Trinity Medical Center
Trinity Medical Center in Rock Island, IL publishes cash prices for 73 common procedures listed here, from its own machine-readable price file updated Jan 28, 2026. Click a procedure to compare it with other hospitals nearby.
2701 17th St, Rock Island, IL 61201 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST | $624.80 | $781.00 | 20% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $4,299.03 | $5,373.78 | 20% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST | $624.80 | $781.00 | 20% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $4,299.03 | $5,373.78 | 20% |
| CT scan of the head or brain, no contrast dye CPT 70450 PR CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL | $269.60 | $337.00 | 20% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD OR BRAIN WO CONTRAST | $1,705.06 | $2,131.32 | 20% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 PR CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL | $269.60 | $337.00 | 20% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD OR BRAIN WO CONTRAST | $1,705.06 | $2,131.32 | 20% |
| CT scan of the pelvis, with contrast dye CPT 72193 PR CT SCAN OF PELVIS CONTRAST | $536.80 | $671.00 | 20% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST | $2,088.38 | $2,610.47 | 20% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 PR CT SCAN OF PELVIS CONTRAST | $536.80 | $671.00 | 20% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST | $2,088.38 | $2,610.47 | 20% |
| Diagnostic mammogram, both breasts both sides CPT 77066 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI | $285.60 | $357.00 | 20% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BILAT | $484.25 | $605.31 | 20% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI | $285.60 | $357.00 | 20% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DX MAMMO INCL CAD BILAT | $484.25 | $605.31 | 20% |
| Diagnostic mammogram, one breast CPT 77065 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI | $226.40 | $283.00 | 20% |
| Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNIL | $401.76 | $502.20 | 20% |
| Diagnostic mammogram, one breast inpatient CPT 77065 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI | $226.40 | $283.00 | 20% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC DX MAMMO INCL CAD UNIL | $401.76 | $502.20 | 20% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 PR MRI LOWER EXTREM JT, W/O CONTRAST | $552.00 | $690.00 | 20% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOW EXTR ANY JOINT WO CONTRAST | $2,729.83 | $3,412.28 | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 PR MRI LOWER EXTREM JT, W/O CONTRAST | $552.00 | $690.00 | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOW EXTR ANY JOINT WO CONTRAST | $2,729.83 | $3,412.28 | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 PR MRI, JOINT OF LEG. COMBO | $1,125.60 | $1,407.00 | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOW EXTR ANY JOINT W WO CONTR | $4,941.45 | $6,176.81 | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 PR MRI, JOINT OF LEG. COMBO | $1,125.60 | $1,407.00 | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOW EXTR ANY JOINT W WO CONTR | $4,941.45 | $6,176.81 | 20% |
| MRI of the brain, no contrast dye CPT 70551 PR MRI BRAIN | $538.40 | $673.00 | 20% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN WO CONTRAST | $2,034.04 | $2,542.54 | 20% |
| MRI of the brain, no contrast dye inpatient CPT 70551 PR MRI BRAIN | $538.40 | $673.00 | 20% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN WO CONTRAST | $2,034.04 | $2,542.54 | 20% |
| MRI of the brain, with and without contrast dye CPT 70553 PR MRI BRAIN COMBO | $945.60 | $1,182.00 | 20% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W WO CONTRAST | $4,776.48 | $5,970.59 | 20% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 PR MRI BRAIN COMBO | $945.60 | $1,182.00 | 20% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W WO CONTRAST | $4,776.48 | $5,970.59 | 20% |
| MRI of the lower back, no contrast dye CPT 72148 PR MRI, LUMBAR SPINE | $520.00 | $650.00 | 20% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI SPINE LUMBAR WO CONTRAST | $2,729.83 | $3,412.28 | 20% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 PR MRI, LUMBAR SPINE | $520.00 | $650.00 | 20% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI SPINE LUMBAR WO CONTRAST | $2,729.83 | $3,412.28 | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US, OB >/= 14 WKS, SNGL FETUS | $270.40 | $338.00 | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB COMPLETE SNGL FETUS | $706.48 | $883.09 | 20% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US, OB >/= 14 WKS, SNGL FETUS | $270.40 | $338.00 | 20% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB COMPLETE SNGL FETUS | $706.48 | $883.09 | 20% |
| Screening mammogram, both breasts both sides CPT 77067 CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $231.20 | $289.00 | 20% |
| Screening mammogram, both breasts both sides CPT 77067 HC SCR MAMMO INCL CAD BILAT | $396.94 | $496.17 | 20% |
| Screening mammogram, both breasts CPT 77067 HC SCR MAMMO INCL CAD UNIL | $396.94 | $496.17 | 20% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $231.20 | $289.00 | 20% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCR MAMMO INCL CAD BILAT | $396.94 | $496.17 | 20% |
| Screening mammogram, both breasts inpatient CPT 77067 HC SCR MAMMO INCL CAD UNIL | $396.94 | $496.17 | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | $1,396.80 | $1,746.00 | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 HC PSS W 4/> PARAM W TECH 6+ YRS | $4,175.77 | $5,219.71 | 20% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | $1,396.80 | $1,746.00 | 20% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC PSS W 4/> PARAM W TECH 6+ YRS | $4,175.77 | $5,219.71 | 20% |
| Transvaginal pelvic ultrasound CPT 76830 PR ECHOGRAPHY,TRANSVAGINAL | $237.60 | $297.00 | 20% |
| Transvaginal pelvic ultrasound CPT 76830 HC US NON OB TRANSVAG | $503.67 | $629.58 | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 PR ECHOGRAPHY,TRANSVAGINAL | $237.60 | $297.00 | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US NON OB TRANSVAG | $503.67 | $629.58 | 20% |
| Ultrasound of the abdomen, complete CPT 76700 US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE | $243.20 | $304.00 | 20% |
| Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE | $1,060.68 | $1,325.85 | 20% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE | $243.20 | $304.00 | 20% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE | $1,060.68 | $1,325.85 | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 CHG X-RAY LUMBAR SPINE 4 VW | $135.20 | $169.00 | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 HC LUMBOSACR SPINE MIN 4 VIEWS | $514.23 | $642.78 | 20% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 CHG X-RAY LUMBAR SPINE 4 VW | $135.20 | $169.00 | 20% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC LUMBOSACR SPINE MIN 4 VIEWS | $514.23 | $642.78 | 20% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL | $21.60 | $27.00 | 20% |
| Basic metabolic panel (blood test) CPT 80048 HC METABOLIC PANEL TOTAL CA | $68.56 | $85.70 | 20% |
| Basic metabolic panel (blood test) inpatient CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL | $21.60 | $27.00 | 20% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC METABOLIC PANEL TOTAL CA | $68.56 | $85.70 | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 CHG LIPID PANEL | $33.60 | $42.00 | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL | $68.56 | $85.70 | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 CHG LIPID PANEL | $33.60 | $42.00 | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL | $68.56 | $85.70 | 20% |
| Complete blood count (CBC) with differential CPT 85025 CHG COMPLETE CBC & AUTO DIFF WBC | $20.00 | $25.00 | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC COMPL CBC W PLT W AUTOM DIFF | $33.57 | $41.96 | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CHG COMPLETE CBC & AUTO DIFF WBC | $20.00 | $25.00 | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC COMPL CBC W PLT W AUTOM DIFF | $33.57 | $41.96 | 20% |
| Complete blood count (CBC), no differential CPT 85027 CHG COMPLETE CBC | $16.80 | $21.00 | 20% |
| Complete blood count (CBC), no differential CPT 85027 HC COMPL AUTOM CBC W PLT | $33.57 | $41.96 | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CHG COMPLETE CBC | $16.80 | $21.00 | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC COMPL AUTOM CBC W PLT | $33.57 | $41.96 | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 CHG METABOLIC PANEL,COMPREHENSIVE | $27.20 | $34.00 | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHEN METABOLIC PANEL | $68.56 | $85.70 | 20% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CHG METABOLIC PANEL,COMPREHENSIVE | $27.20 | $34.00 | 20% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHEN METABOLIC PANEL | $68.56 | $85.70 | 20% |
| Kidney function blood test panel CPT 80069 CHG RENAL FUNCTION PANEL | $22.40 | $28.00 | 20% |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL | $68.56 | $85.70 | 20% |
| Kidney function blood test panel inpatient CPT 80069 CHG RENAL FUNCTION PANEL | $22.40 | $28.00 | 20% |
| Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL | $68.56 | $85.70 | 20% |
| Liver function blood test panel CPT 80076 CHG HEPATIC FUNCTION PANEL | $20.80 | $26.00 | 20% |
| Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL | $68.56 | $85.70 | 20% |
| Liver function blood test panel inpatient CPT 80076 CHG HEPATIC FUNCTION PANEL | $20.80 | $26.00 | 20% |
| Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL | $68.56 | $85.70 | 20% |
| Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL | $68.56 | $85.70 | 20% |
| Obstetric blood test panel CPT 80055 CHG OBSTETRIC PANEL | $96.00 | $120.00 | 20% |
| Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL | $68.56 | $85.70 | 20% |
| Obstetric blood test panel inpatient CPT 80055 CHG OBSTETRIC PANEL | $96.00 | $120.00 | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 CHG PROSTATE SPECIFIC ANTIGEN,FREE | $46.40 | $58.00 | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA; FREE | $64.28 | $80.35 | 20% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 CHG PROSTATE SPECIFIC ANTIGEN,FREE | $46.40 | $58.00 | 20% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA; FREE | $64.28 | $80.35 | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 CHG PROSTATE SPECIFIC ANTIGEN,TOTAL | $46.40 | $58.00 | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA; TOTAL | $64.28 | $80.35 | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CHG PROSTATE SPECIFIC ANTIGEN,TOTAL | $46.40 | $58.00 | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA; TOTAL | $64.28 | $80.35 | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 CHG THROMBOPLAS TIME PARTIAL | $15.20 | $19.00 | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT; PLASMA OR WHOLE BLOOD | $32.85 | $41.06 | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 CHG THROMBOPLAS TIME PARTIAL | $15.20 | $19.00 | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT; PLASMA OR WHOLE BLOOD | $32.85 | $41.06 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME | $10.40 | $13.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME | $32.85 | $41.06 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME | $10.40 | $13.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME | $32.85 | $41.06 | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 CHG ASSAY THYROID STIM HORMONE | $42.40 | $53.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE | $55.00 | $68.75 | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 CHG ASSAY THYROID STIM HORMONE | $42.40 | $53.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE | $55.00 | $68.75 | 20% |
| Urinalysis with microscope exam, automated CPT 81001 CHG URINALYSIS, AUTO, W/SCOPE | $8.00 | $10.00 | 20% |
| Urinalysis with microscope exam, automated CPT 81001 HC AUTOM URINE DIP W MICRO | $25.72 | $32.14 | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 CHG URINALYSIS, AUTO, W/SCOPE | $8.00 | $10.00 | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC AUTOM URINE DIP W MICRO | $25.72 | $32.14 | 20% |
| Urinalysis with microscope exam, manual CPT 81000 CHG URINALYSIS, NONAUTO, W/SCOPE | $9.60 | $12.00 | 20% |
| Urinalysis with microscope exam, manual CPT 81000 HC N-AUTOM URINE DIP W MICRO | $25.72 | $32.14 | 20% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 CHG URINALYSIS, NONAUTO, W/SCOPE | $9.60 | $12.00 | 20% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC N-AUTOM URINE DIP W MICRO | $25.72 | $32.14 | 20% |
| Urinalysis without microscope exam, automated CPT 81003 CHG URINALYSIS, AUTO, W/O SCOPE | $6.40 | $8.00 | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC AUTOM URINALYSIS WO MICRO | $25.72 | $32.14 | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 CHG URINALYSIS, AUTO, W/O SCOPE | $6.40 | $8.00 | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC AUTOM URINALYSIS WO MICRO | $25.72 | $32.14 | 20% |
| Urinalysis without microscope exam, manual CPT 81002 CHG URINALYSIS NONAUTO W/O SCOPE | $7.20 | $9.00 | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC N-AUTOM URINALYS WO MICRO | $25.72 | $32.14 | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 CHG URINALYSIS NONAUTO W/O SCOPE | $7.20 | $9.00 | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC N-AUTOM URINALYS WO MICRO | $25.72 | $32.14 | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $1,357.60 | $1,697.00 | 20% |
| Cataract surgery with lens implant inpatient CPT 66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $1,357.60 | $1,697.00 | 20% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 PR FULL ROUT OBSTE CARE,CESAREAN DELIV | $4,739.20 | $5,924.00 | 20% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 PR FULL ROUT OBSTE CARE,CESAREAN DELIV | $4,739.20 | $5,924.00 | 20% |
| Colonoscopy with endoscopic ultrasound CPT 45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $652.00 | $815.00 | 20% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $652.00 | $815.00 | 20% |
| Colonoscopy with polyp removal CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $1,096.80 | $1,371.00 | 20% |
| Colonoscopy with polyp removal inpatient CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $1,096.80 | $1,371.00 | 20% |
| Colonoscopy with tissue sample CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $1,047.20 | $1,309.00 | 20% |
| Colonoscopy with tissue sample inpatient CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $1,047.20 | $1,309.00 | 20% |
| Colonoscopy, diagnostic CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $813.60 | $1,017.00 | 20% |
| Colonoscopy, diagnostic inpatient CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $813.60 | $1,017.00 | 20% |
| Gallbladder removal, laparoscopic CPT 47562 PR LAP,CHOLECYSTECTOMY | $1,614.40 | $2,018.00 | 20% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PR LAP,CHOLECYSTECTOMY | $1,614.40 | $2,018.00 | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PR REPAIR ING HERNIA,5+Y/O,REDUCIBL | $1,277.60 | $1,597.00 | 20% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR REPAIR ING HERNIA,5+Y/O,REDUCIBL | $1,277.60 | $1,597.00 | 20% |
| Knee arthroscopy with meniscus trim CPT 29881 PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG | $1,329.60 | $1,662.00 | 20% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG | $1,329.60 | $1,662.00 | 20% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HC AFTER CATARACT LASER SURGERY 1+ STGS | $685.13 | $856.41 | 20% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 PR DISCISSION,2ND CATARACT,LASER | $820.00 | $1,025.00 | 20% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HC AFTER CATARACT LASER SURGERY 1+ STGS | $685.13 | $856.41 | 20% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 PR DISCISSION,2ND CATARACT,LASER | $820.00 | $1,025.00 | 20% |
| Left heart catheterization, diagnostic CPT 93452 PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I | $1,947.20 | $2,434.00 | 20% |
| Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY | $7,685.82 | $9,607.27 | 20% |
| Left heart catheterization, diagnostic inpatient CPT 93452 PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I | $1,947.20 | $2,434.00 | 20% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY | $7,685.82 | $9,607.27 | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $629.60 | $787.00 | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ INTERLAM L/S W IMG | $1,510.00 | $1,887.49 | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $629.60 | $787.00 | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ INTERLAM L/S W IMG | $1,510.00 | $1,887.49 | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $371.20 | $464.00 | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ INTERLAM L/S WO IMG | $1,510.00 | $1,887.49 | 20% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $371.20 | $464.00 | 20% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ INTERLAM L/S WO IMG | $1,510.00 | $1,887.49 | 20% |
| Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 HC INJ(S) FORAMEN EPID L/S SGL LEV BILAT | $3,351.88 | $4,189.84 | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $582.40 | $728.00 | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ(S) FORAMEN EPIDURAL L/S SGL LEV | $1,675.94 | $2,094.92 | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 HC INJ(S) FORAMEN EPID L/S SGL LEV BILAT | $3,351.88 | $4,189.84 | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $582.40 | $728.00 | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ(S) FORAMEN EPIDURAL L/S SGL LEV | $1,675.94 | $2,094.92 | 20% |
| Prostate biopsy CPT 55700 PR BIOPSY OF PROSTATE,NEEDLE/PUNCH | $613.60 | $767.00 | 20% |
| Prostate biopsy CPT 55700 HC BX PROSTATE NDLE PUNCH | $2,598.82 | $3,248.52 | 20% |
| Prostate biopsy inpatient CPT 55700 PR BIOPSY OF PROSTATE,NEEDLE/PUNCH | $613.60 | $767.00 | 20% |
| Prostate biopsy inpatient CPT 55700 HC BX PROSTATE NDLE PUNCH | $2,598.82 | $3,248.52 | 20% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE | $3,648.00 | $4,560.00 | 20% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE | $3,648.00 | $4,560.00 | 20% |
| Removal of a breast lump, open surgery CPT 19120 PR REMOVAL OF BREAST LESION | $1,227.20 | $1,534.00 | 20% |
| Removal of a breast lump, open surgery inpatient CPT 19120 PR REMOVAL OF BREAST LESION | $1,227.20 | $1,534.00 | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 PR SHOULDER SCOPE BONE SHAVING | $530.40 | $663.00 | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 PR SHOULDER SCOPE BONE SHAVING | $530.40 | $663.00 | 20% |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS/ADENOIDS,<12 Y/O | $715.20 | $894.00 | 20% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 REMOVE TONSILS/ADENOIDS,<12 Y/O | $715.20 | $894.00 | 20% |
| Total hip replacement CPT 27130 PR TOTAL HIP ARTHROPLASTY | $3,337.60 | $4,172.00 | 20% |
| Total hip replacement inpatient CPT 27130 PR TOTAL HIP ARTHROPLASTY | $3,337.60 | $4,172.00 | 20% |
| Total knee replacement CPT 27447 PR TOTAL KNEE ARTHROPLASTY | $3,334.40 | $4,168.00 | 20% |
| Total knee replacement inpatient CPT 27447 PR TOTAL KNEE ARTHROPLASTY | $3,334.40 | $4,168.00 | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $914.40 | $1,143.00 | 20% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $914.40 | $1,143.00 | 20% |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $687.20 | $859.00 | 20% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $687.20 | $859.00 | 20% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 PR ROUT OB CARE,VAG DELIV,PREV C-SEC | $4,492.00 | $5,615.00 | 20% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 PR ROUT OB CARE,VAG DELIV,PREV C-SEC | $4,492.00 | $5,615.00 | 20% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 PR FULL ROUT OBSTE CARE,VAGINAL DELIV | $4,552.00 | $5,690.00 | 20% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 PR FULL ROUT OBSTE CARE,VAGINAL DELIV | $4,552.00 | $5,690.00 | 20% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR ELECTROCARDIOGRAM, COMPLETE | $37.60 | $47.00 | 20% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PR ELECTROCARDIOGRAM, COMPLETE | $37.60 | $47.00 | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $239.20 | $299.00 | 20% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $239.20 | $299.00 | 20% |
| Family therapy without the patient, 50 minutes CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $230.40 | $288.00 | 20% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $230.40 | $288.00 | 20% |
| Group psychotherapy session CPT 90853 PR GROUP PSYCHOTHERAPY | $62.40 | $78.00 | 20% |
| Group psychotherapy session CPT 90853 HC EXTENDED OUTPATIENT TREATMENT | $114.52 | $143.14 | 20% |
| Group psychotherapy session CPT 90853 HC GROUP THERAPY NOT MULTI-FAMILY | $389.15 | $486.43 | 20% |
| Group psychotherapy session inpatient CPT 90853 PR GROUP PSYCHOTHERAPY | $62.40 | $78.00 | 20% |
| Group psychotherapy session inpatient CPT 90853 HC EXTENDED OUTPATIENT TREATMENT | $114.52 | $143.14 | 20% |
| Group psychotherapy session inpatient CPT 90853 HC GROUP THERAPY NOT MULTI-FAMILY | $389.15 | $486.43 | 20% |
| New patient office visit, about 30 minutes CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $189.60 | $237.00 | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $189.60 | $237.00 | 20% |
| New patient office visit, about 45 minutes CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $289.60 | $362.00 | 20% |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $289.60 | $362.00 | 20% |
| New patient office visit, about 60 minutes CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $367.20 | $459.00 | 20% |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $367.20 | $459.00 | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PR THERAPEUTIC EXERCISES | $55.20 | $69.00 | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAP EXERCISE ROM EA 15M | $113.54 | $141.92 | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PR THERAPEUTIC EXERCISES | $55.20 | $69.00 | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAP EXERCISE ROM EA 15M | $113.54 | $141.92 | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR PREVENTIVE VISIT,NEW,18-39 | $235.20 | $294.00 | 20% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR PREVENTIVE VISIT,NEW,18-39 | $235.20 | $294.00 | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR PREVENTIVE VISIT,NEW,40-64 | $272.80 | $341.00 | 20% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR PREVENTIVE VISIT,NEW,40-64 | $272.80 | $341.00 | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PSYTX W PT 30 MIN (16-37 MIN) | $69.87 | $87.33 | 20% |
| Psychotherapy session, 30 minutes CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES | $168.00 | $210.00 | 20% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYTX W PT 30 MIN (16-37 MIN) | $69.87 | $87.33 | 20% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES | $168.00 | $210.00 | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PSYTX W PT 45 MIN (38-52 MIN) | $126.16 | $157.70 | 20% |
| Psychotherapy session, 45 minutes CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES | $209.60 | $262.00 | 20% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYTX W PT 45 MIN (38-52 MIN) | $126.16 | $157.70 | 20% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES | $209.60 | $262.00 | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PSYTX W PT 60 MIN (>53 MIN) | $113.54 | $141.92 | 20% |
| Psychotherapy session, 60 minutes CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES | $313.60 | $392.00 | 20% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYTX W PT 60 MIN (>53 MIN) | $113.54 | $141.92 | 20% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES | $313.60 | $392.00 | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $219.20 | $274.00 | 20% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $219.20 | $274.00 | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $328.80 | $411.00 | 20% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $328.80 | $411.00 | 20% |