Ann & Robert H. Lurie Children's Hospital of Chicago
Ann & Robert H. Lurie Children's Hospital of Chicago in Chicago, IL publishes cash prices for 332 common procedures listed here, from its own machine-readable price file updated Sep 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Illinois median for 279 of 314 procedures and below it for 34. By typical cash price it ranks #104 of 114 Illinois hospitals and #54 of 62 hospitals in the Chicago, IL area, cheapest first. Select a procedure to compare it with other hospitals nearby.
225 E. Chicago Avenue, Chicago, IL 60611 Collected Oct 16, 2026 Source price file Check a bill from this hospital (312) 227-4000
Children's hospital Nonprofit hospital Emergency department CCN 143300 · CMS hospital register NPI 1235234535
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Ann & Robert H. Lurie Children's Hospital of Chicago is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.
You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.
Source: IRS, section 501(r) requirements for nonprofit hospitals.
State law
This state limits hospital bills for lower-income patients
Illinois law (Hospital Uninsured Patient Discount Act, 210 ILCS 89): an uninsured Illinois resident with family income up to 600% of the federal poverty level (300% at rural and critical access hospitals) can apply for a discount that brings the bill down to about 135% of the hospital's cost; up to 200% (125% at rural hospitals) medically necessary care is free. A hospital may collect no more than 25% of family income in 12 months. Ask the billing office for the application. Other states' laws.
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 1 action for a hospital named Ann & Robert H. Lurie Children's Hospital of Chicago in Chicago, IL:
- Jul 30, 2025 Met requirements
Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.
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 |
|---|---|---|---|---|---|
| Abdominal X-ray, 2 views CPT 74019 H XR ABDOMEN 2 VIEWS | $518.00 | $740.00 | $125.80–$703.00 | 57% above | 30% |
| Abdominal X-ray, 2 views inpatient CPT 74019 H XR ABDOMEN 2 VIEWS | $518.00 | $740.00 | $273.80–$3,678.00 | — | 30% |
| Ankle X-ray, complete, 3 or more views CPT 73610 H XR ANKLE MIN 3 VIEWS | $534.10 | $763.00 | $129.71–$724.85 | 58% above | 30% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 H XR ANKLE MIN 3 VIEWS | $534.10 | $763.00 | $282.31–$3,678.00 | — | 30% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 H XR ESOPHAGUS | $1,012.90 | $1,447.00 | $245.99–$1,374.65 | 69% above | 30% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 H IR 74220 RAD EXAM ESOPHAGUS | $1,012.90 | $1,447.00 | $245.99–$1,374.65 | 69% above | 30% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 H XR ESOPHAGUS | $1,012.90 | $1,447.00 | $535.39–$3,678.00 | — | 30% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 H IR 74220 RAD EXAM ESOPHAGUS | $1,012.90 | $1,447.00 | $535.39–$3,678.00 | — | 30% |
| Bone scan, whole body (nuclear medicine) CPT 78306 H NM BONE SCAN WHOLE BODY | $3,080.00 | $4,400.00 | $748.00–$4,180.00 | 95% above | 30% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 H NM BONE SCAN WHOLE BODY | $3,080.00 | $4,400.00 | $900.00–$4,180.00 | — | 30% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 H CT CTA ABDOMEN AND PELVIS | $6,677.30 | $9,539.00 | $1,126.00–$9,062.05 | 80% above | 30% |
| CT angiography (CTA) of the head CPT 70496 H CT CTA HEAD W/WO CONTRAST | $3,260.60 | $4,658.00 | $791.86–$4,425.10 | 27% above | 30% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 H CT HEART WO CONTRAST & EVAL CORONARY CALCIUM | $688.80 | $984.00 | $167.28–$2,614.00 | 212% above | 30% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 H CT HEART WO CONTRAST & EVAL CORONARY CALCIUM | $688.80 | $984.00 | $364.08–$3,678.00 | — | 30% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 H CT ABD PELVIS WO CONTRAST | $3,959.20 | $5,656.00 | $900.00–$5,373.20 | — | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 H CT ABD PELVIS W CONTRAST | $5,149.90 | $7,357.00 | $900.00–$6,989.15 | — | 30% |
| CT scan of the abdomen without contrast inpatient CPT 74150 H CT ABDOMEN WO CONTRAST | $2,476.60 | $3,538.00 | $900.00–$3,678.00 | — | 30% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 H CT SPINE LUMBAR WO CONTRAST | $3,008.60 | $4,298.00 | $900.00–$4,083.10 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 H US DOPPLER CAROTID ARTERY BILAT | $2,105.60 | $3,008.00 | $511.36–$2,857.60 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 H US DOPPLER CAROTID ARTERY BILAT | $2,105.60 | $3,008.00 | $900.00–$3,678.00 | — | 30% |
| Chest X-ray, 2 views CPT 71046 H XRAY CHEST 2 VIEW | $648.20 | $926.00 | $157.42–$879.70 | 110% above | 30% |
| Chest X-ray, 2 views inpatient CPT 71046 H XRAY CHEST 2 VIEW | $648.20 | $926.00 | $342.62–$3,678.00 | — | 30% |
| Chest X-ray, single view CPT 71045 H XR CHEST 1 VIEW | $503.30 | $719.00 | $122.23–$683.05 | 98% above | 30% |
| Chest X-ray, single view inpatient CPT 71045 H XR CHEST 1 VIEW | $503.30 | $719.00 | $266.03–$3,678.00 | — | 30% |
| Collarbone (clavicle) X-ray, complete CPT 73000 H XR CLAVICLE COMPLETE | $487.20 | $696.00 | $118.32–$661.20 | 86% above | 30% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 H XR CLAVICLE COMPLETE | $487.20 | $696.00 | $257.52–$3,678.00 | — | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 H US RETROPERITONEUM COMPLETE | $1,574.30 | $2,249.00 | $382.33–$2,136.55 | 91% above | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 H US RETROPERITONEUM COMPLETE | $1,574.30 | $2,249.00 | $832.13–$3,678.00 | — | 30% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 H XR DXA AXIAL | $682.50 | $975.00 | $165.75–$926.25 | 43% above | 30% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 H XR DXA AXIAL | $682.50 | $975.00 | $360.75–$3,678.00 | — | 30% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 H XR DXA APPENDICULAR SKELETEL | $123.20 | $176.00 | $29.92–$597.00 | 48% below | 30% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 H XR DXA APPENDICULAR SKELETEL | $123.20 | $176.00 | $65.12–$3,678.00 | — | 30% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 H US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION | $1,397.90 | $1,997.00 | $339.49–$1,897.15 | 43% above | 30% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 H US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION | $1,397.90 | $1,997.00 | $738.89–$3,678.00 | — | 30% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 H CT CHEST W CONTRAST | $3,313.10 | $4,733.00 | $804.61–$4,496.35 | 38% above | 30% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 H US DPLR LOW EXTREM ART BILAT | $2,050.30 | $2,929.00 | $497.93–$2,782.55 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 H US DPLR LOW EXTREM ART BILAT | $2,050.30 | $2,929.00 | $900.00–$3,678.00 | — | 30% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 H US DOPPLER EXTREMITY VEIN BILAT | $2,760.10 | $3,943.00 | $670.31–$3,745.85 | — | 30% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 H US DOPPLER EXTREMITY VEIN BILAT | $2,760.10 | $3,943.00 | $900.00–$3,745.85 | — | 30% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 H ECHO TRANSTHORACIC COMP 2DW SPECTRAL AND COLOR | $4,447.10 | $6,353.00 | $1,080.01–$6,035.35 | 110% above | 30% |
| Elbow X-ray, 2 views CPT 73070 H XR ELBOW 2 VIEWS | $413.70 | $591.00 | $100.47–$597.00 | 50% above | 30% |
| Elbow X-ray, 2 views inpatient CPT 73070 H XR ELBOW 2 VIEWS | $413.70 | $591.00 | $218.67–$3,678.00 | — | 30% |
| Elbow X-ray, complete, 3 or more views CPT 73080 H XR ELBOW MIN 3 VIEWS | $547.40 | $782.00 | $132.94–$742.90 | 61% above | 30% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 H XR ELBOW MIN 3 VIEWS | $547.40 | $782.00 | $289.34–$3,678.00 | — | 30% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 H CT ORBIT POST FOSSA EAR W/O CONT | $3,301.90 | $4,717.00 | $900.00–$4,481.15 | — | 30% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 H XR FACIAL BONES 5 VIEWS | $833.00 | $1,190.00 | $202.30–$1,130.50 | 102% above | 30% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 H XR FACIAL BONES MIN 3 VIEWS | $833.00 | $1,190.00 | $202.30–$1,130.50 | 102% above | 30% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 H XR FACIAL BONES 5 VIEWS | $833.00 | $1,190.00 | $440.30–$3,678.00 | — | 30% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 H XR FACIAL BONES MIN 3 VIEWS | $833.00 | $1,190.00 | $440.30–$3,678.00 | — | 30% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 H XR FOREARM 1 VIEW | $504.70 | $721.00 | $122.57–$684.95 | 59% above | 30% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 H XR FOREARM 2 VIEWS | $529.90 | $757.00 | $128.69–$719.15 | 67% above | 30% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 H XR FOREARM 3 VIEWS | $555.10 | $793.00 | $134.81–$753.35 | 75% above | 30% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 H XR FOREARM 1 VIEW | $504.70 | $721.00 | $266.77–$3,678.00 | — | 30% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 H XR FOREARM 2 VIEWS | $529.90 | $757.00 | $280.09–$3,678.00 | — | 30% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 H XR FOREARM 3 VIEWS | $555.10 | $793.00 | $293.41–$3,678.00 | — | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 H NM HEPATOBILIARY IMAGING | $1,882.30 | $2,689.00 | $457.13–$2,554.55 | 25% above | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 H NM HEPATOBILIARY IMAGING | $1,882.30 | $2,689.00 | $900.00–$3,678.00 | — | 30% |
| Hand X-ray, 2 views CPT 73120 H XR HAND 1 VIEW | $536.20 | $766.00 | $130.22–$727.70 | 93% above | 30% |
| Hand X-ray, 2 views CPT 73120 H XR HAND 2 VIEWS | $536.20 | $766.00 | $130.22–$727.70 | 93% above | 30% |
| Hand X-ray, 2 views inpatient CPT 73120 H XR HAND 1 VIEW | $536.20 | $766.00 | $283.42–$3,678.00 | — | 30% |
| Hand X-ray, 2 views inpatient CPT 73120 H XR HAND 2 VIEWS | $536.20 | $766.00 | $283.42–$3,678.00 | — | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 H XR HEEL 2 VIEWS | $459.20 | $656.00 | $111.52–$623.20 | 90% above | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 H XR HEEL 2 VIEWS | $459.20 | $656.00 | $242.72–$3,678.00 | — | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 H SLEEP POLYSOM 4+ WCPAP OR PPV AGE 6 AND OVER | $5,553.10 | $7,933.00 | $1,348.61–$7,536.35 | 18% above | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 H SLEEP POLYSOM 4+ WCPAP OR PPV AGE 6 AND OVER | $5,553.10 | $7,933.00 | $900.00–$7,536.35 | — | 30% |
| Knee X-ray, 3 views CPT 73562 H XR KNEE 3 VIEWS | $591.50 | $845.00 | $143.65–$802.75 | 69% above | 30% |
| Knee X-ray, 3 views inpatient CPT 73562 H XR KNEE 3 VIEWS | $591.50 | $845.00 | $312.65–$3,678.00 | — | 30% |
| Knee X-ray, complete, 4 or more views CPT 73564 H XR KNEE 4 OR MORE VIEWS | $893.20 | $1,276.00 | $216.92–$1,212.20 | 102% above | 30% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 H XR KNEE 4 OR MORE VIEWS | $893.20 | $1,276.00 | $472.12–$3,678.00 | — | 30% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 H CT LOWER EXTREM WO CONTRAST | $2,452.10 | $3,503.00 | $900.00–$3,678.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 H US LOWER BACK SOFT TISSUE | $1,346.10 | $1,923.00 | $326.91–$1,826.85 | 92% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 H IR 76705 US ABD LIMITED | $1,346.10 | $1,923.00 | $326.91–$1,826.85 | 92% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 H POC US ABDOMINAL LIMITED | $1,346.10 | $1,923.00 | $326.91–$1,826.85 | 92% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 H US ABDOMEN LIMITED | $1,346.10 | $1,923.00 | $326.91–$1,826.85 | 92% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 H US LOWER BACK SOFT TISSUE | $1,346.10 | $1,923.00 | $711.51–$3,678.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 H IR 76705 US ABD LIMITED | $1,346.10 | $1,923.00 | $711.51–$3,678.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 H POC US ABDOMINAL LIMITED | $1,346.10 | $1,923.00 | $711.51–$3,678.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 H US ABDOMEN LIMITED | $1,346.10 | $1,923.00 | $711.51–$3,678.00 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 H POC US LIMITED MTD JT/NONVASC EXTREMITY STRUX LIMITED | $676.90 | $967.00 | $164.39–$918.65 | 120% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 H US LMTD JT/NONVASC EXTREMITY STRUX | $676.90 | $967.00 | $164.39–$918.65 | 120% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 H US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG | $676.90 | $967.00 | $164.39–$918.65 | 120% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 H IR 76882 US LMTD JT/NONVASC EXTREMITY STRUX | $676.90 | $967.00 | $164.39–$918.65 | 120% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 H US LMTD JT/NONVASC EXTREMITY STRUX (NONRADIOLOGY) | $676.90 | $967.00 | $164.39–$918.65 | 120% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 H POC US LIMITED MTD JT/NONVASC EXTREMITY STRUX LIMITED | $676.90 | $967.00 | $357.79–$3,678.00 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 H US LMTD JT/NONVASC EXTREMITY STRUX (NONRADIOLOGY) | $676.90 | $967.00 | $357.79–$3,678.00 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 H IR 76882 US LMTD JT/NONVASC EXTREMITY STRUX | $676.90 | $967.00 | $357.79–$3,678.00 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 H US LMTD JT/NONVASC EXTREMITY STRUX | $676.90 | $967.00 | $357.79–$3,678.00 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 H US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG | $676.90 | $967.00 | $357.79–$3,678.00 | — | 30% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 H XR TIBIA & FIBULA 2 VIEWS | $534.10 | $763.00 | $129.71–$724.85 | 65% above | 30% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 H XR TIBIA/FIBULA 3 VIEWS | $534.10 | $763.00 | $129.71–$724.85 | 65% above | 30% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 H XR TIBIA & FIBULA 2 VIEWS | $534.10 | $763.00 | $282.31–$3,678.00 | — | 30% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 H XR TIBIA/FIBULA 3 VIEWS | $534.10 | $763.00 | $282.31–$3,678.00 | — | 30% |
| MR angiography (MRA) of the head without contrast CPT 70544 H MR MRA HEAD WO CONTRAST | $4,044.60 | $5,778.00 | $982.26–$5,489.10 | 52% above | 30% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 H MR MRA HEAD WO CONTRAST | $4,044.60 | $5,778.00 | $900.00–$5,489.10 | — | 30% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 H MR LOWER EXTREM JOINT WO CONTRAST | $3,627.40 | $5,182.00 | $880.94–$4,922.90 | 29% above | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 H MR LOWER EXTREM JOINT WO CONTRAST | $3,627.40 | $5,182.00 | $900.00–$4,922.90 | — | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 H MR LOWER EXTREM JOINT W AND WO CONTRA | $4,876.20 | $6,966.00 | $1,184.22–$6,617.70 | 41% above | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 H MR LOWER EXTREM JOINT W AND WO CONTRA | $4,876.20 | $6,966.00 | $900.00–$6,617.70 | — | 30% |
| MRI of the abdomen without contrast CPT 74181 H MR ABDOMEN WO CONTRAST | $3,976.00 | $5,680.00 | $965.60–$5,396.00 | 44% above | 30% |
| MRI of the abdomen without contrast inpatient CPT 74181 H MR ABDOMEN WO CONTRAST | $3,976.00 | $5,680.00 | $900.00–$5,396.00 | — | 30% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 H MR ABDOMEN W AND WO CONTRAST | $5,831.70 | $8,331.00 | $1,416.27–$7,914.45 | 56% above | 30% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 H MR ABDOMEN W AND WO CONTRAST | $5,831.70 | $8,331.00 | $900.00–$7,914.45 | — | 30% |
| MRI of the brain, no contrast dye CPT 70551 H MR BRAIN WO CONTRAST | $3,899.70 | $5,571.00 | $947.07–$5,292.45 | 39% above | 30% |
| MRI of the brain, no contrast dye CPT 70551 H MR BRAIN VENTICLES WO CONTRAST | $3,899.70 | $5,571.00 | $947.07–$5,292.45 | 39% above | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 H MR BRAIN WO CONTRAST | $3,899.70 | $5,571.00 | $900.00–$5,292.45 | — | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 H MR BRAIN VENTICLES WO CONTRAST | $3,899.70 | $5,571.00 | $900.00–$5,292.45 | — | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 H MR BRAIN W AND WO CONTRAST | $5,255.60 | $7,508.00 | $1,276.36–$7,132.60 | 30% above | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 H MR BRAIN W AND WO CONTRAST | $5,255.60 | $7,508.00 | $900.00–$7,132.60 | — | 30% |
| MRI of the lower back, no contrast dye CPT 72148 H MR SPINE LUMBAR NEURO WO CONT | $4,099.20 | $5,856.00 | $995.52–$5,563.20 | 42% above | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 H MR SPINE LUMBAR NEURO WO CONT | $4,099.20 | $5,856.00 | $900.00–$5,563.20 | — | 30% |
| MRI of the lower back, without and then with contrast dye CPT 72158 H MR SPINE LUMBAR W AND WO CONTRAST | $5,252.80 | $7,504.00 | $1,275.68–$7,128.80 | 29% above | 30% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 H MR SPINE LUMBAR W AND WO CONTRAST | $5,252.80 | $7,504.00 | $900.00–$7,128.80 | — | 30% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 H MR SPINE THORACIC NEURO WO CONTR | $3,978.80 | $5,684.00 | $966.28–$5,399.80 | 38% above | 30% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 H MR SPINE THORACIC NEURO WO CONTR | $3,978.80 | $5,684.00 | $900.00–$5,399.80 | — | 30% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 H MR SPINE CERVICAL W AND WO CONTRAST | $5,367.60 | $7,668.00 | $1,303.56–$7,284.60 | 34% above | 30% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 H MR SPINE CERVICAL W AND WO CONTRAST | $5,367.60 | $7,668.00 | $900.00–$7,284.60 | — | 30% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 H MR SPINE CERVICAL NEURO WO CONTR | $4,540.20 | $6,486.00 | $1,102.62–$6,161.70 | 55% above | 30% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 H MR SPINE CERVICAL NEURO WO CONTR | $4,540.20 | $6,486.00 | $900.00–$6,161.70 | — | 30% |
| MRI of the pelvis without and with contrast CPT 72197 H MR PELVIS W AND WO CONTRAS | $5,796.00 | $8,280.00 | $1,407.60–$7,866.00 | 62% above | 30% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 H MR PELVIS W AND WO CONTRAS | $5,796.00 | $8,280.00 | $900.00–$7,866.00 | — | 30% |
| MRI of the pelvis, no contrast dye CPT 72195 H MR PELVIS WO CONTRAST | $3,840.90 | $5,487.00 | $932.79–$5,212.65 | 44% above | 30% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 H MR PELVIS WO CONTRAST | $3,840.90 | $5,487.00 | $900.00–$5,212.65 | — | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 H MR UPPER EXTREM JOINT WO CONTRAS | $4,055.80 | $5,794.00 | $984.98–$5,504.30 | 44% above | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 H MR UPPER EXTREM JOINT WO CONTRAS | $4,055.80 | $5,794.00 | $900.00–$5,504.30 | — | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 H XR SPINE CERVICAL 4 OR 5 VIEWS | $855.40 | $1,222.00 | $207.74–$1,160.90 | 56% above | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 H XR SPINE CERVICAL 4 OR 5 VIEWS | $855.40 | $1,222.00 | $452.14–$3,678.00 | — | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 H NM MYOCARD PERF SPECT MULTIPLE | $3,068.10 | $4,383.00 | $745.11–$4,163.85 | 23% below | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 H NM MYOCARD PERF SPECT MULTIPLE | $3,068.10 | $4,383.00 | $900.00–$4,163.85 | — | 30% |
| OCT scan of the retina (optical coherence tomography) CPT 92134 H CPTRZ OPH DX IMG PST SGM RTA | $350.00 | $500.00 | $85.00–$936.00 | 273% above | 30% |
| OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 H CPTRZ OPH DX IMG PST SGM RTA | $350.00 | $500.00 | $185.00–$3,678.00 | — | 30% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 H PET/CT SKULL TO MID THIGH | $9,169.30 | $13,099.00 | $2,226.83–$12,444.05 | 55% above | 30% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 H PET/CT SKULL TO MID THIGH | $9,169.30 | $13,099.00 | $900.00–$12,444.05 | — | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 POC US PELVIC LIMITED | $850.50 | $1,215.00 | $206.55–$1,154.25 | 58% above | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 H US PELVIS LIMITED | $850.50 | $1,215.00 | $206.55–$1,154.25 | 58% above | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 POC US PELVIC LIMITED | $850.50 | $1,215.00 | $449.55–$3,678.00 | — | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 H US PELVIS LIMITED | $850.50 | $1,215.00 | $449.55–$3,678.00 | — | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 H US PELVIS COMPLETE | $1,499.40 | $2,142.00 | $364.14–$2,034.90 | 89% above | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 H US PELVIS COMPLETE | $1,499.40 | $2,142.00 | $792.54–$3,678.00 | — | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 H US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $1,177.40 | $1,682.00 | $285.94–$1,597.90 | 58% above | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 H US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $1,177.40 | $1,682.00 | $622.34–$3,678.00 | — | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 H US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTATI | $562.10 | $803.00 | $136.51–$762.85 | 17% below | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 H US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTATI | $562.10 | $803.00 | $297.11–$3,678.00 | — | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 H US PREGNANT UTERUS LIMITED 1/> FETUSES | $310.10 | $443.00 | $75.31–$633.00 | 41% below | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 H POC US PREGNANT UTERUS LIMITED 1/> FETUSES | $310.10 | $443.00 | $75.31–$633.00 | 41% below | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 H POC US PREGNANT UTERUS LIMITED 1/> FETUSES | $310.10 | $443.00 | $163.91–$3,678.00 | — | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 H US PREGNANT UTERUS LIMITED 1/> FETUSES | $310.10 | $443.00 | $163.91–$3,678.00 | — | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 H XR RIBS UNILAT W/PA CHEST | $875.70 | $1,251.00 | $212.67–$1,188.45 | 81% above | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 H XR RIBS UNILAT W/PA CHEST | $875.70 | $1,251.00 | $462.87–$3,678.00 | — | 30% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 H XR SHOULDER MIN 2 VIEW | $553.00 | $790.00 | $134.30–$750.50 | 54% above | 30% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 H XR SHOULDER MIN 2 VIEW | $553.00 | $790.00 | $292.30–$3,678.00 | — | 30% |
| Sinus X-ray, complete, 3 or more views CPT 70220 H XR SINUS MIN 3 VIEWS | $750.40 | $1,072.00 | $182.24–$1,018.40 | 98% above | 30% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 H XR SINUS MIN 3 VIEWS | $750.40 | $1,072.00 | $396.64–$3,678.00 | — | 30% |
| Skull X-ray, fewer than 4 views CPT 70250 H XR SKULL < 4 VIEWS | $521.50 | $745.00 | $126.65–$707.75 | 69% above | 30% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 H XR SKULL < 4 VIEWS | $521.50 | $745.00 | $275.65–$3,678.00 | — | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 H SLEEP POLYSOMNOGR 4+ PARA AGE 6 AND OVER | $4,943.40 | $7,062.00 | $1,200.54–$6,708.90 | 28% above | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 H SLEEP POLYSOMNOGR 4+ PARA AGE 6 AND OVER | $4,943.40 | $7,062.00 | $900.00–$6,708.90 | — | 30% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 H XR REHAB SWALLOW STUDY | $1,120.00 | $1,600.00 | $272.00–$1,520.00 | 84% above | 30% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 H XR REHAB SWALLOW STUDY | $1,120.00 | $1,600.00 | $592.00–$3,678.00 | — | 30% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 H XR FEMUR MIN 2 VIEWS | $515.20 | $736.00 | $125.12–$699.20 | 82% above | 30% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 H XR FEMUR MIN 2 VIEWS | $515.20 | $736.00 | $272.32–$3,678.00 | — | 30% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 H CT SPINE THORACIC WO CONTRAST | $2,646.70 | $3,781.00 | $900.00–$3,678.00 | — | 30% |
| Toe X-ray, 2 or more views CPT 73660 H XR TOE(S) MIN 2 VIEWS | $424.20 | $606.00 | $103.02–$597.00 | 86% above | 30% |
| Toe X-ray, 2 or more views inpatient CPT 73660 H XR TOE(S) MIN 2 VIEWS | $424.20 | $606.00 | $224.22–$3,678.00 | — | 30% |
| Transvaginal pelvic ultrasound CPT 76830 H US PELVIS TRANSVAGINAL | $665.00 | $950.00 | $161.50–$902.50 | 4% above | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 H US PELVIS TRANSVAGINAL | $665.00 | $950.00 | $351.50–$3,678.00 | — | 30% |
| Transvaginal ultrasound during pregnancy CPT 76817 H US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG | $845.60 | $1,208.00 | $205.36–$1,147.60 | 60% above | 30% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 H US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG | $845.60 | $1,208.00 | $446.96–$3,678.00 | — | 30% |
| Ultrasound of the abdomen, complete CPT 76700 H US ABDOMEN | $1,726.20 | $2,466.00 | $419.22–$2,342.70 | 68% above | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 H US ABDOMEN | $1,726.20 | $2,466.00 | $900.00–$3,678.00 | — | 30% |
| Ultrasound of the scrotum and testicles CPT 76870 H US SCROTUM AND/OR TESTICLE | $1,348.90 | $1,927.00 | $327.59–$1,830.65 | 80% above | 30% |
| Ultrasound of the scrotum and testicles CPT 76870 H POC US SCROTUM LIMITED | $1,348.90 | $1,927.00 | $327.59–$1,830.65 | 80% above | 30% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 H POC US SCROTUM LIMITED | $1,348.90 | $1,927.00 | $712.99–$3,678.00 | — | 30% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 H US SCROTUM AND/OR TESTICLE | $1,348.90 | $1,927.00 | $712.99–$3,678.00 | — | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 H POC US SOFT TISSUE HEAD AND NECK LIMITED | $1,357.30 | $1,939.00 | $329.63–$1,842.05 | 99% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 H IR 76536 UR SOFT TISSUE HEAD AND NECK | $1,357.30 | $1,939.00 | $329.63–$1,842.05 | 99% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 H US SOFT TISSUE HEAD AND NECK | $1,357.30 | $1,939.00 | $329.63–$1,842.05 | 99% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 H US SOFT TISSUE HEAD AND NECK | $1,357.30 | $1,939.00 | $717.43–$3,678.00 | — | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 H POC US SOFT TISSUE HEAD AND NECK LIMITED | $1,357.30 | $1,939.00 | $717.43–$3,678.00 | — | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 H IR 76536 UR SOFT TISSUE HEAD AND NECK | $1,357.30 | $1,939.00 | $717.43–$3,678.00 | — | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 H XR UPPER GI TRC SINGLE CONTRAST STUDY | $1,159.90 | $1,657.00 | $281.69–$1,574.15 | 67% above | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 H XR UGI W/O KUB | $1,159.90 | $1,657.00 | $281.69–$1,574.15 | 67% above | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 H XR UGI W/O KUB | $1,159.90 | $1,657.00 | $613.09–$3,678.00 | — | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 H XR UPPER GI TRC SINGLE CONTRAST STUDY | $1,159.90 | $1,657.00 | $613.09–$3,678.00 | — | 30% |
| Upper arm X-ray (humerus), 2 views CPT 73060 H XR HUMERUS MIN 2 VIEWS | $541.80 | $774.00 | $131.58–$735.30 | 84% above | 30% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 H XR HUMERUS MIN 2 VIEWS | $541.80 | $774.00 | $286.38–$3,678.00 | — | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 H POC DVT EXTREMITY LIMITED | $1,664.60 | $2,378.00 | $404.26–$2,259.10 | 135% above | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 H US DPLER EXTREM VEIN UNILAT | $1,664.60 | $2,378.00 | $404.26–$2,259.10 | 135% above | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 H POC DVT EXTREMITY LIMITED | $1,664.60 | $2,378.00 | $879.86–$3,678.00 | — | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 H US DPLER EXTREM VEIN UNILAT | $1,664.60 | $2,378.00 | $879.86–$3,678.00 | — | 30% |
| Wrist X-ray, 2 views CPT 73100 H XR WRIST 2 VIEWS | $446.60 | $638.00 | $108.46–$606.10 | 67% above | 30% |
| Wrist X-ray, 2 views inpatient CPT 73100 H XR WRIST 2 VIEWS | $446.60 | $638.00 | $236.06–$3,678.00 | — | 30% |
| Wrist X-ray, complete, 3 or more views CPT 73110 H XR WRIST MIN. 3 VIEWS | $527.10 | $753.00 | $128.01–$715.35 | 61% above | 30% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 H XR WRIST MIN. 3 VIEWS | $527.10 | $753.00 | $278.61–$3,678.00 | — | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 H XR HIP UNILATERAL 2 TO 3 VIEWS | $528.50 | $755.00 | $128.35–$717.25 | 75% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 H XR HIP UNILATERAL 2 TO 3 VIEWS | $528.50 | $755.00 | $279.35–$3,678.00 | — | 30% |
| X-ray of the abdomen, 1 view CPT 74018 H XR ABDOMEN 1 VIEW | $412.30 | $589.00 | $100.13–$597.00 | 55% above | 30% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 H XR ABDOMEN 1 VIEW | $412.30 | $589.00 | $217.93–$3,678.00 | — | 30% |
| X-ray of the ankle, 2 views CPT 73600 H XR ANKLE 2 VIEWS | $418.60 | $598.00 | $101.66–$597.00 | 52% above | 30% |
| X-ray of the ankle, 2 views inpatient CPT 73600 H XR ANKLE 2 VIEWS | $418.60 | $598.00 | $221.26–$3,678.00 | — | 30% |
| X-ray of the finger(s), 2 or more views CPT 73140 H XR FINGER(S) 3 VIEWS | $464.10 | $663.00 | $112.71–$629.85 | 78% above | 30% |
| X-ray of the finger(s), 2 or more views CPT 73140 H XR FINGER(S) MIN 2 VIEWS | $464.10 | $663.00 | $112.71–$629.85 | 78% above | 30% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 H XR FINGER(S) 3 VIEWS | $464.10 | $663.00 | $245.31–$3,678.00 | — | 30% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 H XR FINGER(S) MIN 2 VIEWS | $464.10 | $663.00 | $245.31–$3,678.00 | — | 30% |
| X-ray of the foot, 2 views CPT 73620 H XR FOOT 2 VIEWS | $392.00 | $560.00 | $95.20–$597.00 | 43% above | 30% |
| X-ray of the foot, 2 views inpatient CPT 73620 H XR FOOT 2 VIEWS | $392.00 | $560.00 | $207.20–$3,678.00 | — | 30% |
| X-ray of the foot, complete, 3 or more views CPT 73630 H XR FOOT MIN 3 VIEWS | $559.30 | $799.00 | $135.83–$759.05 | 62% above | 30% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 H XR FOOT WEIGHT BEARING LEFT | $559.30 | $799.00 | $135.83–$759.05 | 62% above | 30% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 H XR FOOT MIN 3 VIEWS | $559.30 | $799.00 | $295.63–$3,678.00 | — | 30% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 H XR FOOT WEIGHT BEARING LEFT | $559.30 | $799.00 | $295.63–$3,678.00 | — | 30% |
| X-ray of the hand, 3 or more views CPT 73130 H XR HAND MIN 3 VIEWS | $602.00 | $860.00 | $146.20–$817.00 | 74% above | 30% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 H XR HAND MIN 3 VIEWS | $602.00 | $860.00 | $318.20–$3,678.00 | — | 30% |
| X-ray of the knee, 1 or 2 views CPT 73560 H XR KNEE 1 VIEW | $483.70 | $691.00 | $117.47–$656.45 | 68% above | 30% |
| X-ray of the knee, 1 or 2 views CPT 73560 H XR KNEE 1 OR 2 VIEWS | $483.70 | $691.00 | $117.47–$656.45 | 68% above | 30% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 H XR KNEE 1 OR 2 VIEWS | $483.70 | $691.00 | $255.67–$3,678.00 | — | 30% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 H XR KNEE 1 VIEW | $483.70 | $691.00 | $255.67–$3,678.00 | — | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 H XR SPINE LUMBAR 2 OR 3 VIEWS | $527.80 | $754.00 | $128.18–$716.30 | 19% above | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 H XR SPINE LUMBAR 2 OR 3 VIEWS | $527.80 | $754.00 | $278.98–$3,678.00 | — | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 H XR SPINE LUMBAR MIN 4 VIEWS | $840.70 | $1,201.00 | $204.17–$1,140.95 | 46% above | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 H XR SPINE LUMBAR 5 VIEWS | $840.70 | $1,201.00 | $204.17–$1,140.95 | 46% above | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 H XR SPINE LUMBAR 5 VIEWS | $840.70 | $1,201.00 | $444.37–$3,678.00 | — | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 H XR SPINE LUMBAR MIN 4 VIEWS | $840.70 | $1,201.00 | $444.37–$3,678.00 | — | 30% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 H XR SPINE THORACIC 2 VIEWS | $621.60 | $888.00 | $150.96–$843.60 | 70% above | 30% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 H XR SPINE THORACIC 2 VIEWS | $621.60 | $888.00 | $328.56–$3,678.00 | — | 30% |
| X-ray of the nasal bones, 3 or more views CPT 70160 H XR NASAL BONES MIN 3 VIEWS | $637.00 | $910.00 | $154.70–$864.50 | 113% above | 30% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 H XR NASAL BONES MIN 3 VIEWS | $637.00 | $910.00 | $336.70–$3,678.00 | — | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 H XR SPINE CERVICAL 2 OR 3 VIEWS | $647.50 | $925.00 | $157.25–$878.75 | 81% above | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 H XR SPINE CERVICAL FLEX/EXT | $647.50 | $925.00 | $157.25–$878.75 | 81% above | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 H XR SPINE CERVICAL FLEX/EXT | $647.50 | $925.00 | $342.25–$3,678.00 | — | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 H XR SPINE CERVICAL 2 OR 3 VIEWS | $647.50 | $925.00 | $342.25–$3,678.00 | — | 30% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 H XR PELVIS 1 OR 2 VIEWS | $583.10 | $833.00 | $141.61–$791.35 | 69% above | 30% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 H XR PELVIS 1 OR 2 VIEWS | $583.10 | $833.00 | $308.21–$3,678.00 | — | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 H XR SACRUM/COCCYX MIN 2 VIEWS | $654.50 | $935.00 | $158.95–$888.25 | 90% above | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 H XR SACRUM/COCCYX MIN 2 VIEWS | $654.50 | $935.00 | $345.95–$3,678.00 | — | 30% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 H ALANINE AMINOTRANSFERASE (ALT) (GPT) SERUM | $98.00 | $140.00 | $23.80–$133.00 | 78% above | 30% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 H ALANINE AMINOTRANSFERASE (ALT) (GPT) SERUM | $98.00 | $140.00 | $51.80–$3,678.00 | — | 30% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 H ASPARTATE AMINOTRANSFERASE (AST)(GOT) SERUM | $91.00 | $130.00 | $22.10–$123.50 | 65% above | 30% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 H ASPARTATE AMINOTRANSFERASE (AST)(GOT) SERUM | $91.00 | $130.00 | $48.10–$3,678.00 | — | 30% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 H ACUTE HEPATITIS PANEL | $663.60 | $948.00 | $84.00–$900.60 | 153% above | 30% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 H ACUTE HEPATITIS PANEL | $663.60 | $948.00 | $350.76–$3,678.00 | — | 30% |
| Albumin blood test CPT 82040 H ALBUMIN SERUM | $86.80 | $124.00 | $21.08–$117.80 | 102% above | 30% |
| Albumin blood test inpatient CPT 82040 H ALBUMIN SERUM | $86.80 | $124.00 | $45.88–$3,678.00 | — | 30% |
| Alkaline phosphatase (ALP) blood test CPT 84075 H ALKALINE PHOSPHATASE SERUM | $85.40 | $122.00 | $20.74–$115.90 | 55% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 H RAST TEST-1 ALLERGEN | $46.20 | $66.00 | $11.22–$92.00 | 68% above | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 H RAST TEST-1 ALLERGEN | $46.20 | $66.00 | $24.42–$3,678.00 | — | 30% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 H ALPHA-FETOPROTEIN (AFP) TUMOR MARKER PLASMA OR SERUM | $338.80 | $484.00 | $82.28–$459.80 | 210% above | 30% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 H ALPHA-FETOPROTEIN (AFP) TUMOR MARKER PLASMA OR SERUM | $338.80 | $484.00 | $179.08–$3,678.00 | — | 30% |
| Ammonia blood test CPT 82140 H AMMONIA PLASMA | $253.40 | $362.00 | $61.54–$343.90 | 128% above | 30% |
| Ammonia blood test inpatient CPT 82140 H AMMONIA PLASMA | $253.40 | $362.00 | $133.94–$3,678.00 | — | 30% |
| Amylase blood test CPT 82150 H URINE AMYLASERANDOM | $160.30 | $229.00 | $38.93–$217.55 | 99% above | 30% |
| Amylase blood test CPT 82150 H AMYLASE TOTAL SERUM | $160.30 | $229.00 | $38.93–$217.55 | 99% above | 30% |
| Amylase blood test CPT 82150 H AMYLASE BODY FLUIDS | $160.30 | $229.00 | $38.93–$217.55 | 99% above | 30% |
| Amylase blood test CPT 82150 H ASSAY OF AMYLASE | $160.30 | $229.00 | $38.93–$217.55 | 99% above | 30% |
| Amylase blood test inpatient CPT 82150 H ASSAY OF AMYLASE | $160.30 | $229.00 | $84.73–$3,678.00 | — | 30% |
| Amylase blood test inpatient CPT 82150 H URINE AMYLASERANDOM | $160.30 | $229.00 | $84.73–$3,678.00 | — | 30% |
| Amylase blood test inpatient CPT 82150 H AMYLASE BODY FLUIDS | $160.30 | $229.00 | $84.73–$3,678.00 | — | 30% |
| Amylase blood test inpatient CPT 82150 H AMYLASE TOTAL SERUM | $160.30 | $229.00 | $84.73–$3,678.00 | — | 30% |
| Amylase blood test inpatient CPT 82150 H AMYLASE URINE 24-HOUR COLLECTION | $160.30 | $229.00 | $84.73–$3,678.00 | — | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 H ANTINUCLEAR ANTIBODIES ANA | $191.80 | $274.00 | $46.58–$260.30 | 107% above | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 H ANTINUCLEAR AB (ANA) HEP-2 | $191.80 | $274.00 | $46.58–$260.30 | 107% above | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 H ANTICENTROMERE ANTIBODY | $191.80 | $274.00 | $46.58–$260.30 | 107% above | 30% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 H ANTINUCLEAR AB (ANA) HEP-2 | $191.80 | $274.00 | $101.38–$3,678.00 | — | 30% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 H ANTICENTROMERE ANTIBODY | $191.80 | $274.00 | $101.38–$3,678.00 | — | 30% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 H ANTINUCLEAR ANTIBODIES ANA | $191.80 | $274.00 | $101.38–$3,678.00 | — | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 H NATRIURETIC PEPTIDE PLASMA | $383.60 | $548.00 | $84.00–$520.60 | 103% above | 30% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 H NATRIURETIC PEPTIDE PLASMA | $383.60 | $548.00 | $202.76–$3,678.00 | — | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 H CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL | $227.50 | $325.00 | $55.25–$308.75 | 160% above | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 H RESPIRATORY CULTURE /MC | $227.50 | $325.00 | $55.25–$308.75 | 160% above | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 H RESPIRATORY CULTURE /MC | $227.50 | $325.00 | $120.25–$3,678.00 | — | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 H CULTURE ENVIRONMENTAL | $227.50 | $325.00 | $120.25–$3,678.00 | — | 30% |
| Basic metabolic panel (blood test) CPT 80048 H BASIC METABOLIC PROFILE | $254.10 | $363.00 | $61.71–$344.85 | 98% above | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 H BASIC METABOLIC PROFILE | $254.10 | $363.00 | $134.31–$3,678.00 | — | 30% |
| Bilirubin blood test, total CPT 82247 H BILIRUBIN TOTAL BODY FLUID | $118.30 | $169.00 | $28.73–$160.55 | 92% above | 30% |
| Bilirubin blood test, total CPT 82247 H BILIRUBINTOTAL PLASMA/SERUM | $118.30 | $169.00 | $28.73–$160.55 | 92% above | 30% |
| Bilirubin blood test, total inpatient CPT 82247 H BILIRUBIN TOTAL BODY FLUID | $118.30 | $169.00 | $62.53–$3,678.00 | — | 30% |
| Bilirubin blood test, total inpatient CPT 82247 H BILIRUBIN TOTAL | $118.30 | $169.00 | $62.53–$3,678.00 | — | 30% |
| Bilirubin blood test, total inpatient CPT 82247 H BILIRUBINTOTAL PLASMA/SERUM | $118.30 | $169.00 | $62.53–$3,678.00 | — | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 H OPHTHALM PATH4 (NWH) | $490.00 | $700.00 | $94.00–$665.00 | 100% above | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 H LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | $490.00 | $700.00 | $94.00–$665.00 | 100% above | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 H SURG CASE LEVEL IV /AP | $490.00 | $700.00 | $94.00–$665.00 | 100% above | 30% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 H OPHTHALM PATH4 (NWH) | $490.00 | $700.00 | $259.00–$3,678.00 | — | 30% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 H SURG CASE LEVEL IV /AP | $490.00 | $700.00 | $259.00–$3,678.00 | — | 30% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 H LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | $490.00 | $700.00 | $259.00–$3,678.00 | — | 30% |
| Blood culture for bacteria CPT 87040 H CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES | $343.70 | $491.00 | $83.47–$466.45 | 138% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 H WST-PHLEBOTOMY CHARGE | $44.10 | $63.00 | $10.71–$92.00 | 87% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 H SKOKIE PHLEBOTOMY CHARGE | $44.10 | $63.00 | $10.71–$92.00 | 87% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 H LF PHLEBOTOMY CHARGE | $44.10 | $63.00 | $10.71–$92.00 | 87% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 H NB-PHLEBOTOMY CHARGE | $44.10 | $63.00 | $10.71–$92.00 | 87% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 H NWC PHLEBOTOMY | $44.10 | $63.00 | $10.71–$92.00 | 87% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 H NLX-PHLEBOTOMY CHARGE | $44.10 | $63.00 | $10.71–$92.00 | 87% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 H PHLEBOTOMY CHARGE | $44.10 | $63.00 | $10.71–$92.00 | 87% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 H HO-PHLEBOTOMY CHARGE | $44.10 | $63.00 | $10.71–$92.00 | 87% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 H NWC PHLEBOTOMY | $44.10 | $63.00 | $23.31–$3,678.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 H PHLEBOTOMY VENIPUNCTURE | $44.10 | $63.00 | $23.31–$3,678.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 H WST-PHLEBOTOMY CHARGE | $44.10 | $63.00 | $23.31–$3,678.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 H NB-PHLEBOTOMY CHARGE | $44.10 | $63.00 | $23.31–$3,678.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 H NLX-PHLEBOTOMY CHARGE | $44.10 | $63.00 | $23.31–$3,678.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 H HO-PHLEBOTOMY CHARGE | $44.10 | $63.00 | $23.31–$3,678.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 H SKOKIE PHLEBOTOMY CHARGE | $44.10 | $63.00 | $23.31–$3,678.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 H LF PHLEBOTOMY CHARGE | $44.10 | $63.00 | $23.31–$3,678.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 H PHLEBOTOMY CHARGE | $44.10 | $63.00 | $23.31–$3,678.00 | — | 30% |
| Blood glucose (sugar) test CPT 82947 H GLUCOSE 1-HOUR POST ORAL DOSE | $73.50 | $105.00 | $17.85–$99.75 | 79% above | 30% |
| Blood glucose (sugar) test CPT 82947 H GLUCOSE PLASMA | $73.50 | $105.00 | $17.85–$99.75 | 79% above | 30% |
| Blood glucose (sugar) test CPT 82947 H GLUCOSE BLOOD GAS POC | $73.50 | $105.00 | $17.85–$99.75 | 79% above | 30% |
| Blood glucose (sugar) test CPT 82947 H GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP | $73.50 | $105.00 | $17.85–$99.75 | 79% above | 30% |
| Blood glucose (sugar) test CPT 82947 H GLUCOSE FASTING | $73.50 | $105.00 | $17.85–$99.75 | 79% above | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 H GLUCOSE BLOOD GAS POC | $73.50 | $105.00 | $38.85–$3,678.00 | — | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 H GLUCOSE PLASMA | $73.50 | $105.00 | $38.85–$3,678.00 | — | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 H GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP | $73.50 | $105.00 | $38.85–$3,678.00 | — | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 H GLUCOSE 1-HOUR POST ORAL DOSE | $73.50 | $105.00 | $38.85–$3,678.00 | — | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 H GONADOTROPIN CHORIONIC QUALITATIVE | $122.50 | $175.00 | $29.75–$166.25 | 36% above | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 H HCG (PREGNANCY TEST) SERUM QUALITATIVE | $122.50 | $175.00 | $29.75–$166.25 | 36% above | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 H GONADOTROPIN CHORIONIC QUALITATIVE | $122.50 | $175.00 | $64.75–$3,678.00 | — | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 H HCG (PREGNANCY TEST) SERUM QUALITATIVE | $122.50 | $175.00 | $64.75–$3,678.00 | — | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 H ABO TYPING (BILL) SEROLOGIC | $151.20 | $216.00 | $36.72–$205.20 | 80% above | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 H ABO TYPING (BILL) SEROLOGIC | $151.20 | $216.00 | $79.92–$3,678.00 | — | 30% |
| Blood urea nitrogen (BUN) test CPT 84520 H ASSAY OF UREA NITROGEN QUANTITATIVE | $96.60 | $138.00 | $23.46–$131.10 | 99% above | 30% |
| Blood urea nitrogen (BUN) test CPT 84520 H UREA NITROGEN QUANT BF | $96.60 | $138.00 | $23.46–$131.10 | 99% above | 30% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 H BLOOD UREA NITROGEN (BUN) | $96.60 | $138.00 | $51.06–$3,678.00 | — | 30% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 H ASSAY OF UREA NITROGEN QUANTITATIVE | $96.60 | $138.00 | $51.06–$3,678.00 | — | 30% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 H UREA NITROGEN QUANT BF | $96.60 | $138.00 | $51.06–$3,678.00 | — | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 H C-REACTIVE PROTEIN (CRP) SERUM | $161.70 | $231.00 | $39.27–$219.45 | 129% above | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 H C-REACTIVE PROTEIN (CRP) SERUM | $161.70 | $231.00 | $85.47–$3,678.00 | — | 30% |
| C. difficile toxin gene test (stool PCR) CPT 87493 H INF AGENT DET NUCLEIC C DIF TOXIN GENE(S) AMP PROBE | $298.90 | $427.00 | $72.59–$405.65 | 62% above | 30% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 H INF AGENT DET NUCLEIC C DIF TOXIN GENE(S) AMP PROBE | $298.90 | $427.00 | $157.99–$3,678.00 | — | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 H IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ MC | $222.60 | $318.00 | $54.06–$302.10 | 93% above | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 H IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ | $222.60 | $318.00 | $54.06–$302.10 | 93% above | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 H NFCT DS RNA 1 TARGET UPPER RESPIRATORY PCR_COVORO | $222.60 | $318.00 | $54.06–$302.10 | 93% above | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 H SARS-COV-2 | $222.60 | $318.00 | $54.06–$302.10 | 93% above | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 H SARS-COV-2 | $222.60 | $318.00 | $117.66–$3,678.00 | — | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 H IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ | $222.60 | $318.00 | $117.66–$3,678.00 | — | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 H IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ MC | $222.60 | $318.00 | $117.66–$3,678.00 | — | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 H COV-19 AMP PRB HGH THRUPUT | $222.60 | $318.00 | $117.66–$3,678.00 | — | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 H NFCT DS RNA 1 TARGET UPPER RESPIRATORY PCR_COVORO | $222.60 | $318.00 | $117.66–$3,678.00 | — | 30% |
| Calcium blood test, total CPT 82310 H CALCIUM URINE RANDOM | $112.70 | $161.00 | $27.37–$152.95 | 157% above | 30% |
| Calcium blood test, total CPT 82310 H CALCIUM TOTAL SERUM | $112.70 | $161.00 | $27.37–$152.95 | 157% above | 30% |
| Calcium blood test, total inpatient CPT 82310 H CALCIUM URINE RANDOM | $112.70 | $161.00 | $59.57–$3,678.00 | — | 30% |
| Calcium blood test, total inpatient CPT 82310 H CALCIUM TOTAL SERUM | $112.70 | $161.00 | $59.57–$3,678.00 | — | 30% |
| Chickenpox (varicella) immunity blood test CPT 86787 H VARICELLA-ZOSTER VIRUS (VZV) ANTIBODY IGG | $212.10 | $303.00 | $51.51–$287.85 | 193% above | 30% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 H VARICELLA-ZOSTER VIRUS (VZV) ANTIBODY IGG | $212.10 | $303.00 | $112.11–$3,678.00 | — | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 H CHLMYD TRACH DNA AMP PROBE | $294.70 | $421.00 | $71.57–$399.95 | 138% above | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 H IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $294.70 | $421.00 | $71.57–$399.95 | 138% above | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 H IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $294.70 | $421.00 | $155.77–$3,678.00 | — | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 H CHLMYD TRACH DNA AMP PROBE | $294.70 | $421.00 | $155.77–$3,678.00 | — | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 H LIPID SCREEN FASTING | $282.10 | $403.00 | $68.51–$382.85 | 125% above | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 H LIPID SCREEN RANDOM | $282.10 | $403.00 | $68.51–$382.85 | 125% above | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 H LIPID PANEL | $282.10 | $403.00 | $68.51–$382.85 | 125% above | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 H LIPID SCREEN RANDOM | $282.10 | $403.00 | $149.11–$3,678.00 | — | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 H LIPID PANEL | $282.10 | $403.00 | $149.11–$3,678.00 | — | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 H LIPID SCREEN FASTING | $282.10 | $403.00 | $149.11–$3,678.00 | — | 30% |
| Complete blood count (CBC) with differential CPT 85025 H CBC & AUTOMATED DIFFERENTIAL/H | $156.10 | $223.00 | $37.91–$211.85 | 90% above | 30% |
| Complete blood count (CBC), no differential CPT 85027 H CBC | $100.10 | $143.00 | $24.31–$135.85 | 54% above | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 H CBC | $100.10 | $143.00 | $52.91–$3,678.00 | — | 30% |
| Cortisol blood test, total CPT 82533 H CORTISOL 240 MIN | $282.80 | $404.00 | $68.68–$383.80 | 151% above | 30% |
| Cortisol blood test, total CPT 82533 H CORTISOL 290 MIN | $282.80 | $404.00 | $68.68–$383.80 | 151% above | 30% |
| Cortisol blood test, total CPT 82533 H CORTISOL 180 MIN | $282.80 | $404.00 | $68.68–$383.80 | 151% above | 30% |
| Cortisol blood test, total inpatient CPT 82533 H CORTISOL TOTAL PRE STIMULATION | $282.80 | $404.00 | $149.48–$3,678.00 | — | 30% |
| Cortisol blood test, total inpatient CPT 82533 H CORTISOL TOTAL | $282.80 | $404.00 | $149.48–$3,678.00 | — | 30% |
| Cortisol blood test, total inpatient CPT 82533 H CORTISOL 240 MIN | $282.80 | $404.00 | $149.48–$3,678.00 | — | 30% |
| Cortisol blood test, total inpatient CPT 82533 H CORTISOL 180 MIN | $282.80 | $404.00 | $149.48–$3,678.00 | — | 30% |
| Creatine kinase (CK) blood test, total CPT 82550 H CREATINE KINASE (CK) SERUM | $109.90 | $157.00 | $26.69–$149.15 | 79% above | 30% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 H CREATINE KINASE (CK) SERUM | $109.90 | $157.00 | $58.09–$3,678.00 | — | 30% |
| Creatinine blood test CPT 82565 H CREATININE BLOOD | $105.00 | $150.00 | $25.50–$142.50 | 121% above | 30% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 H ELECTROLYTE PANEL | $127.40 | $182.00 | $30.94–$172.90 | 32% above | 30% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 H ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA | $248.50 | $355.00 | $60.35–$337.25 | 130% above | 30% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 H EPSTEIN BARR VIRUS TEST PER ANTIB | $248.50 | $355.00 | $60.35–$337.25 | 130% above | 30% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 H DONOR EPSTEIN BARR VIRUS TEST PER ANTIB | $248.50 | $355.00 | $131.35–$3,678.00 | — | 30% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 H ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA | $248.50 | $355.00 | $131.35–$3,678.00 | — | 30% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 H EPSTEIN BARR VIRUS TEST PER ANTIB | $248.50 | $355.00 | $131.35–$3,678.00 | — | 30% |
| FSH (follicle-stimulating hormone) test CPT 83001 H FOLLICLE-STIMULATING HORMONE (FSH) SERUM | $326.20 | $466.00 | $79.22–$442.70 | 174% above | 30% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 H FOLLICLE-STIMULATING HORMONE (FSH) SERUM | $326.20 | $466.00 | $172.42–$3,678.00 | — | 30% |
| Ferritin blood test (iron stores) CPT 82728 H FERRITIN PLASMA OR SERUM | $240.80 | $344.00 | $58.48–$326.80 | 85% above | 30% |
| Fibrinogen blood test inpatient CPT 85384 H FIBRINOGEN PLASMA | $184.10 | $263.00 | $97.31–$3,678.00 | — | 30% |
| Free T3 thyroid hormone test CPT 84481 H FREE T3 (TRIIODOTHYRONINE) | $367.50 | $525.00 | $84.00–$498.75 | 202% above | 30% |
| Free T3 thyroid hormone test inpatient CPT 84481 H FREE T3 (TRIIODOTHYRONINE) | $367.50 | $525.00 | $194.25–$3,678.00 | — | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 H THYROXINE FREE (FT4) SERUM | $201.60 | $288.00 | $48.96–$273.60 | 75% above | 30% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 H THYROXINE FREE (FT4) SERUM | $201.60 | $288.00 | $106.56–$3,678.00 | — | 30% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 H GAMMA-GLUTAMYLTRANSFERASE (GGT) SERUM | $136.50 | $195.00 | $33.15–$185.25 | 136% above | 30% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 H GAMMA-GLUTAMYLTRANSFERASE (GGT) SERUM | $136.50 | $195.00 | $72.15–$3,678.00 | — | 30% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 H GENERAL HEALTH PANEL | $786.10 | $1,123.00 | $84.00–$1,066.85 | 161% above | 30% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 H GENERAL HEALTH PANEL | $786.10 | $1,123.00 | $415.51–$3,678.00 | — | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 H GLUCOSE 2-HOUR POST ORAL DOSE | $73.50 | $105.00 | $17.85–$99.75 | 23% above | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 H GLUCOSE 2-HOUR POST ORAL DOSE | $73.50 | $105.00 | $38.85–$3,678.00 | — | 30% |
| Glucose tolerance test, 3 samples CPT 82951 H TOLERANCE TEST - 3 SPECIMENS | $102.90 | $147.00 | $24.99–$139.65 | 24% below | 30% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 H TOLERANCE TEST - 3 SPECIMENS | $102.90 | $147.00 | $54.39–$3,678.00 | — | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 H N. GONORRHOREA DNA AMP PROBE | $280.70 | $401.00 | $68.17–$380.95 | 132% above | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 H IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $292.60 | $418.00 | $71.06–$397.10 | 142% above | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 H N. GONORRHOREA DNA AMP PROBE | $280.70 | $401.00 | $148.37–$3,678.00 | — | 30% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 H HIV-1/HIV-2 1 RESULT ANTBDY | $121.80 | $174.00 | $64.38–$3,678.00 | — | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 H LAV-1/2 ANTIGEN & ANTIBODY EVALUATION SERUM | $170.10 | $243.00 | $41.31–$230.85 | 48% above | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 H LAV-1/2 ANTIGEN & ANTIBODY EVALUATION SERUM | $170.10 | $243.00 | $89.91–$3,678.00 | — | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 H HEMOGLOBIN GLYCOSYLATED A1C LAB | $200.90 | $287.00 | $48.79–$272.65 | 126% above | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 H HEMOGLOBIN GLYCOSYLATED A1C | $200.90 | $287.00 | $48.79–$272.65 | 126% above | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 H HEMOGLOBIN GLYCOSYLATED A1C | $200.90 | $287.00 | $106.19–$3,678.00 | — | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 H HEMOGLOBIN GLYCOSYLATED A1C LAB | $200.90 | $287.00 | $106.19–$3,678.00 | — | 30% |
| Hemoglobin blood test CPT 85018 H BLOOD COUNT HEMOGLOBIN | $63.00 | $90.00 | $15.30–$92.00 | 102% above | 30% |
| Hemoglobin blood test CPT 85018 H HEMOGLOBIN (HGB) | $63.00 | $90.00 | $15.30–$92.00 | 102% above | 30% |
| Hemoglobin blood test CPT 85018 H HEMOGLOBIN (MANUAL) /H | $63.00 | $90.00 | $15.30–$92.00 | 102% above | 30% |
| Hemoglobin blood test CPT 85018 H HEMOGLOBIN BLOOD | $63.00 | $90.00 | $15.30–$92.00 | 102% above | 30% |
| Hemoglobin blood test inpatient CPT 85018 H HEMOGLOBIN BLOOD POC | $63.00 | $90.00 | $33.30–$3,678.00 | — | 30% |
| Hemoglobin blood test inpatient CPT 85018 H HEMOGLOBIN (MANUAL) /H | $63.00 | $90.00 | $33.30–$3,678.00 | — | 30% |
| Hemoglobin blood test inpatient CPT 85018 H HEMOGLOBIN BLOOD | $63.00 | $90.00 | $33.30–$3,678.00 | — | 30% |
| Hemoglobin blood test inpatient CPT 85018 H BLOOD COUNT HEMOGLOBIN | $63.00 | $90.00 | $33.30–$3,678.00 | — | 30% |
| Hemoglobin blood test inpatient CPT 85018 H HEMOGLOBIN (HGB) | $63.00 | $90.00 | $33.30–$3,678.00 | — | 30% |
| Hepatitis B core antibody test (total) CPT 86704 H HEPATITIS BC ANTIBODY IGG AND IGM (ANTI-HBC [IGG AND IGM]) SERUM | $237.30 | $339.00 | $57.63–$322.05 | 197% above | 30% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 H HEPATITIS BC ANTIBODY IGG AND IGM (ANTI-HBC [IGG AND IGM]) SERUM | $237.30 | $339.00 | $125.43–$3,678.00 | — | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 H HEPATITIS B SURFACE ANTIBODY (ANTI-HBS) SERUM | $186.20 | $266.00 | $45.22–$252.70 | 99% above | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 H HEPATITIS B SURFACE ANTIBODY (ANTI-HBS) SERUM | $186.20 | $266.00 | $98.42–$3,678.00 | — | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 H HEPATITIS B SURFACE ANTIGEN (HBSAG) SERUM | $216.30 | $309.00 | $52.53–$293.55 | 146% above | 30% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 H HEPATITIS B SURFACE ANTIGEN (HBSAG) SERUM | $216.30 | $309.00 | $114.33–$3,678.00 | — | 30% |
| Hepatitis C antibody blood test (screening) CPT 86803 H HEPATITIS C ANTIBODY EIA | $316.40 | $452.00 | $76.84–$429.40 | 182% above | 30% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 H HEPATITIS C ANTIBODY EIA | $316.40 | $452.00 | $167.24–$3,678.00 | — | 30% |
| Insulin blood test CPT 83525 H INSULIN TOTAL | $256.90 | $367.00 | $62.39–$348.65 | 253% above | 30% |
| Insulin blood test inpatient CPT 83525 H INSULIN TOTAL | $256.90 | $367.00 | $135.79–$3,678.00 | — | 30% |
| Iron blood test (serum iron) CPT 83540 H IRON SERUM | $136.50 | $195.00 | $33.15–$185.25 | 76% above | 30% |
| Iron blood test (serum iron) inpatient CPT 83540 H IRON SERUM | $136.50 | $195.00 | $72.15–$3,678.00 | — | 30% |
| Iron-binding capacity (TIBC) test CPT 83550 H TOTAL IRON BINDING CAPACITY SERUM | $174.30 | $249.00 | $42.33–$236.55 | 121% above | 30% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 H TOTAL IRON BINDING CAPACITY SERUM | $174.30 | $249.00 | $92.13–$3,678.00 | — | 30% |
| Kidney function blood test panel CPT 80069 H RENAL FUNCTION PANEL | $301.00 | $430.00 | $73.10–$408.50 | 103% above | 30% |
| Kidney function blood test panel inpatient CPT 80069 H RENAL FUNCTION PANEL | $301.00 | $430.00 | $159.10–$3,678.00 | — | 30% |
| LH (luteinizing hormone) test CPT 83002 H LUTEINIZING HORMONE (LH) SERUM | $268.10 | $383.00 | $65.11–$363.85 | 134% above | 30% |
| LH (luteinizing hormone) test inpatient CPT 83002 H LUTEINIZING HORMONE (LH) SERUM | $268.10 | $383.00 | $141.71–$3,678.00 | — | 30% |
| Lactate (lactic acid) blood test CPT 83605 H LACTATE BLOOD GAS POC | $216.30 | $309.00 | $52.53–$293.55 | 141% above | 30% |
| Lactate (lactic acid) blood test CPT 83605 H ASSAY OF LACTATE | $216.30 | $309.00 | $52.53–$293.55 | 141% above | 30% |
| Lactate (lactic acid) blood test CPT 83605 H LACTATE ISTAT POC | $216.30 | $309.00 | $52.53–$293.55 | 141% above | 30% |
| Lactate (lactic acid) blood test CPT 83605 H LACTATE PLASMA | $216.30 | $309.00 | $52.53–$293.55 | 141% above | 30% |
| Lactate (lactic acid) blood test inpatient CPT 83605 H LACTATE PLASMA | $216.30 | $309.00 | $114.33–$3,678.00 | — | 30% |
| Lactate (lactic acid) blood test inpatient CPT 83605 H LACTATE ISTAT POC | $216.30 | $309.00 | $114.33–$3,678.00 | — | 30% |
| Lactate (lactic acid) blood test inpatient CPT 83605 H ASSAY OF LACTATE | $216.30 | $309.00 | $114.33–$3,678.00 | — | 30% |
| Lactate (lactic acid) blood test inpatient CPT 83605 H LACTATE BLOOD GAS POC | $216.30 | $309.00 | $114.33–$3,678.00 | — | 30% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 H LACTATE DEHYDROGENASE (LD) BODY FLUID | $119.00 | $170.00 | $28.90–$161.50 | 122% above | 30% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 H LACTATE DEHYDROGENASE LDH | $119.00 | $170.00 | $28.90–$161.50 | 122% above | 30% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 H LACTATE DEHYDROGENASE (LD) SERUM | $119.00 | $170.00 | $28.90–$161.50 | 122% above | 30% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 H LACTATE DEHYDROGENASE LDH | $119.00 | $170.00 | $62.90–$3,678.00 | — | 30% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 H LACTATE DEHYDROGENASE (LD) BODY FLUID | $119.00 | $170.00 | $62.90–$3,678.00 | — | 30% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 H LACTATE DEHYDROGENASE (LD) SERUM | $119.00 | $170.00 | $62.90–$3,678.00 | — | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 H LIPASE SERUM | $185.50 | $265.00 | $45.05–$251.75 | 108% above | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 H LIPASE BODY FLUID | $185.50 | $265.00 | $45.05–$251.75 | 108% above | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 H ASSAY OF LIPASE | $185.50 | $265.00 | $45.05–$251.75 | 108% above | 30% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 H ASSAY OF LIPASE | $185.50 | $265.00 | $98.05–$3,678.00 | — | 30% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 H LIPASE BODY FLUID | $185.50 | $265.00 | $98.05–$3,678.00 | — | 30% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 H LIPASE SERUM | $185.50 | $265.00 | $98.05–$3,678.00 | — | 30% |
| Liver function blood test panel CPT 80076 H HEPATIC FUNCTION PANEL | $217.70 | $311.00 | $52.87–$295.45 | 58% above | 30% |
| Magnesium blood test CPT 83735 H ASSAY OF MAGNESIUM | $102.20 | $146.00 | $24.82–$138.70 | 51% above | 30% |
| Magnesium blood test CPT 83735 H MAGNESIUM URINE 24-HOUR COLLECTION | $102.20 | $146.00 | $24.82–$138.70 | 51% above | 30% |
| Magnesium blood test CPT 83735 H MAGNESIUM URINE RANDOM | $102.20 | $146.00 | $24.82–$138.70 | 51% above | 30% |
| Magnesium blood test CPT 83735 H MAGNESIUM SERUM | $102.20 | $146.00 | $24.82–$138.70 | 51% above | 30% |
| Magnesium blood test inpatient CPT 83735 H MAGNESIUM URINE 24-HOUR COLLECTION | $102.20 | $146.00 | $54.02–$3,678.00 | — | 30% |
| Magnesium blood test inpatient CPT 83735 H ASSAY OF MAGNESIUM | $102.20 | $146.00 | $54.02–$3,678.00 | — | 30% |
| Magnesium blood test inpatient CPT 83735 H MAGNESIUM URINE RANDOM | $102.20 | $146.00 | $54.02–$3,678.00 | — | 30% |
| Magnesium blood test inpatient CPT 83735 H MAGNESIUM SERUM | $102.20 | $146.00 | $54.02–$3,678.00 | — | 30% |
| Mono test (heterophile antibody, Monospot) CPT 86308 H HETEROPHILE ANTIBODIES SCREEN | $144.20 | $206.00 | $35.02–$195.70 | 87% above | 30% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 H HETEROPHILE ANTIBODIES SCREEN | $144.20 | $206.00 | $76.22–$3,678.00 | — | 30% |
| Mumps immunity blood test CPT 86735 H MUMPS VIRUS ANTIBODIES IGG (IFA) | $116.90 | $167.00 | $28.39–$158.65 | 56% above | 30% |
| Mumps immunity blood test inpatient CPT 86735 H MUMPS VIRUS ANTIBODIES IGG (IFA) | $116.90 | $167.00 | $61.79–$3,678.00 | — | 30% |
| Parathyroid hormone (PTH) blood test CPT 83970 H PARATHYROID HORMONE (PTH) INTACT SERUM | $434.70 | $621.00 | $84.00–$589.95 | 93% above | 30% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 H PARATHYROID HORMONE (PTH) INTACT SERUM | $434.70 | $621.00 | $229.77–$3,678.00 | — | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 H THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD | $124.60 | $178.00 | $30.26–$169.10 | 91% above | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 H ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) PLASMA | $124.60 | $178.00 | $30.26–$169.10 | 91% above | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 H ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) PLASMA | $124.60 | $178.00 | $65.86–$3,678.00 | — | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 H THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD | $124.60 | $178.00 | $65.86–$3,678.00 | — | 30% |
| Phosphorus (phosphate) blood test CPT 84100 H PHOSPHORUS (INORGANIC) SERUM | $95.20 | $136.00 | $23.12–$129.20 | 63% above | 30% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 H PHOSPHORUS (INORGANIC) SERUM | $95.20 | $136.00 | $50.32–$3,678.00 | — | 30% |
| Potassium blood test CPT 84132 H POTASSIUM PLASMA OR SERUM | $72.10 | $103.00 | $17.51–$97.85 | 67% above | 30% |
| Potassium blood test CPT 84132 H POTASSIUM SERUM PLASMA/WHOLE BLOOD | $72.10 | $103.00 | $17.51–$97.85 | 67% above | 30% |
| Potassium blood test CPT 84132 H POTASSIUM BLOOD GAS POC | $72.10 | $103.00 | $17.51–$97.85 | 67% above | 30% |
| Potassium blood test inpatient CPT 84132 H POTASSIUM SERUM PLASMA/WHOLE BLOOD | $72.10 | $103.00 | $38.11–$3,678.00 | — | 30% |
| Potassium blood test inpatient CPT 84132 H POTASSIUM BLOOD GAS POC | $72.10 | $103.00 | $38.11–$3,678.00 | — | 30% |
| Potassium blood test inpatient CPT 84132 H POTASSIUM PLASMA OR SERUM | $72.10 | $103.00 | $38.11–$3,678.00 | — | 30% |
| Prolactin blood test CPT 84146 H PROLACTIN SERUM | $340.90 | $487.00 | $82.79–$462.65 | 166% above | 30% |
| Prolactin blood test inpatient CPT 84146 H PROLACTIN SERUM | $340.90 | $487.00 | $180.19–$3,678.00 | — | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 H PROTHROMBIN TIME | $105.00 | $150.00 | $25.50–$142.50 | 150% above | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 H PROTHROMBIN TIME PLASMA | $105.00 | $150.00 | $25.50–$142.50 | 150% above | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 H PROTHROMBIN TIME | $105.00 | $150.00 | $55.50–$3,678.00 | — | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 H PROTHROMBIN TIME PLASMA | $105.00 | $150.00 | $55.50–$3,678.00 | — | 30% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 H RAPID STREP A | $48.30 | $69.00 | $11.73–$92.00 | 20% below | 30% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 H RAPID STREP A | $48.30 | $69.00 | $25.53–$3,678.00 | — | 30% |
| Rh blood typing CPT 86901 H RH (D) TYPING (BILL) SEROLOGIC | $126.70 | $181.00 | $30.77–$171.95 | 86% above | 30% |
| Rh blood typing inpatient CPT 86901 H RH (D) TYPING (BILL) SEROLOGIC | $126.70 | $181.00 | $66.97–$3,678.00 | — | 30% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT SERUM | $147.00 | $210.00 | $35.70–$199.50 | 135% above | 30% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT SERUM | $147.00 | $210.00 | $77.70–$3,678.00 | — | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 H SEDIMENTATION RATE RBC AUTOMATED | $106.40 | $152.00 | $25.84–$144.40 | 125% above | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 H SEDIMENTATION RATE RBC AUTOMATED | $106.40 | $152.00 | $56.24–$3,678.00 | — | 30% |
| Sodium blood test CPT 84295 H SODIUM BLOOD | $91.00 | $130.00 | $22.10–$123.50 | 86% above | 30% |
| Sodium blood test CPT 84295 H SODIUM BLOOD GAS POC | $91.00 | $130.00 | $22.10–$123.50 | 86% above | 30% |
| Sodium blood test CPT 84295 H SODIUM PLASMA OR SERUM | $91.00 | $130.00 | $22.10–$123.50 | 86% above | 30% |
| Sodium blood test CPT 84295 H SODIUM SERUM PLASMA OR WHOLE BLOOD | $91.00 | $130.00 | $22.10–$123.50 | 86% above | 30% |
| Sodium blood test inpatient CPT 84295 H SODIUM BLOOD GAS POC | $91.00 | $130.00 | $48.10–$3,678.00 | — | 30% |
| Sodium blood test inpatient CPT 84295 H SODIUM BLOOD | $91.00 | $130.00 | $48.10–$3,678.00 | — | 30% |
| Sodium blood test inpatient CPT 84295 H SODIUM SERUM PLASMA OR WHOLE BLOOD | $91.00 | $130.00 | $48.10–$3,678.00 | — | 30% |
| Sodium blood test inpatient CPT 84295 H SODIUM PLASMA OR SERUM | $91.00 | $130.00 | $48.10–$3,678.00 | — | 30% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 H BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER | $25.20 | $36.00 | $6.12–$92.00 | 13% below | 30% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 H BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER | $25.20 | $36.00 | $13.32–$3,678.00 | — | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 H RPR (RAPID PLASMA REAGIN) TEST | $94.50 | $135.00 | $22.95–$128.25 | 85% above | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 H RPR (RAPID PLASMA REAGIN) TEST | $94.50 | $135.00 | $49.95–$3,678.00 | — | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 H MICROSOMAL ANTIBODIES EACH | $301.70 | $431.00 | $73.27–$409.45 | 280% above | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 H LIVER/KIDNEY MICROSOME TYPE 1 ANTIBODIES SERUM | $301.70 | $431.00 | $73.27–$409.45 | 280% above | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 H THYROID PEROXIDASE (TPO) ANTIBODIES SERUM | $301.70 | $431.00 | $73.27–$409.45 | 280% above | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 H LIVER/KIDNEY MICROSOME TYPE 1 ANTIBODIES SERUM | $301.70 | $431.00 | $159.47–$3,678.00 | — | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 H THYROID PEROXIDASE (TPO) ANTIBODIES SERUM | $301.70 | $431.00 | $159.47–$3,678.00 | — | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 H MICROSOMAL ANTIBODIES EACH | $301.70 | $431.00 | $159.47–$3,678.00 | — | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 H THYROID-STIMULATING HORMONE - SENSITIVE (S-TSH) SERUM | $286.30 | $409.00 | $69.53–$388.55 | 142% above | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 H THYROID-STIMULATING HORMONE - SENSITIVE (S-TSH) SERUM | $286.30 | $409.00 | $151.33–$3,678.00 | — | 30% |
| Total IgE blood test CPT 82785 H IMMUNOGLOBULIN E (IGE) SERUM | $130.20 | $186.00 | $31.62–$176.70 | 49% above | 30% |
| Total IgE blood test inpatient CPT 82785 H IMMUNOGLOBULIN E (IGE) SERUM | $130.20 | $186.00 | $68.82–$3,678.00 | — | 30% |
| Total cholesterol blood test CPT 82465 H CHOLESTEROL TOTAL SERUM | $126.70 | $181.00 | $30.77–$171.95 | 196% above | 30% |
| Total thyroxine (T4) blood test CPT 84436 H T4 (THYROXINE) TOTAL ONLY SERUM | $175.70 | $251.00 | $42.67–$238.45 | 115% above | 30% |
| Total thyroxine (T4) blood test inpatient CPT 84436 H T4 (THYROXINE) TOTAL ONLY SERUM | $175.70 | $251.00 | $92.87–$3,678.00 | — | 30% |
| Total triiodothyronine (T3) blood test CPT 84480 H T3 (TRIIODOTHYRONINE) TOTAL ONLY SERUM | $237.30 | $339.00 | $57.63–$322.05 | 149% above | 30% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 H T3 (TRIIODOTHYRONINE) TOTAL ONLY SERUM | $237.30 | $339.00 | $125.43–$3,678.00 | — | 30% |
| Transferrin blood test CPT 84466 H TRANSFERRIN SERUM | $182.00 | $260.00 | $44.20–$247.00 | 93% above | 30% |
| Transferrin blood test inpatient CPT 84466 H TRANSFERRIN SERUM | $182.00 | $260.00 | $96.20–$3,678.00 | — | 30% |
| Triglycerides blood test CPT 84478 H TRIGLYCERIDES SERUM | $112.70 | $161.00 | $27.37–$152.95 | 137% above | 30% |
| Triglycerides blood test CPT 84478 H TRIGLYCERIDES BODY FLUID | $112.70 | $161.00 | $27.37–$152.95 | 137% above | 30% |
| Triglycerides blood test inpatient CPT 84478 H ASSAY OF TRIGLYCERIDES | $112.70 | $161.00 | $59.57–$3,678.00 | — | 30% |
| Triglycerides blood test inpatient CPT 84478 H TRIGLYCERIDES BODY FLUID | $112.70 | $161.00 | $59.57–$3,678.00 | — | 30% |
| Triglycerides blood test inpatient CPT 84478 H TRIGLYCERIDES SERUM | $112.70 | $161.00 | $59.57–$3,678.00 | — | 30% |
| Troponin test, quantitative CPT 84484 H TROPONIN T PLASMA | $230.30 | $329.00 | $55.93–$312.55 | 51% above | 30% |
| Troponin test, quantitative inpatient CPT 84484 H TROPONIN T PLASMA | $230.30 | $329.00 | $121.73–$3,678.00 | — | 30% |
| Uric acid blood test CPT 84550 H URIC ACID PLASMA OR SERUM | $110.60 | $158.00 | $26.86–$150.10 | 57% above | 30% |
| Uric acid blood test inpatient CPT 84550 H URIC ACID PLASMA OR SERUM | $110.60 | $158.00 | $58.46–$3,678.00 | — | 30% |
| Urinalysis with microscope exam, automated CPT 81001 H URINALYSIS COMPLETE INCLUDES MICROSCOPIC | $107.10 | $153.00 | $26.01–$145.35 | 67% above | 30% |
| Urinalysis with microscope exam, automated CPT 81001 H URINALYSIS TRANSFUSION REACTION | $107.10 | $153.00 | $26.01–$145.35 | 67% above | 30% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 H URINALYSIS TRANSFUSION REACTION | $107.10 | $153.00 | $56.61–$3,678.00 | — | 30% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 H URINALYSIS COMPLETE INCLUDES MICROSCOPIC | $107.10 | $153.00 | $56.61–$3,678.00 | — | 30% |
| Urinalysis without microscope exam, automated CPT 81003 H URINE KETONES DIPSTICK | $67.20 | $96.00 | $16.32–$92.00 | 168% above | 30% |
| Urinalysis without microscope exam, automated CPT 81003 H URINE PROTEIN DIPSTICK | $67.20 | $96.00 | $16.32–$92.00 | 168% above | 30% |
| Urinalysis without microscope exam, automated CPT 81003 H SPECIFIC GRAVITY URINE | $67.20 | $96.00 | $16.32–$92.00 | 168% above | 30% |
| Urinalysis without microscope exam, automated CPT 81003 H URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $67.20 | $96.00 | $16.32–$92.00 | 168% above | 30% |
| Urinalysis without microscope exam, automated CPT 81003 H URINE OCCULT BLOOD /H | $67.20 | $96.00 | $16.32–$92.00 | 168% above | 30% |
| Urinalysis without microscope exam, automated CPT 81003 H URINE MACROSCOPIC EXAMINATION | $67.20 | $96.00 | $16.32–$92.00 | 168% above | 30% |
| Urinalysis without microscope exam, automated CPT 81003 H URINALYSIS COMPLETE WITHOUT MICROSCOPIC | $67.20 | $96.00 | $16.32–$92.00 | 168% above | 30% |
| Urinalysis without microscope exam, automated CPT 81003 H URINE PH DIPSTICK | $67.20 | $96.00 | $16.32–$92.00 | 168% above | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 H URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $67.20 | $96.00 | $35.52–$3,678.00 | — | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 H URINE PH DIPSTICK | $67.20 | $96.00 | $35.52–$3,678.00 | — | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 H URINE KETONES DIPSTICK | $67.20 | $96.00 | $35.52–$3,678.00 | — | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 H URINE PROTEIN DIPSTICK | $67.20 | $96.00 | $35.52–$3,678.00 | — | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 H SPECIFIC GRAVITY URINE | $67.20 | $96.00 | $35.52–$3,678.00 | — | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 H URINE MACROSCOPIC EXAMINATION | $67.20 | $96.00 | $35.52–$3,678.00 | — | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 H URINALYSIS COMPLETE WITHOUT MICROSCOPIC | $67.20 | $96.00 | $35.52–$3,678.00 | — | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 H URINE OCCULT BLOOD /H | $67.20 | $96.00 | $35.52–$3,678.00 | — | 30% |
| Urinalysis without microscope exam, manual CPT 81002 H URNLS DIP STICK NON-AUTO W/O MICRSCP | $17.50 | $25.00 | $4.25–$92.00 | 22% below | 30% |
| Urinalysis without microscope exam, manual CPT 81002 H URINALYSIS NONAUTO W/O SCOPE | $17.50 | $25.00 | $4.25–$92.00 | 22% below | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 H URNLS DIP STICK NON-AUTO W/O MICRSCP | $17.50 | $25.00 | $9.25–$3,678.00 | — | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 H URINALYSIS NONAUTO W/O SCOPE | $17.50 | $25.00 | $9.25–$3,678.00 | — | 30% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 H CULTURE AEROBIC BACTERIA URINE | $179.20 | $256.00 | $94.72–$3,678.00 | — | 30% |
| Urine microalbumin (albumin) test CPT 82043 H MICROALBUMIN URINE RANDOM QUANTITATIVE | $152.60 | $218.00 | $37.06–$207.10 | 137% above | 30% |
| Urine microalbumin (albumin) test CPT 82043 H MICROALBUMIN 24-HOUR COLLECTION URINE | $152.60 | $218.00 | $37.06–$207.10 | 137% above | 30% |
| Urine microalbumin (albumin) test inpatient CPT 82043 H MICROALBUMIN URINE RANDOM QUANTITATIVE | $152.60 | $218.00 | $80.66–$3,678.00 | — | 30% |
| Urine microalbumin (albumin) test inpatient CPT 82043 H MICROALBUMIN 24-HOUR COLLECTION URINE | $152.60 | $218.00 | $80.66–$3,678.00 | — | 30% |
| Urine pregnancy test, read by color change CPT 81025 H HCG (PREGNANCY TEST) URINE QUALITATIVE | $173.60 | $248.00 | $42.16–$235.60 | 134% above | 30% |
| Urine pregnancy test, read by color change inpatient CPT 81025 H HCG (PREGNANCY TEST) URINE QUALITATIVE | $173.60 | $248.00 | $91.76–$3,678.00 | — | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 H 25 OH VITAMIN D3 | $364.00 | $520.00 | $84.00–$494.00 | 98% above | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 H 25-OH VITAMIN D - TOTAL CALCIDIOL | $364.00 | $520.00 | $84.00–$494.00 | 98% above | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 H 25-OH VITAMIN D - TOTAL CALCIDIOL | $364.00 | $520.00 | $192.40–$3,678.00 | — | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 H 25 OH VITAMIN D3 | $364.00 | $520.00 | $192.40–$3,678.00 | — | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 H WHOLE BLOOD HCG I-STAT POC | $280.00 | $400.00 | $68.00–$380.00 | 160% above | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 H CHORIONIC GONADOTROPIN (HCG) BETA-SUBUNIT (QUANT) SERU | $280.00 | $400.00 | $68.00–$380.00 | 160% above | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 H GONADOTROPIN CHORIONIC QUANTITATIVE | $280.00 | $400.00 | $68.00–$380.00 | 160% above | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 H CHORIONIC GONADOTROPIN (HCG) BETA-SUBUNIT (QUANT) SERU | $280.00 | $400.00 | $148.00–$3,678.00 | — | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 H GONADOTROPIN CHORIONIC QUANTITATIVE | $280.00 | $400.00 | $148.00–$3,678.00 | — | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 H WHOLE BLOOD HCG I-STAT POC | $280.00 | $400.00 | $148.00–$3,678.00 | — | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| Botox injections for chronic migraine CPT 64615 H CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL BIL | $1,054.90 | $1,507.00 | $256.19–$1,431.65 | 178% above | 30% |
| Botox injections for chronic migraine CPT 64615 H IR 64615 CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL BIL | $1,054.90 | $1,507.00 | $256.19–$1,431.65 | 178% above | 30% |
| Botox injections for chronic migraine inpatient CPT 64615 H CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL BIL | $1,054.90 | $1,507.00 | $557.59–$3,678.00 | — | 30% |
| Botox injections for chronic migraine inpatient CPT 64615 H IR 64615 CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL BIL | $1,054.90 | $1,507.00 | $557.59–$3,678.00 | — | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 H CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ | $1,055.60 | $1,508.00 | $256.36–$1,432.60 | 151% above | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 H CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ | $1,055.60 | $1,508.00 | $557.96–$3,678.00 | — | 30% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 H CLOSED TX METATARSAL FRACTURE W/O MANIPULATION | $879.20 | $1,256.00 | $213.52–$1,474.00 | 36% above | 30% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 H CLOSED TX METATARSAL FRACTURE W/O MANIPULATION | $879.20 | $1,256.00 | $464.72–$3,678.00 | — | 30% |
| Cardiac catheterization with coronary angiogram one side CPT 93458 H CC 93458 HEART CATH LEFT W CORONARY & LT VENT ANGIO | $11,643.80 | $16,634.00 | $2,827.78–$18,349.00 | 13% above | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 H CARDIOVERSION ELECTRIC EXT | $2,630.60 | $3,758.00 | $638.86–$3,570.10 | 119% above | 30% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 H CARDIOVERSION ELECTRIC EXT | $2,630.60 | $3,758.00 | $900.00–$3,678.00 | — | 30% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 H CC 92960 DC CARDIOVERSION - EXTERNAL | $2,630.60 | $3,758.00 | $900.00–$3,678.00 | — | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 H CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ | $1,273.30 | $1,819.00 | $309.23–$1,728.05 | 146% above | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 H CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ | $1,273.30 | $1,819.00 | $673.03–$3,678.00 | — | 30% |
| Coronary stent placement, one artery CPT 92928 H CC 92928 PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH | $6,768.30 | $9,669.00 | $1,643.73–$9,185.55 | 52% below | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 H IR 52000 CYSTOURETHROSCOPY | $522.90 | $747.00 | $126.99–$709.65 | 59% below | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 H IR 52000 CYSTOURETHROSCOPY | $522.90 | $747.00 | $276.39–$3,678.00 | — | 30% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 H CREATE EARDRUM OPENING | $621.60 | $888.00 | $328.56–$3,678.00 | — | 30% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 H REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $76.30 | $109.00 | $18.53–$103.55 | 34% below | 30% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 H REMOVAL IMPACTED CERUMEN IRRIG/LAV UNILAT | $76.30 | $109.00 | $18.53–$1,474.00 | 34% below | 30% |
| Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 H REMOVAL IMPACTED CERUMEN IRRIG/LAV UNILAT | $76.30 | $109.00 | $40.33–$3,678.00 | — | 30% |
| Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 H REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $76.30 | $109.00 | $40.33–$3,678.00 | — | 30% |
| Earwax removal with instruments, one ear one side CPT 69210 H REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT | $394.80 | $564.00 | $95.88–$535.80 | 216% above | 30% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 H REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT | $394.80 | $564.00 | $208.68–$3,678.00 | — | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 H IR 62321 INJECTION DX/THER LUMBAR/SACRAL W IMAGING GUIDANCE | $1,202.60 | $1,718.00 | $292.06–$1,632.10 | 34% below | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 H IR 62321 INJECTION DX/THER LUMBAR/SACRAL W IMAGING GUIDANCE | $1,202.60 | $1,718.00 | $635.66–$3,678.00 | — | 30% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 H INTRAVITREAL NJX PHARMACOLOGIC AGT SPX | $513.10 | $733.00 | $124.61–$696.35 | 25% below | 30% |
| Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 H INTRAVITREAL NJX PHARMACOLOGIC AGT SPX | $513.10 | $733.00 | $271.21–$3,678.00 | — | 30% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 H IR 64493 INJ PARAVERT FACET JNT LUMB/SACR 1 LEVEL | $2,302.30 | $3,289.00 | $559.13–$3,124.55 | 49% above | 30% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 H IR 64493 INJ PARAVERT FACET JNT LUMB/SACR 1 LEVEL | $2,302.30 | $3,289.00 | $900.00–$3,678.00 | — | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 H IR 58340 CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI | $448.00 | $640.00 | $108.80–$608.00 | 16% above | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 H IR 58340 CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI | $448.00 | $640.00 | $236.80–$3,678.00 | — | 30% |
| IUD insertion (the device itself billed separately) CPT 58300 H INSERTION INTRAUTERINE DEVICE IUD | $1,290.10 | $1,843.00 | $313.31–$1,750.85 | 253% above | 30% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 H INSERTION INTRAUTERINE DEVICE IUD | $1,290.10 | $1,843.00 | $681.91–$3,678.00 | — | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 H INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $296.80 | $424.00 | $72.08–$1,474.00 | 25% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 H POC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $296.80 | $424.00 | $72.08–$402.80 | 25% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 H IR 10060 DRAIN ABSCESSCUTANEOUSSUBCUTAN | $296.80 | $424.00 | $72.08–$402.80 | 25% below | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 H POC INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $296.80 | $424.00 | $156.88–$3,678.00 | — | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 H IR 10060 DRAIN ABSCESSCUTANEOUSSUBCUTAN | $296.80 | $424.00 | $156.88–$3,678.00 | — | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 H INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $296.80 | $424.00 | $156.88–$3,678.00 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 H IR 20550 INJECTION SINGLE TENDON SHEATH OR LIGAMENT | $231.00 | $330.00 | $56.10–$313.50 | 46% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 H INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS | $231.00 | $330.00 | $56.10–$313.50 | 46% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 H INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS | $231.00 | $330.00 | $122.10–$3,678.00 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 H IR 20550 INJECTION SINGLE TENDON SHEATH OR LIGAMENT | $231.00 | $330.00 | $122.10–$3,678.00 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 H IR 20610 ARTHROCENTESIS LG JT WO US | $1,333.50 | $1,905.00 | $323.85–$1,809.75 | 164% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 H ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $1,333.50 | $1,905.00 | $323.85–$1,809.75 | 164% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 H IR 20610 ARTHROCENTESIS LG JT WO US | $1,333.50 | $1,905.00 | $704.85–$3,678.00 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 H ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $1,333.50 | $1,905.00 | $704.85–$3,678.00 | — | 30% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 H INSJ NON-BIODEGRADABLE BIORESORBABLE BIODEGRAD | $555.80 | $794.00 | $134.98–$754.30 | 99% above | 30% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 H INSJ NON-BIODEGRADABLE BIORESORBABLE BIODEGRAD | $555.80 | $794.00 | $293.78–$3,678.00 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 H IR 20605 ARTHROCENTESIS IMD JT WO US | $1,013.60 | $1,448.00 | $246.16–$1,375.60 | 144% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 H ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US | $1,013.60 | $1,448.00 | $246.16–$1,474.00 | 144% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 H ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US | $1,013.60 | $1,448.00 | $535.76–$3,678.00 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 H IR 20605 ARTHROCENTESIS IMD JT WO US | $1,013.60 | $1,448.00 | $535.76–$3,678.00 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 H ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US | $305.20 | $436.00 | $74.12–$1,474.00 | 2% below | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 H IR 20600 ARTHROCENTESIS SM JT WO US | $305.20 | $436.00 | $74.12–$414.20 | 2% below | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 H IR 20600 ARTHROCENTESIS SM JT WO US | $305.20 | $436.00 | $161.32–$3,678.00 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 H ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US | $305.20 | $436.00 | $161.32–$3,678.00 | — | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 H REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< | $537.60 | $768.00 | $130.56–$1,474.00 | 11% below | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 H REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< | $537.60 | $768.00 | $284.16–$3,678.00 | — | 30% |
| Left heart catheterization, diagnostic one side CPT 93452 H CC 93452 HEART CATH LEFT W LT VENT ANGIO | $5,889.10 | $8,413.00 | $1,430.21–$18,349.00 | 19% below | 30% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 H CC 93452 HEART CATH LEFT W LT VENT ANGIO | $5,889.10 | $8,413.00 | $900.00–$7,992.35 | — | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 H IR 62323 INJECTION DX/THER CERVICAL/THORACIC W IMAGING GUIDANCE | $2,630.60 | $3,758.00 | $638.86–$3,570.10 | 80% above | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 H IR 62323 INJECTION DX/THER CERVICAL/THORACIC W IMAGING GUIDANCE | $2,630.60 | $3,758.00 | $900.00–$3,678.00 | — | 30% |
| Lower-back epidural injection, without imaging guidance CPT 62322 H IR 62322 INJECTION DX/THER CERVICAL/THORACIC WO IMAGING | $996.10 | $1,423.00 | $241.91–$1,351.85 | 32% below | 30% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 H IR 62322 INJECTION DX/THER CERVICAL/THORACIC WO IMAGING | $996.10 | $1,423.00 | $526.51–$3,678.00 | — | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 H IR 64483 INJ TF EPIDURAL LUMBAR/SACRL SGL | $1,400.00 | $2,000.00 | $340.00–$1,900.00 | 1% below | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 H IR 64483 INJ TF EPIDURAL LUMBAR/SACRL SGL | $1,400.00 | $2,000.00 | $740.00–$3,678.00 | — | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 H EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< | $1,015.70 | $1,451.00 | $536.87–$3,678.00 | — | 30% |
| Nail removal (partial or complete), one nail CPT 11730 H AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 | $215.60 | $308.00 | $52.36–$292.60 | 25% below | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 H AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 | $215.60 | $308.00 | $113.96–$3,678.00 | — | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 H INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV | $974.40 | $1,392.00 | $236.64–$1,474.00 | 89% above | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 H INJECTION AA&/STRD GREATER OCCIPITAL NERVE | $974.40 | $1,392.00 | $236.64–$1,322.40 | 89% above | 30% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 H INJECTION AA&/STRD GREATER OCCIPITAL NERVE | $974.40 | $1,392.00 | $515.04–$3,678.00 | — | 30% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 H INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV | $974.40 | $1,392.00 | $515.04–$3,678.00 | — | 30% |
| Pacemaker implant (dual chamber) CPT 33208 H CC 33208 INSERT/REPLACE PACEMAKER PERM & ATRIAL VENT LEADS | $12,539.80 | $17,914.00 | $3,045.38–$17,018.30 | 9% above | 30% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 H CC 33208 INSERT/REPLACE PACEMAKER PERM & ATRIAL VENT LEADS | $12,539.80 | $17,914.00 | $900.00–$17,018.30 | — | 30% |
| Paracentesis with imaging guidance CPT 49083 H IR 49083 PARACENTESIS ABD W IMAGING GUIDANCE | $1,502.20 | $2,146.00 | $364.82–$2,038.70 | 3% above | 30% |
| Paracentesis with imaging guidance inpatient CPT 49083 H IR 49083 PARACENTESIS ABD W IMAGING GUIDANCE | $1,502.20 | $2,146.00 | $794.02–$3,678.00 | — | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 H EXCISION NAIL MATRIX PERMANENT REMOVAL | $385.00 | $550.00 | $93.50–$522.50 | 39% below | 30% |
| Prostate biopsy CPT 55700 H IR 55700 BIOPSYPROSTRATENEEDLE/PUNCH | $1,782.90 | $2,547.00 | $432.99–$2,419.65 | 45% below | 30% |
| Prostate biopsy inpatient CPT 55700 H IR 55700 BIOPSYPROSTRATENEEDLE/PUNCH | $1,782.90 | $2,547.00 | $900.00–$3,678.00 | — | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 H INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE | $437.50 | $625.00 | $106.25–$1,474.00 | 9% below | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 H INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE | $437.50 | $625.00 | $231.25–$3,678.00 | — | 30% |
| Short arm cast (elbow to hand) CPT 29075 H APPLICATION CAST ELBOW FINGER SHORT ARM | $756.00 | $1,080.00 | $183.60–$1,026.00 | 136% above | 30% |
| Short arm cast (elbow to hand) inpatient CPT 29075 H APPLICATION CAST ELBOW FINGER SHORT ARM | $756.00 | $1,080.00 | $399.60–$3,678.00 | — | 30% |
| Short arm splint (forearm and hand) CPT 29125 H APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC | $737.10 | $1,053.00 | $179.01–$1,000.35 | 192% above | 30% |
| Short arm splint (forearm and hand) inpatient CPT 29125 H APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC | $737.10 | $1,053.00 | $389.61–$3,678.00 | — | 30% |
| Short leg cast (below the knee) CPT 29405 H APPLICATION SHORT LEG CAST BELOW KNEE-TOE | $731.50 | $1,045.00 | $177.65–$992.75 | 106% above | 30% |
| Short leg cast (below the knee) inpatient CPT 29405 H APPLICATION SHORT LEG CAST BELOW KNEE-TOE | $731.50 | $1,045.00 | $386.65–$3,678.00 | — | 30% |
| Short leg splint (calf to foot) CPT 29515 H APPLICATION SHORT LEG SPLINT CALF FOOT | $606.90 | $867.00 | $147.39–$1,474.00 | 129% above | 30% |
| Short leg splint (calf to foot) inpatient CPT 29515 H APPLICATION SHORT LEG SPLINT CALF FOOT | $606.90 | $867.00 | $320.79–$3,678.00 | — | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 H SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< | $450.10 | $643.00 | $109.31–$610.85 | 23% above | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 H SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< | $450.10 | $643.00 | $237.91–$3,678.00 | — | 30% |
| Skin biopsy, punch, one lesion CPT 11104 H PUNCH BIOPSY SKIN SINGLE LESION | $255.50 | $365.00 | $62.05–$346.75 | 31% below | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 H PUNCH BIOPSY SKIN SINGLE LESION | $255.50 | $365.00 | $135.05–$3,678.00 | — | 30% |
| Skin tag removal, up to 15 tags CPT 11200 H REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 | $186.20 | $266.00 | $45.22–$1,474.00 | 26% below | 30% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 H REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 | $186.20 | $266.00 | $98.42–$3,678.00 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 H SPINAL PUNCTURE LUMBAR DIAGNOSTIC | $1,964.90 | $2,807.00 | $477.19–$2,666.65 | 106% above | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 H IR 62270 LUMBAR PUNCTURE DIAGNOSTIC | $1,964.90 | $2,807.00 | $477.19–$2,666.65 | 106% above | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 H POC DIAGNOSTIC LUMBAR SPINAL PUNCTURE | $1,964.90 | $2,807.00 | $477.19–$2,666.65 | 106% above | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 H SPINAL FLUID TAP | $1,964.90 | $2,807.00 | $477.19–$2,666.65 | 106% above | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 H DIAGNOSTIC LUMBAR SPINAL PUNCTURE | $1,964.90 | $2,807.00 | $900.00–$3,678.00 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 H SPINAL FLUID TAP | $1,964.90 | $2,807.00 | $900.00–$3,678.00 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 H POC DIAGNOSTIC LUMBAR SPINAL PUNCTURE | $1,964.90 | $2,807.00 | $900.00–$3,678.00 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 H SPINAL PUNCTURE LUMBAR DIAGNOSTIC | $1,964.90 | $2,807.00 | $900.00–$3,678.00 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 H IR 62270 LUMBAR PUNCTURE DIAGNOSTIC | $1,964.90 | $2,807.00 | $900.00–$3,678.00 | — | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 H SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM | $588.00 | $840.00 | $142.80–$798.00 | 42% above | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 H SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM | $588.00 | $840.00 | $310.80–$3,678.00 | — | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 H SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< | $433.30 | $619.00 | $105.23–$1,474.00 | 8% above | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 H SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< | $433.30 | $619.00 | $229.03–$3,678.00 | — | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 H H SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< | $433.30 | $619.00 | $229.03–$3,678.00 | — | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 H TANGENTIAL BIOPSY SKIN SINGLE LESION | $303.80 | $434.00 | $73.78–$412.30 | 2% above | 30% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 H TANGENTIAL BIOPSY SKIN SINGLE LESION | $303.80 | $434.00 | $160.58–$3,678.00 | — | 30% |
| Thoracentesis with imaging guidance CPT 32555 H POC ASPIRATE PLEURA W/ IMAGING | $1,863.40 | $2,662.00 | $452.54–$2,528.90 | 49% above | 30% |
| Thoracentesis with imaging guidance CPT 32555 H 32555 THORACENTESIS W IMAGING GUIDANCE | $1,863.40 | $2,662.00 | $452.54–$2,528.90 | 49% above | 30% |
| Thoracentesis with imaging guidance inpatient CPT 32555 H 32555 THORACENTESIS W IMAGING GUIDANCE | $1,863.40 | $2,662.00 | $900.00–$3,678.00 | — | 30% |
| Thoracentesis with imaging guidance inpatient CPT 32555 H POC ASPIRATE PLEURA W/ IMAGING | $1,863.40 | $2,662.00 | $900.00–$3,678.00 | — | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 H INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $901.60 | $1,288.00 | $218.96–$1,223.60 | 73% above | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 H IR 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $901.60 | $1,288.00 | $218.96–$1,223.60 | 73% above | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 H IR 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $901.60 | $1,288.00 | $476.56–$3,678.00 | — | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 H INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $901.60 | $1,288.00 | $476.56–$3,678.00 | — | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 H19083 US GUIDED BX BREAST W/DEVICE 1ST LESION | $1,962.80 | $2,804.00 | $476.68–$2,663.80 | 20% below | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 H19083 US GUIDED BX BREAST W/DEVICE 1ST LESION | $1,962.80 | $2,804.00 | $900.00–$3,678.00 | — | 30% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 H 43249 EDG BALLOON DILATION ESOPHAGUS <30 MM DIAM | $2,489.20 | $3,556.00 | $604.52–$3,378.20 | 6% above | 30% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 H 43249 EDG BALLOON DILATION ESOPHAGUS <30 MM DIAM | $2,489.20 | $3,556.00 | $900.00–$3,678.00 | — | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 H 43239 EDG TRANSORAL BIOPSY SINGLE/MULTIPLE | $2,257.50 | $3,225.00 | $548.25–$3,063.75 | 3% below | 30% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 H 43239 EDG TRANSORAL BIOPSY SINGLE/MULTIPLE | $2,257.50 | $3,225.00 | $900.00–$3,678.00 | — | 30% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 H 43236 ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION | $2,257.50 | $3,225.00 | $548.25–$3,063.75 | 8% above | 30% |
| Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 H 43236 ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION | $2,257.50 | $3,225.00 | $900.00–$3,678.00 | — | 30% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 H 43251 EDG REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH | $3,160.50 | $4,515.00 | $767.55–$4,289.25 | 3% above | 30% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 H 43251 EDG REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH | $3,160.50 | $4,515.00 | $900.00–$4,289.25 | — | 30% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 H 43248 EDG INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS | $2,702.70 | $3,861.00 | $656.37–$3,667.95 | 9% below | 30% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 H 43248 EDG INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS | $2,702.70 | $3,861.00 | $900.00–$3,678.00 | — | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 H 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $2,019.50 | $2,885.00 | $490.45–$2,740.75 | 4% above | 30% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 H 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $2,019.50 | $2,885.00 | $900.00–$3,678.00 | — | 30% |
| Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 H 43240 EDG TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST | $6,247.50 | $8,925.00 | $1,517.25–$8,478.75 | 43% above | 30% |
| Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 H 43240 EDG TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST | $6,247.50 | $8,925.00 | $900.00–$8,478.75 | — | 30% |
| Vein ablation, radiofrequency, first vein CPT 36475 H IR 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN | $3,189.90 | $4,557.00 | $774.69–$4,329.15 | 39% below | 30% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 H IR 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN | $3,189.90 | $4,557.00 | $900.00–$4,329.15 | — | 30% |
| Wart removal, up to 14 warts CPT 17110 H DESTRUCTION BENIGN LESIONS UP TO 14 | $298.20 | $426.00 | $72.42–$404.70 | 24% above | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 H TRANSFUSION PROCEDURE | $2,047.50 | $2,925.00 | $340.00–$2,778.75 | 132% above | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 H TRANSFUSION PROCEDURE | $2,047.50 | $2,925.00 | $900.00–$3,678.00 | — | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 H CHEMO IV INFUSION 1ST HOUR INITIAL | $1,557.50 | $2,225.00 | $378.25–$2,113.75 | 143% above | 30% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 H CHEMO IV INFUSION 1ST HOUR INITIAL | $1,557.50 | $2,225.00 | $823.25–$3,678.00 | — | 30% |
| Comprehensive eye exam by an eye doctor, new patient CPT 92004 H OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST | $175.00 | $250.00 | $42.50–$936.00 | 28% above | 30% |
| Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 H OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST | $175.00 | $250.00 | $92.50–$3,678.00 | — | 30% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ | $396.90 | $567.00 | $96.39–$936.00 | 54% above | 30% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ | $396.90 | $567.00 | $209.79–$3,678.00 | — | 30% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 H AUDIO EVAL COMPREHENSIVE | $396.90 | $567.00 | $209.79–$3,678.00 | — | 30% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 H EEG AWAKE AND DROWSY | $1,267.00 | $1,810.00 | $669.70–$3,678.00 | — | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 H ELECTROCARDIOGRAM | $390.60 | $558.00 | $94.86–$530.10 | 68% above | 30% |
| Electroconvulsive therapy (ECT), one session CPT 90870 H ELECTROCONVULSIVE THERAPY | $845.60 | $1,208.00 | $44.40–$1,147.60 | 7% below | 30% |
| Electroconvulsive therapy (ECT), one session inpatient CPT 90870 H ELECTROCONVULSIVE THERAPY | $845.60 | $1,208.00 | $446.96–$3,678.00 | — | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 H ED LEVEL 1 VISIT - LOW (99281) | $458.50 | $655.00 | $111.35–$1,474.00 | 105% above | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 H ED LEVEL 1 VISIT - LOW (99281) | $458.50 | $655.00 | $242.35–$3,678.00 | — | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 H ED LEVEL 4 VISIT (99284) | $2,562.00 | $3,660.00 | $900.00–$3,678.00 | — | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 H ED LEVEL 5 VISIT - HIGH (99285) | $3,703.00 | $5,290.00 | $88.00–$5,025.50 | 132% above | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 H ED LEVEL 5 VISIT - HIGH (99285) | $3,703.00 | $5,290.00 | $900.00–$5,025.50 | — | 30% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 H CARDIOVASCULAR STRESS TEST | $1,560.30 | $2,229.00 | $378.93–$2,117.55 | 64% above | 30% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 H CC 93017 PHARMACOLOGICAL CARDIAC STRESS TEST (DRUG INFUSION) | $1,560.30 | $2,229.00 | $378.93–$2,117.55 | 64% above | 30% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 H CARDIOVASCULAR STRESS TEST | $1,560.30 | $2,229.00 | $824.73–$3,678.00 | — | 30% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 H CC 93017 PHARMACOLOGICAL CARDIAC STRESS TEST (DRUG INFUSION) | $1,560.30 | $2,229.00 | $824.73–$3,678.00 | — | 30% |
| Eye exam, returning patient, intermediate CPT 92012 H OPHTH EYE EXAM ESTABLISH PATIENT | $175.00 | $250.00 | $42.50–$936.00 | 41% above | 30% |
| Eye exam, returning patient, intermediate inpatient CPT 92012 H OPHTH EYE EXAM ESTABLISH PATIENT | $175.00 | $250.00 | $92.50–$3,678.00 | — | 30% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTHERAPY W/O PATIENT 50 MIN | $326.20 | $466.00 | $70.00–$442.70 | 78% above | 30% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTHERAPY W/O PATIENT 50 MIN | $326.20 | $466.00 | $172.42–$3,678.00 | — | 30% |
| Group psychotherapy session CPT 90853 H GROUP PSYCHOTHERAPY | $244.30 | $349.00 | $33.70–$331.55 | 90% above | 30% |
| Group psychotherapy session inpatient CPT 90853 H GROUP PSYCHOTHERAPY | $244.30 | $349.00 | $129.13–$3,678.00 | — | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 H IV INF HYDRATION 1ST 31-60 MIN INITIAL | $673.40 | $962.00 | $145.00–$913.90 | 99% above | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 H IV INF HYDRATION 1ST 31-60 MIN INITIAL | $673.40 | $962.00 | $355.94–$3,678.00 | — | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 H ED IV INF HYDRATION 1ST 31-60 MIN INITIAL | $673.40 | $962.00 | $355.94–$3,678.00 | — | 30% |
| IV infusion of a medicine, first hour CPT 96365 H THER/PROPH/DX IV INF INITIAL HOUR | $830.90 | $1,187.00 | $145.00–$1,127.65 | 104% above | 30% |
| IV infusion of a medicine, first hour CPT 96365 H ED THER/PROPH/DX IV INF INITIAL HOUR | $830.90 | $1,187.00 | $201.79–$1,474.00 | 104% above | 30% |
| IV infusion of a medicine, first hour inpatient CPT 96365 H THER/PROPH/DX IV INF INITIAL HOUR | $830.90 | $1,187.00 | $439.19–$3,678.00 | — | 30% |
| IV infusion of a medicine, first hour inpatient CPT 96365 H ED THER/PROPH/DX IV INF INITIAL HOUR | $830.90 | $1,187.00 | $439.19–$3,678.00 | — | 30% |
| IV push of a medicine, first drug CPT 96374 H THER/PROPH/DX INJECTION IV PUSH INIT | $392.70 | $561.00 | $95.37–$532.95 | 83% above | 30% |
| IV push of a medicine, first drug inpatient CPT 96374 H THER/PROPH/DX INJECTION IV PUSH INIT | $392.70 | $561.00 | $207.57–$3,678.00 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 H MED ADMIN IM OR SQ NON CHEMO | $211.40 | $302.00 | $51.34–$286.90 | 94% above | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 H THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM | $211.40 | $302.00 | $51.34–$286.90 | 94% above | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 H THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM | $211.40 | $302.00 | $111.74–$3,678.00 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 H MED ADMIN IM OR SQ NON CHEMO | $211.40 | $302.00 | $111.74–$3,678.00 | — | 30% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 H PSYCHIATRIC DIAGNOSTIC EVALUATION | $576.10 | $823.00 | $70.00–$781.85 | 116% above | 30% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 H SA PSYCHIATRIC DIAGNOSTIC EVALUATION | $576.10 | $823.00 | $70.00–$781.85 | 116% above | 30% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 H SA PSYCHIATRIC DIAGNOSTIC EVALUATION | $576.10 | $823.00 | $304.51–$3,678.00 | — | 30% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 H PSYCHIATRIC DIAGNOSTIC EVALUATION | $576.10 | $823.00 | $304.51–$3,678.00 | — | 30% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 H NERVE CONDUCTION 7-8 STUDIES | $2,373.00 | $3,390.00 | $576.30–$3,220.50 | 226% above | 30% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 H NERVE CONDUCTION 7-8 STUDIES | $2,373.00 | $3,390.00 | $900.00–$3,678.00 | — | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 H THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA | $123.90 | $177.00 | $30.09–$168.15 | 4% above | 30% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 H THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA | $123.90 | $177.00 | $65.49–$3,678.00 | — | 30% |
| New patient office visit, about 30 minutes CPT 99203 H OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES | $404.60 | $578.00 | $41.60–$643.00 | 83% above | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 H OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES | $404.60 | $578.00 | $213.86–$3,678.00 | — | 30% |
| New patient office visit, about 45 minutes CPT 99204 H OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES | $604.80 | $864.00 | $66.40–$820.80 | 103% above | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 H OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES | $604.80 | $864.00 | $319.68–$3,678.00 | — | 30% |
| New patient office visit, about 60 minutes CPT 99205 H OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES | $798.70 | $1,141.00 | $70.85–$1,083.95 | 105% above | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 H OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES | $798.70 | $1,141.00 | $422.17–$3,678.00 | — | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 H OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES | $260.40 | $372.00 | $32.00–$643.00 | 50% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 H OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES | $260.40 | $372.00 | $137.64–$3,678.00 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 H NUTRITIONAL THERAPY THERAPEUTIC INITIAL EVALPER | $109.90 | $157.00 | $26.69–$149.15 | 105% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 H NUTRITIONAL THERAPY EDUCATION EVAL PER 15 MIN | $109.90 | $157.00 | $26.69–$149.15 | 105% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 H NUTRITIONAL THERAPY EDUCATION EVAL PER 15 MIN | $109.90 | $157.00 | $58.09–$3,678.00 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 H NUTRITIONAL THERAPY THERAPEUTIC INITIAL EVALPER | $109.90 | $157.00 | $58.09–$3,678.00 | — | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 H MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES | $109.20 | $156.00 | $26.52–$148.20 | 18% below | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 H MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES | $109.20 | $156.00 | $57.72–$3,678.00 | — | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 H THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $123.90 | $177.00 | $30.09–$168.15 | 11% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 H THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $123.90 | $177.00 | $65.49–$3,678.00 | — | 30% |
| Psychiatric evaluation with medical services CPT 90792 H PSYCHIATRIC DIAGNOSTIC EVALUATION W MEDICAL SERV | $654.50 | $935.00 | $72.33–$888.25 | 83% above | 30% |
| Psychiatric evaluation with medical services inpatient CPT 90792 H PSYCHIATRIC DIAGNOSTIC EVALUATION W MEDICAL SERV | $654.50 | $935.00 | $345.95–$3,678.00 | — | 30% |
| Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 H PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR | $315.70 | $451.00 | $76.67–$643.00 | 1% above | 30% |
| Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 H PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR | $315.70 | $451.00 | $166.87–$3,678.00 | — | 30% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 H PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN | $491.40 | $702.00 | $66.71–$666.90 | 97% above | 30% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 H PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN | $491.40 | $702.00 | $259.74–$3,678.00 | — | 30% |
| Psychotherapy session, 30 minutes CPT 90832 H PSYCHOTHERAPY 30 MIN | $301.00 | $430.00 | $29.48–$408.50 | 59% above | 30% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 H PSYCHOTHERAPY 30 MIN | $301.00 | $430.00 | $159.10–$3,678.00 | — | 30% |
| Psychotherapy session, 45 minutes CPT 90834 H PSYCHOTHERAPY 45 MIN | $399.70 | $571.00 | $44.20–$542.45 | 107% above | 30% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 H PSYCHOTHERAPY 45 MIN | $399.70 | $571.00 | $211.27–$3,678.00 | — | 30% |
| Psychotherapy session, 60 minutes CPT 90837 H PSYCHOTHERAPY 60 MIN | $508.90 | $727.00 | $66.71–$690.65 | 77% above | 30% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 H PSYCHOTHERAPY 60 MIN | $508.90 | $727.00 | $268.99–$3,678.00 | — | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 H OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN | $649.60 | $928.00 | $48.00–$881.60 | 135% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 H OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN | $649.60 | $928.00 | $343.36–$3,678.00 | — | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 H OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN | $326.20 | $466.00 | $28.35–$643.00 | 114% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 H OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN | $326.20 | $466.00 | $172.42–$3,678.00 | — | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 H OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN | $459.90 | $657.00 | $42.50–$643.00 | 149% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 H OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN | $459.90 | $657.00 | $243.09–$3,678.00 | — | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 H OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN | $203.70 | $291.00 | $24.25–$643.00 | 63% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 H OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN | $203.70 | $291.00 | $107.67–$3,678.00 | — | 30% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 H OP OR ED PSYCH CONSULT (40MIN) | $401.10 | $573.00 | $90.00–$643.00 | 180% above | 30% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 H OP OR ED PSYCH CONSULT (40MIN) | $401.10 | $573.00 | $212.01–$3,678.00 | — | 30% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 H OP OR ED PSYCH CONSULT MOD MDM 40 MIN | $572.60 | $818.00 | $71.40–$777.10 | 136% above | 30% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 H OP OR ED PSYCH CONSULT MOD MDM 40 MIN | $572.60 | $818.00 | $302.66–$3,678.00 | — | 30% |
| Spirometry (breathing test) CPT 94010 H SPIROMETRY W/MAX VOL VENT PER PROTOCOL | $581.70 | $831.00 | $141.27–$789.45 | 92% above | 30% |
| Spirometry (breathing test) inpatient CPT 94010 H SPIROMETRY W/MAX VOL VENT PER PROTOCOL | $581.70 | $831.00 | $307.47–$3,678.00 | — | 30% |
| Spirometry before and after a bronchodilator CPT 94060 H BRONCHOSPASM EVALUATION PER PROTOCOL | $1,054.20 | $1,506.00 | $256.02–$1,430.70 | 93% above | 30% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 H BRONCHOSPASM EVALUATION PER PROTOCOL | $1,054.20 | $1,506.00 | $557.22–$3,678.00 | — | 30% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 H PHLEBOTOMY THERAPEUTIC | $382.20 | $546.00 | $92.82–$518.70 | 78% above | 30% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 H PHLEBOTOMY THERAPEUTIC | $382.20 | $546.00 | $202.02–$3,678.00 | — | 30% |
| Visual field test, extended CPT 92083 H VISUAL FIELD EXAMINATION(S) | $203.70 | $291.00 | $49.47–$936.00 | 40% above | 30% |
| Visual field test, extended inpatient CPT 92083 H VISUAL FIELD EXAMINATION(S) | $203.70 | $291.00 | $107.67–$3,678.00 | — | 30% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Illinois | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 H COVID-19 MODERNA 50 MCG/0.5 ML IM 12 AND OVER | $247.80 | $354.00 | $60.18–$336.30 | 21% above | 30% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 H COVID-19 MODERNA 50 MCG/0.5 ML IM 12 AND OVER | $247.80 | $354.00 | $130.98–$3,678.00 | — | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 H VARIVAX CHICKEN POX | $518.55 | $740.79 | $125.93–$703.75 | 88% above | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1350 UNIT/0.5 ML SUBCUTANEOUS SUSP | $884.11 | $1,263.01 | $214.71–$1,199.86 | 220% above | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 H VARIVAX CHICKEN POX | $518.55 | $740.79 | $274.09–$3,678.00 | — | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1350 UNIT/0.5 ML SUBCUTANEOUS SUSP | $884.11 | $1,263.01 | $467.31–$3,678.00 | — | 30% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHPERTUS(ACEL)TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE | $143.32 | $204.74 | $34.81–$194.50 | 126% above | 30% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHPERTUS(ACEL)TET PED(PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SYRINGE | $143.32 | $204.74 | $75.75–$3,678.00 | — | 30% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 H DTAP-HEPB-IPV VACCINE INTRAMUSCULAR (PEDIARIX) | $293.65 | $419.50 | $71.32–$398.52 | 84% above | 30% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE | $496.47 | $709.24 | $120.57–$673.78 | 212% above | 30% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 H DTAP-HEPB-IPV VACCINE INTRAMUSCULAR (PEDIARIX) | $293.65 | $419.50 | $155.22–$3,678.00 | — | 30% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE | $496.47 | $709.24 | $262.42–$3,678.00 | — | 30% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 H DTAP HIB IPV VACCINE (PENTACEL) | $338.53 | $483.62 | $178.94–$3,678.00 | — | 30% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 H DTAP-IPV-HIB-HEPB VACCINE IM | $667.80 | $954.00 | $162.18–$906.30 | 178% above | 30% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 H DTAP-IPV-HIB-HEPB VACCINE IM | $667.80 | $954.00 | $352.98–$3,678.00 | — | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 H IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE | $38.50 | $55.00 | $9.35–$52.25 | 8% above | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 H IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE | $38.50 | $55.00 | $20.35–$3,678.00 | — | 30% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE | $1,516.94 | $2,167.05 | $368.40–$2,058.70 | 210% above | 30% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 H 9VHPV VACC 2/3 DOSE SCHED IM USE | $858.73 | $1,226.76 | $453.90–$3,678.00 | — | 30% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE | $1,516.94 | $2,167.05 | $801.81–$3,678.00 | — | 30% |
| Hepatitis A vaccine, adult dose CPT 90632 H HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE | $254.15 | $363.07 | $61.72–$344.92 | 111% above | 30% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 H HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE | $254.15 | $363.07 | $134.34–$3,678.00 | — | 30% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 H HEPATITITS A (HAVRIX) | $125.78 | $179.68 | $30.55–$170.70 | 52% above | 30% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE | $199.23 | $284.61 | $48.38–$270.38 | 140% above | 30% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 H HEPATITIS A (1440) | $254.15 | $363.07 | $61.72–$344.92 | 206% above | 30% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 H HEPATITITS A (HAVRIX) | $125.78 | $179.68 | $66.48–$3,678.00 | — | 30% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRINGE | $199.23 | $284.61 | $105.31–$3,678.00 | — | 30% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 H HEPATITIS A (1440) | $254.15 | $363.07 | $134.34–$3,678.00 | — | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 H HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE | $216.17 | $308.82 | $52.50–$293.38 | 100% above | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP | $343.50 | $490.71 | $83.42–$466.17 | 218% above | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 H HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE | $216.17 | $308.82 | $114.26–$3,678.00 | — | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SUSP | $343.50 | $490.71 | $181.56–$3,678.00 | — | 30% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE | $147.97 | $211.38 | $35.93–$200.81 | 70% above | 30% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 H HEPATITIS B (ENGERIX B) | $95.14 | $135.92 | $50.29–$3,678.00 | — | 30% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE | $147.97 | $211.38 | $78.21–$3,678.00 | — | 30% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 H HEMOPHILUS INF B BOOSTER | $102.43 | $146.33 | $24.88–$139.01 | 65% above | 30% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 H HEMOPHILUS INF B BOOSTER | $102.43 | $146.33 | $54.14–$3,678.00 | — | 30% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 H HEMOPHILUS INFLUENZA B VACCINE | $102.43 | $146.33 | $24.88–$139.01 | 93% above | 30% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 H HEMOPHILUS INFLUENZA B VACCINE | $102.43 | $146.33 | $54.14–$3,678.00 | — | 30% |
| Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 H JAPANESE ENCEPHALITIS IM | $826.64 | $1,180.92 | $200.76–$1,121.87 | 95% above | 30% |
| Japanese encephalitis vaccine (Ixiaro), 2-dose schedule inpatient CPT 90738 H JAPANESE ENCEPHALITIS IM | $826.64 | $1,180.92 | $436.94–$3,678.00 | — | 30% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 H MMR | $274.76 | $392.51 | $66.73–$372.88 | 42% above | 30% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLESMUMPSRUBELLA VACCINE LIVE(PF)1000-12500TCID50/0.5 ML SUBCUT | $442.32 | $631.89 | $107.42–$600.30 | 128% above | 30% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 H MMR | $274.76 | $392.51 | $145.23–$3,678.00 | — | 30% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLESMUMPSRUBELLA VACCINE LIVE(PF)1000-12500TCID50/0.5 ML SUBCUT | $442.32 | $631.89 | $233.80–$3,678.00 | — | 30% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 H MMRV VACCINE | $772.20 | $1,103.14 | $187.53–$1,047.98 | 86% above | 30% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 H MMRV VACCINE | $772.20 | $1,103.14 | $408.16–$3,678.00 | — | 30% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 H MENINGOCOCCAL (MENACTRA) MCV4 OR MENACWY IM | $165.90 | $237.00 | $40.29–$225.15 | 33% below | 30% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOC VAC ACYW-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS) | $812.93 | $1,161.33 | $197.43–$1,103.26 | 228% above | 30% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 H MENINGOCOCCAL (MENACTRA) MCV4 OR MENACWY IM | $165.90 | $237.00 | $87.69–$3,678.00 | — | 30% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOC VAC ACYW-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS) | $812.93 | $1,161.33 | $429.69–$3,678.00 | — | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 H MENING REC B 2 DOSE IM (BEXSERO) | $666.31 | $951.87 | $161.82–$904.28 | 84% above | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B VAC4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE | $1,157.59 | $1,653.70 | $281.13–$1,571.01 | 220% above | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 H MENING REC B 2 DOSE IM (BEXSERO) | $666.31 | $951.87 | $352.19–$3,678.00 | — | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B VAC4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE | $1,157.59 | $1,653.70 | $611.87–$3,678.00 | — | 30% |
| Meningococcal B vaccine (Trumenba) CPT 90621 H MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM | $584.93 | $835.62 | $142.06–$793.84 | 85% above | 30% |
| Meningococcal B vaccine (Trumenba) inpatient CPT 90621 H MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM | $584.93 | $835.62 | $309.18–$3,678.00 | — | 30% |
| Nasal spray flu vaccine, live (FluMist) CPT 90660 H LAIV3 VACCINE LIVE FOR INTRANASAL USE | $38.50 | $55.00 | $9.35–$52.25 | 41% above | 30% |
| Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 H LAIV3 VACCINE LIVE FOR INTRANASAL USE | $38.50 | $55.00 | $20.35–$3,678.00 | — | 30% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 H PEUMOCOCCAL VACINE 13 VALENT (PREVNAR) | $792.12 | $1,131.60 | $192.37–$1,075.02 | 119% above | 30% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 H PEUMOCOCCAL VACINE 13 VALENT (PREVNAR) | $792.12 | $1,131.60 | $418.69–$3,678.00 | — | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 H PCV20 VACCINE IM | $792.40 | $1,132.00 | $192.44–$1,075.40 | 78% above | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE | $1,461.82 | $2,088.31 | $355.01–$1,983.89 | 229% above | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 H PCV20 VACCINE IM | $792.40 | $1,132.00 | $418.84–$3,678.00 | — | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE | $1,461.82 | $2,088.31 | $772.67–$3,678.00 | — | 30% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 H PCV21 VACCINE FOR INTRAMUSCULAR USE | $804.51 | $1,149.30 | $195.38–$1,091.84 | 59% above | 30% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 H PCV21 VACCINE FOR INTRAMUSCULAR USE | $804.51 | $1,149.30 | $425.24–$3,678.00 | — | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 H PNEUMOCOCCAL 23 VALENT >2 YRS | $340.63 | $486.62 | $82.73–$462.29 | 81% above | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE | $540.92 | $772.74 | $131.37–$734.10 | 188% above | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 H PNEUMOCOCCAL 23 VALENT >2 YRS | $340.63 | $486.62 | $180.05–$3,678.00 | — | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SYRINGE | $540.92 | $772.74 | $285.91–$3,678.00 | — | 30% |
| Polio vaccine, inactivated (IPV) CPT 90713 H POLIO INACTIVE (SUBCU/IM) | $141.08 | $201.54 | $34.26–$191.46 | at median | 30% |
| Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION | $237.19 | $338.84 | $57.60–$321.90 | 68% above | 30% |
| Polio vaccine, inactivated (IPV) inpatient CPT 90713 H POLIO INACTIVE (SUBCU/IM) | $141.08 | $201.54 | $74.57–$3,678.00 | — | 30% |
| Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION | $237.19 | $338.84 | $125.37–$3,678.00 | — | 30% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 H RSV MONOCLONAL ANTIBODY 1 ML FOR IM USE | $1,539.30 | $2,199.00 | $373.83–$2,089.05 | 80% above | 30% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 H RSV MONOCLONAL ANTIBODY 1 ML FOR IM USE | $1,539.30 | $2,199.00 | $813.63–$3,678.00 | — | 30% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 H RSV MONOCLONAL ANTIBODY 0.5 ML FOR IM USE | $1,539.30 | $2,199.00 | $373.83–$2,089.05 | 53% above | 30% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 H RSV MONOCLONAL ANTIBODY 0.5 ML FOR IM USE | $1,539.30 | $2,199.00 | $813.63–$3,678.00 | — | 30% |
| Rabies vaccine, one dose CPT 90675 H RABIES IMOVAX KIT 2.5 UNITS | $1,205.30 | $1,721.86 | $292.72–$1,635.77 | 60% above | 30% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP | $2,088.20 | $2,983.14 | $507.13–$2,833.98 | 176% above | 30% |
| Rabies vaccine, one dose inpatient CPT 90675 H RABIES IMOVAX KIT 2.5 UNITS | $1,205.30 | $1,721.86 | $637.09–$3,678.00 | — | 30% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP | $2,088.20 | $2,983.14 | $900.00–$3,678.00 | — | 30% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 H RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE | $420.32 | $600.46 | $102.08–$570.44 | 88% above | 30% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 H RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE | $420.32 | $600.46 | $222.17–$3,678.00 | — | 30% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 H ROTAVIRUS VACCINE 2ML ORAL | $288.73 | $412.47 | $70.12–$391.85 | 95% above | 30% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VACCINE LIVE PENTAVALENT 2 ML ORAL SOLUTION | $471.21 | $673.15 | $114.44–$639.49 | 219% above | 30% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 H ROTAVIRUS VACCINE 2ML ORAL | $288.73 | $412.47 | $152.61–$3,678.00 | — | 30% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VACCINE LIVE PENTAVALENT 2 ML ORAL SOLUTION | $471.21 | $673.15 | $249.07–$3,678.00 | — | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 H VARICELLA ZOSTER REC IM (SHINGRIX) | $164.50 | $235.00 | $39.95–$223.25 | 33% below | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 H VARICELLA ZOSTER REC IM (SHINGRIX) | $164.50 | $235.00 | $86.95–$3,678.00 | — | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 H DIPTHERIA TETANUS (DT)>7 YRS | $126.95 | $181.35 | $30.83–$172.28 | 65% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE | $223.83 | $319.76 | $54.36–$303.77 | 191% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 H DIPTHERIA TETANUS (DT)>7 YRS | $126.95 | $181.35 | $67.10–$3,678.00 | — | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE | $223.83 | $319.76 | $118.31–$3,678.00 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 H TDAP > 7 YRS (ADACEL) | $149.18 | $213.11 | $36.23–$202.45 | 42% above | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTHPERTUS(ACEL)TETANUS(PF)2LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SUSP | $246.11 | $351.58 | $59.77–$334.00 | 135% above | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTHPERTUS(AC)TETANUS(PF)2 LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SYRINGE | $246.11 | $351.58 | $59.77–$334.00 | 135% above | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 H TDAP > 7 YRS (ADACEL) | $149.18 | $213.11 | $78.85–$3,678.00 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTHPERTUS(ACEL)TETANUS(PF)2LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SUSP | $246.11 | $351.58 | $130.08–$3,678.00 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTHPERTUS(AC)TETANUS(PF)2 LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SYRINGE | $246.11 | $351.58 | $130.08–$3,678.00 | — | 30% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 H TYPHIM VI IMMUNIZATION | $421.14 | $601.63 | $102.28–$571.55 | 101% above | 30% |
| Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 H TYPHIM VI IMMUNIZATION | $421.14 | $601.63 | $222.60–$3,678.00 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 H IMMUNIZATION ADMIN INITIAL | $70.70 | $101.00 | $17.17–$95.95 | 23% above | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 H IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE | $70.70 | $101.00 | $17.17–$95.95 | 23% above | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 H IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE | $70.70 | $101.00 | $37.37–$3,678.00 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 H IMMUNIZATION ADMIN INITIAL | $70.70 | $101.00 | $37.37–$3,678.00 | — | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 H IM ADM PRQ ID SUBQ/IM NJXS EA ADDL VACCINE | $47.60 | $68.00 | $11.56–$64.60 | 23% above | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 H IMMUNIZATION ADMIN ADDITIONAL | $47.60 | $68.00 | $11.56–$64.60 | 23% above | 30% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 H IM ADM PRQ ID SUBQ/IM NJXS EA ADDL VACCINE | $47.60 | $68.00 | $25.16–$3,678.00 | — | 30% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 H IMMUNIZATION ADMIN ADDITIONAL | $47.60 | $68.00 | $25.16–$3,678.00 | — | 30% |
| Yellow fever vaccine, live CPT 90717 H YELLOW FEVER SQ | $632.43 | $903.47 | $153.59–$858.30 | 127% above | 30% |
| Yellow fever vaccine, live inpatient CPT 90717 H YELLOW FEVER SQ | $632.43 | $903.47 | $334.28–$3,678.00 | — | 30% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.