Hospital St. Louis, MO-IL

Jersey Community Hospital

Jersey Community Hospital in Jerseyville, IL publishes cash prices for 247 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Illinois median for 144 of 240 procedures and below it for 91. By typical cash price it ranks #60 of 115 Illinois hospitals and #10 of 17 hospitals in the St. Louis, MO area, cheapest first. Click a procedure to compare it with other hospitals nearby.

400 Maple Summit Rd, Jerseyville, IL 62052 Collected Sep 22, 2026 Source price file (618) 498-6402

Acute care hospital Emergency department CMS star rating 3 of 5 CCN 140059 · CMS hospital register NPI 1184630519

The price file shows no self-pay discount

For 1041 of the 1041 prices listed here, the cash price in Jersey Community Hospital's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing. Other US hospitals whose cash price is their full list price.

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Jersey Community Hospital in Jerseyville, IL:

Jan 28, 2026 Warning notice
May 6, 2026 Corrective action plan requested
May 15, 2026 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI	$734.00	$734.00	$474.90–$623.90	80% above	—
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABI	$734.00	$734.00	$474.90–$623.90	—	—
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Barium Swallow	$1,125.00	$1,125.00	$265.00–$956.25	72% above	—
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Barium Swallow	$1,125.00	$1,125.00	$265.00–$956.25	—	—
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Imaging Whole Body	$1,731.00	$1,731.00	$1,005.00–$1,471.35	9% above	—
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Imaging Whole Body	$1,731.00	$1,731.00	$1,005.00–$1,471.35	—	—
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Left.	$1,308.00	$1,308.00	$354.00–$1,111.80	146% above	—
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Right.	$1,308.00	$1,308.00	$354.00–$1,111.80	146% above	—
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Left.	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Right.	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Pulmonary	$2,609.00	$2,609.00	$437.00–$2,087.20	12% below	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest	$2,609.00	$2,609.00	$437.00–$2,087.20	12% below	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest PE w/ Contrast	$2,609.00	$2,609.00	$437.00–$2,087.20	12% below	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest/Abdomen/Pelvis	$2,726.00	$2,726.00	$437.00–$2,180.80	8% below	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Pulmonary	$2,609.00	$2,609.00	$437.00–$2,087.20	—	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest PE w/ Contrast	$2,609.00	$2,609.00	$437.00–$2,087.20	—	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest	$2,609.00	$2,609.00	$437.00–$2,087.20	—	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest/Abdomen/Pelvis	$2,726.00	$2,726.00	$437.00–$2,180.80	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Stone Protocol	$3,835.00	$3,835.00	$437.00–$3,068.00	3% above	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 74176 CT ABD & PELVIS W/O CONTRAST: AddOn	$3,835.00	$3,835.00	$437.00–$3,068.00	3% above	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen and Pelvis w/o Contrast	$3,835.00	$3,835.00	$437.00–$3,068.00	3% above	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen and Pelvis w/o Contrast	$3,835.00	$3,835.00	$437.00–$3,068.00	—	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 74176 CT ABD & PELVIS W/O CONTRAST: AddOn	$3,835.00	$3,835.00	$437.00–$3,068.00	—	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Stone Protocol	$3,835.00	$3,835.00	$437.00–$3,068.00	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Enterography w/ Contrast	$5,712.00	$5,712.00	$437.00–$4,569.60	27% above	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 74177 CT ABD & PELVIS W/CONTRAST: AddOn	$6,283.00	$6,283.00	$437.00–$5,026.40	40% above	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis w/ Contrast	$6,283.00	$6,283.00	$437.00–$5,026.40	40% above	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Enterography w/ Contrast	$5,712.00	$5,712.00	$437.00–$4,569.60	—	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 74177 CT ABD & PELVIS W/CONTRAST: AddOn	$6,283.00	$6,283.00	$437.00–$5,026.40	—	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis w/ Contrast	$6,283.00	$6,283.00	$437.00–$5,026.40	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Urogram	$6,481.00	$6,481.00	$437.00–$5,184.80	25% above	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 74178 CT ABD & PELVIS W & W/O CONTRAST: AddOn	$6,481.00	$6,481.00	$437.00–$5,184.80	25% above	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$6,481.00	$6,481.00	$437.00–$5,184.80	25% above	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$6,481.00	$6,481.00	$437.00–$5,184.80	—	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 74178 CT ABD & PELVIS W & W/O CONTRAST: AddOn	$6,481.00	$6,481.00	$437.00–$5,184.80	—	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Urogram	$6,481.00	$6,481.00	$437.00–$5,184.80	—	—
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast	$2,533.00	$2,533.00	$437.00–$2,026.40	4% above	—
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast	$2,533.00	$2,533.00	$437.00–$2,026.40	—	—
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast	$1,678.00	$1,678.00	$437.00–$1,342.40	15% below	—
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast	$1,678.00	$1,678.00	$437.00–$1,342.40	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast	$1,844.00	$1,844.00	$437.00–$1,475.20	7% above	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus w/o Contrast	$1,844.00	$1,844.00	$437.00–$1,475.20	7% above	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Contrast	$1,844.00	$1,844.00	$437.00–$1,475.20	—	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus w/o Contrast	$1,844.00	$1,844.00	$437.00–$1,475.20	—	—
CT scan of the head or brain, no contrast dye CPT 70450 CT Brain/Head w/o Contrast	$1,678.00	$1,678.00	$437.00–$1,342.40	12% below	—
CT scan of the head or brain, no contrast dye CPT 70450 CT Brain/Head Stroke Protocol	$1,678.00	$1,678.00	$437.00–$1,342.40	12% below	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain/Head Stroke Protocol	$1,678.00	$1,678.00	$437.00–$1,342.40	—	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain/Head w/o Contrast	$1,678.00	$1,678.00	$437.00–$1,342.40	—	—
CT scan of the head with contrast CPT 70460 CT Brain/Head w/ Contrast	$2,454.00	$2,454.00	$437.00–$1,963.20	18% above	—
CT scan of the head with contrast inpatient CPT 70460 CT Brain/Head w/ Contrast	$2,454.00	$2,454.00	$437.00–$1,963.20	—	—
CT scan of the head without and with contrast CPT 70470 CT Brain/Head w/ + w/o Contrast	$2,726.00	$2,726.00	$437.00–$2,180.80	9% above	—
CT scan of the head without and with contrast inpatient CPT 70470 CT Brain/Head w/ + w/o Contrast	$2,726.00	$2,726.00	$437.00–$2,180.80	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast	$1,762.00	$1,762.00	$437.00–$1,409.60	22% below	—
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Contrast	$1,762.00	$1,762.00	$437.00–$1,409.60	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast	$1,762.00	$1,762.00	$437.00–$1,409.60	25% below	—
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Contrast	$1,762.00	$1,762.00	$437.00–$1,409.60	—	—
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast	$2,726.00	$2,726.00	$437.00–$2,180.80	24% above	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast	$2,726.00	$2,726.00	$437.00–$2,180.80	—	—
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral	$1,235.00	$1,235.00	$591.00–$1,049.75	—	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral	$1,235.00	$1,235.00	$591.00–$1,049.75	—	—
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views w/ Apical Lordotic	$449.00	$449.00	$265.00–$381.65	46% above	—
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views w/ Obliques	$449.00	$449.00	$265.00–$381.65	46% above	—
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$493.00	$493.00	$265.00–$419.05	60% above	—
Chest X-ray, 2 views CPT 71046 XR Chest Decubitus	$493.00	$493.00	$265.00–$419.05	60% above	—
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views w/ Apical Lordotic	$449.00	$449.00	$265.00–$381.65	—	—
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views w/ Obliques	$449.00	$449.00	$265.00–$381.65	—	—
Chest X-ray, 2 views inpatient CPT 71046 XR Chest Decubitus	$493.00	$493.00	$265.00–$419.05	—	—
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$493.00	$493.00	$265.00–$419.05	—	—
Chest X-ray, single view CPT 71045 XR Chest 1 View	$449.00	$449.00	$265.00–$381.65	80% above	—
Chest X-ray, single view CPT 71045 71045 XR Chest 1 View AddOn	$449.00	$449.00	$265.00–$381.65	80% above	—
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View	$449.00	$449.00	$265.00–$381.65	—	—
Chest X-ray, single view inpatient CPT 71045 71045 XR Chest 1 View AddOn	$449.00	$449.00	$265.00–$381.65	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Renal Complete w/ Renal Duplex	$1,188.00	$1,188.00	$354.00–$1,009.80	42% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$1,188.00	$1,188.00	$354.00–$1,009.80	42% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Renal Complete w/ Renal Duplex	$1,188.00	$1,188.00	$354.00–$1,009.80	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$1,188.00	$1,188.00	$354.00–$1,009.80	—	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton	$694.00	$694.00	$265.00–$589.90	40% above	—
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton	$694.00	$694.00	$265.00–$589.90	—	—
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB Anatomy Scan	$1,016.00	$1,016.00	$354.00–$863.60	5% above	—
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB Anatomy Scan	$1,016.00	$1,016.00	$354.00–$863.60	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Contrast	$1,678.00	$1,678.00	$437.00–$1,342.40	11% below	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Lung Cancer Screening Follow Up	$1,678.00	$1,678.00	$437.00–$1,342.40	11% below	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest/Abdomen/Pelvis w/o Cont	$1,678.00	$1,678.00	$437.00–$1,342.40	11% below	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Lung Cancer Screening Follow Up	$1,678.00	$1,678.00	$437.00–$1,342.40	—	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest/Abdomen/Pelvis w/o Cont	$1,678.00	$1,678.00	$437.00–$1,342.40	—	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Contrast	$1,678.00	$1,678.00	$437.00–$1,342.40	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Contrast	$2,726.00	$2,726.00	$437.00–$2,180.80	12% above	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest/Abdomen/Pelvis w/ Cont	$2,726.00	$2,726.00	$437.00–$2,180.80	12% above	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ + Abd/Pelvis w/ + w/o Cont	$2,726.00	$2,726.00	$437.00–$2,180.80	12% above	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Contrast	$2,726.00	$2,726.00	$437.00–$2,180.80	—	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ + Abd/Pelvis w/ + w/o Cont	$2,726.00	$2,726.00	$437.00–$2,180.80	—	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest/Abdomen/Pelvis w/ Cont	$2,726.00	$2,726.00	$437.00–$2,180.80	—	—
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral.	$512.00	$512.00	$108.00–$435.20	—	—
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral w/ Tomo	$512.00	$512.00	$108.00–$435.20	—	—
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Addl Projections Bilat.	$512.00	$512.00	$108.00–$435.20	—	—
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral w/ Tomo.	$512.00	$512.00	$108.00–$435.20	—	—
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral.	$512.00	$512.00	$108.00–$435.20	—	—
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral w/ Tomo	$512.00	$512.00	$108.00–$435.20	—	—
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral w/ Tomo.	$512.00	$512.00	$108.00–$435.20	—	—
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Addl Projections Bilat.	$512.00	$512.00	$108.00–$435.20	—	—
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral	$1,235.00	$1,235.00	$591.00–$1,049.75	—	—
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral	$1,235.00	$1,235.00	$591.00–$1,049.75	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Upper Ext Venous Duplex Bilateral	$1,112.00	$1,112.00	$591.00–$945.20	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Lower Ext Venous Duplex Bilateral	$1,235.00	$1,235.00	$64.70–$1,049.75	—	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Upper Ext Venous Duplex Bilateral	$1,112.00	$1,112.00	$591.00–$945.20	—	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Lower Ext Venous Duplex Bilateral	$1,235.00	$1,235.00	$64.70–$1,049.75	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 JERS US ECHO COMPLETE	$3,799.00	$3,799.00	$2,457.95–$3,229.15	77% above	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo Complete	$3,799.00	$3,799.00	$2,457.95–$3,229.15	77% above	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo Complete	$3,799.00	$3,799.00	$2,457.95–$3,229.15	—	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 JERS US ECHO COMPLETE	$3,799.00	$3,799.00	$2,457.95–$3,229.15	—	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary Imaging	$1,377.00	$1,377.00	$890.92–$1,170.45	9% below	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary Imaging	$1,377.00	$1,377.00	$890.92–$1,170.45	—	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 Sleep Staging With Cpap	$4,814.00	$4,814.00	$1,182.00–$4,091.90	at median	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 95811 Sleep Staging With Cpap	$4,814.00	$4,814.00	$1,182.00–$4,091.90	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Soft Tissue Lower Back	$1,308.00	$1,308.00	$354.00–$1,111.80	83% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Soft Tissue Lower Back	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Cancer Screening	$1,197.00	$1,197.00	$437.00–$957.60	112% above	—
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Cancer Screening	$1,197.00	$1,197.00	$437.00–$957.60	—	—
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	34% below	—
MRI of the abdomen without contrast CPT 74181 MRI MRCP	$1,828.00	$1,828.00	$816.00–$1,553.80	34% below	—
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	—	—
MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP	$1,828.00	$1,828.00	$816.00–$1,553.80	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast	$3,040.00	$3,040.00	$816.00–$2,584.00	19% below	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Contrast	$3,040.00	$3,040.00	$816.00–$2,584.00	—	—
MRI of the brain, no contrast dye CPT 70551 70551 MRI BRAIN W/O CONTRAST: AddOn	$1,828.00	$1,828.00	$816.00–$1,553.80	38% below	—
MRI of the brain, no contrast dye CPT 70551 70551 MRI IAC W/O CONTRAST: AddOn	$1,828.00	$1,828.00	$816.00–$1,553.80	38% below	—
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	38% below	—
MRI of the brain, no contrast dye inpatient CPT 70551 70551 MRI BRAIN W/O CONTRAST: AddOn	$1,828.00	$1,828.00	$816.00–$1,553.80	—	—
MRI of the brain, no contrast dye inpatient CPT 70551 70551 MRI IAC W/O CONTRAST: AddOn	$1,828.00	$1,828.00	$816.00–$1,553.80	—	—
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	—	—
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast	$4,207.00	$4,207.00	$816.00–$3,575.95	1% above	—
MRI of the brain, with and without contrast dye CPT 70553 70553 MRI BRAIN W/ + W/O CONTRAST: AddOn	$4,207.00	$4,207.00	$816.00–$3,575.95	1% above	—
MRI of the brain, with and without contrast dye CPT 70553 70553 MRI IAC W/ + W/O CONTRAST: AddOn	$4,207.00	$4,207.00	$816.00–$3,575.95	1% above	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 70553 MRI IAC W/ + W/O CONTRAST: AddOn	$4,207.00	$4,207.00	$816.00–$3,575.95	—	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast	$4,207.00	$4,207.00	$816.00–$3,575.95	—	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 70553 MRI BRAIN W/ + W/O CONTRAST: AddOn	$4,207.00	$4,207.00	$816.00–$3,575.95	—	—
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	40% below	—
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$3,040.00	$3,040.00	$816.00–$2,584.00	27% below	—
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$3,040.00	$3,040.00	$816.00–$2,584.00	—	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	39% below	—
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$3,040.00	$3,040.00	$816.00–$2,584.00	25% below	—
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$3,040.00	$3,040.00	$816.00–$2,584.00	—	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	39% below	—
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	—	—
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast	$3,362.00	$3,362.00	$816.00–$2,857.70	10% below	—
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast	$3,362.00	$3,362.00	$816.00–$2,857.70	—	—
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	33% below	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Contrast	$1,828.00	$1,828.00	$816.00–$1,553.80	—	—
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial SPECT Rest and Stress	$4,758.00	$4,758.00	$1,005.00–$4,044.30	26% above	—
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial SPECT Rest and Stress	$4,758.00	$4,758.00	$1,005.00–$4,044.30	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Limited	$1,308.00	$1,308.00	$354.00–$1,111.80	135% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Soft Tissue Pelvic Wall	$1,308.00	$1,308.00	$354.00–$1,111.80	135% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Limited	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Soft Tissue Pelvic Wall	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Comp w/Transvag	$1,252.00	$1,252.00	$354.00–$1,064.20	53% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Comp w/Transvag w/ Doppler	$1,308.00	$1,308.00	$354.00–$1,111.80	60% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Comp w/Transvag if indicated	$1,308.00	$1,308.00	$354.00–$1,111.80	60% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Comp w/Transvag	$1,252.00	$1,252.00	$354.00–$1,064.20	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Comp w/Transvag if indicated	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Comp w/Transvag w/ Doppler	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Greater Than 14 Weeks	$1,308.00	$1,308.00	$354.00–$1,111.80	76% above	—
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Greater Than 14 Weeks	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB < 14 weeks w/ TVS w/ Doppler	$1,308.00	$1,308.00	$354.00–$1,111.80	92% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB < 14 weeks w/ TVS	$1,308.00	$1,308.00	$354.00–$1,111.80	92% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB < 14 weeks w/ TVS w/ Doppler	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB < 14 weeks w/ TVS	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited	$1,308.00	$1,308.00	$354.00–$1,111.80	159% above	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Screening Bilateral.	$415.00	$415.00	$108.00–$352.75	—	—
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Screening Bilateral w/ Tomo.	$415.00	$415.00	$108.00–$352.75	—	—
Screening mammogram, both breasts CPT 77067 MG Mammo Implant Screening Bil w/ Tomo.	$415.00	$415.00	$108.00–$352.75	53% above	—
Screening mammogram, both breasts CPT 77067 MG Mammo Implant Digital Screening Bil.	$415.00	$415.00	$108.00–$352.75	53% above	—
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Screening Bilateral w/ Tomo.	$415.00	$415.00	$108.00–$352.75	—	—
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Screening Bilateral.	$415.00	$415.00	$108.00–$352.75	—	—
Screening mammogram, both breasts inpatient CPT 77067 MG Mammo Implant Digital Screening Bil.	$415.00	$415.00	$108.00–$352.75	—	—
Screening mammogram, both breasts inpatient CPT 77067 MG Mammo Implant Screening Bil w/ Tomo.	$415.00	$415.00	$108.00–$352.75	—	—
Sleep study in a lab (polysomnography) CPT 95810 95810 Sleep Staging	$4,814.00	$4,814.00	$1,182.00–$4,091.90	20% above	—
Sleep study in a lab (polysomnography) inpatient CPT 95810 95810 Sleep Staging	$4,814.00	$4,814.00	$1,182.00–$4,091.90	—	—
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US Stress Echo w/ Treadmill	$3,799.00	$3,799.00	$2,457.95–$3,229.15	143% above	—
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US Stress Echo w/ Pharm	$3,799.00	$3,799.00	$2,457.95–$3,229.15	143% above	—
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 US Stress Echo w/ Treadmill	$3,799.00	$3,799.00	$2,457.95–$3,229.15	—	—
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 US Stress Echo w/ Pharm	$3,799.00	$3,799.00	$2,457.95–$3,229.15	—	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Modified Barium Swallow	$1,023.00	$1,023.00	$265.00–$869.55	55% above	—
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Modified Barium Swallow	$1,023.00	$1,023.00	$265.00–$869.55	—	—
Transvaginal pelvic ultrasound CPT 76830 76830 US TRANSVAGINAL: AddOn	$1,308.00	$1,308.00	$354.00–$1,111.80	97% above	—
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$1,308.00	$1,308.00	$354.00–$1,111.80	97% above	—
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Transvaginal pelvic ultrasound inpatient CPT 76830 76830 US TRANSVAGINAL: AddOn	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal	$1,308.00	$1,308.00	$354.00–$1,111.80	150% above	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$1,308.00	$1,308.00	$354.00–$1,111.80	23% above	—
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents) w/ Doppler if ind	$1,308.00	$1,308.00	$354.00–$1,111.80	73% above	—
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents) w/ Doppler	$1,308.00	$1,308.00	$354.00–$1,111.80	73% above	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents) w/ Doppler if ind	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents) w/ Doppler	$1,308.00	$1,308.00	$354.00–$1,111.80	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head/Neck Soft Tissue	$1,252.00	$1,252.00	$354.00–$1,064.20	83% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head/Neck Soft Tissue	$1,252.00	$1,252.00	$354.00–$1,064.20	—	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI	$1,125.00	$1,125.00	$265.00–$956.25	43% above	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI	$1,125.00	$1,125.00	$265.00–$956.25	—	—
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View	$493.00	$493.00	$265.00–$419.05	85% above	—
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View	$493.00	$493.00	$265.00–$419.05	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$694.00	$694.00	$265.00–$589.90	53% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$694.00	$694.00	$265.00–$589.90	—	—
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral 4+ Views	$694.00	$694.00	$265.00–$589.90	20% above	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral 4+ Views	$694.00	$694.00	$265.00–$589.90	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views	$694.00	$694.00	$265.00–$589.90	83% above	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views	$694.00	$694.00	$265.00–$589.90	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones 3+ Views	$493.00	$493.00	$265.00–$419.05	63% above	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones 3+ Views	$493.00	$493.00	$265.00–$419.05	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views	$493.00	$493.00	$265.00–$419.05	34% above	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 Views	$493.00	$493.00	$265.00–$419.05	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$629.00	$629.00	$265.00–$534.65	80% above	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$629.00	$629.00	$265.00–$534.65	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx 2+ Views	$449.00	$449.00	$265.00–$381.65	24% above	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx 2+ Views	$449.00	$449.00	$265.00–$381.65	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine aminotransferase	$69.00	$69.00	$36.09–$58.65	31% above	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine aminotransferase	$69.00	$69.00	$36.09–$58.65	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate aminotransferase	$68.00	$68.00	$35.56–$57.80	30% above	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate aminotransferase	$68.00	$68.00	$35.56–$57.80	—	—
Allergy blood test, specific IgE, per allergen CPT 86003 Stemphylium Botryosum (M10) IgE QST	$55.00	$55.00	$28.77–$46.75	112% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Mucor racemosus (M4) IgE QST	$55.00	$55.00	$28.77–$46.75	112% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 White Mulberry (T70) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria alternata (M6) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus fumigatus (M3) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass (G2) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Brome Grass (G11) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Dander (E1) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium herbarum (M2) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach (I6) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Common Ragweed (Short) (W1) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood (T14) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 D. Pteronyssinus (D1) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides Farinae (D2) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander (E5) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Elm (T8) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Hickory/Pecan Tree (T22) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Johnson Grass (G10) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 June Grass(Kentucky Blue) (G8) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Maple (Box Elder) (T1) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Meadow Fescue (G4) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Mountain Cedar (T6) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Mouse Urine Proteins (E72) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Oak (T7) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Orchard Grass (Cocksfoot) (G3) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium Notatum (M1) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Marsh Elder (W16) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Pigweed (W14) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Russian Thistle (W11) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Sycamore (T11) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass (G6) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Tree (T10) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 White Ash (T15) IgE QST	$60.00	$60.00	$31.38–$51.00	131% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat (F4) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean (F14) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Almond (F20) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Codfish (F3) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut (F13) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp (F24) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Brazil Nut (F18) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Tuna (F40) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cow's Milk (F2) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut (F256) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Hazelnut (F17) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cashew Nut (F202) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Sesame Seed (F10) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Salmon (F41) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Macadamia Nut (Rf345)$ige **	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White (F1) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 Scallop (F338) IgE QST	$64.00	$64.00	$33.47–$54.40	146% above	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Stemphylium Botryosum (M10) IgE QST	$55.00	$55.00	$28.77–$46.75	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mucor racemosus (M4) IgE QST	$55.00	$55.00	$28.77–$46.75	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium herbarum (M2) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Marsh Elder (W16) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach (I6) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Ash (T15) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Common Ragweed (Short) (W1) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Pigweed (W14) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cottonwood (T14) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut Tree (T10) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 D. Pteronyssinus (D1) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Russian Thistle (W11) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog Dander (E5) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Elm (T8) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophagoides Farinae (D2) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hickory/Pecan Tree (T22) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Johnson Grass (G10) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 June Grass(Kentucky Blue) (G8) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus fumigatus (M3) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Maple (Box Elder) (T1) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Meadow Fescue (G4) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mountain Cedar (T6) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sycamore (T11) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mouse Urine Proteins (E72) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria alternata (M6) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Mulberry (T70) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oak (T7) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Timothy Grass (G6) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Orchard Grass (Cocksfoot) (G3) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bermuda Grass (G2) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Brome Grass (G11) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillium Notatum (M1) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat Dander (E1) IgE QST	$60.00	$60.00	$31.38–$51.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Macadamia Nut (Rf345)$ige **	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wheat (F4) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut (F256) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tuna (F40) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Soybean (F14) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Shrimp (F24) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sesame Seed (F10) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Scallop (F338) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Salmon (F41) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peanut (F13) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hazelnut (F17) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg White (F1) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cow's Milk (F2) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Codfish (F3) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cashew Nut (F202) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Brazil Nut (F18) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Almond (F20) IgE QST	$64.00	$64.00	$33.47–$54.40	—	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Screen, IFA QST	$155.00	$155.00	$81.07–$131.75	72% above	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Screen, IFA QST	$155.00	$155.00	$81.07–$131.75	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-Type Natriuretic Peptide	$455.00	$455.00	$237.97–$386.75	141% above	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-Type Natriuretic Peptide	$455.00	$455.00	$237.97–$386.75	—	—
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$111.00	$111.00	$58.05–$94.35	13% below	—
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$111.00	$111.00	$58.05–$94.35	—	—
Blood culture for bacteria CPT 87040 Body Fluid Culture	$100.00	$100.00	$52.30–$85.00	35% below	—
Blood culture for bacteria CPT 87040 Blood Culture x2	$115.00	$115.00	$60.15–$97.75	25% below	—
Blood culture for bacteria CPT 87040 Blood Culture	$120.00	$120.00	$62.76–$102.00	22% below	—
Blood culture for bacteria inpatient CPT 87040 Body Fluid Culture	$100.00	$100.00	$52.30–$85.00	—	—
Blood culture for bacteria inpatient CPT 87040 Blood Culture x2	$115.00	$115.00	$60.15–$97.75	—	—
Blood culture for bacteria inpatient CPT 87040 Blood Culture	$120.00	$120.00	$62.76–$102.00	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$41.00	$41.00	$21.44–$34.85	74% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only DUI Venipuncture	$41.00	$41.00	$21.44–$34.85	74% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only Venipuncture	$41.00	$41.00	$21.44–$34.85	74% above	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only Venipuncture	$41.00	$41.00	$21.44–$34.85	—	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only DUI Venipuncture	$41.00	$41.00	$21.44–$34.85	—	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$41.00	$41.00	$21.44–$34.85	—	—
Blood glucose (sugar) test CPT 82947 Glucose 2 Hour Post Prandial	$50.00	$50.00	$26.15–$42.50	10% above	—
Blood glucose (sugar) test CPT 82947 Glucose Level	$50.00	$50.00	$26.15–$42.50	10% above	—
Blood glucose (sugar) test CPT 82947 .Glucose Fasting	$165.00	$165.00	$86.30–$140.25	263% above	—
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$50.00	$50.00	$26.15–$42.50	—	—
Blood glucose (sugar) test inpatient CPT 82947 Glucose 2 Hour Post Prandial	$50.00	$50.00	$26.15–$42.50	—	—
Blood glucose (sugar) test inpatient CPT 82947 .Glucose Fasting	$165.00	$165.00	$86.30–$140.25	—	—
Blood lead test CPT 83655 Lead, Blood QST	$155.00	$155.00	$81.07–$131.75	177% above	—
Blood lead test inpatient CPT 83655 Lead, Blood QST	$155.00	$155.00	$81.07–$131.75	—	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Beta hCG Qualitative	$97.00	$97.00	$50.73–$82.45	7% above	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Beta hCG Qualitative	$97.00	$97.00	$50.73–$82.45	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh	$208.00	$208.00	$108.78–$176.80	147% above	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh	$208.00	$208.00	$108.78–$176.80	—	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Coronavirus (COVID-19) PCR (GeneXpert)	$168.00	$168.00	$87.86–$142.80	45% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Coronavirus (COVID-19) PCR (GeneXpert)	$168.00	$168.00	$87.86–$142.80	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis (GeneXpert)	$115.00	$115.00	$60.15–$97.75	7% below	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis RNA, TMA QST	$189.00	$189.00	$98.85–$160.65	53% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trachomatis (GeneXpert)	$115.00	$115.00	$60.15–$97.75	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis RNA, TMA QST	$189.00	$189.00	$98.85–$160.65	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$171.00	$171.00	$89.43–$145.35	33% above	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$171.00	$171.00	$89.43–$145.35	—	—
Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential	$99.00	$99.00	$51.78–$84.15	26% above	—
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Differential	$99.00	$99.00	$51.78–$84.15	—	—
Complete blood count (CBC), no differential CPT 85027 CBC without Differential	$75.00	$75.00	$39.23–$63.75	15% above	—
Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential	$75.00	$75.00	$39.23–$63.75	—	—
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$162.00	$162.00	$84.73–$137.70	2% above	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$162.00	$162.00	$84.73–$137.70	—	—
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$119.00	$119.00	$62.24–$101.15	2% below	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$119.00	$119.00	$62.24–$101.15	—	—
Estradiol blood test CPT 82670 Estradiol: QST	$435.00	$435.00	$227.51–$369.75	310% above	—
Estradiol blood test inpatient CPT 82670 Estradiol: QST	$435.00	$435.00	$227.51–$369.75	—	—
FSH (follicle-stimulating hormone) test CPT 83001 FSH QST	$236.00	$236.00	$123.43–$200.60	99% above	—
FSH (follicle-stimulating hormone) test CPT 83001 FSH, Pediatrics QST	$237.00	$237.00	$123.95–$201.45	100% above	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH QST	$236.00	$236.00	$123.43–$200.60	—	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH, Pediatrics QST	$237.00	$237.00	$123.95–$201.45	—	—
Ferritin blood test (iron stores) CPT 82728 Ferritin	$175.00	$175.00	$91.53–$148.75	32% above	—
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$175.00	$175.00	$91.53–$148.75	—	—
Folate (folic acid) blood test CPT 82746 Folate Level	$158.00	$158.00	$82.63–$134.30	41% above	—
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$158.00	$158.00	$82.63–$134.30	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Level	$117.00	$117.00	$61.19–$99.45	1% above	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 Level	$117.00	$117.00	$61.19–$99.45	—	—
Free testosterone test CPT 84402 84402 .ASSOC CHR TESTOSTERONE FREE	$324.00	$324.00	$169.45–$275.40	164% above	—
Free testosterone test inpatient CPT 84402 84402 .ASSOC CHR TESTOSTERONE FREE	$324.00	$324.00	$169.45–$275.40	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gestational Diabetes Screen (Glucose)	$63.00	$63.00	$32.95–$53.55	11% above	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Gestational Diabetes Screen (Glucose)	$63.00	$63.00	$32.95–$53.55	—	—
Glucose tolerance test, 3 samples CPT 82951 .Glucose Fasting OB	$165.00	$165.00	$86.30–$140.25	22% above	—
Glucose tolerance test, 3 samples CPT 82951 .Glucose Fasting	$165.00	$165.00	$86.30–$140.25	22% above	—
Glucose tolerance test, 3 samples inpatient CPT 82951 .Glucose Fasting OB	$165.00	$165.00	$86.30–$140.25	—	—
Glucose tolerance test, 3 samples inpatient CPT 82951 .Glucose Fasting	$165.00	$165.00	$86.30–$140.25	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae (GeneXpert)	$55.00	$55.00	$28.77–$46.75	55% below	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae RNA, TMA QST	$189.00	$189.00	$98.85–$160.65	53% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae (GeneXpert)	$55.00	$55.00	$28.77–$46.75	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae RNA, TMA QST	$189.00	$189.00	$98.85–$160.65	—	—
H. pylori antibody blood test CPT 86677 Urease Test for H. pylori	$215.00	$215.00	$112.45–$182.75	88% above	—
H. pylori antibody blood test CPT 86677 Urease (POCT)	$215.00	$215.00	$112.45–$182.75	88% above	—
H. pylori antibody blood test inpatient CPT 86677 Urease Test for H. pylori	$215.00	$215.00	$112.45–$182.75	—	—
H. pylori antibody blood test inpatient CPT 86677 Urease (POCT)	$215.00	$215.00	$112.45–$182.75	—	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV MRNA E6/E7 QST	$446.00	$446.00	$233.26–$379.10	205% above	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV MRNA E6/E7 QST	$446.00	$446.00	$233.26–$379.10	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C QST	$115.00	$115.00	$60.15–$97.75	29% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$124.00	$124.00	$64.85–$105.40	39% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C QST	$115.00	$115.00	$60.15–$97.75	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c	$124.00	$124.00	$64.85–$105.40	—	—
Hepatitis C viral load (HCV RNA) test one side CPT 87522 .HCV RNA, Quant. RT-PCR QST	$473.00	$473.00	$247.38–$402.05	78% above	—
Hepatitis C viral load (HCV RNA) test one side CPT 87522 HCV RNA, Qnt RT PCR QST	$494.00	$494.00	$258.36–$419.90	86% above	—
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 .HCV RNA, Quant. RT-PCR QST	$473.00	$473.00	$247.38–$402.05	—	—
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 HCV RNA, Qnt RT PCR QST	$494.00	$494.00	$258.36–$419.90	—	—
Herpes blood test, HSV-1 antibody CPT 86695 HSV Type 1 QST	$154.00	$154.00	$80.54–$130.90	137% above	—
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IgG, Type Specific Ab QST	$154.00	$154.00	$80.54–$130.90	137% above	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV Type 1 QST	$154.00	$154.00	$80.54–$130.90	—	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IgG, Type Specific Ab QST	$154.00	$154.00	$80.54–$130.90	—	—
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IgG, Type Specific Ab QST	$247.00	$247.00	$129.18–$209.95	208% above	—
Herpes blood test, HSV-2 antibody CPT 86696 HSV Type 2 QST	$247.00	$247.00	$129.18–$209.95	208% above	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV Type 2 QST	$247.00	$247.00	$129.18–$209.95	—	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IgG, Type Specific Ab QST	$247.00	$247.00	$129.18–$209.95	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sensitivity	$68.00	$68.00	$35.56–$57.80	26% below	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein High Sensitivity	$68.00	$68.00	$35.56–$57.80	—	—
Homocysteine blood test CPT 83090 Homocysteine QST	$228.00	$228.00	$119.24–$193.80	89% above	—
Homocysteine blood test inpatient CPT 83090 Homocysteine QST	$228.00	$228.00	$119.24–$193.80	—	—
Iron blood test (serum iron) CPT 83540 Iron Level	$72.00	$72.00	$37.66–$61.20	9% below	—
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$72.00	$72.00	$37.66–$61.20	—	—
Iron-binding capacity (TIBC) test CPT 83550 Total Iron Binding Capacity	$102.00	$102.00	$53.35–$86.70	36% above	—
Iron-binding capacity (TIBC) test inpatient CPT 83550 Total Iron Binding Capacity	$102.00	$102.00	$53.35–$86.70	—	—
Kidney function blood test panel CPT 80069 Renal Function Panel	$111.00	$111.00	$58.05–$94.35	25% below	—
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$111.00	$111.00	$58.05–$94.35	—	—
LH (luteinizing hormone) test CPT 83002 LH, Pediatrics QST	$236.00	$236.00	$123.43–$200.60	106% above	—
LH (luteinizing hormone) test CPT 83002 FSH QST	$236.00	$236.00	$123.43–$200.60	106% above	—
LH (luteinizing hormone) test CPT 83002 LH QST	$236.00	$236.00	$123.43–$200.60	106% above	—
LH (luteinizing hormone) test inpatient CPT 83002 LH QST	$236.00	$236.00	$123.43–$200.60	—	—
LH (luteinizing hormone) test inpatient CPT 83002 FSH QST	$236.00	$236.00	$123.43–$200.60	—	—
LH (luteinizing hormone) test inpatient CPT 83002 LH, Pediatrics QST	$236.00	$236.00	$123.43–$200.60	—	—
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$90.00	$90.00	$47.07–$76.50	4% below	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$90.00	$90.00	$47.07–$76.50	—	—
Liver function blood test panel CPT 80076 Hepatic Function Panel	$116.00	$116.00	$60.67–$98.60	16% below	—
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$116.00	$116.00	$60.67–$98.60	—	—
Lyme disease antibody test CPT 86618 Lyme Antibody Screen QST	$217.00	$217.00	$113.49–$184.45	199% above	—
Lyme disease antibody test inpatient CPT 86618 Lyme Antibody Screen QST	$217.00	$217.00	$113.49–$184.45	—	—
Magnesium blood test CPT 83735 Magnesium Level	$78.00	$78.00	$40.79–$66.30	11% above	—
Magnesium blood test inpatient CPT 83735 Magnesium Level	$78.00	$78.00	$40.79–$66.30	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$68.00	$68.00	$35.56–$57.80	16% below	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$68.00	$68.00	$35.56–$57.80	—	—
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total QST	$205.00	$205.00	$107.22–$174.25	81% above	—
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total Screening	$246.00	$246.00	$128.66–$209.10	117% above	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Total QST	$205.00	$205.00	$107.22–$174.25	—	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total Screening	$246.00	$246.00	$128.66–$209.10	—	—
Pap test (liquid-based, automated screening with review) CPT 88175 PAP Interpretation/Result QST:	$340.00	$340.00	$177.82–$289.00	148% above	—
Pap test (liquid-based, automated screening with review) CPT 88175 Pap ThinPrep TIS Rfx HPV mRNA E6/E7 QST	$340.00	$340.00	$177.82–$289.00	148% above	—
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap ThinPrep TIS Rfx HPV mRNA E6/E7 QST	$340.00	$340.00	$177.82–$289.00	—	—
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP Interpretation/Result QST:	$340.00	$340.00	$177.82–$289.00	—	—
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$71.00	$71.00	$37.13–$60.35	2% above	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$71.00	$71.00	$37.13–$60.35	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR POC (RE)	$42.00	$42.00	$21.97–$35.70	9% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR	$50.00	$50.00	$26.15–$42.50	30% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time	$50.00	$50.00	$26.15–$42.50	30% above	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR POC (RE)	$42.00	$42.00	$21.97–$35.70	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR	$50.00	$50.00	$26.15–$42.50	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time	$50.00	$50.00	$26.15–$42.50	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; ca	$43.00	$43.00	$21.44–$36.55	47% below	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Fentanyl Screen Urine	$69.00	$69.00	$36.09–$58.65	16% below	—
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; ca	$43.00	$43.00	$21.44–$36.55	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Fentanyl Screen Urine	$69.00	$69.00	$36.09–$58.65	—	—
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR Westergren	$55.00	$55.00	$28.77–$46.75	20% above	—
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR Westergren	$55.00	$55.00	$28.77–$46.75	—	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Stool Diagnostic	$49.00	$49.00	$25.63–$41.65	70% above	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Stool Diagnostic	$49.00	$49.00	$25.63–$41.65	—	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Free Dialysis & Totl MS QST	$329.00	$329.00	$172.07–$279.65	163% above	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Free Dialysis & Totl MS QST	$329.00	$329.00	$172.07–$279.65	—	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibodies QST	$186.00	$186.00	$97.28–$158.10	133% above	—
Thyroid peroxidase (TPO) antibody test CPT 86376 ANA Titer QST	$437.00	$437.00	$228.55–$371.45	447% above	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibodies QST	$186.00	$186.00	$97.28–$158.10	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANA Titer QST	$437.00	$437.00	$228.55–$371.45	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$98.00	$98.00	$51.25–$83.30	23% below	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/ Rflx to Free T4	$215.00	$215.00	$112.45–$182.75	69% above	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$98.00	$98.00	$51.25–$83.30	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/ Rflx to Free T4	$215.00	$215.00	$112.45–$182.75	—	—
Uric acid blood test CPT 84550 Uric Acid	$60.00	$60.00	$31.38–$51.00	18% below	—
Uric acid blood test inpatient CPT 84550 Uric Acid	$60.00	$60.00	$31.38–$51.00	—	—
Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Microscopic	$42.00	$42.00	$21.97–$35.70	35% below	—
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Microscopic	$42.00	$42.00	$21.97–$35.70	—	—
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick Clinic POC (RE)	$9.00	$9.00	$4.71–$7.65	64% below	—
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick Clinic POC (RE)	$9.00	$9.00	$4.71–$7.65	—	—
Urine culture for bacteria, with colony count CPT 87086 Urine Culture	$103.00	$103.00	$53.87–$87.55	12% above	—
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture	$103.00	$103.00	$53.87–$87.55	—	—
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test POC (RE)	$28.00	$28.00	$14.12–$23.80	62% below	—
Urine pregnancy test, read by color change CPT 81025 Beta hCG Qualitative Urine	$97.00	$97.00	$50.73–$82.45	31% above	—
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test POC (RE)	$28.00	$28.00	$14.12–$23.80	—	—
Urine pregnancy test, read by color change inpatient CPT 81025 Beta hCG Qualitative Urine	$97.00	$97.00	$50.73–$82.45	—	—
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$169.00	$169.00	$88.39–$143.65	31% above	—
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$169.00	$169.00	$88.39–$143.65	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level	$343.00	$343.00	$179.39–$291.55	88% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level	$343.00	$343.00	$179.39–$291.55	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta hCG Quantitative	$192.00	$192.00	$100.42–$163.20	83% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta hCG Quantitative	$192.00	$192.00	$100.42–$163.20	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Botox injections for chronic migraine both sides CPT 64615 64615 Chemodenervation of muscle(s); muscle(s) innervated nerves, bilateral	$495.00	$495.00	$60.00–$420.75	—	—
Botox injections for chronic migraine inpatient both sides CPT 64615 64615 Chemodenervation of muscle(s); muscle(s) innervated nerves, bilateral	$495.00	$495.00	$60.00–$420.75	—	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Closed treatment of distal fibular fracture, without manipulation 27786	$981.00	$981.00	$60.00–$1,082.40	122% above	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation	$981.00	$981.00	$60.00–$1,082.40	122% above	—
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation	$981.00	$981.00	$60.00–$1,082.40	—	—
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Closed treatment of distal fibular fracture, without manipulation 27786	$981.00	$981.00	$60.00–$1,082.40	—	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed treatment of metatarsal fracture, without manipulation, each 28470	$646.00	$646.00	$60.00–$873.60	at median	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 Closed treatment of metatarsal fracture; without manipulation, each	$646.00	$646.00	$60.00–$873.60	at median	—
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Closed treatment of metatarsal fracture, without manipulation, each 28470	$646.00	$646.00	$60.00–$873.60	—	—
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 28470 Closed treatment of metatarsal fracture; without manipulation, each	$646.00	$646.00	$60.00–$873.60	—	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 CARDIOVERSION CHARGE	$3,846.00	$3,846.00	$2,488.36–$3,269.10	236% above	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 JERS CARDIOVERSION	$3,846.00	$3,846.00	$2,488.36–$3,269.10	236% above	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 - Cardioversion; Elective	$4,581.00	$4,581.00	$329.97–$3,893.85	300% above	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 CARDIOVERSION CHARGE	$3,846.00	$3,846.00	$2,488.36–$3,269.10	—	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 JERS CARDIOVERSION	$3,846.00	$3,846.00	$2,488.36–$3,269.10	—	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 - Cardioversion; Elective	$4,581.00	$4,581.00	$329.97–$3,893.85	—	—
Cervical biopsy CPT 57500 Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration 57500	$482.00	$482.00	$311.85–$409.70	47% below	—
Cervical biopsy CPT 57500 57500 Biopsy of cervix, single or multiple, or local excision of lesion, w/ or w/o fulguration	$482.00	$482.00	$311.85–$409.70	47% below	—
Cervical biopsy inpatient CPT 57500 57500 Biopsy of cervix, single or multiple, or local excision of lesion, w/ or w/o fulguration	$482.00	$482.00	$311.85–$409.70	—	—
Cervical biopsy inpatient CPT 57500 Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration 57500	$482.00	$482.00	$311.85–$409.70	—	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 Circumcision, using clamp or other device with regional dorsal penile or ring block	$440.00	$440.00	$284.68–$374.00	74% below	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 54150 Circumcision, using clamp or other device with regional dorsal penile or ring block	$440.00	$440.00	$284.68–$374.00	—	—
Circumcision, surgical, older than a newborn CPT 54160 54160 Circumcision, surgical excision other than clamp or device; younger than 28 days of age	$440.00	$440.00	$280.80–$1,503.65	62% below	—
Circumcision, surgical, older than a newborn inpatient CPT 54160 54160 Circumcision, surgical excision other than clamp or device; younger than 28 days of age	$440.00	$440.00	$280.80–$1,503.65	—	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Closed treatment of distal radial fracture; without manipulation	$1,027.00	$1,027.00	$664.47–$872.95	96% above	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600-Distal Radial w/o Manipulation	$1,764.00	$1,764.00	$1,106.37–$1,499.40	237% above	—
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600 Closed treatment of distal radial fracture; without manipulation	$1,027.00	$1,027.00	$664.47–$872.95	—	—
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600-Distal Radial w/o Manipulation	$1,764.00	$1,764.00	$1,106.37–$1,499.40	—	—
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 57460 Colposcopy of the cervix incl. upper vagina; with loop electrode biopsy(s) of the cervix	$899.00	$899.00	$581.65–$764.15	71% below	—
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Colposcopy of the cervix including upper/adjacent vagina, with loop electrode biopsy(s) of the cervi	$899.00	$899.00	$581.65–$764.15	71% below	—
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 Colposcopy of the cervix including upper/adjacent vagina, with loop electrode biopsy(s) of the cervi	$899.00	$899.00	$581.65–$764.15	—	—
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 57460 Colposcopy of the cervix incl. upper vagina; with loop electrode biopsy(s) of the cervix	$899.00	$899.00	$581.65–$764.15	—	—
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 57454 Colposcopy of the cervix incl. vagina; w/ biopsy of cervix and endocervical curettage	$490.00	$490.00	$317.03–$416.50	6% above	—
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Colposcopy of the cervix including upper/adjacent vagina, with biopsy(s) of the cervix and endocervi	$490.00	$490.00	$317.03–$416.50	6% above	—
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 57454 Colposcopy of the cervix incl. vagina; w/ biopsy of cervix and endocervical curettage	$490.00	$490.00	$317.03–$416.50	—	—
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 Colposcopy of the cervix including upper/adjacent vagina, with biopsy(s) of the cervix and endocervi	$490.00	$490.00	$317.03–$416.50	—	—
D&C (dilation and curettage), not related to pregnancy CPT 58120 58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)	$875.00	$875.00	$566.13–$743.75	70% below	—
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)	$875.00	$875.00	$566.13–$743.75	—	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction premalignant lesions; first lesion	$239.00	$239.00	$154.63–$203.15	37% above	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction, premalignant lesions, first lesion 17000	$239.00	$239.00	$60.00–$443.20	37% above	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruction, premalignant lesions, first lesion 17000	$239.00	$239.00	$60.00–$443.20	—	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 17000 Destruction premalignant lesions; first lesion	$239.00	$239.00	$154.63–$203.15	—	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209-Cerumen Irrigation/Lavage	$416.00	$416.00	$91.87–$353.60	263% above	—
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 69209-Cerumen Irrigation/Lavage	$416.00	$416.00	$91.87–$353.60	—	—
Earwax removal with instruments, one ear CPT 69210 69210-Cerumen w/ Instrumentation	$416.00	$416.00	$91.87–$353.60	233% above	—
Earwax removal with instruments, one ear inpatient CPT 69210 69210-Cerumen w/ Instrumentation	$416.00	$416.00	$91.87–$353.60	—	—
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Endometrial sampling with or without endocervical sampling, without cervical dilation, any method 58	$348.00	$348.00	$225.16–$295.80	at median	—
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 58100 Endometrial biopsy with or w/o endocer biopsy, w/o cervical dilation, any method	$348.00	$348.00	$225.16–$295.80	at median	—
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 58100 Endometrial biopsy with or w/o endocer biopsy, w/o cervical dilation, any method	$348.00	$348.00	$225.16–$295.80	—	—
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Endometrial sampling with or without endocervical sampling, without cervical dilation, any method 58	$348.00	$348.00	$225.16–$295.80	—	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 IR Injection Cerv/Thor Interlaminar	$2,418.00	$2,418.00	$1,564.45–$2,055.30	40% above	—
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 IR Injection Cerv/Thor Interlaminar	$2,418.00	$2,418.00	$1,564.45–$2,055.30	—	—
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 IR MBB Injection Lumb/Sacr Lv1 Left	$3,044.00	$3,044.00	$1,969.47–$2,587.40	104% above	—
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 IR MBB Injection Lumb/Sacr Lv1 Right	$3,044.00	$3,044.00	$1,969.47–$2,587.40	104% above	—
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 IR Facet Injection Lumb/Sacr Lv1 Right	$3,044.00	$3,044.00	$1,969.47–$2,587.40	104% above	—
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 IR Facet Injection Lumb/Sacr Lv1 Left	$3,044.00	$3,044.00	$1,969.47–$2,587.40	104% above	—
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 IR Facet Injection Lumb/Sacr Lv1 Left	$3,044.00	$3,044.00	$1,969.47–$2,587.40	—	—
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 IR Facet Injection Lumb/Sacr Lv1 Right	$3,044.00	$3,044.00	$1,969.47–$2,587.40	—	—
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 IR MBB Injection Lumb/Sacr Lv1 Right	$3,044.00	$3,044.00	$1,969.47–$2,587.40	—	—
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 IR MBB Injection Lumb/Sacr Lv1 Left	$3,044.00	$3,044.00	$1,969.47–$2,587.40	—	—
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 XR Hysterosalpingography Cath/Injection	$728.00	$728.00	$471.02–$618.80	88% above	—
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 58340 XR HYSTEROSALPINGOGRAPHY CATH/INJECTION: AddOn	$728.00	$728.00	$471.02–$618.80	88% above	—
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 XR Hysterosalpingography Cath/Injection	$728.00	$728.00	$471.02–$618.80	—	—
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 58340 XR HYSTEROSALPINGOGRAPHY CATH/INJECTION: AddOn	$728.00	$728.00	$471.02–$618.80	—	—
IUD insertion (the device itself billed separately) CPT 58300 Insertion of intrauterine device 58300	$305.00	$305.00	$197.34–$259.25	22% below	—
IUD insertion (the device itself billed separately) CPT 58300 AMB Admin Charge (Insertion/Implant) -> 58300 insertion, iud	$305.00	$305.00	$60.00–$244.00	22% below	—
IUD insertion (the device itself billed separately) inpatient CPT 58300 Insertion of intrauterine device 58300	$305.00	$305.00	$197.34–$259.25	—	—
IUD insertion (the device itself billed separately) inpatient CPT 58300 AMB Admin Charge (Insertion/Implant) -> 58300 insertion, iud	$305.00	$305.00	$60.00–$244.00	—	—
Incision and drainage of a simple or single skin abscess CPT 10060 10060 Incision and drainage of abscess; simple or single	$329.00	$329.00	$60.00–$564.80	18% below	—
Incision and drainage of a simple or single skin abscess CPT 10060 Incision and drainage of abscess, simple of single 10060	$329.00	$329.00	$60.00–$564.80	18% below	—
Incision and drainage of a simple or single skin abscess CPT 10060 10060-I&D Abscess/Cyst/Hematoma Simple	$1,391.00	$1,391.00	$286.62–$1,182.35	246% above	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 Incision and drainage of abscess; simple or single	$329.00	$329.00	$60.00–$564.80	—	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision and drainage of abscess, simple of single 10060	$329.00	$329.00	$60.00–$564.80	—	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060-I&D Abscess/Cyst/Hematoma Simple	$1,391.00	$1,391.00	$286.62–$1,182.35	—	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 AMB Admin Charge (Inj Joint) -> 20550 inj tendon sheath/ligam	$229.00	$229.00	$60.00–$183.20	40% below	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 AMB Admin Charge (Joint/IM/IV) -> 20550 inj tendon sheath/ligam	$590.00	$590.00	$60.00–$567.20	55% above	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)	$590.00	$590.00	$76.99–$602.65	55% above	—
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 AMB Admin Charge (Inj Joint) -> 20550 inj tendon sheath/ligam	$229.00	$229.00	$60.00–$183.20	—	—
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)	$590.00	$590.00	$76.99–$602.65	—	—
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 AMB Admin Charge (Joint/IM/IV) -> 20550 inj tendon sheath/ligam	$590.00	$590.00	$60.00–$567.20	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 AMB Admin Charge (Inj Joint) -> 20610 inj joint major	$236.00	$236.00	$60.00–$188.80	48% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 AMB Admin Charge (Joint/IM/IV) -> 20610 inj joint major	$590.00	$590.00	$60.00–$582.40	31% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa without ultrasound guidance	$1,305.00	$1,305.00	$60.00–$1,109.25	190% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 IR Arthrocentesis	$1,305.00	$1,305.00	$844.34–$1,109.25	190% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 IR PM Aspirate or INJ Major Joint	$1,305.00	$1,305.00	$217.39–$1,109.25	190% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610-Major Joint Aspirate/Inject w/o US	$2,066.00	$2,066.00	$217.39–$1,756.10	359% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Left	$1,305.00	$1,305.00	$844.34–$1,109.25	190% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Right	$1,305.00	$1,305.00	$844.34–$1,109.25	190% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 AMB Admin Charge (Inj Joint) -> 20610 inj joint major	$236.00	$236.00	$60.00–$188.80	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 AMB Admin Charge (Joint/IM/IV) -> 20610 inj joint major	$590.00	$590.00	$60.00–$582.40	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 IR Arthrocentesis	$1,305.00	$1,305.00	$844.34–$1,109.25	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 IR PM Aspirate or INJ Major Joint	$1,305.00	$1,305.00	$217.39–$1,109.25	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa without ultrasound guidance	$1,305.00	$1,305.00	$60.00–$1,109.25	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610-Major Joint Aspirate/Inject w/o US	$2,066.00	$2,066.00	$217.39–$1,756.10	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Left	$1,305.00	$1,305.00	$844.34–$1,109.25	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Right	$1,305.00	$1,305.00	$844.34–$1,109.25	—	—
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Insertion, non-biodegradable drug delivery implant	$413.00	$413.00	$267.21–$351.05	31% above	—
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 AMB Admin Charge (Insertion/Implant) -> 11981 insertion, implant	$413.00	$413.00	$60.00–$330.40	31% above	—
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insertion, non-biodegradable drug delivery implant 11981	$413.00	$413.00	$60.00–$362.40	31% above	—
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 AMB Admin Charge (Insertion/Implant) -> 11981 insertion, implant	$413.00	$413.00	$60.00–$330.40	—	—
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insertion, non-biodegradable drug delivery implant 11981	$413.00	$413.00	$60.00–$362.40	—	—
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 11981 Insertion, non-biodegradable drug delivery implant	$413.00	$413.00	$267.21–$351.05	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 AMB Admin Charge (Inj Joint) -> 20605 inj joint interm	$177.00	$177.00	$60.00–$141.60	54% below	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa	$590.00	$590.00	$71.17–$595.00	52% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 AMB Admin Charge (Joint/IM/IV) -> 20605 inj joint interm	$590.00	$590.00	$60.00–$560.00	52% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 IR PM Aspirate or INJ Medium Joint	$956.00	$956.00	$179.87–$812.60	146% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605-Intermediate Aspiration/Inj w/o US	$2,066.00	$2,066.00	$179.87–$1,756.10	433% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 XR Joint/Bursa Intmd Arthr/Asp/Inj Right	$956.00	$956.00	$618.53–$812.60	146% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 XR Joint/Bursa Intmd Arthr/Asp/Inj Left	$1,863.00	$1,863.00	$1,205.36–$1,583.55	380% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 AMB Admin Charge (Inj Joint) -> 20605 inj joint interm	$177.00	$177.00	$60.00–$141.60	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa	$590.00	$590.00	$71.17–$595.00	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 AMB Admin Charge (Joint/IM/IV) -> 20605 inj joint interm	$590.00	$590.00	$60.00–$560.00	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 IR PM Aspirate or INJ Medium Joint	$956.00	$956.00	$179.87–$812.60	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605-Intermediate Aspiration/Inj w/o US	$2,066.00	$2,066.00	$179.87–$1,756.10	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 XR Joint/Bursa Intmd Arthr/Asp/Inj Right	$956.00	$956.00	$618.53–$812.60	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 XR Joint/Bursa Intmd Arthr/Asp/Inj Left	$1,863.00	$1,863.00	$1,205.36–$1,583.55	—	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 AMB Admin Charge (Inj Joint) -> 20600 inj joint small	$162.00	$162.00	$60.00–$129.60	46% below	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 AMB Admin Charge (Joint/IM/IV) -> 20600 inj joint small	$162.00	$162.00	$60.00–$129.60	46% below	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa; without ultrasound guidance	$590.00	$590.00	$69.23–$592.45	97% above	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600-Small Joint Aspirate/Inject w/o US	$2,066.00	$2,066.00	$164.34–$1,756.10	589% above	—
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 XR Joint/Bursa Small Arthr/Asp/Inj Left	$911.00	$911.00	$589.42–$774.35	204% above	—
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 XR Joint/Bursa Small Arthr/Asp/Inj Right	$911.00	$911.00	$589.42–$774.35	204% above	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 AMB Admin Charge (Inj Joint) -> 20600 inj joint small	$162.00	$162.00	$60.00–$129.60	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 AMB Admin Charge (Joint/IM/IV) -> 20600 inj joint small	$162.00	$162.00	$60.00–$129.60	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa; without ultrasound guidance	$590.00	$590.00	$69.23–$592.45	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600-Small Joint Aspirate/Inject w/o US	$2,066.00	$2,066.00	$164.34–$1,756.10	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 XR Joint/Bursa Small Arthr/Asp/Inj Left	$911.00	$911.00	$589.42–$774.35	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 XR Joint/Bursa Small Arthr/Asp/Inj Right	$911.00	$911.00	$589.42–$774.35	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities, 2.5 cm or less 12031	$733.00	$733.00	$60.00–$993.60	24% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; <2.5cm	$733.00	$733.00	$474.25–$623.05	24% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm	$2,797.00	$2,797.00	$401.14–$2,377.45	374% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities, 2.5 cm or less 12031	$733.00	$733.00	$60.00–$993.60	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; <2.5cm	$733.00	$733.00	$474.25–$623.05	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm	$2,797.00	$2,797.00	$401.14–$2,377.45	—	—
Lower-back epidural injection, with imaging guidance CPT 62323 62323 ESI lumbar or sacral with fluoroscopy	$2,066.00	$2,066.00	$189.57–$1,756.10	43% above	—
Lower-back epidural injection, with imaging guidance CPT 62323 IR Injection Lumb/Sac Interlaminar	$2,418.00	$2,418.00	$1,564.45–$2,055.30	67% above	—
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 62323 ESI lumbar or sacral with fluoroscopy	$2,066.00	$2,066.00	$189.57–$1,756.10	—	—
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 IR Injection Lumb/Sac Interlaminar	$2,418.00	$2,418.00	$1,564.45–$2,055.30	—	—
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 IR Injection Lmbr/Scrl Transforam Right	$3,044.00	$3,044.00	$1,969.47–$2,587.40	117% above	—
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 IR Injection Lmbr/Scrl Transforam Left	$3,044.00	$3,044.00	$1,969.47–$2,587.40	117% above	—
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 IR Injection Lmbr/Scrl Transforam Left	$3,044.00	$3,044.00	$1,969.47–$2,587.40	—	—
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 IR Injection Lmbr/Scrl Transforam Right	$3,044.00	$3,044.00	$1,969.47–$2,587.40	—	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc Tr-Ext B9+Marg 0.5 < Cm 11400	$352.00	$352.00	$60.00–$1,323.20	49% below	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Excision, benign lesion including margins; trunk, arms or legs; < 0.5cm	$352.00	$352.00	$227.74–$299.20	49% below	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 11400 Excision, benign lesion including margins; trunk, arms or legs; < 0.5cm	$352.00	$352.00	$227.74–$299.20	—	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Exc Tr-Ext B9+Marg 0.5 < Cm 11400	$352.00	$352.00	$60.00–$1,323.20	—	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; < 0.5cm	$390.00	$390.00	$252.33–$331.50	39% below	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 11440 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; < 0.5cm	$390.00	$390.00	$252.33–$331.50	—	—
Nail removal (partial or complete), one nail CPT 11730 11730 Avulsion of nail plate, partial or complete, simple; single	$282.00	$282.00	$182.45–$239.70	at median	—
Nail removal (partial or complete), one nail CPT 11730 Avulsion of nail plate, partial or complete, simple, single 11730	$282.00	$282.00	$60.00–$444.00	at median	—
Nail removal (partial or complete), one nail CPT 11730 11730-Avulsion Nail Plate Single	$1,391.00	$1,391.00	$275.62–$1,182.35	393% above	—
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 Avulsion of nail plate, partial or complete, simple; single	$282.00	$282.00	$182.45–$239.70	—	—
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion of nail plate, partial or complete, simple, single 11730	$282.00	$282.00	$60.00–$444.00	—	—
Nail removal (partial or complete), one nail inpatient CPT 11730 11730-Avulsion Nail Plate Single	$1,391.00	$1,391.00	$275.62–$1,182.35	—	—
Occipital nerve block (injection for headaches) CPT 64405 64405 Injection, anesthetic agent; greater occiptal nerve	$258.00	$258.00	$60.00–$219.30	48% below	—
Occipital nerve block (injection for headaches) CPT 64405 IR Inject Anesth Greater Occipital Nerve	$1,119.00	$1,119.00	$723.99–$951.15	126% above	—
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 Injection, anesthetic agent; greater occiptal nerve	$258.00	$258.00	$60.00–$219.30	—	—
Occipital nerve block (injection for headaches) inpatient CPT 64405 IR Inject Anesth Greater Occipital Nerve	$1,119.00	$1,119.00	$723.99–$951.15	—	—
Paracentesis with imaging guidance CPT 49083 US Paracentesis	$1,960.00	$1,960.00	$1,268.12–$1,666.00	36% above	—
Paracentesis with imaging guidance CPT 49083 49083-Abdominal Paracentesis w/ Imaging Guide	$6,563.00	$6,563.00	$687.11–$5,578.55	354% above	—
Paracentesis with imaging guidance inpatient CPT 49083 US Paracentesis	$1,960.00	$1,960.00	$1,268.12–$1,666.00	—	—
Paracentesis with imaging guidance inpatient CPT 49083 49083-Abdominal Paracentesis w/ Imaging Guide	$6,563.00	$6,563.00	$687.11–$5,578.55	—	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision of nail and nail matrix, partial or complete, for permanent removal 11750	$641.00	$641.00	$60.00–$876.80	2% above	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Excision of nail and nail matrix, partial or complete, for permanent removal	$641.00	$641.00	$414.73–$544.85	2% above	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750-Excision Nail and Matrix	$1,998.00	$1,998.00	$192.16–$1,698.30	218% above	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750-Excision Nail & Matrix	$2,797.00	$2,797.00	$388.85–$2,377.45	345% above	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision of nail and nail matrix, partial or complete, for permanent removal 11750	$641.00	$641.00	$60.00–$876.80	—	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 Excision of nail and nail matrix, partial or complete, for permanent removal	$641.00	$641.00	$414.73–$544.85	—	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750-Excision Nail and Matrix	$1,998.00	$1,998.00	$192.16–$1,698.30	—	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750-Excision Nail & Matrix	$2,797.00	$2,797.00	$388.85–$2,377.45	—	—
Prostate biopsy CPT 55700 US Biopsy Prostate	$6,144.00	$6,144.00	$354.00–$5,222.40	147% above	—
Prostate biopsy inpatient CPT 55700 US Biopsy Prostate	$6,144.00	$6,144.00	$354.00–$5,222.40	—	—
Removal of a foreign object under the skin, simple CPT 10120 Incision and removal of foreign body, subcutaneous tissues, simple 10120	$407.00	$407.00	$60.00–$884.80	12% below	—
Removal of a foreign object under the skin, simple CPT 10120 10120 Incision and removal of foreign body, subcutaneous tissues; simple	$407.00	$407.00	$60.00–$884.80	12% below	—
Removal of a foreign object under the skin, simple CPT 10120 10120-Subcutaneous Tissue Simple	$2,797.00	$2,797.00	$299.56–$2,377.45	502% above	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 Incision and removal of foreign body, subcutaneous tissues; simple	$407.00	$407.00	$60.00–$884.80	—	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision and removal of foreign body, subcutaneous tissues, simple 10120	$407.00	$407.00	$60.00–$884.80	—	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120-Subcutaneous Tissue Simple	$2,797.00	$2,797.00	$299.56–$2,377.45	—	—
Short arm cast (elbow to hand) CPT 29075 29075 Application, cast; elbow to finger (short arm)	$263.00	$263.00	$60.00–$577.60	14% below	—
Short arm cast (elbow to hand) CPT 29075 Application, cast, elbow to finger 29075	$263.00	$263.00	$60.00–$577.60	14% below	—
Short arm cast (elbow to hand) inpatient CPT 29075 29075 Application, cast; elbow to finger (short arm)	$263.00	$263.00	$60.00–$577.60	—	—
Short arm cast (elbow to hand) inpatient CPT 29075 Application, cast, elbow to finger 29075	$263.00	$263.00	$60.00–$577.60	—	—
Short arm splint (forearm and hand) CPT 29125 29125 Application of short arm splint (forearm to hand); static	$197.00	$197.00	$60.00–$302.40	20% below	—
Short arm splint (forearm and hand) CPT 29125 Application of short arm splint, static 29125	$197.00	$197.00	$60.00–$302.40	20% below	—
Short arm splint (forearm and hand) CPT 29125 29125-Short Arm	$902.00	$902.00	$117.11–$766.70	268% above	—
Short arm splint (forearm and hand) inpatient CPT 29125 29125 Application of short arm splint (forearm to hand); static	$197.00	$197.00	$60.00–$302.40	—	—
Short arm splint (forearm and hand) inpatient CPT 29125 Application of short arm splint, static 29125	$197.00	$197.00	$60.00–$302.40	—	—
Short arm splint (forearm and hand) inpatient CPT 29125 29125-Short Arm	$902.00	$902.00	$117.11–$766.70	—	—
Short leg cast (below the knee) CPT 29405 29405 Application of short leg cast (below knee to toes);	$195.00	$195.00	$60.00–$566.40	41% below	—
Short leg cast (below the knee) CPT 29405 Application of short leg cast 29405	$195.00	$195.00	$60.00–$566.40	41% below	—
Short leg cast (below the knee) inpatient CPT 29405 Application of short leg cast 29405	$195.00	$195.00	$60.00–$566.40	—	—
Short leg cast (below the knee) inpatient CPT 29405 29405 Application of short leg cast (below knee to toes);	$195.00	$195.00	$60.00–$566.40	—	—
Short leg splint (calf to foot) CPT 29515 Application of short leg splint 29515	$212.00	$212.00	$60.00–$373.60	15% below	—
Short leg splint (calf to foot) CPT 29515 29515 Application of short leg splint (calf to foot)	$212.00	$212.00	$60.00–$373.60	15% below	—
Short leg splint (calf to foot) CPT 29515 29515-Short Leg	$1,105.00	$1,105.00	$146.87–$939.25	342% above	—
Short leg splint (calf to foot) inpatient CPT 29515 Application of short leg splint 29515	$212.00	$212.00	$60.00–$373.60	—	—
Short leg splint (calf to foot) inpatient CPT 29515 29515 Application of short leg splint (calf to foot)	$212.00	$212.00	$60.00–$373.60	—	—
Short leg splint (calf to foot) inpatient CPT 29515 29515-Short Leg	$1,105.00	$1,105.00	$146.87–$939.25	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Rep Superfic Wound 2.5Cm Less 12001	$291.00	$291.00	$188.28–$247.35	20% below	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; <2.5cm	$291.00	$291.00	$188.28–$247.35	20% below	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extrem	$472.00	$472.00	$60.00–$936.80	30% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm	$1,391.00	$1,391.00	$156.57–$1,182.35	282% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Rep Superfic Wound 2.5Cm Less 12001	$291.00	$291.00	$188.28–$247.35	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; <2.5cm	$291.00	$291.00	$188.28–$247.35	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extrem	$472.00	$472.00	$60.00–$936.80	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm	$1,391.00	$1,391.00	$156.57–$1,182.35	—	—
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed); single lesion	$372.00	$372.00	$60.00–$751.20	4% below	—
Skin biopsy, punch, one lesion CPT 11104 Punch biopsy of skin (including simple closure, when performed); single lesion 11104	$372.00	$372.00	$60.00–$751.20	4% below	—
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch biopsy of skin (including simple closure, when performed); single lesion 11104	$372.00	$372.00	$60.00–$751.20	—	—
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed); single lesion	$372.00	$372.00	$60.00–$751.20	—	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Excision, malignant lesion including margins, trunk, arms, or legs; < 0.5cm	$568.00	$568.00	$367.50–$482.80	at median	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Excision, malignant lesion including margins, trunk, arms, or legs, excised diameter 0.5 cm or less	$568.00	$568.00	$60.00–$1,412.80	at median	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Excision, malignant lesion including margins, trunk, arms, or legs, excised diameter 0.5 cm or less	$568.00	$568.00	$60.00–$1,412.80	—	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 11600 Excision, malignant lesion including margins, trunk, arms, or legs; < 0.5cm	$568.00	$568.00	$367.50–$482.80	—	—
Skin tag removal, up to 15 tags CPT 11200 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions	$254.00	$254.00	$164.34–$215.90	at median	—
Skin tag removal, up to 15 tags CPT 11200 11200-Removal Skin Tag up to 15	$1,435.00	$1,435.00	$221.92–$1,219.75	467% above	—
Skin tag removal, up to 15 tags inpatient CPT 11200 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions	$254.00	$254.00	$164.34–$215.90	—	—
Skin tag removal, up to 15 tags inpatient CPT 11200 11200-Removal Skin Tag up to 15	$1,435.00	$1,435.00	$221.92–$1,219.75	—	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270-Lumbar Puncture Diagnostic	$4,848.00	$4,848.00	$318.32–$4,120.80	439% above	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270-Lumbar Puncture Diagnostic	$4,848.00	$4,848.00	$318.32–$4,120.80	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 2.6-7.5cm	$345.00	$345.00	$223.22–$293.25	17% below	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Rep Superfic Wound 2.6-7.5Cm 12002	$345.00	$345.00	$60.00–$464.80	17% below	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm	$1,391.00	$1,391.00	$186.34–$1,182.35	236% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Rep Superfic Wound 2.6-7.5Cm 12002	$345.00	$345.00	$60.00–$464.80	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 2.6-7.5cm	$345.00	$345.00	$223.22–$293.25	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm	$1,391.00	$1,391.00	$186.34–$1,182.35	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm	$352.00	$352.00	$227.74–$299.20	12% below	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm	$1,391.00	$1,391.00	$186.98–$1,182.35	246% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm	$352.00	$352.00	$227.74–$299.20	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm	$1,391.00	$1,391.00	$186.98–$1,182.35	—	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette) single lesion 11102	$296.00	$296.00	$60.00–$405.60	1% below	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential biopsy of skin (shave,curette); single lesion	$296.00	$296.00	$60.00–$405.60	1% below	—
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 Tangential biopsy of skin (shave,curette); single lesion	$296.00	$296.00	$60.00–$405.60	—	—
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette) single lesion 11102	$296.00	$296.00	$60.00–$405.60	—	—
Thoracentesis with imaging guidance CPT 32555 US Thoracentesis	$804.00	$804.00	$265.00–$683.40	33% below	—
Thoracentesis with imaging guidance CPT 32555 32555-Thoracentesis w/ Imaging Guidance	$4,328.00	$4,328.00	$364.26–$3,678.80	263% above	—
Thoracentesis with imaging guidance inpatient CPT 32555 US Thoracentesis	$804.00	$804.00	$265.00–$683.40	—	—
Thoracentesis with imaging guidance inpatient CPT 32555 32555-Thoracentesis w/ Imaging Guidance	$4,328.00	$4,328.00	$364.26–$3,678.80	—	—
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)	$590.00	$590.00	$69.88–$593.30	20% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 20552-Inject Trigger Point 1-2 Muscles	$1,476.00	$1,476.00	$163.04–$1,254.60	200% above	—
Trigger point injections, 1 or 2 muscles CPT 20552 IR Injection Trigger Pnt 1 or 2 Muscles	$1,754.00	$1,754.00	$1,134.84–$1,490.90	256% above	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)	$590.00	$590.00	$69.88–$593.30	—	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552-Inject Trigger Point 1-2 Muscles	$1,476.00	$1,476.00	$163.04–$1,254.60	—	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 IR Injection Trigger Pnt 1 or 2 Muscles	$1,754.00	$1,754.00	$1,134.84–$1,490.90	—	—
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 Routine obstetric care including antepartum care, vaginal delivery and postpartum care 59400	$7,627.00	$7,627.00	$800.00–$2,430.96	—	—
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 Vasectomy, unilateral or bilateral, including postoperative semen examination(s)	$809.00	$809.00	$523.42–$687.65	—	—
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 55250 Vasectomy, unilateral or bilateral, including postoperative semen examination(s)	$809.00	$809.00	$523.42–$687.65	—	—
Wart removal, up to 14 warts CPT 17110 17110 Cryotherapy for wart removal	$326.00	$326.00	$210.92–$277.10	40% above	—
Wart removal, up to 14 warts CPT 17110 17110 Destruction of benign lesions; 1-14 lesions	$326.00	$326.00	$210.92–$277.10	40% above	—
Wart removal, up to 14 warts CPT 17110 17110 - Destruction benign; up to 14	$1,391.00	$1,391.00	$210.92–$1,182.35	499% above	—
Wart removal, up to 14 warts inpatient CPT 17110 17110 Cryotherapy for wart removal	$326.00	$326.00	$210.92–$277.10	—	—
Wart removal, up to 14 warts inpatient CPT 17110 17110 Destruction of benign lesions; 1-14 lesions	$326.00	$326.00	$210.92–$277.10	—	—
Wart removal, up to 14 warts inpatient CPT 17110 17110 - Destruction benign; up to 14	$1,391.00	$1,391.00	$210.92–$1,182.35	—	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement, subcutaneous tissue first 20 sq cm or less	$298.00	$298.00	$192.81–$253.30	55% below	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042-SQ Tissue Less Than/Equal to 1st 20 sq cm	$2,797.00	$2,797.00	$195.39–$2,377.45	321% above	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 Debridement, subcutaneous tissue first 20 sq cm or less	$298.00	$298.00	$192.81–$253.30	—	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042-SQ Tissue Less Than/Equal to 1st 20 sq cm	$2,797.00	$2,797.00	$195.39–$2,377.45	—	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse Fresh Frozen Plasma	$969.00	$969.00	$626.94–$823.65	4% above	—
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE Fresh Frozen Plasma	$2,161.00	$2,161.00	$1,398.17–$1,836.85	131% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse Platelet Product (Bridge)	$2,161.00	$2,161.00	$1,398.17–$1,836.85	131% above	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Product Administration	$2,161.00	$2,161.00	$1,398.17–$1,836.85	131% above	—
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE Red Blood Cells Leukoreduced	$2,161.00	$2,161.00	$1,398.17–$1,836.85	131% above	—
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE Cryoprecipitate Product	$2,161.00	$2,161.00	$1,398.17–$1,836.85	131% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD PRODUCT ADMINISTRATION CHARGE	$2,161.00	$2,161.00	$1,398.17–$1,836.85	131% above	—
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE Platelet Product	$2,161.00	$2,161.00	$1,398.17–$1,836.85	131% above	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfuse Fresh Frozen Plasma	$969.00	$969.00	$626.94–$823.65	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfuse Platelet Product (Bridge)	$2,161.00	$2,161.00	$1,398.17–$1,836.85	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Product Administration	$2,161.00	$2,161.00	$1,398.17–$1,836.85	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD PRODUCT ADMINISTRATION CHARGE	$2,161.00	$2,161.00	$1,398.17–$1,836.85	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE Cryoprecipitate Product	$2,161.00	$2,161.00	$1,398.17–$1,836.85	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE Fresh Frozen Plasma	$2,161.00	$2,161.00	$1,398.17–$1,836.85	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE Platelet Product	$2,161.00	$2,161.00	$1,398.17–$1,836.85	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE Red Blood Cells Leukoreduced	$2,161.00	$2,161.00	$1,398.17–$1,836.85	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction	$47.00	$47.00	$30.41–$39.95	75% below	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT CHARGE MDI -> Subsequent	$577.00	$577.00	$373.32–$490.45	208% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT CHARGE Aerosol Therapy -> Initial	$577.00	$577.00	$373.32–$490.45	208% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT CHARGE MDI -> Initial	$577.00	$577.00	$373.32–$490.45	208% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT CHARGE Aerosol Therapy -> Subsequent	$577.00	$577.00	$373.32–$490.45	208% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler Treatment	$577.00	$577.00	$373.32–$490.45	208% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT CHARGE Continuous Humidification -> Initial day	$976.00	$976.00	$631.47–$829.60	421% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction	$47.00	$47.00	$30.41–$39.95	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT CHARGE Aerosol Therapy -> Subsequent	$577.00	$577.00	$373.32–$490.45	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT CHARGE MDI -> Initial	$577.00	$577.00	$373.32–$490.45	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Meter Dose Inhaler Treatment	$577.00	$577.00	$373.32–$490.45	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT CHARGE Aerosol Therapy -> Initial	$577.00	$577.00	$373.32–$490.45	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT CHARGE MDI -> Subsequent	$577.00	$577.00	$373.32–$490.45	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT CHARGE Continuous Humidification -> Initial day	$976.00	$976.00	$631.47–$829.60	—	—
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 92557 Comprehensive audiometry threshold evaluation and speech recognition	$105.00	$105.00	$60.00–$84.00	59% below	—
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 92557 Comprehensive audiometry threshold evaluation and speech recognition	$105.00	$105.00	$60.00–$84.00	—	—
Critical care, first 30 to 74 minutes CPT 99291 Critical Care Ill/Injured Patient Init 30-74 Min 99291	$1,990.00	$1,990.00	$1,287.53–$1,691.50	3% above	—
Critical care, first 30 to 74 minutes CPT 99291 G0383- Level 4	$1,990.00	$1,990.00	$1,287.53–$1,691.50	3% above	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 G0383- Level 4	$1,990.00	$1,990.00	$1,287.53–$1,691.50	—	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care Ill/Injured Patient Init 30-74 Min 99291	$1,990.00	$1,990.00	$1,287.53–$1,691.50	—	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 93000 EKG w/ 12+ leads; Tracing/Interp/Report	$42.00	$42.00	$27.17–$60.00	55% below	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG POC	$133.00	$133.00	$86.05–$113.05	42% above	—
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 93000 EKG w/ 12+ leads; Tracing/Interp/Report	$42.00	$42.00	$27.17–$60.00	—	—
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG POC	$133.00	$133.00	$86.05–$113.05	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 EKG w/ 12 or more leads Tracing Only	$133.00	$133.00	$86.05–$113.05	43% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram 12 Lead	$139.00	$139.00	$89.93–$118.15	40% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 93005 EKG w/ 12 or more leads Tracing Only	$133.00	$133.00	$86.05–$113.05	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram 12 Lead	$139.00	$139.00	$89.93–$118.15	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 - Level 1	$218.00	$218.00	$141.05–$702.00	6% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 - Level 1	$218.00	$218.00	$141.05–$702.00	—	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - Level 2	$440.00	$440.00	$83.00–$702.00	13% above	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 - Level 2	$440.00	$440.00	$83.00–$702.00	—	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - Level 3	$767.00	$767.00	$83.00–$793.00	10% above	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - Level 3	$767.00	$767.00	$83.00–$793.00	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - Level 4	$1,097.00	$1,097.00	$702.00–$1,517.00	3% below	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - Level 4	$1,097.00	$1,097.00	$702.00–$1,517.00	—	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - Level 5	$1,574.00	$1,574.00	$1,018.38–$1,713.00	6% below	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - Level 5	$1,574.00	$1,574.00	$1,018.38–$1,713.00	—	—
Exercise stress test, tracing only, the hospital charge CPT 93017 CV Stress test - Trace Only Charge (POC)	$1,662.00	$1,662.00	$67.29–$1,412.70	74% above	—
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiovascular Stress Test	$1,737.00	$1,737.00	$1,123.84–$1,476.45	82% above	—
Exercise stress test, tracing only, the hospital charge CPT 93017 93017 CV STRESS TEST - TRACE ONLY CHARGE	$1,737.00	$1,737.00	$1,123.84–$1,476.45	82% above	—
Exercise stress test, tracing only, the hospital charge CPT 93017 93017 CV Stress Test - Trace Only: Add on	$1,737.00	$1,737.00	$1,123.84–$1,476.45	82% above	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CV Stress test - Trace Only Charge (POC)	$1,662.00	$1,662.00	$67.29–$1,412.70	—	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 93017 CV STRESS TEST - TRACE ONLY CHARGE	$1,737.00	$1,737.00	$1,123.84–$1,476.45	—	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiovascular Stress Test	$1,737.00	$1,737.00	$1,123.84–$1,476.45	—	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 93017 CV Stress Test - Trace Only: Add on	$1,737.00	$1,737.00	$1,123.84–$1,476.45	—	—
Family therapy without the patient, 50 minutes CPT 90846 90846 Family Psychotherapy w/o patient 50 minutes	$298.00	$298.00	$60.00–$238.40	58% above	—
Family therapy without the patient, 50 minutes inpatient CPT 90846 90846 Family Psychotherapy w/o patient 50 minutes	$298.00	$298.00	$60.00–$238.40	—	—
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 93224 Holter ECG Monitor, up to 48 hr, w/ scan, interp, and report	$200.00	$200.00	$129.40–$274.55	at median	—
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 93224 Holter ECG Monitor, up to 48 hr, w/ scan, interp, and report	$200.00	$200.00	$129.40–$274.55	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360-59 IV Hydration Initial Addl Site w/ Modification	$630.00	$630.00	$181.00–$535.50	81% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV HYDRATION THERAPY - 1ST HR	$630.00	$630.00	$181.00–$535.50	81% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360-IV Hydration Initial 31 min - 1 hr	$630.00	$630.00	$181.00–$535.50	81% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV Infusion, Hydration, Initial, 31 min to 1 hr	$630.00	$630.00	$55.00–$535.50	81% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - Hydration, first hour	$1,475.00	$1,475.00	$181.00–$1,253.75	323% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV HYDRATION THERAPY - 1ST HR	$630.00	$630.00	$181.00–$535.50	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360-IV Hydration Initial 31 min - 1 hr	$630.00	$630.00	$181.00–$535.50	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV Infusion, Hydration, Initial, 31 min to 1 hr	$630.00	$630.00	$55.00–$535.50	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360-59 IV Hydration Initial Addl Site w/ Modification	$630.00	$630.00	$181.00–$535.50	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 - Hydration, first hour	$1,475.00	$1,475.00	$181.00–$1,253.75	—	—
IV infusion of a medicine, first hour CPT 96365 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); ini	$175.00	$175.00	$60.00–$468.00	58% below	—
IV infusion of a medicine, first hour CPT 96365 96365-59 Infusion Initial Addl Site w/ Modification	$574.00	$574.00	$181.00–$487.90	36% above	—
IV infusion of a medicine, first hour CPT 96365 96365- IV tx, first hour	$574.00	$574.00	$181.00–$487.90	36% above	—
IV infusion of a medicine, first hour CPT 96365 96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST <1 HOUR	$574.00	$574.00	$181.00–$487.90	36% above	—
IV infusion of a medicine, first hour CPT 96365 96365-Infusion Drug Initial up to 1 hr Greater Than 15 mins	$574.00	$574.00	$181.00–$487.90	36% above	—
IV infusion of a medicine, first hour inpatient CPT 96365 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); ini	$175.00	$175.00	$60.00–$468.00	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 96365-59 Infusion Initial Addl Site w/ Modification	$574.00	$574.00	$181.00–$487.90	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST <1 HOUR	$574.00	$574.00	$181.00–$487.90	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 96365-Infusion Drug Initial up to 1 hr Greater Than 15 mins	$574.00	$574.00	$181.00–$487.90	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 96365- IV tx, first hour	$574.00	$574.00	$181.00–$487.90	—	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic, prophylactic or diagnostic injection; subcutane	$41.00	$41.00	$26.53–$34.85	62% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 AMB Admin Charge (Inj/IV) -> 96372 therapy inj subq/im	$142.00	$142.00	$26.53–$113.60	30% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 IM INJECTION ANTIBIOTIC	$181.00	$181.00	$117.11–$181.00	66% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372-59 SQ/IM Injection w/ Modification	$209.00	$209.00	$135.22–$181.00	91% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM INJECTION	$209.00	$209.00	$135.22–$181.00	91% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 SQ INJECTION	$209.00	$209.00	$135.22–$181.00	91% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372- Subq/IM Injection	$209.00	$209.00	$135.22–$181.00	91% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372-Injection/SQ/IM	$209.00	$209.00	$135.22–$181.00	91% above	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Therapeutic, prophylactic or diagnostic injection; subcutane	$41.00	$41.00	$26.53–$34.85	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 AMB Admin Charge (Inj/IV) -> 96372 therapy inj subq/im	$142.00	$142.00	$26.53–$113.60	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 IM INJECTION ANTIBIOTIC	$181.00	$181.00	$117.11–$181.00	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM INJECTION	$209.00	$209.00	$135.22–$181.00	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372-Injection/SQ/IM	$209.00	$209.00	$135.22–$181.00	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 SQ INJECTION	$209.00	$209.00	$135.22–$181.00	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372-59 SQ/IM Injection w/ Modification	$209.00	$209.00	$135.22–$181.00	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372- Subq/IM Injection	$209.00	$209.00	$135.22–$181.00	—	—
New patient office visit, about 30 minutes CPT 99203 99243 Office Consultation, Level 3	$202.00	$202.00	$60.00–$161.60	6% below	—
New patient office visit, about 30 minutes inpatient CPT 99203 99243 Office Consultation, Level 3	$202.00	$202.00	$60.00–$161.60	—	—
New patient office visit, about 45 minutes CPT 99204 99244 Office Consultation, Level 4	$296.00	$296.00	$60.00–$236.80	1% above	—
New patient office visit, about 45 minutes inpatient CPT 99204 99244 Office Consultation, Level 4	$296.00	$296.00	$60.00–$236.80	—	—
New patient office visit, about 60 minutes CPT 99205 Office Visit Level 5 New 99205	$285.00	$285.00	$60.00–$638.40	22% below	—
New patient office visit, about 60 minutes CPT 99205 99245 Office Consultation, Level 5	$378.00	$378.00	$60.00–$302.40	4% above	—
New patient office visit, about 60 minutes inpatient CPT 99205 Office Visit Level 5 New 99205	$285.00	$285.00	$60.00–$638.40	—	—
New patient office visit, about 60 minutes inpatient CPT 99205 99245 Office Consultation, Level 5	$378.00	$378.00	$60.00–$302.40	—	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99242 Office Consultation, Level 2	$180.00	$180.00	$60.00–$144.00	15% above	—
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99242 Office Consultation, Level 2	$180.00	$180.00	$60.00–$144.00	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Dietitian Duration of Contact -> 60 Minutes	$68.00	$68.00	$44.00–$57.80	25% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Dietitian Duration of Contact -> 15 Minutes	$68.00	$68.00	$44.00–$57.80	25% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Dietitian Duration of Contact -> 30 Minutes	$68.00	$68.00	$44.00–$57.80	25% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Dietitian Duration of Contact -> 45 Minutes	$68.00	$68.00	$44.00–$57.80	25% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Dietitian Duration of Contact -> 15 Minutes	$68.00	$68.00	$44.00–$57.80	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Dietitian Duration of Contact -> 60 Minutes	$68.00	$68.00	$44.00–$57.80	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Dietitian Duration of Contact -> 45 Minutes	$68.00	$68.00	$44.00–$57.80	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Dietitian Duration of Contact -> 30 Minutes	$68.00	$68.00	$44.00–$57.80	—	—
Preventive checkup, new patient aged 65 or older CPT 99387 99387 Preventive Evaluation, New Pt; 65+ Yrs	$274.00	$274.00	$60.00–$219.20	30% above	—
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 99387 Preventive Evaluation, New Pt; 65+ Yrs	$274.00	$274.00	$60.00–$219.20	—	—
Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 Smoking/Tobacco Cessation Counseling; 3-10 Min	$47.00	$47.00	$27.82–$60.00	38% above	—
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 99406 Smoking/Tobacco Cessation Counseling; 3-10 Min	$47.00	$47.00	$27.82–$60.00	—	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office Visit Established Pt. Level 5	$196.00	$196.00	$60.00–$544.00	29% below	—
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 Office Visit Established Pt. Level 5	$196.00	$196.00	$60.00–$544.00	—	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office Visit Established Pt. Level 3	$99.00	$99.00	$60.00–$361.60	35% below	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Office Visit Established Pt. Level 3	$99.00	$99.00	$60.00–$361.60	—	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office Visit Established Pt. Level 4	$145.00	$145.00	$60.00–$435.20	18% below	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Office Visit Established Pt. Level 4	$145.00	$145.00	$60.00–$435.20	—	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office Visit Established Pt. Level 2	$26.00	$26.00	$16.82–$288.80	78% below	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Office Visit Established Pt. Level 2	$26.00	$26.00	$16.82–$288.80	—	—
Spirometry (breathing test) CPT 94010 94010 Spirometry, w/ graphic record, total/timed vital capacity, expiratory flow rate measurement(s)	$77.00	$77.00	$49.17–$591.00	75% below	—
Spirometry (breathing test) CPT 94010 RT Incentive Spirometry	$470.00	$470.00	$304.09–$591.00	54% above	—
Spirometry (breathing test) CPT 94010 RT CHARGE Incentive Spirometry -> Yes	$491.00	$491.00	$317.68–$591.00	61% above	—
Spirometry (breathing test) inpatient CPT 94010 94010 Spirometry, w/ graphic record, total/timed vital capacity, expiratory flow rate measurement(s)	$77.00	$77.00	$49.17–$591.00	—	—
Spirometry (breathing test) inpatient CPT 94010 RT Incentive Spirometry	$470.00	$470.00	$304.09–$591.00	—	—
Spirometry (breathing test) inpatient CPT 94010 RT CHARGE Incentive Spirometry -> Yes	$491.00	$491.00	$317.68–$591.00	—	—
Spirometry before and after a bronchodilator CPT 94060 94060 Bronchodilation responsiveness, spirometry pre and post interp	$109.00	$109.00	$69.88–$621.35	79% below	—
Spirometry before and after a bronchodilator inpatient CPT 94060 94060 Bronchodilation responsiveness, spirometry pre and post interp	$109.00	$109.00	$69.88–$621.35	—	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy 1	$413.00	$413.00	$267.21–$351.05	99% above	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Therapeutic Phlebotomy 1	$413.00	$413.00	$267.21–$351.05	—	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 AMB influenza vacc Charge -> 90653 influ triv adjuvant vacc im	$121.00	$121.00	$78.29–$102.85	at median	—
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 70461-0025-03 - influenza virus vaccine, inactivated adjuvanted preservative-free trivalent Sus	$237.65	$237.65	$153.76–$202.00	96% above	—
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 70461-0025-03 - influenza virus vaccine, inactivated adjuvanted preservative-free trivalent Sus	$237.65	$237.65	$153.76–$202.00	96% above	—
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 AMB influenza vacc Charge -> 90653 influ triv adjuvant vacc im	$121.00	$121.00	$78.29–$102.85	—	—
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 70461-0025-03 - influenza virus vaccine, inactivated adjuvanted preservative-free trivalent Sus	$237.65	$237.65	$153.76–$202.00	—	—
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 70461-0025-03 - influenza virus vaccine, inactivated adjuvanted preservative-free trivalent Sus	$237.65	$237.65	$153.76–$202.00	—	—
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 58160-0842-52 - tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2.5 units-18.5 mcg/0.5 mL Sus	$133.50	$133.50	$86.37–$113.48	52% below	—
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 58160-0842-11 - tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2.5 units-18.5 mcg/0.5 mL Sus {JERS	$133.50	$133.50	$86.37–$113.48	52% below	—
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 AMB Med Charge (Varicella) -> 90716 varicella virus	$217.00	$217.00	$82.00–$184.45	22% below	—
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 58160-0842-11 - tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2.5 units-18.5 mcg/0.5 mL Sus {JERS	$133.50	$133.50	$86.37–$113.48	—	—
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 58160-0842-52 - tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2.5 units-18.5 mcg/0.5 mL Sus	$133.50	$133.50	$86.37–$113.48	—	—
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 AMB Med Charge (Varicella) -> 90716 varicella virus	$217.00	$217.00	$82.00–$184.45	—	—
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 AMB Med Charge (DTaP-IPV) -> 90696 dtap-ipv inactivated	$153.00	$153.00	$82.00–$130.05	49% above	—
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 AMB Med Charge (DTaP-IPV) -> 90696 dtap-ipv inactivated	$153.00	$153.00	$82.00–$130.05	—	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 AMB Med Charge (DTaP) -> 90700 dtap < 7 yrs im	$63.00	$63.00	$40.76–$82.00	2% below	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 AMB Med Charge (DTaP)	$63.00	$63.00	$40.76–$82.00	2% below	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 AMB Med Charge (DTaP)	$63.00	$63.00	$40.76–$82.00	—	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 AMB Med Charge (DTaP) -> 90700 dtap < 7 yrs im	$63.00	$63.00	$40.76–$82.00	—	—
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 AMB Med Charge (DTaP-HepB-IPV) -> 90723 dtap-hepb-ipv vacc	$226.00	$226.00	$82.00–$192.10	42% above	—
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 AMB Med Charge (DTaP-HepB-IPV) -> 90723 dtap-hepb-ipv vacc	$226.00	$226.00	$82.00–$192.10	—	—
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 AMB Med Charge (DTaP-HIB-HepB-IBV) -> 90697 dtap-ipv-hib-hepb vacc im	$383.43	$383.43	$248.08–$325.92	60% above	—
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 AMB Med Charge (DTaP-HIB-HepB-IBV)	$383.43	$383.43	$248.08–$325.92	60% above	—
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 AMB Med Charge (DTaP-HIB-HepB-IBV) -> 90697 dtap-ipv-hib-hepb vacc im	$383.43	$383.43	$248.08–$325.92	—	—
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 AMB Med Charge (DTaP-HIB-HepB-IBV)	$383.43	$383.43	$248.08–$325.92	—	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 AMB Med Charge (Influenza) -> Q2039 flu vacc, 3 yrs + >, im, nos	$45.00	$45.00	$29.12–$82.00	31% above	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 19515-0904-52 - influenza virus vaccine, inactivated preservative-free trivalent Sus	$45.39	$45.39	$29.37–$38.58	32% above	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 19515-0904-52 - influenza virus vaccine, inactivated preservative-free trivalent Sus	$45.39	$45.39	$29.37–$38.58	32% above	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 AMB influenza vacc Charge -> Q2036 flulaval 3 yrs=> im	$49.00	$49.00	$31.70–$82.00	42% above	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 AMB Med Charge (Influenza) -> Q2036 flulaval 3 yrs = > im	$49.00	$49.00	$31.70–$82.00	42% above	—
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 AMB Med Charge (Influenza) -> Q2039 flu vacc, 3 yrs + >, im, nos	$45.00	$45.00	$29.12–$82.00	—	—
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 19515-0904-52 - influenza virus vaccine, inactivated preservative-free trivalent Sus	$45.39	$45.39	$29.37–$38.58	—	—
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 19515-0904-52 - influenza virus vaccine, inactivated preservative-free trivalent Sus	$45.39	$45.39	$29.37–$38.58	—	—
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 AMB Med Charge (Influenza) -> Q2036 flulaval 3 yrs = > im	$49.00	$49.00	$31.70–$82.00	—	—
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 AMB influenza vacc Charge -> Q2036 flulaval 3 yrs=> im	$49.00	$49.00	$31.70–$82.00	—	—
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 AMB Med Charge (HPV)	$527.00	$527.00	$60.00–$421.60	8% above	—
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 AMB Med Charge (HPV) -> 90651 HPV valent 9	$836.76	$836.76	$82.00–$711.25	71% above	—
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 AMB Med Charge (HPV)	$527.00	$527.00	$60.00–$421.60	—	—
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 AMB Med Charge (HPV) -> 90651 HPV valent 9	$836.76	$836.76	$82.00–$711.25	—	—
Hepatitis A vaccine, adult dose CPT 90632 AMB Med Charge (Hep A Adult) -> 90632 hep a adult	$203.00	$203.00	$82.00–$172.55	69% above	—
Hepatitis A vaccine, adult dose inpatient CPT 90632 AMB Med Charge (Hep A Adult) -> 90632 hep a adult	$203.00	$203.00	$82.00–$172.55	—	—
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 AMB Med Charge (Hep A Ped) -> 90633 hep a ped im	$92.00	$92.00	$59.52–$82.00	12% above	—
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 AMB Med Charge (Hep A Ped)	$92.00	$92.00	$59.52–$73.60	12% above	—
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 AMB Med Charge (Hep A Ped) -> 90633 hep a ped im	$92.00	$92.00	$59.52–$82.00	—	—
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 AMB Med Charge (Hep A Ped)	$92.00	$92.00	$59.52–$73.60	—	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 AMB Med Charge (Hep B Adult) -> 90746 hep b adult	$100.00	$100.00	$64.70–$85.00	7% below	—
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 AMB Med Charge (Hep B Adult) -> 90746 hep b adult	$100.00	$100.00	$64.70–$85.00	—	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 AMB Med Charge (Hep B Ped) -> 90744 hep b 3 dose	$86.00	$86.00	$55.64–$82.00	2% below	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 AMB Med Charge (Hep B Ped) -> 90744 hep b 3 dose	$86.00	$86.00	$55.64–$82.00	—	—
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 AMB Med Charge (HIB PRP-OMP) -> 90647 hib prp-omp	$65.00	$65.00	$42.06–$82.00	5% above	—
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 AMB Med Charge (HIB PRP-OMP) -> 90647 hib prp-omp	$65.00	$65.00	$42.06–$82.00	—	—
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 AMB Med Charge (HIB PRP-T) -> 90648 hib prp-t 4	$85.00	$85.00	$55.00–$82.00	60% above	—
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 90648 Hemophilus influenzae type b vaccine(Hib), PRP-T conjugate, 4 dose schedule for intramuscular	$89.00	$89.00	$57.58–$82.00	68% above	—
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 AMB Med Charge (HIB PRP-T) -> 90648 hib prp-t 4	$85.00	$85.00	$55.00–$82.00	—	—
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 90648 Hemophilus influenzae type b vaccine(Hib), PRP-T conjugate, 4 dose schedule for intramuscular	$89.00	$89.00	$57.58–$82.00	—	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 AMB Med Charge (Influenza) -> 90662 prsv free inc antig	$96.00	$96.00	$62.11–$82.00	25% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenisity for int	$96.00	$96.00	$62.11–$82.00	25% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 AMB Med Charge (Influenza) -> 90662 prsv free inc antig	$96.00	$96.00	$62.11–$82.00	—	—
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenisity for int	$96.00	$96.00	$62.11–$82.00	—	—
MMR vaccine (measles, mumps and rubella), live CPT 90707 AMB Med Charge (MMR) -> 90707 MMR live	$163.00	$163.00	$82.00–$138.55	18% below	—
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 AMB Med Charge (MMR) -> 90707 MMR live	$163.00	$163.00	$82.00–$138.55	—	—
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 AMB Med Charge (MMRV) -> 90710 MMRV live	$453.00	$453.00	$82.00–$385.05	9% above	—
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 AMB Med Charge (MMRV) -> 90710 MMRV live	$453.00	$453.00	$82.00–$385.05	—	—
Meningococcal ACWY (MenACWY) vaccine CPT 90734 AMB Med Charge (MCV4) -> 90734 meningococcal im	$171.00	$171.00	$82.00–$145.35	31% below	—
Meningococcal ACWY (MenACWY) vaccine CPT 90734 AMB Med Charge (MCV4)	$171.00	$171.00	$82.00–$145.35	31% below	—
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 AMB Med Charge (MCV4) -> 90734 meningococcal im	$171.00	$171.00	$82.00–$145.35	—	—
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 AMB Med Charge (MCV4)	$171.00	$171.00	$82.00–$145.35	—	—
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 AMB Med Charge (Meningococcal) -> 90620 menb rp w/omv vacc im	$395.00	$395.00	$82.00–$335.75	9% above	—
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 AMB Med Charge (Meningococcal) -> 90620 menb rp w/omv vacc im	$395.00	$395.00	$82.00–$335.75	—	—
Meningococcal B vaccine (Trumenba) CPT 90621 AMB Med Charge (Meningococcal) -> 90621 Menb rlp im	$326.00	$326.00	$82.00–$277.10	2% above	—
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 AMB Med Charge (Meningococcal) -> 90621 Menb rlp im	$326.00	$326.00	$82.00–$277.10	—	—
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 AMB Med Charge (PCV13) -> 90670 pneumococcal 13	$389.00	$389.00	$82.00–$330.65	8% above	—
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 AMB Med Charge (PCV13) -> 90670 pneumococcal 13	$389.00	$389.00	$82.00–$330.65	—	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 00005-2000-10 - pneumococcal 20-valent conjugate vaccine intramuscular suspension 0.5 mL [JERS]	$378.78	$378.78	$245.07–$321.96	15% below	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 AMB Med Charge (PCV20) -> 90677 pneumococcal 20	$565.00	$565.00	$82.00–$480.25	27% above	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 00005-2000-10 - pneumococcal 20-valent conjugate vaccine intramuscular suspension 0.5 mL [JERS]	$378.78	$378.78	$245.07–$321.96	—	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 AMB Med Charge (PCV20) -> 90677 pneumococcal 20	$565.00	$565.00	$82.00–$480.25	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 AMB Med Charge (PPSV) -> 90732 PPSV subq/im	$330.00	$330.00	$82.00–$280.50	80% above	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 AMB Med Charge (PPSV) -> 90732 PPSV subq/im	$330.00	$330.00	$82.00–$280.50	—	—
Polio vaccine, inactivated (IPV) CPT 90713 AMB Med Charge (Polio) -> 90713 poliovirus ipv sc/im	$88.00	$88.00	$56.94–$82.00	46% below	—
Polio vaccine, inactivated (IPV) inpatient CPT 90713 AMB Med Charge (Polio) -> 90713 poliovirus ipv sc/im	$88.00	$88.00	$56.94–$82.00	—	—
Rabies vaccine, one dose CPT 90675 76125-0150-02 - rabies immune globulin, human 150 intl units/mL Sol	$745.62	$745.62	$482.42–$633.78	1% below	—
Rabies vaccine, one dose CPT 90675 76125-0150-02 - rabies immune globulin, human 150 intl units/mL Sol	$745.62	$745.62	$482.42–$633.78	1% below	—
Rabies vaccine, one dose CPT 90675 13533-0618-02 - rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [JERS]	$749.42	$749.42	$484.87–$637.01	at median	—
Rabies vaccine, one dose CPT 90675 13533-0618-02 - rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [JERS]	$749.42	$749.42	$484.87–$637.01	at median	—
Rabies vaccine, one dose CPT 90675 50632-0010-01 - rabies vaccine, purified chick embryo cell 2.5 intl units intramuscular injection [JERS]	$1,199.52	$1,199.52	$776.09–$1,019.59	59% above	—
Rabies vaccine, one dose CPT 90675 50632-0010-01 - rabies vaccine, purified chick embryo cell 2.5 intl units intramuscular injection [JERS]	$1,199.52	$1,199.52	$776.09–$1,019.59	59% above	—
Rabies vaccine, one dose CPT 90675 76125-0150-10 - rabies immune globulin, human 150 intl units/mL Sol {JERS}	$1,789.48	$1,789.48	$1,157.79–$1,521.06	138% above	—
Rabies vaccine, one dose CPT 90675 76125-0150-10 - rabies immune globulin, human 150 intl units/mL Sol {JERS}	$1,789.48	$1,789.48	$1,157.79–$1,521.06	138% above	—
Rabies vaccine, one dose inpatient CPT 90675 76125-0150-02 - rabies immune globulin, human 150 intl units/mL Sol	$745.62	$745.62	$482.42–$633.78	—	—
Rabies vaccine, one dose inpatient CPT 90675 76125-0150-02 - rabies immune globulin, human 150 intl units/mL Sol	$745.62	$745.62	$482.42–$633.78	—	—
Rabies vaccine, one dose inpatient CPT 90675 13533-0618-02 - rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [JERS]	$749.42	$749.42	$484.87–$637.01	—	—
Rabies vaccine, one dose inpatient CPT 90675 13533-0618-02 - rabies immune globulin, human 150 intl units/mL intramuscular solution 2 mL [JERS]	$749.42	$749.42	$484.87–$637.01	—	—
Rabies vaccine, one dose inpatient CPT 90675 50632-0010-01 - rabies vaccine, purified chick embryo cell 2.5 intl units intramuscular injection [JERS]	$1,199.52	$1,199.52	$776.09–$1,019.59	—	—
Rabies vaccine, one dose inpatient CPT 90675 50632-0010-01 - rabies vaccine, purified chick embryo cell 2.5 intl units intramuscular injection [JERS]	$1,199.52	$1,199.52	$776.09–$1,019.59	—	—
Rabies vaccine, one dose inpatient CPT 90675 76125-0150-10 - rabies immune globulin, human 150 intl units/mL Sol {JERS}	$1,789.48	$1,789.48	$1,157.79–$1,521.06	—	—
Rabies vaccine, one dose inpatient CPT 90675 76125-0150-10 - rabies immune globulin, human 150 intl units/mL Sol {JERS}	$1,789.48	$1,789.48	$1,157.79–$1,521.06	—	—
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 AMB Med Charge (Rotavirus) -> 90681 2 dose oral	$217.00	$217.00	$82.00–$184.45	3% below	—
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 90681 Rotavirus vaccine, human, attenuated (RV1), 2dose schedule, live, for oral use	$227.00	$227.00	$82.00–$192.95	1% above	—
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 AMB Med Charge (Rotavirus) -> 90681 2 dose oral	$217.00	$217.00	$82.00–$184.45	—	—
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 90681 Rotavirus vaccine, human, attenuated (RV1), 2dose schedule, live, for oral use	$227.00	$227.00	$82.00–$192.95	—	—
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 AMB Med Charge (Rotavirus) -> 90680 3 dose oral	$217.00	$217.00	$82.00–$184.45	47% above	—
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 AMB Med Charge (Rotavirus) -> 90680 3 dose oral	$217.00	$217.00	$82.00–$184.45	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 AMB Med Charge (Td) -> 90714 td no prsrv >= 7	$53.00	$53.00	$34.29–$82.00	31% below	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 13533-0131-01 - tetanus-diphth toxoids (Td) adult/adol 2 units-2 units/0.5 mL Sus {JERS}	$133.50	$133.50	$86.37–$113.48	73% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 AMB Med Charge (Td) -> 90714 td no prsrv >= 7	$53.00	$53.00	$34.29–$82.00	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 13533-0131-01 - tetanus-diphth toxoids (Td) adult/adol 2 units-2 units/0.5 mL Sus {JERS}	$133.50	$133.50	$86.37–$113.48	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 58160-0810-52 - diphtheria/tetanus/pertussis (DTaP) ped 25 units-10 units-58 mcg/0.5 mL Sus {JERS}	$71.13	$71.13	$46.02–$60.46	29% below	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 58160-0810-52 - diphtheria/tetanus/pertussis (DTaP) ped 25 units-10 units-58 mcg/0.5 mL Sus {JERS}	$71.13	$71.13	$46.02–$60.46	29% below	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 AMB Med Charge (Tdap) -> 90715 tdap vaccine >7 IM	$120.00	$120.00	$77.64–$102.00	19% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 58160-0810-52 - diphtheria/tetanus/pertussis (DTaP) ped 25 units-10 units-58 mcg/0.5 mL Sus {JERS}	$71.13	$71.13	$46.02–$60.46	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 58160-0810-52 - diphtheria/tetanus/pertussis (DTaP) ped 25 units-10 units-58 mcg/0.5 mL Sus {JERS}	$71.13	$71.13	$46.02–$60.46	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 AMB Med Charge (Tdap) -> 90715 tdap vaccine >7 IM	$120.00	$120.00	$77.64–$102.00	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 AMB Admin Charge (HepB Peds Vacc) -> 90471 adm w/no counsel(or)+18	$35.00	$35.00	$22.65–$82.00	39% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 AMB Admin Charge (Vaccine) -> 90471 adm w/no counsel(or)+18	$142.00	$142.00	$37.53–$120.70	147% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 AMB Admin Charge (Influenza Vacc) -> 90471 adm w/no counsel(or)+18	$142.00	$142.00	$36.88–$120.70	147% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 AMB Admin Charge (PPSV Vaccine) -> 90471 adm w/no counsel(or)+18	$142.00	$142.00	$36.88–$120.70	147% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 AMB Admin Charge (HepB Vacc) -> 90471 adm w/no counsel(or)+18	$142.00	$142.00	$36.88–$120.70	147% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 AMB Admin Charge (Peds Vaccine) -> 90471 adm w/no counsel(or) over18 years	$142.00	$142.00	$38.17–$120.70	147% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 AMB Admin Charge (PCV Peds Vacc) -> 90471 adm w/no counsel(or)+18	$142.00	$142.00	$36.88–$120.70	147% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 AMB Admin Charge (Peds Vaccine) -> 90471 x1, 90472 x2 over 18	$142.00	$142.00	$37.53–$120.70	147% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 AMB Admin Charge (Peds Vaccine) -> 90471 x3	$142.00	$142.00	$37.53–$120.70	147% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 VACCINE ADMIN SUBQ/IM 1	$167.00	$167.00	$82.00–$141.95	190% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 VACCINE/TOXOID INJECTION	$167.00	$167.00	$82.00–$141.95	190% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 AMB Admin Charge (HepB Peds Vacc) -> 90471 adm w/no counsel(or)+18	$35.00	$35.00	$22.65–$82.00	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 AMB Admin Charge (HepB Vacc) -> 90471 adm w/no counsel(or)+18	$142.00	$142.00	$36.88–$120.70	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 AMB Admin Charge (Peds Vaccine) -> 90471 adm w/no counsel(or) over18 years	$142.00	$142.00	$38.17–$120.70	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 AMB Admin Charge (Vaccine) -> 90471 adm w/no counsel(or)+18	$142.00	$142.00	$37.53–$120.70	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 AMB Admin Charge (PCV Peds Vacc) -> 90471 adm w/no counsel(or)+18	$142.00	$142.00	$36.88–$120.70	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 AMB Admin Charge (Peds Vaccine) -> 90471 x3	$142.00	$142.00	$37.53–$120.70	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 AMB Admin Charge (PPSV Vaccine) -> 90471 adm w/no counsel(or)+18	$142.00	$142.00	$36.88–$120.70	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 AMB Admin Charge (Influenza Vacc) -> 90471 adm w/no counsel(or)+18	$142.00	$142.00	$36.88–$120.70	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 AMB Admin Charge (Peds Vaccine) -> 90471 x1, 90472 x2 over 18	$142.00	$142.00	$37.53–$120.70	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 VACCINE ADMIN SUBQ/IM 1	$167.00	$167.00	$82.00–$141.95	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 VACCINE/TOXOID INJECTION	$167.00	$167.00	$82.00–$141.95	—	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 AMB Admin Charge (Vaccine) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	54% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 AMB Admin Charge (HepB Peds Vacc) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	54% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 AMB Admin Charge (PCV Peds Vacc) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	54% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 AMB Admin Charge (Peds Vaccine) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	54% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 AMB Admin Charge (HepB Vacc) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	54% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 AMB Admin Charge (PPSV Vaccine) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	54% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 AMB Admin Charge (Influenza Vacc) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	54% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 VACCINE ADMIN SUBQ/IM 1 - ADDITIONAL VAC	$96.00	$96.00	$62.11–$82.00	145% above	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 AMB Admin Charge (Peds Vaccine) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 AMB Admin Charge (PPSV Vaccine) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 AMB Admin Charge (HepB Vacc) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 AMB Admin Charge (HepB Peds Vacc) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 AMB Admin Charge (Influenza Vacc) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 AMB Admin Charge (PCV Peds Vacc) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 AMB Admin Charge (Vaccine) -> 90472 adm w/no consl(or)+18; addl	$18.00	$18.00	$11.65–$82.00	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 VACCINE ADMIN SUBQ/IM 1 - ADDITIONAL VAC	$96.00	$96.00	$62.11–$82.00	—	—

Source file: https://hospitalpricetransparencyfiles.com/jersey-community-hospital/376013958_Jersey-Community-Hospital_standardcharges.csv