Does Westchester Medical Center have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Westchester Medical Center. In a medical emergency, call 911.

Where is Westchester Medical Center?

100 Woods Rd, Valhalla, NY 10595, in Westchester County, New York.

What is the phone number of Westchester Medical Center?

(914) 493-7000, as listed by Medicare (CMS).

What is the Medicare star rating of Westchester Medical Center?

2 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Westchester Medical Center — Valhalla, NY

Quick answers

Does Westchester Medical Center have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Westchester Medical Center. In a medical emergency, call 911.
Where is Westchester Medical Center?: 100 Woods Rd, Valhalla, NY 10595, in Westchester County, New York.
What is the phone number of Westchester Medical Center?: (914) 493-7000, as listed by Medicare (CMS).
What is the Medicare star rating of Westchester Medical Center?: 2 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[6][7][8]

Trauma surgery
Surgical critical care
Emergency medicine
Rehabilitation medicine

Conditions treated^[6]

Multi-system trauma
Traumatic brain injuries
Blunt force trauma
Vascular injuries
Internal bleeding
Soft tissue injuries
Chest wall and rib fractures
Broken bones and fractures
Complex abdominal injuries
Burns

Treatments^[6][9]

ECMO (extracorporeal membrane oxygenation)
REBOA (resuscitative endovascular balloon occlusion of the aorta)
Critical care and intensive monitoring
Electronic ICU (eICU) telehealth consultation
Trauma rehabilitation
Physical, occupational, speech and respiratory therapy

Procedures^[6]

Robotic emergency surgery
Minimally invasive surgery
Rib and sternum fracture fixation
Complex abdominal wall reconstruction
Emergency general surgery (appendectomy, bowel obstruction)
Hybrid OR procedures combining surgery with interventional radiology

Programs and centers^[6][9][10]

Trauma Survivors Network
Injury Prevention Program
Chest wall injury care (Chest Wall Injury Society designated center)
Caregiver Center
Spiritual Health Services
Patient and family support groups
Legal Health services for patients

Emergency care (hospital website)^[6]

Emergency room	Yes
Trauma designation	Level I (Adult), ACS-verified

Visiting and practical information

Parking	Paid visitor self-park lots, $4 up to 1 hour and $7 up to 24 hours; valet parking is $7 per day; all-day pass $8^[9]
Interpreters and languages	Free interpreters 24/7 by phone or video in 200+ languages; 24/7 remote ASL; in-person ASL with notice^[9]
Patient portal	WMCHealth Patient Portal

Recognition^[6]

Level I Adult Trauma Center (American College of Surgeons verified)
Chest Wall Injury Society designated center

Doctors and clinicians (1,069)

1,069 doctors and other clinicians list Westchester Medical Center as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

Doctors with a page on this site (1,069)

Aaron A. Forbes, CNACertified Registered Nurse Anesthetist (CRNA)
Aaron J. Zuckerman, MDGeneral Surgery
Aarti G. Campo, MDCardiovascular Disease (Cardiology)
Abdolmajid Eshghi, MDUrology
Abdullah Mahmood, MDInternal Medicine
Abha R. Amin, MDOphthalmology
Abhay Dhand, MDInfectious Disease
Abhishek Sarkar, MDPulmonary Disease
Abishake Sapkota, MDInternal Medicine
Adam D. Bier, MDOrthopedic Surgery
Adam L. Rubinstein, MDInternal Medicine
Adam M. Karp, MDNeurology
Adam Shaner, MDOrthopedic Surgery
Adam T. Silverman, MDPlastic and Reconstructive Surgery
Adeel S. Cyril, CNACertified Registered Nurse Anesthetist (CRNA)
Adele Brudnicki, MDDiagnostic Radiology
Adil Iqbal, MDNeurology
Adrianna M. Alves, PAPhysician Assistant
Ahmad A. Hadid, MDCardiovascular Disease (Cardiology)
Ahmad B. Hadid, MDCardiovascular Disease (Cardiology)
Ahmad Choudry, MDHospitalist
Ahmed Alabbady, MDInterventional Cardiology
Aisha A. Stroop, MDEmergency Medicine
Ajsza Matela, MDCritical Care (Intensivists)

And 1,045 more: the button below opens the full list.

Other emergency rooms nearby

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

Phelps Hospital3.2 mi · Sleepy Hollow, NY · Acute Care Hospital
White Plains Hospital Center4.2 mi · White Plains, NY · Acute Care Hospital
Nyack Hospital6.4 mi · Nyack, NY · Acute Care Hospital
Northern Westchester Hospital8.6 mi · Mount Kisco, NY · Acute Care Hospital
St John's Riverside Hospital9.2 mi · Yonkers, NY · Acute Care Hospital

Other hospitals nearby

Blythedale Children's Hospital1.2 mi · Valhalla, NY · Children's Hospital
Burke Rehabilitation Hospital5.6 mi · White Plains, NY · Inpatient Rehabilitation Hospital

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

The Steven and Alexandra Cohen Ped L T C Pavilion0.8 mi · Valhalla, NY · 5 of 5 stars
The Grove at Valhalla Rehab and Nursing Center1.2 mi · Valhalla, NY · 2 of 5 stars
The Knolls1.2 mi · Valhalla, NY · 5 of 5 stars

All nursing homes in the state →

Hospice providers

Hospice of Westchester3.1 mi · White Plains, NY · 4 of 5 stars
Jansen Hospice and Palliative Care3.1 mi · White Plains, NY · 3 of 5 stars
Health Care Connectors LLC9.9 mi · Greenwich, CT

All hospice providers in the state →

Home health agencies

Archcare at Home1.2 mi · Valhalla, NY · 3 of 5 stars
Lawrence Home Care of Westchester3.1 mi · White Plains, NY · 3 of 5 stars
VNS Westchester Chha6.0 mi · White Plains, NY

All home health agencies in the state →

Dialysis facilities

DIALYSIS CLINIC INC, Hawthorne1.0 mi · Hawthorne, NY · 5 of 5 stars
Westchester Artificial Kidney Center2.0 mi · Elmsford, NY · 5 of 5 stars
DaVita Hudson Valley Dialysis Center2.4 mi · Tarrytown, NY · 4 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.

New York Endoscopy Center3.1 mi · White Plains, NY
Surgical Specialty Center of Westchester8.7 mi · Harrison, NY
The Ambulatory Surgery Center of Westchester9.0 mi · Mount Kisco, NY

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

The Grasslands Homeless Shelter0.4 mi · Valhalla, NY · Community health center
John Paulding School Tarrytown Art 312.8 mi · Tarrytown, NY · Community health center
Sleepy Hollow High School/Middle School Art 312.8 mi · Sleepy Hollow, NY · Community health center

Clinics and urgent care

City Medical of Upper East Side PLLC3.1 mi · White Plains, NY · Urgent care center
Westchester Urgent Care PLLC3.1 mi · White Plains, NY · Urgent care center
Ashraf Medical Group PLLC4.1 mi · Briarcliff Manor, NY · Urgent care center

Pharmacies

Acariahealth Pharmacy 12 Inc1.0 mi · Hawthorne, NY · Pharmacy
Walgreen Co1.0 mi · Hawthorne, NY · Pharmacy
Walgreen Co1.2 mi · Valhalla, NY · Pharmacy

Assisted living nearby

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

Crestview Manor ALP1.0 mi · Hawthorne, NY
The Knolls1.2 mi · Valhalla, NY
Brightview Tarrytown2.4 mi · Tarrytown, NY
Kendal on Hudson2.4 mi · Sleepy Hollow, NY

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

What patients said (patient survey)

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

Summary star rating (all survey topics)	2 of 5 stars
Overall rating of the hospital	2 of 5 stars
Would recommend the hospital	2 of 5 stars
Nurses communicated well	2 of 5 stars
Doctors communicated well	2 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	2 of 5 stars
Room and bathroom kept clean	2 of 5 stars
Quiet at night	1 of 5 stars
Rated the hospital 9 or 10 out of 10	57%National average: 72%
Would definitely recommend the hospital	60%National average: 71%
Nurses “always” communicated well	70%National average: 80%
Doctors “always” communicated well	72%National average: 80%
Staff “always” explained medicines before giving them	54%National average: 62%
Were given information about recovery at home	83%National average: 86%
Room and bathroom “always” clean	62%National average: 74%
Area around the room “always” quiet at night	36%National average: 60%
Completed surveys	3,294Response rate: 18%

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)	0.468Better than the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.342Better than the national benchmark
Surgical site infections after colon surgery	0.304No different from the national benchmark
Surgical site infections after abdominal hysterectomy	3.101No different from the national benchmark
MRSA bloodstream infections	0.661No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.677Better than the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	12.1%
Deaths within 30 days: heart failure patients	11.8%
Deaths within 30 days: pneumonia patients	15.3%
Deaths within 30 days: COPD patients	7.6%
Deaths within 30 days: stroke patients	11.5%
Deaths within 30 days: coronary bypass surgery (CABG)	1.5%
Serious complications (patient safety indicator PSI-90)	1.22No different from the national rate
Complications after hip or knee replacement	3.7%

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	13.7%
Readmitted within 30 days: heart failure	21.4%
Readmitted within 30 days: pneumonia	16.4%
Readmitted within 30 days: COPD	19%
Readmitted within 30 days: coronary bypass surgery	10.5%
Readmitted within 30 days: hip or knee replacement	5.9%

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Very high (60,000 or more)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	235 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)	67%National average: 65%

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in New York Best hospitals in New York

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 82 common services exactly as Westchester Medical Center lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

$ 4 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.

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: OFFICE O/P NEW LOW 30-44 MIN	$223	$223	$66.90 – $7,849
New patient office visit (about 30–44 minutes): 10 of 33 insurance plan rates Aetna — Aetna: $7,849 Aetna Employee — Aetna Employee: $144.95 AETNA HP NETWORK — AETNA HP NETWORK: $131.57 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $107.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $133.80 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $100.35 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $120.42 CDPHP — CDPHP: $133.80 CIGNA PPO — CIGNA PPO: $156.10 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $167.25
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYPERBARIC OP NEW INT.	$378	$378	$71 – $7,849
New patient office visit (about 30–44 minutes): 10 of 33 insurance plan rates Aetna — Aetna: $7,849 Aetna Employee — Aetna Employee: $245.70 AETNA HP NETWORK — AETNA HP NETWORK: $223.02 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $181.44 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $226.80 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $170.10 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $204.12 CDPHP — CDPHP: $226.80 CIGNA PPO — CIGNA PPO: $264.60 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $283.50
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPAT VISIT NEW 30 MIN	$345	$345	$71 – $584
New patient office visit (about 30–44 minutes): 10 of 33 insurance plan rates Aetna — Aetna: $224.25 Aetna Employee — Aetna Employee: $224.25 AETNA HP NETWORK — AETNA HP NETWORK: $203.55 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $165.60 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $207 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $155.25 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $186.30 CDPHP — CDPHP: $207 CIGNA PPO — CIGNA PPO: $241.50 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $258.75
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYPERBARIC NEW PT. EXTENSIVE	$347	$347	$104.10 – $7,849
New patient office visit (about 45–59 minutes): 10 of 33 insurance plan rates Aetna — Aetna: $7,849 Aetna Employee — Aetna Employee: $225.55 AETNA HP NETWORK — AETNA HP NETWORK: $204.73 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $166.56 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $208.20 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $156.15 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $187.38 CDPHP — CDPHP: $208.20 CIGNA PPO — CIGNA PPO: $242.90 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $260.25
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW MOD 45-59 MIN	$223	$223	$66.90 – $7,849
New patient office visit (about 45–59 minutes): 10 of 33 insurance plan rates Aetna — Aetna: $7,849 Aetna Employee — Aetna Employee: $144.95 AETNA HP NETWORK — AETNA HP NETWORK: $131.57 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $107.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $133.80 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $100.35 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $120.42 CDPHP — CDPHP: $133.80 CIGNA PPO — CIGNA PPO: $156.10 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $167.25
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPAT VISIT NEW 45 MIN	$460	$460	$108 – $716.44
New patient office visit (about 45–59 minutes): 10 of 33 insurance plan rates Aetna — Aetna: $299 Aetna Employee — Aetna Employee: $299 AETNA HP NETWORK — AETNA HP NETWORK: $271.40 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $220.80 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $276 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $207 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $248.40 CDPHP — CDPHP: $276 CIGNA PPO — CIGNA PPO: $322 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $345
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW HI 60-74 MIN	$223	$223	$66.90 – $7,849
New patient office visit (about 60–74 minutes): 10 of 33 insurance plan rates Aetna — Aetna: $7,849 Aetna Employee — Aetna Employee: $144.95 AETNA HP NETWORK — AETNA HP NETWORK: $131.57 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $107.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $133.80 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $100.35 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $120.42 CDPHP — CDPHP: $133.80 CIGNA PPO — CIGNA PPO: $156.10 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $167.25
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPAT VISIT NEW 60 MIN	$628	$628	$133 – $975.01
New patient office visit (about 60–74 minutes): 10 of 33 insurance plan rates Aetna — Aetna: $408.20 Aetna Employee — Aetna Employee: $408.20 AETNA HP NETWORK — AETNA HP NETWORK: $370.52 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $301.44 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $376.80 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $282.60 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $339.12 CDPHP — CDPHP: $376.80 CIGNA PPO — CIGNA PPO: $439.60 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $471
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: E/M PROV ESKETAMINE <OR =56MG	$4,441	$4,441	$133 – $4,441
New patient office visit (about 60–74 minutes): 10 of 31 insurance plan rates Aetna — Aetna: $2,886.65 Aetna Employee — Aetna Employee: $2,886.65 AETNA HP NETWORK — AETNA HP NETWORK: $2,620.19 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,131.68 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,664.60 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $1,998.45 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $2,398.14 CDPHP — CDPHP: $2,664.60 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $3,330.75 EMBLEM GHI/HIP HMO/EPO/POS — EMBLEM GHI/HIP HMO/EPO/POS: $2,797.83
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P EST LOW 20-29 MIN	$223	$223	$25 – $7,849
Established patient office visit (about 20–29 minutes): 10 of 40 insurance plan rates Aetna — Aetna: $7,849 Aetna Employee — Aetna Employee: $144.95 AETNA HP NETWORK — AETNA HP NETWORK: $131.57 BEACON COMMERCIAL — BEACON COMMERCIAL: $269 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $107.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $133.80 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $100.35 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $120.42 CDPHP — CDPHP: $133.80 CIGNA PPO — CIGNA PPO: $156.10
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPAT VISIT EST 20 MIN	$259	$259	$25 – $584
Established patient office visit (about 20–29 minutes): 10 of 39 insurance plan rates Aetna — Aetna: $168.35 Aetna Employee — Aetna Employee: $168.35 AETNA HP NETWORK — AETNA HP NETWORK: $152.81 BEACON COMMERCIAL — BEACON COMMERCIAL: $269 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $124.32 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $155.40 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $116.55 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $139.86 CDPHP — CDPHP: $155.40 CIGNA PPO — CIGNA PPO: $181.30
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE O/P EST LOW 20-29 MIN	$223	$223	$66.90 – $223
Established patient office visit (about 20–29 minutes): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $167.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $189.55 Medigap — Medigap: $223 MULTIPLAN — MULTIPLAN: $156.10 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $223 PHCS — PHCS: $189.55 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $66.90 SELF-PAY - CC 50% — SELF-PAY - CC 50: $111.50
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P EST MOD 30-39 MIN	$223	$223	$25 – $7,849
Established patient office visit (about 30–39 minutes): 10 of 40 insurance plan rates Aetna — Aetna: $7,849 Aetna Employee — Aetna Employee: $144.95 AETNA HP NETWORK — AETNA HP NETWORK: $131.57 BEACON COMMERCIAL — BEACON COMMERCIAL: $302 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $107.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $133.80 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $100.35 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $120.42 CDPHP — CDPHP: $133.80 CIGNA PPO — CIGNA PPO: $156.10
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYPERBARIC OP CONT. EXT.	$484	$484	$25 – $7,849
Established patient office visit (about 30–39 minutes): 10 of 39 insurance plan rates Aetna — Aetna: $7,849 Aetna Employee — Aetna Employee: $314.60 AETNA HP NETWORK — AETNA HP NETWORK: $285.56 BEACON COMMERCIAL — BEACON COMMERCIAL: $302 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $232.32 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $290.40 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $217.80 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $261.36 CDPHP — CDPHP: $290.40 CIGNA PPO — CIGNA PPO: $338.80
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPAT VISIT EST 30 MIN	$340	$340	$25 – $584
Established patient office visit (about 30–39 minutes): 10 of 39 insurance plan rates Aetna — Aetna: $221 Aetna Employee — Aetna Employee: $221 AETNA HP NETWORK — AETNA HP NETWORK: $200.60 BEACON COMMERCIAL — BEACON COMMERCIAL: $302 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $163.20 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $204 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $153 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $183.60 CDPHP — CDPHP: $204 CIGNA PPO — CIGNA PPO: $238
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PED HLTH SPVSN NEW 18 TO 39YR	$251	$251	$75.30 – $568
Preventive checkup, new patient, age 18–39: 10 of 28 insurance plan rates Aetna — Aetna: $163.15 Aetna Employee — Aetna Employee: $163.15 AETNA HP NETWORK — AETNA HP NETWORK: $148.09 CDPHP — CDPHP: $435 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $188.25 EMBLEM GHI/HIP HMO/EPO/POS — EMBLEM GHI/HIP HMO/EPO/POS: $158.13 EMBLEM GHI/HIP PPO — EMBLEM GHI/HIP PPO: $417.47 EMBLEM GHI/HIP PPO/CBP — EMBLEM GHI/HIP PPO/CBP: $158.13 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $213.35 EMBLEM SELECT CARE (EXCHANGE) — EMBLEM SELECT CARE (EXCHANGE): $354.66
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PED HLTH SPVSN NEW 18 TO 39YR	$251	$251	$75.30 – $251
Preventive checkup, new patient, age 18–39: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $188.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $213.35 Medigap — Medigap: $251 MULTIPLAN — MULTIPLAN: $175.70 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $251 PHCS — PHCS: $213.35 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $75.30 SELF-PAY - CC 50% — SELF-PAY - CC 50: $125.50
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$92.36 – $25,000 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Preventive checkup, new patient, age 18–39: 10 of 25 insurance plan rates EMBLEM GHI/HIP PPO — EMBLEM GHI/HIP PPO: $417.47 EMBLEM SELECT CARE (EXCHANGE) — EMBLEM SELECT CARE (EXCHANGE): $354.66 MVP EXCHANGE — MVP EXCHANGE: $319.20 Tricare — Tricare: $92.36 VALUE OPTIONS (Non-HMO) — VALUE OPTIONS (Non-HMO): $25,000 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) VALUE OPTIONS MEDICARE (CHCS) — VALUE OPTIONS MEDICARE (CHCS): $25,000 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Aetna — Aetna: 6,500% (a percentage in the contract, not a dollar amount) Aetna Employee — Aetna Employee: 6,500% (a percentage in the contract, not a dollar amount) AETNA HP NETWORK — AETNA HP NETWORK: 5,900% (a percentage in the contract, not a dollar amount) CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: 75% (a percentage in the contract, not a dollar amount)
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 40-64	$364	$364	$109.20 – $568
Preventive checkup, new patient, age 40–64: 10 of 28 insurance plan rates Aetna — Aetna: $236.60 Aetna Employee — Aetna Employee: $236.60 AETNA HP NETWORK — AETNA HP NETWORK: $214.76 CDPHP — CDPHP: $435 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $273 EMBLEM GHI/HIP HMO/EPO/POS — EMBLEM GHI/HIP HMO/EPO/POS: $229.32 EMBLEM GHI/HIP PPO — EMBLEM GHI/HIP PPO: $507.87 EMBLEM GHI/HIP PPO/CBP — EMBLEM GHI/HIP PPO/CBP: $229.32 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $309.40 EMBLEM SELECT CARE (EXCHANGE) — EMBLEM SELECT CARE (EXCHANGE): $431.46
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 40-64	$364	$364	$109.20 – $364
Preventive checkup, new patient, age 40–64: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $273 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $309.40 Medigap — Medigap: $364 MULTIPLAN — MULTIPLAN: $254.80 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $364 PHCS — PHCS: $309.40 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $109.20 SELF-PAY - CC 50% — SELF-PAY - CC 50: $182
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LEVEL 3	$5,157	$5,157	$250 – $5,157
Emergency room visit (moderate): 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $356.03 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $339.08 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,270 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,837 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,128
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LEV 3 OB	$5,157	$5,157	$250 – $5,157
Emergency room visit (moderate): 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $356.03 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $339.08 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,270 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,837 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,128
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LEVEL 3	$5,157	$5,157	$1,547.10 – $5,157
Emergency room visit (moderate): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $3,867.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $4,383.45 Medigap — Medigap: $5,157 MULTIPLAN — MULTIPLAN: $3,609.90 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $5,157 PHCS — PHCS: $4,383.45 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $1,547.10 SELF-PAY - CC 50% — SELF-PAY - CC 50: $2,578.50
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LEVEL 4	$6,447	$6,447	$250 – $6,447
Emergency room visit (moderately high): 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $544.23 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $518.31 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,270 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,837 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,128
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LEV 4 OB	$6,447	$6,447	$250 – $6,447
Emergency room visit (moderately high): 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $544.23 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $518.31 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,270 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,837 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,128
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LEVEL 4	$6,447	$6,447	$1,934.10 – $6,447
Emergency room visit (moderately high): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $4,835.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $5,479.95 Medigap — Medigap: $6,447 MULTIPLAN — MULTIPLAN: $4,512.90 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $6,447 PHCS — PHCS: $5,479.95 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $1,934.10 SELF-PAY - CC 50% — SELF-PAY - CC 50: $3,223.50
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LEVEL 5	$8,288	$8,288	$250 – $8,288
Emergency room visit (high): 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $776.74 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $739.75 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,270 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,837 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,128
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LEV 5 OB	$8,288	$8,288	$250 – $8,288
Emergency room visit (high): 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $776.74 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $739.75 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,270 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,837 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,128
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EMERGENCY DEPT VISIT LEVEL 5	$8,288	$8,288	$2,486.40 – $8,288
Emergency room visit (high): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $6,216 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $7,044.80 Medigap — Medigap: $8,288 MULTIPLAN — MULTIPLAN: $5,801.60 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $8,288 PHCS — PHCS: $7,044.80 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $2,486.40 SELF-PAY - CC 50% — SELF-PAY - CC 50: $4,144

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: METABOLIC PANEL TOTAL CA	$102	$102	$5.92 – $102
Basic metabolic panel (blood test): 10 of 52 insurance plan rates Aetna — Aetna: $14.72 Aetna Employee — Aetna Employee: $14.72 AETNA HP NETWORK — AETNA HP NETWORK: $13.28 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $8.88 BEACON COMMERCIAL — BEACON COMMERCIAL: $11 BEACON MEDICARE — BEACON MEDICARE: $8.46 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $75.11 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $32.33 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $24.29 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $8.46
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: METABOLIC PANEL TOTAL CA	$102	$102	$30.60 – $102
Basic metabolic panel (blood test): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $76.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $86.70 Medigap — Medigap: $102 MULTIPLAN — MULTIPLAN: $71.40 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $102 PHCS — PHCS: $86.70 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $30.60 SELF-PAY - CC 50% — SELF-PAY - CC 50: $51
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHEN METABOLIC PANEL	$128	$128	$7.39 – $128
Comprehensive metabolic panel (blood test): 10 of 51 insurance plan rates Aetna — Aetna: $18.37 Aetna Employee — Aetna Employee: $18.37 AETNA HP NETWORK — AETNA HP NETWORK: $16.58 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $11.09 BEACON COMMERCIAL — BEACON COMMERCIAL: $13.73 BEACON MEDICARE — BEACON MEDICARE: $10.56 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $112.35 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $48.36 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $36.34 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $10.56
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPREHEN METABOLIC PANEL	$128	$128	$38.40 – $128
Comprehensive metabolic panel (blood test): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $96 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $108.80 Medigap — Medigap: $128 MULTIPLAN — MULTIPLAN: $89.60 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $128 PHCS — PHCS: $108.80 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $38.40 SELF-PAY - CC 50% — SELF-PAY - CC 50: $64
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL	$235	$235	$23.01 – $265.40
Obstetric blood test panel: 10 of 52 insurance plan rates Aetna — Aetna: $83.19 Aetna Employee — Aetna Employee: $83.19 AETNA HP NETWORK — AETNA HP NETWORK: $75.06 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $50.20 BEACON COMMERCIAL — BEACON COMMERCIAL: $62.15 BEACON MEDICARE — BEACON MEDICARE: $47.81 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $112.80 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $23.01 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $23.01 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $47.81
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL	$235	$235	$70.50 – $235
Obstetric blood test panel: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $176.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $199.75 Medigap — Medigap: $235 MULTIPLAN — MULTIPLAN: $164.50 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $235 PHCS — PHCS: $199.75 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $70.50 SELF-PAY - CC 50% — SELF-PAY - CC 50: $117.50
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL	$162	$162	$9.37 – $162
Cholesterol panel (lipid panel): 10 of 52 insurance plan rates Aetna — Aetna: $23.30 Aetna Employee — Aetna Employee: $23.30 AETNA HP NETWORK — AETNA HP NETWORK: $21.02 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $14.06 BEACON COMMERCIAL — BEACON COMMERCIAL: $17.41 BEACON MEDICARE — BEACON MEDICARE: $13.39 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $157.44 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $67.77 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $50.92 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $13.39
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LIPID PANEL	$162	$162	$48.60 – $162
Cholesterol panel (lipid panel): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $121.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $137.70 Medigap — Medigap: $162 MULTIPLAN — MULTIPLAN: $113.40 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $162 PHCS — PHCS: $137.70 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $48.60 SELF-PAY - CC 50% — SELF-PAY - CC 50: $81
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$105	$105	$6.08 – $105
Kidney function panel: 10 of 52 insurance plan rates Aetna — Aetna: $15.10 Aetna Employee — Aetna Employee: $15.10 AETNA HP NETWORK — AETNA HP NETWORK: $13.63 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $9.11 BEACON COMMERCIAL — BEACON COMMERCIAL: $11.28 BEACON MEDICARE — BEACON MEDICARE: $8.68 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $94.19 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $40.54 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $30.46 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $8.68
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$105	$105	$31.50 – $105
Kidney function panel: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $78.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $89.25 Medigap — Medigap: $105 MULTIPLAN — MULTIPLAN: $73.50 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $105 PHCS — PHCS: $89.25 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $31.50 SELF-PAY - CC 50% — SELF-PAY - CC 50: $52.50
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL	$99	$99	$5.72 – $99
Liver function panel: 10 of 52 insurance plan rates Aetna — Aetna: $14.22 Aetna Employee — Aetna Employee: $14.22 AETNA HP NETWORK — AETNA HP NETWORK: $12.83 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $8.58 BEACON COMMERCIAL — BEACON COMMERCIAL: $10.62 BEACON MEDICARE — BEACON MEDICARE: $8.17 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $75.11 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $32.33 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $24.29 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $8.17
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL	$99	$99	$29.70 – $99
Liver function panel: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $74.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $84.15 Medigap — Medigap: $99 MULTIPLAN — MULTIPLAN: $69.30 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $99 PHCS — PHCS: $84.15 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $29.70 SELF-PAY - CC 50% — SELF-PAY - CC 50: $49.50
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/SCOPE	$59	$59	$2.22 – $59
Urine test (automated, with microscope): 10 of 52 insurance plan rates Aetna — Aetna: $5.52 Aetna Employee — Aetna Employee: $5.52 AETNA HP NETWORK — AETNA HP NETWORK: $4.98 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $3.33 BEACON COMMERCIAL — BEACON COMMERCIAL: $4.12 BEACON MEDICARE — BEACON MEDICARE: $3.17 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $37.27 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $16.04 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $12.05 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $3.17
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/SCOPE	$59	$59	$17.70 – $59
Urine test (automated, with microscope): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $44.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $50.15 Medigap — Medigap: $59 MULTIPLAN — MULTIPLAN: $41.30 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $59 PHCS — PHCS: $50.15 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $17.70 SELF-PAY - CC 50% — SELF-PAY - CC 50: $29.50
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE	$63	$63	$2.44 – $63
Urine test (manual, without microscope): 10 of 52 insurance plan rates Aetna — Aetna: $6.06 Aetna Employee — Aetna Employee: $6.06 AETNA HP NETWORK — AETNA HP NETWORK: $5.46 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $3.65 BEACON COMMERCIAL — BEACON COMMERCIAL: $4.52 BEACON MEDICARE — BEACON MEDICARE: $3.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $30.01 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $12.92 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $9.71 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $3.48
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE	$63	$63	$18.90 – $63
Urine test (manual, without microscope): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $47.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $53.55 Medigap — Medigap: $63 MULTIPLAN — MULTIPLAN: $44.10 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $63 PHCS — PHCS: $53.55 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $18.90 SELF-PAY - CC 50% — SELF-PAY - CC 50: $31.50
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/O SCOPE	$42	$42	$1.57 – $42
Urine test (automated, without microscope): 10 of 52 insurance plan rates Aetna — Aetna: $3.92 Aetna Employee — Aetna Employee: $3.92 AETNA HP NETWORK — AETNA HP NETWORK: $3.53 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $2.36 BEACON COMMERCIAL — BEACON COMMERCIAL: $2.93 BEACON MEDICARE — BEACON MEDICARE: $2.25 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $26.42 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $11.37 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $8.54 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $2.25
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS AUTO W/O SCOPE	$42	$42	$12.60 – $42
Urine test (automated, without microscope): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $31.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $35.70 Medigap — Medigap: $42 MULTIPLAN — MULTIPLAN: $29.40 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $42 PHCS — PHCS: $35.70 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $12.60 SELF-PAY - CC 50% — SELF-PAY - CC 50: $21
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY OF PSA TOTAL	$220	$220	$12.87 – $220
PSA (prostate specific antigen) blood test: 10 of 52 insurance plan rates Aetna — Aetna: $32 Aetna Employee — Aetna Employee: $32 AETNA HP NETWORK — AETNA HP NETWORK: $28.87 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $19.31 BEACON COMMERCIAL — BEACON COMMERCIAL: $23.91 BEACON MEDICARE — BEACON MEDICARE: $18.39 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $216.14 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $93.03 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $69.90 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $18.39
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ASSAY OF PSA TOTAL	$220	$220	$66 – $220
PSA (prostate specific antigen) blood test: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $165 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $187 Medigap — Medigap: $220 MULTIPLAN — MULTIPLAN: $154 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $220 PHCS — PHCS: $187 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $66 SELF-PAY - CC 50% — SELF-PAY - CC 50: $110
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY THYROID STIM HORMONE	$201	$201	$11.76 – $201
Thyroid stimulating hormone (TSH) test: 10 of 51 insurance plan rates Aetna — Aetna: $29.23 Aetna Employee — Aetna Employee: $29.23 AETNA HP NETWORK — AETNA HP NETWORK: $26.38 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $17.64 BEACON COMMERCIAL — BEACON COMMERCIAL: $21.84 BEACON MEDICARE — BEACON MEDICARE: $16.80 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $197.37 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $84.96 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $63.84 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $16.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ASSAY THYROID STIM HORMONE	$201	$201	$60.30 – $201
Thyroid stimulating hormone (TSH) test: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $150.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $170.85 Medigap — Medigap: $201 MULTIPLAN — MULTIPLAN: $140.70 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $201 PHCS — PHCS: $170.85 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $60.30 SELF-PAY - CC 50% — SELF-PAY - CC 50: $100.50
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC W/AUTO DIFF WBC	$95	$95	$5.44 – $95
Complete blood count (CBC) with differential: 10 of 51 insurance plan rates Aetna — Aetna: $13.52 Aetna Employee — Aetna Employee: $13.52 AETNA HP NETWORK — AETNA HP NETWORK: $12.20 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $8.16 BEACON COMMERCIAL — BEACON COMMERCIAL: $10.10 BEACON MEDICARE — BEACON MEDICARE: $7.77 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $91.32 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $39.31 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $29.54 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $7.77
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPLETE CBC W/AUTO DIFF WBC	$95	$95	$28.50 – $95
Complete blood count (CBC) with differential: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $71.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $80.75 Medigap — Medigap: $95 MULTIPLAN — MULTIPLAN: $66.50 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $95 PHCS — PHCS: $80.75 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $28.50 SELF-PAY - CC 50% — SELF-PAY - CC 50: $47.50
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC AUTOMATED	$79	$79	$4.53 – $79
Complete blood count (CBC), automated: 10 of 52 insurance plan rates Aetna — Aetna: $11.26 Aetna Employee — Aetna Employee: $11.26 AETNA HP NETWORK — AETNA HP NETWORK: $10.16 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $6.79 BEACON COMMERCIAL — BEACON COMMERCIAL: $8.41 BEACON MEDICARE — BEACON MEDICARE: $6.47 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $68.30 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $29.39 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $22.09 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $6.47
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPLETE CBC AUTOMATED	$79	$79	$23.70 – $79
Complete blood count (CBC), automated: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $59.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $67.15 Medigap — Medigap: $79 MULTIPLAN — MULTIPLAN: $55.30 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $79 PHCS — PHCS: $67.15 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $23.70 SELF-PAY - CC 50% — SELF-PAY - CC 50: $39.50
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME	$53	$53	$3 – $53
Blood clotting time test (prothrombin time, PT): 10 of 52 insurance plan rates Aetna — Aetna: $7.46 Aetna Employee — Aetna Employee: $7.46 AETNA HP NETWORK — AETNA HP NETWORK: $6.74 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $5.58 BEACON MEDICARE — BEACON MEDICARE: $4.29 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $46.17 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $19.87 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $14.93 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4.29
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME	$53	$53	$15.90 – $53
Blood clotting time test (prothrombin time, PT): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $39.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $45.05 Medigap — Medigap: $53 MULTIPLAN — MULTIPLAN: $37.10 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $53 PHCS — PHCS: $45.05 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $15.90 SELF-PAY - CC 50% — SELF-PAY - CC 50: $26.50
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: POC COAGUSENSE PT INR	$53	$53	$3 – $53
Blood clotting time test (prothrombin time, PT): 10 of 52 insurance plan rates Aetna — Aetna: $7.46 Aetna Employee — Aetna Employee: $7.46 AETNA HP NETWORK — AETNA HP NETWORK: $6.74 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $5.58 BEACON MEDICARE — BEACON MEDICARE: $4.29 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $46.17 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $19.87 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $14.93 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4.29
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTIAL	$74	$74	$4.21 – $74
Blood clotting test (partial thromboplastin time, PTT): 10 of 52 insurance plan rates Aetna — Aetna: $10.46 Aetna Employee — Aetna Employee: $10.46 AETNA HP NETWORK — AETNA HP NETWORK: $9.44 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $6.31 BEACON COMMERCIAL — BEACON COMMERCIAL: $7.81 BEACON MEDICARE — BEACON MEDICARE: $6.01 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $70.47 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $30.34 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $22.79 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTIAL	$74	$74	$22.20 – $74
Blood clotting test (partial thromboplastin time, PTT): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $55.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $62.90 Medigap — Medigap: $74 MULTIPLAN — MULTIPLAN: $51.80 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $74 PHCS — PHCS: $62.90 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $22.20 SELF-PAY - CC 50% — SELF-PAY - CC 50: $37

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 · modifier TC In the file: CT HEAD/BRAIN W/O DYE	$2,311	$2,311	$130.50 – $5,623
CT scan of the head or brain, without contrast: 10 of 52 insurance plan rates Aetna — Aetna: $228.98 Aetna Employee — Aetna Employee: $276.24 AETNA HP NETWORK — AETNA HP NETWORK: $248.80 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $136.35 BEACON COMMERCIAL — BEACON COMMERCIAL: $168.82 BEACON MEDICARE — BEACON MEDICARE: $129.86 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,071.88 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $891.82 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $670.10 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $129.86
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: CT HEAD/BRAIN W/O DYE	$2,311	$2,311	$693.30 – $2,311
CT scan of the head or brain, without contrast: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $1,733.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $1,964.35 Medigap — Medigap: $2,311 MULTIPLAN — MULTIPLAN: $1,617.70 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $2,311 PHCS — PHCS: $1,964.35 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $693.30 SELF-PAY - CC 50% — SELF-PAY - CC 50: $1,155.50
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI BRAIN STEM W/O & W/DYE	$10,494	$10,494	$435.49 – $10,923.84
MRI of the brain, before and after contrast: 10 of 52 insurance plan rates Aetna — Aetna: $722.65 Aetna Employee — Aetna Employee: $902.99 AETNA HP NETWORK — AETNA HP NETWORK: $813.27 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $455.03 BEACON COMMERCIAL — BEACON COMMERCIAL: $563.37 BEACON MEDICARE — BEACON MEDICARE: $433.36 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $10,923.84 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $4,702.05 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $3,533.04 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $433.36
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI BRAIN STEM WO & W DYE W 59	$4,517	$4,517	$435.49 – $10,923.84
MRI of the brain, before and after contrast: 10 of 52 insurance plan rates Aetna — Aetna: $722.65 Aetna Employee — Aetna Employee: $902.99 AETNA HP NETWORK — AETNA HP NETWORK: $813.27 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $455.03 BEACON COMMERCIAL — BEACON COMMERCIAL: $563.37 BEACON MEDICARE — BEACON MEDICARE: $433.36 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $10,923.84 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $4,702.05 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $3,533.04 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $433.36
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: MRI BRAIN STEM W/O & W/DYE	$10,494	$10,494	$3,148.20 – $10,494
MRI of the brain, before and after contrast: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $7,870.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $8,919.90 Medigap — Medigap: $10,494 MULTIPLAN — MULTIPLAN: $7,345.80 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $10,494 PHCS — PHCS: $8,919.90 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $3,148.20 SELF-PAY - CC 50% — SELF-PAY - CC 50: $5,247
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: X-RAY EXAM CHEST 2 VIEWS	$1,099	$1,099	$18.62 – $1,099
Chest X-ray, 2 views: 10 of 52 insurance plan rates Aetna — Aetna: $78.31 Aetna Employee — Aetna Employee: $92.70 AETNA HP NETWORK — AETNA HP NETWORK: $83.49 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $113.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $140.53 BEACON MEDICARE — BEACON MEDICARE: $108.10 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $527.52 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $18.62 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $18.62 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $108.10
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier FY In the file: X-RAY EXM CHST 2 VWS W/ FY MOD	$392	$392	$18.62 – $392
Chest X-ray, 2 views: 10 of 52 insurance plan rates Aetna — Aetna: $254.80 Aetna Employee — Aetna Employee: $92.70 AETNA HP NETWORK — AETNA HP NETWORK: $83.49 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $102.15 BEACON COMMERCIAL — BEACON COMMERCIAL: $126.48 BEACON MEDICARE — BEACON MEDICARE: $97.29 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $188.16 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $18.62 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $18.62 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $97.29
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: X-RAY EXAM CHEST 2 VIEWS	$1,099	$1,099	$329.70 – $1,099
Chest X-ray, 2 views: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $824.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $934.15 Medigap — Medigap: $1,099 MULTIPLAN — MULTIPLAN: $769.30 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $1,099 PHCS — PHCS: $934.15 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $329.70 SELF-PAY - CC 50% — SELF-PAY - CC 50: $549.50
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: X-RAY EXAM L-2 SPINE 4/>VWS	$1,542	$1,542	$98.63 – $1,542
X-ray of the lower spine, at least 4 views: 10 of 52 insurance plan rates Aetna — Aetna: $131.88 Aetna Employee — Aetna Employee: $154.78 AETNA HP NETWORK — AETNA HP NETWORK: $139.40 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $136.35 BEACON COMMERCIAL — BEACON COMMERCIAL: $168.82 BEACON MEDICARE — BEACON MEDICARE: $129.86 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $405.36 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $174.48 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $131.10 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $129.86
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: X-RAY EXAM L-2 SPINE 4/>VWS	$1,542	$1,542	$462.60 – $1,542
X-ray of the lower spine, at least 4 views: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $1,156.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $1,310.70 Medigap — Medigap: $1,542 MULTIPLAN — MULTIPLAN: $1,079.40 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $1,542 PHCS — PHCS: $1,310.70 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $462.60 SELF-PAY - CC 50% — SELF-PAY - CC 50: $771
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI LUMBAR SPINE W/O DYE	$6,405	$6,405	$297.84 – $6,405
MRI of the lower back (lumbar spine), without contrast: 10 of 52 insurance plan rates Aetna — Aetna: $416.68 Aetna Employee — Aetna Employee: $518.17 AETNA HP NETWORK — AETNA HP NETWORK: $466.68 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $311.20 BEACON COMMERCIAL — BEACON COMMERCIAL: $385.29 BEACON MEDICARE — BEACON MEDICARE: $296.38 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $5,455.39 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,348.22 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $1,764.41 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $296.38
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: MRI LUMBAR SPINE W/O DYE	$6,405	$6,405	$1,921.50 – $6,405
MRI of the lower back (lumbar spine), without contrast: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $4,803.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $5,444.25 Medigap — Medigap: $6,405 MULTIPLAN — MULTIPLAN: $4,483.50 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $6,405 PHCS — PHCS: $5,444.25 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $1,921.50 SELF-PAY - CC 50% — SELF-PAY - CC 50: $3,202.50
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT PELVIS W/DYE	$3,756	$3,756	$218.95 – $5,623
CT scan of the pelvis, with contrast: 10 of 52 insurance plan rates Aetna — Aetna: $588.56 Aetna Employee — Aetna Employee: $697.51 AETNA HP NETWORK — AETNA HP NETWORK: $628.20 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $228.77 BEACON COMMERCIAL — BEACON COMMERCIAL: $283.24 BEACON MEDICARE — BEACON MEDICARE: $217.88 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $3,003.39 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $1,292.77 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $971.37 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $217.88
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: CT PELVIS W/DYE	$3,756	$3,756	$1,126.80 – $3,756
CT scan of the pelvis, with contrast: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $2,817 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $3,192.60 Medigap — Medigap: $3,756 MULTIPLAN — MULTIPLAN: $2,629.20 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $3,756 PHCS — PHCS: $3,192.60 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $1,126.80 SELF-PAY - CC 50% — SELF-PAY - CC 50: $1,878
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI JNT OF LWR EXTR W/O DYE RT	$4,804	$4,804	$297.84 – $4,804
MRI of a leg joint (such as the knee), without contrast: 10 of 52 insurance plan rates Aetna — Aetna: $478.23 Aetna Employee — Aetna Employee: $584.22 AETNA HP NETWORK — AETNA HP NETWORK: $526.17 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $311.20 BEACON COMMERCIAL — BEACON COMMERCIAL: $385.29 BEACON MEDICARE — BEACON MEDICARE: $296.38 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $4,803.30 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,067.53 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $1,553.50 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $296.38
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI KNEE LT	$4,804	$4,804	$297.84 – $4,804
MRI of a leg joint (such as the knee), without contrast: 10 of 52 insurance plan rates Aetna — Aetna: $478.23 Aetna Employee — Aetna Employee: $584.22 AETNA HP NETWORK — AETNA HP NETWORK: $526.17 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $311.20 BEACON COMMERCIAL — BEACON COMMERCIAL: $385.29 BEACON MEDICARE — BEACON MEDICARE: $296.38 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $4,803.30 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,067.53 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $1,553.50 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $296.38
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI JNT OF LWR EXTR W/O DYE LT	$4,804	$4,804	$297.84 – $4,804
MRI of a leg joint (such as the knee), without contrast: 10 of 52 insurance plan rates Aetna — Aetna: $478.23 Aetna Employee — Aetna Employee: $584.22 AETNA HP NETWORK — AETNA HP NETWORK: $526.17 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $311.20 BEACON COMMERCIAL — BEACON COMMERCIAL: $385.29 BEACON MEDICARE — BEACON MEDICARE: $296.38 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $4,803.30 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,067.53 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $1,553.50 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $296.38
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT ABD & PELV W/CONTRAST	$11,018	$11,018	$218.45 – $11,018
CT scan of the abdomen and pelvis, with contrast: 10 of 52 insurance plan rates Aetna — Aetna: $738.13 Aetna Employee — Aetna Employee: $935.47 AETNA HP NETWORK — AETNA HP NETWORK: $842.52 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $455.03 BEACON COMMERCIAL — BEACON COMMERCIAL: $563.37 BEACON MEDICARE — BEACON MEDICARE: $433.36 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $5,288.64 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $218.45 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $218.45 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $433.36
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: CT ABD & PELV W/CONTRAST	$11,018	$11,018	$3,305.40 – $11,018
CT scan of the abdomen and pelvis, with contrast: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $8,263.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $9,365.30 Medigap — Medigap: $11,018 MULTIPLAN — MULTIPLAN: $7,712.60 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $11,018 PHCS — PHCS: $9,365.30 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $3,305.40 SELF-PAY - CC 50% — SELF-PAY - CC 50: $5,509
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US EXAM ABDOM COMPLETE	$1,542	$1,542	$130.50 – $1,542
Ultrasound of the abdomen, complete: 10 of 52 insurance plan rates Aetna — Aetna: $259.27 Aetna Employee — Aetna Employee: $317.18 AETNA HP NETWORK — AETNA HP NETWORK: $909.78 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $136.35 BEACON COMMERCIAL — BEACON COMMERCIAL: $168.82 BEACON MEDICARE — BEACON MEDICARE: $129.86 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $870.35 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $374.63 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $281.49 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $129.86
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: US EXAM ABDOM COMPLETE	$1,542	$1,542	$462.60 – $1,542
Ultrasound of the abdomen, complete: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $1,156.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $1,310.70 Medigap — Medigap: $1,542 MULTIPLAN — MULTIPLAN: $1,079.40 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $1,542 PHCS — PHCS: $1,310.70 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $462.60 SELF-PAY - CC 50% — SELF-PAY - CC 50: $771
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: OB US >= 14 WKS SNGL FETUS	$1,542	$1,542	$130.50 – $1,542
Pregnancy ultrasound (after the first trimester): 10 of 52 insurance plan rates Aetna — Aetna: $291.66 Aetna Employee — Aetna Employee: $351.53 AETNA HP NETWORK — AETNA HP NETWORK: $909.78 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $136.35 BEACON COMMERCIAL — BEACON COMMERCIAL: $168.82 BEACON MEDICARE — BEACON MEDICARE: $129.86 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $929.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $399.90 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $300.48 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $129.86
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: OB US >= 14 WKS SNGL FETUS	$1,542	$1,542	$462.60 – $1,542
Pregnancy ultrasound (after the first trimester): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $1,156.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $1,310.70 Medigap — Medigap: $1,542 MULTIPLAN — MULTIPLAN: $1,079.40 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $1,542 PHCS — PHCS: $1,310.70 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $462.60 SELF-PAY - CC 50% — SELF-PAY - CC 50: $771
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: TRANSVAGINAL US NON-OB	$1,542	$1,542	$130.50 – $1,542
Transvaginal ultrasound: 10 of 52 insurance plan rates Aetna — Aetna: $284.95 Aetna Employee — Aetna Employee: $348.88 AETNA HP NETWORK — AETNA HP NETWORK: $909.78 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $136.35 BEACON COMMERCIAL — BEACON COMMERCIAL: $168.82 BEACON MEDICARE — BEACON MEDICARE: $129.86 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $677.01 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $291.41 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $218.96 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $129.86
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: TRANSVAGINAL US NON-OB	$1,542	$1,542	$462.60 – $1,542
Transvaginal ultrasound: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $1,156.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $1,310.70 Medigap — Medigap: $1,542 MULTIPLAN — MULTIPLAN: $1,079.40 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $1,542 PHCS — PHCS: $1,310.70 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $462.60 SELF-PAY - CC 50% — SELF-PAY - CC 50: $771
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DX MAMMO INCL CAD UNI RT	$1,347	$1,347	$71.88 – $1,347
Diagnostic mammogram, one breast: 10 of 52 insurance plan rates Aetna — Aetna: $293.87 Aetna Employee — Aetna Employee: $347.57 AETNA HP NETWORK — AETNA HP NETWORK: $794.73 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $107.81 BEACON COMMERCIAL — BEACON COMMERCIAL: $122.72 BEACON MEDICARE — BEACON MEDICARE: $102.68 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $646.56 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $72.65 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $72.65 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $102.68
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DX MAMMO INCL CAD UNI LT	$1,347	$1,347	$71.88 – $1,347
Diagnostic mammogram, one breast: 10 of 52 insurance plan rates Aetna — Aetna: $293.87 Aetna Employee — Aetna Employee: $347.57 AETNA HP NETWORK — AETNA HP NETWORK: $794.73 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $107.81 BEACON COMMERCIAL — BEACON COMMERCIAL: $122.72 BEACON MEDICARE — BEACON MEDICARE: $102.68 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $646.56 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $72.65 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $72.65 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $102.68
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: DX MAMMO INCL CAD UNI RT	$1,347	$1,347	$404.10 – $1,347
Diagnostic mammogram, one breast: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $1,010.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $1,144.95 Medigap — Medigap: $1,347 MULTIPLAN — MULTIPLAN: $942.90 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $1,347 PHCS — PHCS: $1,144.95 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $404.10 SELF-PAY - CC 50% — SELF-PAY - CC 50: $673.50
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DX MAMMO INCL CAD BI	$1,715	$1,715	$92.33 – $1,715
Diagnostic mammogram, both breasts: 10 of 52 insurance plan rates Aetna — Aetna: $374.24 Aetna Employee — Aetna Employee: $442.63 AETNA HP NETWORK — AETNA HP NETWORK: $1,011.85 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $138.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $157.48 BEACON MEDICARE — BEACON MEDICARE: $131.90 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $823.20 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $92.79 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $92.79 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $131.90
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: DX MAMMO INCL CAD BI	$1,715	$1,715	$514.50 – $1,715
Diagnostic mammogram, both breasts: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $1,286.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $1,457.75 Medigap — Medigap: $1,715 MULTIPLAN — MULTIPLAN: $1,200.50 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $1,715 PHCS — PHCS: $1,457.75 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $514.50 SELF-PAY - CC 50% — SELF-PAY - CC 50: $857.50
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: SCR MAMMO BI INCL CAD	$1,423	$1,423	$76.05 – $1,423
Screening mammogram, both breasts: 10 of 52 insurance plan rates Aetna — Aetna: $309.35 Aetna Employee — Aetna Employee: $366.04 AETNA HP NETWORK — AETNA HP NETWORK: $839.57 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $114.07 BEACON COMMERCIAL — BEACON COMMERCIAL: $129.86 BEACON MEDICARE — BEACON MEDICARE: $108.64 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $683.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $76.73 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $76.73 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $108.64
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MAMMOGRAM SCREEN UNI RT CAD	$1,330	$1,330	$76.05 – $1,330
Screening mammogram, both breasts: 10 of 52 insurance plan rates Aetna — Aetna: $309.35 Aetna Employee — Aetna Employee: $366.04 AETNA HP NETWORK — AETNA HP NETWORK: $784.70 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $114.07 BEACON COMMERCIAL — BEACON COMMERCIAL: $129.86 BEACON MEDICARE — BEACON MEDICARE: $108.64 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $638.40 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $76.73 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $76.73 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $108.64
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MAMMOGRAM SCREEN UNI RT CAD 3D	$1,330	$1,330	$76.05 – $1,330
Screening mammogram, both breasts: 10 of 52 insurance plan rates Aetna — Aetna: $309.35 Aetna Employee — Aetna Employee: $366.04 AETNA HP NETWORK — AETNA HP NETWORK: $784.70 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $114.07 BEACON COMMERCIAL — BEACON COMMERCIAL: $129.86 BEACON MEDICARE — BEACON MEDICARE: $108.64 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $638.40 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $76.73 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $76.73 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $108.64

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$250 – $25,040
Left heart catheterization (diagnostic): 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,228.37 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $4,027.02 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $19,333 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $24,166 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $18,125
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$8,355 – $50,000
Heart rhythm study (electrophysiology evaluation): 10 of 52 insurance plan rates Aetna — Aetna: $18,637 Aetna Employee — Aetna Employee: $18,637 AETNA HP NETWORK — AETNA HP NETWORK: $16,773 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $10,172.91 BEACON COMMERCIAL — BEACON COMMERCIAL: $12,595.04 BEACON MEDICARE — BEACON MEDICARE: $9,688.49 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $19,511 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $24,389 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $18,292 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $9,688.49
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$250 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $50,000
Heart rhythm study with ablation for atrial fibrillation: 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $34,090.97 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $32,467.59 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $19,511 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $24,389 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $18,292
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POLYSOM 6/> YRS 4/> PARAM	Not listed in the file	Not listed in the file	$2,235.89 – $6,208.99
Sleep study (overnight, in a sleep lab): 10 of 42 insurance plan rates AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,261.26 BEACON COMMERCIAL — BEACON COMMERCIAL: $1,386.71 BEACON MEDICARE — BEACON MEDICARE: $4,058.34 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,383.86 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,975.71 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,235.89 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,058.34 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $2,679.79 CDPHP MEDICARE — CDPHP MEDICARE: $4,058.34 EMBLEM GHI/HIP MEDICARE — EMBLEM GHI/HIP MEDICARE: $4,139.51
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: POLYSOM 6/> YRS 4/> PARAM	$10,045	$10,045	$1,071.95 – $10,045
Sleep study (overnight, in a sleep lab): 10 of 52 insurance plan rates Aetna — Aetna: $3,838 Aetna Employee — Aetna Employee: $3,838 AETNA HP NETWORK — AETNA HP NETWORK: $3,454 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $1,120.04 BEACON COMMERCIAL — BEACON COMMERCIAL: $1,386.71 BEACON MEDICARE — BEACON MEDICARE: $1,066.70 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,383.86 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,975.71 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,235.89 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $1,066.70
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: POLYSOM 6/> YRS 4/> PARAM	$10,045	$10,045	$3,013.50 – $10,045
Sleep study (overnight, in a sleep lab): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $7,533.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $8,538.25 Medigap — Medigap: $10,045 MULTIPLAN — MULTIPLAN: $7,031.50 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $10,045 PHCS — PHCS: $8,538.25 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $3,013.50 SELF-PAY - CC 50% — SELF-PAY - CC 50: $5,022.50

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: THERAPEUTIC EXERCISES EA 15	$420	$420	$23.03 – $482
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 52 insurance plan rates Aetna — Aetna: $376 Aetna Employee — Aetna Employee: $376 AETNA HP NETWORK — AETNA HP NETWORK: $338 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $34.55 BEACON COMMERCIAL — BEACON COMMERCIAL: $40.44 BEACON MEDICARE — BEACON MEDICARE: $32.90 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $93.93 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $117.25 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $88.10 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $32.90
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: THERAPEUTIC EXERCISE EA 15 PTA	$420	$420	$23.03 – $482
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 52 insurance plan rates Aetna — Aetna: $376 Aetna Employee — Aetna Employee: $376 AETNA HP NETWORK — AETNA HP NETWORK: $338 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $34.55 BEACON COMMERCIAL — BEACON COMMERCIAL: $40.44 BEACON MEDICARE — BEACON MEDICARE: $32.90 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $93.93 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $117.25 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $88.10 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $32.90
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GO In the file: THERAPEUTIC EXERCISES EA 15	$420	$420	$23.03 – $482
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 52 insurance plan rates Aetna — Aetna: $376 Aetna Employee — Aetna Employee: $376 AETNA HP NETWORK — AETNA HP NETWORK: $338 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $34.55 BEACON COMMERCIAL — BEACON COMMERCIAL: $40.44 BEACON MEDICARE — BEACON MEDICARE: $32.90 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $93.93 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $117.25 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $88.10 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $32.90
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL LOW COMPLEX 20 MIN	$409	$409	$76.19 – $482
Physical therapy evaluation (low complexity): 10 of 52 insurance plan rates Aetna — Aetna: $376 Aetna Employee — Aetna Employee: $376 AETNA HP NETWORK — AETNA HP NETWORK: $338 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $115.66 BEACON COMMERCIAL — BEACON COMMERCIAL: $136.02 BEACON MEDICARE — BEACON MEDICARE: $110.15 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $196.32 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $76.19 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $76.19 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $110.15
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL LOW COMPLEX 20 MIN PTA	$409	$409	$76.19 – $482
Physical therapy evaluation (low complexity): 10 of 52 insurance plan rates Aetna — Aetna: $376 Aetna Employee — Aetna Employee: $376 AETNA HP NETWORK — AETNA HP NETWORK: $338 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $115.66 BEACON COMMERCIAL — BEACON COMMERCIAL: $136.02 BEACON MEDICARE — BEACON MEDICARE: $110.15 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $196.32 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $76.19 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $76.19 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $110.15
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL LOW COMPLEX 20 MIN	$409	$409	$122.70 – $409
Physical therapy evaluation (low complexity): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $306.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $347.65 Medigap — Medigap: $409 MULTIPLAN — MULTIPLAN: $286.30 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $409 PHCS — PHCS: $347.65 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $122.70 SELF-PAY - CC 50% — SELF-PAY - CC 50: $204.50
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL MOD COMPLEX 30 MIN	$449	$449	$76.19 – $482
Physical therapy evaluation (moderate complexity): 10 of 52 insurance plan rates Aetna — Aetna: $376 Aetna Employee — Aetna Employee: $376 AETNA HP NETWORK — AETNA HP NETWORK: $338 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $115.66 BEACON COMMERCIAL — BEACON COMMERCIAL: $136.02 BEACON MEDICARE — BEACON MEDICARE: $110.15 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $215.52 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $76.19 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $76.19 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $110.15
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL MOD COMPLEX 30 MIN PTA	$449	$449	$76.19 – $482
Physical therapy evaluation (moderate complexity): 10 of 52 insurance plan rates Aetna — Aetna: $376 Aetna Employee — Aetna Employee: $376 AETNA HP NETWORK — AETNA HP NETWORK: $338 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $115.66 BEACON COMMERCIAL — BEACON COMMERCIAL: $136.02 BEACON MEDICARE — BEACON MEDICARE: $110.15 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $215.52 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $76.19 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $76.19 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $110.15
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL MOD COMPLEX 30 MIN	$449	$449	$134.70 – $449
Physical therapy evaluation (moderate complexity): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $336.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $381.65 Medigap — Medigap: $449 MULTIPLAN — MULTIPLAN: $314.30 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $449 PHCS — PHCS: $381.65 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $134.70 SELF-PAY - CC 50% — SELF-PAY - CC 50: $224.50
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL HIGH COMPLEX 45 MIN	$673	$673	$76.19 – $673
Physical therapy evaluation (high complexity): 10 of 52 insurance plan rates Aetna — Aetna: $376 Aetna Employee — Aetna Employee: $376 AETNA HP NETWORK — AETNA HP NETWORK: $338 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $115.66 BEACON COMMERCIAL — BEACON COMMERCIAL: $136.02 BEACON MEDICARE — BEACON MEDICARE: $110.15 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $323.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $76.19 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $76.19 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $110.15
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL HIGH COMPLX 45 MIN PTA	$673	$673	$76.19 – $673
Physical therapy evaluation (high complexity): 10 of 52 insurance plan rates Aetna — Aetna: $376 Aetna Employee — Aetna Employee: $376 AETNA HP NETWORK — AETNA HP NETWORK: $338 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $115.66 BEACON COMMERCIAL — BEACON COMMERCIAL: $136.02 BEACON MEDICARE — BEACON MEDICARE: $110.15 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $323.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $76.19 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $76.19 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $110.15
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee · modifier GP In the file: PT EVAL HIGH COMPLEX 45 MIN	$673	$673	$201.90 – $673
Physical therapy evaluation (high complexity): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $504.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $572.05 Medigap — Medigap: $673 MULTIPLAN — MULTIPLAN: $471.10 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $673 PHCS — PHCS: $572.05 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $201.90 SELF-PAY - CC 50% — SELF-PAY - CC 50: $336.50
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYTX PT&/FAMILY 30 MIN	$349	$349	$40 – $526
Psychotherapy, 30 minutes: 10 of 51 insurance plan rates Aetna — Aetna: $226.85 Aetna Employee — Aetna Employee: $226.85 AETNA HP NETWORK — AETNA HP NETWORK: $205.91 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $231.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $286.62 BEACON MEDICARE — BEACON MEDICARE: $220.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $167.52 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $302 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $227 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $220.48
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYTX W PT 30 MINUTES	$554	$554	$40 – $554
Psychotherapy, 30 minutes: 10 of 51 insurance plan rates Aetna — Aetna: $360.10 Aetna Employee — Aetna Employee: $360.10 AETNA HP NETWORK — AETNA HP NETWORK: $326.86 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $231.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $286.62 BEACON MEDICARE — BEACON MEDICARE: $220.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $265.92 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $302 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $227 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $220.48
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSYTX PT&/FAMILY 30 MIN	$349	$349	$104.70 – $349
Psychotherapy, 30 minutes: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $261.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $296.65 Medigap — Medigap: $349 MULTIPLAN — MULTIPLAN: $244.30 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $349 PHCS — PHCS: $296.65 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $104.70 SELF-PAY - CC 50% — SELF-PAY - CC 50: $174.50
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYTX PT&/FAMILY 45 MIN	$423	$423	$80 – $526
Psychotherapy, 45 minutes: 10 of 51 insurance plan rates Aetna — Aetna: $274.95 Aetna Employee — Aetna Employee: $274.95 AETNA HP NETWORK — AETNA HP NETWORK: $249.57 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $231.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $286.62 BEACON MEDICARE — BEACON MEDICARE: $220.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $203.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $369 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $277 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $220.48
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYTX W PT 45 MINUTES	$554	$554	$80 – $554
Psychotherapy, 45 minutes: 10 of 51 insurance plan rates Aetna — Aetna: $360.10 Aetna Employee — Aetna Employee: $360.10 AETNA HP NETWORK — AETNA HP NETWORK: $326.86 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $231.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $286.62 BEACON MEDICARE — BEACON MEDICARE: $220.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $265.92 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $369 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $277 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $220.48
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 1500 PSYTX PT&/FAMILY 45 MINU	$349	$349	$80 – $526
Psychotherapy, 45 minutes: 10 of 51 insurance plan rates Aetna — Aetna: $226.85 Aetna Employee — Aetna Employee: $226.85 AETNA HP NETWORK — AETNA HP NETWORK: $205.91 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $231.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $286.62 BEACON MEDICARE — BEACON MEDICARE: $220.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $167.52 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $369 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $277 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $220.48
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYTX W PT 60 MINUTES	$609	$609	$91.86 – $609
Psychotherapy, 60 minutes: 10 of 51 insurance plan rates Aetna — Aetna: $395.85 Aetna Employee — Aetna Employee: $395.85 AETNA HP NETWORK — AETNA HP NETWORK: $359.31 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $231.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $286.62 BEACON MEDICARE — BEACON MEDICARE: $220.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $292.32 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $369 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $277 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $220.48
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSYTX W PT 60 MINUTES	$609	$609	$182.70 – $609
Psychotherapy, 60 minutes: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $456.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $517.65 Medigap — Medigap: $609 MULTIPLAN — MULTIPLAN: $426.30 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $609 PHCS — PHCS: $517.65 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $182.70 SELF-PAY - CC 50% — SELF-PAY - CC 50: $304.50
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/O PT 50 MIN	$554	$554	$60 – $554
Family psychotherapy, without the patient: 10 of 51 insurance plan rates Aetna — Aetna: $360.10 Aetna Employee — Aetna Employee: $360.10 AETNA HP NETWORK — AETNA HP NETWORK: $326.86 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $231.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $286.62 BEACON MEDICARE — BEACON MEDICARE: $220.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $282 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $353 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $265 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $220.48
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/O PT 50 MIN	$554	$554	$166.20 – $554
Family psychotherapy, without the patient: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $415.50 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $470.90 Medigap — Medigap: $554 MULTIPLAN — MULTIPLAN: $387.80 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $554 PHCS — PHCS: $470.90 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $166.20 SELF-PAY - CC 50% — SELF-PAY - CC 50: $277
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 95 In the file: FAMILY PSYTX W/O PT 50 MIN TH	$554	$554	$60 – $554
Family psychotherapy, without the patient: 10 of 51 insurance plan rates Aetna — Aetna: $360.10 Aetna Employee — Aetna Employee: $360.10 AETNA HP NETWORK — AETNA HP NETWORK: $326.86 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $231.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $286.62 BEACON MEDICARE — BEACON MEDICARE: $220.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $282 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $353 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $265 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $220.48
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/PT 50 MIN	$1,224	$1,224	$60 – $1,224
Family psychotherapy, with the patient: 10 of 51 insurance plan rates Aetna — Aetna: $795.60 Aetna Employee — Aetna Employee: $795.60 AETNA HP NETWORK — AETNA HP NETWORK: $722.16 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $231.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $286.62 BEACON MEDICARE — BEACON MEDICARE: $220.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $587.52 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $734.40 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $550.80 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $220.48
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/PT 50 MIN	$1,224	$1,224	$367.20 – $1,224
Family psychotherapy, with the patient: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $918 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $1,040.40 Medigap — Medigap: $1,224 MULTIPLAN — MULTIPLAN: $856.80 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $1,224 PHCS — PHCS: $1,040.40 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $367.20 SELF-PAY - CC 50% — SELF-PAY - CC 50: $612
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 95 In the file: FAMILY PSYTX W/PT 50 MIN TH	$1,224	$1,224	$60 – $1,224
Family psychotherapy, with the patient: 10 of 51 insurance plan rates Aetna — Aetna: $795.60 Aetna Employee — Aetna Employee: $795.60 AETNA HP NETWORK — AETNA HP NETWORK: $722.16 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $231.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $286.62 BEACON MEDICARE — BEACON MEDICARE: $220.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $587.52 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $734.40 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $550.80 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $220.48
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP THERAPY NOT MULTI-FAMILY	$223	$223	$45 – $526
Group psychotherapy: 10 of 51 insurance plan rates Aetna — Aetna: $144.95 Aetna Employee — Aetna Employee: $144.95 AETNA HP NETWORK — AETNA HP NETWORK: $131.57 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $132.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $164.05 BEACON MEDICARE — BEACON MEDICARE: $126.19 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $107.04 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $133.80 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $100.35 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $126.19
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP PSYCHOTHERAPY	$399	$399	$45 – $526
Group psychotherapy: 10 of 51 insurance plan rates Aetna — Aetna: $259.35 Aetna Employee — Aetna Employee: $259.35 AETNA HP NETWORK — AETNA HP NETWORK: $235.41 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $132.50 BEACON COMMERCIAL — BEACON COMMERCIAL: $164.05 BEACON MEDICARE — BEACON MEDICARE: $126.19 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $191.52 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $239.40 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $179.55 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $126.19
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Hospital (facility) fee In the file: GROUP THERAPY NOT MULTI-FAMILY	$223	$223	$66.90 – $223
Group psychotherapy: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $167.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $189.55 Medigap — Medigap: $223 MULTIPLAN — MULTIPLAN: $156.10 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $223 PHCS — PHCS: $189.55 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $66.90 SELF-PAY - CC 50% — SELF-PAY - CC 50: $111.50

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$5,663 – $15,274
Removal of breast growth (open surgery): 10 of 52 insurance plan rates Aetna — Aetna: $9,038 Aetna Employee — Aetna Employee: $9,038 AETNA HP NETWORK — AETNA HP NETWORK: $8,134 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $5,106.80 BEACON COMMERCIAL — BEACON COMMERCIAL: $6,322.71 BEACON MEDICARE — BEACON MEDICARE: $4,863.62 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $6,040 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $7,550 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $5,663 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,863.62
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$8,355 – $50,000
Total hip replacement: 10 of 52 insurance plan rates Aetna — Aetna: $12,424 Aetna Employee — Aetna Employee: $12,424 AETNA HP NETWORK — AETNA HP NETWORK: $11,182 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $16,745.18 BEACON COMMERCIAL — BEACON COMMERCIAL: $20,732.13 BEACON MEDICARE — BEACON MEDICARE: $15,947.79 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $8,915 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $11,144 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $8,358 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $15,947.79
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$8,355 – $50,000
Total knee replacement: 10 of 52 insurance plan rates Aetna — Aetna: $12,424 Aetna Employee — Aetna Employee: $12,424 AETNA HP NETWORK — AETNA HP NETWORK: $11,182 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $16,745.18 BEACON COMMERCIAL — BEACON COMMERCIAL: $20,732.13 BEACON MEDICARE — BEACON MEDICARE: $15,947.79 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $9,202 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $11,502 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $8,627 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $15,947.79
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$3,670 – $50,000
Shoulder arthroscopy: shaving of shoulder bone: 10 of 32 insurance plan rates Aetna — Aetna: $9,038 Aetna Employee — Aetna Employee: $9,038 AETNA HP NETWORK — AETNA HP NETWORK: $8,134 CDPHP — CDPHP: $8,355 CIGNA PPO — CIGNA PPO: $6,379 MVP EXCHANGE — MVP EXCHANGE: $3,670 MVP HMO/PPO — MVP HMO/PPO: $4,318 OXFORD EXCHANGE — OXFORD EXCHANGE: $5,193 Tricare — Tricare: $50,000 UHC Commercial — UHC Commercial: $5,770
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$3,670 – $11,860
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 52 insurance plan rates Aetna — Aetna: $11,860 Aetna Employee — Aetna Employee: $11,860 AETNA HP NETWORK — AETNA HP NETWORK: $10,674 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,267.59 BEACON COMMERCIAL — BEACON COMMERCIAL: $5,283.68 BEACON MEDICARE — BEACON MEDICARE: $4,064.37 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $6,040 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $7,550 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $5,663 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,064.37
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$6,379 – $15,274
Removal of tonsils and adenoids (under age 12): 10 of 52 insurance plan rates Aetna — Aetna: $9,038 Aetna Employee — Aetna Employee: $9,038 AETNA HP NETWORK — AETNA HP NETWORK: $8,134 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $7,721.09 BEACON COMMERCIAL — BEACON COMMERCIAL: $9,559.45 BEACON MEDICARE — BEACON MEDICARE: $7,353.42 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $7,822 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $9,778 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $7,334 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $7,353.42
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD DIAGNOSTIC BRUSH WASH	$3,951	$3,951	$250 – $5,006
Upper GI endoscopy (diagnostic): 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $1,182.96 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $1,126.63 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,270 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,837 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,128
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EGD DIAGNOSTIC BRUSH WASH	$3,951	$3,951	$1,185.30 – $3,951
Upper GI endoscopy (diagnostic): rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $2,963.25 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $3,358.35 Medigap — Medigap: $3,951 MULTIPLAN — MULTIPLAN: $2,765.70 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $3,951 PHCS — PHCS: $3,358.35 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $1,185.30 SELF-PAY - CC 50% — SELF-PAY - CC 50: $1,975.50
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY, BIOP	$2,640	$2,640	$250 – $5,006
Upper GI endoscopy with biopsy: 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $1,182.96 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $1,126.63 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,270 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,837 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,128
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY, BIOP	$2,640	$2,640	$792 – $2,640
Upper GI endoscopy with biopsy: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $1,980 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $2,244 Medigap — Medigap: $2,640 MULTIPLAN — MULTIPLAN: $1,848 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $2,640 PHCS — PHCS: $2,244 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $792 SELF-PAY - CC 50% — SELF-PAY - CC 50: $1,320
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$2,848 – $8,355
Upper GI endoscopy with biopsy: 10 of 52 insurance plan rates Aetna — Aetna: $7,060 Aetna Employee — Aetna Employee: $7,060 AETNA HP NETWORK — AETNA HP NETWORK: $6,354 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,269.12 BEACON COMMERCIAL — BEACON COMMERCIAL: $1,464.62 BEACON MEDICARE — BEACON MEDICARE: $4,065.83 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $3,038 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $3,797 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,848 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,065.83
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$2,848 – $8,355
Colonoscopy (diagnostic): 10 of 52 insurance plan rates Aetna — Aetna: $7,060 Aetna Employee — Aetna Employee: $7,060 AETNA HP NETWORK — AETNA HP NETWORK: $6,354 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,272.86 BEACON COMMERCIAL — BEACON COMMERCIAL: $1,501.71 BEACON MEDICARE — BEACON MEDICARE: $4,069.39 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $3,038 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $3,797 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,848 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,069.39
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$3,670 – $8,355
Colonoscopy with biopsy: 10 of 52 insurance plan rates Aetna — Aetna: $7,060 Aetna Employee — Aetna Employee: $7,060 AETNA HP NETWORK — AETNA HP NETWORK: $6,354 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,316.34 BEACON COMMERCIAL — BEACON COMMERCIAL: $1,932.36 BEACON MEDICARE — BEACON MEDICARE: $4,110.80 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $4,831 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $6,039 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $4,529 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,110.80
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$3,670 – $8,355
Colonoscopy with removal of polyps (snare): 10 of 52 insurance plan rates Aetna — Aetna: $7,060 Aetna Employee — Aetna Employee: $7,060 AETNA HP NETWORK — AETNA HP NETWORK: $6,354 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,316.34 BEACON COMMERCIAL — BEACON COMMERCIAL: $1,932.36 BEACON MEDICARE — BEACON MEDICARE: $4,110.80 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $4,831 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $6,039 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $4,529 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,110.80
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$3,670 – $8,355
Ultrasound of the lower bowel by endoscope: 10 of 52 insurance plan rates Aetna — Aetna: $7,060 Aetna Employee — Aetna Employee: $7,060 AETNA HP NETWORK — AETNA HP NETWORK: $6,354 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,316.34 BEACON COMMERCIAL — BEACON COMMERCIAL: $1,932.36 BEACON MEDICARE — BEACON MEDICARE: $4,110.80 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $4,831 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $6,039 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $4,529 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,110.80
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLON CA SCRN NOT HI RSK IND	Not listed in the file	Not listed in the file	$625.86 – $16,502
Screening colonoscopy (not high risk): 10 of 52 insurance plan rates Aetna — Aetna: $7,060 Aetna Employee — Aetna Employee: $7,060 AETNA HP NETWORK — AETNA HP NETWORK: $6,354 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,272.86 BEACON COMMERCIAL — BEACON COMMERCIAL: $1,501.71 BEACON MEDICARE — BEACON MEDICARE: $4,069.39 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $3,038 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $3,797 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,848 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,069.39
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$7,546.53 – $15,274
Gallbladder removal by laparoscope: 10 of 52 insurance plan rates Aetna — Aetna: $12,990 Aetna Employee — Aetna Employee: $12,990 AETNA HP NETWORK — AETNA HP NETWORK: $11,691 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $7,885.04 BEACON COMMERCIAL — BEACON COMMERCIAL: $9,762.43 BEACON MEDICARE — BEACON MEDICARE: $7,509.56 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $8,111 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $10,139 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $7,604 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $7,509.56
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REPAIR INGUINAL HERNIA	$11,436	$11,436	$250 – $15,274
Groin (inguinal) hernia repair, age 5 or older: 10 of 53 insurance plan rates Aetna — Aetna: $2,785 Aetna Employee — Aetna Employee: $2,785 AETNA HP NETWORK — AETNA HP NETWORK: $2,507 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,669.83 BEACON COMMERCIAL — BEACON COMMERCIAL: $386 BEACON EXCHANGE — BEACON EXCHANGE: $391 BEACON MEDICARE — BEACON MEDICARE: $4,447.46 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $2,270 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $2,837 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,128
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient (hospital stay) · Hospital (facility) fee In the file: REPAIR INGUINAL HERNIA	$11,436	$11,436	$3,430.80 – $11,436
Groin (inguinal) hernia repair, age 5 or older: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $8,577 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $9,720.60 Medigap — Medigap: $11,436 MULTIPLAN — MULTIPLAN: $8,005.20 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $11,436 PHCS — PHCS: $9,720.60 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $3,430.80 SELF-PAY - CC 50% — SELF-PAY - CC 50: $5,718
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$5,663 – $15,274
Groin (inguinal) hernia repair, age 5 or older: 10 of 52 insurance plan rates Aetna — Aetna: $11,860 Aetna Employee — Aetna Employee: $11,860 AETNA HP NETWORK — AETNA HP NETWORK: $10,674 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,669.83 BEACON COMMERCIAL — BEACON COMMERCIAL: $5,781.70 BEACON MEDICARE — BEACON MEDICARE: $4,447.46 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $6,040 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $7,550 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $5,663 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,447.46
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$440.04 – $50,000
Prostate biopsy: 10 of 34 insurance plan rates Aetna — Aetna: $7,060 Aetna Employee — Aetna Employee: $7,060 AETNA HP NETWORK — AETNA HP NETWORK: $6,354 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $4,831 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $6,039 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $4,529 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $5,435 CDPHP — CDPHP: $8,355 CIGNA PPO — CIGNA PPO: $6,379 MVP EXCHANGE — MVP EXCHANGE: $440.04
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$8,355 – $15,274
Prostate removal by laparoscope (radical prostatectomy): 10 of 52 insurance plan rates Aetna — Aetna: $12,990 Aetna Employee — Aetna Employee: $12,990 AETNA HP NETWORK — AETNA HP NETWORK: $11,691 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $13,864.23 BEACON COMMERCIAL — BEACON COMMERCIAL: $17,165.24 BEACON MEDICARE — BEACON MEDICARE: $13,204.03 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $9,202 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $11,502 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $8,627 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $13,204.03
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$3,670 – $9,038
Hysteroscopy with biopsy of the uterus lining: 10 of 52 insurance plan rates Aetna — Aetna: $9,038 Aetna Employee — Aetna Employee: $9,038 AETNA HP NETWORK — AETNA HP NETWORK: $8,134 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,222.10 BEACON COMMERCIAL — BEACON COMMERCIAL: $5,227.37 BEACON MEDICARE — BEACON MEDICARE: $4,021.05 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $4,831 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $6,039 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $4,529 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,021.05
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$338.58 – $16,502
Spinal injection, lower back (epidural), with imaging guidance: 10 of 52 insurance plan rates Aetna — Aetna: $5,086 Aetna Employee — Aetna Employee: $5,086 AETNA HP NETWORK — AETNA HP NETWORK: $4,578 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,236.33 BEACON COMMERCIAL — BEACON COMMERCIAL: $1,139.87 BEACON MEDICARE — BEACON MEDICARE: $4,034.60 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $3,038 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $3,797 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,848 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,034.60
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$379.62 – $16,502
Nerve root injection, lower back, with imaging guidance: 10 of 52 insurance plan rates Aetna — Aetna: $5,086 Aetna Employee — Aetna Employee: $5,086 AETNA HP NETWORK — AETNA HP NETWORK: $4,578 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,265.45 BEACON COMMERCIAL — BEACON COMMERCIAL: $1,428.26 BEACON MEDICARE — BEACON MEDICARE: $4,062.33 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $3,038 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $3,797 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $2,848 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,062.33
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$4,529 – $15,274
Carpal tunnel release: 10 of 52 insurance plan rates Aetna — Aetna: $7,060 Aetna Employee — Aetna Employee: $7,060 AETNA HP NETWORK — AETNA HP NETWORK: $6,354 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $2,546.89 BEACON COMMERCIAL — BEACON COMMERCIAL: $3,153.29 BEACON MEDICARE — BEACON MEDICARE: $2,425.61 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $4,831 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $6,039 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $4,529 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $2,425.61
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$1,053.36 – $6,160.82
Laser treatment of clouding after cataract surgery: 10 of 43 insurance plan rates AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $4,210.92 BEACON COMMERCIAL — BEACON COMMERCIAL: $888.15 BEACON MEDICARE — BEACON MEDICARE: $4,010.40 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $4,010.40 CDPHP MEDICARE — CDPHP MEDICARE: $4,010.40 EMBLEM GHI/HIP MEDICARE — EMBLEM GHI/HIP MEDICARE: $4,090.61 EMBLEM GHI/HIP PPO — EMBLEM GHI/HIP PPO: $1,441.52 EMBLEM SELECT CARE (EXCHANGE) — EMBLEM SELECT CARE (EXCHANGE): $1,224.65 FIDELIS EXCHANGE — FIDELIS EXCHANGE: $7,820.28 FIDELIS MEDICARE — FIDELIS MEDICARE: $4,010.40
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$4,529 – $15,274
Cataract removal with lens implant: 10 of 52 insurance plan rates Aetna — Aetna: $14,402 Aetna Employee — Aetna Employee: $12,990 AETNA HP NETWORK — AETNA HP NETWORK: $11,691 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $3,010.03 BEACON COMMERCIAL — BEACON COMMERCIAL: $3,726.71 BEACON MEDICARE — BEACON MEDICARE: $2,866.70 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $4,831 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $6,039 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $4,529 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $2,866.70

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VBAC DELIVERY	$15,449	$15,449	$4,634.70 – $15,449
Vaginal delivery after a previous C-section, with care before and after: 10 of 32 insurance plan rates Aetna — Aetna: $10,041.85 Aetna Employee — Aetna Employee: $9,038 AETNA HP NETWORK — AETNA HP NETWORK: $8,134 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $6,040 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $7,550 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $5,663 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $6,795 CDPHP — CDPHP: $7,724.50 CIGNA PPO — CIGNA PPO: $10,814.30 CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $11,586.75
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: VBAC DELIVERY	$15,449	$15,449	$4,634.70 – $15,449
Vaginal delivery after a previous C-section, with care before and after: rates for 8 insurance plans CONSOLIDATED HEALTH — CONSOLIDATED HEALTH: $11,586.75 EMBLEM LEASED NETWORK — EMBLEM LEASED NETWORK: $13,131.65 Medigap — Medigap: $15,449 MULTIPLAN — MULTIPLAN: $10,814.30 NON CONTRACTED (100% POC) — NON CONTRACTED (100 PerCent POC): $15,449 PHCS — PHCS: $13,131.65 SELF-PAY - CC 30% — SELF-PAY - CC 30 PerCent: $4,634.70 SELF-PAY - CC 50% — SELF-PAY - CC 50: $7,724.50

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	$1,523 – $537,777.83
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 46 insurance plan rates Aetna — Aetna: $451,153.39 Aetna Employee — Aetna Employee: $451,153.39 AETNA HP NETWORK — AETNA HP NETWORK: $406,035.11 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $98,905.59 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $413,665.70 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $517,079.68 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $387,809.76 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $94,195.80 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $465,367.80 CDPHP — CDPHP: $504,117.47
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) · Hospital (facility) fee In the file: SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	Not listed in the file	Not listed in the file	$1,523 – $69,422.23
Spinal fusion (not neck), without major complications: 10 of 26 insurance plan rates AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $37,381.20 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $35,601.14 CDPHP MEDICARE — CDPHP MEDICARE: $35,601.14 EMBLEM GHI/HIP MEDICARE — EMBLEM GHI/HIP MEDICARE: $36,313.16 FIDELIS EXCHANGE — FIDELIS EXCHANGE: $69,422.23 FIDELIS MEDICARE — FIDELIS MEDICARE: $35,601.14 MAGNACARE STANDARD — MAGNACARE STANDARD: $8,625 MEDICARE — MEDICARE: $35,601.14 MEDICARE MANAGED 100% WMC — MEDICARE MANAGED 100 WMC: $35,601.14 MVP GOLD (MCR) — MVP GOLD (MCR): $35,601.14
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	$1,523 – $106,035.05
Hip or knee replacement (major joint of the leg), without major complications: 10 of 46 insurance plan rates Aetna — Aetna: $88,955.08 Aetna Employee — Aetna Employee: $88,955.08 AETNA HP NETWORK — AETNA HP NETWORK: $80,058.99 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $20,013.48 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $81,563.54 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $101,953.94 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $76,465.45 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $19,060.46 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $91,757.77 CDPHP — CDPHP: $99,398.15
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	$1,523 – $134,202.58
Neck (cervical) spinal fusion, without complications: 10 of 46 insurance plan rates Aetna — Aetna: $112,585.43 Aetna Employee — Aetna Employee: $112,585.43 AETNA HP NETWORK — AETNA HP NETWORK: $101,326.16 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $25,160.51 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $103,230.37 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $129,037.35 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $96,778.01 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $23,962.39 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $116,132.64 CDPHP — CDPHP: $125,802.63
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$1,523 – $68,203.48
Uterus and ovary surgery (not for cancer), without complications: 10 of 46 insurance plan rates Aetna — Aetna: $57,217.36 Aetna Employee — Aetna Employee: $57,217.36 AETNA HP NETWORK — AETNA HP NETWORK: $51,495.25 AFFINITY BY MOLINA MCR — AFFINITY BY MOLINA MCR: $13,100.52 BLUE CROSS ACCESS — BLUE CROSS ACCESS: $52,463 BLUE CROSS COMMERCIAL/HEALTHY NY — BLUE CROSS COMMERCIAL/HEALTHY NY: $65,578.44 BLUE CROSS CONNECTION/EXCHANGE — BLUE CROSS CONNECTION/EXCHANGE: $49,183.83 BLUE CROSS MEDICARE — BLUE CROSS MEDICARE: $12,476.69 BLUE CROSS SMALL GROUP — BLUE CROSS SMALL GROUP: $59,020.10 CDPHP — CDPHP: $63,934.51

Source: Westchester Medical Center’s standard charges file (wmchealth.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on July 28, 2026; retrieved November 5, 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	100 Woods Rd, Valhalla, NY 10595
County	Westchester County
State	New York
Phone	(914) 493‑7000
Emergency services	Yes
Ownership	Voluntary non-profit - Other
Medicare overall rating	2 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	330234
Name in Medicare records	WESTCHESTER MEDICAL CENTER
Profile level	Medicare data + hospital website
Official website	wmchealth.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
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 2026-11-02.

Trauma - Westchester Medical Center Health Network — wmchealth.org
Emergency Services - Westchester Medical Center Health Network — wmchealth.org
Patient and Family Guide - Westchester Medical Center Health Network — wmchealth.org
Westchester Medical Center Patient Guide — wmchealth.org
Visitor Information - Westchester Medical Center Health Network — wmchealth.org

Westchester Medical Center

Summary

Profile from official sources

At a glance