Does Wilbarger General Hospital have an emergency room?

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

Where is Wilbarger General Hospital?

920 Hillcrest Dr, Vernon, TX 76384, in Wilbarger County, Texas.

What is the phone number of Wilbarger General Hospital?

(940) 552-9351, as listed by Medicare (CMS).

What is the Medicare star rating of Wilbarger General Hospital?

CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Does Medicare reduce its payments to Wilbarger General Hospital for hospital-acquired conditions?

No. For fiscal year 2026, CMS lists no Medicare payment reduction for Wilbarger General Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.1408; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Wilbarger General Hospital — Phone, Address & ER

Quick answers

Does Wilbarger General Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Wilbarger General Hospital. In a medical emergency, call 911.
Where is Wilbarger General Hospital?: 920 Hillcrest Dr, Vernon, TX 76384, in Wilbarger County, Texas.
What is the phone number of Wilbarger General Hospital?: (940) 552-9351, as listed by Medicare (CMS).
What is the Medicare star rating of Wilbarger General Hospital?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.
Does Medicare reduce its payments to Wilbarger General Hospital for hospital-acquired conditions?: No. For fiscal year 2026, CMS lists no Medicare payment reduction for Wilbarger General Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.1408; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas^[4][5]

Conditions treated^[5]

Chronic and non-healing wounds
Diabetic foot problems
Bunions
Ingrown toenails
Hernia

Treatments^[4][5]

Procedures^[4][5]

Programs and centers^[4][5]

Cardiac Rehabilitation
Pulmonary Rehab
Dialysis Center
Wound Care Center

Emergency care (hospital website)^[4]

Emergency room	Yes

Visiting and practical information

Visiting	No visiting hours stated. Hospital doors are locked at 5 p.m.; later visitors use the Emergency Department entrance^[6]
Patient portal	Patient Portal

Doctors and clinicians (115)

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

Main specialties

And 91 more: the button below opens the full list.

Other emergency rooms nearby

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

Electra Memorial Hospital24 mi · Electra, TX · Critical Access Hospital
Hardeman County Memorial Hospital26 mi · Quanah, TX · Critical Access Hospital
Jackson County Memorial Hospital Authority33 mi · Altus, OK · Acute Care Hospital
Seymour Hospital39 mi · Seymour, TX · Critical Access Hospital
United Regional Health Care System50 mi · Wichita Falls, TX · Acute Care Hospital

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

Other hospitals near Vernon

Red River Hospital50 mi · Wichita Falls, TX · Psychiatric Hospital

Hospitals in Wilbarger County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Advanced Rehabilitation and Healthcare of Vernon0.2 mi · Vernon, TX · 4 of 5 stars
Electra Healthcare Center24 mi · Electra, TX · 5 of 5 stars

All nursing homes in the state →

Hospice providers

Hospice of Wichita Falls1.3 mi · Vernon, TX · 5 of 5 stars

All hospice providers in the state →

Home health agencies

Centerwell Home Health1.3 mi · Vernon, TX · 4 of 5 stars

All home health agencies in the state →

Dialysis facilities

Wilbarger General Hospital Dialysis of Vernon1.3 mi · Vernon, TX · 3 of 5 stars

All dialysis facilities 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

CHC at Wilbarger General0.1 mi · Vernon, TX · Community health center
Community Healthcare Center at Wilbarger General0.2 mi · Vernon, TX · Community health center
Club Health Center of Vernon1.7 mi · Vernon, TX · Community health center

Pharmacies

Jim B Spears, Inc.1.3 mi · Vernon, TX · Community/retail pharmacy
The Eddick Corporation1.3 mi · Vernon, TX · Community/retail pharmacy
United Supermarkets LLC1.3 mi · Vernon, TX · Community/retail pharmacy

Assisted living nearby

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

Eagle Flats Village1.3 mi · Vernon, TX

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

What patients said (patient survey)

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

Rated the hospital 9 or 10 out of 10	72%National average: 72%
Would definitely recommend the hospital	70%National average: 71%
Nurses “always” communicated well	86%National average: 80%
Doctors “always” communicated well	88%National average: 80%
“Always” got help as soon as they wanted	80%National average: 64%
Staff “always” explained medicines before giving them	70%National average: 62%
Were given information about recovery at home	93%National average: 86%
Room and bathroom “always” clean	77%National average: 73%
Not reported to Medicare	Summary star rating (all survey topics); Overall rating of the hospital; Would recommend the hospital; Nurses communicated well; Doctors communicated well; Patients got help quickly from staff; Staff explained medicines; Information about recovery at home; Room and bathroom kept clean; Restfulness of Environment; Care Coordination; Symptoms After Stay
Completed surveys	98Response rate: 25%

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

Complications and deaths

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

Deaths within 30 days: pneumonia patients	18.4%
Serious complications (patient safety indicator PSI-90)	0.97No different from the national rate
Not reported to Medicare	Deaths within 30 days: coronary bypass surgery (CABG)
Too few cases to report	Deaths within 30 days: heart attack patients; Deaths within 30 days: heart failure patients; Deaths within 30 days: COPD patients; Deaths within 30 days: stroke patients; Complications after hip or knee replacement

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	17.9%
Readmitted within 30 days: pneumonia	17%
Not reported to Medicare	Readmitted within 30 days: coronary bypass surgery
Too few cases to report	Readmitted within 30 days: heart attack; Readmitted within 30 days: heart failure; Readmitted within 30 days: COPD; Readmitted within 30 days: hip or knee replacement

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	78 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	37%National average: 66%

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

Not reported to Medicare: infections caught in the hospital. For these topics Medicare shows no result for this hospital (not reported, or too few cases).

See every measure on Medicare Care Compare →

Medicare payment programs

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

Show the Medicare payment program results

Hospital-Acquired Condition Reduction Program

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

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

Medicare payment reduction, fiscal year 2026	NoCMS lists no payment reduction for this hospital.
Total HAC Score	-0.1408Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

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

Hospital Readmissions Reduction Program

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

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

Pneumonia	0.9951Fewer readmissions than expected
No result published	Heart attack; Heart failure; COPD (chronic lung disease); Hip or knee replacement; Coronary bypass surgery (CABG) (not reported, or too few cases)

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

Medicare spending per patient (MSPB)

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

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

Medicare spending per patient, ratio	1.03Above the national median hospital (1.00): Medicare spent more

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

No result for this hospital: Hospital Value-Based Purchasing Program. This is normal when a hospital is paid under another Medicare system (for example critical access, children’s or psychiatric hospitals), is not in the program that year, or has too few cases.

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 Texas Best hospitals in Texas

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 60 common services exactly as Wilbarger General Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

$ 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.

Show the prices of 60 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: PF Office/OP Visit New Pt Level 3 Non	$242.85	$145.71	$143.34 – $239.41
New patient office visit (about 30–44 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $196.71 BCBS Blue Advantage HMO — HMO: $143.34 BCBS Blue Essentials HMO — HMO: $150.31 BCBS Traditional/PPO — PPO: $239.41 Cash Pay — Self Pay: $145.71 Cigna Commercial — PPO: $204.72 United Healthcare Commercial — PPO: $218.57
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: OFFICE/OUTPATIENT VISIT NEW 99203	$366.31	$219.79	$143.34 – $329.68
New patient office visit (about 30–44 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $296.71 BCBS Blue Advantage HMO — HMO: $143.34 BCBS Blue Essentials HMO — HMO: $150.31 BCBS Traditional/PPO — PPO: $239.41 Cash Pay — Self Pay: $219.79 Cigna Commercial — PPO: $308.80 United Healthcare Commercial — PPO: $329.68
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: OFFICE/OUTPATIENT VISIT NEW 99203 PB	$366.31	$219.79	$143.34 – $329.68
New patient office visit (about 30–44 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $296.71 BCBS Blue Advantage HMO — HMO: $143.34 BCBS Blue Essentials HMO — HMO: $150.31 BCBS Traditional/PPO — PPO: $239.41 Cash Pay — Self Pay: $219.79 Cigna Commercial — PPO: $308.80 United Healthcare Commercial — PPO: $329.68
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: PF Office/OP Visit New Pt Level 4 Non	$372	$223.20	$223.20 – $405.35
New patient office visit (about 45–59 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $301.32 BCBS Blue Advantage HMO — HMO: $242.68 BCBS Blue Essentials HMO — HMO: $254.49 BCBS Traditional/PPO — PPO: $405.35 Cash Pay — Self Pay: $223.20 Cigna Commercial — PPO: $313.60 United Healthcare Commercial — PPO: $334.80
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: OFFICE/OUTPATIENT VISIT NEW 99204	$558.64	$335.18	$242.68 – $502.78
New patient office visit (about 45–59 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $452.50 BCBS Blue Advantage HMO — HMO: $242.68 BCBS Blue Essentials HMO — HMO: $254.49 BCBS Traditional/PPO — PPO: $405.35 Cash Pay — Self Pay: $335.18 Cigna Commercial — PPO: $470.93 United Healthcare Commercial — PPO: $502.78
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: OFFICE/OUTPATIENT VISIT NEW 99204 PB	$558.64	$335.18	$242.68 – $502.78
New patient office visit (about 45–59 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $452.50 BCBS Blue Advantage HMO — HMO: $242.68 BCBS Blue Essentials HMO — HMO: $254.49 BCBS Traditional/PPO — PPO: $405.35 Cash Pay — Self Pay: $335.18 Cigna Commercial — PPO: $470.93 United Healthcare Commercial — PPO: $502.78
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: PF Office/OP Visit New Pt Level 5 Non	$519.84	$311.90	$311.90 – $528.98
New patient office visit (about 60–74 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $421.07 BCBS Blue Advantage HMO — HMO: $316.70 BCBS Blue Essentials HMO — HMO: $332.11 BCBS Traditional/PPO — PPO: $528.98 Cash Pay — Self Pay: $311.90 Cigna Commercial — PPO: $438.23 United Healthcare Commercial — PPO: $467.86
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: OFFICE/OUTPATIENT VISIT NEW 99205	$704.20	$422.52	$316.70 – $633.78
New patient office visit (about 60–74 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $570.40 BCBS Blue Advantage HMO — HMO: $316.70 BCBS Blue Essentials HMO — HMO: $332.11 BCBS Traditional/PPO — PPO: $528.98 Cash Pay — Self Pay: $422.52 Cigna Commercial — PPO: $593.64 United Healthcare Commercial — PPO: $633.78
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: OFFICE/OUTPATIENT VISIT NEW 99205 PB	$704.20	$422.52	$316.70 – $633.78
New patient office visit (about 60–74 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $570.40 BCBS Blue Advantage HMO — HMO: $316.70 BCBS Blue Essentials HMO — HMO: $332.11 BCBS Traditional/PPO — PPO: $528.98 Cash Pay — Self Pay: $422.52 Cigna Commercial — PPO: $593.64 United Healthcare Commercial — PPO: $633.78
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: PF Office/OP Visit Est Pt Level 3 Non	$260.34	$156.20	$96.02 – $234.31
Established patient office visit (about 20–29 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $210.88 BCBS Blue Advantage HMO — HMO: $96.02 BCBS Blue Essentials HMO — HMO: $100.69 BCBS Traditional/PPO — PPO: $160.37 Cash Pay — Self Pay: $156.20 Cigna Commercial — PPO: $219.47 United Healthcare Commercial — PPO: $234.31
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: OFFICE/OUTPATIENT VISIT EST 99213	$267.15	$160.29	$96.02 – $240.44
Established patient office visit (about 20–29 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $216.39 BCBS Blue Advantage HMO — HMO: $96.02 BCBS Blue Essentials HMO — HMO: $100.69 BCBS Traditional/PPO — PPO: $160.37 Cash Pay — Self Pay: $160.29 Cigna Commercial — PPO: $225.21 United Healthcare Commercial — PPO: $240.44
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: OFFICE/OUTPATIENT VISIT EST 99213 PB	$267.15	$160.29	$96.02 – $240.44
Established patient office visit (about 20–29 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $216.39 BCBS Blue Advantage HMO — HMO: $96.02 BCBS Blue Essentials HMO — HMO: $100.69 BCBS Traditional/PPO — PPO: $160.37 Cash Pay — Self Pay: $160.29 Cigna Commercial — PPO: $225.21 United Healthcare Commercial — PPO: $240.44
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: PF Office/OP Visit Est Pt Level 4 Non	$278.49	$167.09	$148.02 – $250.64
Established patient office visit (about 30–39 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $225.58 BCBS Blue Advantage HMO — HMO: $148.02 BCBS Blue Essentials HMO — HMO: $155.22 BCBS Traditional/PPO — PPO: $247.23 Cash Pay — Self Pay: $167.09 Cigna Commercial — PPO: $234.77 United Healthcare Commercial — PPO: $250.64
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: OFFICE/OUTPATIENT VISIT EST 99214	$379.50	$227.70	$148.02 – $341.55
Established patient office visit (about 30–39 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $307.40 BCBS Blue Advantage HMO — HMO: $148.02 BCBS Blue Essentials HMO — HMO: $155.22 BCBS Traditional/PPO — PPO: $247.23 Cash Pay — Self Pay: $227.70 Cigna Commercial — PPO: $319.92 United Healthcare Commercial — PPO: $341.55
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: OFFICE/OUTPATIENT VISIT EST 99214 PB	$379.50	$227.70	$148.02 – $341.55
Established patient office visit (about 30–39 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $307.40 BCBS Blue Advantage HMO — HMO: $148.02 BCBS Blue Essentials HMO — HMO: $155.22 BCBS Traditional/PPO — PPO: $247.23 Cash Pay — Self Pay: $227.70 Cigna Commercial — PPO: $319.92 United Healthcare Commercial — PPO: $341.55
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) In the file: PREV VISIT NEW AGE 18-39	$275	$165	$165 – $307.36
Preventive checkup, new patient, age 18–39: rates for 7 insurance plans Aetna Commercial — PPO: $222.75 BCBS Blue Advantage HMO — HMO: $184.02 BCBS Blue Essentials HMO — HMO: $192.97 BCBS Traditional/PPO — PPO: $307.36 Cash Pay — Self Pay: $165 Cigna Commercial — PPO: $231.83 United Healthcare Commercial — PPO: $247.50
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) In the file: PREV VISIT NEW AGE 18-39	$275	$165	$165 – $247.50
Preventive checkup, new patient, age 18–39: rates for 6 insurance plans Aetna Commercial — PPO: $247.50 BCBS Blue Advantage HMO — HMO: $170.50 BCBS Blue Essentials HMO — HMO: $192.50 Cash Pay — Self Pay: $165 Cigna Commercial — PPO: $247.50 United Healthcare Commercial — PPO: $247.50
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) In the file: PREV VISIT NEW AGE 40-64	$275	$165	$165 – $374.17
Preventive checkup, new patient, age 40–64: rates for 7 insurance plans Aetna Commercial — PPO: $222.75 BCBS Blue Advantage HMO — HMO: $224.02 BCBS Blue Essentials HMO — HMO: $234.91 BCBS Traditional/PPO — PPO: $374.17 Cash Pay — Self Pay: $165 Cigna Commercial — PPO: $231.83 United Healthcare Commercial — PPO: $247.50
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) In the file: PREV VISIT NEW AGE 40-64	$275	$165	$165 – $247.50
Preventive checkup, new patient, age 40–64: rates for 6 insurance plans Aetna Commercial — PPO: $247.50 BCBS Blue Advantage HMO — HMO: $170.50 BCBS Blue Essentials HMO — HMO: $192.50 Cash Pay — Self Pay: $165 Cigna Commercial — PPO: $247.50 United Healthcare Commercial — PPO: $247.50
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: ER LEVEL 3	$815.55	$489.33	$292.25 – $819
Emergency room visit (moderate): 10 of 11 insurance plan rates Aetna Commercial — PPO: $660.60 Aetna Medicare Advantage — HMO: $292.25 BCBS Blue Advantage HMO — HMO: $588 BCBS Blue Essentials HMO — HMO: $714 BCBS Medicare Advantage — HMO: $292.25 BCBS Traditional/PPO — PPO: $819 Cash Pay — Self Pay: $489.33 Cigna Commercial — PPO: $687.51 Humana Medicare Advantage — HMO: $292.25 United Healthcare Commercial — PPO: $734
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) In the file: ER LEVEL 3	$815.55	$489.33	$489.33 – $734
Emergency room visit (moderate): rates for 6 insurance plans Aetna Commercial — PPO: $734 BCBS Blue Advantage HMO — HMO: $505.64 BCBS Blue Essentials HMO — HMO: $570.89 Cash Pay — Self Pay: $489.33 Cigna Commercial — PPO: $734 United Healthcare Commercial — PPO: $734
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · modifier 25 In the file: ER LEVEL 3 W PROCEDURE	$1,023.27	$613.96	$292.25 – $920.94
Emergency room visit (moderate): 10 of 11 insurance plan rates Aetna Commercial — PPO: $828.85 Aetna Medicare Advantage — HMO: $292.25 BCBS Blue Advantage HMO — HMO: $588 BCBS Blue Essentials HMO — HMO: $714 BCBS Medicare Advantage — HMO: $292.25 BCBS Traditional/PPO — PPO: $819 Cash Pay — Self Pay: $613.96 Cigna Commercial — PPO: $862.62 Humana Medicare Advantage — HMO: $292.25 United Healthcare Commercial — PPO: $920.94
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: ER LEVEL 4	$1,266	$759.60	$446.73 – $2,580
Emergency room visit (moderately high): 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,025.46 Aetna Medicare Advantage — HMO: $446.73 BCBS Blue Advantage HMO — HMO: $1,160 BCBS Blue Essentials HMO — HMO: $1,280 BCBS Medicare Advantage — HMO: $446.73 BCBS Traditional/PPO — PPO: $2,580 Cash Pay — Self Pay: $759.60 Cigna Commercial — PPO: $1,067.24 Humana Medicare Advantage — HMO: $446.73 United Healthcare Commercial — PPO: $1,139.40
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) In the file: ER LEVEL 4	$1,266	$759.60	$759.60 – $1,139.40
Emergency room visit (moderately high): rates for 6 insurance plans Aetna Commercial — PPO: $1,139.40 BCBS Blue Advantage HMO — HMO: $784.92 BCBS Blue Essentials HMO — HMO: $886.20 Cash Pay — Self Pay: $759.60 Cigna Commercial — PPO: $1,139.40 United Healthcare Commercial — PPO: $1,139.40
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · modifier 25 In the file: ER LEVEL 4 W PROCEDURE	$1,619.52	$971.71	$446.73 – $2,580
Emergency room visit (moderately high): 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,311.81 Aetna Medicare Advantage — HMO: $446.73 BCBS Blue Advantage HMO — HMO: $1,160 BCBS Blue Essentials HMO — HMO: $1,280 BCBS Medicare Advantage — HMO: $446.73 BCBS Traditional/PPO — PPO: $2,580 Cash Pay — Self Pay: $971.71 Cigna Commercial — PPO: $1,365.26 Humana Medicare Advantage — HMO: $446.73 United Healthcare Commercial — PPO: $1,457.57
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: ER LEVEL 5	$1,835.97	$1,101.58	$637.58 – $4,040
Emergency room visit (high): 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,487.14 Aetna Medicare Advantage — HMO: $637.58 BCBS Blue Advantage HMO — HMO: $2,960 BCBS Blue Essentials HMO — HMO: $3,120 BCBS Medicare Advantage — HMO: $637.58 BCBS Traditional/PPO — PPO: $4,040 Cash Pay — Self Pay: $1,101.58 Cigna Commercial — PPO: $1,547.72 Humana Medicare Advantage — HMO: $637.58 United Healthcare Commercial — PPO: $1,652.37
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) In the file: ER LEVEL 5	$1,835.97	$1,101.58	$1,101.58 – $1,652.37
Emergency room visit (high): rates for 6 insurance plans Aetna Commercial — PPO: $1,652.37 BCBS Blue Advantage HMO — HMO: $1,138.30 BCBS Blue Essentials HMO — HMO: $1,285.18 Cash Pay — Self Pay: $1,101.58 Cigna Commercial — PPO: $1,652.37 United Healthcare Commercial — PPO: $1,652.37
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · modifier 25 In the file: ER LEVEL 5 W PROCEDURE	$2,348.19	$1,408.91	$637.58 – $4,040
Emergency room visit (high): 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,902.03 Aetna Medicare Advantage — HMO: $637.58 BCBS Blue Advantage HMO — HMO: $2,960 BCBS Blue Essentials HMO — HMO: $3,120 BCBS Medicare Advantage — HMO: $637.58 BCBS Traditional/PPO — PPO: $4,040 Cash Pay — Self Pay: $1,408.91 Cigna Commercial — PPO: $1,979.52 Humana Medicare Advantage — HMO: $637.58 United Healthcare Commercial — PPO: $2,113.37

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: BASIC METABOLIC PANEL	$109	$65.40	$39.68 – $98.10
Basic metabolic panel (blood test): rates for 7 insurance plans Aetna Commercial — PPO: $88.29 BCBS Blue Advantage HMO — HMO: $39.68 BCBS Blue Essentials HMO — HMO: $41.96 BCBS Traditional/PPO — PPO: $46.61 Cash Pay — Self Pay: $65.40 Cigna Commercial — PPO: $91.89 United Healthcare Commercial — PPO: $98.10
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) In the file: BASIC METABOLIC PANEL	$109	$65.40	$65.40 – $98.10
Basic metabolic panel (blood test): rates for 6 insurance plans Aetna Commercial — PPO: $98.10 BCBS Blue Advantage HMO — HMO: $67.58 BCBS Blue Essentials HMO — HMO: $76.30 Cash Pay — Self Pay: $65.40 Cigna Commercial — PPO: $98.10 United Healthcare Commercial — PPO: $98.10
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: COMPREHENSIVE METABOLIC PANEL	$147	$88.20	$49.53 – $132.30
Comprehensive metabolic panel (blood test): rates for 7 insurance plans Aetna Commercial — PPO: $119.07 BCBS Blue Advantage HMO — HMO: $49.53 BCBS Blue Essentials HMO — HMO: $52.38 BCBS Traditional/PPO — PPO: $58.19 Cash Pay — Self Pay: $88.20 Cigna Commercial — PPO: $123.92 United Healthcare Commercial — PPO: $132.30
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) In the file: COMPREHENSIVE METABOLIC PANEL	$147	$88.20	$88.20 – $132.30
Comprehensive metabolic panel (blood test): rates for 6 insurance plans Aetna Commercial — PPO: $132.30 BCBS Blue Advantage HMO — HMO: $91.14 BCBS Blue Essentials HMO — HMO: $102.90 Cash Pay — Self Pay: $88.20 Cigna Commercial — PPO: $132.30 United Healthcare Commercial — PPO: $132.30
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: LIPID PANEL	$117	$70.20	$62.80 – $105.30
Cholesterol panel (lipid panel): rates for 7 insurance plans Aetna Commercial — PPO: $94.77 BCBS Blue Advantage HMO — HMO: $62.80 BCBS Blue Essentials HMO — HMO: $66.41 BCBS Traditional/PPO — PPO: $73.78 Cash Pay — Self Pay: $70.20 Cigna Commercial — PPO: $98.63 United Healthcare Commercial — PPO: $105.30
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: *LIPID CARDIOPULMONARY	$40.17	$24.10	$24.10 – $73.78
Cholesterol panel (lipid panel): rates for 7 insurance plans Aetna Commercial — PPO: $32.54 BCBS Blue Advantage HMO — HMO: $62.80 BCBS Blue Essentials HMO — HMO: $66.41 BCBS Traditional/PPO — PPO: $73.78 Cash Pay — Self Pay: $24.10 Cigna Commercial — PPO: $33.86 United Healthcare Commercial — PPO: $36.15
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) In the file: LIPID PANEL	$117	$70.20	$70.20 – $105.30
Cholesterol panel (lipid panel): rates for 6 insurance plans Aetna Commercial — PPO: $105.30 BCBS Blue Advantage HMO — HMO: $72.54 BCBS Blue Essentials HMO — HMO: $81.90 Cash Pay — Self Pay: $70.20 Cigna Commercial — PPO: $105.30 United Healthcare Commercial — PPO: $105.30
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL FUNCTION PANEL	$251	$150.60	$40.71 – $225.90
Kidney function panel: rates for 7 insurance plans Aetna Commercial — PPO: $203.31 BCBS Blue Advantage HMO — HMO: $40.71 BCBS Blue Essentials HMO — HMO: $43.05 BCBS Traditional/PPO — PPO: $47.83 Cash Pay — Self Pay: $150.60 Cigna Commercial — PPO: $211.59 United Healthcare Commercial — PPO: $225.90
Kidney function panel CPT 80069 · Inpatient (hospital stay) In the file: RENAL FUNCTION PANEL	$251	$150.60	$150.60 – $225.90
Kidney function panel: rates for 6 insurance plans Aetna Commercial — PPO: $225.90 BCBS Blue Advantage HMO — HMO: $155.62 BCBS Blue Essentials HMO — HMO: $175.70 Cash Pay — Self Pay: $150.60 Cigna Commercial — PPO: $225.90 United Healthcare Commercial — PPO: $225.90
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HEPATIC FUNCTION PANEL A	$126	$75.60	$38.32 – $113.40
Liver function panel: rates for 7 insurance plans Aetna Commercial — PPO: $102.06 BCBS Blue Advantage HMO — HMO: $38.32 BCBS Blue Essentials HMO — HMO: $40.52 BCBS Traditional/PPO — PPO: $45.02 Cash Pay — Self Pay: $75.60 Cigna Commercial — PPO: $106.22 United Healthcare Commercial — PPO: $113.40
Liver function panel CPT 80076 · Inpatient (hospital stay) In the file: HEPATIC FUNCTION PANEL A	$126	$75.60	$75.60 – $113.40
Liver function panel: rates for 6 insurance plans Aetna Commercial — PPO: $113.40 BCBS Blue Advantage HMO — HMO: $78.12 BCBS Blue Essentials HMO — HMO: $88.20 Cash Pay — Self Pay: $75.60 Cigna Commercial — PPO: $113.40 United Healthcare Commercial — PPO: $113.40
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: URINALYSIS W/ MICRO	$46	$27.60	$14.87 – $41.40
Urine test (automated, with microscope): rates for 7 insurance plans Aetna Commercial — PPO: $37.26 BCBS Blue Advantage HMO — HMO: $14.87 BCBS Blue Essentials HMO — HMO: $15.72 BCBS Traditional/PPO — PPO: $17.47 Cash Pay — Self Pay: $27.60 Cigna Commercial — PPO: $38.78 United Healthcare Commercial — PPO: $41.40
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) In the file: URINALYSIS W/ MICRO	$46	$27.60	$27.60 – $41.40
Urine test (automated, with microscope): rates for 6 insurance plans Aetna Commercial — PPO: $41.40 BCBS Blue Advantage HMO — HMO: $28.52 BCBS Blue Essentials HMO — HMO: $32.20 Cash Pay — Self Pay: $27.60 Cigna Commercial — PPO: $41.40 United Healthcare Commercial — PPO: $41.40
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: TL-URINALYSIS NONAUTO W/O SCOPE	$25	$15	$15 – $22.50
Urine test (manual, without microscope): rates for 7 insurance plans Aetna Commercial — PPO: $20.25 BCBS Blue Advantage HMO — HMO: $16.32 BCBS Blue Essentials HMO — HMO: $17.26 BCBS Traditional/PPO — PPO: $19.17 Cash Pay — Self Pay: $15 Cigna Commercial — PPO: $21.08 United Healthcare Commercial — PPO: $22.50
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: MH-URINALYSIS NONAUTO W/O SCOPE	$25	$15	$15 – $22.50
Urine test (manual, without microscope): rates for 7 insurance plans Aetna Commercial — PPO: $20.25 BCBS Blue Advantage HMO — HMO: $16.32 BCBS Blue Essentials HMO — HMO: $17.26 BCBS Traditional/PPO — PPO: $19.17 Cash Pay — Self Pay: $15 Cigna Commercial — PPO: $21.08 United Healthcare Commercial — PPO: $22.50
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: MT-URINALYSIS NONAUTO W/O SCOPE	$25	$15	$15 – $22.50
Urine test (manual, without microscope): rates for 7 insurance plans Aetna Commercial — PPO: $20.25 BCBS Blue Advantage HMO — HMO: $16.32 BCBS Blue Essentials HMO — HMO: $17.26 BCBS Traditional/PPO — PPO: $19.17 Cash Pay — Self Pay: $15 Cigna Commercial — PPO: $21.08 United Healthcare Commercial — PPO: $22.50
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: URINALYSIS W/O MICRO	$31	$18.60	$10.55 – $27.90
Urine test (automated, without microscope): rates for 7 insurance plans Aetna Commercial — PPO: $25.11 BCBS Blue Advantage HMO — HMO: $10.55 BCBS Blue Essentials HMO — HMO: $11.16 BCBS Traditional/PPO — PPO: $12.40 Cash Pay — Self Pay: $18.60 Cigna Commercial — PPO: $26.13 United Healthcare Commercial — PPO: $27.90
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) In the file: URINALYSIS W/O MICRO	$31	$18.60	$18.60 – $27.90
Urine test (automated, without microscope): rates for 6 insurance plans Aetna Commercial — PPO: $27.90 BCBS Blue Advantage HMO — HMO: $19.22 BCBS Blue Essentials HMO — HMO: $21.70 Cash Pay — Self Pay: $18.60 Cigna Commercial — PPO: $27.90 United Healthcare Commercial — PPO: $27.90
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA-SCREENING SERUM	$70	$42	$42 – $101.33
PSA (prostate specific antigen) blood test: rates for 7 insurance plans Aetna Commercial — PPO: $56.70 BCBS Blue Advantage HMO — HMO: $86.25 BCBS Blue Essentials HMO — HMO: $91.21 BCBS Traditional/PPO — PPO: $101.33 Cash Pay — Self Pay: $42 Cigna Commercial — PPO: $59.01 United Healthcare Commercial — PPO: $63
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA-TOTAL SERUM	$70	$42	$42 – $101.33
PSA (prostate specific antigen) blood test: rates for 7 insurance plans Aetna Commercial — PPO: $56.70 BCBS Blue Advantage HMO — HMO: $86.25 BCBS Blue Essentials HMO — HMO: $91.21 BCBS Traditional/PPO — PPO: $101.33 Cash Pay — Self Pay: $42 Cigna Commercial — PPO: $59.01 United Healthcare Commercial — PPO: $63
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) In the file: PSA-SCREENING SERUM	$70	$42	$42 – $63
PSA (prostate specific antigen) blood test: rates for 6 insurance plans Aetna Commercial — PPO: $63 BCBS Blue Advantage HMO — HMO: $43.40 BCBS Blue Essentials HMO — HMO: $49 Cash Pay — Self Pay: $42 Cigna Commercial — PPO: $63 United Healthcare Commercial — PPO: $63
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: TSH	$110	$66	$66 – $99
Thyroid stimulating hormone (TSH) test: rates for 7 insurance plans Aetna Commercial — PPO: $89.10 BCBS Blue Advantage HMO — HMO: $78.79 BCBS Blue Essentials HMO — HMO: $83.33 BCBS Traditional/PPO — PPO: $92.57 Cash Pay — Self Pay: $66 Cigna Commercial — PPO: $92.73 United Healthcare Commercial — PPO: $99
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) In the file: TSH	$110	$66	$66 – $99
Thyroid stimulating hormone (TSH) test: rates for 6 insurance plans Aetna Commercial — PPO: $99 BCBS Blue Advantage HMO — HMO: $68.20 BCBS Blue Essentials HMO — HMO: $77 Cash Pay — Self Pay: $66 Cigna Commercial — PPO: $99 United Healthcare Commercial — PPO: $99
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: CBC W/AUTO	$80	$48	$36.44 – $72
Complete blood count (CBC) with differential: rates for 7 insurance plans Aetna Commercial — PPO: $64.80 BCBS Blue Advantage HMO — HMO: $36.44 BCBS Blue Essentials HMO — HMO: $38.54 BCBS Traditional/PPO — PPO: $42.81 Cash Pay — Self Pay: $48 Cigna Commercial — PPO: $67.44 United Healthcare Commercial — PPO: $72
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) In the file: CBC W/AUTO	$80	$48	$48 – $72
Complete blood count (CBC) with differential: rates for 6 insurance plans Aetna Commercial — PPO: $72 BCBS Blue Advantage HMO — HMO: $49.60 BCBS Blue Essentials HMO — HMO: $56 Cash Pay — Self Pay: $48 Cigna Commercial — PPO: $72 United Healthcare Commercial — PPO: $72
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: CBC W/MANUAL	$90	$54	$30.34 – $81
Complete blood count (CBC), automated: rates for 7 insurance plans Aetna Commercial — PPO: $72.90 BCBS Blue Advantage HMO — HMO: $30.34 BCBS Blue Essentials HMO — HMO: $32.09 BCBS Traditional/PPO — PPO: $35.65 Cash Pay — Self Pay: $54 Cigna Commercial — PPO: $75.87 United Healthcare Commercial — PPO: $81
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) In the file: CBC W/MANUAL	$90	$54	$54 – $81
Complete blood count (CBC), automated: rates for 6 insurance plans Aetna Commercial — PPO: $81 BCBS Blue Advantage HMO — HMO: $55.80 BCBS Blue Essentials HMO — HMO: $63 Cash Pay — Self Pay: $54 Cigna Commercial — PPO: $81 United Healthcare Commercial — PPO: $81
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PT, PROTIME	$62	$37.20	$20.12 – $55.80
Blood clotting time test (prothrombin time, PT): rates for 7 insurance plans Aetna Commercial — PPO: $50.22 BCBS Blue Advantage HMO — HMO: $20.12 BCBS Blue Essentials HMO — HMO: $21.28 BCBS Traditional/PPO — PPO: $23.64 Cash Pay — Self Pay: $37.20 Cigna Commercial — PPO: $52.27 United Healthcare Commercial — PPO: $55.80
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) In the file: PT, PROTIME	$62	$37.20	$37.20 – $55.80
Blood clotting time test (prothrombin time, PT): rates for 6 insurance plans Aetna Commercial — PPO: $55.80 BCBS Blue Advantage HMO — HMO: $38.44 BCBS Blue Essentials HMO — HMO: $43.40 Cash Pay — Self Pay: $37.20 Cigna Commercial — PPO: $55.80 United Healthcare Commercial — PPO: $55.80
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: PTT, PARTIAL THROMBOPLASTIN TIME	$78	$46.80	$28.19 – $70.20
Blood clotting test (partial thromboplastin time, PTT): rates for 7 insurance plans Aetna Commercial — PPO: $63.18 BCBS Blue Advantage HMO — HMO: $28.19 BCBS Blue Essentials HMO — HMO: $29.81 BCBS Traditional/PPO — PPO: $33.12 Cash Pay — Self Pay: $46.80 Cigna Commercial — PPO: $65.75 United Healthcare Commercial — PPO: $70.20
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) In the file: PTT, PARTIAL THROMBOPLASTIN TIME	$78	$46.80	$46.80 – $70.20
Blood clotting test (partial thromboplastin time, PTT): rates for 6 insurance plans Aetna Commercial — PPO: $70.20 BCBS Blue Advantage HMO — HMO: $48.36 BCBS Blue Essentials HMO — HMO: $54.60 Cash Pay — Self Pay: $46.80 Cigna Commercial — PPO: $70.20 United Healthcare Commercial — PPO: $70.20

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) In the file: CT HEAD W/O	$1,279	$767.40	$111.93 – $1,078.20
CT scan of the head or brain, without contrast: 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,035.99 Aetna Medicare Advantage — HMO: $111.93 BCBS Blue Advantage HMO — HMO: $431.51 BCBS Blue Essentials HMO — HMO: $457.29 BCBS Medicare Advantage — HMO: $111.93 BCBS Traditional/PPO — PPO: $507.72 Cash Pay — Self Pay: $767.40 Cigna Commercial — PPO: $1,078.20 Humana Medicare Advantage — HMO: $111.93 United Healthcare Commercial — PPO: $250.18
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) In the file: CT HEAD W/O	$1,279	$767.40	$767.40 – $1,151.10
CT scan of the head or brain, without contrast: rates for 6 insurance plans Aetna Commercial — PPO: $1,151.10 BCBS Blue Advantage HMO — HMO: $792.98 BCBS Blue Essentials HMO — HMO: $895.30 Cash Pay — Self Pay: $767.40 Cigna Commercial — PPO: $1,151.10 United Healthcare Commercial — PPO: $1,151.10
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN WO/W	$3,090	$1,854	$373.51 – $2,604.87
MRI of the brain, before and after contrast: 10 of 11 insurance plan rates Aetna Commercial — PPO: $2,502.90 Aetna Medicare Advantage — HMO: $373.51 BCBS Blue Advantage HMO — HMO: $1,470.12 BCBS Blue Essentials HMO — HMO: $1,557.95 BCBS Medicare Advantage — HMO: $373.51 BCBS Traditional/PPO — PPO: $1,729.78 Cash Pay — Self Pay: $1,854 Cigna Commercial — PPO: $2,604.87 Humana Medicare Advantage — HMO: $373.51 United Healthcare Commercial — PPO: $846.20
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) In the file: MRI BRAIN WO/W	$3,090	$1,854	$1,854 – $2,781
MRI of the brain, before and after contrast: rates for 6 insurance plans Aetna Commercial — PPO: $2,781 BCBS Blue Advantage HMO — HMO: $1,915.80 BCBS Blue Essentials HMO — HMO: $2,163 Cash Pay — Self Pay: $1,854 Cigna Commercial — PPO: $2,781 United Healthcare Commercial — PPO: $2,781
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: CHEST 2 VIEWS	$250	$150	$93.17 – $210.75
Chest X-ray, 2 views: 10 of 11 insurance plan rates Aetna Commercial — PPO: $202.50 Aetna Medicare Advantage — HMO: $93.17 BCBS Blue Advantage HMO — HMO: $117.32 BCBS Blue Essentials HMO — HMO: $117.32 BCBS Medicare Advantage — HMO: $93.17 BCBS Traditional/PPO — PPO: $205.91 Cash Pay — Self Pay: $150 Cigna Commercial — PPO: $210.75 Humana Medicare Advantage — HMO: $93.17 United Healthcare Commercial — PPO: $185.87
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) In the file: CHEST 2 VIEWS	$250	$150	$150 – $225
Chest X-ray, 2 views: rates for 6 insurance plans Aetna Commercial — PPO: $225 BCBS Blue Advantage HMO — HMO: $155 BCBS Blue Essentials HMO — HMO: $175 Cash Pay — Self Pay: $150 Cigna Commercial — PPO: $225 United Healthcare Commercial — PPO: $225
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: SPINE LUMBAR 5V	$416	$249.60	$111.93 – $350.69
X-ray of the lower spine, at least 4 views: 10 of 11 insurance plan rates Aetna Commercial — PPO: $336.96 Aetna Medicare Advantage — HMO: $111.93 BCBS Blue Advantage HMO — HMO: $164.76 BCBS Blue Essentials HMO — HMO: $164.76 BCBS Medicare Advantage — HMO: $111.93 BCBS Traditional/PPO — PPO: $289.17 Cash Pay — Self Pay: $249.60 Cigna Commercial — PPO: $350.69 Humana Medicare Advantage — HMO: $111.93 United Healthcare Commercial — PPO: $250.18
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) In the file: SPINE LUMBAR 5V	$416	$249.60	$249.60 – $374.40
X-ray of the lower spine, at least 4 views: rates for 6 insurance plans Aetna Commercial — PPO: $374.40 BCBS Blue Advantage HMO — HMO: $257.92 BCBS Blue Essentials HMO — HMO: $291.20 Cash Pay — Self Pay: $249.60 Cigna Commercial — PPO: $374.40 United Healthcare Commercial — PPO: $374.40
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI LUMBAR W/O	$1,987	$1,192.20	$255.45 – $1,675.04
MRI of the lower back (lumbar spine), without contrast: 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,609.47 Aetna Medicare Advantage — HMO: $255.45 BCBS Blue Advantage HMO — HMO: $897.20 BCBS Blue Essentials HMO — HMO: $950.80 BCBS Medicare Advantage — HMO: $255.45 BCBS Traditional/PPO — PPO: $1,055.67 Cash Pay — Self Pay: $1,192.20 Cigna Commercial — PPO: $1,675.04 Humana Medicare Advantage — HMO: $255.45 United Healthcare Commercial — PPO: $528.75
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) In the file: MRI LUMBAR W/O	$1,987	$1,192.20	$1,192.20 – $1,788.30
MRI of the lower back (lumbar spine), without contrast: rates for 6 insurance plans Aetna Commercial — PPO: $1,788.30 BCBS Blue Advantage HMO — HMO: $1,231.94 BCBS Blue Essentials HMO — HMO: $1,390.90 Cash Pay — Self Pay: $1,192.20 Cigna Commercial — PPO: $1,788.30 United Healthcare Commercial — PPO: $1,788.30
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS WITH	$2,046.83	$1,228.10	$187.79 – $1,725.48
CT scan of the pelvis, with contrast: 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,657.93 Aetna Medicare Advantage — HMO: $187.79 BCBS Blue Advantage HMO — HMO: $701.55 BCBS Blue Essentials HMO — HMO: $743.46 BCBS Medicare Advantage — HMO: $187.79 BCBS Traditional/PPO — PPO: $825.46 Cash Pay — Self Pay: $1,228.10 Cigna Commercial — PPO: $1,725.48 Humana Medicare Advantage — HMO: $187.79 United Healthcare Commercial — PPO: $410.47
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) In the file: CT PELVIS WITH	$2,046.83	$1,228.10	$1,228.10 – $1,842.15
CT scan of the pelvis, with contrast: rates for 6 insurance plans Aetna Commercial — PPO: $1,842.15 BCBS Blue Advantage HMO — HMO: $1,269.03 BCBS Blue Essentials HMO — HMO: $1,432.78 Cash Pay — Self Pay: $1,228.10 Cigna Commercial — PPO: $1,842.15 United Healthcare Commercial — PPO: $1,842.15
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier RT In the file: MRI KNEE RT W/O	$1,882	$1,129.20	$255.45 – $1,586.53
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,524.42 Aetna Medicare Advantage — HMO: $255.45 BCBS Blue Advantage HMO — HMO: $897.20 BCBS Blue Essentials HMO — HMO: $950.80 BCBS Medicare Advantage — HMO: $255.45 BCBS Traditional/PPO — PPO: $1,055.67 Cash Pay — Self Pay: $1,129.20 Cigna Commercial — PPO: $1,586.53 Humana Medicare Advantage — HMO: $255.45 United Healthcare Commercial — PPO: $528.75
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier LT In the file: MRI KNEE LT W/O	$1,882	$1,129.20	$255.45 – $1,586.53
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,524.42 Aetna Medicare Advantage — HMO: $255.45 BCBS Blue Advantage HMO — HMO: $897.20 BCBS Blue Essentials HMO — HMO: $950.80 BCBS Medicare Advantage — HMO: $255.45 BCBS Traditional/PPO — PPO: $1,055.67 Cash Pay — Self Pay: $1,129.20 Cigna Commercial — PPO: $1,586.53 Humana Medicare Advantage — HMO: $255.45 United Healthcare Commercial — PPO: $528.75
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier RT In the file: MRI HIP RT W/O	$1,882	$1,129.20	$255.45 – $1,586.53
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,524.42 Aetna Medicare Advantage — HMO: $255.45 BCBS Blue Advantage HMO — HMO: $897.20 BCBS Blue Essentials HMO — HMO: $950.80 BCBS Medicare Advantage — HMO: $255.45 BCBS Traditional/PPO — PPO: $1,055.67 Cash Pay — Self Pay: $1,129.20 Cigna Commercial — PPO: $1,586.53 Humana Medicare Advantage — HMO: $255.45 United Healthcare Commercial — PPO: $528.75
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABD&PEL WITH	$2,670	$1,602	$373.51 – $2,250.81
CT scan of the abdomen and pelvis, with contrast: 10 of 11 insurance plan rates Aetna Commercial — PPO: $2,162.70 Aetna Medicare Advantage — HMO: $373.51 BCBS Blue Advantage HMO — HMO: $1,470.12 BCBS Blue Essentials HMO — HMO: $1,557.95 BCBS Medicare Advantage — HMO: $373.51 BCBS Traditional/PPO — PPO: $1,729.78 Cash Pay — Self Pay: $1,602 Cigna Commercial — PPO: $2,250.81 Humana Medicare Advantage — HMO: $373.51 United Healthcare Commercial — PPO: $846.20
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) In the file: CT ABD&PEL WITH	$2,670	$1,602	$1,602 – $2,403
CT scan of the abdomen and pelvis, with contrast: rates for 6 insurance plans Aetna Commercial — PPO: $2,403 BCBS Blue Advantage HMO — HMO: $1,655.40 BCBS Blue Essentials HMO — HMO: $1,869 Cash Pay — Self Pay: $1,602 Cigna Commercial — PPO: $2,403 United Healthcare Commercial — PPO: $2,403
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US ABDOMEN	$750	$450	$111.93 – $632.25
Ultrasound of the abdomen, complete: 10 of 11 insurance plan rates Aetna Commercial — PPO: $607.50 Aetna Medicare Advantage — HMO: $111.93 BCBS Blue Advantage HMO — HMO: $164.76 BCBS Blue Essentials HMO — HMO: $164.76 BCBS Medicare Advantage — HMO: $111.93 BCBS Traditional/PPO — PPO: $289.17 Cash Pay — Self Pay: $450 Cigna Commercial — PPO: $632.25 Humana Medicare Advantage — HMO: $111.93 United Healthcare Commercial — PPO: $250.18
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) In the file: US ABDOMEN	$750	$450	$450 – $675
Ultrasound of the abdomen, complete: rates for 6 insurance plans Aetna Commercial — PPO: $675 BCBS Blue Advantage HMO — HMO: $465 BCBS Blue Essentials HMO — HMO: $525 Cash Pay — Self Pay: $450 Cigna Commercial — PPO: $675 United Healthcare Commercial — PPO: $675
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: US OB > / =14 WKS SINGLE FETUS	$379	$227.40	$111.93 – $319.50
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates Aetna Commercial — PPO: $306.99 Aetna Medicare Advantage — HMO: $111.93 BCBS Blue Advantage HMO — HMO: $134.56 BCBS Blue Essentials HMO — HMO: $134.56 BCBS Medicare Advantage — HMO: $111.93 BCBS Traditional/PPO — PPO: $236.17 Cash Pay — Self Pay: $227.40 Cigna Commercial — PPO: $319.50 Humana Medicare Advantage — HMO: $111.93 United Healthcare Commercial — PPO: $250.18
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) In the file: US OB > / =14 WKS SINGLE FETUS	$379	$227.40	$227.40 – $341.10
Pregnancy ultrasound (after the first trimester): rates for 6 insurance plans Aetna Commercial — PPO: $341.10 BCBS Blue Advantage HMO — HMO: $234.98 BCBS Blue Essentials HMO — HMO: $265.30 Cash Pay — Self Pay: $227.40 Cigna Commercial — PPO: $341.10 United Healthcare Commercial — PPO: $341.10
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: *US PELVIC/TV NON-OB	$494	$296.40	$111.93 – $416.44
Transvaginal ultrasound: 10 of 11 insurance plan rates Aetna Commercial — PPO: $400.14 Aetna Medicare Advantage — HMO: $111.93 BCBS Blue Advantage HMO — HMO: $129.80 BCBS Blue Essentials HMO — HMO: $129.80 BCBS Medicare Advantage — HMO: $111.93 BCBS Traditional/PPO — PPO: $227.81 Cash Pay — Self Pay: $296.40 Cigna Commercial — PPO: $416.44 Humana Medicare Advantage — HMO: $111.93 United Healthcare Commercial — PPO: $250.18
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: US TV NON-OB	$499	$299.40	$111.93 – $420.66
Transvaginal ultrasound: 10 of 11 insurance plan rates Aetna Commercial — PPO: $404.19 Aetna Medicare Advantage — HMO: $111.93 BCBS Blue Advantage HMO — HMO: $129.80 BCBS Blue Essentials HMO — HMO: $129.80 BCBS Medicare Advantage — HMO: $111.93 BCBS Traditional/PPO — PPO: $227.81 Cash Pay — Self Pay: $299.40 Cigna Commercial — PPO: $420.66 Humana Medicare Advantage — HMO: $111.93 United Healthcare Commercial — PPO: $250.18
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) In the file: *US PELVIC/TV NON-OB	$494	$296.40	$296.40 – $444.60
Transvaginal ultrasound: rates for 6 insurance plans Aetna Commercial — PPO: $444.60 BCBS Blue Advantage HMO — HMO: $306.28 BCBS Blue Essentials HMO — HMO: $345.80 Cash Pay — Self Pay: $296.40 Cigna Commercial — PPO: $444.60 United Healthcare Commercial — PPO: $444.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: MAMMO DIAGNOSTIC UNILATERAL	$387.81	$232.69	$37.09 – $326.92
Diagnostic mammogram, one breast: 10 of 11 insurance plan rates Aetna Commercial — PPO: $314.13 Aetna Medicare Advantage — HMO: $37.09 BCBS Blue Advantage HMO — HMO: $138.27 BCBS Blue Essentials HMO — HMO: $138.27 BCBS Medicare Advantage — HMO: $37.09 BCBS Traditional/PPO — PPO: $242.67 Cash Pay — Self Pay: $232.69 Cigna Commercial — PPO: $326.92 Humana Medicare Advantage — HMO: $37.09 United Healthcare Commercial — PPO: $204.01
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) In the file: MAMMO DIAGNOSTIC UNILATERAL	$387.81	$232.69	$232.69 – $349.03
Diagnostic mammogram, one breast: rates for 6 insurance plans Aetna Commercial — PPO: $349.03 BCBS Blue Advantage HMO — HMO: $240.44 BCBS Blue Essentials HMO — HMO: $271.47 Cash Pay — Self Pay: $232.69 Cigna Commercial — PPO: $349.03 United Healthcare Commercial — PPO: $349.03
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: MAMMO DIAGNOSTIC BILATERAL	$490.02	$294.01	$45.64 – $413.09
Diagnostic mammogram, both breasts: 10 of 11 insurance plan rates Aetna Commercial — PPO: $396.92 Aetna Medicare Advantage — HMO: $45.64 BCBS Blue Advantage HMO — HMO: $176.94 BCBS Blue Essentials HMO — HMO: $176.94 BCBS Medicare Advantage — HMO: $45.64 BCBS Traditional/PPO — PPO: $310.55 Cash Pay — Self Pay: $294.01 Cigna Commercial — PPO: $413.09 Humana Medicare Advantage — HMO: $45.64 United Healthcare Commercial — PPO: $260.06
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) In the file: MAMMO DIAGNOSTIC BILATERAL	$490.02	$294.01	$294.01 – $441.02
Diagnostic mammogram, both breasts: rates for 6 insurance plans Aetna Commercial — PPO: $441.02 BCBS Blue Advantage HMO — HMO: $303.81 BCBS Blue Essentials HMO — HMO: $343.01 Cash Pay — Self Pay: $294.01 Cigna Commercial — PPO: $441.02 United Healthcare Commercial — PPO: $441.02
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: MAMMO SCREENING BILATERAL	$394.92	$236.95	$34.48 – $332.92
Screening mammogram, both breasts: 10 of 11 insurance plan rates Aetna Commercial — PPO: $319.89 Aetna Medicare Advantage — HMO: $34.48 BCBS Blue Advantage HMO — HMO: $146.22 BCBS Blue Essentials HMO — HMO: $146.22 BCBS Medicare Advantage — HMO: $34.48 BCBS Traditional/PPO — PPO: $256.63 Cash Pay — Self Pay: $236.95 Cigna Commercial — PPO: $332.92 Humana Medicare Advantage — HMO: $34.48 United Healthcare Commercial — PPO: $214.90
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) In the file: MAMMO SCREENING BILATERAL	$394.92	$236.95	$236.95 – $355.43
Screening mammogram, both breasts: rates for 6 insurance plans Aetna Commercial — PPO: $355.43 BCBS Blue Advantage HMO — HMO: $244.85 BCBS Blue Essentials HMO — HMO: $276.44 Cash Pay — Self Pay: $236.95 Cigna Commercial — PPO: $355.43 United Healthcare Commercial — PPO: $355.43
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · modifier 52 In the file: MAMMO SCREENING UNILATERAL	$394.92	$236.95	$34.48 – $332.92
Screening mammogram, both breasts: 10 of 11 insurance plan rates Aetna Commercial — PPO: $319.89 Aetna Medicare Advantage — HMO: $34.48 BCBS Blue Advantage HMO — HMO: $146.22 BCBS Blue Essentials HMO — HMO: $146.22 BCBS Medicare Advantage — HMO: $34.48 BCBS Traditional/PPO — PPO: $256.63 Cash Pay — Self Pay: $236.95 Cigna Commercial — PPO: $332.92 Humana Medicare Advantage — HMO: $34.48 United Healthcare Commercial — PPO: $214.90

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) In the file: ELECTROCARDIOGRAM COMPLETE	$57.23	$34.34	$34.34 – $95.32
Electrocardiogram (ECG/EKG) with reading: rates for 7 insurance plans Aetna Commercial — PPO: $46.36 BCBS Blue Advantage HMO — HMO: $81.14 BCBS Blue Essentials HMO — HMO: $85.81 BCBS Traditional/PPO — PPO: $95.32 Cash Pay — Self Pay: $34.34 Cigna Commercial — PPO: $48.24 United Healthcare Commercial — PPO: $51.51
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient (hospital stay) In the file: ELECTROCARDIOGRAM COMPLETE	$57.23	$34.34	$34.34 – $51.51
Electrocardiogram (ECG/EKG) with reading: rates for 6 insurance plans Aetna Commercial — PPO: $51.51 BCBS Blue Advantage HMO — HMO: $35.48 BCBS Blue Essentials HMO — HMO: $40.06 Cash Pay — Self Pay: $34.34 Cigna Commercial — PPO: $51.51 United Healthcare Commercial — PPO: $51.51

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) · modifier GP In the file: PT THER EXERCISE 15 MIN	$118	$70.80	$58 – $130
Physical therapy: therapeutic exercise (each 15 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $95.58 BCBS Blue Advantage HMO — HMO: $58 BCBS Blue Essentials HMO — HMO: $60.82 BCBS Traditional/PPO — PPO: $96.87 Cash Pay — Self Pay: $70.80 Cigna Commercial — PPO: $99.47 United Healthcare Commercial — PPO: $130
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier U5 In the file: PT THER EXERCISE 15 MIN	$118	$70.80	$58 – $130
Physical therapy: therapeutic exercise (each 15 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $95.58 BCBS Blue Advantage HMO — HMO: $58 BCBS Blue Essentials HMO — HMO: $60.82 BCBS Traditional/PPO — PPO: $96.87 Cash Pay — Self Pay: $70.80 Cigna Commercial — PPO: $99.47 United Healthcare Commercial — PPO: $130
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier UB In the file: PT/PTA THER EXERCISE 15 MIN	$118	$70.80	$58 – $130
Physical therapy: therapeutic exercise (each 15 minutes): rates for 7 insurance plans Aetna Commercial — PPO: $95.58 BCBS Blue Advantage HMO — HMO: $58 BCBS Blue Essentials HMO — HMO: $60.82 BCBS Traditional/PPO — PPO: $96.87 Cash Pay — Self Pay: $70.80 Cigna Commercial — PPO: $99.47 United Healthcare Commercial — PPO: $130
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · modifier GP In the file: PT EVAL LOW COMPLEXITY GP	$305.82	$183.49	$130 – $267.25
Physical therapy evaluation (low complexity): rates for 7 insurance plans Aetna Commercial — PPO: $247.71 BCBS Blue Advantage HMO — HMO: $160.01 BCBS Blue Essentials HMO — HMO: $167.79 BCBS Traditional/PPO — PPO: $267.25 Cash Pay — Self Pay: $183.49 Cigna Commercial — PPO: $257.81 United Healthcare Commercial — PPO: $130
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · modifier UB In the file: PT/PTA EVAL LOW COMPLEXITY	$305.82	$183.49	$130 – $267.25
Physical therapy evaluation (low complexity): rates for 7 insurance plans Aetna Commercial — PPO: $247.71 BCBS Blue Advantage HMO — HMO: $160.01 BCBS Blue Essentials HMO — HMO: $167.79 BCBS Traditional/PPO — PPO: $267.25 Cash Pay — Self Pay: $183.49 Cigna Commercial — PPO: $257.81 United Healthcare Commercial — PPO: $130
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · modifier U5 In the file: PT EVAL LOW COMPLEXITY U5	$305.82	$183.49	$130 – $267.25
Physical therapy evaluation (low complexity): rates for 7 insurance plans Aetna Commercial — PPO: $247.71 BCBS Blue Advantage HMO — HMO: $160.01 BCBS Blue Essentials HMO — HMO: $167.79 BCBS Traditional/PPO — PPO: $267.25 Cash Pay — Self Pay: $183.49 Cigna Commercial — PPO: $257.81 United Healthcare Commercial — PPO: $130
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · modifier GP In the file: PT EVAL MOD COMPLEXITY GP	$305.82	$183.49	$130 – $267.25
Physical therapy evaluation (moderate complexity): rates for 7 insurance plans Aetna Commercial — PPO: $247.71 BCBS Blue Advantage HMO — HMO: $160.01 BCBS Blue Essentials HMO — HMO: $167.79 BCBS Traditional/PPO — PPO: $267.25 Cash Pay — Self Pay: $183.49 Cigna Commercial — PPO: $257.81 United Healthcare Commercial — PPO: $130
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · modifier U5 In the file: PT EVAL MOD COMPLEXITY U5	$305.82	$183.49	$130 – $267.25
Physical therapy evaluation (moderate complexity): rates for 7 insurance plans Aetna Commercial — PPO: $247.71 BCBS Blue Advantage HMO — HMO: $160.01 BCBS Blue Essentials HMO — HMO: $167.79 BCBS Traditional/PPO — PPO: $267.25 Cash Pay — Self Pay: $183.49 Cigna Commercial — PPO: $257.81 United Healthcare Commercial — PPO: $130
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · modifier GP In the file: PT EVAL MOD COMPLEXITY GP	$305.82	$183.49	$183.49 – $275.24
Physical therapy evaluation (moderate complexity): rates for 6 insurance plans Aetna Commercial — PPO: $275.24 BCBS Blue Advantage HMO — HMO: $189.61 BCBS Blue Essentials HMO — HMO: $214.07 Cash Pay — Self Pay: $183.49 Cigna Commercial — PPO: $275.24 United Healthcare Commercial — PPO: $275.24
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · modifier GP In the file: PT EVAL HIGH COMPLEXITY GP	$305.82	$183.49	$130 – $267.25
Physical therapy evaluation (high complexity): rates for 7 insurance plans Aetna Commercial — PPO: $247.71 BCBS Blue Advantage HMO — HMO: $160.01 BCBS Blue Essentials HMO — HMO: $167.79 BCBS Traditional/PPO — PPO: $267.25 Cash Pay — Self Pay: $183.49 Cigna Commercial — PPO: $257.81 United Healthcare Commercial — PPO: $130
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · modifier U5 In the file: PT EVAL HIGH COMPLEXITY U5	$305.82	$183.49	$130 – $267.25
Physical therapy evaluation (high complexity): rates for 7 insurance plans Aetna Commercial — PPO: $247.71 BCBS Blue Advantage HMO — HMO: $160.01 BCBS Blue Essentials HMO — HMO: $167.79 BCBS Traditional/PPO — PPO: $267.25 Cash Pay — Self Pay: $183.49 Cigna Commercial — PPO: $257.81 United Healthcare Commercial — PPO: $130
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · modifier UB In the file: PT/PTA EVAL HIGH COMPLEXITY	$305.82	$183.49	$130 – $267.25
Physical therapy evaluation (high complexity): rates for 7 insurance plans Aetna Commercial — PPO: $247.71 BCBS Blue Advantage HMO — HMO: $160.01 BCBS Blue Essentials HMO — HMO: $167.79 BCBS Traditional/PPO — PPO: $267.25 Cash Pay — Self Pay: $183.49 Cigna Commercial — PPO: $257.81 United Healthcare Commercial — PPO: $130

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: REMOVAL BREAST LESION	$12,100.98	$7,260.59	$4,191.90 – $11,694.06
Removal of breast growth (open surgery): 10 of 11 insurance plan rates Aetna Commercial — PPO: $9,801.79 Aetna Medicare Advantage — HMO: $4,191.90 BCBS Blue Advantage HMO — HMO: $8,270.67 BCBS Blue Essentials HMO — HMO: $9,209.83 BCBS Medicare Advantage — HMO: $4,191.90 BCBS Traditional/PPO — PPO: $11,694.06 Cash Pay — Self Pay: $7,260.59 Cigna Commercial — PPO: $10,201.13 Humana Medicare Advantage — HMO: $4,191.90 United Healthcare Commercial — PPO: $10,890.88
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) In the file: REMOVAL BREAST LESION	$12,100.98	$7,260.59	$7,260.59 – $10,890.88
Removal of breast growth (open surgery): rates for 6 insurance plans Aetna Commercial — PPO: $10,890.88 BCBS Blue Advantage HMO — HMO: $7,502.61 BCBS Blue Essentials HMO — HMO: $8,470.69 Cash Pay — Self Pay: $7,260.59 Cigna Commercial — PPO: $10,890.88 United Healthcare Commercial — PPO: $10,890.88
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: TOTAL HIP ARTHROPLASTY	$39,350.28	$23,610.17	$13,745.21 – $45,936.74
Total hip replacement: 10 of 11 insurance plan rates Aetna Commercial — PPO: $31,873.73 Aetna Medicare Advantage — HMO: $13,745.21 BCBS Blue Advantage HMO — HMO: $32,488.94 BCBS Blue Essentials HMO — HMO: $36,178.16 BCBS Medicare Advantage — HMO: $13,745.21 BCBS Traditional/PPO — PPO: $45,936.74 Cash Pay — Self Pay: $23,610.17 Cigna Commercial — PPO: $33,172.29 Humana Medicare Advantage — HMO: $13,745.21 United Healthcare Commercial — PPO: $35,415.25
Total hip replacement CPT 27130 · Inpatient (hospital stay) In the file: TOTAL HIP ARTHROPLASTY	$39,350.28	$23,610.17	$23,610.17 – $35,415.25
Total hip replacement: rates for 6 insurance plans Aetna Commercial — PPO: $35,415.25 BCBS Blue Advantage HMO — HMO: $24,397.17 BCBS Blue Essentials HMO — HMO: $27,545.20 Cash Pay — Self Pay: $23,610.17 Cigna Commercial — PPO: $35,415.25 United Healthcare Commercial — PPO: $35,415.25
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: TOTAL KNEE ARTHROPLASTY	$42,325.92	$25,395.55	$13,745.21 – $45,936.74
Total knee replacement: 10 of 11 insurance plan rates Aetna Commercial — PPO: $34,284 Aetna Medicare Advantage — HMO: $13,745.21 BCBS Blue Advantage HMO — HMO: $32,488.94 BCBS Blue Essentials HMO — HMO: $36,178.16 BCBS Medicare Advantage — HMO: $13,745.21 BCBS Traditional/PPO — PPO: $45,936.74 Cash Pay — Self Pay: $25,395.55 Cigna Commercial — PPO: $35,680.75 Humana Medicare Advantage — HMO: $13,745.21 United Healthcare Commercial — PPO: $38,093.33
Total knee replacement CPT 27447 · Inpatient (hospital stay) In the file: TOTAL KNEE ARTHROPLASTY	$42,325.92	$25,395.55	$25,395.55 – $38,093.33
Total knee replacement: rates for 6 insurance plans Aetna Commercial — PPO: $38,093.33 BCBS Blue Advantage HMO — HMO: $26,242.07 BCBS Blue Essentials HMO — HMO: $29,628.14 Cash Pay — Self Pay: $25,395.55 Cigna Commercial — PPO: $38,093.33 United Healthcare Commercial — PPO: $38,093.33
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient (hospital stay) In the file: SHO ARTHRS SRG DECOMPRESSION	$497.49	$298.49	$298.49 – $447.74
Shoulder arthroscopy: shaving of shoulder bone: rates for 6 insurance plans Aetna Commercial — PPO: $447.74 BCBS Blue Advantage HMO — HMO: $308.44 BCBS Blue Essentials HMO — HMO: $348.24 Cash Pay — Self Pay: $298.49 Cigna Commercial — PPO: $447.74 United Healthcare Commercial — PPO: $447.74
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient (hospital stay) In the file: SHOULDER ARTHRO DECOMP SUBACROMIAL SP	$3,244.62	$1,946.77	$1,946.77 – $2,920.16
Shoulder arthroscopy: shaving of shoulder bone: rates for 6 insurance plans Aetna Commercial — PPO: $2,920.16 BCBS Blue Advantage HMO — HMO: $2,011.66 BCBS Blue Essentials HMO — HMO: $2,271.23 Cash Pay — Self Pay: $1,946.77 Cigna Commercial — PPO: $2,920.16 United Healthcare Commercial — PPO: $2,920.16
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: SHO ARTHRS SRG DECOMPRESSION	$497.49	$298.49	$298.49 – $447.74
Shoulder arthroscopy: shaving of shoulder bone: rates for 4 insurance plans Aetna Commercial — PPO: $402.97 Cash Pay — Self Pay: $298.49 Cigna Commercial — PPO: $419.38 United Healthcare Commercial — PPO: $447.74
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: KNEE ARTHROSCOPY/SURGERY	$10,220.14	$6,132.08	$3,503.03 – $10,566.56
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 11 insurance plan rates Aetna Commercial — PPO: $8,278.31 Aetna Medicare Advantage — HMO: $3,503.03 BCBS Blue Advantage HMO — HMO: $7,473.24 BCBS Blue Essentials HMO — HMO: $8,321.85 BCBS Medicare Advantage — HMO: $3,503.03 BCBS Traditional/PPO — PPO: $10,566.56 Cash Pay — Self Pay: $6,132.08 Cigna Commercial — PPO: $8,615.58 Humana Medicare Advantage — HMO: $3,503.03 United Healthcare Commercial — PPO: $9,198.13
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: KNEE ARTHROSCOPY, SURG W MENISCECTOMY	$9,733.83	$5,840.30	$3,503.03 – $10,566.56
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 11 insurance plan rates Aetna Commercial — PPO: $7,884.40 Aetna Medicare Advantage — HMO: $3,503.03 BCBS Blue Advantage HMO — HMO: $7,473.24 BCBS Blue Essentials HMO — HMO: $8,321.85 BCBS Medicare Advantage — HMO: $3,503.03 BCBS Traditional/PPO — PPO: $10,566.56 Cash Pay — Self Pay: $5,840.30 Cigna Commercial — PPO: $8,205.62 Humana Medicare Advantage — HMO: $3,503.03 United Healthcare Commercial — PPO: $8,760.45
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient (hospital stay) In the file: KNEE ARTHROSCOPY/SURGERY	$10,220.14	$6,132.08	$6,132.08 – $9,198.13
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 6 insurance plans Aetna Commercial — PPO: $9,198.13 BCBS Blue Advantage HMO — HMO: $6,336.49 BCBS Blue Essentials HMO — HMO: $7,154.10 Cash Pay — Self Pay: $6,132.08 Cigna Commercial — PPO: $9,198.13 United Healthcare Commercial — PPO: $9,198.13
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: EGD DIAGNOSTIC BRUSH WASH	$2,832.42	$1,699.45	$971.03 – $3,033.65
Upper GI endoscopy (diagnostic): 10 of 11 insurance plan rates Aetna Commercial — PPO: $2,294.26 Aetna Medicare Advantage — HMO: $971.03 BCBS Blue Advantage HMO — HMO: $2,145.56 BCBS Blue Essentials HMO — HMO: $2,389.20 BCBS Medicare Advantage — HMO: $971.03 BCBS Traditional/PPO — PPO: $3,033.65 Cash Pay — Self Pay: $1,699.45 Cigna Commercial — PPO: $2,387.73 Humana Medicare Advantage — HMO: $971.03 United Healthcare Commercial — PPO: $2,549.18
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) In the file: EGD DIAGNOSTIC BRUSH WASH	$2,832.42	$1,699.45	$1,699.45 – $2,549.18
Upper GI endoscopy (diagnostic): rates for 6 insurance plans Aetna Commercial — PPO: $2,549.18 BCBS Blue Advantage HMO — HMO: $1,756.10 BCBS Blue Essentials HMO — HMO: $1,982.69 Cash Pay — Self Pay: $1,699.45 Cigna Commercial — PPO: $2,549.18 United Healthcare Commercial — PPO: $2,549.18
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: EGD BIOPSY SINGLE/MULTIPLE	$2,875.17	$1,725.10	$971.03 – $3,033.65
Upper GI endoscopy with biopsy: 10 of 11 insurance plan rates Aetna Commercial — PPO: $2,328.89 Aetna Medicare Advantage — HMO: $971.03 BCBS Blue Advantage HMO — HMO: $2,145.56 BCBS Blue Essentials HMO — HMO: $2,389.20 BCBS Medicare Advantage — HMO: $971.03 BCBS Traditional/PPO — PPO: $3,033.65 Cash Pay — Self Pay: $1,725.10 Cigna Commercial — PPO: $2,423.77 Humana Medicare Advantage — HMO: $971.03 United Healthcare Commercial — PPO: $2,587.65
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) In the file: EGD BIOPSY SINGLE/MULTIPLE	$2,875.17	$1,725.10	$1,725.10 – $2,587.65
Upper GI endoscopy with biopsy: rates for 6 insurance plans Aetna Commercial — PPO: $2,587.65 BCBS Blue Advantage HMO — HMO: $1,782.61 BCBS Blue Essentials HMO — HMO: $2,012.62 Cash Pay — Self Pay: $1,725.10 Cigna Commercial — PPO: $2,587.65 United Healthcare Commercial — PPO: $2,587.65
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	$2,966.67	$1,780	$995.63 – $2,948.58
Colonoscopy (diagnostic): 10 of 11 insurance plan rates Aetna Commercial — PPO: $2,403 Aetna Medicare Advantage — HMO: $995.63 BCBS Blue Advantage HMO — HMO: $2,085.39 BCBS Blue Essentials HMO — HMO: $2,322.20 BCBS Medicare Advantage — HMO: $995.63 BCBS Traditional/PPO — PPO: $2,948.58 Cash Pay — Self Pay: $1,780 Cigna Commercial — PPO: $2,500.90 Humana Medicare Advantage — HMO: $995.63 United Healthcare Commercial — PPO: $2,670
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) In the file: DIAGNOSTIC COLONOSCOPY	$2,966.67	$1,780	$1,780 – $2,670
Colonoscopy (diagnostic): rates for 6 insurance plans Aetna Commercial — PPO: $2,670 BCBS Blue Advantage HMO — HMO: $1,839.34 BCBS Blue Essentials HMO — HMO: $2,076.67 Cash Pay — Self Pay: $1,780 Cigna Commercial — PPO: $2,670 United Healthcare Commercial — PPO: $2,670
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: COLONOSCOPY AND BIOPSY	$3,951.48	$2,370.89	$1,281.13 – $3,876.29
Colonoscopy with biopsy: 10 of 11 insurance plan rates Aetna Commercial — PPO: $3,200.70 Aetna Medicare Advantage — HMO: $1,281.13 BCBS Blue Advantage HMO — HMO: $2,741.52 BCBS Blue Essentials HMO — HMO: $3,052.83 BCBS Medicare Advantage — HMO: $1,281.13 BCBS Traditional/PPO — PPO: $3,876.29 Cash Pay — Self Pay: $2,370.89 Cigna Commercial — PPO: $3,331.10 Humana Medicare Advantage — HMO: $1,281.13 United Healthcare Commercial — PPO: $3,556.33
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) In the file: COLONOSCOPY AND BIOPSY	$3,951.48	$2,370.89	$2,370.89 – $3,556.33
Colonoscopy with biopsy: rates for 6 insurance plans Aetna Commercial — PPO: $3,556.33 BCBS Blue Advantage HMO — HMO: $2,449.92 BCBS Blue Essentials HMO — HMO: $2,766.04 Cash Pay — Self Pay: $2,370.89 Cigna Commercial — PPO: $3,556.33 United Healthcare Commercial — PPO: $3,556.33
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: COLONOSCOPY W/LESION REMOVAL	$3,980.79	$2,388.47	$1,281.13 – $3,876.29
Colonoscopy with removal of polyps (snare): 10 of 11 insurance plan rates Aetna Commercial — PPO: $3,224.44 Aetna Medicare Advantage — HMO: $1,281.13 BCBS Blue Advantage HMO — HMO: $2,741.52 BCBS Blue Essentials HMO — HMO: $3,052.83 BCBS Medicare Advantage — HMO: $1,281.13 BCBS Traditional/PPO — PPO: $3,876.29 Cash Pay — Self Pay: $2,388.47 Cigna Commercial — PPO: $3,355.81 Humana Medicare Advantage — HMO: $1,281.13 United Healthcare Commercial — PPO: $3,582.71
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) In the file: COLONOSCOPY W/LESION REMOVAL	$3,980.79	$2,388.47	$2,388.47 – $3,582.71
Colonoscopy with removal of polyps (snare): rates for 6 insurance plans Aetna Commercial — PPO: $3,582.71 BCBS Blue Advantage HMO — HMO: $2,468.09 BCBS Blue Essentials HMO — HMO: $2,786.55 Cash Pay — Self Pay: $2,388.47 Cigna Commercial — PPO: $3,582.71 United Healthcare Commercial — PPO: $3,582.71
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: COLON CA SCN; NOT HI RSK IND	$3,136.44	$1,881.86	$995.63 – $2,948.58
Screening colonoscopy (not high risk): 10 of 11 insurance plan rates Aetna Commercial — PPO: $2,540.52 Aetna Medicare Advantage — HMO: $995.63 BCBS Blue Advantage HMO — HMO: $2,085.39 BCBS Blue Essentials HMO — HMO: $2,322.20 BCBS Medicare Advantage — HMO: $995.63 BCBS Traditional/PPO — PPO: $2,948.58 Cash Pay — Self Pay: $1,881.86 Cigna Commercial — PPO: $2,644.02 Humana Medicare Advantage — HMO: $995.63 United Healthcare Commercial — PPO: $2,822.80
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) In the file: COLON CA SCN; NOT HI RSK IND	$3,136.44	$1,881.86	$1,881.86 – $2,822.80
Screening colonoscopy (not high risk): rates for 6 insurance plans Aetna Commercial — PPO: $2,822.80 BCBS Blue Advantage HMO — HMO: $1,944.59 BCBS Blue Essentials HMO — HMO: $2,195.51 Cash Pay — Self Pay: $1,881.86 Cigna Commercial — PPO: $2,822.80 United Healthcare Commercial — PPO: $2,822.80
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: LAPAROSCOIC CHOLECYSTECTOMY	$18,395.64	$11,037.38	$6,472.39 – $18,658.12
Gallbladder removal by laparoscope: 10 of 11 insurance plan rates Aetna Commercial — PPO: $14,900.47 Aetna Medicare Advantage — HMO: $6,472.39 BCBS Blue Advantage HMO — HMO: $13,196.03 BCBS Blue Essentials HMO — HMO: $14,694.48 BCBS Medicare Advantage — HMO: $6,472.39 BCBS Traditional/PPO — PPO: $18,658.12 Cash Pay — Self Pay: $11,037.38 Cigna Commercial — PPO: $15,507.52 Humana Medicare Advantage — HMO: $6,472.39 United Healthcare Commercial — PPO: $16,556.08
Gallbladder removal by laparoscope CPT 47562 · Inpatient (hospital stay) In the file: LAPAROSCOIC CHOLECYSTECTOMY	$18,395.64	$11,037.38	$11,037.38 – $16,556.08
Gallbladder removal by laparoscope: rates for 6 insurance plans Aetna Commercial — PPO: $16,556.08 BCBS Blue Advantage HMO — HMO: $11,405.30 BCBS Blue Essentials HMO — HMO: $12,876.95 Cash Pay — Self Pay: $11,037.38 Cigna Commercial — PPO: $16,556.08 United Healthcare Commercial — PPO: $16,556.08
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: PRP I/HERN INIT REDUC >5 YR	$11,398.41	$6,839.05	$3,833.20 – $12,002.05
Groin (inguinal) hernia repair, age 5 or older: 10 of 11 insurance plan rates Aetna Commercial — PPO: $9,232.71 Aetna Medicare Advantage — HMO: $3,833.20 BCBS Blue Advantage HMO — HMO: $8,488.50 BCBS Blue Essentials HMO — HMO: $9,452.39 BCBS Medicare Advantage — HMO: $3,833.20 BCBS Traditional/PPO — PPO: $12,002.05 Cash Pay — Self Pay: $6,839.05 Cigna Commercial — PPO: $9,608.86 Humana Medicare Advantage — HMO: $3,833.20 United Healthcare Commercial — PPO: $10,258.57
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient (hospital stay) In the file: PRP I/HERN INIT REDUC >5 YR	$11,398.41	$6,839.05	$6,839.05 – $10,258.57
Groin (inguinal) hernia repair, age 5 or older: rates for 6 insurance plans Aetna Commercial — PPO: $10,258.57 BCBS Blue Advantage HMO — HMO: $7,067.01 BCBS Blue Essentials HMO — HMO: $7,978.89 Cash Pay — Self Pay: $6,839.05 Cigna Commercial — PPO: $10,258.57 United Healthcare Commercial — PPO: $10,258.57
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: NJX INTERLAMINAR LMBR/SAC	$2,261.01	$1,356.61	$755.72 – $2,412.69
Spinal injection, lower back (epidural), with imaging guidance: 10 of 11 insurance plan rates Aetna Commercial — PPO: $1,831.42 Aetna Medicare Advantage — HMO: $755.72 BCBS Blue Advantage HMO — HMO: $1,706.39 BCBS Blue Essentials HMO — HMO: $1,900.15 BCBS Medicare Advantage — HMO: $755.72 BCBS Traditional/PPO — PPO: $2,412.69 Cash Pay — Self Pay: $1,356.61 Cigna Commercial — PPO: $1,906.03 Humana Medicare Advantage — HMO: $755.72 United Healthcare Commercial — PPO: $2,034.91
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) In the file: NJX INTERLAMINAR LMBR/SAC	$2,261.01	$1,356.61	$1,356.61 – $2,034.91
Spinal injection, lower back (epidural), with imaging guidance: rates for 6 insurance plans Aetna Commercial — PPO: $2,034.91 BCBS Blue Advantage HMO — HMO: $1,401.83 BCBS Blue Essentials HMO — HMO: $1,582.71 Cash Pay — Self Pay: $1,356.61 Cigna Commercial — PPO: $2,034.91 United Healthcare Commercial — PPO: $2,034.91
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: NJX AA&/STRD TFRM EPI L/S 1	$2,923.62	$1,754.17	$946.93 – $3,134.51
Nerve root injection, lower back, with imaging guidance: 10 of 11 insurance plan rates Aetna Commercial — PPO: $2,368.13 Aetna Medicare Advantage — HMO: $946.93 BCBS Blue Advantage HMO — HMO: $2,216.90 BCBS Blue Essentials HMO — HMO: $2,468.63 BCBS Medicare Advantage — HMO: $946.93 BCBS Traditional/PPO — PPO: $3,134.51 Cash Pay — Self Pay: $1,754.17 Cigna Commercial — PPO: $2,464.61 Humana Medicare Advantage — HMO: $946.93 United Healthcare Commercial — PPO: $2,631.26
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) In the file: NJX AA&/STRD TFRM EPI L/S 1	$2,923.62	$1,754.17	$1,754.17 – $2,631.26
Nerve root injection, lower back, with imaging guidance: rates for 6 insurance plans Aetna Commercial — PPO: $2,631.26 BCBS Blue Advantage HMO — HMO: $1,812.64 BCBS Blue Essentials HMO — HMO: $2,046.53 Cash Pay — Self Pay: $1,754.17 Cigna Commercial — PPO: $2,631.26 United Healthcare Commercial — PPO: $2,631.26
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: CARPAL TUNNEL SURGERY	$7,148.48	$4,289.09	$2,090.61 – $6,636.69
Carpal tunnel release: 10 of 11 insurance plan rates Aetna Commercial — PPO: $5,790.27 Aetna Medicare Advantage — HMO: $2,090.61 BCBS Blue Advantage HMO — HMO: $4,693.83 BCBS Blue Essentials HMO — HMO: $5,226.82 BCBS Medicare Advantage — HMO: $2,090.61 BCBS Traditional/PPO — PPO: $6,636.69 Cash Pay — Self Pay: $4,289.09 Cigna Commercial — PPO: $6,026.17 Humana Medicare Advantage — HMO: $2,090.61 United Healthcare Commercial — PPO: $6,433.63
Carpal tunnel release CPT 64721 · Inpatient (hospital stay) In the file: CARPAL TUNNEL SURGERY	$7,148.48	$4,289.09	$4,289.09 – $6,433.63
Carpal tunnel release: rates for 6 insurance plans Aetna Commercial — PPO: $6,433.63 BCBS Blue Advantage HMO — HMO: $4,432.06 BCBS Blue Essentials HMO — HMO: $5,003.94 Cash Pay — Self Pay: $4,289.09 Cigna Commercial — PPO: $6,433.63 United Healthcare Commercial — PPO: $6,433.63

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$100 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $19,522.51
Hip or knee replacement (major joint of the leg), without major complications: rates for 7 insurance plans Aetna Medicare Advantage — HMO: $19,522.51 BCBS Blue Advantage HMO — HMO: $100 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCBS Blue Essentials HMO — HMO: $100 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCBS Medicare Advantage — HMO: $19,522.51 BCBS Traditional/PPO — PPO: $100 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Humana Medicare Advantage — HMO: $19,522.51 United Medicare Advantage — HMO: $19,522.51

Source: Wilbarger General Hospital’s standard charges file (wilbargergeneral.slicedhealth.io, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on October 27, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	920 Hillcrest Dr, Vernon, TX 76384
County	Wilbarger County
State	Texas
Phone	(940) 552‑9351
Emergency services	Yes
Ownership	Government - Hospital District or Authority
Medicare overall rating	Not rated by CMS
CMS Certification Number	450584
Name in Medicare records	WILBARGER GENERAL HOSPITAL
Profile level	Medicare data + hospital website
Official website	wghospital.com
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

Wilbarger General Hospital — wghospital.com
Outpatient Specialty Clinics — wghospital.com
Visitor Information — wghospital.com

Wilbarger General Hospital

Summary

Profile from official sources

At a glance