Commercial: $72.07 Geisinger — Medicaid: $33.86 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $34.52 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $27.27
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSA % FREE & TOTAL - A	$183	$109.80	$18.17 – $137.25
PSA (prostate specific antigen) blood test: 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $73.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $27.97 AmeriHealth Caritas — Medicare: $18.39 CBHNP — Commercial: $24.36 CCBHN — Commercial: $24.36 Galaxy Health Plan — Commercial: $118.95 Geisinger — Commercial: $72.07 Geisinger — Medicaid: $33.86 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $34.52 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $27.27
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE HEALTH INDEX (PHI) W/REF, SERUM	$183	$109.80	$18.17 – $137.25
PSA (prostate specific antigen) blood test: 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $73.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $27.97 AmeriHealth Caritas — Medicare: $18.39 CBHNP — Commercial: $24.36 CCBHN — Commercial: $24.36 Galaxy Health Plan — Commercial: $118.95 Geisinger — Commercial: $72.07 Geisinger — Medicaid: $33.86 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $34.52 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $27.27
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TSH T/F	$143	$85.80	$16.60 – $107.25
Thyroid stimulating hormone (TSH) test: 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $57.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $26.65 AmeriHealth Caritas — Medicare: $16.80 CBHNP — Commercial: $23.21 CCBHN — Commercial: $23.21 Galaxy Health Plan — Commercial: $92.95 Geisinger — Commercial: $56.31 Geisinger — Medicaid: $32.26 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $31.54 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $24.92
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC TSH T/F	$143	$85.80	$92.95 – $107.25
Thyroid stimulating hormone (TSH) test: rates for 3 insurance plans Galaxy Health Plan — Commercial: $92.95 Humana — Commercial: $107.25 Multiplan — PPO (Includes PHCS as a Payer): $92.95
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC & AUTO DIFFERENTIAL	$67	$40.20	$6 – $50.25
Complete blood count (CBC) with differential: 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $26.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $6.89 AmeriHealth Caritas — Medicare: $7.77 CBHNP — Commercial: $6 CCBHN — Commercial: $6 Galaxy Health Plan — Commercial: $43.55 Geisinger — Commercial: $26.38 Geisinger — Medicaid: $8.34 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $14.59 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $11.52
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC & AUTO DIFFERENTIAL	$67	$40.20	$43.55 – $50.25
Complete blood count (CBC) with differential: rates for 3 insurance plans Galaxy Health Plan — Commercial: $43.55 Humana — Commercial: $50.25 Multiplan — PPO (Includes PHCS as a Payer): $43.55
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC (HEMOGRAM)	$54	$32.40	$6.39 – $40.50
Complete blood count (CBC), automated: 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $21.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $8.63 AmeriHealth Caritas — Medicare: $6.47 CBHNP — Commercial: $7.52 CCBHN — Commercial: $7.52 Galaxy Health Plan — Commercial: $35.10 Geisinger — Commercial: $21.27 Geisinger — Medicaid: $10.45 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $12.15 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $9.60
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC AND BUFFY COAT DIFF A	$54	$32.40	$6.39 – $40.50
Complete blood count (CBC), automated: 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $21.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $8.63 AmeriHealth Caritas — Medicare: $6.47 CBHNP — Commercial: $7.52 CCBHN — Commercial: $7.52 Galaxy Health Plan — Commercial: $35.10 Geisinger — Commercial: $21.27 Geisinger — Medicaid: $10.45 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $12.15 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $9.60
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC AND MANUAL DIFF A	$54	$32.40	$6.39 – $40.50
Complete blood count (CBC), automated: 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $21.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $8.63 AmeriHealth Caritas — Medicare: $6.47 CBHNP — Commercial: $7.52 CCBHN — Commercial: $7.52 Galaxy Health Plan — Commercial: $35.10 Geisinger — Commercial: $21.27 Geisinger — Medicaid: $10.45 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $12.15 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $9.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME	$37	$22.20	$4 – $27.75
Blood clotting time test (prothrombin time, PT): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $14.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.59 AmeriHealth Caritas — Medicare: $4.29 CBHNP — Commercial: $4 CCBHN — Commercial: $4 Galaxy Health Plan — Commercial: $24.05 Geisinger — Commercial: $14.57 Geisinger — Medicaid: $5.56 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $8.05 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $6.36
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LUPUS ANTICOAG SCRN PROFILE A	$37	$22.20	$4 – $27.75
Blood clotting time test (prothrombin time, PT): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $14.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.59 AmeriHealth Caritas — Medicare: $4.29 CBHNP — Commercial: $4 CCBHN — Commercial: $4 Galaxy Health Plan — Commercial: $24.05 Geisinger — Commercial: $14.57 Geisinger — Medicaid: $5.56 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $8.05 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $6.36
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ISTAT PT INR POC	$37	$22.20	$4 – $27.75
Blood clotting time test (prothrombin time, PT): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $14.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $4.59 AmeriHealth Caritas — Medicare: $4.29 CBHNP — Commercial: $4 CCBHN — Commercial: $4 Galaxy Health Plan — Commercial: $24.05 Geisinger — Commercial: $14.57 Geisinger — Medicaid: $5.56 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $8.05 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $6.36
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PTT	$51	$30.60	$5.94 – $38.25
Blood clotting test (partial thromboplastin time, PTT): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $20.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $8.61 AmeriHealth Caritas — Medicare: $6.01 CBHNP — Commercial: $7.50 CCBHN — Commercial: $7.50 Galaxy Health Plan — Commercial: $33.15 Geisinger — Commercial: $20.08 Geisinger — Medicaid: $10.42 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $11.28 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $8.91
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC VON WILLEBRAND'S PANEL - D	$51	$30.60	$5.94 – $38.25
Blood clotting test (partial thromboplastin time, PTT): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $20.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $8.61 AmeriHealth Caritas — Medicare: $6.01 CBHNP — Commercial: $7.50 CCBHN — Commercial: $7.50 Galaxy Health Plan — Commercial: $33.15 Geisinger — Commercial: $20.08 Geisinger — Medicaid: $10.42 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $11.28 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $8.91
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LUPUS ANTICOAG SCRN PROFILE D	$51	$30.60	$5.94 – $38.25
Blood clotting test (partial thromboplastin time, PTT): 10 of 25 insurance plan rates Aetna of PA — TPA/Carrier: $20.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $8.61 AmeriHealth Caritas — Medicare: $6.01 CBHNP — Commercial: $7.50 CCBHN — Commercial: $7.50 Galaxy Health Plan — Commercial: $33.15 Geisinger — Commercial: $20.08 Geisinger — Medicaid: $10.42 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $11.28 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $8.91

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT BRAIN W/O CONTRAST	$1,328	$796.80	$89.12 – $996
CT scan of the head or brain, without contrast: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $531.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $134.03 AmeriHealth Caritas — Medicare: $101.38 Galaxy Health Plan — Commercial: $863.20 Geisinger — Commercial: $522.97 Geisinger — Medicaid: $162.27 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $190.31 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $150.36 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $100.37 Highmark BCBS of PA — Medicare Advantage: $254.90
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT BRAIN W/O CONTRAST	$1,328	$796.80	$863.20 – $996
CT scan of the head or brain, without contrast: rates for 3 insurance plans Galaxy Health Plan — Commercial: $863.20 Humana — Commercial: $996 Multiplan — PPO (Includes PHCS as a Payer): $863.20
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI Brain W/Wo Contrast	$4,758	$2,854.80	$309.35 – $3,812.26
MRI of the brain, before and after contrast: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $1,903.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $389.17 AmeriHealth Caritas — Medicare: $340.48 Galaxy Health Plan — Commercial: $3,092.70 Geisinger — Commercial: $1,873.70 Geisinger — Medicaid: $471.18 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $639.15 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $504.97 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $337.08 Highmark BCBS of PA — Medicare Advantage: $1,190.48
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI Brain W/Wo Contrast	$4,758	$2,854.80	$3,092.70 – $3,568.50
MRI of the brain, before and after contrast: rates for 3 insurance plans Galaxy Health Plan — Commercial: $3,092.70 Humana — Commercial: $3,568.50 Multiplan — PPO (Includes PHCS as a Payer): $3,092.70
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CHEST 2 VIEWS	$314	$188.40	$11.67 – $235.50
Chest X-ray, 2 views: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $125.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $27.14 AmeriHealth Caritas — Medicare: $83.95 Galaxy Health Plan — Commercial: $204.10 Geisinger — Commercial: $123.65 Geisinger — Medicaid: $32.86 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $157.59 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $124.51 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $83.11 Highmark BCBS of PA — Medicare Advantage: $11.67
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC XRAY CHEST 2 VIEWS	$255	$153	$11.67 – $191.25
Chest X-ray, 2 views: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $102 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $27.14 AmeriHealth Caritas — Medicare: $83.95 Galaxy Health Plan — Commercial: $165.75 Geisinger — Commercial: $100.42 Geisinger — Medicaid: $32.86 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $157.59 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $124.51 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $83.11 Highmark BCBS of PA — Medicare Advantage: $11.67
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC XRAY CHEST 2 VIEWS MD	$39	$23.40	$11.67 – $157.59
Chest X-ray, 2 views: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $15.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $27.14 AmeriHealth Caritas — Medicare: $83.95 Galaxy Health Plan — Commercial: $25.35 Geisinger — Commercial: $15.36 Geisinger — Medicaid: $32.86 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $157.59 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $124.51 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $83.11 Highmark BCBS of PA — Medicare Advantage: $11.67
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LUMBAR SPINE MIN 4 VIEWS	$438	$262.80	$25.88 – $328.50
X-ray of the lower spine, at least 4 views: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $175.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $42.04 AmeriHealth Caritas — Medicare: $101.38 Galaxy Health Plan — Commercial: $284.70 Geisinger — Commercial: $172.48 Geisinger — Medicaid: $50.90 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $190.31 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $150.36 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $100.37 Highmark BCBS of PA — Medicare Advantage: $57.81
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LUMBAR SPINE MIN 4 VIEWS MD	$77	$46.20	$25.88 – $192.02
X-ray of the lower spine, at least 4 views: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $30.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $42.04 AmeriHealth Caritas — Medicare: $101.38 Galaxy Health Plan — Commercial: $50.05 Geisinger — Commercial: $30.32 Geisinger — Medicaid: $50.90 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $190.31 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $150.36 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $100.37 Highmark BCBS of PA — Medicare Advantage: $57.81
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LUMBAR SPINE MIN 4 VIEWS	$438	$262.80	$284.70 – $328.50
X-ray of the lower spine, at least 4 views: rates for 3 insurance plans Galaxy Health Plan — Commercial: $284.70 Humana — Commercial: $328.50 Multiplan — PPO (Includes PHCS as a Payer): $284.70
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI Lumbar W/O Contrast	$2,760	$1,656	$215.28 – $2,070
MRI of the lower back (lumbar spine), without contrast: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $1,104 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $294.06 AmeriHealth Caritas — Medicare: $230.45 Galaxy Health Plan — Commercial: $1,794 Geisinger — Commercial: $1,086.89 Geisinger — Medicaid: $356.02 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $432.60 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $341.78 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $228.15 Highmark BCBS of PA — Medicare Advantage: $613.22
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI Lumbar W/O Contrast	$2,760	$1,656	$1,794 – $2,070
MRI of the lower back (lumbar spine), without contrast: rates for 3 insurance plans Galaxy Health Plan — Commercial: $1,794 Humana — Commercial: $2,070 Multiplan — PPO (Includes PHCS as a Payer): $1,794
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT PELVIS W/CONTRAST	$2,374	$1,424.40	$99.47 – $1,780.50
CT scan of the pelvis, with contrast: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $949.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $160.82 AmeriHealth Caritas — Medicare: $169.72 Galaxy Health Plan — Commercial: $1,543.10 Geisinger — Commercial: $934.88 Geisinger — Medicaid: $194.71 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $318.60 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $251.71 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $168.02 Highmark BCBS of PA — Medicare Advantage: $358.56
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT PELVIS W/CONTRAST MD	$374	$224.40	$99.47 – $1,154.10
CT scan of the pelvis, with contrast: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $149.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $160.82 AmeriHealth Caritas — Medicare: $169.72 Galaxy Health Plan — Commercial: $243.10 Geisinger — Commercial: $147.28 Geisinger — Medicaid: $194.71 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $318.60 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $251.71 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $168.02 Highmark BCBS of PA — Medicare Advantage: $358.56
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT PELVIS W/CONTRAST	$2,374	$1,424.40	$1,543.10 – $1,780.50
CT scan of the pelvis, with contrast: rates for 3 insurance plans Galaxy Health Plan — Commercial: $1,543.10 Humana — Commercial: $1,780.50 Multiplan — PPO (Includes PHCS as a Payer): $1,543.10
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier RT In the file: HC MRI LOW EXT JT W/O CNTRST - RT	$2,760	$1,656	$309.35 – $2,070
MRI of a leg joint (such as the knee), without contrast: 10 of 16 insurance plan rates Aetna of PA — TPA/Carrier: $1,104 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $380.44 Galaxy Health Plan — Commercial: $1,794 Geisinger — Commercial: $1,086.89 Geisinger — Medicaid: $460.60 Highmark BCBS of PA — Medicare Advantage: $528.67 Highmark Wholecare (prev Gateway) — Medicaid: $425.17 Highmark Wholecare (prev Gateway) — Medicare: $1,380 Humana — Commercial: $2,070 Multiplan — PPO (Includes PHCS as a Payer): $1,380
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier LT In the file: HC MRI LOW EXT JT W/O CNTRST - LT	$2,760	$1,656	$309.35 – $2,070
MRI of a leg joint (such as the knee), without contrast: 10 of 16 insurance plan rates Aetna of PA — TPA/Carrier: $1,104 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $380.44 Galaxy Health Plan — Commercial: $1,794 Geisinger — Commercial: $1,086.89 Geisinger — Medicaid: $460.60 Highmark BCBS of PA — Medicare Advantage: $528.67 Highmark Wholecare (prev Gateway) — Medicaid: $425.17 Highmark Wholecare (prev Gateway) — Medicare: $1,380 Humana — Commercial: $2,070 Multiplan — PPO (Includes PHCS as a Payer): $1,380
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee · modifier RT In the file: HC MRI LOW EXT JT W/O CNTRST - RT	$2,760	$1,656	$1,794 – $2,070
MRI of a leg joint (such as the knee), without contrast: rates for 3 insurance plans Galaxy Health Plan — Commercial: $1,794 Humana — Commercial: $2,070 Multiplan — PPO (Includes PHCS as a Payer): $1,794
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT ABDOMEN / PELVIS W/CNTRST	$4,976	$2,985.60	$221.64 – $3,952.42
CT scan of the abdomen and pelvis, with contrast: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $1,990.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $302.11 AmeriHealth Caritas — Medicare: $340.48 Galaxy Health Plan — Commercial: $3,234.40 Geisinger — Commercial: $1,959.55 Geisinger — Medicaid: $365.77 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $639.15 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $504.97 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $337.08 Highmark BCBS of PA — Medicare Advantage: $543.09
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT ABDOMEN/ PELVIS W/CNTRST MD	$563	$337.80	$221.64 – $3,952.42
CT scan of the abdomen and pelvis, with contrast: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $225.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $302.11 AmeriHealth Caritas — Medicare: $340.48 Galaxy Health Plan — Commercial: $365.95 Geisinger — Commercial: $221.71 Geisinger — Medicaid: $365.77 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $639.15 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $504.97 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $337.08 Highmark BCBS of PA — Medicare Advantage: $543.09
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT ABDOMEN / PELVIS W/CNTRST	$4,976	$2,985.60	$3,234.40 – $3,732
CT scan of the abdomen and pelvis, with contrast: rates for 3 insurance plans Galaxy Health Plan — Commercial: $3,234.40 Humana — Commercial: $3,732 Multiplan — PPO (Includes PHCS as a Payer): $3,234.40
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US ABDOMEN COMPLETE	$657	$394.20	$66.12 – $492.75
Ultrasound of the abdomen, complete: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $262.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $109.37 AmeriHealth Caritas — Medicare: $101.38 Galaxy Health Plan — Commercial: $427.05 Geisinger — Commercial: $258.73 Geisinger — Medicaid: $132.42 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $190.31 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $150.36 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $100.37 Highmark BCBS of PA — Medicare Advantage: $133.14
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US ABDOMEN COMPLETE MD	$306	$183.60	$66.12 – $416.14
Ultrasound of the abdomen, complete: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $122.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $109.37 AmeriHealth Caritas — Medicare: $101.38 Galaxy Health Plan — Commercial: $198.90 Geisinger — Commercial: $120.50 Geisinger — Medicaid: $132.42 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $190.31 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $150.36 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $100.37 Highmark BCBS of PA — Medicare Advantage: $133.14
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US ABDOMEN COMPLETE	$657	$394.20	$427.05 – $492.75
Ultrasound of the abdomen, complete: rates for 3 insurance plans Galaxy Health Plan — Commercial: $427.05 Humana — Commercial: $492.75 Multiplan — PPO (Includes PHCS as a Payer): $427.05
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US OB >/=14 WKS SINGLE FETUS	$657	$394.20	$53.48 – $492.75
Pregnancy ultrasound (after the first trimester): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $262.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $88.97 AmeriHealth Caritas — Medicare: $101.38 Galaxy Health Plan — Commercial: $427.05 Geisinger — Commercial: $258.73 Geisinger — Medicaid: $107.72 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $190.31 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $150.36 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $100.37 Highmark BCBS of PA — Medicare Advantage: $150.14
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US OB >/=14 WKS SINGLE FETUS	$657	$394.20	$427.05 – $492.75
Pregnancy ultrasound (after the first trimester): rates for 3 insurance plans Galaxy Health Plan — Commercial: $427.05 Humana — Commercial: $492.75 Multiplan — PPO (Includes PHCS as a Payer): $427.05
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL	$657	$394.20	$53.48 – $492.75
Transvaginal ultrasound: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $262.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $87.82 AmeriHealth Caritas — Medicare: $101.38 Galaxy Health Plan — Commercial: $427.05 Geisinger — Commercial: $258.73 Geisinger — Medicaid: $106.33 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $190.31 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $150.36 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $100.37 Highmark BCBS of PA — Medicare Advantage: $107.75
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL MD	$123	$73.80	$48.44 – $350.56
Transvaginal ultrasound: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $49.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $87.82 AmeriHealth Caritas — Medicare: $101.38 Galaxy Health Plan — Commercial: $79.95 Geisinger — Commercial: $48.44 Geisinger — Medicaid: $106.33 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $190.31 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $150.36 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $100.37 Highmark BCBS of PA — Medicare Advantage: $107.75
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL	$657	$394.20	$427.05 – $492.75
Transvaginal ultrasound: rates for 3 insurance plans Galaxy Health Plan — Commercial: $427.05 Humana — Commercial: $492.75 Multiplan — PPO (Includes PHCS as a Payer): $427.05
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC MAMMOGRAPH DIG UNIL	$583	$349.80	$57.13 – $437.25
Diagnostic mammogram, one breast: 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $233.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $117.57 Galaxy Health Plan — Commercial: $378.95 Geisinger — Commercial: $229.59 Geisinger — Medicaid: $142.34 Highmark BCBS of PA — Medicare Advantage: $57.13 Highmark Wholecare (prev Gateway) — Medicaid: $131.39 Highmark Wholecare (prev Gateway) — Medicare: $291.50 Humana — Commercial: $437.25 Multiplan — PPO (Includes PHCS as a Payer): $291.50
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC MAMMOGRAPH DIG MD	$142	$85.20	$55.92 – $364.39
Diagnostic mammogram, one breast: 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $56.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $117.57 Galaxy Health Plan — Commercial: $92.30 Geisinger — Commercial: $55.92 Geisinger — Medicaid: $142.34 Highmark BCBS of PA — Medicare Advantage: $57.13 Highmark Wholecare (prev Gateway) — Medicaid: $131.39 Highmark Wholecare (prev Gateway) — Medicare: $71 Humana — Commercial: $106.50 Multiplan — PPO (Includes PHCS as a Payer): $71
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC MAMMOGRAPH DIG UNIL	$583	$349.80	$378.95 – $437.25
Diagnostic mammogram, one breast: rates for 3 insurance plans Galaxy Health Plan — Commercial: $378.95 Humana — Commercial: $437.25 Multiplan — PPO (Includes PHCS as a Payer): $378.95
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BILAT DIGITAL MAMMOGRAPHY	$517	$310.20	$72.86 – $675.02
Diagnostic mammogram, both breasts: 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $206.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $149.07 Galaxy Health Plan — Commercial: $336.05 Geisinger — Commercial: $203.59 Geisinger — Medicaid: $180.48 Highmark BCBS of PA — Medicare Advantage: $72.86 Highmark Wholecare (prev Gateway) — Medicaid: $166.60 Highmark Wholecare (prev Gateway) — Medicare: $258.50 Humana — Commercial: $387.75 Multiplan — PPO (Includes PHCS as a Payer): $258.50
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BI DIAG MAMMO BILAT W/CAD	$517	$310.20	$72.86 – $675.02
Diagnostic mammogram, both breasts: 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $206.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $149.07 Galaxy Health Plan — Commercial: $336.05 Geisinger — Commercial: $203.59 Geisinger — Medicaid: $180.48 Highmark BCBS of PA — Medicare Advantage: $72.86 Highmark Wholecare (prev Gateway) — Medicaid: $166.60 Highmark Wholecare (prev Gateway) — Medicare: $258.50 Humana — Commercial: $387.75 Multiplan — PPO (Includes PHCS as a Payer): $258.50
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BILAT DIGITAL MAMMOGRAPHY	$517	$310.20	$336.05 – $387.75
Diagnostic mammogram, both breasts: rates for 3 insurance plans Galaxy Health Plan — Commercial: $336.05 Humana — Commercial: $387.75 Multiplan — PPO (Includes PHCS as a Payer): $336.05
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREENING DIG MAMMOGRAPHY	$429	$257.40	$60.33 – $551.43
Screening mammogram, both breasts: 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $171.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $120.20 Galaxy Health Plan — Commercial: $278.85 Geisinger — Commercial: $168.94 Geisinger — Medicaid: $145.52 Highmark BCBS of PA — Medicare Advantage: $60.33 Highmark Wholecare (prev Gateway) — Medicaid: $134.33 Highmark Wholecare (prev Gateway) — Medicare: $214.50 Humana — Commercial: $321.75 Multiplan — PPO (Includes PHCS as a Payer): $214.50
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREENING DIGITAL MAMMO W/IMPL	$429	$257.40	$60.33 – $551.43
Screening mammogram, both breasts: 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $171.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $120.20 Galaxy Health Plan — Commercial: $278.85 Geisinger — Commercial: $168.94 Geisinger — Medicaid: $145.52 Highmark BCBS of PA — Medicare Advantage: $60.33 Highmark Wholecare (prev Gateway) — Medicaid: $134.33 Highmark Wholecare (prev Gateway) — Medicare: $214.50 Humana — Commercial: $321.75 Multiplan — PPO (Includes PHCS as a Payer): $214.50
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BI SCRN MAMMO LEFT W/CAD	$429	$257.40	$60.33 – $551.43
Screening mammogram, both breasts: 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $171.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $120.20 Galaxy Health Plan — Commercial: $278.85 Geisinger — Commercial: $168.94 Geisinger — Medicaid: $145.52 Highmark BCBS of PA — Medicare Advantage: $60.33 Highmark Wholecare (prev Gateway) — Medicaid: $134.33 Highmark Wholecare (prev Gateway) — Medicare: $214.50 Humana — Commercial: $321.75 Multiplan — PPO (Includes PHCS as a Payer): $214.50

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EKG W INTERP & REPORT MD	$76	$45.60	$19.22 – $65.79
Electrocardiogram (ECG/EKG) with reading: 10 of 17 insurance plan rates Aetna of PA — TPA/Carrier: $30.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $22.06 CBHNP — Commercial: $19.22 Galaxy Health Plan — Commercial: $49.40 Geisinger — Commercial: $29.93 Geisinger — Medicaid: $26.71 Highmark BCBS of PA — Medicare Advantage: $22.32 Highmark Wholecare (prev Gateway) — Medicaid: $24.66 Highmark Wholecare (prev Gateway) — Medicare: $38 Humana — Commercial: $57
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EKG & INTERP REPORT	$413	$247.80	$19.22 – $309.75
Electrocardiogram (ECG/EKG) with reading: 10 of 17 insurance plan rates Aetna of PA — TPA/Carrier: $165.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $22.06 CBHNP — Commercial: $19.22 Galaxy Health Plan — Commercial: $268.45 Geisinger — Commercial: $162.64 Geisinger — Medicaid: $26.71 Highmark BCBS of PA — Medicare Advantage: $22.32 Highmark Wholecare (prev Gateway) — Medicaid: $24.66 Highmark Wholecare (prev Gateway) — Medicare: $206.50 Humana — Commercial: $309.75
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PED EKG & INTERP REPORT	$413	$247.80	$19.22 – $309.75
Electrocardiogram (ECG/EKG) with reading: 10 of 17 insurance plan rates Aetna of PA — TPA/Carrier: $165.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $22.06 CBHNP — Commercial: $19.22 Galaxy Health Plan — Commercial: $268.45 Geisinger — Commercial: $162.64 Geisinger — Medicaid: $26.71 Highmark BCBS of PA — Medicare Advantage: $22.32 Highmark Wholecare (prev Gateway) — Medicaid: $24.66 Highmark Wholecare (prev Gateway) — Medicare: $206.50 Humana — Commercial: $309.75
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COR ANGIO OR LHC	$8,734	$5,240.40	$892.40 – $6,550.50
Left heart catheterization (diagnostic): 10 of 20 insurance plan rates Aetna of PA — TPA/Carrier: $3,493.60 AmeriHealth Caritas — Medicare: $3,066.46 Galaxy Health Plan — Commercial: $5,677.10 Geisinger — Commercial: $3,439.45 Geisinger — Medicaid: $4,803.70 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $5,756.36 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $4,547.87 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3,035.80 Highmark BCBS of PA — Medicare Advantage: $1,035.77 Highmark Wholecare (prev Gateway) — Medicare: $3,311.47
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COR ANGIO OR LHC	$8,734	$5,240.40	$5,677.10 – $6,550.50
Left heart catheterization (diagnostic): rates for 3 insurance plans Galaxy Health Plan — Commercial: $5,677.10 Humana — Commercial: $6,550.50 Multiplan — PPO (Includes PHCS as a Payer): $5,677.10
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TX ATRIAL FIB PULM VEIN ISOL	$51,625	$30,975	$892.40 – $43,905.08
Heart rhythm study with ablation for atrial fibrillation: 10 of 20 insurance plan rates Aetna of PA — TPA/Carrier: $20,650 AmeriHealth Caritas — Medicare: $23,388.60 Galaxy Health Plan — Commercial: $33,556.25 Geisinger — Commercial: $20,329.92 Geisinger — Medicaid: $28,393.75 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $43,905.08 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $34,687.63 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $23,154.71 Highmark BCBS of PA — Medicare Advantage: $922.63 Highmark Wholecare (prev Gateway) — Medicare: $25,257.35
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC TX ATRIAL FIB PULM VEIN ISOL	$51,625	$30,975	$33,556.25 – $38,718.75
Heart rhythm study with ablation for atrial fibrillation: rates for 3 insurance plans Galaxy Health Plan — Commercial: $33,556.25 Humana — Commercial: $38,718.75 Multiplan — PPO (Includes PHCS as a Payer): $33,556.25

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC EXERCISE PT 15 MIN	$74	$44.40	$9.22 – $87.53
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 17 insurance plan rates Aetna of PA — TPA/Carrier: $29.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $9.62 Galaxy Health Plan — Commercial: $48.10 Geisinger — Commercial: $29.14 Geisinger — Medicaid: $11.65 Highmark BCBS of PA — Medicare Advantage: $25.23 Highmark Wholecare (prev Gateway) — Medicaid: $10.75 Highmark Wholecare (prev Gateway) — Medicare: $37 Humana — Commercial: $55.50 Multiplan — PPO (Includes PHCS as a Payer): $37
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GO In the file: HC THERAP EXER OT 15 MIN	$123	$73.80	$9.22 – $92.25
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 16 insurance plan rates Aetna of PA — TPA/Carrier: $49.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $9.62 Galaxy Health Plan — Commercial: $79.95 Geisinger — Commercial: $48.44 Geisinger — Medicaid: $11.65 Highmark BCBS of PA — Medicare Advantage: $25.23 Highmark Wholecare (prev Gateway) — Medicaid: $10.75 Highmark Wholecare (prev Gateway) — Medicare: $61.50 Humana — Commercial: $92.25 Multiplan — PPO (Includes PHCS as a Payer): $61.50
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: HC EXERCISE PT 15 MIN	$74	$44.40	$48.10 – $55.50
Physical therapy: therapeutic exercise (each 15 minutes): rates for 3 insurance plans Galaxy Health Plan — Commercial: $48.10 Humana — Commercial: $55.50 Multiplan — PPO (Includes PHCS as a Payer): $48.10
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: LOW COMPLEXITY	$378	$226.80	$51.04 – $283.50
Physical therapy evaluation (low complexity): 10 of 14 insurance plan rates Aetna of PA — TPA/Carrier: $151.20 Galaxy Health Plan — Commercial: $245.70 Geisinger — Commercial: $148.86 Geisinger — Medicaid: $207.90 Highmark BCBS of PA — Medicare Advantage: $51.04 Highmark Wholecare (prev Gateway) — Medicare: $189 Humana — Commercial: $283.50 Multiplan — PPO (Includes PHCS as a Payer): $189 Premier Comp Solutions — Worker's Comp: $148.43 United Healthcare — Commercial: $162.92
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: LOW COMPLEXITY	$378	$226.80	$245.70 – $283.50
Physical therapy evaluation (low complexity): rates for 3 insurance plans Galaxy Health Plan — Commercial: $245.70 Humana — Commercial: $283.50 Multiplan — PPO (Includes PHCS as a Payer): $245.70
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: MODERATE COMPLEXITY	$506	$303.60	$29.13 – $379.50
Physical therapy evaluation (moderate complexity): 10 of 14 insurance plan rates Aetna of PA — TPA/Carrier: $202.40 Galaxy Health Plan — Commercial: $328.90 Geisinger — Commercial: $199.26 Geisinger — Medicaid: $278.30 Highmark BCBS of PA — Medicare Advantage: $51.04 Highmark Wholecare (prev Gateway) — Medicare: $253 Humana — Commercial: $379.50 Multiplan — PPO (Includes PHCS as a Payer): $253 Premier Comp Solutions — Worker's Comp: $148.43 United Healthcare — Commercial: $218.09
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: MODERATE COMPLEXITY	$506	$303.60	$328.90 – $379.50
Physical therapy evaluation (moderate complexity): rates for 3 insurance plans Galaxy Health Plan — Commercial: $328.90 Humana — Commercial: $379.50 Multiplan — PPO (Includes PHCS as a Payer): $328.90
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: HIGH COMPLEXITY	$605	$363	$51.04 – $453.75
Physical therapy evaluation (high complexity): 10 of 14 insurance plan rates Aetna of PA — TPA/Carrier: $242 Galaxy Health Plan — Commercial: $393.25 Geisinger — Commercial: $238.25 Geisinger — Medicaid: $332.75 Highmark BCBS of PA — Medicare Advantage: $51.04 Highmark Wholecare (prev Gateway) — Medicare: $302.50 Humana — Commercial: $453.75 Multiplan — PPO (Includes PHCS as a Payer): $302.50 Premier Comp Solutions — Worker's Comp: $148.43 United Healthcare — Commercial: $260.75
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: HC NEW PT EVAL: HIGH COMPLEXITY	$605	$363	$393.25 – $453.75
Physical therapy evaluation (high complexity): rates for 3 insurance plans Galaxy Health Plan — Commercial: $393.25 Humana — Commercial: $453.75 Multiplan — PPO (Includes PHCS as a Payer): $393.25
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INDIVID PSYCHO 60MIN MD	$504	$302.40	$57.20 – $378
Psychotherapy, 60 minutes: 10 of 21 insurance plan rates Aetna of PA — TPA/Carrier: $201.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $59.70 AmeriHealth Caritas — Medicare: $153.18 Galaxy Health Plan — Commercial: $327.60 Geisinger — Commercial: $198.48 Geisinger — Medicaid: $72.27 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $287.55 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $227.18 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $151.65 Highmark BCBS of PA — Medicare Advantage: $253.92
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INDIVID PSYCHO 60MIN MD	$504	$302.40	$327.60 – $378
Psychotherapy, 60 minutes: rates for 3 insurance plans Galaxy Health Plan — Commercial: $327.60 Humana — Commercial: $378 Multiplan — PPO (Includes PHCS as a Payer): $327.60

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee In the file: HC RMVL OF BREAST LESION, 1 OR MORE LESIONS P/F	$1,797	$1,078.20	$396.50 – $428.18
Removal of breast growth (open surgery): rates for 2 insurance plans Highmark Wholecare (prev Gateway) — Medicare: $428.18 UPMC Health Plan — Managed Medicare: $396.50
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 – $6,853.21
Removal of breast growth (open surgery): 10 of 17 insurance plan rates AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $198.60 AmeriHealth Caritas — Medicare: $3,650.76 Geisinger — Medicaid: $240.45 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $6,853.21 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $5,414.44 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3,614.25 Highmark BCBS of PA — Medicare Advantage: $828.50 Highmark Wholecare (prev Gateway) — Medicaid: $221.96 Highmark Wholecare (prev Gateway) — Medicare: $3,942.46 United Healthcare — Medicare: $3,650.76
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	$892.40 – $23,027.56
Total hip replacement: 10 of 11 insurance plan rates AmeriHealth Caritas — Medicare: $12,266.97 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $23,027.56 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $18,193.14 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $12,144.30 Highmark BCBS of PA — Medicare Advantage: $2,444.33 Highmark Wholecare (prev Gateway) — Medicare: $13,247.10 United Healthcare — Medicare: $12,266.97 United Healthcare Community Plan for Families — PA Medicaid: $892.40 UPMC Health Plan — EPO Partners/EPO Select Plan/HMO: $12,512.31 UPMC Health Plan — Managed Medicare: $12,266.97
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	$892.40 – $23,027.56
Total knee replacement: 10 of 12 insurance plan rates AmeriHealth Caritas — Medicare: $12,266.97 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $23,027.56 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $18,193.14 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $12,144.30 Highmark BCBS of PA — Medicare Advantage: $2,638.50 Highmark Wholecare (prev Gateway) — Medicare: $13,247.10 United Healthcare — Medicare: $12,266.97 United Healthcare Community Plan for Families — PA Medicaid: $892.40 UPMC Health Plan — CHIP: $14,888.05 UPMC Health Plan — EPO Partners/EPO Select Plan/HMO: $12,512.31
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	$625.02 – $3,406
Shoulder arthroscopy: shaving of shoulder bone: rates for 5 insurance plans Highmark BCBS of PA — Medicare Advantage: $828.50 United Healthcare Community Plan for Families — PA Medicaid: $625.02 UPMC Health Plan — CHIP: $2,655.58 UPMC Health Plan — Commercial: $3,406 UPMC Work Partners — Workers Comp: $2,139.16
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 – $5,806.84
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 17 insurance plan rates AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $623.94 AmeriHealth Caritas — Medicare: $3,093.35 Geisinger — Medicaid: $755.41 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $5,806.84 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $4,587.75 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3,062.42 Highmark BCBS of PA — Medicare Advantage: $1,020.54 Highmark Wholecare (prev Gateway) — Medicaid: $697.31 Highmark Wholecare (prev Gateway) — Medicare: $3,340.51 United Healthcare — Medicare: $3,093.35
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TONSILLECTOMY AND ADENOIDECTOMY; YOUNGER THAN AGE 12	Not listed in the file	Not listed in the file	$635.33 – $10,587.16
Removal of tonsils and adenoids (under age 12): 10 of 13 insurance plan rates AmeriHealth Caritas — Medicare: $5,639.87 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $10,587.16 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $8,364.49 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $5,583.47 Highmark BCBS of PA — Medicare Advantage: $1,614.93 Highmark Wholecare (prev Gateway) — Medicare: $6,090.50 United Healthcare — Medicare: $5,639.87 United Healthcare Community Plan for Families — PA Medicaid: $798.10 UPMC Health Plan — CHIP: $5,149.42 UPMC Health Plan — Commercial: $3,406
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC UPPER GI ENDOSCOPY EGD/EGJ	$2,515	$1,509	$137.74 – $2,220
Upper GI endoscopy (diagnostic): 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $1,006 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $143.75 AmeriHealth Caritas — Medicare: $893.85 Galaxy Health Plan — Commercial: $1,634.75 Geisinger — Commercial: $990.41 Geisinger — Medicaid: $174.04 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,677.94 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $1,325.67 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $884.91 Highmark BCBS of PA — Medicare Advantage: $539.52
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC UPPER GI ENDOSCOPY EGD/EGJ	$2,515	$1,509	$1,634.75 – $1,886.25
Upper GI endoscopy (diagnostic): rates for 3 insurance plans Galaxy Health Plan — Commercial: $1,634.75 Humana — Commercial: $1,886.25 Multiplan — PPO (Includes PHCS as a Payer): $1,634.75
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee In the file: HC EGD P/F	$3,183	$1,909.80	$114.36 – $123.50
Upper GI endoscopy (diagnostic): rates for 2 insurance plans Highmark Wholecare (prev Gateway) — Medicare: $123.50 UPMC Health Plan — Managed Medicare: $114.36
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC UPPER GI ENDOSCOPY W/BIOPSY	$3,366	$2,019.60	$163.44 – $2,937
Upper GI endoscopy with biopsy: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $1,346.40 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $170.57 AmeriHealth Caritas — Medicare: $893.85 Galaxy Health Plan — Commercial: $2,187.90 Geisinger — Commercial: $1,325.53 Geisinger — Medicaid: $206.51 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,677.94 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $1,325.67 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $884.91 Highmark BCBS of PA — Medicare Advantage: $722.42
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EGD BIOPSY SINGLE/MULTIPLE	$3,472	$2,083.20	$163.44 – $2,937
Upper GI endoscopy with biopsy: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $1,388.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $170.57 AmeriHealth Caritas — Medicare: $893.85 Galaxy Health Plan — Commercial: $2,256.80 Geisinger — Commercial: $1,367.27 Geisinger — Medicaid: $206.51 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,677.94 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $1,325.67 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $884.91 Highmark BCBS of PA — Medicare Advantage: $722.42
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC UPPER GI ENDOSCOPY W/BIOPSY	$3,366	$2,019.60	$2,187.90 – $2,524.50
Upper GI endoscopy with biopsy: rates for 3 insurance plans Galaxy Health Plan — Commercial: $2,187.90 Humana — Commercial: $2,524.50 Multiplan — PPO (Includes PHCS as a Payer): $2,187.90
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COLONOSCOPY DIAGNOSTIC	$2,218	$1,330.80	$198.55 – $2,937
Colonoscopy (diagnostic): 10 of 22 insurance plan rates Aetna of PA — TPA/Carrier: $887.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $207.21 AmeriHealth Caritas — Medicare: $869.21 Galaxy Health Plan — Commercial: $1,441.70 Geisinger — Commercial: $873.45 Geisinger — Medicaid: $250.88 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,631.68 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $1,289.13 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $860.52 Highmark BCBS of PA — Medicare Advantage: $722.42
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COLONOSCOPY DIAGNOSTIC MD	$739	$443.40	$198.55 – $2,937
Colonoscopy (diagnostic): 10 of 22 insurance plan rates Aetna of PA — TPA/Carrier: $295.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $207.21 AmeriHealth Caritas — Medicare: $869.21 Galaxy Health Plan — Commercial: $480.35 Geisinger — Commercial: $291.02 Geisinger — Medicaid: $250.88 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,631.68 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $1,289.13 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $860.52 Highmark BCBS of PA — Medicare Advantage: $722.42
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COLONOSCOPY DIAGNOSTIC	$2,218	$1,330.80	$1,441.70 – $1,663.50
Colonoscopy (diagnostic): rates for 3 insurance plans Galaxy Health Plan — Commercial: $1,441.70 Humana — Commercial: $1,663.50 Multiplan — PPO (Includes PHCS as a Payer): $1,441.70
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE	Not listed in the file	Not listed in the file	$247.96 – $2,937
Colonoscopy with biopsy: 10 of 17 insurance plan rates AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $258.78 AmeriHealth Caritas — Medicare: $1,124.11 Geisinger — Medicaid: $313.31 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $2,110.18 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $1,667.17 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $1,112.87 Highmark BCBS of PA — Medicare Advantage: $722.42 Highmark Wholecare (prev Gateway) — Medicaid: $289.21 Highmark Wholecare (prev Gateway) — Medicare: $1,213.93 United Healthcare — Medicare: $1,124.11
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COLONOSCOPY W/ LES REM	$2,778	$1,666.80	$294.89 – $2,937
Colonoscopy with removal of polyps (snare): 10 of 22 insurance plan rates Aetna of PA — TPA/Carrier: $1,111.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $307.76 AmeriHealth Caritas — Medicare: $1,124.11 Galaxy Health Plan — Commercial: $1,805.70 Geisinger — Commercial: $1,093.98 Geisinger — Medicaid: $372.60 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $2,110.18 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $1,667.17 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $1,112.87 Highmark BCBS of PA — Medicare Advantage: $722.42
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COLONOSCOPY W/ LES REM MD	$1,650	$990	$294.89 – $2,937
Colonoscopy with removal of polyps (snare): 10 of 22 insurance plan rates Aetna of PA — TPA/Carrier: $660 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $307.76 AmeriHealth Caritas — Medicare: $1,124.11 Galaxy Health Plan — Commercial: $1,072.50 Geisinger — Commercial: $649.77 Geisinger — Medicaid: $372.60 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $2,110.18 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $1,667.17 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $1,112.87 Highmark BCBS of PA — Medicare Advantage: $722.42
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COLONOSCOPY W/ LES REM	$2,778	$1,666.80	$1,805.70 – $2,083.50
Colonoscopy with removal of polyps (snare): rates for 3 insurance plans Galaxy Health Plan — Commercial: $1,805.70 Humana — Commercial: $2,083.50 Multiplan — PPO (Includes PHCS as a Payer): $1,805.70
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK	Not listed in the file	Not listed in the file	$582.97 – $2,937
Screening colonoscopy (not high risk): 10 of 12 insurance plan rates AmeriHealth Caritas — Medicare: $869.21 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,631.68 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $1,289.13 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $860.52 Highmark BCBS of PA — Medicare Advantage: $614.27 Highmark Wholecare (prev Gateway) — Medicare: $938.66 United Healthcare — Medicare: $869.21 United Healthcare Community Plan for Families — PA Medicaid: $582.97 UPMC Health Plan — CHIP: $2,182.77 UPMC Health Plan — Commercial: $2,937
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LAPAROSCOP CHOLECYSTECTOMY	$13,816	$8,289.60	$892.40 – $10,441.66
Gallbladder removal by laparoscope: 10 of 19 insurance plan rates Aetna of PA — TPA/Carrier: $5,526.40 AmeriHealth Caritas — Medicare: $5,562.36 Galaxy Health Plan — Commercial: $8,980.40 Geisinger — Commercial: $5,440.74 Geisinger — Medicaid: $7,598.80 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $10,441.66 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $8,249.54 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $5,506.74 Highmark BCBS of PA — Medicare Advantage: $1,614.93 Highmark Wholecare (prev Gateway) — Medicare: $6,006.79
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LAPAROSCOP CHOLECYSTECTOMY MD	$3,784	$2,270.40	$892.40 – $10,441.66
Gallbladder removal by laparoscope: 10 of 19 insurance plan rates Aetna of PA — TPA/Carrier: $1,513.60 AmeriHealth Caritas — Medicare: $5,562.36 Galaxy Health Plan — Commercial: $2,459.60 Geisinger — Commercial: $1,490.14 Geisinger — Medicaid: $2,081.20 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $10,441.66 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $8,249.54 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $5,506.74 Highmark BCBS of PA — Medicare Advantage: $1,614.93 Highmark Wholecare (prev Gateway) — Medicare: $6,006.79
Gallbladder removal by laparoscope CPT 47562 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LAPAROSCOP CHOLECYSTECTOMY	$13,816	$8,289.60	$8,980.40 – $10,362
Gallbladder removal by laparoscope: rates for 3 insurance plans Galaxy Health Plan — Commercial: $8,980.40 Humana — Commercial: $10,362 Multiplan — PPO (Includes PHCS as a Payer): $8,980.40
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee In the file: HC REPR INITIAL ING HERNIA 5 OLDER REDUCIB P/F	$2,828	$1,696.80	$496.63 – $536.31
Groin (inguinal) hernia repair, age 5 or older: rates for 2 insurance plans Highmark Wholecare (prev Gateway) — Medicare: $536.31 UPMC Health Plan — Managed Medicare: $496.63
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 – $6,315.91
Groin (inguinal) hernia repair, age 5 or older: 10 of 17 insurance plan rates AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $364.49 AmeriHealth Caritas — Medicare: $3,364.54 Geisinger — Medicaid: $441.29 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $6,315.91 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $4,989.95 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3,330.89 Highmark BCBS of PA — Medicare Advantage: $1,020.54 Highmark Wholecare (prev Gateway) — Medicaid: $407.35 Highmark Wholecare (prev Gateway) — Medicare: $3,633.37 United Healthcare — Medicare: $3,364.54
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NEEDLE BX PROSTATE	$5,493	$3,295.80	$98.45 – $4,119.75
Prostate biopsy: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $2,197.20 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $102.75 AmeriHealth Caritas — Medicare: $1,953.01 Galaxy Health Plan — Commercial: $3,570.45 Geisinger — Commercial: $2,163.14 Geisinger — Medicaid: $124.40 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $3,666.19 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $2,896.51 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $1,933.48 Highmark BCBS of PA — Medicare Advantage: $722.42
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NEEDLE BX PROSTATE MD	$735	$441	$98.45 – $3,666.19
Prostate biopsy: 10 of 22 insurance plan rates Aetna of PA — TPA/Carrier: $294 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $102.75 AmeriHealth Caritas — Medicare: $1,953.01 Galaxy Health Plan — Commercial: $477.75 Geisinger — Commercial: $289.44 Geisinger — Medicaid: $124.40 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $3,666.19 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $2,896.51 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $1,933.48 Highmark BCBS of PA — Medicare Advantage: $722.42
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NEEDLE BX PROSTATE	$5,493	$3,295.80	$3,570.45 – $4,119.75
Prostate biopsy: rates for 3 insurance plans Galaxy Health Plan — Commercial: $3,570.45 Humana — Commercial: $4,119.75 Multiplan — PPO (Includes PHCS as a Payer): $3,570.45
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	$577.87 – $5,690.36
Hysteroscopy with biopsy of the uterus lining: 10 of 13 insurance plan rates AmeriHealth Caritas — Medicare: $3,031.30 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $5,690.36 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $4,495.72 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $3,000.99 Highmark BCBS of PA — Medicare Advantage: $888.70 Highmark Wholecare (prev Gateway) — Medicare: $3,273.50 United Healthcare — Medicare: $3,031.30 United Healthcare Community Plan for Families — PA Medicaid: $892.40 UPMC Health Plan — CHIP: $1,336.10 UPMC Health Plan — Commercial: $3,406
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NJX INTERLUML LMBR/SAC W/IMG INJ	$3,414	$2,048.40	$89.45 – $2,560.50
Spinal injection, lower back (epidural), with imaging guidance: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $1,365.60 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $93.36 AmeriHealth Caritas — Medicare: $660.23 Galaxy Health Plan — Commercial: $2,219.10 Geisinger — Commercial: $1,344.43 Geisinger — Medicaid: $113.03 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,239.38 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $979.19 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $653.63 Highmark BCBS of PA — Medicare Advantage: $152.09
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NJX INTERLUML LMBR/SAC W/IMG INJ	$3,414	$2,048.40	$2,219.10 – $2,560.50
Spinal injection, lower back (epidural), with imaging guidance: rates for 3 insurance plans Galaxy Health Plan — Commercial: $2,219.10 Humana — Commercial: $2,560.50 Multiplan — PPO (Includes PHCS as a Payer): $2,219.10
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ EPIDURAL L/S SINGLE	$4,412	$2,647.20	$104.54 – $3,309
Nerve root injection, lower back, with imaging guidance: 10 of 23 insurance plan rates Aetna of PA — TPA/Carrier: $1,764.80 AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $109.11 AmeriHealth Caritas — Medicare: $848.78 Galaxy Health Plan — Commercial: $2,867.80 Geisinger — Commercial: $1,737.45 Geisinger — Medicaid: $132.10 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $1,593.33 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $1,258.83 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $840.29 Highmark BCBS of PA — Medicare Advantage: $580.26
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ EPIDURAL L/S SINGLE	$4,412	$2,647.20	$2,867.80 – $3,309
Nerve root injection, lower back, with imaging guidance: rates for 3 insurance plans Galaxy Health Plan — Commercial: $2,867.80 Humana — Commercial: $3,309 Multiplan — PPO (Includes PHCS as a Payer): $2,867.80
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 – $3,494.84
Carpal tunnel release: 10 of 17 insurance plan rates AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $344.40 AmeriHealth Caritas — Medicare: $1,861.73 Geisinger — Medicaid: $416.97 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $3,494.84 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $2,761.13 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $1,843.11 Highmark BCBS of PA — Medicare Advantage: $722.42 Highmark Wholecare (prev Gateway) — Medicaid: $384.90 Highmark Wholecare (prev Gateway) — Medicare: $2,010.48 United Healthcare — Medicare: $1,861.73
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 – $6,636
Cataract removal with lens implant: 10 of 17 insurance plan rates AmeriHealth Caritas — Community HealthChoices (CHC)/Medicaid: $691.70 AmeriHealth Caritas — Medicare: $2,174.40 Geisinger — Medicaid: $837.46 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $4,081.78 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $3,224.85 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $2,152.66 Highmark BCBS of PA — Medicare Advantage: $1,429.70 Highmark Wholecare (prev Gateway) — Medicaid: $773.05 Highmark Wholecare (prev Gateway) — Medicare: $2,348.13 United Healthcare — Medicare: $2,174.40

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC C/SECTION	$16,724	$10,034.40	$50.26 – $12,543
Cesarean delivery (C-section), with care before and after: 10 of 15 insurance plan rates Aetna of PA — TPA/Carrier: $6,689.60 Galaxy Health Plan — Commercial: $10,870.60 Geisinger — Commercial: $6,585.91 Geisinger — Medicaid: $9,198.20 Highmark BCBS of PA — Medicare Advantage: $3,275.37 Highmark Wholecare (prev Gateway) — Medicare: $8,362 Humana — Commercial: $12,543 Multiplan — PPO (Includes PHCS as a Payer): $8,362 United Healthcare — Commercial: $7,208.04 United Healthcare Community Plan for Families — PA Medicaid: $2,053.90
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC C/SECTION	$16,724	$10,034.40	$10,870.60 – $12,543
Cesarean delivery (C-section), with care before and after: rates for 3 insurance plans Galaxy Health Plan — Commercial: $10,870.60 Humana — Commercial: $12,543 Multiplan — PPO (Includes PHCS as a Payer): $10,870.60

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$3.91 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $106,273.39
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 15 insurance plan rates Aetna of PA — Medicare: $73,347.89 Aetna of PA — TPA/Carrier: $3.91 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) AmeriHealth Caritas — Medicare: $73,347.89 Geisinger — Commercial: $94,037.56 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $99,103.52 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $89,772.66 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $72,614.41 Highmark BCBS of PA — Medicare Advantage: $72,614.41 Highmark Wholecare (prev Gateway) — Medicare: $79,208.39 Multiplan — PPO (Includes PHCS as a Payer): $106,273.39
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	$19,766.59
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 1 insurance plan UPMC Work Partners — Workers Comp: $19,766.59
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	$9,413.69
Spinal fusion (not neck), without major complications: rates for 1 insurance plan UPMC Work Partners — Workers Comp: $9,413.69
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	$0.77 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $20,954.20
Hip or knee replacement (major joint of the leg), without major complications: 10 of 15 insurance plan rates Aetna of PA — Medicare: $14,462.19 Aetna of PA — TPA/Carrier: $0.77 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) AmeriHealth Caritas — Medicare: $14,462.19 Geisinger — Commercial: $18,541.63 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $17,427.65 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $15,786.79 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $14,317.57 Highmark BCBS of PA — Medicare Advantage: $14,317.57 Highmark Wholecare (prev Gateway) — Medicare: $15,617.72 Multiplan — PPO (Includes PHCS as a Payer): $20,954.20
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	$0.98 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $26,520.55
Neck (cervical) spinal fusion, without complications: 10 of 15 insurance plan rates Aetna of PA — Medicare: $18,303.98 Aetna of PA — TPA/Carrier: $0.98 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) AmeriHealth Caritas — Medicare: $18,303.98 Geisinger — Commercial: $23,467.09 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $22,427.63 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $20,316.01 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $18,120.94 Highmark BCBS of PA — Medicare Advantage: $18,120.94 Highmark Wholecare (prev Gateway) — Medicare: $19,766.47 Multiplan — PPO (Includes PHCS as a Payer): $26,520.55
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	$33,924.23
Neck (cervical) spinal fusion, without complications: rates for 1 insurance plan UPMC Work Partners — Workers Comp: $33,924.23
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	$0.50 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $13,478.08
Uterus and ovary surgery (not for cancer), without complications: 10 of 15 insurance plan rates Aetna of PA — Medicare: $9,489.71 Aetna of PA — TPA/Carrier: $0.50 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) AmeriHealth Caritas — Medicare: $9,489.71 Geisinger — Commercial: $11,926.28 Highmark BCBS of PA — Commercial - Indemnity/Managed Care: $12,615.54 Highmark BCBS of PA — Commercial - Social Mission Indemnity/Managed Care - Social : $11,427.75 Highmark BCBS of PA — Community Blue Medicare Advantage/Complete Blue Medicare Adv: $9,394.81 Highmark BCBS of PA — Medicare Advantage: $9,394.81 Highmark Wholecare (prev Gateway) — Medicare: $10,247.94 Multiplan — PPO (Includes PHCS as a Payer): $13,478.08

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

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

Hospital information

Hospital type	Acute Care Hospital
Address	225 South Center Avenue, Somerset, PA 15501
County	Somerset County
State	Pennsylvania
Phone	(814) 443‑5000
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	4 of 5 stars
CMS Certification Number	390039
Name in Medicare records	UPMC SOMERSET
Profile level	Medicare data + hospital website
Official website	upmc.com
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

UPMC Somerset — upmc.com
UPMC Somerset Services — upmc.com
About UPMC Somerset — upmc.com
Visitor Information — upmc.com
Stroke Care | UPMC Somerset | Somerset, Pa — upmc.com
Surgical Services | UPMC Somerset | Somerset, Pa — upmc.com
Behavioral Health Services | UPMC Somerset — upmc.com
Patient & Visitor Info | UPMC Somerset — upmc.com
After Your Stay | UPMC Somerset | Somerset, Pa — upmc.com
Amenities | UPMC Somerset | Somerset, Pa — upmc.com
Request Medical Records | UPMC Somerset | Somerset, Pa — upmc.com

UPMC Somerset

Summary

Profile from official sources

At a glance