Hospital Chicago-Naperville-Elgin, IL-IN

Jackson Park Hospital Foundation

Jackson Park Hospital Foundation in Chicago, IL publishes cash prices for 261 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 238 of 258 procedures and below it for 19. By typical cash price it ranks #74 of 90 Illinois hospitals and #52 of 61 hospitals in the Chicago, IL area, cheapest first. Click a procedure to compare it with other hospitals nearby.

7531 S Stony Island Ave, Chicago, IL 60649 Collected Sep 27, 2026 Source price file (773) 947-7500

Acute care hospital Emergency department CMS star rating 1 of 5 CCN 140177 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Bone scan, whole body (nuclear medicine) CPT 78306 NM SCAN BONE/JOINT WHOLE BODY	$2,080.00	$2,600.00	—	36% above	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM SCAN BONE/JOINT WHOLE BODY	$2,080.00	$2,600.00	—	—	20%
Breast ultrasound, complete, one breast CPT 76641 US BREAST(S)	$621.34	$776.68	—	41% above	20%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST(S)	$621.34	$776.68	—	—	20%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST LIMITED	$623.04	$778.80	—	68% above	20%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST LIMITED	$623.04	$778.80	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA -CHEST W/CONTRAST PULOMONARY ARTERY	$4,115.76	$5,144.70	—	77% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA -CHEST W/CONTRAST AORTA	$4,115.76	$5,144.70	—	77% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA -CHEST W/CONTRAST AORTA	$4,115.76	$5,144.70	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA -CHEST W/CONTRAST PULOMONARY ARTERY	$4,115.76	$5,144.70	—	—	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA HEART W/3D IMAGE	$3,511.20	$4,389.00	—	107% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA HEART W/3D IMAGE	$3,511.20	$4,389.00	—	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN & PELVIS WO CONTRAST	$2,807.43	$3,509.29	—	7% below	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN & PELVIS WO CONTRAST	$2,807.43	$3,509.29	—	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS W CONTRAST	$4,729.70	$5,912.12	—	39% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W CONTRAST	$4,729.70	$5,912.12	—	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN & PELVIS W/WO CONTRAST	$5,285.06	$6,606.33	—	22% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN & PELVIS W/WO CONTRAST	$5,285.06	$6,606.33	—	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 Stroke Protocol	$2,139.28	$2,674.10	—	36% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Stroke Protocol	$2,139.28	$2,674.10	—	—	20%
CT scan of the head without and with contrast CPT 70470 SCAN HEAD W/O AND W/CONTRAST	$2,436.10	$3,045.13	—	14% above	20%
CT scan of the head without and with contrast inpatient CPT 70470 SCAN HEAD W/O AND W/CONTRAST	$2,436.10	$3,045.13	—	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 LUMBER SPINE WITHOUT CONTRAST	$1,920.63	$2,400.79	—	2% below	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 LUMBER SPINE WITHOUT CONTRAST	$1,920.63	$2,400.79	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 VASC DUPLEX CAROTID BILATERAL	$1,234.30	$1,542.87	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 VASC DUPLEX CAROTID BILATERAL	$1,234.30	$1,542.87	—	—	20%
Chest X-ray, 2 views CPT 71046 RADEX CHEST DECUB SPECIAL VIEW	$239.94	$299.92	—	15% below	20%
Chest X-ray, 2 views CPT 71046 RADEX CHEST FRONT LAT 2 VIEW	$278.39	$347.99	—	2% below	20%
Chest X-ray, 2 views CPT 71046 RADIOLOGIC EXAMINATION CHEST 2 VIEW	$278.39	$347.99	—	2% below	20%
Chest X-ray, 2 views CPT 71046 RADIOLOGIC EXAM CHEST 2 VIEWS	$278.39	$347.99	—	2% below	20%
Chest X-ray, 2 views inpatient CPT 71046 RADEX CHEST DECUB SPECIAL VIEW	$239.94	$299.92	—	—	20%
Chest X-ray, 2 views inpatient CPT 71046 RADIOLOGIC EXAM CHEST 2 VIEWS	$278.39	$347.99	—	—	20%
Chest X-ray, 2 views inpatient CPT 71046 RADIOLOGIC EXAMINATION CHEST 2 VIEW	$278.39	$347.99	—	—	20%
Chest X-ray, 2 views inpatient CPT 71046 RADEX CHEST FRONT LAT 2 VIEW	$278.39	$347.99	—	—	20%
Chest X-ray, single view CPT 71045 RADIOLOGIC EXAMINATION CHEST SINGLE	$500.77	$625.96	—	113% above	20%
Chest X-ray, single view CPT 71045 RADIOLOGIC EXAMINATION CHEST SINGLE VIEW	$500.77	$625.96	—	113% above	20%
Chest X-ray, single view inpatient CPT 71045 RADIOLOGIC EXAMINATION CHEST SINGLE	$500.77	$625.96	—	—	20%
Chest X-ray, single view inpatient CPT 71045 RADIOLOGIC EXAMINATION CHEST SINGLE VIEW	$500.77	$625.96	—	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL ULTRASOUND COMPLETE	$1,150.16	$1,437.70	—	46% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL ULTRASOUND COMPLETE	$1,150.16	$1,437.70	—	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL SKELETON	$733.04	$916.30	—	74% above	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY AXIAL SKELETON	$733.04	$916.30	—	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY / PERPHERAL	$463.76	$579.70	—	102% above	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA BONE DENSITY / PERPHERAL	$463.76	$579.70	—	—	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB US, DETAILED,SNGL FETUS	$1,051.60	$1,314.50	—	12% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 OB US, DETAILED,SNGL FETUS	$1,051.60	$1,314.50	—	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI	$601.92	$752.40	—	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO, INCL CAD BI	$702.24	$877.80	—	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI	$601.92	$752.40	—	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO, INCL CAD BI	$702.24	$877.80	—	—	20%
Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI	$470.01	$587.51	—	66% above	20%
Diagnostic mammogram, one breast CPT 77065 DX MAMMO, INCL CAD UNI	$508.64	$635.80	—	80% above	20%
Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI	$470.01	$587.51	—	—	20%
Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO, INCL CAD UNI	$508.64	$635.80	—	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VASC DUPLEX UE VENOUS BILAT	$1,618.97	$2,023.71	—	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VASC DUPLEX LE VENOUS BILAT	$1,618.97	$2,023.71	—	—	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 ULTRASOUND VEIN BIL	$1,618.97	$2,023.71	—	5% above	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VASC DUPLEX UE VENOUS BILAT	$1,618.97	$2,023.71	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VASC DUPLEX LE VENOUS BILAT	$1,618.97	$2,023.71	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 ULTRASOUND VEIN BIL	$1,618.97	$2,023.71	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO TRANS THOR 2D	$1,103.84	$1,379.80	—	39% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TEE W/DOPPLER COMPLETE	$2,054.62	$2,568.28	—	14% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO TRANS THOR 2D	$1,103.84	$1,379.80	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TEE W/DOPPLER COMPLETE	$2,054.62	$2,568.28	—	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM SCAN HEPATOBILIARY	$1,664.08	$2,080.10	—	30% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM SCAN HEPATOBILIARY	$1,664.08	$2,080.10	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ONE ORGAN OR FOLLOW UP	$792.50	$990.63	—	37% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SPLEEN	$792.50	$990.63	—	37% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER	$792.50	$990.63	—	37% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS LTD	$792.50	$990.63	—	37% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 APPENDIX RT LOWER QUANDRANT	$792.50	$990.63	—	37% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SPLEEN	$792.50	$990.63	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIVER	$792.50	$990.63	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PANCREAS LTD	$792.50	$990.63	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ONE ORGAN OR FOLLOW UP	$792.50	$990.63	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient one side CPT 76705 APPENDIX RT LOWER QUANDRANT	$792.50	$990.63	—	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR	$2,817.32	$3,521.65	—	416% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCR	$2,817.32	$3,521.65	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI HIPS BIL WO CONTRAST	$2,777.18	$3,471.47	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LT WO CONTRAST	$2,777.18	$3,471.47	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE RT WO CONTRAST	$2,777.18	$3,471.47	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE LT WO CONTRAST	$2,777.18	$3,471.47	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE RT LT WO CONTRAST	$2,777.18	$3,471.47	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE LT WO CONTRAST	$2,777.18	$3,471.47	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP RT WO CONTRAST	$2,777.18	$3,471.47	—	15% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI HIPS BIL WO CONTRAST	$2,777.18	$3,471.47	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LT WO CONTRAST	$2,777.18	$3,471.47	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP RT WO CONTRAST	$2,777.18	$3,471.47	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE RT WO CONTRAST	$2,777.18	$3,471.47	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE LT WO CONTRAST	$2,777.18	$3,471.47	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE RT LT WO CONTRAST	$2,777.18	$3,471.47	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE LT WO CONTRAST	$2,777.18	$3,471.47	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI HIPS BIL WO W CONTRAST	$4,391.02	$5,488.78	—	36% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE LT WO W CONTRAST	$4,391.02	$5,488.78	—	36% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE RT WO W CONTRAST	$4,391.02	$5,488.78	—	36% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP RT WO W CONTRAST	$4,391.02	$5,488.78	—	36% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP LT WO W CONTRAST	$4,391.02	$5,488.78	—	36% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE LT WO W CONTRAST	$4,391.02	$5,488.78	—	36% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE RT WO W CONTRAST	$4,391.02	$5,488.78	—	36% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI HIPS BIL WO W CONTRAST	$4,391.02	$5,488.78	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP RT WO W CONTRAST	$4,391.02	$5,488.78	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP LT WO W CONTRAST	$4,391.02	$5,488.78	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE RT WO W CONTRAST	$4,391.02	$5,488.78	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE RT WO W CONTRAST	$4,391.02	$5,488.78	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE LT WO W CONTRAST	$4,391.02	$5,488.78	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE LT WO W CONTRAST	$4,391.02	$5,488.78	—	—	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WO CONTRAST	$2,911.54	$3,639.42	—	40% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WO CONTRAST	$2,911.54	$3,639.42	—	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO W CONTRAST	$4,121.92	$5,152.40	—	34% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO W CONTRAST	$4,121.92	$5,152.40	—	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI AUDITORY CANAL WO CONTRAST	$2,803.11	$3,503.89	—	28% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST	$2,803.11	$3,503.89	—	28% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI PITUITARY WO CONTRAST	$2,803.11	$3,503.89	—	28% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST	$2,803.11	$3,503.89	—	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI AUDITORY CANAL WO CONTRAST	$2,803.11	$3,503.89	—	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI PITUITARY WO CONTRAST	$2,803.11	$3,503.89	—	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO W CONTRAST	$4,107.27	$5,134.09	—	27% above	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI AUDITORY CANAL WO W CONTRAST	$4,107.27	$5,134.09	—	27% above	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI PITUITARY WO W CONTRAST	$4,107.27	$5,134.09	—	27% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO W CONTRAST	$4,107.27	$5,134.09	—	—	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI PITUITARY WO W CONTRAST	$4,107.27	$5,134.09	—	—	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI AUDITORY CANAL WO W CONTRAST	$4,107.27	$5,134.09	—	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR PLEXUS WO CONTRAST	$3,090.62	$3,863.28	—	22% above	20%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE WO CONTRAST	$3,090.62	$3,863.28	—	22% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR PLEXUS WO CONTRAST	$3,090.62	$3,863.28	—	—	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE WO CONTRAST	$3,090.62	$3,863.28	—	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR PLEXUS WO W CONTRAST	$4,095.57	$5,119.46	—	26% above	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE WO W CONTRAST	$4,095.57	$5,119.46	—	26% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR PLEXUS WO W CONTRAST	$4,095.57	$5,119.46	—	—	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE WO W CONTRAST	$4,095.57	$5,119.46	—	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE WO CONTRAST	$3,124.58	$3,905.73	—	23% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE WO CONTRAST	$3,124.58	$3,905.73	—	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE WO W CONTRAST	$4,022.00	$5,027.50	—	25% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE WO W CONTRAST	$4,022.00	$5,027.50	—	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE WO CONTRAST	$3,122.47	$3,903.09	—	36% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE WO CONTRAST	$3,122.47	$3,903.09	—	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WO W CONTRAST	$4,422.79	$5,528.49	—	58% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WO W CONTRAST	$4,422.79	$5,528.49	—	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO CONTRAST	$2,791.37	$3,489.21	—	30% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO CONTRAST	$2,791.37	$3,489.21	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW RT WO CONTRAST	$2,874.26	$3,592.83	—	11% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST RT WO CONTRAST	$2,874.26	$3,592.83	—	11% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST LT WO CONTRAST	$2,874.26	$3,592.83	—	11% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER LT WO CONTRAST	$2,874.26	$3,592.83	—	11% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW LT WO CONTRAST	$2,874.26	$3,592.83	—	11% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER RT WO CONTRAST	$2,874.26	$3,592.83	—	11% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST RT WO CONTRAST	$2,874.26	$3,592.83	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST LT WO CONTRAST	$2,874.26	$3,592.83	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER RT WO CONTRAST	$2,874.26	$3,592.83	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW RT WO CONTRAST	$2,874.26	$3,592.83	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW LT WO CONTRAST	$2,874.26	$3,592.83	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER LT WO CONTRAST	$2,874.26	$3,592.83	—	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC NON-OB	$794.19	$992.74	—	26% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC NON-OB	$794.19	$992.74	—	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OBSTETRIC SINGLE GESTATION	$792.61	$990.76	—	30% above	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US, >/= 14 WKS, SNGL FETUS	$812.59	$1,015.74	—	34% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OBSTETRIC SINGLE GESTATION	$792.61	$990.76	—	—	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US, >/= 14 WKS, SNGL FETUS	$812.59	$1,015.74	—	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US 0-14 WEEKS	$714.78	$893.48	—	29% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US, < 14 WKS, SNGL FETUS	$735.68	$919.60	—	33% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US 0-14 WEEKS	$714.78	$893.48	—	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US, < 14 WKS, SNGL FETUS	$735.68	$919.60	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US BIO PHYSICAL PROFILE	$584.76	$730.95	—	44% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US, LIMITED, FETUS(S)	$584.76	$730.95	—	44% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Limited Fetal Ultrasound	$722.48	$903.10	—	77% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US BIO PHYSICAL PROFILE	$584.76	$730.95	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US, LIMITED, FETUS(S)	$584.76	$730.95	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Limited Fetal Ultrasound	$722.48	$903.10	—	—	20%
Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD	$515.68	$644.60	—	—	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD	$515.68	$644.60	—	—	20%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$584.37	$730.46	—	6% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$584.37	$730.46	—	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANT UTERUS TRANSVAG	$647.90	$809.88	—	37% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANT UTERUS TRANSVAG	$647.90	$809.88	—	—	20%
Ultrasound of the abdomen, complete CPT 76700 US MULTI ORG-UPPER QU AB	$1,067.26	$1,334.07	—	11% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US MULTI ORG-UPPER QU AB	$1,067.26	$1,334.07	—	—	20%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$730.69	$913.36	—	11% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$730.69	$913.36	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUES- HEAD & NCK-THYROID,PARA	$789.57	$986.96	—	28% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUES- HEAD & NCK-THYROID,PARA	$789.57	$986.96	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 ULTRASOUND VEIN UNI	$1,019.26	$1,274.08	—	60% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VASC DUPLEX UE VENOUS UN LT	$1,019.26	$1,274.08	—	60% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VASC DUPLEX LE VENOUS UNI RT	$1,019.26	$1,274.08	—	60% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VASC DUPLEX UE VENOUS UNI RT	$1,019.26	$1,274.08	—	60% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 ULTRASOUND VEIN UNI	$1,019.26	$1,274.08	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VASC DUPLEX LE VENOUS UNI RT	$1,019.26	$1,274.08	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VASC DUPLEX UE VENOUS UN LT	$1,019.26	$1,274.08	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VASC DUPLEX UE VENOUS UNI RT	$1,019.26	$1,274.08	—	—	20%
X-ray of the abdomen, 1 view CPT 74018 RADIOLOGIC EXAMINATION ABDOMEN 1 VIEW	$254.98	$318.73	—	2% below	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 RADIOLOGIC EXAMINATION ABDOMEN 1 VIEW	$254.98	$318.73	—	—	20%
X-ray of the foot, 2 views CPT 73620 XR FOOT 2 VIEWS	$256.90	$321.12	—	3% below	20%
X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT 2 VIEWS	$256.90	$321.12	—	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 S G P T ALANINE AMINO	$127.91	$159.89	—	144% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 S G P T ALANINE AMINO	$127.91	$159.89	—	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT	$127.91	$159.89	—	144% above	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT	$127.91	$159.89	—	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL ACUTE	$456.11	$570.14	—	88% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL ACUTE	$456.11	$570.14	—	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 DOG DANDER	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALMOND NUT TREE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LOBSTER	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 FEATHER MIX	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 WHEAT	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 A. ALTERNATA MOLD	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MILK	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HOUSE DUST	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 TUNA	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CLAM	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 BERMUDA GRASS	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 EGG WHITE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 SHRIMP	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 TIMOTHY GRASS	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COTTONWOOD	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HAZEL NUT TREE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CASHEW NUT TREE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COW DANDER	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 BRAZIL NUT TREE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 WHITE ASH	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HELMINTHOSPORIUM HALODES	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MAPLE LEAF	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PECAN NUT TREE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CAT DANDER	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ZINC LEVEL UR	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 WALNUT NUT TREE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HORSE DANDER	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PISTACHIO NUT TREE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CRAB	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MAPLE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 SOYBEAN	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 SCALLOP	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CORN	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CODFISH	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ROUGH MARSH ELDER	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 SESAME SEED	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ROUGH PIGWEED	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIUM NOTATUS	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 RUSSIAN TISTLE	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUNTAIN CEDAR	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COMMON RAGWEED	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MULBERRY	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 OAK	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALTERNATA ALTERNATA	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PECAN	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ELM	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 WALNUT	$84.44	$105.55	—	207% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 M5 CANDIDA ALBICANS	$102.83	$128.54	—	274% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 I 16 COCKROACH	$102.83	$128.54	—	274% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 M3 ASPERILLUS FUMIGATUS	$102.83	$128.54	—	274% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 M2 CLADOSPORIUM HERBARUM	$102.83	$128.54	—	274% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 M6 ALTERNARIA TENUIS	$102.83	$128.54	—	274% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 M4 MUCOR RACEMOSUS	$102.83	$128.54	—	274% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 D2 DERTMATOPHAGOIDES FARINAE	$102.83	$128.54	—	274% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 D1 DERATOPHAGOIDES PTERONYSSINUS	$102.83	$128.54	—	274% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COTTONWOOD	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 A. ALTERNATA MOLD	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PENICILLIUM NOTATUS	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALTERNATA ALTERNATA	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HELMINTHOSPORIUM HALODES	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CAT DANDER	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HORSE DANDER	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COW DANDER	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DOG DANDER	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 FEATHER MIX	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HOUSE DUST	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BERMUDA GRASS	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TIMOTHY GRASS	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAPLE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CORN	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SESAME SEED	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUNTAIN CEDAR	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OAK	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ELM	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WALNUT	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAPLE LEAF	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZINC LEVEL UR	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WALNUT NUT TREE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PISTACHIO NUT TREE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PECAN NUT TREE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HAZEL NUT TREE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CASHEW NUT TREE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BRAZIL NUT TREE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WHITE ASH	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALMOND NUT TREE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LOBSTER	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WHEAT	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MILK	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TUNA	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CLAM	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 EGG WHITE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SHRIMP	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUSE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CRAB	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SOYBEAN	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SCALLOP	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CODFISH	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ROUGH MARSH ELDER	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ROUGH PIGWEED	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RUSSIAN TISTLE	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COMMON RAGWEED	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MULBERRY	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PEANUT	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PECAN	$84.44	$105.55	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 M6 ALTERNARIA TENUIS	$102.83	$128.54	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 I 16 COCKROACH	$102.83	$128.54	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 M5 CANDIDA ALBICANS	$102.83	$128.54	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 M4 MUCOR RACEMOSUS	$102.83	$128.54	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 M3 ASPERILLUS FUMIGATUS	$102.83	$128.54	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 M2 CLADOSPORIUM HERBARUM	$102.83	$128.54	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 D2 DERTMATOPHAGOIDES FARINAE	$102.83	$128.54	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 D1 DERATOPHAGOIDES PTERONYSSINUS	$102.83	$128.54	—	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTITE AB	$167.20	$209.00	—	99% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTITE AB	$167.20	$209.00	—	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTI NUCLEAR ANTIBODY	$196.46	$245.58	—	118% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTI NUCLEAR ANTIBODY	$196.46	$245.58	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-NATRIURETIC PEPTIDE	$595.23	$744.04	—	248% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-NATRIURETIC PEPTIDE	$595.23	$744.04	—	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PROFILE	$315.18	$393.97	—	146% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PROFILE	$315.18	$393.97	—	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SMEAR CELL BLOCK CYSTOPATH	$418.19	$522.74	—	75% above	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SMEAR CELL BLOCK CYSTOPATH	$418.19	$522.74	—	—	20%
Blood culture for bacteria CPT 87040 CULTURE BLOOD (AEROBIC & ANEROBIC)	$205.57	$256.96	—	37% above	20%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD (AEROBIC & ANEROBIC)	$205.57	$256.96	—	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$29.26	$36.58	—	30% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ER VENIPUNCTURE	$143.79	$179.74	—	539% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$29.26	$36.58	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ER VENIPUNCTURE	$143.79	$179.74	—	—	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE, RANDOM	$66.05	$82.56	—	101% above	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE, RANDOM	$66.05	$82.56	—	—	20%
Blood lead test CPT 83655 LEAD LEVEL	$88.11	$110.14	—	53% above	20%
Blood lead test inpatient CPT 83655 LEAD LEVEL	$88.11	$110.14	—	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 SERUM PREGNANCY QUAL BETAQ	$157.17	$196.46	—	118% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 SERUM PREGNANCY QUAL BETAQ	$157.17	$196.46	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING ABO	$91.32	$114.15	—	11% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/RH SECOND SAMPLE-NEONATAL	$91.32	$114.15	—	11% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/RH SECOND SAMPLE	$91.32	$114.15	—	11% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO	$157.81	$197.26	—	92% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/RH and ANTIBODY SCREEN-NEONATAL	$217.36	$271.70	—	164% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/RH SECOND SAMPLE-NEONATAL	$91.32	$114.15	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING ABO	$91.32	$114.15	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/RH SECOND SAMPLE	$91.32	$114.15	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO	$157.81	$197.26	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/RH and ANTIBODY SCREEN-NEONATAL	$217.36	$271.70	—	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN	$98.65	$123.31	—	46% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN	$98.65	$123.31	—	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 IMMUNO ASSAY CA 19-9	$175.56	$219.45	—	67% above	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19/9	$204.82	$256.03	—	95% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNO ASSAY CA 19-9	$175.56	$219.45	—	—	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19/9	$204.82	$256.03	—	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA-125	$209.78	$262.22	—	35% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA-125	$209.78	$262.22	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$220.00	$275.00	—	120% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$220.00	$275.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 GC CHLAMYDIA AmpDNA PROBE	$151.82	$189.77	—	15% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA PROBE TECH	$189.78	$237.22	—	43% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CT/GC/TV COMBINED	$579.30	$724.13	—	338% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 GC CHLAMYDIA AmpDNA PROBE	$151.82	$189.77	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA PROBE TECH	$189.78	$237.22	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CT/GC/TV COMBINED	$579.30	$724.13	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$342.76	$428.45	—	209% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$342.76	$428.45	—	—	20%
Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD COUNT AUTO.	$118.29	$147.86	—	51% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE BLOOD COUNT AUTO.	$118.29	$147.86	—	—	20%
Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED	$117.92	$147.40	—	84% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED	$117.92	$147.40	—	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 PROFILE METABOLIC COMPREH	$653.75	$817.19	—	333% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 PROFILE METABOLIC COMPREH	$653.75	$817.19	—	—	20%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$265.02	$331.27	—	152% above	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER	$265.02	$331.27	—	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-SULPHATE	$249.63	$312.04	—	132% above	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-SULPHATE	$249.63	$312.04	—	—	20%
Estradiol blood test CPT 82670 ESTRIODIAL	$255.82	$319.77	—	141% above	20%
Estradiol blood test CPT 82670 ESTRIOL REF LAB	$329.38	$411.73	—	210% above	20%
Estradiol blood test CPT 82670 ESTRADIOL	$347.78	$434.72	—	227% above	20%
Estradiol blood test inpatient CPT 82670 ESTRIODIAL	$255.82	$319.77	—	—	20%
Estradiol blood test inpatient CPT 82670 ESTRIOL REF LAB	$329.38	$411.73	—	—	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$347.78	$434.72	—	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH GONADOTROPIN	$239.94	$299.92	—	109% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH GONADOTROPIN	$239.94	$299.92	—	—	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$243.28	$304.10	—	89% above	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$243.28	$304.10	—	—	20%
Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM	$259.16	$323.95	—	148% above	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM	$259.16	$323.95	—	—	20%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$232.41	$290.51	—	148% above	20%
Free T3 thyroid hormone test CPT 84481 T-3 FREE	$319.35	$399.19	—	240% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$232.41	$290.51	—	—	20%
Free T3 thyroid hormone test inpatient CPT 84481 T-3 FREE	$319.35	$399.19	—	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE	$160.51	$200.64	—	40% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE	$160.51	$200.64	—	—	20%
Free testosterone test CPT 84402 TESTOSTERONE, FREE	$146.92	$183.65	—	20% above	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE	$146.92	$183.65	—	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE; GESTATIONAL DIABETES	$94.33	$117.91	—	136% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE; GESTATIONAL DIABETES	$94.33	$117.91	—	—	20%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST 1 HOUR	$182.92	$228.65	—	46% above	20%
Glucose tolerance test, 3 samples CPT 82951 FBS GLUCOSE QUANTITATIVE	$182.92	$228.65	—	46% above	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST 1 HOUR	$182.92	$228.65	—	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 FBS GLUCOSE QUANTITATIVE	$182.92	$228.65	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC DNA PROBE	$162.50	$203.13	—	14% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONNORHEA PROBE TECH	$180.58	$225.72	—	27% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC DNA PROBE	$162.50	$203.13	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONNORHEA PROBE TECH	$180.58	$225.72	—	—	20%
H. pylori antibody blood test CPT 86677 ANTIBODY H. PYLORI	$168.04	$210.05	—	47% above	20%
H. pylori antibody blood test CPT 86677 H. PYLORI, IGA	$179.74	$224.68	—	57% above	20%
H. pylori antibody blood test CPT 86677 H. PYLORI, IGM	$179.74	$224.68	—	57% above	20%
H. pylori antibody blood test inpatient CPT 86677 ANTIBODY H. PYLORI	$168.04	$210.05	—	—	20%
H. pylori antibody blood test inpatient CPT 86677 H. PYLORI, IGM	$179.74	$224.68	—	—	20%
H. pylori antibody blood test inpatient CPT 86677 H. PYLORI, IGA	$179.74	$224.68	—	—	20%
H. pylori stool antigen test CPT 87338 H.Pylori Stool	$247.28	$309.10	—	155% above	20%
H. pylori stool antigen test inpatient CPT 87338 H.Pylori Stool	$247.28	$309.10	—	—	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 DNA QUANT	$408.32	$510.40	—	36% above	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 ULTRA QUANT [bdna]	$506.62	$633.27	—	69% above	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 VIRAL LOAD HIV-1 QUANT.	$757.42	$946.77	—	152% above	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 DNA QUANT	$408.32	$510.40	—	—	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 ULTRA QUANT [bdna]	$506.62	$633.27	—	—	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 VIRAL LOAD HIV-1 QUANT.	$757.42	$946.77	—	—	20%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1&2 SINGLE RESULT-RAPID	$132.93	$166.16	—	11% above	20%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1 & 2 SINGLE RESULT	$157.17	$196.46	—	31% above	20%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1&2 SINGLE RESULT-RAPID	$132.93	$166.16	—	—	20%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1 & 2 SINGLE RESULT	$157.17	$196.46	—	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV I SCREENING	$117.04	$146.30	—	4% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV I SCREENING	$117.04	$146.30	—	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV High Risk 16/18 Geno	$157.18	$196.47	—	7% above	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV High Risk 16/18 Geno	$157.18	$196.47	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOHEMOGLOBIN	$120.38	$150.48	—	48% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOHEMOGLOBIN	$120.38	$150.48	—	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB	$143.79	$179.74	—	68% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY	$161.35	$201.69	—	88% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB	$143.79	$179.74	—	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY	$161.35	$201.69	—	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG	$147.86	$184.82	—	84% above	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN	$161.35	$201.69	—	101% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG	$147.86	$184.82	—	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGEN	$161.35	$201.69	—	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$179.88	$224.85	—	67% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$179.88	$224.85	—	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C QUATIFICATION	$855.23	$1,069.04	—	242% above	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C QUATIFICATION	$855.23	$1,069.04	—	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IGG AB	$135.43	$169.29	—	108% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IGG AB	$135.43	$169.29	—	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGG AB	$132.93	$166.16	—	48% above	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IGG AB	$132.93	$166.16	—	—	20%
Homocysteine blood test CPT 83090 HOMOCYSTEIN RANDOM URINE	$272.54	$340.67	—	159% above	20%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$272.54	$340.67	—	159% above	20%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE	$272.54	$340.67	—	—	20%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEIN RANDOM URINE	$272.54	$340.67	—	—	20%
Insulin blood test CPT 83525 INSULIN LEVEL TOTAL	$313.50	$391.88	—	331% above	20%
Insulin blood test inpatient CPT 83525 INSULIN LEVEL TOTAL	$313.50	$391.88	—	—	20%
Iron blood test (serum iron) CPT 83540 IRON SERUM	$230.74	$288.42	—	215% above	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON SERUM	$230.74	$288.42	—	—	20%
Iron-binding capacity (TIBC) test CPT 83550 TOTAL IRON BINDING CAPACITY	$219.87	$274.84	—	221% above	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TOTAL IRON BINDING CAPACITY	$219.87	$274.84	—	—	20%
Kidney function blood test panel CPT 80069 RENAL PANEL	$249.13	$311.41	—	73% above	20%
Kidney function blood test panel inpatient CPT 80069 RENAL PANEL	$249.13	$311.41	—	—	20%
LH (luteinizing hormone) test CPT 83002 LUTEINIZING HORMONE LH	$203.15	$253.94	—	114% above	20%
LH (luteinizing hormone) test inpatient CPT 83002 LUTEINIZING HORMONE LH	$203.15	$253.94	—	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$127.91	$159.89	—	60% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$127.91	$159.89	—	—	20%
Liver function blood test panel CPT 80076 LIVER PROFILE	$265.85	$332.31	—	121% above	20%
Liver function blood test panel inpatient CPT 80076 LIVER PROFILE	$265.85	$332.31	—	—	20%
Magnesium blood test CPT 83735 MAGNESIUM, URINE RANDOM	$107.85	$134.81	—	51% above	20%
Magnesium blood test CPT 83735 MAGNESIUM RBC	$113.70	$142.12	—	59% above	20%
Magnesium blood test CPT 83735 MAGNESIUM	$157.17	$196.46	—	120% above	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, URINE RANDOM	$107.85	$134.81	—	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM RBC	$113.70	$142.12	—	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$157.17	$196.46	—	—	20%
Measles (rubeola) antibody test CPT 86765 MEASLES - RUBEOLA TITER	$209.00	$261.25	—	188% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES - RUBEOLA TITER	$209.00	$261.25	—	—	20%
Obstetric blood test panel CPT 80055 PRENATAL STUDIES	$192.28	$240.35	—	3% above	20%
Obstetric blood test panel inpatient CPT 80055 PRENATAL STUDIES	$192.28	$240.35	—	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATE SPECIFIC ANTIGEN- FREE	$433.89	$542.36	—	322% above	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATE SPECIFIC ANTIGEN- FREE	$433.89	$542.36	—	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPECIFIC ANTIGEN	$198.14	$247.67	—	84% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPECIFIC ANTIGEN	$198.14	$247.67	—	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 LIQUID BASED PAP, IMAGE GUIDED	$139.48	$174.35	—	4% above	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 LIQUID BASED PAP, IMAGE GUIDED	$139.48	$174.35	—	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE HORMONE C	$741.54	$926.92	—	241% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE HORMONE C	$741.54	$926.92	—	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 DVVRT	$121.22	$151.53	—	120% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL PROTHROMBIN TIME	$192.28	$240.35	—	248% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 DVVRT	$121.22	$151.53	—	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL PROTHROMBIN TIME	$192.28	$240.35	—	—	20%
Progesterone blood test CPT 84144 PROGESTRONE	$560.96	$701.20	—	323% above	20%
Progesterone blood test inpatient CPT 84144 PROGESTRONE	$560.96	$701.20	—	—	20%
Prolactin blood test CPT 84146 PROLACTIN	$290.93	$363.66	—	152% above	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$290.93	$363.66	—	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A	$153.12	$191.40	—	181% above	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A	$153.12	$191.40	—	—	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY	$117.04	$146.30	—	53% above	20%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY	$117.04	$146.30	—	—	20%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 ANALYSIS SEMEN COMPLETE	$57.69	$72.11	—	50% below	20%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 ANALYSIS SEMEN COMPLETE	$57.69	$72.11	—	—	20%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES	$151.42	$189.27	—	107% above	20%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES	$151.42	$189.27	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHLLIS TESTING QUALIT(VDRL,RPR,ART).	$72.93	$91.16	—	43% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHLLIS TESTING QUALIT(VDRL,RPR,ART).	$72.93	$91.16	—	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB GOLD	$276.72	$345.90	—	19% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB GOLD	$276.72	$345.90	—	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$347.78	$434.72	—	179% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$347.78	$434.72	—	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE	$202.01	$252.51	—	125% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AUTO ANTI BODY	$202.01	$252.51	—	125% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOME IGG AB	$202.01	$252.51	—	125% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY MICROSOME IGG AB	$202.01	$252.51	—	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE	$202.01	$252.51	—	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AUTO ANTI BODY	$202.01	$252.51	—	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$284.24	$355.30	—	116% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$284.24	$355.30	—	—	20%
Trichomonas test (NAAT) one side CPT 87661 TRICHOMONAS VAGINALIS RT/PCR	$249.92	$312.40	—	101% above	20%
Trichomonas test (NAAT) inpatient one side CPT 87661 TRICHOMONAS VAGINALIS RT/PCR	$249.92	$312.40	—	—	20%
Uric acid blood test CPT 84550 URIC ACID SERUM	$127.91	$159.89	—	82% above	20%
Uric acid blood test inpatient CPT 84550 URIC ACID SERUM	$127.91	$159.89	—	—	20%
Urinalysis with microscope exam, automated CPT 81001 URINE ANALYSIS AUTOMATED W/ MICRO	$76.08	$95.10	—	27% above	20%
Urinalysis with microscope exam, automated CPT 81001 UA COMPLETE NO REFLEX	$86.11	$107.64	—	44% above	20%
Urinalysis with microscope exam, automated CPT 81001 UA W/O MICRO NO REFLEX	$86.11	$107.64	—	44% above	20%
Urinalysis with microscope exam, automated CPT 81001 UA W/O MICRO W/REFLEX	$86.11	$107.64	—	44% above	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINE ANALYSIS AUTOMATED W/ MICRO	$76.08	$95.10	—	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA W/O MICRO W/REFLEX	$86.11	$107.64	—	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA W/O MICRO NO REFLEX	$86.11	$107.64	—	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA COMPLETE NO REFLEX	$86.11	$107.64	—	—	20%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS COMPLETE W/MIC	$86.11	$107.64	—	318% above	20%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS COMPLETE W/MIC	$86.11	$107.64	—	—	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE	$168.04	$210.05	—	89% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE	$168.04	$210.05	—	—	20%
Urine pregnancy test, read by color change CPT 81025 ED PREGNANCY TEST	$31.77	$39.71	—	53% below	20%
Urine pregnancy test, read by color change inpatient CPT 81025 ED PREGNANCY TEST	$31.77	$39.71	—	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 B12 VITAMIN REF LAB	$244.11	$305.14	—	93% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 B12 VITAMIN REF LAB	$244.11	$305.14	—	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$301.80	$377.25	—	62% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY	$301.80	$377.25	—	—	20%
Zinc blood test CPT 84630 ZINC LEVEL-BLD	$125.33	$156.66	—	101% above	20%
Zinc blood test inpatient CPT 84630 ZINC LEVEL-BLD	$125.33	$156.66	—	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 SERUM PREGNANCY QUANTITATIVE	$267.52	$334.40	—	155% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANTITATIVE	$273.68	$342.10	—	161% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 SERUM PREGNANCY QUANTITATIVE	$267.52	$334.40	—	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANTITATIVE	$273.68	$342.10	—	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY FOR RUPT APPENDIX W/ABCESS	$12,699.82	$15,874.78	—	280% above	20%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 APPENDECTOMY FOR RUPT APPENDIX W/ABCESS	$12,699.82	$15,874.78	—	—	20%
Appendectomy, open surgery CPT 44950 APPENDECTOMY	$4,563.73	$5,704.66	—	45% above	20%
Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY	$4,563.73	$5,704.66	—	—	20%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Knee Arthroscopy/Surgery	$13,909.20	$17,386.50	—	10% below	20%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 Knee Arthroscopy/Surgery	$13,909.20	$17,386.50	—	—	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST 1ST LESION STRTCTC	$4,905.71	$6,132.14	—	70% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BX BREAST 1ST LESION STRTCTC	$4,905.71	$6,132.14	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TRTMNT DISTAL FIBULA FX WO MN	$660.00	$825.00	—	91% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TRTMNT DISTAL FIBULA FX WO MN	$660.00	$825.00	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TRTMNT METATARSAL FX W/O MNP	$846.56	$1,058.20	—	32% above	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TRTMNT METATARSAL FX W/O MNP	$846.56	$1,058.20	—	—	20%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRECTION HALLUX VALGUS	$10,155.20	$12,694.00	—	191% above	20%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 CORRECTION HALLUX VALGUS	$10,155.20	$12,694.00	—	—	20%
Bunion correction with removal of part of the big toe joint CPT 28292 CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PRO	$3,756.98	$4,696.23	—	8% above	20%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PRO	$3,756.98	$4,696.23	—	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ER HEART ELECTROCONVERSION	$1,392.45	$1,740.56	—	22% above	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ER HEART ELECTROCONVERSION	$1,392.45	$1,740.56	—	—	20%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY	$6,208.32	$7,760.40	—	106% above	20%
Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL SURGERY	$6,208.32	$7,760.40	—	—	20%
Cataract surgery with lens implant CPT 66984 CATARACT REMOVAL INSERTION OF LENS	$5,059.27	$6,324.09	—	53% below	20%
Cataract surgery with lens implant inpatient CPT 66984 CATARACT REMOVAL INSERTION OF LENS	$5,059.27	$6,324.09	—	—	20%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX	$3,940.64	$4,925.80	—	331% above	20%
Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX	$3,940.64	$4,925.80	—	—	20%
Cesarean delivery, including prenatal and postpartum care CPT 59510 Cesarean Delivery	$2,088.24	$2,610.30	—	46% below	20%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 Cesarean Delivery	$2,088.24	$2,610.30	—	—	20%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMSION >28DAYS OF AGE	$4,503.54	$5,629.42	—	93% above	20%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUMSION >28DAYS OF AGE	$4,503.54	$5,629.42	—	—	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMSION W/REGIONAL BLOCK	$4,567.07	$5,708.84	—	112% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMSION W/REGIONAL BLOCK	$4,567.07	$5,708.84	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLSED TRTMT DISTAL RADIUS FX	$684.69	$855.86	—	31% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREATMENT FX RADIUS/ULNA	$777.48	$971.85	—	49% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLSED TRTMT DISTAL RADIUS FX	$684.69	$855.86	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TREATMENT FX RADIUS/ULNA	$777.48	$971.85	—	—	20%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY LESION REMOVAL	$2,417.71	$3,022.14	—	3% below	20%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY LESION REMOVAL	$2,417.71	$3,022.14	—	—	20%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY	$2,743.50	$3,429.37	—	50% above	20%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY	$2,743.50	$3,429.37	—	—	20%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY DIAGNOSTIC	$2,394.30	$2,992.88	—	29% above	20%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY DIAGNOSTIC	$2,394.30	$2,992.88	—	—	20%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX OF CERVIX W/SCOPE LEEP	$5,454.90	$6,818.63	—	198% above	20%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 BX OF CERVIX W/SCOPE LEEP	$5,454.90	$6,818.63	—	—	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$960.08	$1,200.10	—	141% above	20%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$960.08	$1,200.10	—	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystoscopy	$5,607.36	$7,009.20	—	419% above	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystoscopy	$5,607.36	$7,009.20	—	—	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION & CURETTAGE DX &/THER NONOBSTET	$8,698.70	$10,873.37	—	196% above	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION & CURETTAGE DX&/THER NONOBSTETR	$8,698.70	$10,873.37	—	196% above	20%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION & CURETTAGE DX&/THER NONOBSTETR	$8,698.70	$10,873.37	—	—	20%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION & CURETTAGE DX &/THER NONOBSTET	$8,698.70	$10,873.37	—	—	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 TYPANOSTOMY	$6,623.22	$8,279.02	—	267% above	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 TYPANOSTOMY	$6,623.22	$8,279.02	—	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$303.85	$379.81	—	167% above	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI	$303.85	$379.81	—	—	20%
Earwax removal with instruments, one ear CPT 69210 ER REMOVE IMPACTED EAR WAX	$197.74	$247.18	—	58% above	20%
Earwax removal with instruments, one ear CPT 69210 RMVL IMPACTED CERIMEN ONE OR BOTH EARS	$286.75	$358.44	—	129% above	20%
Earwax removal with instruments, one ear inpatient CPT 69210 ER REMOVE IMPACTED EAR WAX	$197.74	$247.18	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 RMVL IMPACTED CERIMEN ONE OR BOTH EARS	$286.75	$358.44	—	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING	$574.64	$718.30	—	69% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY OF UTERUS LINING	$574.64	$718.30	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC	$3,203.20	$4,004.00	—	90% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX INTERLAMINAR CRV/THRC	$3,203.20	$4,004.00	—	—	20%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HRN 1ST >10 RDC	$14,108.34	$17,635.42	—	129% above	20%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 RPR AA HRN 1ST >10 RDC	$14,108.34	$17,635.42	—	—	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST <3 CM RDC	$16,770.60	$20,963.25	—	339% above	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 RPR AA HRN 1ST <3 CM RDC	$16,770.60	$20,963.25	—	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY DIAGNOSTIC	$1,805.12	$2,256.40	—	97% above	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY DIAGNOSTIC	$1,805.12	$2,256.40	—	—	20%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECSTECTOMY	$11,063.98	$13,829.97	—	70% above	20%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPIC CHOLECSTECTOMY	$11,063.98	$13,829.97	—	—	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECSTECTOMY W GRAPH	$17,498.21	$21,872.76	—	24% above	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPARO CHOLECSTECTOMY W GRAPH	$17,498.21	$21,872.76	—	—	20%
Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECOMY	$7,703.74	$9,629.68	—	47% above	20%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 CHOLECYSTECOMY	$7,703.74	$9,629.68	—	—	20%
Hammertoe correction surgery CPT 28285 CORRECTION HAMMERTOE	$4,378.00	$5,472.50	—	69% above	20%
Hammertoe correction surgery inpatient CPT 28285 CORRECTION HAMMERTOE	$4,378.00	$5,472.50	—	—	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOIDECTOMY	$1,673.67	$2,092.09	—	112% above	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HEMORRHOIDECTOMY	$1,673.67	$2,092.09	—	—	20%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY NTRNL/XTRNL 1 COLUM/GRP	$6,126.78	$7,658.48	—	124% above	20%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY NTRNL/XTRNL 1 COLUM/GRP	$6,126.78	$7,658.48	—	—	20%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL ABDOMINAL HYSTERECTOMY	$5,908.32	$7,385.40	—	at median	20%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL ABDOMINAL HYSTERECTOMY	$5,908.32	$7,385.40	—	—	20%
IUD insertion (the device itself billed separately) CPT 58300 INSERTION INTRAUTERINE DEVICE IUD	$2,159.43	$2,699.29	—	648% above	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERTION INTRAUTERINE DEVICE IUD	$2,159.43	$2,699.29	—	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D OF ABSCESS SIMPLE	$514.98	$643.72	—	28% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE SKIN ABSCESS SIMPLE	$523.34	$654.17	—	30% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D OF ABSCESS SIMPLE	$514.98	$643.72	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE SKIN ABSCESS SIMPLE	$523.34	$654.17	—	—	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR INIT INGUINAL HERNIA 5 Y/0 OR OLD	$6,702.93	$8,378.66	—	76% above	20%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR INIT INGUINAL HERNIA 5 Y/0 OR OLD	$6,702.93	$8,378.66	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON/LIGAMENT/CYST	$778.56	$973.20	—	104% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON/LIGAMENT/CYST	$778.56	$973.20	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS (MAJOR JOINT)	$1,161.58	$1,451.98	—	158% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS (MAJOR JOINT)	$1,161.58	$1,451.98	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS (INTERM JOINT)	$861.39	$1,076.74	—	128% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS (INTERM JOINT)	$861.39	$1,076.74	—	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS (SMALL JOINT)	$515.30	$644.13	—	74% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS (SMALL JOINT)	$515.30	$644.13	—	—	20%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 ARTHROSCOPY KNEE W/MENISCUS REPAIR	$7,424.78	$9,280.98	—	64% above	20%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 ARTHROSCOPY KNEE W/MENISCUS REPAIR	$7,424.78	$9,280.98	—	—	20%
Knee arthroscopy with meniscus trim CPT 29881 ARTHROSCOPY KNEE SURG W/MENISCECTOMY M/L	$7,164.44	$8,955.55	—	28% above	20%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHROSCOPY KNEE SURG W/MENISCECTOMY M/L	$7,164.44	$8,955.55	—	—	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ARTHROSCOPY KNEE SURGICAL W MENISCECTOMY	$8,484.90	$10,606.12	—	88% above	20%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 ARTHROSCOPY KNEE SURGICAL W MENISCECTOMY	$8,484.90	$10,606.12	—	—	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 DEBRIDEMENT SHAVING ARTICULAR CARTILAGE	$10,321.52	$12,901.90	—	112% above	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 DEBRIDEMENT SHAVING ARTICULAR CARTILAGE	$10,321.52	$12,901.90	—	—	20%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPIC APPENDECTOMY	$11,745.04	$14,681.30	—	82% above	20%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAPAROSCOPIC APPENDECTOMY	$11,745.04	$14,681.30	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 SC/AX/TR/EXTM/EX-HF <2.5CM	$1,060.46	$1,325.57	—	76% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 SC/AX/TR/EXTM/EX-HF <2.5CM	$1,060.46	$1,325.57	—	—	20%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX/DX/THER SBST INTRLMNR LMBR/SAC W/IMG	$493.26	$616.58	—	65% below	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX/DX/THER SBST INTRLMNR LMBR/SAC W/IMG	$493.26	$616.58	—	—	20%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC	$675.66	$844.57	—	53% below	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC	$675.66	$844.57	—	—	20%
Lumpectomy (partial mastectomy) CPT 19301 PARTIAL MASTECTOMY	$9,305.83	$11,632.29	—	122% above	20%
Lumpectomy (partial mastectomy) inpatient CPT 19301 PARTIAL MASTECTOMY	$9,305.83	$11,632.29	—	—	20%
Miscarriage treatment with D&C, first trimester CPT 59820 ER TX MISSED ABORTION 1ST TRI	$4,106.96	$5,133.70	—	9% above	20%
Miscarriage treatment with D&C, first trimester CPT 59820 TX OF MISSED ABORTION COMP SURG 1ST TRI	$4,106.96	$5,133.70	—	9% above	20%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 ER TX MISSED ABORTION 1ST TRI	$4,106.96	$5,133.70	—	—	20%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 TX OF MISSED ABORTION COMP SURG 1ST TRI	$4,106.96	$5,133.70	—	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION LIPOMAS	$2,365.05	$2,956.31	—	242% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISION LIPOMAS	$2,365.05	$2,956.31	—	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION BENIGN LESION-LESION <0.5CM	$2,919.47	$3,649.34	—	433% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXCISION BENIGN LESION-LESION <0.5CM	$2,919.47	$3,649.34	—	—	20%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$1,003.20	$1,254.00	—	244% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE	$1,003.20	$1,254.00	—	—	20%
Paracentesis with imaging guidance CPT 49083 PERITONEAL LAVAGE SUB	$2,499.08	$3,123.85	—	82% above	20%
Paracentesis with imaging guidance inpatient CPT 49083 PERITONEAL LAVAGE SUB	$2,499.08	$3,123.85	—	—	20%
Partial knee replacement (one compartment) CPT 27446 RIVISION OF KNEE JOINT	$19,290.13	$24,112.66	—	167% above	20%
Partial knee replacement (one compartment) inpatient CPT 27446 RIVISION OF KNEE JOINT	$19,290.13	$24,112.66	—	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL NAIL BED	$1,424.72	$1,780.90	—	168% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL NAIL BED	$1,424.72	$1,780.90	—	—	20%
Removal of a breast lump, open surgery CPT 19120 REMOVAL BREAST LESION	$4,970.01	$6,212.51	—	183% above	20%
Removal of a breast lump, open surgery inpatient CPT 19120 REMOVAL BREAST LESION	$4,970.01	$6,212.51	—	—	20%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY SIMPLE	$1,764.62	$2,205.78	—	279% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FOREIGN BODY SIMPLE	$1,764.62	$2,205.78	—	—	20%
Short arm cast (elbow to hand) CPT 29075 APPLY ELBOW/FINGER CAST	$601.04	$751.30	—	95% above	20%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLY ELBOW/FINGER CAST	$601.04	$751.30	—	—	20%
Short arm splint (forearm and hand) CPT 29125 APP SHORT ARM SPLINT FOREARM-HAND STATIC	$560.40	$700.50	—	125% above	20%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$560.40	$700.50	—	125% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APP SHORT ARM SPLINT FOREARM-HAND STATIC	$560.40	$700.50	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT	$560.40	$700.50	—	—	20%
Short leg cast (below the knee) CPT 29405 APP OF SHORT LEG CAST BELOW KNEE-TOES	$632.72	$790.90	—	103% above	20%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST	$632.72	$790.90	—	103% above	20%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST	$632.72	$790.90	—	—	20%
Short leg cast (below the knee) inpatient CPT 29405 APP OF SHORT LEG CAST BELOW KNEE-TOES	$632.72	$790.90	—	—	20%
Short leg splint (calf to foot) CPT 29515 APP OF SHORT LEG SPLINT (CALF-FOOT)	$407.32	$509.15	—	54% above	20%
Short leg splint (calf to foot) CPT 29515 APPLY LOWER LEG SPLINT	$427.20	$534.00	—	61% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 APP OF SHORT LEG SPLINT (CALF-FOOT)	$407.32	$509.15	—	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 APPLY LOWER LEG SPLINT	$427.20	$534.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SC/NE/AX/EX/GE/TR <2.5CM	$581.20	$726.50	—	58% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SC/NE/AX/EX/GE/TR <2.5CM	$581.20	$726.50	—	—	20%
Skin tag removal, up to 15 tags CPT 11200 RMVL SKIN TAGS MULTIPLE UP TO 15	$1,887.95	$2,359.94	—	662% above	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 RMVL SKIN TAGS MULTIPLE UP TO 15	$1,887.95	$2,359.94	—	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 ER SPINAL PUNCTURE LUMBAR DX	$1,137.72	$1,422.15	—	42% above	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ER SPINAL PUNCTURE LUMBAR DX	$1,137.72	$1,422.15	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SC/NE/AX/EX/GE/TR 2.6-7.5CM	$656.86	$821.08	—	59% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SC/NE/AX/EX/GE/TR 2.6-7.5CM	$656.86	$821.08	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 FACE/ER/EYLDS/N/L/MM <2.5CM	$545.69	$682.11	—	34% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 FACE/ER/EYLDS/N/L/MM <2.5CM	$545.69	$682.11	—	—	20%
TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP)	$7,082.59	$8,853.24	—	24% above	20%
TURP (transurethral resection of the prostate) inpatient CPT 52601 PROSTATECTOMY (TURP)	$7,082.59	$8,853.24	—	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$642.73	$803.41	—	138% above	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES	$642.73	$803.41	—	—	20%
Tonsil and adenoid removal, age 12 or older CPT 42821 TONSILLECTOMY AND ADENOIDECTOMY >12	$3,862.32	$4,827.90	—	6% below	20%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 TONSILLECTOMY AND ADENOIDECTOMY >12	$3,862.32	$4,827.90	—	—	20%
Total hip replacement CPT 27130 TOTAL HIP REPLACEMENT	$6,716.42	$8,395.53	—	7% above	20%
Total hip replacement inpatient CPT 27130 TOTAL HIP REPLACEMENT	$6,716.42	$8,395.53	—	—	20%
Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY	$21,558.39	$26,947.99	—	191% above	20%
Total knee replacement inpatient CPT 27447 TOTAL KNEE ARTHROPLASTY	$21,558.39	$26,947.99	—	—	20%
Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH	$4,518.20	$5,647.75	—	241% above	20%
Trigger finger release surgery inpatient CPT 26055 INCISE FINGER TENDON SHEATH	$4,518.20	$5,647.75	—	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION(S) TRIGGER PTS 1 OR 2 MUSCLES	$759.09	$948.86	—	54% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION(S) TRIGGER PTS 1 OR 2 MUSCLES	$759.09	$948.86	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1S LESION US IMAG	$3,971.00	$4,963.75	—	79% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1S LESION US IMAG	$3,971.00	$4,963.75	—	—	20%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPR GI ENDOSCOPY BIOPSY	$2,171.15	$2,713.94	—	31% above	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPR GI ENDOSCOPY BIOPSY	$2,171.15	$2,713.94	—	—	20%
Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GASTROINTESINAL ENDOSCOPY DIRECT	$2,979.86	$3,724.82	—	40% above	20%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 UPPR GASTROINTESINAL ENDOSCOPY DIRECT	$2,979.86	$3,724.82	—	—	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 UPPR GI ENDOSCOPY W SNARE	$3,420.26	$4,275.33	—	11% above	20%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 UPPR GI ENDOSCOPY W SNARE	$3,420.26	$4,275.33	—	—	20%
Upper endoscopy (EGD), diagnostic CPT 43235 UPPR GI ENDOSCOPY DIAGNOSIS	$2,248.54	$2,810.67	—	6% above	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPR GI ENDOSCOPY DIAGNOSIS	$2,248.54	$2,810.67	—	—	20%
Vaginal delivery, including prenatal and postpartum care CPT 59400 RTNE OB CARE INC ANTE VAG DEL & POST	$1,657.04	$2,071.30	—	64% below	20%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 RTNE OB CARE INC ANTE VAG DEL & POST	$1,657.04	$2,071.30	—	—	20%
Wart removal, up to 14 warts CPT 17110 BENIGN LESION DESTRUCTION UP TO 14	$712.27	$890.34	—	206% above	20%
Wart removal, up to 14 warts inpatient CPT 17110 BENIGN LESION DESTRUCTION UP TO 14	$712.27	$890.34	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRDMENT SUBQ TISSUE 1ST <20SQ CM	$1,151.18	$1,438.97	—	73% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRDMENT SUBQ TISSUE 1ST <20SQ CM	$1,151.18	$1,438.97	—	—	20%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$18,276.28	$22,845.35	—	136% above	20%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP	$18,276.28	$22,845.35	—	136% above	20%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$18,276.28	$22,845.35	—	—	20%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP	$18,276.28	$22,845.35	—	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANS OF BLOOD / BLOOD COMPONENT I UNIT	$1,291.62	$1,614.53	—	42% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANS BLOOD / BLOOD COMPONENT I UNIT	$1,291.62	$1,614.53	—	42% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 2E TRANS BLOOD / BLOOD COMPONENT- 1UNIT	$1,291.62	$1,614.53	—	42% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANS BOOD / BLOOD COMPONENT- I UNIT	$1,291.62	$1,614.53	—	42% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANS BOOD / BLOOD COMPONENT- I UNIT	$1,291.62	$1,614.53	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANS BLOOD / BLOOD COMPONENT I UNIT	$1,291.62	$1,614.53	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANS OF BLOOD / BLOOD COMPONENT I UNIT	$1,291.62	$1,614.53	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 2E TRANS BLOOD / BLOOD COMPONENT- 1UNIT	$1,291.62	$1,614.53	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MEDICATED NEBULIZER	$207.70	$259.62	—	11% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 DEEP SPUTUM INDUCTION INITIAL	$207.70	$259.62	—	11% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 TREATMENT IPPB	$207.70	$259.62	—	11% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TREAT NON PRESSURIZED	$207.70	$259.62	—	11% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$378.74	$473.42	—	102% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MEDICATED NEBULIZER	$207.70	$259.62	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 TREATMENT IPPB	$207.70	$259.62	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 DEEP SPUTUM INDUCTION INITIAL	$207.70	$259.62	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL TREAT NON PRESSURIZED	$207.70	$259.62	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$378.74	$473.42	—	—	20%
Chemotherapy IV infusion, first hour CPT 96413 IV ADMIN CHEMO INITIAL	$968.00	$1,210.00	—	57% above	20%
Chemotherapy IV infusion, first hour CPT 96413 Chemo, IV Infusion, Up to 1HR	$968.00	$1,210.00	—	57% above	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo, IV Infusion, Up to 1HR	$968.00	$1,210.00	—	—	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 IV ADMIN CHEMO INITIAL	$968.00	$1,210.00	—	—	20%
Critical care, first 30 to 74 minutes CPT 99291 ER CRITICAL CARE 1st HR	$2,561.09	$3,201.36	—	44% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ER CRITICAL CARE 1st HR	$2,561.09	$3,201.36	—	—	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY	$1,073.54	$1,341.93	—	29% above	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY	$1,073.54	$1,341.93	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD TRACING ONLY	$188.48	$235.60	—	15% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 Tracing only	$279.68	$349.60	—	27% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD TRACING ONLY	$188.48	$235.60	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 Tracing only	$279.68	$349.60	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 E/R LEVEL 1	$300.50	$375.63	—	69% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 E/R LEVEL 1	$300.50	$375.63	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 E/R LEVEL 2	$532.10	$665.12	—	42% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 E/R LEVEL 2	$532.10	$665.12	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 E/R LEVEL 3	$784.26	$980.32	—	25% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 E/R LEVEL 3	$784.26	$980.32	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 E/R LEVEL 4	$1,424.81	$1,781.01	—	40% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 E/R LEVEL 4	$1,424.81	$1,781.01	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 E/R LEVEL 5	$2,064.39	$2,580.49	—	39% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 E/R LEVEL 5	$2,064.39	$2,580.49	—	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS T / DOBUTAMIN STRESS TEST	$1,459.66	$1,824.57	—	76% above	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS T / DOBUTAMIN STRESS TEST	$1,459.66	$1,824.57	—	—	20%
Group psychotherapy session CPT 90853 Group Psychotherapy	$279.22	$349.03	—	151% above	20%
Group psychotherapy session inpatient CPT 90853 Group Psychotherapy	$279.22	$349.03	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ED IV INF HYDRATION UP TO 1HR	$434.22	$542.77	—	35% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OB IV HYDRATION UP TP 1 HOUR	$434.22	$542.77	—	35% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT	$550.24	$687.80	—	71% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OB IV HYDRATION UP TP 1 HOUR	$434.22	$542.77	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ED IV INF HYDRATION UP TO 1HR	$434.22	$542.77	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT	$550.24	$687.80	—	—	20%
IV infusion of a medicine, first hour CPT 96365 2E INFU THER DIAG TO 1 HR	$414.32	$517.90	—	6% above	20%
IV infusion of a medicine, first hour CPT 96365 ER IV INF THER/ DIAG UP TO 1HR	$414.32	$517.90	—	6% above	20%
IV infusion of a medicine, first hour CPT 96365 L& D INFU THERA UP TO 1HR	$414.32	$517.90	—	6% above	20%
IV infusion of a medicine, first hour CPT 96365 IV ADMIN MEDICATION (INITIAL HR)	$414.32	$517.90	—	6% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 ER IV INF THER/ DIAG UP TO 1HR	$414.32	$517.90	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 2E INFU THER DIAG TO 1 HR	$414.32	$517.90	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 L& D INFU THERA UP TO 1HR	$414.32	$517.90	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV ADMIN MEDICATION (INITIAL HR)	$414.32	$517.90	—	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERA PROPHYL OR DIAG INJ/ SUBSUT OR IM	$237.42	$296.78	—	126% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER INJECTION SUB-Q/IM	$237.42	$296.78	—	126% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 L & D INJ SUB CUT/ IM	$308.49	$385.61	—	194% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ER INJECTION SUB-Q/IM	$237.42	$296.78	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERA PROPHYL OR DIAG INJ/ SUBSUT OR IM	$237.42	$296.78	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 L & D INJ SUB CUT/ IM	$308.49	$385.61	—	—	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psychiatric Diagnostic Evaluation	$271.62	$339.52	—	29% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psych Daignostic Evaluation	$271.62	$339.52	—	29% above	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psych Daignostic Evaluation	$271.62	$339.52	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psychiatric Diagnostic Evaluation	$271.62	$339.52	—	—	20%
New patient office visit, about 30 minutes CPT 99203 OUTPATIENT VISIT NEW INTERMEDIATE	$285.08	$356.35	—	33% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 OUTPATIENT VISIT NEW INTERMEDIATE	$285.08	$356.35	—	—	20%
New patient office visit, about 45 minutes CPT 99204 OUTPATIENT VISIT NEW EXTENDED	$357.81	$447.26	—	27% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 OUTPATIENT VISIT NEW EXTENDED	$357.81	$447.26	—	—	20%
New patient office visit, about 60 minutes CPT 99205 OUTPATIENT VISIT NEW COMPREHENSIVE	$449.77	$562.21	—	20% above	20%
New patient office visit, about 60 minutes inpatient CPT 99205 OUTPATIENT VISIT NEW COMPREHENSIVE	$449.77	$562.21	—	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OUTPATIENT VISIT NEW MODERATE	$203.15	$253.94	—	35% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OUTPATIENT VISIT NEW MODERATE	$203.15	$253.94	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 EXERCISE 1 UNIT	$64.00	$80.00	—	36% below	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 EXERCISE 1 UNIT	$64.00	$80.00	—	—	20%
Psychotherapy for crisis, first 60 minutes CPT 90839 Psychotherapy, for crisis initial 60 min	$336.16	$420.20	—	40% above	20%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 Psychotherapy, for crisis initial 60 min	$336.16	$420.20	—	—	20%
Psychotherapy session, 30 minutes CPT 90832 Psychotherapy 30 min w/pt 7 or family	$198.00	$247.50	—	24% above	20%
Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 min. w/ pt &/ Family	$198.14	$247.67	—	24% above	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy 30 min w/pt 7 or family	$198.00	$247.50	—	—	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy, 30 min. w/ pt &/ Family	$198.14	$247.67	—	—	20%
Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 min. w/ pt &/ Family	$263.34	$329.18	—	46% above	20%
Psychotherapy session, 45 minutes CPT 90834 Psychotherapy 45 min w/pt & or family	$264.00	$330.00	—	47% above	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy, 45 min. w/ pt &/ Family	$263.34	$329.18	—	—	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy 45 min w/pt & or family	$264.00	$330.00	—	—	20%
Psychotherapy session, 60 minutes CPT 90837 Psychotherapy 60 min. w/pt/or family	$261.36	$326.70	—	19% above	20%
Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 min. w/ Pt &/ Family	$263.34	$329.18	—	19% above	20%
Psychotherapy session, 60 minutes CPT 90837 Group Psychotherapy	$279.22	$349.03	—	27% above	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy 60 min. w/pt/or family	$261.36	$326.70	—	—	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy, 60 min. w/ Pt &/ Family	$263.34	$329.18	—	—	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 Group Psychotherapy	$279.22	$349.03	—	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OUTPATIENT VISIT EST COMPREHENSIVE/MODIF	$359.48	$449.35	—	36% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OUTPATIENT VISIT EST COMPREHENSIVE/MODIF	$359.48	$449.35	—	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OUTPATIENT VISIT EST INTERMEDIATE	$227.39	$284.24	—	54% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OUTPATIENT VISIT EST INTERMEDIATE	$227.39	$284.24	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OUTPATIENT VISIT EST EXTENDED	$292.60	$365.75	—	65% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OUTPATIENT VISIT EST EXTENDED	$292.60	$365.75	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OUTPATIENT VISIT EST MODERATE	$188.94	$236.17	—	65% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OUTPATIENT VISIT EST MODERATE	$188.94	$236.17	—	—	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY W/GRAPHIC RECORD	$426.54	$533.17	—	43% above	20%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY W/GRAPHIC RECORD	$426.54	$533.17	—	—	20%
Spirometry before and after a bronchodilator CPT 94060 PULMONARY FUNCTION TESTING	$879.47	$1,099.34	—	68% above	20%
Spirometry before and after a bronchodilator CPT 94060 POST BRONCHODILATOR	$879.47	$1,099.34	—	68% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 POST BRONCHODILATOR	$879.47	$1,099.34	—	—	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 PULMONARY FUNCTION TESTING	$879.47	$1,099.34	—	—	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 CARDIAC STRESS TEST	$1,171.24	$1,464.05	—	172% above	20%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 CARDIAC STRESS TEST	$1,171.24	$1,464.05	—	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV VACCINE 1X0.5ML ABRYSVO	$259.60	$324.50	—	29% below	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV VACCINE 1X0.5ML ABRYSVO	$259.60	$324.50	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED ADMIN IMMUNIZATION 1 VACCINE	$97.17	$121.46	—	73% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED ADMIN IMMUNIZATION 1 VACCINE	$97.17	$121.46	—	—	20%

Source file: https://www.jacksonparkhospital.org/assets/1/7/362448028%20Jackson%20Park%20Hospital%20Foundation%20standardcharges4.csv