Loyola Gottlieb Memorial Hospital
701 West North Ave, Melrose Park, IL 60160 · Acute care hospital · Emergency room
These are Loyola Gottlieb Memorial Hospital's own posted figures from its standard-charges file dated March 31, 2026. 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; 169 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 | $804.27 | $4,233.00 | $1,024.39 – $3,090.09 |
| Emergency room visit, level 1 (minor) CPT 99281 | $104.50 | $550.00 | $85.36 – $682.00 |
| Emergency room visit, level 2 CPT 99282 | $158.46 | $834.00 | $153.52 – $834.00 |
| Emergency room visit, level 3 (moderate) CPT 99283 | $342.00 | $1,800.00 | $435.60 – $1,314.00 |
| Emergency room visit, level 4 CPT 99284 | $646.00 | $3,400.00 | $822.80 – $2,482.00 |
| Emergency room visit, level 5 (most severe) CPT 99285 | $722.00 | $3,800.00 | $919.60 – $2,774.00 |
| Simple wound repair (stitches), 2.5 cm or less CPT 12001 | $95.57 | $503.00 | $166.52 – $2,252.00 |
Office visits
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| New patient office visit, about 15 to 29 minutes CPT 99202 | $24.13 | $127.00 | |
| New patient office visit, about 30 minutes CPT 99203 | $25.08 | $132.00 | |
| New patient office visit, about 45 minutes CPT 99204 | $31.54 | $166.00 | |
| New patient office visit, about 60 minutes CPT 99205 | $46.74 | $246.00 | |
| Office consultation, about 60 minutes CPT 99244 | $100.13 | $527.00 | $158.63 – $441.63 |
| Office visit, established patient, about 10 to 19 minutes CPT 99212 | $25.27 | $133.00 | $40.03 – $97.09 |
| Office visit, established patient, about 20 to 29 minutes CPT 99213 | $25.08 | $132.00 | |
| Office visit, established patient, about 30 to 39 minutes CPT 99214 | $34.77 | $183.00 | $55.08 – $133.59 |
| Office visit, established patient, about 40 to 54 minutes CPT 99215 | $57.00 | $300.00 | $127.80 – $219.00 |
| Office visit, established patient, brief (often a nurse) CPT 99211 | $23.75 | $125.00 | $53.25 – $91.25 |
Imaging
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| 3D screening mammogram (tomosynthesis), add-on CPT 77063 | $56.24 | $296.00 | $136.75 – $216.08 |
| Abdominal X-ray, 1 view CPT 74018 | $106.97 | $563.00 | $50.10 – $2,544.00 |
| Ankle X-ray, 3 or more views CPT 73610 | $165.87 | $873.00 | $54.71 – $144.04 |
| Bone density scan (DEXA), hips and spine CPT 77080 | $150.86 | $794.00 | $74.26 – $155.55 |
| Breast ultrasound, one breast, complete CPT 76641 | $194.37 | $1,023.00 | $160.65 – $2,544.00 |
| Breast ultrasound, one breast, limited CPT 76642 | $182.21 | $959.00 | $122.77 – $2,544.00 |
| Chest X-ray, 1 view CPT 71045 | $97.09 | $511.00 | $236.08 – $373.03 |
| Chest X-ray, 2 views CPT 71046 | $106.97 | $563.00 | $260.11 – $410.99 |
| CT angiogram of the chest (checks for lung clots) CPT 71275 | $610.85 | $3,215.00 | $519.00 – $2,544.00 |
| CT angiogram of the head CPT 70496 | $579.88 | $3,052.00 | $519.00 – $2,544.00 |
| CT scan of the abdomen and pelvis, with contrast CPT 74177 | $1,101.05 | $5,795.00 | $2,677.29 – $4,230.35 |
| CT scan of the abdomen and pelvis, without and with contrast CPT 74178 | $1,274.33 | $6,707.00 | $3,098.63 – $4,896.11 |
| CT scan of the abdomen and pelvis, without contrast CPT 74176 | $879.51 | $4,629.00 | $2,138.60 – $3,379.17 |
| CT scan of the abdomen, without contrast CPT 74150 | $483.17 | $2,543.00 | $1,174.87 – $1,856.39 |
| CT scan of the chest, with contrast CPT 71260 | $582.92 | $3,068.00 | $172.58 – $661.32 |
| CT scan of the chest, without contrast CPT 71250 | $462.65 | $2,435.00 | $1,124.97 – $1,777.55 |
| CT scan of the head, without contrast CPT 70450 | $475.19 | $2,501.00 | $103.09 – $419.15 |
| CT scan of the neck (cervical spine), without contrast CPT 72125 | $507.49 | $2,671.00 | $519.00 – $2,544.00 |
| CT scan of the pelvis, with contrast CPT 72193 | $566.01 | $2,979.00 | $172.58 – $913.83 |
| CT scan of the sinuses or face, without contrast CPT 70486 | $439.28 | $2,312.00 | $519.00 – $2,544.00 |
| Diagnostic mammogram, both breasts CPT 77066 | $166.63 | $877.00 | |
| Diagnostic mammogram, one breast CPT 77065 | $142.31 | $749.00 | $319.07 – $546.77 |
| Foot X-ray, 3 or more views CPT 73630 | $184.49 | $971.00 | $54.71 – $134.33 |
| Hand X-ray, 3 or more views CPT 73130 | $163.59 | $861.00 | $65.55 – $2,544.00 |
| Knee X-ray, 3 views CPT 73562 | $154.47 | $813.00 | $54.71 – $161.73 |
| Leg or arm vein ultrasound, both sides CPT 93970 | $391.40 | $2,060.00 | $620.06 – $1,503.80 |
| Leg or arm vein ultrasound, one side CPT 93971 | $259.92 | $1,368.00 | $411.77 – $998.64 |
| Lower back X-ray, 2 or 3 views CPT 72100 | $133.00 | $700.00 | $67.88 – $2,544.00 |
| MRI of both breasts, without and with contrast CPT 77049 | $1,094.21 | $5,759.00 | |
| MRI of the abdomen, without and with contrast CPT 74183 | $1,048.23 | $5,517.00 | $346.22 – $1,342.30 |
| MRI of the brain, without and with contrast CPT 70553 | $994.84 | $5,236.00 | $2,419.03 – $3,822.28 |
| MRI of the brain, without contrast CPT 70551 | $752.78 | $3,962.00 | $761.00 – $2,544.00 |
| MRI of the knee or other leg joint, without contrast CPT 73721 | $1,233.48 | $6,492.00 | $761.00 – $2,544.00 |
| MRI of the lower back (lumbar spine), without contrast CPT 72148 | $783.37 | $4,123.00 | $761.00 – $2,544.00 |
| MRI of the mid back (thoracic spine), without contrast CPT 72146 | $744.04 | $3,916.00 | $1,858.00 – $2,544.00 |
| MRI of the neck (cervical spine), without contrast CPT 72141 | $754.49 | $3,971.00 | $761.00 – $2,544.00 |
| MRI of the pelvis, without and with contrast CPT 72197 | $1,032.46 | $5,434.00 | $2,510.51 – $3,966.82 |
| MRI of the shoulder or other arm joint, without contrast CPT 73221 | $1,172.30 | $6,170.00 | $1,858.00 – $2,544.00 |
| Neck X-ray, 2 or 3 views CPT 72040 | $117.99 | $621.00 | $54.71 – $156.29 |
| Pelvic ultrasound, complete (not pregnancy) CPT 76856 | $314.45 | $1,655.00 | $764.61 – $1,208.15 |
| Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805 | $223.63 | $1,177.00 | $205.50 – $2,544.00 |
| Pregnancy ultrasound, under 14 weeks, single baby CPT 76801 | $127.30 | $670.00 | $165.29 – $2,544.00 |
| Screening mammogram, both breasts CPT 77067 | $139.27 | $733.00 | |
| Shoulder X-ray, 2 or more views CPT 73030 | $209.19 | $1,101.00 | $59.36 – $2,544.00 |
| Transvaginal pregnancy ultrasound CPT 76817 | $122.17 | $643.00 | $133.60 – $2,544.00 |
| Transvaginal ultrasound CPT 76830 | $218.69 | $1,151.00 | $203.96 – $2,544.00 |
| Ultrasound of the abdomen, complete CPT 76700 | $344.09 | $1,811.00 | $836.68 – $1,322.03 |
| Ultrasound of the neck or thyroid CPT 76536 | $279.49 | $1,471.00 | $679.60 – $1,073.83 |
| Wrist X-ray, 3 or more views CPT 73110 | $181.07 | $953.00 | $75.61 – $2,544.00 |
| X-ray of the lower back, 4 or more views CPT 72110 | $190.76 | $1,004.00 | $90.31 – $2,544.00 |
Lab tests
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 | $49.97 | $263.00 | $112.04 – $220.39 |
| Blood culture CPT 87040 | $48.64 | $256.00 | |
| Blood draw (venipuncture) CPT 36415 | $11.59 | $61.00 | $25.99 – $51.12 |
| BNP test (heart failure) CPT 83880 | $53.77 | $283.00 | $120.56 – $237.15 |
| C-reactive protein (CRP) test CPT 86140 | $29.26 | $154.00 | $65.60 – $129.05 |
| Chlamydia test (DNA/NAAT) CPT 87491 | $42.94 | $226.00 | $96.28 – $189.39 |
| Complete blood count (CBC) with differential CPT 85025 | $28.69 | $151.00 | $64.33 – $126.54 |
| Complete blood count (CBC), automated CPT 85027 | $22.23 | $117.00 | $49.84 – $98.05 |
| Comprehensive metabolic panel (blood test) CPT 80053 | $60.80 | $320.00 | $136.32 – $268.16 |
| COVID-19 PCR test CPT 87635 | $76.00 | $400.00 | $120.40 – $335.20 |
| D-dimer test (blood clots) CPT 85379 | $35.15 | $185.00 | |
| Drug screen, instrument chemistry CPT 80307 | $112.48 | $592.00 | $252.19 – $496.10 |
| Ferritin (iron stores) test CPT 82728 | $44.08 | $232.00 | |
| Free T4 (thyroid) test CPT 84439 | $36.67 | $193.00 | $82.22 – $161.73 |
| General health panel (blood tests) CPT 80050 | not posted | $40.66 – $92.00 | |
| Glucose (blood sugar) test CPT 82947 | $21.66 | $114.00 | $48.56 – $95.53 |
| Gonorrhea test (DNA/NAAT) CPT 87591 | $46.17 | $243.00 | |
| Hemoglobin A1c test CPT 83036 | $38.57 | $203.00 | $86.48 – $170.11 |
| Hepatitis C antibody test CPT 86803 | $71.82 | $378.00 | $161.03 – $316.76 |
| HIV-1/HIV-2 antigen and antibody test CPT 87389 | $37.43 | $197.00 | $83.92 – $165.09 |
| Iron test CPT 83540 | $26.22 | $138.00 | |
| Kidney function panel CPT 80069 | $58.14 | $306.00 | $130.36 – $256.43 |
| Lipase test (pancreas) CPT 83690 | $35.15 | $185.00 | |
| Lipid panel, cholesterol and triglycerides CPT 80061 | $48.64 | $256.00 | |
| Liver function panel CPT 80076 | $50.16 | $264.00 | $112.46 – $221.23 |
| Magnesium test CPT 83735 | $25.08 | $132.00 | $56.23 – $110.62 |
| Obstetric blood test panel CPT 80055 | not posted | $47.81 – $106.70 | |
| Partial thromboplastin time (PTT), clotting test CPT 85730 | $24.32 | $128.00 | |
| Pregnancy blood test (hCG), quantitative CPT 84702 | $51.30 | $270.00 | |
| Prothrombin time (PT/INR), clotting test CPT 85610 | $23.75 | $125.00 | |
| PSA (prostate specific antigen), free CPT 84154 | $36.29 | $191.00 | |
| PSA (prostate specific antigen), total CPT 84153 | $44.08 | $232.00 | |
| Rapid strep test CPT 87880 | $33.25 | $175.00 | $74.55 – $146.65 |
| Sed rate (ESR) test CPT 85652 | $17.67 | $93.00 | $39.62 – $77.93 |
| TB skin test CPT 86580 | $9.31 | $49.00 | $20.87 – $35.77 |
| Thyroid stimulating hormone (TSH) CPT 84443 | $56.05 | $295.00 | |
| Tissue exam by a pathologist (biopsy specimen) CPT 88305 | $121.60 | $640.00 | $32.05 – $272.30 |
| Troponin test (heart damage) CPT 84484 | $48.45 | $255.00 | $108.63 – $213.69 |
| Urinalysis, automated, with microscope CPT 81001 | $53.39 | $281.00 | |
| Urinalysis, automated, without microscope CPT 81003 | $13.49 | $71.00 | |
| Urinalysis, manual, with microscope CPT 81000 | not posted | $4.02 – $9.29 | |
| Urinalysis, manual, without microscope CPT 81002 | $7.22 | $38.00 | $16.19 – $31.84 |
| Urine culture, colony count CPT 87086 | $31.54 | $166.00 | |
| Urine pregnancy test CPT 81025 | $33.06 | $174.00 | $74.12 – $145.81 |
| Vitamin B12 test CPT 82607 | $40.85 | $215.00 | |
| Vitamin D test CPT 82306 | $56.43 | $297.00 | $126.52 – $248.89 |
Heart
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Carotid artery ultrasound, both sides CPT 93880 | $457.90 | $2,410.00 | $725.41 – $1,759.30 |
| ECG tracing only (no interpretation) CPT 93005 | $82.08 | $432.00 | $25.53 – $77.40 |
| Echocardiogram (heart ultrasound), complete with Doppler CPT 93306 | $618.26 | $3,254.00 | $979.45 – $2,375.42 |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 | not posted | $25.59 – $25.59 | |
| Holter monitor, up to 48 hours CPT 93224 | not posted | $57.76 – $57.76 | |
| Left heart catheterization CPT 93452 | $1,774.22 | $9,338.00 | $2,829.41 – $6,816.74 |
| Left heart catheterization with coronary angiogram CPT 93458 | $2,633.59 | $13,861.00 | $3,449.00 – $10,118.53 |
| Nuclear stress test (heart perfusion imaging) CPT 78452 | $1,263.31 | $6,649.00 | $1,302.78 – $2,544.00 |
| Treadmill stress test, complete CPT 93015 | not posted | $168.13 – $168.13 |
Surgery
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| ACL reconstruction, arthroscopic CPT 29888 | not posted | $5,543.64 – $9,308.46 | |
| Appendix removal, laparoscopic CPT 44970 | not posted | $3,985.42 – $10,960.00 | |
| Breast biopsy with ultrasound guidance CPT 19083 | $971.85 | $5,115.00 | $584.86 – $3,266.00 |
| Carpal tunnel release CPT 64721 | $654.93 | $3,447.00 | $1,339.63 – $3,266.00 |
| Colonoscopy with biopsy CPT 45380 | $1,018.78 | $5,362.00 | $744.92 – $3,266.00 |
| Colonoscopy with polyp removal (snare) CPT 45385 | $811.49 | $4,271.00 | $1,157.44 – $3,117.83 |
| Colonoscopy, diagnostic CPT 45378 | $878.18 | $4,622.00 | $684.48 – $3,266.00 |
| Colposcopy with biopsy CPT 57454 | $269.23 | $1,417.00 | $384.01 – $1,034.41 |
| Cystoscopy (bladder scope) CPT 52000 | $749.74 | $3,946.00 | $954.93 – $2,880.58 |
| Ear tubes, under general anesthesia CPT 69436 | not posted | $1,399.60 – $1,930.14 | |
| Flexible sigmoidoscopy, diagnostic CPT 45330 | $317.49 | $1,671.00 | $206.60 – $2,252.00 |
| Gallbladder removal, laparoscopic CPT 47562 | not posted | $3,577.95 – $10,960.00 | |
| Gastric bypass (weight loss surgery), laparoscopic CPT 43644 | not posted | $5,140.96 – $5,140.96 | |
| Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571 | not posted | $5,759.12 – $13,566.08 | |
| Hysteroscopy with biopsy or polyp removal CPT 58558 | $974.32 | $5,128.00 | $860.68 – $4,278.00 |
| Inguinal (groin) hernia repair, laparoscopic CPT 49650 | not posted | $3,602.71 – $10,960.00 | |
| Inguinal (groin) hernia repair, open, age 5 or older CPT 49505 | $2,065.87 | $10,873.00 | $2,631.27 – $7,937.29 |
| Kidney stone shock-wave lithotripsy CPT 50590 | $1,215.62 | $6,398.00 | $2,143.35 – $11,824.00 |
| Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881 | not posted | $2,136.26 – $5,480.00 | |
| Lower colon endoscopy with ultrasound CPT 45391 | $367.65 | $1,935.00 | $524.39 – $1,412.55 |
| Nasal endoscopy, diagnostic CPT 31231 | $110.01 | $579.00 | $140.12 – $422.67 |
| Prostate biopsy CPT 55700 | $823.46 | $4,334.00 | $491.00 – $3,266.00 |
| Prostate removal, laparoscopic or robotic CPT 55866 | not posted | $4,450.81 – $13,566.08 | |
| Removal of a breast lump, open surgery CPT 19120 | $716.49 | $3,771.00 | $1,305.43 – $4,989.65 |
| Rotator cuff repair, arthroscopic CPT 29827 | not posted | $5,543.64 – $10,960.00 | |
| Screening colonoscopy, average risk HCPCS G0121 | not posted | $883.86 – $1,187.98 | |
| Screening colonoscopy, high risk HCPCS G0105 | $704.33 | $3,707.00 | $684.48 – $3,266.00 |
| Septoplasty (nasal septum repair) CPT 30520 | not posted | $2,607.64 – $4,225.80 | |
| Shoulder arthroscopy, bone shaving (decompression) CPT 29826 | not posted | $2,136.26 – $2,136.26 | |
| Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775 | not posted | $3,328.04 – $3,328.04 | |
| Tonsil and adenoid removal, under age 12 CPT 42820 | not posted | $2,124.18 – $7,708.25 | |
| Total hip replacement CPT 27130 | not posted | $9,279.25 – $16,765.79 | |
| Total knee replacement CPT 27447 | not posted | $9,279.25 – $16,765.79 | |
| Upper endoscopy (EGD) with biopsy CPT 43239 | $652.46 | $3,434.00 | $831.03 – $2,506.82 |
| Upper endoscopy (EGD), diagnostic CPT 43235 | $632.32 | $3,328.00 | $453.37 – $2,252.00 |
| Vasectomy CPT 55250 | not posted | $1,985.93 – $2,831.31 |
Pregnancy and birth
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| C-section delivery, routine care including prenatal and postpartum CPT 59510 | not posted | $2,608.59 – $2,608.59 | |
| Fetal non-stress test CPT 59025 | $148.77 | $783.00 | $237.25 – $571.59 |
| IUD insertion CPT 58300 | $66.12 | $348.00 | |
| Vaginal birth after a prior C-section (VBAC), routine care CPT 59610 | not posted | $2,358.86 – $2,358.86 | |
| Vaginal delivery, routine care including prenatal and postpartum CPT 59400 | not posted | $2,358.86 – $2,358.86 |
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 | $6,917.33 – $12,371.97 | |
| C-section, without complications MS-DRG 788 | not posted | $5,852.00 – $11,956.52 | |
| Chest pain MS-DRG 313 | not posted | $5,593.77 – $10,004.72 | |
| COPD flare-up, with major complications MS-DRG 190 | not posted | $8,762.82 – $15,748.95 | |
| COPD flare-up, without complications MS-DRG 192 | not posted | $5,074.70 – $9,076.33 | |
| Fainting (syncope) MS-DRG 312 | not posted | $6,831.86 – $12,219.11 | |
| Gastrointestinal bleeding, with complications MS-DRG 378 | not posted | $7,730.44 – $13,826.26 | |
| Heart failure, with major complications MS-DRG 291 | not posted | $10,095.27 – $18,298.52 | |
| Heart failure, without complications MS-DRG 293 | not posted | $4,302.36 – $7,694.97 | |
| Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216 | not posted | $71,266.74 – $135,347.03 | |
| Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 | not posted | $14,351.31 – $26,442.25 | |
| Irregular heartbeat, without complications MS-DRG 310 | not posted | $4,387.04 – $7,846.43 | |
| Kidney failure, with complications MS-DRG 683 | not posted | $6,969.86 – $12,465.93 | |
| Kidney or urinary tract infection, without major complications MS-DRG 690 | not posted | $6,293.19 – $11,255.66 | |
| Neck (cervical) spinal fusion, without complications MS-DRG 473 | not posted | $17,883.24 – $33,200.42 | |
| Normal newborn care MS-DRG 795 | not posted | $1,566.63 – $2,672.92 | |
| Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641 | not posted | $6,126.96 – $10,958.35 | |
| Pneumonia, with complications MS-DRG 194 | not posted | $6,429.62 – $11,499.68 | |
| Pneumonia, with major complications MS-DRG 193 | not posted | $10,189.81 – $18,479.42 | |
| Pneumonia, without complications MS-DRG 195 | not posted | $4,882.59 – $8,732.74 | |
| Psychoses (inpatient psychiatric stay) MS-DRG 885 | not posted | $10,863.36 – $19,768.23 | |
| Sepsis, with major complications MS-DRG 871 | not posted | $14,912.73 – $27,516.49 | |
| Sepsis, without major complications MS-DRG 872 | not posted | $8,084.07 – $14,458.74 | |
| Skin infection (cellulitis), without major complications MS-DRG 603 | not posted | $6,906.35 – $12,352.34 | |
| Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392 | not posted | $6,118.33 – $10,942.93 | |
| Stroke, with complications or clot-busting drug MS-DRG 65 | not posted | $7,973.51 – $14,261.01 | |
| Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743 | not posted | $9,317.64 – $16,810.57 | |
| Vaginal delivery, without complications MS-DRG 807 | not posted | $4,551.00 – $8,422.56 | |
| Weight loss surgery, without complications MS-DRG 621 | not posted | $11,245.95 – $20,500.28 |
Pain and spine
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Large joint injection or drainage (knee, shoulder, hip) CPT 20610 | $348.27 | $1,833.00 | $168.01 – $2,252.00 |
| Lower back nerve root injection with imaging guidance CPT 64483 | $458.47 | $2,413.00 | $417.44 – $2,252.00 |
| Lower back spinal injection (epidural), with imaging guidance CPT 62323 | $375.63 | $1,977.00 | $535.77 – $1,443.21 |
| Lower back spinal injection (epidural), without imaging CPT 62322 | $320.34 | $1,686.00 | $456.91 – $1,230.78 |
Eye
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Cataract removal with lens implant CPT 66984 | not posted | $1,700.46 – $6,644.00 | |
| Eye exam, new patient, comprehensive CPT 92004 | $46.74 | $246.00 | $124.93 – $360.29 |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 | $316.92 | $1,668.00 | $531.84 – $3,266.00 |
Eye and ear
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Hearing test, comprehensive CPT 92557 | $95.76 | $504.00 | $151.70 – $367.92 |
Sleep
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Home sleep apnea test CPT 95806 | $141.36 | $744.00 | $223.94 – $543.12 |
| Sleep study with CPAP titration CPT 95811 | $1,333.80 | $7,020.00 | $2,113.02 – $5,124.60 |
| Sleep study, overnight in a sleep lab CPT 95810 | $1,058.68 | $5,572.00 | $1,677.17 – $4,067.56 |
Lungs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Spirometry (breathing test) CPT 94010 | $132.43 | $697.00 | $209.80 – $508.81 |
Therapy
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Manual therapy, 15 minutes CPT 97140 | $42.94 | $226.00 | $216.00 – $219.00 |
| Physical therapy evaluation, low complexity CPT 97161 | $76.38 | $402.00 | $216.00 – $219.00 |
| Physical therapy evaluation, moderate complexity CPT 97162 | $105.83 | $557.00 | |
| Physical therapy, therapeutic exercise, 15 minutes CPT 97110 | $40.66 | $214.00 | |
| Therapeutic activities, 15 minutes CPT 97530 | $35.34 | $186.00 |
Mental health
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Family psychotherapy, with the patient, 50 minutes CPT 90847 | not posted | $152.46 – $209.36 | |
| Family psychotherapy, without the patient, 50 minutes CPT 90846 | not posted | $152.46 – $209.36 | |
| Group psychotherapy CPT 90853 | $52.63 | $277.00 | $83.38 – $202.21 |
| Psychiatric diagnostic evaluation CPT 90791 | $119.89 | $631.00 | $155.76 – $612.77 |
| Psychotherapy, 30 minutes CPT 90832 | not posted | $127.71 – $209.36 | |
| Psychotherapy, 45 minutes CPT 90834 | not posted | $143.73 – $209.36 | |
| Psychotherapy, 60 minutes CPT 90837 | not posted | $143.73 – $209.36 |
Infusions and injections
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Injection under the skin or into a muscle CPT 96372 | $45.41 | $239.00 | $50.82 – $92.74 |
| IV hydration, each additional hour CPT 96361 | $67.07 | $353.00 | $106.25 – $257.69 |
| IV hydration, first hour CPT 96360 | $107.92 | $568.00 | $170.97 – $414.64 |
| IV push injection of a drug, first CPT 96374 | $72.96 | $384.00 | $115.58 – $280.32 |
| IV push injection, each additional drug CPT 96375 | $64.41 | $339.00 | $102.04 – $247.47 |
Drugs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696 | $5.83 | $30.69 | $9.24 – $25.72 |
| Dexamethasone injection, per 1 mg HCPCS J1100 | $5.46 | $28.75 | |
| Fentanyl injection, per 0.1 mg HCPCS J3010 | $5.46 | $28.75 | |
| Hydromorphone (Dilaudid) injection, up to 4 mg HCPCS J1170 | $16.39 | $86.25 | $25.96 – $72.28 |
| Ketorolac (Toradol) injection, per 15 mg HCPCS J1885 | $5.46 | $28.75 | |
| Midazolam (Versed) injection, per 1 mg HCPCS J2250 | $38.30 | $201.60 | |
| Morphine injection, up to 10 mg HCPCS J2270 | $5.46 | $28.75 | |
| Ondansetron (Zofran) injection, per 1 mg HCPCS J2405 | $5.46 | $28.75 | $8.65 – $24.09 |
| Propofol injection, per 10 mg HCPCS J2704 | $16.39 | $86.25 | |
| Saline IV solution, 1000 ml HCPCS J7030 | $17.48 | $92.00 | $3.69 – $4.08 |
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.