Hospital

Fairfield Memorial Hospital

Fairfield Memorial Hospital in Fairfield, IL publishes cash prices for 344 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Illinois median for 173 of 343 procedures and below it for 166. By typical cash price it ranks #53 of 114 Illinois hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

303 NW 11TH ST, FAIRFIELD, IL 62837 Collected Sep 27, 2026 Source price file (618) 842-2611

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 3 of 5 CCN 141311 · CMS hospital register NPI 1255422416

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 2 actions for a hospital named Fairfield Memorial Hospital in Fairfield, IL:

Sep 19, 2025 Warning notice
Dec 22, 2025 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE 3 VIEWS	$304.80	$381.00	$38.25–$342.90	20% below	20%
Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE FOUR VIEWS	$304.80	$381.00	$38.25–$342.90	20% below	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE RT 3 VIEWS	$304.80	$381.00	$38.25–$342.90	20% below	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE LT 3 VIEWS	$304.80	$381.00	$38.25–$342.90	20% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ANKLE ARM INDEX (R)	$404.00	$505.00	$74.44–$454.50	1% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ANKLE ARM INDEX (L)	$404.00	$505.00	$74.44–$454.50	1% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ANKLE ARM INDEX BIL	$404.00	$505.00	$74.44–$454.50	1% below	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS	$719.20	$899.00	$38.25–$809.10	10% above	20%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE WHOLE BODY	$2,000.00	$2,500.00	$250.26–$2,250.00	26% above	20%
Breast ultrasound, complete, one breast both sides CPT 76641 ULTRASOUND BREAST BILATERAL COMPLETE	$1,104.80	$1,381.00	$74.44–$1,242.90	—	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST LT COMP	$736.80	$921.00	$74.44–$828.90	40% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST RT COMP	$736.80	$921.00	$74.44–$828.90	40% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LT LIMITED	$736.80	$921.00	$74.44–$828.90	68% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST RT LIMITED	$736.80	$921.00	$74.44–$828.90	68% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST	$4,764.00	$5,955.00	$252.95–$5,359.50	61% above	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN/PELVIS W/O CONTRAST	$4,977.60	$6,222.00	$207.03–$5,599.80	34% above	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN/PELVIS WITH CONTRAST	$5,756.00	$7,195.00	$207.03–$6,475.50	28% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN W/O CONTRAST-PELVIS W/CONTRAS	$5,316.80	$6,646.00	$207.03–$7,800.30	2% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN W/CONTRAST - PELVIS W/O CONTR	$5,412.00	$6,765.00	$207.03–$7,800.30	4% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN W/O CT PELVIS W/WO CONTRAST	$5,889.60	$7,362.00	$207.03–$7,800.30	13% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN W/WO CONTRAST - PELVIS WO	$6,018.40	$7,523.00	$207.03–$7,800.30	16% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMENT W/WO - PELVIS WITH CONTRAST	$6,360.80	$7,951.00	$207.03–$7,800.30	22% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PELVIS WITH/WO CONTRAST	$6,933.60	$8,667.00	$207.03–$7,800.30	33% above	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOM W/CONT	$2,907.20	$3,634.00	$207.03–$3,270.60	19% above	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOM W/O CONT	$2,471.20	$3,089.00	$72.68–$2,780.10	25% above	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS W/O CONT	$2,134.40	$2,668.00	$72.68–$2,401.20	24% above	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL BONES W/O	$2,134.40	$2,668.00	$72.68–$2,401.20	24% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONT	$1,992.00	$2,490.00	$207.03–$2,241.00	5% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT STROKE HEAD	$1,992.00	$2,490.00	$207.03–$2,241.00	5% above	20%
CT scan of the head with contrast CPT 70460 CT HEAD W CONT	$2,444.80	$3,056.00	$207.03–$2,750.40	18% above	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD W & W/O CONT	$2,984.80	$3,731.00	$207.03–$3,357.90	20% above	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR W/O	$2,536.00	$3,170.00	$72.68–$2,853.00	13% above	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINEW/O	$2,536.00	$3,170.00	$72.68–$2,853.00	7% above	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONT	$2,847.20	$3,559.00	$207.03–$3,203.10	29% above	20%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 CAROTID ART DOP R&L	$1,114.40	$1,393.00	$114.69–$1,253.70	29% above	20%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS	$360.80	$451.00	$38.25–$405.90	17% above	20%
Chest X-ray, single view CPT 71045 CHEST 1 VIEW	$283.20	$354.00	$38.25–$318.60	13% above	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA BONE DENSITY	$1,353.60	$1,692.00	$53.70–$1,522.80	173% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB US DETAILED SINGLE FETUS	$1,601.60	$2,002.00	$68.57–$1,801.80	66% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT LOW DOSE FOLLOW UP	$2,536.00	$3,170.00	$72.68–$2,994.30	34% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONT	$2,536.00	$3,170.00	$72.68–$2,994.30	34% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT SC JOINT W/O CONT	$2,594.40	$3,243.00	$72.68–$2,994.30	37% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO CONT	$2,661.60	$3,327.00	$72.68–$2,994.30	41% above	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTRAST	$2,965.60	$3,707.00	$207.03–$3,336.30	22% above	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIGITAL DIAGNOSTIC BILATERAL	$421.60	$527.00	$32.52–$548.10	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIGITAL DIANOSTIC CAD - BILATERAL	$487.20	$609.00	$32.52–$548.10	—	20%
Diagnostic mammogram, both breasts CPT 77066 COMPUTER AIDED DETECTION MAMMO SCREENING	$39.88	$49.85	$11.96–$44.87	88% below	20%
Diagnostic mammogram, one breast CPT 77065 MAMMO DIGITAL DIAGNOSTIC UNI	$300.80	$376.00	$32.52–$474.30	at median	20%
Diagnostic mammogram, one breast CPT 77065 MAMMOGRAM ADDTL VIEW	$339.20	$424.00	$32.52–$474.30	13% above	20%
Diagnostic mammogram, one breast CPT 77065 MAMMO UNI-LAT	$339.20	$424.00	$32.52–$474.30	13% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO UNILAT DIAG	$421.60	$527.00	$32.52–$474.30	40% above	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 ARTERIAL DUPLEX LOW EXT BILAT	$962.40	$1,203.00	$114.69–$1,082.70	—	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 VENOUS INSUFF B/L	$860.00	$1,075.00	$114.69–$1,340.10	40% below	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 VEN DOPP LOW EXT BIL	$860.00	$1,075.00	$114.69–$1,340.10	40% below	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 VENOUS DOPPLER BIL	$1,191.20	$1,489.00	$114.69–$1,340.10	17% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO COMPLETE	$2,594.40	$3,243.00	$294.92–$2,918.70	21% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILLARY DUCT	$1,596.80	$1,996.00	$250.26–$1,796.40	6% above	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HOME SLEEP STUDY	$540.00	$675.00	$103.39–$607.50	7% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP TEST SPLIT NIGHT STUDY	$5,336.80	$6,671.00	$538.33–$6,169.50	11% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP TEST CPAP/BIPA	$5,484.00	$6,855.00	$538.33–$6,169.50	14% above	20%
Knee X-ray, 3 views CPT 73562 KNEE 3 VIEWS	$325.60	$407.00	$38.25–$366.30	17% below	20%
Knee X-ray, 3 views one side CPT 73562 KNEE LT 3 VIEWS	$325.60	$407.00	$38.25–$366.30	17% below	20%
Knee X-ray, 3 views one side CPT 73562 KNEE RT 3 VIEWS	$325.60	$407.00	$38.25–$366.30	17% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 U/S ABDOMINAL (LTD)	$623.20	$779.00	$74.44–$1,304.10	13% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 U/S LIVER	$860.00	$1,075.00	$74.44–$1,304.10	20% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 U/S PANCREAS	$860.00	$1,075.00	$74.44–$1,304.10	20% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 U/S GALL BLADDER	$860.00	$1,075.00	$74.44–$1,304.10	20% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 U/S QUADRANT	$860.00	$1,075.00	$74.44–$1,304.10	20% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 U/S SPLEEN LTD	$1,159.20	$1,449.00	$74.44–$1,304.10	62% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE CT CHEST WO	$2,536.00	$3,170.00	$72.68–$2,853.00	349% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI ANKLE JOINT	$3,208.00	$4,010.00	$164.33–$3,609.00	11% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI HIP JOINT	$3,208.00	$4,010.00	$164.33–$3,609.00	11% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI FOOT JOINT	$3,208.00	$4,010.00	$164.33–$3,609.00	11% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI KNEE JOINT	$3,208.00	$4,010.00	$164.33–$3,609.00	11% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXTREMITY JOINT W/WO CONTRAST	$3,064.00	$3,830.00	$277.26–$3,609.00	17% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI TOE W/WO	$3,208.00	$4,010.00	$277.26–$3,609.00	13% below	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN	$3,316.80	$4,146.00	$164.33–$3,731.40	20% above	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABD W/WO	$3,999.20	$4,999.00	$277.26–$4,499.10	6% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI PITUITARY GLAND	$3,276.80	$4,096.00	$164.33–$3,686.40	11% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONT	$3,276.80	$4,096.00	$164.33–$3,686.40	11% above	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO/W CONT	$6,936.80	$8,671.00	$277.26–$7,803.90	67% above	20%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR W/O CON	$3,576.00	$4,470.00	$164.33–$4,023.00	18% above	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR W/WO	$6,936.80	$8,671.00	$277.26–$7,803.90	66% above	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC W/O CON	$3,622.40	$4,528.00	$164.33–$4,075.20	21% above	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL WO/W CO	$7,012.80	$8,766.00	$277.26–$7,889.40	72% above	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL W/O CON	$3,316.80	$4,146.00	$164.33–$3,731.40	11% above	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/W0 CONTRAST	$6,679.20	$8,349.00	$277.26–$7,514.10	79% above	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$3,122.40	$3,903.00	$164.33–$3,512.70	15% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI WRIST	$3,208.00	$4,010.00	$164.33–$3,609.00	9% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI FINGER	$3,208.00	$4,010.00	$164.33–$3,609.00	9% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI ELBOW	$3,208.00	$4,010.00	$164.33–$3,609.00	9% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI SHOULDER	$3,208.00	$4,010.00	$164.33–$3,609.00	9% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 AIRTEX STRESS CARDIO	$2,378.40	$2,973.00	$599.42–$7,650.00	37% below	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 CARDIAC VIABILITY STUDY	$6,800.00	$8,500.00	$599.42–$7,650.00	81% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 CARD R&S MULTI	$6,800.00	$8,500.00	$599.42–$7,650.00	81% above	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET SCAN - SKULL BASE TO MID THIGH	$5,832.00	$7,290.00	$908.66–$6,561.00	1% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 U/S URINARY BLADDER	$860.00	$1,075.00	$74.44–$967.50	55% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 U/S PELVIS	$963.20	$1,204.00	$114.69–$1,083.60	18% above	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB U/S < 14 WEEKS SINGLE FETUS	$1,183.20	$1,479.00	$68.57–$1,506.60	59% above	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 U/S PREG COMPLETE	$1,339.20	$1,674.00	$68.57–$1,506.60	80% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 U/S LIMITED OB	$736.80	$921.00	$68.57–$1,007.10	46% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 U/S PLACENTA LOC LTD	$895.20	$1,119.00	$68.57–$1,007.10	77% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 U/S FETAL POSIT LTD	$895.20	$1,119.00	$68.57–$1,007.10	77% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 U/S FETAL AFI LTD	$895.20	$1,119.00	$68.57–$1,007.10	77% above	20%
Screening mammogram, both breasts both sides CPT 77067 MAMMO BI-LAT SCREEN	$252.00	$315.00	$32.52–$474.30	—	20%
Screening mammogram, both breasts both sides CPT 77067 MAMMO DIGITAL SCREENING BILATERAL	$356.00	$445.00	$32.52–$474.30	—	20%
Screening mammogram, both breasts CPT 77067 COMPUTER AIDED DETECTION MAMMO DIAGNOSTI	$39.88	$49.85	$11.96–$44.87	85% below	20%
Screening mammogram, both breasts CPT 77067 AIRTEX MAMMO SCREEN	$84.80	$106.00	$32.52–$474.30	69% below	20%
Screening mammogram, both breasts CPT 77067 MAMMO SCREEN SPECIAL	$116.00	$145.00	$32.52–$474.30	57% below	20%
Screening mammogram, both breasts CPT 77067 MAMMO DIGITAL SCREENING UNI	$160.00	$200.00	$32.52–$474.30	41% below	20%
Screening mammogram, both breasts CPT 77067 MAMMO UNI-LAT SCREEN	$252.00	$315.00	$32.52–$474.30	8% below	20%
Screening mammogram, both breasts CPT 77067 MAMMO DIGITAL SCREENING CAD	$421.60	$527.00	$32.52–$474.30	55% above	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER 2 VIEWS MIN	$317.60	$397.00	$38.25–$357.30	15% below	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER 3 VIEWS	$317.60	$397.00	$38.25–$357.30	15% below	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER 4 VIEWS	$317.60	$397.00	$38.25–$357.30	15% below	20%
Sleep study in a lab (polysomnography) CPT 95810 SLEEP TEST DIAGNOSIS	$5,192.80	$6,491.00	$538.33–$5,841.90	29% above	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 SWALLOWING FUNCTION	$808.80	$1,011.00	$80.60–$909.90	23% above	20%
Transvaginal pelvic ultrasound CPT 76830 U/S TRANSVAGINAL	$963.20	$1,204.00	$74.44–$1,083.60	45% above	20%
Transvaginal ultrasound during pregnancy CPT 76817 U/S VAG OB ADDT'L	$207.20	$259.00	$62.16–$1,083.60	60% below	20%
Transvaginal ultrasound during pregnancy CPT 76817 U/S TRANS VAG OB	$963.20	$1,204.00	$62.16–$1,083.60	84% above	20%
Ultrasound of the abdomen, complete both sides CPT 76700 U/S BREAST UNI OR BI	$736.80	$921.00	$114.69–$1,341.00	—	20%
Ultrasound of the abdomen, complete CPT 76700 U/S ABDOMINAL (COMP)	$1,192.00	$1,490.00	$114.69–$1,341.00	12% above	20%
Ultrasound of the scrotum and testicles CPT 76870 U/S SCROTUM	$928.80	$1,161.00	$74.44–$1,044.90	23% above	20%
Ultrasound of the scrotum and testicles CPT 76870 U/S PROSTATE	$928.80	$1,161.00	$74.44–$1,044.90	23% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 U/S SOFT TISSUE NECK	$848.80	$1,061.00	$74.44–$954.90	24% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 U/S THYROID	$848.80	$1,061.00	$74.44–$954.90	24% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study both sides CPT 93971 VENOUS DOP BILAT LEG	$1,234.40	$1,543.00	$74.44–$1,388.70	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS INSUFF B/L	$387.20	$484.00	$74.44–$1,388.70	48% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS DOP L LEG UNI	$822.40	$1,028.00	$74.44–$1,388.70	11% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS DEP R ARM UNI	$822.40	$1,028.00	$74.44–$1,388.70	11% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS DOP L ARM UNI	$822.40	$1,028.00	$74.44–$1,388.70	11% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS DOP R LEG UNI	$822.40	$1,028.00	$74.44–$1,388.70	11% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS SUFFICIENCY	$860.00	$1,075.00	$74.44–$1,388.70	16% above	20%
Wrist X-ray, complete, 3 or more views CPT 73110 WRIST 3 VIEWS MIN	$304.80	$381.00	$38.25–$371.70	15% below	20%
Wrist X-ray, complete, 3 or more views CPT 73110 WRIST 4 VIEWS	$330.40	$413.00	$38.25–$371.70	8% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST RT 3 VIEWS MIN	$304.80	$381.00	$38.25–$371.70	15% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST LT 3 VIEWS MIN	$304.80	$381.00	$38.25–$371.70	15% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST LT 4 VIEWS	$330.40	$413.00	$38.25–$371.70	8% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST RT 4 VIEWS	$330.40	$413.00	$38.25–$371.70	8% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP 2-3V W/WO PELVIS	$272.80	$341.00	$38.25–$496.80	16% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 CHILD PELVIS/HIP 2 V	$336.80	$421.00	$38.25–$496.80	4% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP 2-3 VIEW	$441.60	$552.00	$38.25–$496.80	37% above	20%
X-ray of the abdomen, 1 view CPT 74018 K U B	$112.80	$141.00	$33.84–$342.90	58% below	20%
X-ray of the abdomen, 1 view CPT 74018 KUB/ABDOMEN 1 VIEW	$304.80	$381.00	$33.84–$342.90	14% above	20%
X-ray of the ankle, 2 views CPT 73600 ANKLE 2 VIEWS	$278.40	$348.00	$38.25–$313.20	3% below	20%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE RT 2 VIEWS	$278.40	$348.00	$38.25–$313.20	3% below	20%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE LT 2 VIEWS	$278.40	$348.00	$38.25–$313.20	3% below	20%
X-ray of the finger(s), 2 or more views CPT 73140 FINGER 2 VIEWS	$238.40	$298.00	$38.25–$268.20	18% below	20%
X-ray of the finger(s), 2 or more views CPT 73140 THUMB 2 VIEWS	$238.40	$298.00	$38.25–$268.20	18% below	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER RT 2-3 VIEW	$238.40	$298.00	$38.25–$268.20	18% below	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER LT 2-3 VIEW	$238.40	$298.00	$38.25–$268.20	18% below	20%
X-ray of the foot, 2 views CPT 73620 FOOT 2 VIEWS	$278.40	$348.00	$38.25–$313.20	3% below	20%
X-ray of the foot, 2 views one side CPT 73620 FOOT RT 2 VIEWS	$278.40	$348.00	$38.25–$313.20	3% below	20%
X-ray of the foot, 2 views one side CPT 73620 FOOT LT 2 VIEWS	$278.40	$348.00	$38.25–$313.20	3% below	20%
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT 3 VIEWS	$304.80	$381.00	$38.25–$342.90	17% below	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT RT 3 VIEWS	$304.80	$381.00	$38.25–$342.90	17% below	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT LT 3 VIEWS	$304.80	$381.00	$38.25–$342.90	17% below	20%
X-ray of the hand, 3 or more views CPT 73130 HAND 3 VIEWS	$304.80	$381.00	$38.25–$342.90	16% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 HAND LT 3 VIEWS MIN	$304.80	$381.00	$38.25–$342.90	16% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 HAND RT 3 VIEWS MIN	$304.80	$381.00	$38.25–$342.90	16% below	20%
X-ray of the knee, 1 or 2 views CPT 73560 KNEE 1 OR 2 VIEWS	$298.40	$373.00	$38.25–$335.70	9% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE LT 1 OR 2 VIEWS	$298.40	$373.00	$38.25–$335.70	9% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE RT 1 OR 2 VIEWS	$298.40	$373.00	$38.25–$335.70	9% below	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE 2/3 VWS	$378.40	$473.00	$38.25–$425.70	16% below	20%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE 4VW MIN	$530.40	$663.00	$38.25–$596.70	8% below	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2VIEW	$378.40	$473.00	$38.25–$425.70	at median	20%
X-ray of the nasal bones, 3 or more views CPT 70160 NOSE MIN 3 VIEWS	$302.40	$378.00	$38.25–$340.20	at median	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERV SPINE 2/3 VIEWS	$357.60	$447.00	$38.25–$402.30	3% below	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS	$298.40	$373.00	$38.25–$1,175.40	15% below	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 HIPS BIL AP PELVIS	$1,044.80	$1,306.00	$38.25–$1,175.40	199% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM & COCCYX	$314.40	$393.00	$38.25–$353.70	13% below	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT SGPT	$77.60	$97.00	$2.98–$88.20	48% above	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 NASH FIBROSURE PLUS	$78.40	$98.00	$2.98–$88.20	49% above	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 NASH FIBROSURE PLUS	$76.80	$96.00	$2.98–$87.30	46% above	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST SGOT	$77.60	$97.00	$2.98–$87.30	48% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LATEX NATURAL RAST	$48.00	$60.00	$6.36–$231.30	85% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST SCRN 5 ALLEGENS	$67.60	$84.50	$6.36–$231.30	160% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGENS ZONE 5	$83.20	$104.00	$6.36–$231.30	220% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LATEX IGE AMONATED	$205.60	$257.00	$6.36–$231.30	691% above	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 ANTICYCLIC CITRAL	$222.40	$278.00	$6.36–$250.20	165% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA DIRECT	$64.00	$80.00	$6.36–$405.00	29% below	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY	$180.00	$225.00	$6.36–$405.00	100% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 AUTOIMMUNE LIVER DISEASE PROFILE	$343.20	$429.00	$6.36–$386.10	281% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 VASCULITIS PROFILE (RDL)	$360.00	$450.00	$6.36–$405.00	300% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-NATRIURETIC PEPTID	$302.40	$378.00	$15.55–$340.20	60% above	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PNL	$126.40	$158.00	$4.99–$142.20	1% below	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PROSTATE BIOPSY	$238.40	$298.00	$21.96–$268.20	at median	20%
Blood culture for bacteria CPT 87040 CULTURE BLOOD	$172.80	$216.00	$5.82–$194.40	12% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$25.60	$32.00	$7.68–$63.90	9% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 TECH COLLECTION BLD	$56.80	$71.00	$7.68–$63.90	142% above	20%
Blood glucose (sugar) test CPT 82947 NASH FIBROSURE PLUS	$58.40	$73.00	$2.98–$68.40	29% above	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE SERUM	$60.80	$76.00	$2.98–$68.40	34% above	20%
Blood lead test CPT 83655 LEAD SCR ANY SOURCE	$97.60	$122.00	$6.80–$109.80	74% above	20%
Blood lead test CPT 83655 LEAD BLOOD	$97.60	$122.00	$6.80–$109.80	74% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUAL SERUM	$101.60	$127.00	$2.98–$114.30	12% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPE ABO	$60.80	$76.00	$2.45–$68.40	28% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$90.40	$113.00	$6.36–$101.70	23% above	20%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFFICUILE BY PCR	$46.40	$58.00	$13.92–$52.20	75% below	20%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF A/B BY DNA	$266.40	$333.00	$23.67–$299.70	45% above	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA-19-9	$112.00	$140.00	$6.36–$126.00	1% above	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$282.40	$353.00	$6.36–$317.70	75% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 GENMARK EPLEX RP2 PANELS	$478.40	$598.00	$143.52–$622.80	314% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 BIOMERIEUX BIOFIRE RP2 PANEL	$489.60	$612.00	$143.52–$622.80	324% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 VIRAL PANEL 12-25 TG	$553.60	$692.00	$143.52–$622.80	379% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 RESPIRATORY PANEL LABCORP	$2,795.20	$3,494.00	$838.56–$3,144.60	2320% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLORIDE CSF	$101.60	$127.00	$23.67–$114.30	18% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 URINE CHL	$148.80	$186.00	$23.67–$1,258.20	20% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA PCR URINE	$1,118.40	$1,398.00	$23.67–$1,258.20	804% above	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID CASCADE W/REFLEX	$18.40	$23.00	$4.99–$219.60	86% below	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 NMR LIPOPROFILE	$181.60	$227.00	$4.99–$219.60	41% above	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID SCREEN	$195.20	$244.00	$4.99–$219.60	52% above	20%
Complete blood count (CBC) with differential CPT 85025 VET CBC	$6.40	$8.00	$1.92–$114.30	92% below	20%
Complete blood count (CBC) with differential CPT 85025 CBC AUTO PLT & DIFF	$101.60	$127.00	$1.92–$114.30	30% above	20%
Complete blood count (CBC), no differential CPT 85027 CBC	$101.60	$127.00	$3.28–$114.30	56% above	20%
Comprehensive metabolic panel (blood test) CPT 80053 VET CHEM PROFILE 17	$48.00	$60.00	$0.24–$186.30	70% below	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$165.60	$207.00	$0.24–$186.30	4% above	20%
D-dimer blood test (blood clot marker) CPT 85379 D DIMER QUANT	$402.40	$503.00	$2.45–$452.70	233% above	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE	$207.20	$259.00	$7.29–$233.10	93% above	20%
Estradiol blood test CPT 82670 ESTRADIOL	$214.40	$268.00	$7.29–$241.20	102% above	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$195.20	$244.00	$7.29–$219.60	65% above	20%
Fecal calprotectin (stool inflammation test) CPT 83993 FECAL CALPROTECTION	$387.20	$484.00	$6.60–$435.60	123% above	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$181.60	$227.00	$6.60–$204.30	37% above	20%
Folate (folic acid) blood test CPT 82746 FOLIC ACID FOLATE	$181.60	$227.00	$6.60–$204.30	62% above	20%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$201.60	$252.00	$7.29–$226.80	69% above	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE THYROXINE	$156.00	$195.00	$7.29–$497.70	34% above	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 EQULIBRUM	$442.40	$553.00	$7.29–$497.70	280% above	20%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$171.20	$214.00	$7.29–$192.60	40% above	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$336.80	$421.00	$4.99–$378.90	2% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GTT 1 HR W DRINK	$194.40	$243.00	$2.98–$218.70	243% above	20%
Glucose tolerance test, 3 samples CPT 82951 GTT 3 SPECIMENS	$172.80	$216.00	$6.60–$194.40	28% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 CHLAMYDIA/ GONORRHREA	$24.80	$31.00	$7.44–$167.40	80% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC DNA PROBE	$143.20	$179.00	$7.44–$167.40	16% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 URINE GC	$148.80	$186.00	$7.44–$167.40	21% above	20%
H. pylori antibody blood test CPT 86677 H PYLORI ANTIBODY	$257.60	$322.00	$6.36–$396.90	125% above	20%
H. pylori antibody blood test CPT 86677 H PYLORI IGM QUAN	$352.80	$441.00	$6.36–$396.90	208% above	20%
H. pylori stool antigen test CPT 87338 H PYORI AG STOOL	$400.00	$500.00	$5.82–$450.00	244% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCO A1C	$156.00	$195.00	$2.98–$175.50	75% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE1	$120.00	$150.00	$6.36–$135.00	85% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE2	$119.20	$149.00	$6.36–$134.10	49% above	20%
Homocysteine blood test CPT 83090 HOMOCYSTINE	$302.40	$378.00	$7.29–$340.20	151% above	20%
Insulin blood test CPT 83525 INSULIN TOTAL SERUM	$170.40	$213.00	$7.29–$191.70	134% above	20%
Iron blood test (serum iron) CPT 83540 IRON TOTAL	$96.80	$121.00	$2.98–$681.30	22% above	20%
Iron blood test (serum iron) CPT 83540 IRON URINE	$605.60	$757.00	$2.98–$681.30	666% above	20%
Iron-binding capacity (TIBC) test CPT 83550 TIBC	$156.00	$195.00	$2.98–$175.50	108% above	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$201.60	$252.00	$4.99–$226.80	36% above	20%
LH (luteinizing hormone) test CPT 83002 LUTEINIZING HORMONE	$268.80	$336.00	$7.29–$302.40	134% above	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE SERUM	$126.40	$158.00	$2.98–$167.40	35% above	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE BODY FLD	$148.80	$186.00	$2.98–$167.40	59% above	20%
Liver function blood test panel CPT 80076 LIVER PROFILE	$144.80	$181.00	$4.99–$162.90	5% above	20%
Lyme disease antibody test CPT 86618 LYMES TOTAL AB SCR	$201.60	$252.00	$6.36–$776.70	178% above	20%
Lyme disease antibody test CPT 86618 LYMES AB CSF	$252.80	$316.00	$6.36–$776.70	249% above	20%
Lyme disease antibody test CPT 86618 TICKBORNE DISEASE ANTIBODY PROFILE	$441.60	$552.00	$6.36–$776.70	509% above	20%
Lyme disease antibody test CPT 86618 TICKBORNE DISEASE ANTIBODY PROFILE SERUM	$690.40	$863.00	$6.36–$776.70	852% above	20%
Magnesium blood test CPT 83735 MAGNESIUM SERUM	$101.60	$127.00	$2.98–$371.70	45% above	20%
Magnesium blood test CPT 83735 MAGNESIUM URINE	$144.80	$181.00	$2.98–$371.70	107% above	20%
Magnesium blood test CPT 83735 MAGNESIUM RBC	$330.40	$413.00	$2.98–$371.70	372% above	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB IGG	$219.20	$274.00	$6.36–$416.70	202% above	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB IGM	$370.40	$463.00	$6.36–$416.70	411% above	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO TEST	$112.00	$140.00	$6.36–$162.90	38% above	20%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ABSORPTI	$144.80	$181.00	$6.36–$162.90	79% above	20%
Obstetric blood test panel CPT 80055 PRENATAL I	$268.80	$336.00	$4.99–$302.40	28% above	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$141.60	$177.00	$6.60–$159.30	53% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA PROSTATE SPEC AG	$201.60	$252.00	$6.60–$226.80	78% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 B CELL CD19 CD20	$1,173.60	$1,467.00	$11.30–$1,320.30	757% above	20%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID INTACT	$360.80	$451.00	$19.32–$688.50	66% above	20%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID C-TERMAL	$612.00	$765.00	$19.32–$688.50	181% above	20%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID N-TERMAL	$612.00	$765.00	$19.32–$688.50	181% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBO TIME	$92.80	$116.00	$2.45–$465.30	33% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 COAG MIX/CORRECT STY	$378.40	$473.00	$2.45–$465.30	443% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 APTT MIXING STUDY	$413.60	$517.00	$2.45–$465.30	494% above	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MATERNITY T21 QNATAL	$2,232.80	$2,791.00	$362.16–$2,511.90	154% above	20%
Progesterone blood test CPT 84144 PROGESTERONE SERUM	$220.80	$276.00	$7.29–$248.40	64% above	20%
Prolactin blood test CPT 84146 PROLACTIN	$219.20	$274.00	$7.29–$246.60	73% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME/INR	$60.80	$76.00	$2.45–$68.40	58% above	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 PAIN MANAGEMENT SCRN	$24.80	$31.00	$7.44–$27.90	70% below	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 BETA STREP SCREEN	$80.00	$100.00	$5.82–$90.00	31% above	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID ARTH BLD	$120.00	$150.00	$6.36–$405.00	90% above	20%
Rheumatoid factor (RF) test CPT 86431 RA QUAN	$287.20	$359.00	$6.36–$405.00	354% above	20%
Rheumatoid factor (RF) test CPT 86431 ISLET CELL ANTIBODY	$293.60	$367.00	$6.36–$405.00	364% above	20%
Rheumatoid factor (RF) test CPT 86431 VASCULITIS PROFILE (RDL)	$360.00	$450.00	$6.36–$405.00	469% above	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM	$82.40	$103.00	$6.36–$165.60	8% above	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB IGG	$147.20	$184.00	$6.36–$165.60	93% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE	$68.00	$85.00	$3.28–$76.50	48% above	20%
Stool ova and parasites exam CPT 87177 O & P DIRECT	$159.20	$199.00	$5.82–$179.10	113% above	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 FECAL OCCULT BLOOD SCREEN	$57.60	$72.00	$2.98–$64.80	100% above	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL IMMUNOCHEMICAL	$108.00	$135.00	$6.60–$121.50	50% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR-STS	$72.80	$91.00	$6.36–$162.90	42% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL	$144.80	$181.00	$6.36–$162.90	183% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON	$424.80	$531.00	$22.55–$477.90	92% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$201.60	$252.00	$7.29–$226.80	61% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI LKM-1	$62.40	$78.00	$6.36–$858.60	22% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE	$159.20	$199.00	$6.36–$858.60	99% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID MICROSOMAL	$228.00	$285.00	$6.36–$858.60	185% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYRD MICROSOMAL AB	$228.00	$285.00	$6.36–$858.60	185% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 AUTOIMMUNE LIVER DISEASE PROFILE	$343.20	$429.00	$6.36–$386.10	329% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER CYTOSOL TYPE 1 ABS	$763.20	$954.00	$6.36–$858.60	854% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID CASCADE PROFILE	$18.40	$23.00	$5.52–$226.80	86% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIM HORMONE	$201.60	$252.00	$5.52–$226.80	58% above	20%
Trichomonas test (NAAT) CPT 87661 GC-CHLAMYDIA-TRICHOMONAS DNA	$44.80	$56.00	$13.44–$50.40	64% below	20%
Trichomonas test (NAAT) CPT 87661 XPERT TV	$80.00	$100.00	$23.67–$90.00	36% below	20%
Uric acid blood test CPT 84550 URIC ACID BLOOD	$101.60	$127.00	$2.98–$114.30	39% above	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS W/ MICRO	$80.00	$100.00	$1.66–$90.00	24% above	20%
Urinalysis with microscope exam, automated CPT 81001 UA WITH MICROSCOPY	$80.00	$100.00	$1.66–$90.00	24% above	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIPSTICK	$49.60	$62.00	$1.66–$55.80	98% above	20%
Urinalysis without microscope exam, automated CPT 81003 MORTON BUILDINGS	$288.00	$360.00	$1.66–$324.00	1052% above	20%
Urine culture for bacteria, with colony count CPT 87086 COLONY CNT EXCEPT UA	$84.80	$106.00	$5.82–$114.30	8% below	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE	$101.60	$127.00	$5.82–$114.30	11% above	20%
Urine pregnancy test, read by color change CPT 81025 HCG QUAL URINE	$101.60	$127.00	$1.66–$114.30	37% above	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VIT B12 TOTAL	$159.20	$199.00	$7.29–$179.10	23% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VIT D 25-HYDROXY	$201.60	$252.00	$15.55–$226.80	11% above	20%
Zinc blood test CPT 84630 ZINC URINE	$196.80	$246.00	$6.80–$221.40	180% above	20%
Zinc blood test CPT 84630 ZINC SERUM	$196.80	$246.00	$6.80–$221.40	180% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUAN SERUM	$201.60	$252.00	$7.29–$272.70	92% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUAN URINE	$242.40	$303.00	$7.29–$272.70	131% above	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY	$10,638.40	$13,298.00	$2,599.56–$11,968.20	216% above	20%
Appendectomy, open surgery CPT 44950 EXCISION PROCEDURES ON THE APPENDIX	$21,561.60	$26,952.00	$2,599.56–$24,256.80	445% above	20%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 KNEE ARTHROSCOPY/SURGERY	$3,091.20	$3,864.00	$383.16–$3,674.02	60% below	20%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 ARTHROSCOPICALLY AID	$29,428.00	$36,785.00	$3,674.02–$33,106.50	280% above	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHROSCOPY SHOULDER W/ROTATOR CUFF REPR	$503.20	$629.00	$389.98–$3,783.60	93% below	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHROSCOP ROTATOR CUFF REPR	$3,363.20	$4,204.00	$389.98–$3,783.60	57% below	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHROSCOP ROTATOR C	$20,700.80	$25,876.00	$3,674.02–$23,288.40	168% above	20%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIG	$860.00	$1,075.00	$258.00–$967.50	129% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 MAMMOTOME STEREOTACTIC GUID 1ST LESION	$2,128.80	$2,661.00	$906.02–$2,394.90	28% below	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST 1ST LESION STRTCTC	$4,120.80	$5,151.00	$906.02–$4,635.90	38% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 STEROTACTIC LOCAL	$5,832.00	$7,290.00	$906.02–$9,791.10	96% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 MAMMOTOME BX STEREO	$8,703.20	$10,879.00	$906.02–$9,791.10	192% above	20%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 BUNIONECTOMY WITH A DISTAL METATARSAL OS	$9,979.20	$12,474.00	$2,993.76–$11,226.60	186% above	20%
Bunion correction with removal of part of the big toe joint CPT 28292 HALLUX VALGUS WITH BUNIONECTOMY WITH SE	$1,240.80	$1,551.00	$153.76–$3,711.24	64% below	20%
Bunion correction with removal of part of the big toe joint CPT 28292 SURGICAL PROCEDURE TO CORRECT A BUNION	$9,979.20	$12,474.00	$2,993.76–$11,226.60	186% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$520.00	$650.00	$403.00–$585.00	55% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE EXTERNAL	$2,318.40	$2,898.00	$422.03–$2,608.20	102% above	20%
Carpal tunnel release, open surgery CPT 64721 NEUROPLASTY AT CARPAL TUNNEL	$743.20	$929.00	$575.98–$1,514.70	68% below	20%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL NEUROPLASTY	$1,346.40	$1,683.00	$575.98–$1,514.70	42% below	20%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGER	$5,671.20	$7,089.00	$916.98–$6,380.10	146% above	20%
Cataract surgery with lens implant CPT 66984 EXTRACAPSULAR CATARA	$6,573.60	$8,217.00	$1,162.40–$7,395.30	14% above	20%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX	$2,784.80	$3,481.00	$362.16–$3,132.90	204% above	20%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUM 28 DAYS OR OL	$6,134.40	$7,668.00	$1,342.23–$6,901.20	163% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK	$297.60	$372.00	$230.64–$1,342.23	82% below	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/ CLAMP OR OTHER DEVICE	$501.60	$627.00	$230.64–$1,342.23	70% below	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION	$550.40	$688.00	$165.12–$1,342.23	67% below	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/ REGI	$6,588.80	$8,236.00	$1,342.23–$7,412.40	292% above	20%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL	$974.40	$1,218.00	$671.16–$1,522.80	62% below	20%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY WITH REMOVAL OF LESION	$1,353.60	$1,692.00	$671.16–$1,522.80	47% below	20%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY WITH LESION REMOVAL	$1,353.60	$1,692.00	$671.16–$1,522.80	47% below	20%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION	$3,248.00	$4,060.00	$671.16–$3,654.00	26% above	20%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY WITH BIOPSY	$1,276.80	$1,596.00	$671.16–$1,436.40	43% below	20%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY	$1,276.80	$1,596.00	$671.16–$1,436.40	43% below	20%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY WTIH BIOPSY	$1,276.80	$1,596.00	$671.16–$1,436.40	43% below	20%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOP	$3,248.00	$4,060.00	$671.16–$3,654.00	45% above	20%
Colonoscopy, diagnostic CPT 45378 CONOLOSCOPY DIAGNOSTIC	$1,004.80	$1,256.00	$671.16–$1,130.40	54% below	20%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$1,004.80	$1,256.00	$671.16–$1,130.40	54% below	20%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCO	$3,248.00	$4,060.00	$671.16–$3,654.00	50% above	20%
Complex cataract surgery with lens implant CPT 66982 CATARACT SURGERY COM	$6,927.20	$8,659.00	$1,162.40–$7,793.10	1% below	20%
Cystoscopy with ureteral stent placement CPT 52332 CYSTOURETHROSCOPY WITH INSERTION OF IND	$469.60	$587.00	$363.94–$1,060.42	88% below	20%
Cystoscopy with ureteral stent placement CPT 52332 CYSTOURETHROSCOPY W	$8,503.20	$10,629.00	$1,060.42–$9,566.10	126% above	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 NP/PA- CYSTOURETHROSCOPY	$188.80	$236.00	$146.32–$1,060.42	85% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$236.00	$295.00	$146.32–$1,060.42	81% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$248.00	$310.00	$146.32–$1,060.42	80% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY	$2,244.00	$2,805.00	$673.20–$2,524.50	84% above	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTA	$7,578.40	$9,473.00	$1,582.86–$8,525.70	158% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALIGNANT LESION FIRST LES	$174.40	$218.00	$112.44–$233.10	at median	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMAL LESION FIRST LESION	$240.00	$300.00	$72.00–$270.00	38% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$444.00	$555.00	$80.64–$499.50	155% above	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 LAVAGE EAR	$22.40	$28.00	$17.36–$25.20	80% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVAL OF IMPACTED CERUMEN IRRIGATION	$43.20	$54.00	$33.48–$48.60	62% below	20%
Earwax removal with instruments, one ear CPT 69210 REMOVAL IMP CERUMEN	$112.00	$140.00	$86.80–$126.00	10% below	20%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED CERUMEN ONE/BOTH EARS	$165.60	$207.00	$128.34–$186.30	32% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJECTION INTERLAMINAR EPIDURAL	$350.40	$438.00	$271.56–$520.28	80% below	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJECTION OF A THERAPEUTIC OR DIAGNOSTIC	$2,736.00	$3,420.00	$520.28–$3,495.60	58% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 EPIDURAL STEROID INJ	$3,107.20	$3,884.00	$520.28–$3,495.60	79% above	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 JOINT INJ WITH IMAGE LUBAR OR SACRAL	$308.80	$386.00	$239.32–$520.28	79% below	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L	$2,736.00	$3,420.00	$520.28–$3,078.00	84% above	20%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 REPAIR OF ANTERIOR ABDOMINAL HERNIA	$1,862.40	$2,328.00	$1,443.36–$2,938.34	73% below	20%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 REPAIR OF ANTERIOR	$12,082.40	$15,103.00	$2,938.34–$13,592.70	75% above	20%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 REPAIR OF ANTERIOR A	$12,258.40	$15,323.00	$2,938.34–$13,790.70	78% above	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR VENTRAL HERN INIT REDUC	$376.00	$470.00	$291.40–$3,512.70	90% below	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR ANTERIOR ABD HERNIA < 3CM	$1,108.80	$1,386.00	$291.40–$3,512.70	71% below	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 UMBILICAL HERNIA REPAIR	$1,371.20	$1,714.00	$291.40–$3,512.70	64% below	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR VENTRAL HERNIA INIT REDUCTION	$2,471.20	$3,089.00	$291.40–$3,512.70	35% below	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 VENTRAL HERNIA REPAIR	$3,122.40	$3,903.00	$291.40–$3,512.70	18% below	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR OF ANTERIOR	$10,638.40	$13,298.00	$2,938.34–$11,968.20	179% above	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC	$186.40	$233.00	$144.46–$671.16	80% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$192.00	$240.00	$144.46–$671.16	79% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOS	$2,005.60	$2,507.00	$601.68–$2,256.30	119% above	20%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$2,204.80	$2,756.00	$273.42–$2,480.40	66% below	20%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECY	$10,924.80	$13,656.00	$2,338.34–$12,290.40	69% above	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAP CHOLE/GRAPH	$2,396.00	$2,995.00	$1,856.90–$2,695.50	63% below	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECYSTECTO	$15,390.40	$19,238.00	$2,338.34–$17,314.20	139% above	20%
Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY WITH	$16,294.40	$20,368.00	$3,692.51–$18,331.20	203% above	20%
Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE	$5,926.40	$7,408.00	$1,455.50–$6,667.20	70% above	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHO	$2,005.60	$2,507.00	$601.68–$2,256.30	119% above	20%
Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE IN/EX HEM GRO	$6,765.60	$8,457.00	$1,532.04–$7,611.30	141% above	20%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 TOTAL HIP ARTHROPLASTY	$5,392.80	$6,741.00	$4,179.42–$6,461.53	45% below	20%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 CONVERSION OF A PREVIOUS HIP SURGERY TO	$25,164.80	$31,456.00	$6,461.53–$28,310.40	156% above	20%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTERECTOMY	$14,905.60	$18,632.00	$3,963.31–$16,768.80	152% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D FURUNCLE	$194.40	$243.00	$112.44–$353.70	52% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 REMOV FOR BODY EAR	$194.40	$243.00	$112.44–$353.70	52% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABCESS	$194.40	$243.00	$112.44–$353.70	52% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS	$248.00	$310.00	$112.44–$279.00	38% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D OF ABSCESS; SIMPLE OR SINGLE	$306.40	$383.00	$112.44–$1,844.10	24% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE OR SINGLE	$312.80	$391.00	$112.44–$351.90	22% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE	$312.80	$391.00	$112.44–$351.90	22% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D SIMPLE/SINGLE	$312.80	$391.00	$112.44–$353.70	22% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D SKIN ABSC SIMPLE	$464.00	$580.00	$112.44–$2,169.90	15% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS SIMPLE	$536.80	$671.00	$112.44–$603.90	33% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS - SIMPLE	$560.00	$700.00	$112.44–$630.00	39% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 PARTIAL REMOVAL OF FOOT BONE	$1,639.20	$2,049.00	$112.44–$1,844.10	307% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D OF ABCESS; SIMPLE OR SINGLE	$1,928.80	$2,411.00	$112.44–$2,169.90	379% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 EXC TR-EXT MAL+MARG 0.5 CM/<	$3,721.60	$4,652.00	$112.44–$4,186.80	825% above	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 INGUINAL HERNIA REPAIR	$1,735.20	$2,169.00	$1,344.78–$3,465.00	55% below	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 LAP SURGICAL HERNIA REPAIR; REDUCIBLE	$2,491.20	$3,114.00	$1,344.78–$3,465.00	35% below	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 LAP REPAIR INCISIONAL HERNIA REDUCIBLE	$3,080.00	$3,850.00	$1,344.78–$3,465.00	19% below	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDU	$6,023.20	$7,529.00	$1,806.96–$6,776.10	58% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION	$144.80	$181.00	$112.22–$167.66	65% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION SINGLE TENDON OR LIGAMENT	$666.40	$833.00	$96.10–$749.70	62% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LI	$860.00	$1,075.00	$167.66–$1,048.50	108% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$932.00	$1,165.00	$167.66–$1,048.50	126% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURS	$143.20	$179.00	$42.96–$167.66	68% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$143.20	$179.00	$42.96–$167.66	68% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MAJOR JOINT INJECTION WITHOUT U/S GUID	$180.00	$225.00	$107.26–$202.50	60% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MAJOR JOINT INJECTION	$180.00	$225.00	$89.28–$202.50	60% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT WITHOUT U/S	$201.60	$252.00	$156.24–$226.80	55% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 KNEE ASPIRATION	$214.40	$268.00	$64.32–$241.20	52% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS ASP/INJ JNT/BURSA MAJOR	$930.40	$1,163.00	$167.66–$1,046.70	107% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ MAJOR JOINT	$975.20	$1,219.00	$167.66–$1,097.10	117% above	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT DEVICE	$1,140.00	$1,425.00	$112.44–$1,282.50	262% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INTERMEDIATE JOINT INJECTION	$113.60	$142.00	$70.06–$230.40	71% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$120.80	$151.00	$93.62–$180.90	69% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US INTERMEDIA	$143.20	$179.00	$42.96–$967.50	63% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INJ MED JOINT/BURSA	$160.80	$201.00	$93.62–$180.90	59% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJECT INTERMEDIATE JOINT	$204.80	$256.00	$70.06–$230.40	47% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURS	$860.00	$1,075.00	$42.96–$967.50	122% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS ASP/INJ JNT/BURSA INTERM	$900.00	$1,125.00	$167.66–$1,012.50	132% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INJ INTERMEDIATE JOINT	$975.20	$1,219.00	$167.66–$1,301.40	151% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INJ SMALL JOINT	$1,156.80	$1,446.00	$167.66–$1,301.40	198% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 INJECTION SMALL JOINT W/O U/S GUIDANCE	$108.00	$135.00	$83.70–$167.66	66% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$132.80	$166.00	$39.84–$1,395.00	58% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS	$155.20	$194.00	$120.28–$174.60	51% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURS	$796.00	$995.00	$39.84–$1,395.00	150% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 INJ SMALL JOINT	$975.20	$1,219.00	$167.66–$1,097.10	206% above	20%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 KNEE ARTHROSCOPY/SURGERY	$2,189.60	$2,737.00	$1,456.77–$2,463.30	44% below	20%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 SURGICAL KNEE ARTHRO	$9,980.00	$12,475.00	$1,456.77–$11,227.50	157% above	20%
Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHROSCOPY/SURGERY	$1,720.80	$2,151.00	$199.64–$1,935.90	58% below	20%
Knee arthroscopy with meniscus trim CPT 29881 SURGICAL KNEE ARTHROSCOPY WITH A MENISCE	$9,755.20	$12,194.00	$1,456.77–$10,974.60	137% above	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ARTHROSCOPY KNEE WITH MENISCECTOMY	$1,791.20	$2,239.00	$207.08–$2,015.10	53% below	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 SURGICAL KNEE ARTHROSCOPY WITH A MENISCE	$9,979.20	$12,474.00	$1,456.77–$11,226.60	161% above	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 ARTHROSCOPY KNEE DEBRIDEMENT/SHAVING	$1,884.00	$2,355.00	$218.24–$2,119.50	56% below	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 SURGICAL KNEE ARTHROSCOPY TO SHAVE OR DE	$9,979.20	$12,474.00	$1,456.77–$11,226.60	133% above	20%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPIC APPENDECTOMY	$2,012.80	$2,516.00	$1,559.92–$2,599.56	65% below	20%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAP APPENDECTOMY	$2,012.80	$2,516.00	$1,559.92–$2,599.56	65% below	20%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY APPENDEC	$15,412.00	$19,265.00	$2,599.56–$17,338.50	168% above	20%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY FUNDOPLASTY	$598.40	$748.00	$463.76–$4,095.00	93% below	20%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY SURGICAL ESOPHAGOGASTRIC F	$3,081.60	$3,852.00	$463.76–$4,095.00	63% below	20%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAP ESOPHAGOGASTRIC FUNDOPLASTY	$3,640.00	$4,550.00	$463.76–$4,095.00	56% below	20%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY FUNDOPLA	$27,940.00	$34,925.00	$3,423.56–$31,432.50	239% above	20%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 TLH UTERUS 250 G OR	$15,391.20	$19,239.00	$3,963.31–$17,315.10	15% above	20%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 CO-SURGEON TLH W/T/O 250 G OR LESS	$1,669.60	$2,087.00	$1,293.94–$3,963.31	85% below	20%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 TLH W/T/O 250 G OR L	$15,390.40	$19,238.00	$3,963.31–$17,314.20	36% above	20%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP INGUINAL HERNIA REPAIR	$1,427.20	$1,784.00	$1,106.08–$2,399.82	78% below	20%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAPAROSCOPIC INGUINAL HERNIA REPAIR	$1,427.20	$1,784.00	$1,106.08–$2,399.82	78% below	20%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAI	$9,270.40	$11,588.00	$2,399.82–$10,429.20	44% above	20%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP REPAIR RECURRENT INGUINAL HERNIA	$1,814.40	$2,268.00	$1,406.16–$2,399.82	72% below	20%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA REPAI	$16,295.20	$20,369.00	$2,399.82–$18,332.10	153% above	20%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAP REMOVAL OR ADNEXAL STRUCTURES	$2,121.60	$2,652.00	$1,644.24–$2,885.13	57% below	20%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVE A	$16,294.40	$20,368.00	$2,885.13–$18,331.20	231% above	20%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 AFTER CATARACT LASER	$1,831.20	$2,289.00	$387.55–$2,338.20	167% above	20%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 LASERING OF SECONDAR	$2,078.40	$2,598.00	$387.55–$2,338.20	203% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR SCLP AX TRUNK LESS THAN 2.5 CM	$497.60	$622.00	$259.99–$559.80	16% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/<	$537.60	$672.00	$161.28–$604.80	9% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 WOUND REP <2.5 CM	$646.40	$808.00	$259.99–$727.20	9% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD REP S/A/T/EXT 2.CM/<	$5,758.40	$7,198.00	$259.99–$6,478.20	875% above	20%
Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION INTERLAMINAR EPIDURAL	$324.80	$406.00	$251.72–$520.28	78% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION OF A THERA	$2,736.00	$3,420.00	$520.28–$3,078.00	89% above	20%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMB	$2,291.20	$2,864.00	$520.28–$2,577.60	57% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ EPIDURAL W IMAGIMG LUMBAR OR SACRAL	$384.00	$480.00	$297.60–$520.28	73% below	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPIDURAL	$2,736.00	$3,420.00	$520.28–$3,078.00	96% above	20%
Lumpectomy (partial mastectomy) CPT 19301 MASTECTOMY PARTIAL	$2,169.60	$2,712.00	$1,681.44–$2,440.80	44% below	20%
Lumpectomy (partial mastectomy) CPT 19301 PARTIAL MASTECTOMY	$8,828.00	$11,035.00	$2,215.48–$9,931.50	129% above	20%
Mastectomy (total removal of the breast) CPT 19303 MASTECTOMY SINGLE COMPLETE	$3,196.00	$3,995.00	$142.60–$3,595.50	35% below	20%
Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE	$12,269.60	$15,337.00	$2,215.48–$13,803.30	151% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 PA/NP EXCISED DIAMETER 0.5CM OR LESS	$186.40	$233.00	$144.46–$579.60	73% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION BENIGN LESION INCLUDING MARGIN	$219.20	$274.00	$169.88–$286.36	68% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION BENIGN TRUNK/ARM/LEG < 5CM	$393.60	$492.00	$144.46–$579.60	43% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5CM	$515.20	$644.00	$144.46–$579.60	25% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$1,956.80	$2,446.00	$286.36–$2,201.40	183% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$338.40	$423.00	$262.26–$380.70	47% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION BENIGN FACE/EARS/NOSE <0.5CM	$421.60	$527.00	$251.10–$474.30	34% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION BENIGN LESION 0.5 CM OR LESS	$2,102.40	$2,628.00	$286.36–$2,365.20	230% above	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL PLATE	$177.60	$222.00	$45.24–$199.80	37% below	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE	$207.20	$259.00	$45.24–$233.10	27% below	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE PARTIAL OR COMPLETE	$252.80	$316.00	$45.24–$284.40	10% below	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL PLATE COMPLETE	$276.80	$346.00	$45.24–$311.40	2% below	20%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION PART/COMP SIMP/SNLG	$288.00	$360.00	$45.24–$324.00	2% above	20%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$479.20	$599.00	$45.24–$539.10	70% above	20%
Occipital nerve block (injection for headaches) CPT 64405 INJECTION	$214.40	$268.00	$166.16–$271.68	57% below	20%
Occipital nerve block (injection for headaches) CPT 64405 NERVE BLOCK INJ IN SOMATIC NERVES	$220.00	$275.00	$170.50–$271.68	56% below	20%
Occipital nerve block (injection for headaches) CPT 64405 N BLOCK INJ OCCIPITA	$440.80	$551.00	$132.24–$495.90	11% below	20%
Occipital nerve block (injection for headaches) CPT 64405 NERVE BLOCK OCCIPITAL	$1,643.20	$2,054.00	$271.68–$1,848.60	231% above	20%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS ABDOMEN SUBSEQUENT	$379.20	$474.00	$113.76–$513.00	74% below	20%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS ABDOMEN	$456.00	$570.00	$113.76–$513.00	68% below	20%
Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS WITH IMAGING	$918.40	$1,148.00	$491.38–$1,063.80	36% below	20%
Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS WITH IMAGE GUIDAN	$945.60	$1,182.00	$491.38–$1,431.00	35% below	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$945.60	$1,182.00	$491.38–$1,063.80	35% below	20%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS FOR ASCITES	$1,272.00	$1,590.00	$491.38–$1,431.00	12% below	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/I	$2,008.00	$2,510.00	$491.38–$2,259.00	39% above	20%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS - ABDOM	$2,280.80	$2,851.00	$491.38–$2,565.90	58% above	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL PARTIAL OR COMPLETE PERM REMV	$326.40	$408.00	$209.56–$367.20	48% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL W/NAIL MATRIX PART/COMP PERM	$1,440.80	$1,801.00	$222.96–$1,620.90	129% above	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$1,541.60	$1,927.00	$286.36–$1,734.30	146% above	20%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE	$5,954.40	$7,443.00	$1,159.41–$6,698.70	139% above	20%
Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPARO RADICAL PROSTATECTOMY	$4,357.60	$5,447.00	$2,997.08–$4,902.30	95% below	20%
Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPARO RADICAL PROST	$35,047.20	$43,809.00	$2,997.08–$39,428.10	59% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 SINGLE DESTRUCTION BY NEUROLYTIC AGENT	$758.40	$948.00	$587.76–$871.44	67% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FAC	$5,986.40	$7,483.00	$871.44–$6,734.70	160% above	20%
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION	$7,380.80	$9,226.00	$906.02–$8,303.40	239% above	20%
Removal of a foreign object under the skin, simple CPT 10120 INCISION & REMOVAL FORIEGN BODY SIMPLE	$312.80	$391.00	$112.44–$351.90	33% below	20%
Removal of a foreign object under the skin, simple CPT 10120 INCISION AND REMOVAL OF FOREIGHN BODY	$333.60	$417.00	$112.44–$375.30	28% below	20%
Removal of a foreign object under the skin, simple CPT 10120 SUBCUTANEOUS F/B	$402.40	$503.00	$112.44–$452.70	13% below	20%
Removal of a foreign object under the skin, simple CPT 10120 INCISION AND REMOVAL FOREIGN BODY SUBCUT	$840.00	$1,050.00	$112.44–$1,033.20	81% above	20%
Removal of a foreign object under the skin, simple CPT 10120 INC & REM FB SQ;SIM	$900.00	$1,125.00	$112.44–$1,012.50	94% above	20%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY SIMPLE	$918.40	$1,148.00	$112.44–$1,033.20	98% above	20%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 PARTIAL REMOVAL OF THYROID	$381.60	$477.00	$295.74–$2,941.28	94% below	20%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 TOTAL THYROID LOBECT	$16,294.40	$20,368.00	$2,941.28–$18,331.20	153% above	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 SCREENING COLONOSCOPY	$1,004.80	$1,256.00	$671.16–$1,130.40	54% below	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLNSCPY NO HI RSK	$3,248.00	$4,060.00	$671.16–$3,654.00	49% above	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 SCREENING COLONOSCOPY HIGH RISK	$1,004.80	$1,256.00	$671.16–$1,130.40	58% below	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HIGH RISK SCREENING COLONOSCOPY	$1,004.80	$1,256.00	$671.16–$1,130.40	58% below	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY FOR INDIVIDUAL AT HIGH RISK	$3,248.00	$4,060.00	$671.16–$3,654.00	36% above	20%
Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST	$268.80	$336.00	$122.47–$302.40	13% below	20%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$148.80	$186.00	$51.55–$167.40	39% below	20%
Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM SPLING STATIC	$255.20	$319.00	$51.55–$287.10	4% above	20%
Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM SPLINT	$367.20	$459.00	$51.55–$413.10	50% above	20%
Short leg cast (below the knee) CPT 29405 APPLICATION OF SHORT LEG CAST	$188.80	$236.00	$122.47–$212.40	46% below	20%
Short leg splint (calf to foot) CPT 29515 APP LOWER LEG SPLINT	$162.40	$203.00	$51.55–$182.70	35% below	20%
Short leg splint (calf to foot) CPT 29515 APPLICATION OF SHORT LEG SPLINT	$211.20	$264.00	$51.55–$237.60	16% below	20%
Short leg splint (calf to foot) CPT 29515 APPLY LOWER LEG SPLN	$268.00	$335.00	$51.55–$301.50	7% above	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHOULDER ARTHROSCOPY/SURGERY	$2,013.60	$2,517.00	$233.12–$2,265.30	64% below	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 ARTHROSCOPIC CLAVICU	$9,979.20	$12,474.00	$1,456.77–$11,226.60	78% above	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHOULDER ARTHROSCOPY	$572.00	$715.00	$66.34–$1,456.77	92% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 LACERATION REPAIR 2.5 CM OR LESS	$143.20	$179.00	$110.98–$617.40	61% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR WOUND	$196.80	$246.00	$124.13–$221.40	46% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR SUPERFICIAL WOUND 2.5CM OR LESS	$367.20	$459.00	$110.16–$579.60	1% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5 CM/<	$515.20	$644.00	$110.16–$579.60	42% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND REPAIR <2.5 CM	$548.80	$686.00	$110.98–$617.40	51% above	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN; SINGLE LESION	$242.40	$303.00	$115.94–$286.36	37% below	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN SINGLE LESION	$385.60	$482.00	$127.72–$433.80	at median	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN	$1,036.80	$1,296.00	$286.36–$1,166.40	169% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MAL+MARG 0.5 CM/<	$380.80	$476.00	$286.36–$428.40	33% below	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MALIG TRUNK/ARM/LEG < 0.5CM	$555.20	$694.00	$286.36–$624.60	2% below	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXCISION MALIGNANT LESION 0.5 CM OR LESS	$1,956.80	$2,446.00	$286.36–$2,201.40	245% above	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS	$236.00	$295.00	$112.44–$318.60	7% below	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS < OR = 15	$240.00	$300.00	$72.00–$270.00	5% below	20%
Skin tag removal, up to 15 tags CPT 11200 SKIN TAG REMOVAL <=15	$283.20	$354.00	$112.44–$318.60	12% above	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS <W/15	$290.40	$363.00	$112.44–$326.70	15% above	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS UP TO 15	$479.20	$599.00	$112.44–$539.10	89% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC	$168.80	$211.00	$130.82–$520.28	81% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE	$196.80	$246.00	$152.52–$520.28	78% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SUBARACH BL-SP TAP	$288.00	$360.00	$152.52–$520.28	68% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL TAP/LUMBAR PU	$327.20	$409.00	$96.24–$520.28	64% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR TAP	$560.80	$701.00	$434.62–$630.90	38% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL TAP/LUMBAR P	$1,725.60	$2,157.00	$517.68–$1,941.30	92% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP DIA	$2,438.40	$3,048.00	$520.28–$2,743.20	171% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WOUND REPAIR SIMPLE	$240.00	$300.00	$124.13–$270.00	42% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK 2.6-7.5CM	$515.20	$644.00	$124.13–$579.60	25% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR WOUND 2.6-7.5 CM	$640.00	$800.00	$124.13–$720.00	55% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE WOUND REPAIR	$206.40	$258.00	$124.13–$232.20	49% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/<	$412.80	$516.00	$123.84–$464.40	3% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR INTER WOUND 7.6 - 12.5 CM	$424.80	$531.00	$124.13–$477.90	6% above	20%
TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP)	$14,137.60	$17,672.00	$2,997.08–$15,904.80	147% above	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN SINGLE LESION	$124.80	$156.00	$96.72–$286.36	58% below	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN (EG. SHAVE SC	$198.40	$248.00	$153.76–$286.36	34% below	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$687.20	$859.00	$206.16–$773.10	129% above	20%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS WITH IMAGING GUIDANCE	$805.60	$1,007.00	$624.34–$906.30	33% below	20%
Thoracentesis with imaging guidance CPT 32555 THOACENTESIS ASPIRATION WITH IMAGING	$906.40	$1,133.00	$281.48–$1,019.70	24% below	20%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$2,008.00	$2,510.00	$602.40–$3,330.90	68% above	20%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS & PERCUTANEOUS PLEURAL DRA	$2,960.80	$3,701.00	$602.40–$3,330.90	148% above	20%
Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY	$25,164.80	$31,456.00	$6,461.53–$28,310.40	174% above	20%
Total knee replacement CPT 27447 ATHROPLASTY KNEE (TKA)	$620.80	$776.00	$481.12–$6,461.53	91% below	20%
Total knee replacement CPT 27447 ARTHROPLASTY KNEE WITH OR WITHOUT TKA	$4,154.40	$5,193.00	$481.12–$6,461.53	41% below	20%
Total knee replacement CPT 27447 REPAI FEMUR/THIGH REGION AND KNEE JOINT	$35,868.00	$44,835.00	$6,461.53–$40,351.50	407% above	20%
Total shoulder replacement CPT 23472 ARTHROPLASTY TOTAL SHOULDER	$700.00	$875.00	$542.50–$6,461.53	92% below	20%
Total shoulder replacement CPT 23472 RECONSTRUCT SHOULDER JOINT	$43,899.20	$54,874.00	$6,461.53–$49,386.60	390% above	20%
Total thyroid removal (thyroidectomy) CPT 60240 TOTAL OR COMPLETE TH	$17,265.60	$21,582.00	$2,941.28–$19,423.80	168% above	20%
Trigger finger release surgery CPT 26055 TENDON SHEATH INCISION	$1,616.80	$2,021.00	$888.51–$1,818.90	6% below	20%
Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH	$5,926.40	$7,408.00	$888.51–$6,667.20	246% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$90.40	$113.00	$70.06–$167.66	82% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER POINT INJECTION	$234.40	$293.00	$167.66–$263.70	52% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/	$911.20	$1,139.00	$167.66–$1,149.30	85% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIG PT 1/2 MUSC	$945.60	$1,182.00	$167.66–$1,063.80	92% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2MUSCL	$1,021.60	$1,277.00	$167.66–$1,149.30	107% above	20%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSCOPY TUBAL CA	$16,294.40	$20,368.00	$2,885.13–$18,331.20	527% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 MAMMOTOME U/S GUIDANCE FIRST LESION	$2,071.20	$2,589.00	$906.02–$2,330.10	14% below	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG	$3,836.00	$4,795.00	$906.02–$4,757.40	59% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US MAMMOTOME BX	$4,228.80	$5,286.00	$906.02–$4,757.40	75% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAGING	$4,244.00	$5,305.00	$906.02–$4,774.50	76% above	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD DILATION <30 MM	$515.20	$644.00	$399.28–$656.83	75% below	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM	$530.40	$663.00	$399.28–$656.83	74% below	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOHP EGD DILATION <	$4,429.60	$5,537.00	$656.83–$4,983.30	117% above	20%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD WITH BIOPSY	$1,072.00	$1,340.00	$656.83–$1,206.00	51% below	20%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MU	$3,070.40	$3,838.00	$656.83–$3,454.20	41% above	20%
Upper endoscopy (EGD) with injection into the lining CPT 43236 EGD FLEXIBLE W/SUBMUCOSAL INJECTIONS	$478.40	$598.00	$370.76–$656.83	74% below	20%
Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPER GI SCOPE W/SUB	$3,035.20	$3,794.00	$656.83–$3,414.60	65% above	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE	$682.40	$853.00	$528.86–$1,558.80	72% below	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD FLEXIBLE WITH LESION REMOVAL	$1,385.60	$1,732.00	$528.86–$1,558.80	43% below	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SN	$4,370.40	$5,463.00	$656.83–$4,916.70	79% above	20%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD GUIDE WIRE INSER	$3,035.20	$3,794.00	$656.83–$3,414.60	16% above	20%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD	$806.40	$1,008.00	$624.96–$907.20	46% below	20%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH	$3,035.20	$3,794.00	$656.83–$3,923.10	102% above	20%
Upper endoscopy (EGD), diagnostic CPT 43235 GI ENDO	$3,487.20	$4,359.00	$656.83–$3,923.10	133% above	20%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHOTRIPSY	$1,187.20	$1,484.00	$920.08–$1,971.68	79% below	20%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHO	$14,137.60	$17,672.00	$1,971.68–$15,904.80	147% above	20%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHOTRIPSY	$1,800.80	$2,251.00	$1,395.62–$2,761.30	69% below	20%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/UERTERO W/LITH	$14,137.60	$17,672.00	$2,761.30–$15,904.80	147% above	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY INCLUDING POSTOP SEMEN EXAM	$675.20	$844.00	$523.28–$1,611.52	57% below	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY INCLUDING POSTOP SEMEN	$744.80	$931.00	$577.22–$1,611.52	53% below	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUC	$6,134.40	$7,668.00	$1,611.52–$6,901.20	286% above	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14	$192.00	$240.00	$112.44–$257.40	17% below	20%
Wart removal, up to 14 warts CPT 17110 PA/NP: DESTRUCT BENIGN LESIONS 1-14	$240.00	$300.00	$72.00–$270.00	3% above	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCT BENIGN LESIONS 1-14	$240.00	$300.00	$72.00–$270.00	3% above	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION OF BENIGN LESIONS	$479.20	$599.00	$112.44–$539.10	106% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SUBCUTANEOUS FIRST 20 SQ CM	$202.40	$253.00	$135.78–$259.99	70% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE <= 20 SQ CM	$208.80	$261.00	$161.82–$259.99	69% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRD SUB TS F20 MD	$215.20	$269.00	$166.78–$259.99	68% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE TISS 20 SQCM	$281.60	$352.00	$218.24–$342.00	58% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SUBCUT TISSUE FIRST 20 SQ CM	$304.00	$380.00	$218.24–$342.00	54% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$917.60	$1,147.00	$259.99–$1,032.30	38% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/TISSUE	$933.60	$1,167.00	$259.99–$1,050.30	40% above	20%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$20,700.80	$25,876.00	$3,592.63–$23,288.40	259% above	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD PROCESSING	$207.20	$259.00	$62.16–$275.01	78% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION	$548.80	$686.00	$164.64–$617.40	41% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SE	$1,422.40	$1,778.00	$275.01–$1,600.20	52% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ULTRASONIC NEB TMT	$54.40	$68.00	$16.32–$754.20	71% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INITIAL NEB TX	$170.40	$213.00	$16.32–$754.20	9% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 UC NEB TREATMENT	$620.80	$776.00	$16.32–$754.20	231% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB TREATMENT	$670.40	$838.00	$16.32–$754.20	258% above	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST 30-74 MIN	$356.80	$446.00	$276.52–$401.40	81% below	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE	$1,111.20	$1,389.00	$333.36–$1,250.10	42% below	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE MD	$2,176.80	$2,721.00	$1,687.02–$2,448.90	13% above	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG	$2,263.20	$2,829.00	$225.66–$2,546.10	171% above	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG (STAT)	$428.00	$535.00	$17.51–$481.50	356% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$336.80	$421.00	$17.51–$378.90	45% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 SUTURE OR STAPLE REM	$90.40	$113.00	$27.12–$101.70	56% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER USED BY STAFF M.D	$112.00	$140.00	$17.04–$144.90	46% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 FOLLOWUP VISIT MD	$116.00	$145.00	$89.90–$271.80	44% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 LEVEL 1 EMER ROOM	$128.80	$161.00	$17.04–$144.90	37% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER CONSULT LEVEL 1	$163.20	$204.00	$89.90–$271.80	21% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER CONSULT - LEVEL 1	$176.00	$220.00	$89.90–$271.80	15% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMPLOYEE HEALTH MD	$184.80	$231.00	$89.90–$271.80	10% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 LEVEL 1 EMER MD	$241.60	$302.00	$89.90–$271.80	17% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 LEVEL 2 EMER ROOM	$242.40	$303.00	$72.72–$272.70	38% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER CONSULT - LEVEL 2	$268.00	$335.00	$207.70–$423.90	31% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER CONSULT LEVEL 2	$281.60	$352.00	$207.70–$423.90	28% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 LEVEL 2 EMER MD	$376.80	$471.00	$207.70–$423.90	3% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 LEVEL 3 EMER ROOM	$356.00	$445.00	$106.80–$400.50	49% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER CONSULT - LEVEL 3	$535.20	$669.00	$414.78–$780.30	23% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER CONSULT LEVEL 3	$561.60	$702.00	$414.78–$780.30	19% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 LEVEL 3 EMER MD	$693.60	$867.00	$414.78–$780.30	at median	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LEVEL 4 EMER ROOM	$544.80	$681.00	$163.44–$612.90	52% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER CONSULT LEVEL 4	$891.20	$1,114.00	$657.82–$1,199.70	21% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER CONSULT - LEVEL 4	$962.40	$1,203.00	$657.82–$1,199.70	15% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LEVEL 4 EMER MD	$1,066.40	$1,333.00	$657.82–$1,199.70	5% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 LEVEL 5 RM ADD 30MIN	$706.40	$883.00	$211.92–$966.60	58% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 LEVEL 5 EMER ROOM	$859.20	$1,074.00	$211.92–$966.60	49% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER CONSULT LEVEL 5	$1,432.80	$1,791.00	$1,057.72–$1,893.60	14% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER CONSULT - LEVEL 5	$1,547.20	$1,934.00	$1,057.72–$1,893.60	8% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 LEVEL 5 EMER MD	$1,683.20	$2,104.00	$1,057.72–$1,893.60	1% above	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 AIRTEX STRESS TEST	$330.40	$413.00	$99.12–$1,277.10	65% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TEST	$1,135.20	$1,419.00	$99.12–$1,277.10	19% above	20%
Family therapy with the patient, 50 minutes CPT 90847 PSYCH FAMILY WITH PATIENT - 30 MIN	$116.00	$145.00	$34.80–$507.60	35% below	20%
Family therapy with the patient, 50 minutes CPT 90847 PSYCH FAM W/PATIENT	$451.20	$564.00	$34.80–$507.60	152% above	20%
Family therapy without the patient, 50 minutes CPT 90846 PSYC FAM W/O PATIENT	$451.20	$564.00	$114.79–$507.60	139% above	20%
Group psychotherapy session CPT 90853 PSYCH GROUP THERAPY	$513.60	$642.00	$154.08–$577.80	319% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION INITIAL	$307.20	$384.00	$80.40–$345.60	12% below	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY PROPH INITIAL	$268.00	$335.00	$36.00–$430.20	36% below	20%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION INITIAL	$382.40	$478.00	$36.00–$430.20	9% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SU	$34.40	$43.00	$26.66–$38.70	68% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 RHOGAM INJ	$44.80	$56.00	$13.44–$129.60	59% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM	$57.60	$72.00	$31.55–$64.80	47% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION SUBCUTANEOUS OR INTRAMUSCULAR	$62.40	$78.00	$18.72–$248.40	43% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/SUB	$110.40	$138.00	$13.44–$129.60	1% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION SYNAGIS	$115.20	$144.00	$13.44–$129.60	5% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 NEUPOGEN INJECTION	$119.20	$149.00	$31.55–$144.90	9% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/SQ	$125.60	$157.00	$18.72–$248.40	15% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 EPOET OR FILGRAS INJ	$128.80	$161.00	$31.55–$144.90	18% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION SUB OR IM	$220.80	$276.00	$18.72–$248.40	102% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION	$314.40	$393.00	$31.55–$383.40	188% above	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAG EVAL	$671.20	$839.00	$169.12–$755.10	165% above	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION STUDIES 7-8	$850.40	$1,063.00	$90.28–$956.70	17% above	20%
New patient office visit, about 30 minutes CPT 99203 URG NEW PT LEVEL III	$203.20	$254.00	$157.48–$293.40	5% below	20%
New patient office visit, about 30 minutes CPT 99203 WOUND VST MD N LEV3	$260.80	$326.00	$157.48–$293.40	22% above	20%
New patient office visit, about 30 minutes CPT 99203 WOUND VISIT NEW LV3	$376.00	$470.00	$112.80–$423.00	75% above	20%
New patient office visit, about 45 minutes CPT 99204 URG NEW PT LEVEL IV	$260.00	$325.00	$201.50–$497.70	12% below	20%
New patient office visit, about 45 minutes CPT 99204 EVAL/MGT NEW PT OP	$264.00	$330.00	$204.60–$297.00	10% below	20%
New patient office visit, about 45 minutes CPT 99204 WOUND VST MD N LEV4	$442.40	$553.00	$201.50–$497.70	50% above	20%
New patient office visit, about 45 minutes CPT 99204 WOUND VISIT NEW LV4	$548.80	$686.00	$164.64–$617.40	86% above	20%
New patient office visit, about 60 minutes CPT 99205 EVAL/MGT NEW PT OP	$326.40	$408.00	$252.96–$367.20	11% below	20%
New patient office visit, about 60 minutes CPT 99205 URG NEW PT LEVEL V	$346.40	$433.00	$268.46–$641.70	5% below	20%
New patient office visit, about 60 minutes CPT 99205 WOUND VISIT NEW LV5	$548.80	$686.00	$164.64–$617.40	50% above	20%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT VISIT LEVEL 5	$570.40	$713.00	$268.46–$641.70	56% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OUTPATIENT VISIT FOR CROSSWALK	$112.80	$141.00	$87.42–$126.90	28% below	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OTHER OUTPATIENT VISIT FOR CROSSWALK	$152.00	$190.00	$117.80–$184.50	3% below	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE OR OUTPATIENT VISIT	$164.00	$205.00	$117.80–$184.50	5% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 WOUND VST MD N LEVEL2	$168.80	$211.00	$130.82–$196.20	8% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 URG NEW PT LEVEL II	$174.40	$218.00	$130.82–$196.20	12% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 EVAL/MGT NEW PT OP	$186.40	$233.00	$112.22–$209.70	19% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 WOUND VISIT NEW LV2	$328.80	$411.00	$98.64–$369.90	110% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 DIETICIAN ASSESSMENT 15 MIN	$22.40	$28.00	$6.72–$113.08	59% below	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 WF PT RE-EVALUATION	$152.00	$190.00	$45.60–$311.40	51% below	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 WF- PT EVAL	$276.80	$346.00	$45.60–$311.40	10% below	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 EI THERAPY ONSITE	$14.40	$18.00	$4.32–$24.55	88% below	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 EI THERAPY OFFSITE	$19.20	$24.00	$4.32–$24.55	84% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV INIT AGE 18-39	$184.80	$231.00	$143.22–$207.90	16% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV INIT AGE 40-64	$196.80	$246.00	$152.52–$221.40	18% below	20%
Preventive checkup, new patient aged 65 or older CPT 99387 PREV INIT AGE 65+	$207.20	$259.00	$160.58–$233.10	2% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV ESTAB AGE 18-39	$173.60	$217.00	$134.54–$195.30	1% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV ESTAB AGE 40-64	$184.80	$231.00	$143.22–$207.90	7% below	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 PREV ESTAB AGE 65+	$196.80	$246.00	$152.52–$221.40	8% below	20%
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAGNOSTIC EVAL W/MEDICAL SERVICES	$671.20	$839.00	$169.12–$755.10	140% above	20%
Psychotherapy session, 30 minutes CPT 90832 PSYCH INDV 16-37 MIN	$312.80	$391.00	$88.08–$351.90	67% above	20%
Psychotherapy session, 45 minutes CPT 90834 PSYCH INDV 38-52 MIN	$468.80	$586.00	$105.25–$527.40	131% above	20%
Psychotherapy session, 60 minutes CPT 90837 PSYCH INDV 53-67 MIN	$720.00	$900.00	$105.25–$810.00	139% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 CONSULT OBC CROSSWALK -LEVEL 5	$217.60	$272.00	$168.64–$244.80	21% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT LEVEL 5 - PA/NP	$240.00	$300.00	$186.00–$378.90	13% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EVAL/MGT EST PT OP	$244.00	$305.00	$189.10–$274.50	12% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 LEVEL 5 PA OFFC VST	$252.00	$315.00	$186.00–$378.90	9% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFC VISIT LVL 5 PA	$264.80	$331.00	$186.00–$378.90	4% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PNC NP VISIT LEVEL 5	$278.40	$348.00	$186.00–$378.90	1% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT LEVEL 5 - MD	$282.40	$353.00	$186.00–$378.90	2% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 NP OFFC VISIT LEV 5	$285.60	$357.00	$186.00–$378.90	3% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 LEVEL 5 MD OFFC VST	$296.80	$371.00	$186.00–$378.90	7% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ORTHO VISIT LEVEL 5	$312.00	$390.00	$186.00–$378.90	13% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT LEV 5	$336.80	$421.00	$186.00–$378.90	22% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PNC MD VISIT LEVEL 5	$336.80	$421.00	$186.00–$378.90	22% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 SXC VISIT LEVEL 5	$336.80	$421.00	$186.00–$378.90	22% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 URG EST PT LEVEL V	$346.40	$433.00	$268.46–$416.70	25% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 WOUND VST MD E LEV5	$370.40	$463.00	$268.46–$416.70	34% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 CONSULT OBSERV LEV 5	$384.80	$481.00	$283.96–$467.10	39% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 CONSULT OBSERVATION LEVEL 5	$415.20	$519.00	$283.96–$467.10	50% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 WOUND VISIT EST LV5	$548.80	$686.00	$164.64–$617.40	98% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CLINIC ESTAB PATIENT	$90.40	$113.00	$27.12–$101.70	40% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CONSULT OBC CROSSWALK -LEVEL 3	$100.00	$125.00	$77.50–$275.40	34% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EVAL/MGT EST PT OP	$118.40	$148.00	$91.76–$133.20	22% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT LEVEL 3 - PA/NP	$124.00	$155.00	$96.10–$195.30	18% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL 3 PA OFFC VST	$130.40	$163.00	$96.10–$195.30	14% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFC VISIT LVL 3 PA	$136.80	$171.00	$96.10–$195.30	10% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PNC NP OFFICE VISIT LEVEL 3	$144.00	$180.00	$96.10–$195.30	5% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT LEVEL 3 - MD	$145.60	$182.00	$96.10–$195.30	4% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 NP OFFC VISIT LEV 3	$148.00	$185.00	$96.10–$195.30	2% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL 3 MD OFFC VST	$152.80	$191.00	$96.10–$195.30	1% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ORTHO VISIT LEVEL 3	$160.80	$201.00	$96.10–$195.30	6% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 WOUND VST MD E LEV3	$171.20	$214.00	$132.68–$228.60	13% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 SXC VISIT LEVEL 3	$173.60	$217.00	$96.10–$195.30	15% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PNC MD VISIT LEVEL 3	$173.60	$217.00	$96.10–$195.30	15% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 NURSING HOME CONSULT LEVEL 3	$173.60	$217.00	$132.68–$228.60	15% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT LEV 3	$173.60	$217.00	$96.10–$195.30	15% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT LEVEL 3	$173.60	$217.00	$96.10–$195.30	15% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 URG EST PT LEVEL III	$203.20	$254.00	$132.68–$228.60	34% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CONSULT OBSERV LEV 3	$256.80	$321.00	$199.02–$312.30	70% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CONSULT OBSERVATION LEVEL 3	$277.60	$347.00	$199.02–$312.30	84% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 RECTAL EVACUATION	$320.80	$401.00	$96.24–$360.90	112% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 WOUND VISIT EST LV3	$376.00	$470.00	$112.80–$423.00	149% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CONSULT OBC CROSSWALK -LEVEL 4	$152.00	$190.00	$117.80–$171.00	14% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EVAL/MGT EST PT OP	$162.40	$203.00	$125.86–$182.70	9% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT LEVEL 4 - PA/NP	$186.40	$233.00	$144.46–$294.30	5% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LEVEL 4 PA OFFC VST	$196.00	$245.00	$144.46–$294.30	10% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFC VISIT LVL 4 PA	$205.60	$257.00	$144.46–$294.30	16% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PNC NP OFFICE VISIT LEVEL 4	$217.60	$272.00	$144.46–$294.30	23% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT LEVEL 4 - MD	$220.00	$275.00	$144.46–$294.30	24% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT LEV 4	$220.00	$275.00	$144.46–$294.30	24% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 NP OFFC VISIT LEV 4	$222.40	$278.00	$144.46–$294.30	25% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LEVEL 4 MD OFFC VST	$231.20	$289.00	$144.46–$294.30	30% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ORTHO VISIT LEVEL 4	$242.40	$303.00	$144.46–$294.30	37% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 URG EST PT LEVEL IV	$260.00	$325.00	$201.50–$296.10	46% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PNC MD VISIT LEVEL 4	$261.60	$327.00	$144.46–$294.30	47% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 SXC VISIT LEVEL 4	$261.60	$327.00	$144.46–$294.30	47% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 WOUND VST MD E LEV4	$263.20	$329.00	$201.50–$296.10	48% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CONSULT OBSERV LEV 4	$332.80	$416.00	$245.52–$404.10	87% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CONSULT OBSERVATION LEVEL 4	$359.20	$449.00	$245.52–$404.10	102% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 WOUND VISIT EST LV4	$548.80	$686.00	$164.64–$617.40	209% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CONSULT OBC CROSSWALK -LEVEL 2	$68.00	$85.00	$52.70–$76.50	43% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT LEVEL 2 - PA/NP	$71.20	$89.00	$55.18–$112.50	41% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL 2 PA OFFC VST	$74.40	$93.00	$55.18–$112.50	38% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFC VISIT LVL 2 PA	$78.40	$98.00	$55.18–$112.50	35% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT LEV 2	$84.00	$105.00	$55.18–$112.50	30% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PNC NP OFFICE VISIT LEVEL 2	$84.00	$105.00	$55.18–$112.50	30% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT LEVEL 2 - MD	$84.00	$105.00	$55.18–$112.50	30% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 WOUND VST MD E LEV2	$84.80	$106.00	$65.72–$196.20	29% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 NP OFFC VISIT LEV 2	$84.80	$106.00	$55.18–$112.50	29% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL 2 MD OFFC VST	$88.00	$110.00	$55.18–$112.50	27% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EVAL/MGT EST PT OP	$92.80	$116.00	$71.92–$104.40	23% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ORTHO VISIT LEVEL 2	$92.80	$116.00	$55.18–$112.50	23% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PNC MD VISIT LEVEL 2	$100.00	$125.00	$55.18–$112.50	17% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 SXC VISIT LEVEL 2	$100.00	$125.00	$55.18–$112.50	17% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 URG EST PT LEVEL II	$174.40	$218.00	$65.72–$196.20	45% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CONSULT OBC CROSSWALK - LEVEL 2	$190.40	$238.00	$147.56–$243.00	59% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CONSULT OBSERV LEV 2	$200.00	$250.00	$147.56–$243.00	67% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CONSULT OBSERVATION LEVEL 2	$216.00	$270.00	$147.56–$243.00	80% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 WOUND VISIT EST LV2	$328.80	$411.00	$98.64–$369.90	174% above	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OUTPATIENT CONSULT - LEVEL 3	$202.40	$253.00	$156.86–$227.70	13% below	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 EVAL/MGT CONSULT OP	$257.60	$322.00	$199.64–$289.80	11% above	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OUTPATIENT CONSULT LEVEL 3	$277.60	$347.00	$189.72–$312.30	20% above	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OUTPT CONSULT LEV 3	$277.60	$347.00	$215.14–$312.30	20% above	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OUTPATIENT CONSULT - LEVEL 4	$292.80	$366.00	$226.92–$329.40	4% below	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 EVAL/MGT CONSULT OP	$348.00	$435.00	$269.70–$391.50	14% above	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OUTPT CONSULT LEV 4	$359.20	$449.00	$278.38–$404.10	17% above	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OUTPATIENT CONSULT LEVEL 4	$359.20	$449.00	$245.52–$404.10	17% above	20%
Speech and language evaluation CPT 92523 SPEECH RE-EVALUATION	$191.20	$239.00	$57.36–$215.10	51% below	20%
Spirometry (breathing test) CPT 94010 FVC/VC	$336.80	$421.00	$39.22–$497.70	10% above	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY SIMPLE	$442.40	$553.00	$39.22–$497.70	45% above	20%
Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY-PRE/POST BRONCHO	$776.80	$971.00	$70.28–$873.90	48% above	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPY PHLEBOTOMY	$242.40	$303.00	$51.16–$272.70	17% above	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 CARDIAC STRESS FMH	$989.60	$1,237.00	$112.88–$1,113.30	129% above	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 MODERNA COVID VACCINE DOSE 2	$173.60	$217.00	$14.48–$195.30	15% below	20%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 MODERNA COVID VACCINE DOSE 1	$173.60	$217.00	$14.48–$195.30	15% below	20%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 MODERNA COVID VACCINE DOSE 1	$173.60	$217.00	$14.48–$195.30	—	20%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 MODERNA COVID VACCINE DOSE 2	$173.60	$217.00	$14.48–$195.30	—	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 PFIZER VACCINE DOSE 3	$152.00	$190.00	$14.48–$195.30	38% below	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 PFIZER VACC BOOSTER	$152.00	$190.00	$14.48–$195.30	38% below	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 PFIZER COVID VACCINE SECOND DOSE	$173.60	$217.00	$14.48–$195.30	29% below	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 PFIZER COVID VACCINE FIRST DOSE	$173.60	$217.00	$14.48–$195.30	29% below	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 PFIZER VACC BOOSTER	$152.00	$190.00	$14.48–$195.30	—	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 PFIZER VACCINE DOSE 3	$152.00	$190.00	$14.48–$195.30	—	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 PFIZER COVID VACCINE SECOND DOSE	$173.60	$217.00	$14.48–$195.30	—	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 PFIZER COVID VACCINE FIRST DOSE	$173.60	$217.00	$14.48–$195.30	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE	$207.68	$259.60	$14.48–$233.64	92% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE	$207.68	$259.60	$14.48–$233.64	—	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUAD ADJUVANT	$210.92	$263.65	$14.48–$237.29	174% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUAD ADJUVANT	$210.92	$263.65	$14.48–$237.29	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 0.5ML	$790.48	$988.10	$76.64–$889.29	78% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 0.5ML	$790.48	$988.10	$76.64–$889.29	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMCOCCAL 23-VALENT	$34.40	$43.00	$10.32–$38.70	81% below	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMCOCCAL 23-VALENT	$34.40	$43.00	$10.32–$38.70	—	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 ABRYSVO 120MCG INJ	$883.60	$1,104.50	$265.08–$994.05	92% above	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 ABRYSVO 120MCG INJ	$883.60	$1,104.50	$265.08–$994.05	—	20%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$1,251.68	$1,564.60	$76.64–$1,408.14	66% above	20%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM	$1,251.68	$1,564.60	$76.64–$1,408.14	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHT (TD)	$96.68	$120.85	$14.48–$136.04	26% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TET-DIPH (TD) 2-2 LF	$120.92	$151.15	$14.48–$136.04	57% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHT (TD)	$96.68	$120.85	$14.48–$136.04	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TET-DIPH (TD) 2-2 LF	$120.92	$151.15	$14.48–$136.04	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET-PERT-DIPH (TDAP)	$140.60	$175.75	$14.48–$158.18	40% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET-PERT-DIPH (TDAP)	$140.60	$175.75	$14.48–$158.18	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN 1 VACCINE	$29.60	$37.00	$22.94–$33.30	49% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMINISTRATI	$126.40	$158.00	$26.46–$142.20	120% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN; 1 VACCINE	$126.40	$158.00	$26.46–$142.20	120% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMINISTRATION	$126.40	$158.00	$26.46–$142.20	120% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE ADMINISTRATION EACH ADDT'L	$126.40	$158.00	$26.46–$142.20	222% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE ADMIN ADDTL	$126.40	$158.00	$26.46–$142.20	222% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN; EACH ADDT'L VACCINE	$126.40	$158.00	$26.46–$142.20	222% above	20%

Source file: https://www.fairfieldmemorial.org/getmedia/3148410c-77f7-4131-9705-df34dd772692/370661202_fairfield-memorial-hospital_standardcharges.csv