Advocate Illinois Masonic Medical Center
836 West Wellington Avenue, Chicago, IL 60657 · Acute care hospital · Emergency room
These are Advocate Illinois Masonic Medical Center's own posted figures from its standard-charges file dated November 4, 2025. They are not a quote. Source: the hospital's file · its price transparency page.
231 of the services we track have a posted price here; 159 of them have a discounted cash price. Tap a service to compare it with nearby hospitals. How to read these numbers.
Emergency room
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Critical care, first 30 to 74 minutes CPT 99291 | $2,230.00 | $4,460.00 | $1,273.61 – $11,010.00 |
| Emergency room visit, level 1 (minor) CPT 99281 | $195.00 | $390.00 | $133.09 – $796.00 |
| Emergency room visit, level 2 CPT 99282 | $395.00 | $790.00 | $239.36 – $1,214.00 |
| Emergency room visit, level 3 (moderate) CPT 99283 | $785.00 | $1,570.00 | $418.52 – $2,071.00 |
| Emergency room visit, level 4 CPT 99284 | $1,330.00 | $2,660.00 | $643.63 – $3,426.00 |
| Emergency room visit, level 5 (most severe) CPT 99285 | $1,950.00 | $3,900.00 | $926.71 – $4,020.00 |
| Simple wound repair (stitches), 2.5 cm or less CPT 12001 | $410.00 | $820.00 | $300.34 – $692.08 |
Office visits
Imaging
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| 3D screening mammogram (tomosynthesis), add-on CPT 77063 | $152.50 | $305.00 | $34.55 – $524.00 |
| Abdominal X-ray, 1 view CPT 74018 | $197.50 | $395.00 | $98.18 – $634.00 |
| Ankle X-ray, 3 or more views CPT 73610 | $295.00 | $590.00 | $101.97 – $634.00 |
| Bone density scan (DEXA), hips and spine CPT 77080 | $395.00 | $790.00 | $133.89 – $667.14 |
| Breast ultrasound, one breast, complete CPT 76641 | $645.00 | $1,290.00 | $160.73 – $1,050.06 |
| Breast ultrasound, one breast, limited CPT 76642 | $515.00 | $1,030.00 | $133.09 – $838.42 |
| Chest X-ray, 1 view CPT 71045 | $222.50 | $445.00 | $78.83 – $634.00 |
| Chest X-ray, 2 views CPT 71046 | $267.50 | $535.00 | $105.62 – $634.00 |
| CT angiogram of the chest (checks for lung clots) CPT 71275 | $1,720.00 | $3,440.00 | $269.08 – $2,800.16 |
| CT angiogram of the head CPT 70496 | $1,720.00 | $3,440.00 | $269.08 – $2,800.16 |
| CT scan of the abdomen and pelvis, with contrast CPT 74177 | $1,915.00 | $3,830.00 | $539.81 – $3,117.62 |
| CT scan of the abdomen and pelvis, without and with contrast CPT 74178 | $2,765.00 | $5,530.00 | $539.81 – $4,501.42 |
| CT scan of the abdomen and pelvis, without contrast CPT 74176 | $1,705.00 | $3,410.00 | $365.36 – $2,775.74 |
| CT scan of the abdomen, without contrast CPT 74150 | $855.00 | $1,710.00 | $160.73 – $1,391.94 |
| CT scan of the chest, with contrast CPT 71260 | $955.00 | $1,910.00 | $269.08 – $1,554.74 |
| CT scan of the chest, without contrast CPT 71250 | $855.00 | $1,710.00 | $160.73 – $1,391.94 |
| CT scan of the head, without contrast CPT 70450 | $855.00 | $1,710.00 | $160.73 – $1,391.94 |
| CT scan of the neck (cervical spine), without contrast CPT 72125 | $855.00 | $1,710.00 | $160.73 – $1,391.94 |
| CT scan of the pelvis, with contrast CPT 72193 | $955.00 | $1,910.00 | $269.08 – $1,554.74 |
| CT scan of the sinuses or face, without contrast CPT 70486 | $855.00 | $1,710.00 | $160.73 – $1,391.94 |
| Diagnostic mammogram, both breasts CPT 77066 | $282.50 | $565.00 | $161.67 – $524.00 |
| Diagnostic mammogram, one breast CPT 77065 | $282.50 | $565.00 | $127.12 – $524.00 |
| Foot X-ray, 3 or more views CPT 73630 | $300.00 | $600.00 | $100.21 – $634.00 |
| Hand X-ray, 3 or more views CPT 73130 | $305.00 | $610.00 | $100.21 – $634.00 |
| Knee X-ray, 3 views CPT 73562 | $300.00 | $600.00 | $114.69 – $634.00 |
| Leg or arm vein ultrasound, both sides CPT 93970 | $845.00 | $1,690.00 | $365.36 – $1,580.32 |
| Leg or arm vein ultrasound, one side CPT 93971 | $565.00 | $1,130.00 | $160.73 – $1,045.66 |
| Lower back X-ray, 2 or 3 views CPT 72100 | $335.00 | $670.00 | $130.42 – $634.00 |
| MRI of both breasts, without and with contrast CPT 77049 | $2,920.00 | $5,840.00 | $1,096.00 – $4,753.76 |
| MRI of the abdomen, without and with contrast CPT 74183 | $2,125.00 | $4,250.00 | $539.81 – $3,459.50 |
| MRI of the brain, without and with contrast CPT 70553 | $2,125.00 | $4,250.00 | $539.81 – $3,459.50 |
| MRI of the brain, without contrast CPT 70551 | $1,350.00 | $2,700.00 | $365.36 – $2,197.80 |
| MRI of the knee or other leg joint, without contrast CPT 73721 | $1,690.00 | $3,380.00 | $365.36 – $2,751.32 |
| MRI of the lower back (lumbar spine), without contrast CPT 72148 | $2,125.00 | $4,250.00 | $365.36 – $3,459.50 |
| MRI of the mid back (thoracic spine), without contrast CPT 72146 | $2,125.00 | $4,250.00 | $365.36 – $3,459.50 |
| MRI of the neck (cervical spine), without contrast CPT 72141 | $1,350.00 | $2,700.00 | $365.36 – $2,197.80 |
| MRI of the pelvis, without and with contrast CPT 72197 | $2,125.00 | $4,250.00 | $539.81 – $3,459.50 |
| MRI of the shoulder or other arm joint, without contrast CPT 73221 | $1,690.00 | $3,380.00 | $365.36 – $2,751.32 |
| Neck X-ray, 2 or 3 views CPT 72040 | $190.00 | $380.00 | $119.90 – $634.00 |
| Pelvic ultrasound, complete (not pregnancy) CPT 76856 | $575.00 | $1,150.00 | $160.73 – $936.10 |
| Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805 | $515.00 | $1,030.00 | $160.73 – $979.42 |
| Pregnancy ultrasound, under 14 weeks, single baby CPT 76801 | $447.50 | $895.00 | $160.73 – $884.79 |
| Screening mammogram, both breasts CPT 77067 | $237.50 | $475.00 | $133.37 – $524.00 |
| Shoulder X-ray, 2 or more views CPT 73030 | $290.00 | $580.00 | $107.66 – $634.00 |
| Transvaginal pregnancy ultrasound CPT 76817 | $380.00 | $760.00 | $160.73 – $695.52 |
| Transvaginal ultrasound CPT 76830 | $570.00 | $1,140.00 | $160.73 – $927.96 |
| Ultrasound of the abdomen, complete CPT 76700 | $740.00 | $1,480.00 | $160.73 – $1,204.72 |
| Ultrasound of the neck or thyroid CPT 76536 | $570.00 | $1,140.00 | $160.73 – $927.96 |
| Wrist X-ray, 3 or more views CPT 73110 | $305.00 | $610.00 | $105.47 – $634.00 |
| X-ray of the lower back, 4 or more views CPT 72110 | $505.00 | $1,010.00 | $160.73 – $822.14 |
Lab tests
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 | $57.50 | $115.00 | $8.46 – $164.04 |
| Blood culture CPT 87040 | $80.00 | $160.00 | $10.32 – $130.24 |
| Blood draw (venipuncture) CPT 36415 | $22.50 | $45.00 | $3.00 – $37.98 |
| BNP test (heart failure) CPT 83880 | $155.00 | $310.00 | $39.26 – $305.26 |
| C-reactive protein (CRP) test CPT 86140 | $37.50 | $75.00 | $5.18 – $61.05 |
| Chlamydia test (DNA/NAAT) CPT 87491 | $180.00 | $360.00 | $35.09 – $293.04 |
| Complete blood count (CBC) with differential CPT 85025 | $42.50 | $85.00 | $7.77 – $83.94 |
| Complete blood count (CBC), automated CPT 85027 | $37.50 | $75.00 | $6.47 – $61.05 |
| Comprehensive metabolic panel (blood test) CPT 80053 | $107.50 | $215.00 | $10.56 – $213.96 |
| COVID-19 PCR test CPT 87635 | $87.50 | $175.00 | $51.31 – $233.63 |
| D-dimer test (blood clots) CPT 85379 | $85.00 | $170.00 | $10.18 – $167.88 |
| Drug screen, instrument chemistry CPT 80307 | $380.00 | $760.00 | $62.14 – $641.44 |
| Ferritin (iron stores) test CPT 82728 | $80.00 | $160.00 | $13.63 – $130.24 |
| Free T4 (thyroid) test CPT 84439 | $65.00 | $130.00 | $9.02 – $105.82 |
| General health panel (blood tests) CPT 80050 | $280.00 | $560.00 | $47.28 – $455.84 |
| Glucose (blood sugar) test CPT 82947 | $40.00 | $80.00 | $3.93 – $65.12 |
| Gonorrhea test (DNA/NAAT) CPT 87591 | $180.00 | $360.00 | $35.09 – $293.04 |
| Hemoglobin A1c test CPT 83036 | $70.00 | $140.00 | $9.71 – $113.96 |
| Hepatitis C antibody test CPT 86803 | $90.00 | $180.00 | $14.27 – $146.52 |
| HIV-1/HIV-2 antigen and antibody test CPT 87389 | $112.50 | $225.00 | $24.08 – $189.90 |
| Iron test CPT 83540 | $67.50 | $135.00 | $6.47 – $109.89 |
| Kidney function panel CPT 80069 | $82.50 | $165.00 | $8.68 – $134.31 |
| Lipase test (pancreas) CPT 83690 | $67.50 | $135.00 | $6.89 – $109.89 |
| Lipid panel, cholesterol and triglycerides CPT 80061 | $82.50 | $165.00 | $13.39 – $134.31 |
| Liver function panel CPT 80076 | $80.00 | $160.00 | $8.17 – $156.91 |
| Magnesium test CPT 83735 | $50.00 | $100.00 | $6.70 – $81.40 |
| Obstetric blood test panel CPT 80055 | $187.50 | $375.00 | $47.81 – $373.78 |
| Partial thromboplastin time (PTT), clotting test CPT 85730 | $47.50 | $95.00 | $6.01 – $77.33 |
| Pregnancy blood test (hCG), quantitative CPT 84702 | $105.00 | $210.00 | $15.05 – $170.94 |
| Prothrombin time (PT/INR), clotting test CPT 85610 | $37.50 | $75.00 | $4.29 – $61.05 |
| PSA (prostate specific antigen), free CPT 84154 | $92.50 | $185.00 | $18.39 – $150.59 |
| PSA (prostate specific antigen), total CPT 84153 | $107.50 | $215.00 | $18.39 – $175.01 |
| Rapid strep test CPT 87880 | $47.50 | $95.00 | $16.53 – $77.33 |
| Sed rate (ESR) test CPT 85652 | $25.00 | $50.00 | $2.70 – $40.70 |
| TB skin test CPT 86580 | $25.00 | $50.00 | $19.70 – $49.02 |
| Thyroid stimulating hormone (TSH) CPT 84443 | $110.00 | $220.00 | $16.80 – $179.08 |
| Tissue exam by a pathologist (biopsy specimen) CPT 88305 | $237.50 | $475.00 | $49.47 – $449.49 |
| Troponin test (heart damage) CPT 84484 | $92.50 | $185.00 | $12.47 – $150.59 |
| Urinalysis, automated, with microscope CPT 81001 | $35.00 | $70.00 | $3.17 – $56.98 |
| Urinalysis, automated, without microscope CPT 81003 | $32.50 | $65.00 | $2.25 – $52.91 |
| Urinalysis, manual, with microscope CPT 81000 | not posted | $4.02 – $18.93 | |
| Urinalysis, manual, without microscope CPT 81002 | $25.00 | $50.00 | $3.48 – $40.70 |
| Urine culture, colony count CPT 87086 | $57.50 | $115.00 | $8.07 – $93.61 |
| Urine pregnancy test CPT 81025 | $57.50 | $115.00 | $8.61 – $93.61 |
| Vitamin B12 test CPT 82607 | $92.50 | $185.00 | $15.08 – $150.59 |
| Vitamin D test CPT 82306 | $222.50 | $445.00 | $29.60 – $442.63 |
Heart
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Carotid artery ultrasound, both sides CPT 93880 | $905.00 | $1,810.00 | $365.36 – $1,537.73 |
| ECG tracing only (no interpretation) CPT 93005 | $262.50 | $525.00 | $78.98 – $427.35 |
| Echocardiogram (heart ultrasound), complete with Doppler CPT 93306 | $1,165.00 | $2,330.00 | $813.17 – $1,977.77 |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 | not posted | $137.20 – $156.14 | |
| Holter monitor, up to 48 hours CPT 93224 | not posted | $810.70 – $922.64 | |
| Left heart catheterization CPT 93452 | $6,715.00 | $13,430.00 | $4,861.63 – $18,102.00 |
| Left heart catheterization with coronary angiogram CPT 93458 | $8,105.00 | $16,210.00 | $4,861.63 – $18,102.00 |
| Nuclear stress test (heart perfusion imaging) CPT 78452 | $2,995.00 | $5,990.00 | $1,973.24 – $4,875.86 |
| Treadmill stress test, complete CPT 93015 | not posted | $648.56 – $738.11 |
Surgery
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| ACL reconstruction, arthroscopic CPT 29888 | not posted | $10,797.81 – $25,111.00 | |
| Appendix removal, laparoscopic CPT 44970 | not posted | $8,818.69 – $25,111.00 | |
| Breast biopsy with ultrasound guidance CPT 19083 | $1,760.00 | $3,520.00 | $1,386.88 – $6,181.00 |
| Carpal tunnel release CPT 64721 | not posted | $2,951.63 – $12,362.00 | |
| Colonoscopy with biopsy CPT 45380 | not posted | $1,782.19 – $6,181.00 | |
| Colonoscopy with polyp removal (snare) CPT 45385 | not posted | $1,782.19 – $6,181.00 | |
| Colonoscopy, diagnostic CPT 45378 | not posted | $1,378.06 – $6,181.00 | |
| Colposcopy with biopsy CPT 57454 | $462.50 | $925.00 | $84.00 – $780.70 |
| Cystoscopy (bladder scope) CPT 52000 | $1,080.00 | $2,160.00 | $84.00 – $1,823.04 |
| Ear tubes, under general anesthesia CPT 69436 | not posted | $2,238.97 – $6,181.00 | |
| Flexible sigmoidoscopy, diagnostic CPT 45330 | not posted | $1,378.06 – $6,071.00 | |
| Gallbladder removal, laparoscopic CPT 47562 | not posted | $8,818.69 – $25,111.00 | |
| Gastric bypass (weight loss surgery), laparoscopic CPT 43644 | not posted | $12,700.00 – $25,111.00 | |
| Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571 | not posted | $12,700.00 – $25,111.00 | |
| Hysteroscopy with biopsy or polyp removal CPT 58558 | not posted | $4,805.89 – $12,362.00 | |
| Inguinal (groin) hernia repair, laparoscopic CPT 49650 | not posted | $8,818.69 – $25,111.00 | |
| Inguinal (groin) hernia repair, open, age 5 or older CPT 49505 | not posted | $5,334.21 – $17,439.00 | |
| Kidney stone shock-wave lithotripsy CPT 50590 | not posted | $5,213.15 – $25,111.00 | |
| Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881 | not posted | $4,904.26 – $17,439.00 | |
| Lower colon endoscopy with ultrasound CPT 45391 | not posted | $1,782.19 – $6,181.00 | |
| Nasal endoscopy, diagnostic CPT 31231 | $215.00 | $430.00 | $169.42 – $388.56 |
| Prostate biopsy CPT 55700 | not posted | $3,096.34 – $6,181.00 | |
| Prostate removal, laparoscopic or robotic CPT 55866 | not posted | $15,736.65 – $47,462.00 | |
| Removal of a breast lump, open surgery CPT 19120 | not posted | $5,787.99 – $12,362.00 | |
| Rotator cuff repair, arthroscopic CPT 29827 | not posted | $10,797.81 – $25,111.00 | |
| Screening colonoscopy, average risk HCPCS G0121 | not posted | $1,378.06 – $6,071.00 | |
| Screening colonoscopy, high risk HCPCS G0105 | not posted | $1,378.06 – $6,071.00 | |
| Septoplasty (nasal septum repair) CPT 30520 | not posted | $4,901.93 – $12,362.00 | |
| Shoulder arthroscopy, bone shaving (decompression) CPT 29826 | not posted | $3,181.00 – $6,291.00 | |
| Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775 | not posted | $12,700.00 – $25,111.00 | |
| Tonsil and adenoid removal, under age 12 CPT 42820 | not posted | $6,296.00 – $12,362.00 | |
| Total hip replacement CPT 27130 | not posted | $19,448.31 – $47,462.00 | |
| Total knee replacement CPT 27447 | not posted | $19,448.31 – $47,462.00 | |
| Upper endoscopy (EGD) with biopsy CPT 43239 | not posted | $1,417.13 – $6,181.00 | |
| Upper endoscopy (EGD), diagnostic CPT 43235 | not posted | $1,417.13 – $6,181.00 | |
| Vasectomy CPT 55250 | $3,810.00 | $7,620.00 | $84.00 – $6,431.28 |
Pregnancy and birth
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Fetal non-stress test CPT 59025 | $450.00 | $900.00 | $304.07 – $759.60 |
| IUD insertion CPT 58300 | $212.50 | $425.00 | $167.45 – $6,291.00 |
Hospital stays
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Alcohol or drug use disorder, without rehab, without major complications MS-DRG 897 | not posted | $9,688.32 – $18,875.55 | |
| C-section, without complications MS-DRG 788 | not posted | $6,815.00 – $19,356.96 | |
| Chest pain MS-DRG 313 | not posted | $7,834.56 – $15,509.07 | |
| COPD flare-up, with major complications MS-DRG 190 | not posted | $12,332.79 – $24,027.71 | |
| COPD flare-up, without complications MS-DRG 192 | not posted | $7,107.55 – $14,375.35 | |
| Fainting (syncope) MS-DRG 312 | not posted | $9,568.62 – $18,642.33 | |
| Gastrointestinal bleeding, with complications MS-DRG 378 | not posted | $10,827.15 – $21,094.32 | |
| Heart failure, with major complications MS-DRG 291 | not posted | $14,329.31 – $27,917.50 | |
| Heart failure, without complications MS-DRG 293 | not posted | $6,025.82 – $12,688.49 | |
| Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216 | not posted | $105,988.38 – $206,494.94 | |
| Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 | not posted | $20,706.56 – $40,342.16 | |
| Irregular heartbeat, without complications MS-DRG 310 | not posted | $6,144.43 – $12,873.47 | |
| Kidney failure, with complications MS-DRG 683 | not posted | $9,761.90 – $19,018.90 | |
| Kidney or urinary tract infection, without major complications MS-DRG 690 | not posted | $8,814.15 – $17,172.43 | |
| Neck (cervical) spinal fusion, without complications MS-DRG 473 | not posted | $25,998.79 – $50,652.89 | |
| Normal newborn care MS-DRG 795 | not posted | $2,194.20 – $6,713.45 | |
| Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641 | not posted | $8,581.33 – $16,718.83 | |
| Pneumonia, with complications MS-DRG 194 | not posted | $9,005.24 – $17,544.72 | |
| Pneumonia, with major complications MS-DRG 193 | not posted | $14,470.98 – $28,193.51 | |
| Pneumonia, without complications MS-DRG 195 | not posted | $6,838.49 – $13,955.77 | |
| Psychoses (inpatient psychiatric stay) MS-DRG 885 | not posted | $15,480.23 – $30,159.80 | |
| Sepsis, with major complications MS-DRG 871 | not posted | $21,547.78 – $41,981.09 | |
| Sepsis, without major complications MS-DRG 872 | not posted | $11,322.44 – $22,059.28 | |
| Skin infection (cellulitis), without major complications MS-DRG 603 | not posted | $9,672.95 – $18,845.60 | |
| Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392 | not posted | $8,569.25 – $16,695.30 | |
| Stroke, with complications or clot-busting drug MS-DRG 65 | not posted | $11,167.60 – $21,757.59 | |
| Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743 | not posted | $13,164.12 – $25,647.39 | |
| Vaginal delivery, without complications MS-DRG 807 | not posted | $6,815.00 – $14,205.83 | |
| Weight loss surgery, without complications MS-DRG 621 | not posted | $13,685.00 – $31,276.67 |
Pain and spine
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Large joint injection or drainage (knee, shoulder, hip) CPT 20610 | $452.50 | $905.00 | $356.57 – $6,291.00 |
| Lower back nerve root injection with imaging guidance CPT 64483 | $1,510.00 | $3,020.00 | $84.00 – $2,548.88 |
| Lower back spinal injection (epidural), with imaging guidance CPT 62323 | $1,145.00 | $2,290.00 | $84.00 – $1,932.76 |
| Lower back spinal injection (epidural), without imaging CPT 62322 | $895.00 | $1,790.00 | $84.00 – $1,781.87 |
Eye
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Cataract removal with lens implant CPT 66984 | not posted | $3,447.34 – $12,362.00 | |
| Eye exam, new patient, comprehensive CPT 92004 | not posted | $194.79 – $823.28 | |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 | not posted | $829.21 – $6,071.00 |
Eye and ear
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Hearing test, comprehensive CPT 92557 | $255.00 | $510.00 | $200.94 – $617.00 |
Sleep
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Home sleep apnea test CPT 95806 | $495.00 | $990.00 | $236.49 – $828.00 |
| Sleep study with CPAP titration CPT 95811 | $3,235.00 | $6,470.00 | $1,283.00 – $5,266.58 |
| Sleep study, overnight in a sleep lab CPT 95810 | $3,235.00 | $6,470.00 | $1,283.00 – $5,266.58 |
Lungs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Spirometry (breathing test) CPT 94010 | $307.50 | $615.00 | $228.67 – $1,287.00 |
Therapy
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Manual therapy, 15 minutes CPT 97140 | $85.00 | $170.00 | $40.45 – $469.00 |
| Physical therapy evaluation, low complexity CPT 97161 | $207.50 | $415.00 | $146.09 – $469.00 |
| Physical therapy evaluation, moderate complexity CPT 97162 | $210.00 | $420.00 | $146.09 – $469.00 |
| Physical therapy, therapeutic exercise, 15 minutes CPT 97110 | $85.00 | $170.00 | $42.83 – $469.00 |
| Therapeutic activities, 15 minutes CPT 97530 | $85.00 | $170.00 | $51.48 – $469.00 |
Mental health
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Family psychotherapy, with the patient, 50 minutes CPT 90847 | $297.50 | $595.00 | $207.66 – $723.91 |
| Family psychotherapy, without the patient, 50 minutes CPT 90846 | $310.00 | $620.00 | $216.38 – $558.31 |
| Group psychotherapy CPT 90853 | $157.50 | $315.00 | $109.94 – $457.88 |
| Psychiatric diagnostic evaluation CPT 90791 | $267.50 | $535.00 | $210.79 – $1,556.00 |
| Psychotherapy, 30 minutes CPT 90832 | $135.00 | $270.00 | $94.23 – $411.65 |
| Psychotherapy, 45 minutes CPT 90834 | $180.00 | $360.00 | $125.64 – $596.16 |
| Psychotherapy, 60 minutes CPT 90837 | $225.00 | $450.00 | $157.05 – $875.33 |
Infusions and injections
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Injection under the skin or into a muscle CPT 96372 | $127.50 | $255.00 | $100.47 – $1,270.00 |
| IV hydration, each additional hour CPT 96361 | $125.00 | $250.00 | $69.74 – $1,270.00 |
| IV hydration, first hour CPT 96360 | $375.00 | $750.00 | $295.50 – $1,270.00 |
| IV push injection of a drug, first CPT 96374 | $202.50 | $405.00 | $159.57 – $1,270.00 |
| IV push injection, each additional drug CPT 96375 | $152.50 | $305.00 | $69.74 – $1,270.00 |
Drugs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696 | $7.86 | $15.72 | ? – $13.27 |
| Dexamethasone injection, per 1 mg HCPCS J1100 | $15.43 | $30.86 | ? – $26.05 |
| Fentanyl injection, per 0.1 mg HCPCS J3010 | $60.58 | $121.16 | $1.39 – $102.26 |
| Hydromorphone (Dilaudid) injection, up to 4 mg HCPCS J1170 | not posted | $4.46 – $9.13 | |
| Ketorolac (Toradol) injection, per 15 mg HCPCS J1885 | $59.67 | $119.34 | ? – $100.72 |
| Midazolam (Versed) injection, per 1 mg HCPCS J2250 | $45.24 | $90.47 | ? – $76.36 |
| Morphine injection, up to 10 mg HCPCS J2270 | $72.78 | $145.56 | $5.35 – $122.85 |
| Ondansetron (Zofran) injection, per 1 mg HCPCS J2405 | $15.16 | $30.32 | ? – $25.59 |
| Propofol injection, per 10 mg HCPCS J2704 | $7.93 | $15.86 | ? – $13.39 |
| Saline IV solution, 1000 ml HCPCS J7030 | $86.51 | $173.01 | $4.44 – $146.02 |
Cash price: the hospital's posted discounted price for people paying themselves. Gross charge: its list price before any discount. Insurer rates: the lowest and highest rates it says it negotiated with any insurer. When the file lists a service on several rows, this page shows one (the facility row for the usual setting); the service's own page lists every row.