Mason District Hospital
Mason District Hospital in Havana, IL publishes cash prices for 162 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 below the Illinois median for 121 of 162 procedures and above it for 39. By typical cash price it ranks #16 of 115 Illinois hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
615 N Promenade, Havana, IL 62644 Collected Sep 27, 2026 Source price file (309) 543-4431
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 141313 · CMS hospital register NPI 1902849649
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 2 actions for a hospital named Mason District Hospital in Havana, IL:
- Mar 17, 2026 Corrective action plan requested
- May 19, 2026 Case closed
Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems.
A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 CPAP/BIPAP TITRATION | $5,209.60 | $6,512.00 | $4,864.46 | 8% above | 20% |
| Knee X-ray, complete, 4 or more views CPT 73564 NOT USED | $710.40 | $888.00 | $663.34 | 54% above | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 PSG/SPLIT NIGHT | $4,712.40 | $5,890.50 | $4,400.20 | 17% above | 20% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 OR SGPT | $12.80 | $16.00 | $11.95 | 76% below | 20% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 OR SGOT | $12.80 | $16.00 | $11.95 | 76% below | 20% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ..HEPATITIS PROFILE | $150.80 | $188.50 | $140.81 | 42% below | 20% |
| Aldosterone blood test CPT 82088 .ALDOSTERONE / RENIN ACTIVITY RATIO | $140.40 | $175.50 | $131.10 | 12% below | 20% |
| Aldosterone blood test CPT 82088 OR ALDOSTERONE SERUM | $206.80 | $258.50 | $193.10 | 29% above | 20% |
| Alkaline phosphatase (ALP) blood test CPT 84075 OR ALKALINE PHOSPHATASE | $12.80 | $16.00 | $11.95 | 74% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE - REGION 8 | $8.80 | $11.00 | $8.22 | 66% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 .ALLERGEN PROF - FOOD #1 | $8.80 | $11.00 | $8.22 | 66% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ..ALLERGEN - COMPREHENSIVE FOOD #1 | $326.40 | $408.00 | $304.78 | 1155% above | 20% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 OR ALPHA FETOPROTEIN TUMOR MARKER | $90.00 | $112.50 | $84.04 | 20% below | 20% |
| Ammonia blood test CPT 82140 OR AMMONIA BLOOD | $34.80 | $43.50 | $32.49 | 67% below | 20% |
| Amylase blood test CPT 82150 OR AMYLASE | $16.00 | $20.00 | $14.94 | 80% below | 20% |
| Amylase blood test CPT 82150 OR AMYLASE URINE | $19.60 | $24.50 | $18.30 | 76% below | 20% |
| Amylase blood test CPT 82150 OR ACETONE SERUM | $26.00 | $32.50 | $24.28 | 68% below | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 .CYCLIC CITRUL PEPTIDE AB, IgG | $227.60 | $284.50 | $212.52 | 171% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 OR CULTURE ABSCESS/WOUND SPECIFY | $30.80 | $38.50 | $28.76 | 66% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 OR CULTURE THROAT | $32.80 | $41.00 | $30.63 | 64% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 OR CULTURE SPUTUM | $32.80 | $41.00 | $30.63 | 64% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 OR CULTURE NOSE | $33.20 | $41.50 | $31.00 | 63% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 OR CULTURE VAGINAL | $33.20 | $41.50 | $31.00 | 63% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 OR CULTURE BODY FLUID SPECIFY | $33.20 | $41.50 | $31.00 | 63% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 OR CULTURE EAR | $33.20 | $41.50 | $31.00 | 63% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 OR CULTURE EYE | $33.20 | $41.50 | $31.00 | 63% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 OR CULTURE URETHRAL | $33.20 | $41.50 | $31.00 | 63% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 .EMP HEALTH -- THROAT CULTURE | $60.40 | $75.50 | $56.40 | 33% below | 20% |
| Basic metabolic panel (blood test) CPT 80048 OR BASIC METABOLIC PROFILE | $21.20 | $26.50 | $19.80 | 83% below | 20% |
| Basic metabolic panel (blood test) CPT 80048 ...OR BASIC METABOLIC PROFILE | $22.40 | $28.00 | $20.92 | 83% below | 20% |
| Bilirubin blood test, total CPT 82247 OR BILIRUBIN TOTAL | $11.20 | $14.00 | $10.46 | 82% below | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 ..BONE MARROW TREPHINE BIOPSY | $98.80 | $123.50 | $92.25 | 59% below | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 ..BONE MARROW BIOPSY INTERPRETATION | $181.20 | $226.50 | $169.20 | 24% below | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 ..BONE MARROW PARTICLE SECTIONS | $189.20 | $236.50 | $176.67 | 21% below | 20% |
| Blood culture for bacteria CPT 87040 OR CULTURE BLOOD | $66.00 | $82.50 | $61.63 | 57% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 OR VENIPUNCTURE CHARGE | $6.80 | $8.50 | $6.35 | 71% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE CHARGE | $25.20 | $31.50 | $23.53 | 7% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 DRAWING/COLLECTION FEE | $29.20 | $36.50 | $27.27 | 24% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ..ARTERIAL PUNCTURE | $38.40 | $48.00 | $35.86 | 63% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ..DRAWING FEE FOR INSURANCE | $62.80 | $78.50 | $58.64 | 167% above | 20% |
| Blood glucose (sugar) test CPT 82947 OR GLUCOSE | $11.20 | $14.00 | $10.46 | 75% below | 20% |
| Blood glucose (sugar) test CPT 82947 BGM (BEDSIDE GLUCOSE MONITOR) | $12.00 | $15.00 | $11.21 | 74% below | 20% |
| Blood glucose (sugar) test CPT 82947 OR GLUCOSE RANDOM | $12.80 | $16.00 | $11.95 | 72% below | 20% |
| Blood glucose (sugar) test CPT 82947 OR GLUCOSE 2HR PP | $12.80 | $16.00 | $11.95 | 72% below | 20% |
| Blood glucose (sugar) test CPT 82947 ..CSF GLUCOSE | $29.20 | $36.50 | $27.27 | 36% below | 20% |
| Blood lead test CPT 83655 .OR LEAD BLOOD | $38.40 | $48.00 | $35.86 | 31% below | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 .OR PREGNANCY TEST SERUM | $23.20 | $29.00 | $21.66 | 75% below | 20% |
| Blood urea nitrogen (BUN) test CPT 84520 OR BUN | $11.20 | $14.00 | $10.46 | 78% below | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 OR C REACTIVE PROTEIN QUANT | $88.40 | $110.50 | $82.54 | 20% above | 20% |
| Calcium blood test, total CPT 82310 OR CALCIUM | $13.60 | $17.00 | $12.70 | 70% below | 20% |
| Carcinoembryonic antigen (CEA) test CPT 82378 OR CEA (EIA) | $62.00 | $77.50 | $57.89 | 56% below | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 OR LIPID PROFILE | $31.60 | $39.50 | $29.51 | 75% below | 20% |
| Complete blood count (CBC) with differential CPT 85025 OR CBC | $20.40 | $25.50 | $19.05 | 74% below | 20% |
| Complete blood count (CBC) with differential CPT 85025 ..TEST CBC | $164.00 | $205.00 | $153.14 | 109% above | 20% |
| Complete blood count (CBC), no differential CPT 85027 OR HGB AND HCT (HEMOGRAM) | $15.20 | $19.00 | $14.19 | 77% below | 20% |
| Complete blood count (CBC), no differential CPT 85027 .EMP HEALTH -- HEMOGRAM | $69.60 | $87.00 | $64.99 | 7% above | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 OR COMPREHENSIVE METABOLIC PROFILE | $26.80 | $33.50 | $25.02 | 83% below | 20% |
| Cortisol blood test, total CPT 82533 OR CORTISOL 4 PM | $40.00 | $50.00 | $37.35 | 64% below | 20% |
| Cortisol blood test, total CPT 82533 OR CORTISOL 8 AM | $40.00 | $50.00 | $37.35 | 64% below | 20% |
| Creatine kinase (CK) blood test, total CPT 82550 OR CPK | $12.80 | $16.00 | $11.95 | 79% below | 20% |
| Creatine kinase (CK) blood test, total CPT 82550 .CPK Q4HR | $96.80 | $121.00 | $90.39 | 57% above | 20% |
| Creatinine blood test CPT 82565 OR CREATININE | $11.20 | $14.00 | $10.46 | 78% below | 20% |
| Creatinine blood test CPT 82565 VET CREAT/PROTEIN RATIO - RAN URINE | $53.60 | $67.00 | $50.05 | 7% above | 20% |
| Cytomegalovirus (CMV) antibody test CPT 86644 OR CMV IgG ANTIBODY | $43.20 | $54.00 | $40.34 | 49% below | 20% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 OR DHEA SULFATE | $38.80 | $48.50 | $36.23 | 64% below | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 OR ELECTROLYTES | $18.80 | $23.50 | $17.55 | 81% below | 20% |
| Estradiol blood test CPT 82670 OR ESTRADIOL | $95.60 | $119.50 | $89.27 | 10% below | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 OR FSH SERUM | $40.80 | $51.00 | $38.10 | 66% below | 20% |
| Ferritin blood test (iron stores) CPT 82728 OR FERRITIN | $19.60 | $24.50 | $18.30 | 85% below | 20% |
| Fibrinogen blood test CPT 85384 OR FIBRINOGEN | $22.40 | $28.00 | $20.92 | 74% below | 20% |
| Fibrinogen blood test CPT 85384 ..FIBRINOGEN PANEL | $126.40 | $158.00 | $118.03 | 45% above | 20% |
| Folate (folic acid) blood test CPT 82746 OR FOLATE SERUM | $95.60 | $119.50 | $89.27 | 15% below | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 OR T4 FREE | $22.00 | $27.50 | $20.54 | 81% below | 20% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 OR GAMMA GT | $12.80 | $16.00 | $11.95 | 78% below | 20% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 OR EXECUTIVE SCREEN WITH CBC | $48.40 | $60.50 | $45.19 | 85% below | 20% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3 HR | $126.80 | $158.50 | $118.40 | 6% below | 20% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 4 HR | $134.00 | $167.50 | $125.12 | 1% below | 20% |
| H. pylori antibody blood test CPT 86677 OR H PYLORI AB | $77.60 | $97.00 | $72.46 | 32% below | 20% |
| H. pylori stool antigen test CPT 87338 OR H. PYLORI ANTIGEN, STOOL | $52.80 | $66.00 | $49.30 | 55% below | 20% |
| HIV-1 and HIV-2 antibody test CPT 86703 CELIAC PANEL | $94.40 | $118.00 | $88.15 | 21% below | 20% |
| HIV-1 and HIV-2 antibody test CPT 86703 EXPOSURE HIV | $182.80 | $228.50 | $170.69 | 54% above | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 OR HEMOGLOBIN AIC | $77.60 | $97.00 | $72.46 | 13% below | 20% |
| Hemoglobin blood test CPT 85018 ...MANUAL HGB | $37.60 | $47.00 | $35.11 | 19% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 OR HEPATITIS B SURFACE ANTIBODY | $33.20 | $41.50 | $31.00 | 65% below | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 EXPOSURE HEPATITIS B SURF AB | $89.60 | $112.00 | $83.66 | 4% below | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 .EMP HEALTH -- HEPATITIS B SURF AB | $89.60 | $112.00 | $83.66 | 4% below | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 OR HEPATITIS B SURFACE ANTIGEN | $36.00 | $45.00 | $33.62 | 59% below | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 OR HBsAg HEPATITIS B SURFACE ANTIGEN | $56.80 | $71.00 | $53.04 | 36% below | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 EXPOSURE HEPATITIS B SURF AG (HBsAg) | $122.40 | $153.00 | $114.29 | 38% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 OR HEPATITIS C ANTIBODY | $56.80 | $71.00 | $53.04 | 49% below | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 EXPOSURE HEPATITIS C ANTIBODY | $134.80 | $168.50 | $125.87 | 20% above | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 .HEPATITIS C RNA Q bDNA | $268.80 | $336.00 | $250.99 | 1% above | 20% |
| Insulin blood test CPT 83525 .OR INSULIN LEVEL | $79.20 | $99.00 | $73.95 | 9% above | 20% |
| Iron blood test (serum iron) CPT 83540 OR IRON AND TIBC | $16.00 | $20.00 | $14.94 | 80% below | 20% |
| LH (luteinizing hormone) test CPT 83002 .OR LH | $198.00 | $247.50 | $184.88 | 72% above | 20% |
| Lactate (lactic acid) blood test CPT 83605 .OR LACTIC ACID | $36.00 | $45.00 | $33.62 | 60% below | 20% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 .OR LDH | $36.00 | $45.00 | $33.62 | 37% below | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 .OR LIPASE | $23.20 | $29.00 | $21.66 | 75% below | 20% |
| Liver function blood test panel CPT 80076 OR LIVER PANEL | $20.80 | $26.00 | $19.42 | 85% below | 20% |
| Magnesium blood test CPT 83735 OR MAGNESIUM | $18.40 | $23.00 | $17.18 | 74% below | 20% |
| Measles (rubeola) antibody test CPT 86765 .OR MEASLES IgG & IgM ANTIBODIES | $156.80 | $196.00 | $146.41 | 116% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 OR PSA PROSTATIC SPECIFIC ANTIGEN | $40.00 | $50.00 | $37.35 | 65% below | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 .OR PARATHYROID HORMONE INTACT | $64.80 | $81.00 | $60.51 | 70% below | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 .OR PARATHYROID HORMONE N TERMINAL | $156.80 | $196.00 | $146.41 | 28% below | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 .OR PARATHYROID HORMONE C TERMINAL | $156.80 | $196.00 | $146.41 | 28% below | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 OR PTT | $15.20 | $19.00 | $14.19 | 78% below | 20% |
| Phosphorus (phosphate) blood test CPT 84100 OR PHOSPHORUS | $12.80 | $16.00 | $11.95 | 79% below | 20% |
| Potassium blood test CPT 84132 .OR POTASSIUM | $12.40 | $15.50 | $11.58 | 72% below | 20% |
| Progesterone blood test CPT 84144 .OR PROGESTERONE | $38.40 | $48.00 | $35.86 | 72% below | 20% |
| Prolactin blood test CPT 84146 .OR PROLACTIN | $38.40 | $48.00 | $35.86 | 70% below | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 OR PROTIME | $15.20 | $19.00 | $14.19 | 61% below | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 .PROTIME - GRAHAM | $61.20 | $76.50 | $57.15 | 59% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 .PROTIME-MMC | $61.20 | $76.50 | $57.15 | 59% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 .OR RUBELLA | $30.80 | $38.50 | $28.76 | 60% below | 20% |
| Rubella antibody test (immunity check) CPT 86762 .EMP HEALTH -- RUBELLA | $69.60 | $87.00 | $64.99 | 9% below | 20% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 ..SEMEN ANALYSIS FERTILITY | $145.60 | $182.00 | $135.95 | at median | 20% |
| Sodium blood test CPT 84295 OR SODIUM | $12.80 | $16.00 | $11.95 | 74% below | 20% |
| Sodium blood test CPT 84295 OR SODIUM RANDOM URINE | $21.20 | $26.50 | $19.80 | 57% below | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OR OCCULT BLOOD FECES | $15.20 | $19.00 | $14.19 | 47% below | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 .GASTROCCULT | $50.40 | $63.00 | $47.06 | 75% above | 20% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL OCCULT BLOOD, IFOB | $64.40 | $80.50 | $60.13 | 11% below | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 .OR RPR QUALITATIVE | $23.20 | $29.00 | $21.66 | 55% below | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 OR TESTOSTERONE TOTAL | $43.20 | $54.00 | $40.34 | 66% below | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 .OR MICROSOMAL ANTIBODY | $155.60 | $194.50 | $145.29 | 95% above | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 OR TSH | $39.20 | $49.00 | $36.60 | 69% below | 20% |
| Total IgE blood test CPT 82785 .OR IMMUNOGLOBULIN E | $43.20 | $54.00 | $40.34 | 49% below | 20% |
| Total cholesterol blood test CPT 82465 OR CHOLESTEROL | $12.80 | $16.00 | $11.95 | 71% below | 20% |
| Total thyroxine (T4) blood test CPT 84436 OR T4 | $22.00 | $27.50 | $20.54 | 73% below | 20% |
| Triglycerides blood test CPT 84478 OR TRIGLYCERIDES | $12.80 | $16.00 | $11.95 | 73% below | 20% |
| Triglycerides blood test CPT 84478 ...OR TRIGLYCER | $31.60 | $39.50 | $29.51 | 32% below | 20% |
| Troponin test, quantitative CPT 84484 OR TROPONIN | $56.80 | $71.00 | $53.04 | 64% below | 20% |
| Troponin test, quantitative CPT 84484 TROPONIN I Q8HR | $68.00 | $85.00 | $63.50 | 57% below | 20% |
| Troponin test, quantitative CPT 84484 .TROPONIN I (Q4HR) | $96.80 | $121.00 | $90.39 | 39% below | 20% |
| Uric acid blood test CPT 84550 OR URIC ACID | $12.40 | $15.50 | $11.58 | 83% below | 20% |
| Urinalysis without microscope exam, manual CPT 81002 OR URINALYSIS | $12.80 | $16.00 | $11.95 | 49% below | 20% |
| Urinalysis without microscope exam, manual CPT 81002 VET UROBILINOGEN URINE RANDOM | $26.80 | $33.50 | $25.02 | 7% above | 20% |
| Urinalysis without microscope exam, manual CPT 81002 .EMP HEALTH -- URINALYSIS | $40.80 | $51.00 | $38.10 | 63% above | 20% |
| Urine culture for bacteria, with colony count CPT 87086 OR CULTURE URINE | $33.20 | $41.50 | $31.00 | 64% below | 20% |
| Urine culture for bacteria, with colony count CPT 87086 .CULTURE URINE | $152.80 | $191.00 | $142.68 | 67% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 EXPOSURE PREGNANCY TEST, URINE | $103.60 | $129.50 | $96.74 | 40% above | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 OR VITAMIN B12 | $69.20 | $86.50 | $64.62 | 47% below | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 OR BETA HCG QUANTITATIVE | $109.20 | $136.50 | $101.97 | 4% above | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| Botox injections for chronic migraine CPT 64615 O/R CHEMODENERV MUSC MIGRAINE | $408.80 | $511.00 | $381.72 | 9% above | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 ER DR S REDUC DISTAL FIBULAR ANKLE | $1,728.80 | $2,161.00 | $1,614.27 | 291% above | 20% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 ER DR CLSD TX METATARSAL FR W/O MANIPUL | $878.80 | $1,098.50 | $820.58 | 36% above | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIO VERSION | $122.80 | $153.50 | $114.66 | 89% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 ER DR CARDIOVERSION | $142.40 | $178.00 | $132.97 | 88% below | 20% |
| Cervical biopsy CPT 57500 CERVICAL POLYP REMOVAL | $438.80 | $548.50 | $409.73 | 52% below | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ER DR S REDUC COLLES | $1,096.80 | $1,371.00 | $1,024.14 | 110% above | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 ER DR EXCISION OF LESION | $250.00 | $312.50 | $233.44 | 43% above | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 ER DR EXC WART | $250.00 | $312.50 | $233.44 | 43% above | 20% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 ER DR IMPACT CERUMEN USING IRRIGATION | $45.60 | $57.00 | $42.58 | 60% below | 20% |
| Earwax removal with instruments, one ear CPT 69210 ER DR IMPACT CERUMEN REM | $165.60 | $207.00 | $154.63 | 32% above | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 O/R NJX INTERLAMINAR CRV/THRC | $695.20 | $869.00 | $649.14 | 60% below | 20% |
| Hysterectomy through an abdominal incision (total) CPT 58150 DIAG LAPAROSCOPY W/POSSIBLE LAPAROTOMY | $926.40 | $1,158.00 | $865.03 | 84% below | 20% |
| Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL ABDOMINAL HYSTERECTOMY | $2,858.80 | $3,573.50 | $2,669.40 | 52% below | 20% |
| Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSOCPY ABLATION | $6,068.40 | $7,585.50 | $5,666.37 | 8% above | 20% |
| Hysteroscopy with endometrial ablation CPT 58563 ENDOMETRIAL THERMAL ABLATION | $6,068.40 | $7,585.50 | $5,666.37 | 8% above | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 DILATION & CURETTAGE | $846.00 | $1,057.50 | $789.95 | 75% below | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY WTH D&C | $3,813.20 | $4,766.50 | $3,560.58 | 13% above | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 LAPARO TUBAL LIG, HYSTO,D&C | $3,813.20 | $4,766.50 | $3,560.58 | 13% above | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY | $3,813.20 | $4,766.50 | $3,560.58 | 13% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ER DR I&D ABSCESS SIMPLE | $250.00 | $312.50 | $233.44 | 38% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ER DR I&D ONYCHIA | $250.00 | $312.50 | $233.44 | 38% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ER DR I&D PARONYCHIA | $250.00 | $312.50 | $233.44 | 38% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ER DR I&D SEBACEOUS CYST | $250.00 | $312.50 | $233.44 | 38% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ER DR I&D FURUNCLE | $250.00 | $312.50 | $233.44 | 38% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 O/R INJ TENDON SHEATH/LIGAMENT | $154.00 | $192.50 | $143.80 | 60% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 O/R DRAIN/INJ JOINT/BURSA W/O US | $173.20 | $216.50 | $161.73 | 62% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ER DR LG JOINT ASPIR/INJ | $326.40 | $408.00 | $304.78 | 27% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 O/R DRAIN/INJ JOINT/BURSA W/O US | $146.80 | $183.50 | $137.07 | 62% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ER DR MED JNT ASPIR/INJC | $250.00 | $312.50 | $233.44 | 36% below | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ER DR SM JNT ASPIR/INJCT | $197.20 | $246.50 | $184.14 | 34% below | 20% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPIC TUBAL LIGATION | $1,842.40 | $2,303.00 | $1,720.34 | 61% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ER DR LAC INTERMED 2.5CM OR LESS | $326.40 | $408.00 | $304.78 | 45% below | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 O/R NJX INTERLAMINAR LMBR/SAC | $684.00 | $855.00 | $638.69 | 53% below | 20% |
| Nail removal (partial or complete), one nail CPT 11730 ER DR NAIL REMOVAL | $165.60 | $207.00 | $154.63 | 41% below | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 ER DR INJ AA/STRD GREAT OCCIPITAL NERVE | $225.20 | $281.50 | $210.28 | 55% below | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 ER DR EXCISION OF NAIL | $994.00 | $1,242.50 | $928.15 | 58% above | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 ER DR I&REM FB SUBASIMPL | $165.60 | $207.00 | $154.63 | 64% below | 20% |
| Short arm cast (elbow to hand) CPT 29075 ER DR CASTING SHORT ARM | $300.00 | $375.00 | $280.13 | 2% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 ER DR FOREARM PLAS SPLI | $217.60 | $272.00 | $203.18 | 11% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 ER DR ULNA GUT PLAS SPLI | $250.00 | $312.50 | $233.44 | 2% above | 20% |
| Short arm splint (forearm and hand) CPT 29125 ER DR SHORT ARM SPLINT | $250.00 | $312.50 | $233.44 | 2% above | 20% |
| Short arm splint (forearm and hand) CPT 29125 ER DR SH ARM C THUMB SPI | $300.00 | $375.00 | $280.13 | 22% above | 20% |
| Short leg cast (below the knee) CPT 29405 ER DR SHORT LEG CAST | $354.00 | $442.50 | $330.55 | 7% above | 20% |
| Short leg splint (calf to foot) CPT 29515 ER DR SHORT LEG SPLINT | $250.00 | $312.50 | $233.44 | at median | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ER DR LAC SIMPLE 2.5CM OR LESS | $300.00 | $375.00 | $280.13 | 18% below | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 ER DR LUMBAR PUNCTURE | $378.00 | $472.50 | $352.96 | 58% below | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ER DR LAC/S 2.6CM-7.5CM | $354.00 | $442.50 | $330.55 | 14% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ER DR LAC SIMPLE 2.5CM OR LESS | $326.40 | $408.00 | $304.78 | 19% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 O/R INJ TRIGGER POINT 1/2 MUSCL | $139.60 | $174.50 | $130.35 | 72% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 O/R INJ TRIGGER POINT 1 OR 2 | $139.60 | $174.50 | $130.35 | 72% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 ER DR TRIGGER PT INJ 1/2 MUSCLES | $172.80 | $216.00 | $161.35 | 65% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 ER DR TRIGGER PT INJ 1-2 MUSCLES | $181.20 | $226.50 | $169.20 | 63% below | 20% |
| Wart removal, up to 14 warts CPT 17110 ER DR DESTRUCTION LESION | $293.20 | $366.50 | $273.78 | 26% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 ER DR WOUND DEBRIDEMT LG | $270.00 | $337.50 | $252.11 | 59% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20sq cm/< 10-19 MIN | $447.20 | $559.00 | $417.57 | 33% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20sq cm/< 15-29 MIN | $520.80 | $651.00 | $486.30 | 22% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20sq cm/< 20-29 MIN | $539.20 | $674.00 | $503.48 | 19% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20sq cm/< 30-44 MIN | $617.60 | $772.00 | $576.68 | 7% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20sq cm/< 30-39 MIN | $700.00 | $875.00 | $653.63 | 5% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20sq cm/< 45-59 MIN | $756.00 | $945.00 | $705.92 | 14% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20sq cm/< 40-54 MIN | $791.20 | $989.00 | $738.78 | 19% above | 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 ALBUMIN FOR ADMINISTRATION | $176.80 | $221.00 | $165.09 | 81% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 .PLATELET RANDOM DONOR ADMIN & ARC PROC | $199.20 | $249.00 | $186.00 | 79% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 BB BLOOD PRODUCT ADMINISTRATION | $953.20 | $1,191.50 | $890.05 | 2% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 .PLATELETS PHERESED (FOR ADMINISTRATION) | $1,825.20 | $2,281.50 | $1,704.28 | 95% above | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 .PLATELETS PHERESED (HLA MATCHED) ADMIN | $2,246.40 | $2,808.00 | $2,097.58 | 140% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER THERAPY | $96.00 | $120.00 | $89.64 | 49% below | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHALER THERAPY | $96.00 | $120.00 | $89.64 | 49% below | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 M/S HOSPITALIST CRITICAL I/P 30-74 MIN | $734.80 | $918.50 | $686.12 | 62% below | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 ER DR CRIT CARE | $1,332.80 | $1,666.00 | $1,244.50 | 31% below | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 ER DR CRITICAL CARE | $1,628.40 | $2,035.50 | $1,520.52 | 15% below | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 EMERG TREATMENT 210 MIN | $1,942.80 | $2,428.50 | $1,814.09 | 1% above | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 EMERG TREATMENT 240 MIN | $2,190.80 | $2,738.50 | $2,045.66 | 14% above | 20% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG | $1,248.40 | $1,560.50 | $1,165.69 | 50% above | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG | $195.20 | $244.00 | $182.27 | 16% below | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER DR BRIEF | $495.60 | $619.50 | $462.77 | 141% above | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERG TREATMENT EACH 30 MIN | $253.60 | $317.00 | $236.80 | 35% below | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER DR STRAIGHTFORWARD | $355.20 | $444.00 | $331.67 | 9% below | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERG TREATMENT 30 MIN | $453.20 | $566.50 | $423.18 | 16% above | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER DR LOW LEVEL | $537.20 | $671.50 | $501.61 | 23% below | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERG TREATMENT 60 MIN | $700.80 | $876.00 | $654.37 | 1% above | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERG TREATMENT 90 MIN | $950.00 | $1,187.50 | $887.06 | 37% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER DR MODERATE | $980.80 | $1,226.00 | $915.82 | 13% below | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERG TREATMENT 120 MIN | $1,196.40 | $1,495.50 | $1,117.14 | 6% above | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER DR HIGH | $1,305.20 | $1,631.50 | $1,218.73 | 22% below | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERG TREATMENT 150 MIN | $1,447.60 | $1,809.50 | $1,351.70 | 13% below | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERG TREATMENT 180 MIN | $1,695.20 | $2,119.00 | $1,582.89 | 1% above | 20% |
| Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 MONITOR EA ADD HOUR | $104.40 | $130.50 | $97.48 | 48% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 O/R -- IM/SQ INJECTION | $84.80 | $106.00 | $79.18 | 22% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 OP TREATMENT-INJECTION | $89.20 | $111.50 | $83.29 | 18% below | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 OT-MUSCULAR FACIL/RETRAIN 15 MINS | $257.60 | $322.00 | $240.53 | 110% above | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 OT-NEURO-REED 15 MIN | $257.60 | $322.00 | $240.53 | 110% above | 20% |
| New patient office visit, about 30 minutes CPT 99203 OP ROOM FEE 30-44 MIN | $304.40 | $380.50 | $284.23 | 42% above | 20% |
| New patient office visit, about 30 minutes CPT 99203 OP RM 30-44 MINUTES | $367.20 | $459.00 | $342.87 | 71% above | 20% |
| New patient office visit, about 45 minutes CPT 99204 HOLDING RM-SAME DAY SURG/EA ADDIT HOUR | $68.80 | $86.00 | $64.24 | 77% below | 20% |
| New patient office visit, about 45 minutes CPT 99204 HOLDING RM-SAME DAY SURG/FIRST HOUR | $150.04 | $188.00 | $140.44 | 49% below | 20% |
| New patient office visit, about 45 minutes CPT 99204 OP ROOM FEE 45-49 MIN | $464.80 | $581.00 | $434.01 | 58% above | 20% |
| New patient office visit, about 45 minutes CPT 99204 OP RM 45-59 MINUTES | $536.80 | $671.00 | $501.24 | 82% above | 20% |
| New patient office visit, about 45 minutes CPT 99204 R/R ROOM TIME CLASS 3 | $703.20 | $879.00 | $656.61 | 139% above | 20% |
| New patient office visit, about 60 minutes CPT 99205 OP RM 60-74 MINUTES | $707.60 | $884.50 | $660.72 | 94% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP RM 15-29 MIN NEW | $200.00 | $250.00 | $186.75 | 28% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP ROOM FEE 15-29 MIN | $215.60 | $269.50 | $201.32 | 38% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION THERAPY EA15MIN | $103.20 | $129.00 | $96.36 | 90% above | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HOME PROG INSTRUCT EA 15 MIN | $208.40 | $260.50 | $194.59 | 74% above | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP RM 40-54 MIN ESTABLISHED | $200.00 | $250.00 | $186.75 | 28% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP RM 20-29 MIN ESTABLISHED | $200.00 | $250.00 | $186.75 | 32% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP ROOM FEE 20-29MIN | $213.60 | $267.00 | $199.45 | 41% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP RM 30-39 MIN ESTABLISHED | $200.00 | $250.00 | $186.75 | 13% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CONSULT FEE | $264.80 | $331.00 | $247.26 | 49% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 O/P ROOM FEE 30-39MIN | $264.80 | $331.00 | $247.26 | 49% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP ROOM FEE 30-39 MIN | $307.20 | $384.00 | $286.85 | 73% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP TREATMENT SUTURE REMOVAL | $89.20 | $111.50 | $83.29 | 26% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP ROOM FEE 10-19 MIN | $130.00 | $162.50 | $121.39 | 8% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ER DR SUTURE REMOVAL | $136.40 | $170.50 | $127.36 | 14% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP RM 10-19 MIN ESTABLISHED | $200.00 | $250.00 | $186.75 | 67% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HOLDING ROOM PICC LINE | $1,600.00 | $2,000.00 | $1,494.00 | 1233% above | 20% |
| Speech and language evaluation CPT 92523 S-EI OFFISITE EVAL LANG COMP | $199.20 | $249.00 | $186.00 | 49% below | 20% |
| Speech and language evaluation CPT 92523 S-EI ONSITE EVAL LANG COMP | $199.20 | $249.00 | $186.00 | 49% below | 20% |
| Speech and language evaluation CPT 92523 S COM EVAL LANG COMP | $417.20 | $521.50 | $389.56 | 6% above | 20% |
| Speech therapy session, individual CPT 92507 S-EI ONSITE INDIVID THERAPY | $139.20 | $174.00 | $129.98 | 25% below | 20% |
| Speech therapy session, individual CPT 92507 S-EI ONSITE INDIVID THEREAPY | $198.80 | $248.50 | $185.63 | 7% above | 20% |
| Speech therapy session, individual CPT 92507 S-EI OFFSITE INDIVID THERAPY | $198.80 | $248.50 | $185.63 | 7% above | 20% |
| Speech therapy session, individual CPT 92507 S COMMUNICATION TREATMENT | $474.00 | $592.50 | $442.60 | 154% above | 20% |
| Speech therapy session, individual CPT 92507 S COMMUNICATION TREATMENT/45 MINS | $683.20 | $854.00 | $637.94 | 267% above | 20% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY PROF FEE | $45.20 | $56.50 | $42.21 | 85% below | 20% |
| Spirometry (breathing test) CPT 94010 INCENTIVE SPIROMETER INTIAL | $135.60 | $169.50 | $126.62 | 56% below | 20% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY SCREENING | $176.00 | $220.00 | $164.34 | 42% below | 20% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY | $244.80 | $306.00 | $228.58 | 20% below | 20% |
| Spirometry before and after a bronchodilator CPT 94060 FLOW VOLUME PROF FEE | $52.40 | $65.50 | $48.93 | 90% below | 20% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 OT-EI IND THERAPY OFFSITE 15 MIN | $198.80 | $248.50 | $185.63 | 55% above | 20% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 OT-EI IND THERAPY ONSITE 15 MIN | $198.80 | $248.50 | $185.63 | 55% above | 20% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 OT-THERAPEUTIC ACTIVITIES-PRIMUS-15 MIN | $213.60 | $267.00 | $199.45 | 67% above | 20% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 MYOVIEW STRESS PROF FEE | $199.20 | $249.00 | $186.00 | 54% below | 20% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 STRESS TEST ELECTRO INTERPT/REPRT | $1,299.60 | $1,624.50 | $1,213.50 | 201% above | 20% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 STRESS TEST TRACING WITH INTERP/REPORT | $1,299.60 | $1,624.50 | $1,213.50 | 201% above | 20% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 STRESS TEST PHARM INPRT/REPT | $1,610.00 | $2,012.50 | $1,503.34 | 273% above | 20% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 *INFLUENZA VACCINE : 0.5 ML INJECTION | $38.80 | $48.50 | $36.23 | 13% above | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VACCINE INJ: PED DOSE 10 MCG | $74.44 | $93.05 | $69.51 | 15% below | 20% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL CONJUGATE (PREVNAR 13) INJ | $581.28 | $726.60 | $542.77 | 61% above | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL ADULT (PNEUMOVAX) 0.5 ML IN | $299.48 | $374.35 | $279.64 | 63% above | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS & DIPHTHERIA : 0.5 ML ADULT | $104.32 | $130.40 | $97.41 | 35% above | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap (ADACEL) VACCINE: 0.5 ML SDV | $127.92 | $159.90 | $119.45 | 27% above | 20% |
Source file: https://www.masondistricthospital.org/wp-content/uploads/2026/05/Price-TransV3.0.0_Wide_CSV_Format_Template.csv