Does MC Donough District Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at MC Donough District Hospital. In a medical emergency, call 911.

Where is MC Donough District Hospital?

525 East Grant Street, Macomb, IL 61455, in McDonough County, Illinois.

What is the phone number of MC Donough District Hospital?

(309) 833-4101, as listed by Medicare (CMS).

What is the Medicare star rating of MC Donough District Hospital?

3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).

Does Medicare reduce its payments to MC Donough District Hospital for hospital-acquired conditions?

No. For fiscal year 2026, CMS lists no Medicare payment reduction for MC Donough District Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 0.0448; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

MC Donough District Hospital — Phone, Address & ER

Quick answers

Does MC Donough District Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at MC Donough District Hospital. In a medical emergency, call 911.
Where is MC Donough District Hospital?: 525 East Grant Street, Macomb, IL 61455, in McDonough County, Illinois.
What is the phone number of MC Donough District Hospital?: (309) 833-4101, as listed by Medicare (CMS).
What is the Medicare star rating of MC Donough District Hospital?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to MC Donough District Hospital for hospital-acquired conditions?: No. For fiscal year 2026, CMS lists no Medicare payment reduction for MC Donough District Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 0.0448; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas^[5][6]

Treatments^[5]

Physical Therapy
Occupational Therapy
Speech Therapy
Vestibular Rehabilitation
Cardiac Rehabilitation
Pulmonary Rehabilitation
Industrial Rehabilitation
Home Health Care
Hospice
Diabetes Management
Anticoagulation

Procedures^[5]

3D Mammography
CT
MRI
Ultrasound
X-ray
Nuclear Medicine
Bone densitometry (DEXA)

Programs and centers^[5]

Hospital to Home (H2H) Swing Bed Program
Hospitalist Program
Dolores Kator Switzer Women's Center
Telehealth Services

Emergency care (hospital website)^[6]

Emergency room	Yes
Open 24/7	Yes

Doctors and clinicians (205)

205 doctors and other clinicians list MC Donough District Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 181 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

Sarah D Culbertson Memorial Hospital23 mi · Rushville, IL · Critical Access Hospital
Memorial Hospital24 mi · Carthage, IL · Critical Access Hospital
OSF Holy Family Medical Center33 mi · Monmouth, IL · Critical Access Hospital
Mason District Hospital33 mi · Havana, IL · Critical Access Hospital
Graham Hospital Association34 mi · Canton, IL · Critical Access Hospital

Find the closest emergency room to where you are → · Compare ER wait times

Other hospitals near Macomb

Southeast Iowa Regional Medical Center37 mi · West Burlington, IA · Acute Care Hospital

Hospitals in McDonough County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Macomb Post Acute Care Center0.1 mi · Macomb, IL · 2 of 5 stars
The Elms0.2 mi · Macomb, IL · 5 of 5 stars
Wesley Village0.5 mi · Macomb, IL · 5 of 5 stars

All nursing homes in the state →

Hospice providers

The MDH Hospice1.5 mi · Macomb, IL · 5 of 5 stars

All hospice providers in the state →

Home health agencies

MDH Home Health Care1.5 mi · Macomb, IL · 2 of 5 stars
Hancock County Health Department23 mi · Carthage, IL · 3 of 5 stars

All home health agencies in the state →

Dialysis facilities

FMC - Macomb1.5 mi · Macomb, IL · 3 of 5 stars
DaVita Rushville Dialysis22 mi · Rushville, IL · 5 of 5 stars

All dialysis facilities in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

Eagle View Community Health System - Stronghurst Location24 mi · Stronghurst, IL · Community health center

Clinics and urgent care

Graham Medical Group Macomb - Bushnell1.5 mi · Macomb, IL · Rural health clinic
MDH Family Medicine/Convenience Care/Surgery/Ent Clinic1.5 mi · Macomb, IL · Rural health clinic
MDH Pediatric Clinic1.5 mi · Macomb, IL · Rural health clinic

Pharmacies

Hy-Vee Inc1.5 mi · Macomb, IL · Community/retail pharmacy
McDonough County Hospital District1.5 mi · Macomb, IL · Community/retail pharmacy
Walgreen Co1.5 mi · Macomb, IL · Pharmacy

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What MC Donough District Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	4 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	3 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	4 of 5 stars
Patients got help quickly from staff	4 of 5 stars
Staff explained medicines	4 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Restfulness of Environment	4 of 5 stars
Care Coordination	4 of 5 stars
Symptoms After Stay	4 of 5 stars
Rated the hospital 9 or 10 out of 10	71%National average: 72%
Would definitely recommend the hospital	61%National average: 71%
Nurses “always” communicated well	80%National average: 80%
Doctors “always” communicated well	82%National average: 80%
“Always” got help as soon as they wanted	67%National average: 64%
Staff “always” explained medicines before giving them	62%National average: 62%
Were given information about recovery at home	90%National average: 86%
Room and bathroom “always” clean	73%National average: 73%
Completed surveys	179Response rate: 23%

Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged January 2025 to December 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart failure patients	11.4%
Deaths within 30 days: pneumonia patients	16%
Deaths within 30 days: COPD patients	8.3%
Serious complications (patient safety indicator PSI-90)	0.97No different from the national rate
Not reported to Medicare	Deaths within 30 days: coronary bypass surgery (CABG)
Too few cases to report	Deaths within 30 days: heart attack patients; Deaths within 30 days: stroke patients; Complications after hip or knee replacement

Source: Complications and Deaths - Hospital — CMS, released October 20, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	15.7%
Readmitted within 30 days: heart failure	21.7%
Readmitted within 30 days: pneumonia	17.4%
Readmitted within 30 days: COPD	19.8%
Not reported to Medicare	Readmitted within 30 days: coronary bypass surgery
Too few cases to report	Readmitted within 30 days: heart attack; Readmitted within 30 days: hip or knee replacement

Source: Unplanned Hospital Visits - Hospital — CMS, released October 20, 2026; data from July 2024 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	148 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	2%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	62%National average: 66%

Source: Timely and Effective Care - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

Not reported to Medicare: infections caught in the hospital. For these topics Medicare shows no result for this hospital (not reported, or too few cases).

See every measure on Medicare Care Compare →

Medicare payment programs

Medicare (CMS) uses these federal programs to adjust what it pays hospitals, based on quality, safety and cost results. This is a payment to the hospital for Medicare patients, not a price you pay, and not a prediction for any one person. Results for MC Donough District Hospital, fiscal year 2026 (October 2025 to September 2026).

Show the Medicare payment program results

Hospital-Acquired Condition Reduction Program

What this means: Medicare gives each hospital a Total HAC Score built from patient-safety complications and from infections caught in the hospital. The quarter of hospitals with the highest (worst) scores gets a reduction in its Medicare payments. A lower score is better.

CMS says: Hospitals with a Total HAC Score above the 75th percentile of the Total HAC Score distribution will be subject to a 1-percent payment reduction.

Medicare payment reduction, fiscal year 2026	NoCMS lists no payment reduction for this hospital.
Total HAC Score	0.0448Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

Source: Hospital-Acquired Condition (HAC) Reduction Program — CMS, released January 26, 2026; patient-safety data from July 2022 to June 2024 and infection data from January 2023 to December 2024.

Hospital Readmissions Reduction Program

What this means: For six conditions, Medicare compares how often this hospital’s patients had to go back into a hospital within 30 days with how often that happens at an average hospital with similar patients. The ratio is that comparison: 1 means as many readmissions as expected, above 1 means more than expected (CMS calls these “excess readmissions”), below 1 means fewer.

CMS says: In October 2012, CMS began reducing Medicare payments for subsection(d) hospitals with excess readmissions under the Hospital Readmissions Reduction Program (HRRP).

Heart failure	0.9914Fewer readmissions than expected
Pneumonia	1.1684More readmissions than expected
COPD (chronic lung disease)	1.0000As many readmissions as expected
No result published	Heart attack; Hip or knee replacement; Coronary bypass surgery (CABG) (not reported, or too few cases)

Source: Hospital Readmissions Reduction Program — CMS, released January 26, 2026; patients discharged July 2021 to June 2024.

Hospital Value-Based Purchasing Program

What this means: Medicare scores hospitals in four areas, each from 0 to 100, and combines them into a Total Performance Score from 0 to 100. A higher score means better results on these measures. Medicare uses the score to adjust what it pays the hospital.

CMS says: This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver.

Total Performance Score	42.25 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)	10.00 out of 100
Person and community engagement (patient survey)	49.00 out of 100
Safety (infections and sepsis care)	50.00 out of 100
Efficiency and cost reduction (Medicare spending)	60.00 out of 100

Source: Hospital Value-Based Purchasing (HVBP) - Total Performance Score — CMS, released January 26, 2026, fiscal year 2026. Program description: The Hospital Value-Based Purchasing (VBP) Program — CMS, page last modified September 10, 2024.

Medicare spending per patient (MSPB)

What this means: This compares what Medicare spent on a hospital stay, counting the 3 days before it and the 30 days after, with the national median hospital, after adjusting for the patient’s age and health and for local prices. A ratio of 1.00 is the national median hospital; below 1.00 means Medicare spent less, above 1.00 means more. It measures the cost to Medicare, not the quality of care.

CMS says: The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (episode) at a specific hospital compared to all hospitals nationally.

Medicare spending per patient, ratio	0.93Below the national median hospital (1.00): Medicare spent less

Source: Medicare Spending Per Beneficiary - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Illinois Best hospitals in Illinois

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 80 common services exactly as MC Donough District Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Show the prices of 80 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99203 WOC Level 3 outpatient visit for evaluation and management of new patient	$286	$171.60	$68.64 – $286
New patient office visit (about 30–44 minutes): 10 of 19 insurance plan rates Aetna — Commercial: $243.10 Aetna — Medicaid: $286 Aetna — Medicare: $68.64 Blue Choice — Commercial: $257.40 Blue Cross Blue Shield — Commercial: $286 Consociate — Commercial: $243.10 Current Health — Commercial: $257.40 Health Alliance — Commercial: $254.54 Healthlink — Commercial: $268.84 HFN — Commercial: $257.40
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 99203 WOC Level 3 outpatient visit for evaluation and management of new patient	$286	$171.60	$234.52 – $286
New patient office visit (about 30–44 minutes): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $286 Consociate — Commercial: $243.10 Current Health — Commercial: $257.40 Healthlink — Commercial: $257.40 HFN — Commercial: $257.40 Humana — Commercial: $257.40 Preferred Plan — Commercial: $271.70 Springfield Health — Commercial: $234.52 Trilogy — Commercial: $243.10 United Healthcare — Commercial: $257.40
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office o/p new low 30 min	Not listed in the file	Not listed in the file	$47.56 – $79.26
New patient office visit (about 30–44 minutes): 10 of 14 insurance plan rates Aetna — Medicaid: $79.26 Aetna — Medicare: $79.26 Health Alliance — Commercial: $47.56 Health Alliance — Medicare: $79.26 HFN — Commercial: $74.36 Humana — Medicare: $79.26 Medicaid — Medicaid Illinois: $79.26 Medicare — Medicare: $79.26 Meridian — Medicaid Illinois: $79.26 Molina — Medicaid Illinois: $79.26
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99204 WOC Level 4 outpatient visit for evaluation and management of new patient	$429	$257.40	$102.96 – $429
New patient office visit (about 45–59 minutes): 10 of 19 insurance plan rates Aetna — Commercial: $364.65 Aetna — Medicaid: $429 Aetna — Medicare: $102.96 Blue Choice — Commercial: $386.10 Blue Cross Blue Shield — Commercial: $429 Consociate — Commercial: $364.65 Current Health — Commercial: $386.10 Health Alliance — Commercial: $381.81 Healthlink — Commercial: $403.26 HFN — Commercial: $386.10
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 99204 WOC Level 4 outpatient visit for evaluation and management of new patient	$429	$257.40	$351.78 – $429
New patient office visit (about 45–59 minutes): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $429 Consociate — Commercial: $364.65 Current Health — Commercial: $386.10 Healthlink — Commercial: $386.10 HFN — Commercial: $386.10 Humana — Commercial: $386.10 Preferred Plan — Commercial: $407.55 Springfield Health — Commercial: $351.78 Trilogy — Commercial: $364.65 United Healthcare — Commercial: $386.10
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office o/p new mod 45 min	Not listed in the file	Not listed in the file	$77.25 – $128.75
New patient office visit (about 45–59 minutes): 10 of 14 insurance plan rates Aetna — Medicaid: $128.75 Aetna — Medicare: $128.75 Health Alliance — Commercial: $77.25 Health Alliance — Medicare: $128.75 HFN — Commercial: $119.16 Humana — Medicare: $128.75 Medicaid — Medicaid Illinois: $128.75 Medicare — Medicare: $128.75 Meridian — Medicaid Illinois: $128.75 Molina — Medicaid Illinois: $128.75
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office o/p new hi 60 min	Not listed in the file	Not listed in the file	$105.19 – $175.31
New patient office visit (about 60–74 minutes): 10 of 14 insurance plan rates Aetna — Medicaid: $175.31 Aetna — Medicare: $175.31 Health Alliance — Commercial: $105.19 Health Alliance — Medicare: $175.31 HFN — Commercial: $161.70 Humana — Medicare: $175.31 Medicaid — Medicaid Illinois: $175.31 Medicare — Medicare: $175.31 Meridian — Medicaid Illinois: $175.31 Molina — Medicaid Illinois: $175.31
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 95\|GT\|95 In the file: 99205T - Level 5 Patient Office Visit	$567	$340.20	$136.08 – $567
New patient office visit (about 60–74 minutes): 10 of 19 insurance plan rates Aetna — Commercial: $481.95 Aetna — Medicaid: $567 Aetna — Medicare: $136.08 Blue Choice — Commercial: $510.30 Blue Cross Blue Shield — Commercial: $567 Consociate — Commercial: $481.95 Current Health — Commercial: $510.30 Health Alliance — Commercial: $504.63 Healthlink — Commercial: $532.98 HFN — Commercial: $510.30
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Doctor (professional) fee · modifier 95\|GT\|95 In the file: 99205T - Level 5 Patient Office Visit	$567	$340.20	$464.94 – $567
New patient office visit (about 60–74 minutes): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $567 Consociate — Commercial: $481.95 Current Health — Commercial: $510.30 Healthlink — Commercial: $510.30 HFN — Commercial: $510.30 Humana — Commercial: $510.30 Preferred Plan — Commercial: $538.65 Springfield Health — Commercial: $464.94 Trilogy — Commercial: $481.95 United Healthcare — Commercial: $510.30
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: BC Facility Level 3 Est Patient	$85	$51	$20.40 – $85
Established patient office visit (about 20–29 minutes): 10 of 19 insurance plan rates Aetna — Commercial: $72.25 Aetna — Medicaid: $85 Aetna — Medicare: $20.40 Blue Choice — Commercial: $76.50 Blue Cross Blue Shield — Commercial: $85 Consociate — Commercial: $72.25 Current Health — Commercial: $76.50 Health Alliance — Commercial: $75.65 Healthlink — Commercial: $79.90 HFN — Commercial: $76.50
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ROE physical	$103	$61.80	$24.72 – $103
Established patient office visit (about 20–29 minutes): 10 of 19 insurance plan rates Aetna — Commercial: $87.55 Aetna — Medicaid: $103 Aetna — Medicare: $24.72 Blue Choice — Commercial: $92.70 Blue Cross Blue Shield — Commercial: $103 Consociate — Commercial: $87.55 Current Health — Commercial: $92.70 Health Alliance — Commercial: $91.67 Healthlink — Commercial: $96.82 HFN — Commercial: $92.70
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TWOPX Bus Driver and DOT Contract PX	$155	$93	$37.20 – $155
Established patient office visit (about 20–29 minutes): 10 of 19 insurance plan rates Aetna — Commercial: $131.75 Aetna — Medicaid: $155 Aetna — Medicare: $37.20 Blue Choice — Commercial: $139.50 Blue Cross Blue Shield — Commercial: $155 Consociate — Commercial: $131.75 Current Health — Commercial: $139.50 Health Alliance — Commercial: $137.95 Healthlink — Commercial: $145.70 HFN — Commercial: $139.50
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99214 DOT Physical	$100	$60	$24 – $100
Established patient office visit (about 30–39 minutes): 10 of 19 insurance plan rates Aetna — Commercial: $85 Aetna — Medicaid: $100 Aetna — Medicare: $24 Blue Choice — Commercial: $90 Blue Cross Blue Shield — Commercial: $100 Consociate — Commercial: $85 Current Health — Commercial: $90 Health Alliance — Commercial: $89 Healthlink — Commercial: $94 HFN — Commercial: $90
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99214 - Outpt in a bed - Level 4	$295	$177	$70.80 – $295
Established patient office visit (about 30–39 minutes): 10 of 19 insurance plan rates Aetna — Commercial: $250.75 Aetna — Medicaid: $295 Aetna — Medicare: $70.80 Blue Choice — Commercial: $265.50 Blue Cross Blue Shield — Commercial: $295 Consociate — Commercial: $250.75 Current Health — Commercial: $265.50 Health Alliance — Commercial: $262.55 Healthlink — Commercial: $277.30 HFN — Commercial: $265.50
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 99214 WOC Level 4 outpatient visit for evaluation and management of est patient	$295	$177	$70.80 – $295
Established patient office visit (about 30–39 minutes): 10 of 19 insurance plan rates Aetna — Commercial: $250.75 Aetna — Medicaid: $295 Aetna — Medicare: $70.80 Blue Choice — Commercial: $265.50 Blue Cross Blue Shield — Commercial: $295 Consociate — Commercial: $250.75 Current Health — Commercial: $265.50 Health Alliance — Commercial: $262.55 Healthlink — Commercial: $277.30 HFN — Commercial: $265.50
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prev visit new age 18-39	Not listed in the file	Not listed in the file	$90.04
Preventive checkup, new patient, age 18–39: rates for 1 insurance plan Tricare — Traditional: $90.04
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prev visit new age 40-64	Not listed in the file	Not listed in the file	$108.91
Preventive checkup, new patient, age 40–64: rates for 1 insurance plan Tricare — Traditional: $108.91
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 99283 - Level 3 - Lynx Visit Level	$992	$595.20	$238.08 – $992
Emergency room visit (moderate): 10 of 19 insurance plan rates Aetna — Commercial: $843.20 Aetna — Medicaid: $992 Aetna — Medicare: $238.08 Blue Choice — Commercial: $892.80 Blue Cross Blue Shield — Commercial: $992 Consociate — Commercial: $843.20 Current Health — Commercial: $892.80 Health Alliance — Commercial: $882.88 Healthlink — Commercial: $932.48 HFN — Commercial: $892.80
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 99283 - Level 3 - Lynx Visit Level	$992	$595.20	$813.44 – $992
Emergency room visit (moderate): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $992 Consociate — Commercial: $843.20 Current Health — Commercial: $892.80 Healthlink — Commercial: $892.80 HFN — Commercial: $892.80 Humana — Commercial: $892.80 Preferred Plan — Commercial: $942.40 Springfield Health — Commercial: $813.44 Trilogy — Commercial: $843.20 United Healthcare — Commercial: $892.80
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency dept visit low mdm	Not listed in the file	Not listed in the file	$41.54 – $69.23
Emergency room visit (moderate): 10 of 14 insurance plan rates Aetna — Medicaid: $69.23 Aetna — Medicare: $69.23 Health Alliance — Commercial: $41.54 Health Alliance — Medicare: $69.23 HFN — Commercial: $65.57 Humana — Medicare: $69.23 Medicaid — Medicaid Illinois: $69.23 Medicare — Medicare: $69.23 Meridian — Medicaid Illinois: $69.23 Molina — Medicaid Illinois: $69.23
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency dept visit mod mdm	Not listed in the file	Not listed in the file	$71.04 – $118.40
Emergency room visit (moderately high): 10 of 14 insurance plan rates Aetna — Medicaid: $118.40 Aetna — Medicare: $118.40 Health Alliance — Commercial: $71.04 Health Alliance — Medicare: $118.40 HFN — Commercial: $109.98 Humana — Medicare: $118.40 Medicaid — Medicaid Illinois: $118.40 Medicare — Medicare: $118.40 Meridian — Medicaid Illinois: $118.40 Molina — Medicaid Illinois: $118.40
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit mod mdm	Not listed in the file	Not listed in the file	$443.88 – $475.40
Emergency room visit (moderately high): rates for 9 insurance plans Aetna — Medicare: $475.40 Health Alliance — Medicare: $475.40 Humana — Medicare: $475.40 Medicare — Medicare: $475.40 Meridian — Medicaid Illinois: $475.40 Tricare — Traditional: $443.88 United Healthcare — Medicare: $475.40 Veteran Affairs — Traditional: $475.40 Health Alliance — Commercial: 89% (a percentage in the contract, not a dollar amount)
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: 99284 Level 4 FCT Charge	$1,476	$885.60	$354.24 – $1,476
Emergency room visit (moderately high): 10 of 19 insurance plan rates Aetna — Commercial: $1,254.60 Aetna — Medicaid: $1,476 Aetna — Medicare: $354.24 Blue Choice — Commercial: $1,328.40 Blue Cross Blue Shield — Commercial: $1,476 Consociate — Commercial: $1,254.60 Current Health — Commercial: $1,328.40 Health Alliance — Commercial: $1,313.64 Healthlink — Commercial: $1,387.44 HFN — Commercial: $1,328.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency dept visit hi mdm	Not listed in the file	Not listed in the file	$103.14 – $171.90
Emergency room visit (high): 10 of 14 insurance plan rates Aetna — Medicaid: $171.90 Aetna — Medicare: $171.90 Health Alliance — Commercial: $103.14 Health Alliance — Medicare: $171.90 HFN — Commercial: $160.39 Humana — Medicare: $171.90 Medicaid — Medicaid Illinois: $171.90 Medicare — Medicare: $171.90 Meridian — Medicaid Illinois: $171.90 Molina — Medicaid Illinois: $171.90
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit hi mdm	Not listed in the file	Not listed in the file	$639.11 – $684.48
Emergency room visit (high): rates for 9 insurance plans Aetna — Medicare: $684.48 Health Alliance — Medicare: $684.48 Humana — Medicare: $684.48 Medicare — Medicare: $684.48 Meridian — Medicaid Illinois: $684.48 Tricare — Traditional: $639.11 United Healthcare — Medicare: $684.48 Veteran Affairs — Traditional: $684.48 Health Alliance — Commercial: 89% (a percentage in the contract, not a dollar amount)
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 25 In the file: 99285 Level 5 FCT Charge	$2,161	$1,296.60	$518.64 – $2,161
Emergency room visit (high): 10 of 19 insurance plan rates Aetna — Commercial: $1,836.85 Aetna — Medicaid: $2,161 Aetna — Medicare: $518.64 Blue Choice — Commercial: $1,944.90 Blue Cross Blue Shield — Commercial: $2,161 Consociate — Commercial: $1,836.85 Current Health — Commercial: $1,944.90 Health Alliance — Commercial: $1,923.29 Healthlink — Commercial: $2,031.34 HFN — Commercial: $1,944.90

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Metabolic panel total ca	Not listed in the file	Not listed in the file	$9.19
Basic metabolic panel (blood test): 10 of 18 insurance plan rates Aetna — Medicare: $8.46 Health Alliance — Medicare: $8.46 Humana — Medicare: $8.46 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $9.19 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $9.19 Medicaid Countycare Claims — Medicaid Countycare Claims: $9.19 Medicaid Health Alliance — Medicaid Health Alliance: $9.19 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $9.19 Medicaid Illinois — Medicaid Illinois: $9.19 Medicaid Meridian — Medicaid Meridian: $9.19
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: BMP Standard	$61	$30	$14.64 – $61
Basic metabolic panel (blood test): 10 of 19 insurance plan rates Aetna — Commercial: $51.85 Aetna — Medicaid: $61 Aetna — Medicare: $14.64 Blue Choice — Commercial: $54.90 Blue Cross Blue Shield — Commercial: $61 Consociate — Commercial: $51.85 Current Health — Commercial: $54.90 Health Alliance — Commercial: $54.29 Healthlink — Commercial: $57.34 HFN — Commercial: $54.90
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: BMP Standard	$61	$30	$50.02 – $61
Basic metabolic panel (blood test): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $61 Consociate — Commercial: $51.85 Current Health — Commercial: $54.90 Healthlink — Commercial: $54.90 HFN — Commercial: $54.90 Humana — Commercial: $54.90 Preferred Plan — Commercial: $57.95 Springfield Health — Commercial: $50.02 Trilogy — Commercial: $51.85 United Healthcare — Commercial: $54.90
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehen metabolic panel	Not listed in the file	Not listed in the file	$9.19
Comprehensive metabolic panel (blood test): 10 of 18 insurance plan rates Aetna — Medicare: $10.56 Health Alliance — Medicare: $10.56 Humana — Medicare: $10.56 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $9.19 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $9.19 Medicaid Countycare Claims — Medicaid Countycare Claims: $9.19 Medicaid Health Alliance — Medicaid Health Alliance: $9.19 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $9.19 Medicaid Illinois — Medicaid Illinois: $9.19 Medicaid Meridian — Medicaid Meridian: $9.19
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CMP Standard	$77	$50	$18.48 – $77
Comprehensive metabolic panel (blood test): 10 of 19 insurance plan rates Aetna — Commercial: $65.45 Aetna — Medicaid: $77 Aetna — Medicare: $18.48 Blue Choice — Commercial: $69.30 Blue Cross Blue Shield — Commercial: $77 Consociate — Commercial: $65.45 Current Health — Commercial: $69.30 Health Alliance — Commercial: $68.53 Healthlink — Commercial: $72.38 HFN — Commercial: $69.30
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: Total Prot	$77	$50	$18.48 – $77
Comprehensive metabolic panel (blood test): 10 of 19 insurance plan rates Aetna — Commercial: $65.45 Aetna — Medicaid: $77 Aetna — Medicare: $18.48 Blue Choice — Commercial: $69.30 Blue Cross Blue Shield — Commercial: $77 Consociate — Commercial: $65.45 Current Health — Commercial: $69.30 Health Alliance — Commercial: $68.53 Healthlink — Commercial: $72.38 HFN — Commercial: $69.30
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric panel	Not listed in the file	Not listed in the file	$9.19
Obstetric blood test panel: 10 of 18 insurance plan rates Aetna — Medicare: $47.81 Health Alliance — Medicare: $47.81 Humana — Medicare: $47.81 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $9.19 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $9.19 Medicaid Countycare Claims — Medicaid Countycare Claims: $9.19 Medicaid Health Alliance — Medicaid Health Alliance: $9.19 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $9.19 Medicaid Illinois — Medicaid Illinois: $9.19 Medicaid Meridian — Medicaid Meridian: $9.19
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Obstetric panel	Not listed in the file	Not listed in the file	$28.69 – $47.81
Obstetric blood test panel: 10 of 14 insurance plan rates Aetna — Medicaid: $47.81 Aetna — Medicare: $47.81 Health Alliance — Commercial: $28.69 Health Alliance — Medicare: $47.81 HFN — Commercial: $43.03 Humana — Medicare: $47.81 Medicaid — Medicaid Illinois: $47.81 Medicare — Medicare: $47.81 Meridian — Medicaid Illinois: $47.81 Molina — Medicaid Illinois: $47.81
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel Standard	$16	$9.60	$3.84 – $16
Cholesterol panel (lipid panel): 10 of 19 insurance plan rates Aetna — Commercial: $13.60 Aetna — Medicaid: $16 Aetna — Medicare: $3.84 Blue Choice — Commercial: $14.40 Blue Cross Blue Shield — Commercial: $16 Consociate — Commercial: $13.60 Current Health — Commercial: $14.40 Health Alliance — Commercial: $14.24 Healthlink — Commercial: $15.04 HFN — Commercial: $14.40
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Lipid Panel Standard	$16	$9.60	$13.12 – $16
Cholesterol panel (lipid panel): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $16 Consociate — Commercial: $13.60 Current Health — Commercial: $14.40 Healthlink — Commercial: $14.40 HFN — Commercial: $14.40 Humana — Commercial: $14.40 Preferred Plan — Commercial: $15.20 Springfield Health — Commercial: $13.12 Trilogy — Commercial: $13.60 United Healthcare — Commercial: $14.40
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid panel	Not listed in the file	Not listed in the file	$9.19
Cholesterol panel (lipid panel): 10 of 18 insurance plan rates Aetna — Medicare: $13.39 Health Alliance — Medicare: $13.39 Humana — Medicare: $13.39 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $9.19 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $9.19 Medicaid Countycare Claims — Medicaid Countycare Claims: $9.19 Medicaid Health Alliance — Medicaid Health Alliance: $9.19 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $9.19 Medicaid Illinois — Medicaid Illinois: $9.19 Medicaid Meridian — Medicaid Meridian: $9.19
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal function panel	Not listed in the file	Not listed in the file	$9.19
Kidney function panel: 10 of 18 insurance plan rates Aetna — Medicare: $8.68 Health Alliance — Medicare: $8.68 Humana — Medicare: $8.68 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $9.19 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $9.19 Medicaid Countycare Claims — Medicaid Countycare Claims: $9.19 Medicaid Health Alliance — Medicaid Health Alliance: $9.19 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $9.19 Medicaid Illinois — Medicaid Illinois: $9.19 Medicaid Meridian — Medicaid Meridian: $9.19
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: Renal Panel Standard	$62	$37.20	$14.88 – $62
Kidney function panel: 10 of 19 insurance plan rates Aetna — Commercial: $52.70 Aetna — Medicaid: $62 Aetna — Medicare: $14.88 Blue Choice — Commercial: $55.80 Blue Cross Blue Shield — Commercial: $62 Consociate — Commercial: $52.70 Current Health — Commercial: $55.80 Health Alliance — Commercial: $55.18 Healthlink — Commercial: $58.28 HFN — Commercial: $55.80
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: Renal Panel Standard	$62	$37.20	$50.84 – $62
Kidney function panel: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $62 Consociate — Commercial: $52.70 Current Health — Commercial: $55.80 Healthlink — Commercial: $55.80 HFN — Commercial: $55.80 Humana — Commercial: $55.80 Preferred Plan — Commercial: $58.90 Springfield Health — Commercial: $50.84 Trilogy — Commercial: $52.70 United Healthcare — Commercial: $55.80
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Liver Panel	$67	$40.20	$16.08 – $67
Liver function panel: 10 of 19 insurance plan rates Aetna — Commercial: $56.95 Aetna — Medicaid: $67 Aetna — Medicare: $16.08 Blue Choice — Commercial: $60.30 Blue Cross Blue Shield — Commercial: $67 Consociate — Commercial: $56.95 Current Health — Commercial: $60.30 Health Alliance — Commercial: $59.63 Healthlink — Commercial: $62.98 HFN — Commercial: $60.30
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Liver Panel	$67	$40.20	$54.94 – $67
Liver function panel: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $67 Consociate — Commercial: $56.95 Current Health — Commercial: $60.30 Healthlink — Commercial: $60.30 HFN — Commercial: $60.30 Humana — Commercial: $60.30 Preferred Plan — Commercial: $63.65 Springfield Health — Commercial: $54.94 Trilogy — Commercial: $56.95 United Healthcare — Commercial: $60.30
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic function panel	Not listed in the file	Not listed in the file	$9.19
Liver function panel: 10 of 18 insurance plan rates Aetna — Medicare: $8.17 Health Alliance — Medicare: $8.17 Humana — Medicare: $8.17 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $9.19 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $9.19 Medicaid Countycare Claims — Medicaid Countycare Claims: $9.19 Medicaid Health Alliance — Medicaid Health Alliance: $9.19 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $9.19 Medicaid Illinois — Medicaid Illinois: $9.19 Medicaid Meridian — Medicaid Meridian: $9.19
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$3.06
Urine test (automated, with microscope): 10 of 18 insurance plan rates Aetna — Medicare: $3.17 Health Alliance — Medicare: $3.17 Humana — Medicare: $3.17 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $3.06 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $3.06 Medicaid Countycare Claims — Medicaid Countycare Claims: $3.06 Medicaid Health Alliance — Medicaid Health Alliance: $3.06 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $3.06 Medicaid Illinois — Medicaid Illinois: $3.06 Medicaid Meridian — Medicaid Meridian: $3.06
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$1.90 – $3.17
Urine test (automated, with microscope): 10 of 14 insurance plan rates Aetna — Medicaid: $3.17 Aetna — Medicare: $3.17 Health Alliance — Commercial: $1.90 Health Alliance — Medicare: $3.17 HFN — Commercial: $2.85 Humana — Medicare: $3.17 Medicaid — Medicaid Illinois: $3.17 Medicare — Medicare: $3.17 Meridian — Medicaid Illinois: $3.17 Molina — Medicaid Illinois: $3.17
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: Urinalysis Microscopic Standard	$29	$20	$6.96 – $29
Urine test (automated, with microscope): 10 of 19 insurance plan rates Aetna — Commercial: $24.65 Aetna — Medicaid: $29 Aetna — Medicare: $6.96 Blue Choice — Commercial: $26.10 Blue Cross Blue Shield — Commercial: $29 Consociate — Commercial: $24.65 Current Health — Commercial: $26.10 Health Alliance — Commercial: $25.81 Healthlink — Commercial: $27.26 HFN — Commercial: $26.10
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urine Dipstick POC	$24	$14.40	$5.76 – $24
Urine test (manual, without microscope): 10 of 19 insurance plan rates Aetna — Commercial: $20.40 Aetna — Medicaid: $24 Aetna — Medicare: $5.76 Blue Choice — Commercial: $21.60 Blue Cross Blue Shield — Commercial: $24 Consociate — Commercial: $20.40 Current Health — Commercial: $21.60 Health Alliance — Commercial: $21.36 Healthlink — Commercial: $22.56 HFN — Commercial: $21.60
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Dipstick Standard	$24	$10	$5.76 – $24
Urine test (manual, without microscope): 10 of 19 insurance plan rates Aetna — Commercial: $20.40 Aetna — Medicaid: $24 Aetna — Medicare: $5.76 Blue Choice — Commercial: $21.60 Blue Cross Blue Shield — Commercial: $24 Consociate — Commercial: $20.40 Current Health — Commercial: $21.60 Health Alliance — Commercial: $21.36 Healthlink — Commercial: $22.56 HFN — Commercial: $21.60
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UA w Culture if Ind	$24	$14.40	$5.76 – $24
Urine test (manual, without microscope): 10 of 19 insurance plan rates Aetna — Commercial: $20.40 Aetna — Medicaid: $24 Aetna — Medicare: $5.76 Blue Choice — Commercial: $21.60 Blue Cross Blue Shield — Commercial: $24 Consociate — Commercial: $20.40 Current Health — Commercial: $21.60 Health Alliance — Commercial: $21.36 Healthlink — Commercial: $22.56 HFN — Commercial: $21.60
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/o scope	Not listed in the file	Not listed in the file	$3.06
Urine test (automated, without microscope): 10 of 18 insurance plan rates Aetna — Medicare: $2.25 Health Alliance — Medicare: $2.25 Humana — Medicare: $2.25 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $3.06 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $3.06 Medicaid Countycare Claims — Medicaid Countycare Claims: $3.06 Medicaid Health Alliance — Medicaid Health Alliance: $3.06 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $3.06 Medicaid Illinois — Medicaid Illinois: $3.06 Medicaid Meridian — Medicaid Meridian: $3.06
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 90\|TC In the file: Kidney Stone Urine/Saturation LC	$219	$131.40	$52.56 – $219
Urine test (automated, without microscope): 10 of 19 insurance plan rates Aetna — Commercial: $186.15 Aetna — Medicaid: $219 Aetna — Medicare: $52.56 Blue Choice — Commercial: $197.10 Blue Cross Blue Shield — Commercial: $219 Consociate — Commercial: $186.15 Current Health — Commercial: $197.10 Health Alliance — Commercial: $194.91 Healthlink — Commercial: $205.86 HFN — Commercial: $197.10
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 90\|TC In the file: Kidney Stone Evaluation VI LC	$219	$131.40	$52.56 – $219
Urine test (automated, without microscope): 10 of 19 insurance plan rates Aetna — Commercial: $186.15 Aetna — Medicaid: $219 Aetna — Medicare: $52.56 Blue Choice — Commercial: $197.10 Blue Cross Blue Shield — Commercial: $219 Consociate — Commercial: $186.15 Current Health — Commercial: $197.10 Health Alliance — Commercial: $194.91 Healthlink — Commercial: $205.86 HFN — Commercial: $197.10
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 84153 PSA Total + % Free LC	$134	$80.40	$32.16 – $134
PSA (prostate specific antigen) blood test: 10 of 19 insurance plan rates Aetna — Commercial: $113.90 Aetna — Medicaid: $134 Aetna — Medicare: $32.16 Blue Choice — Commercial: $120.60 Blue Cross Blue Shield — Commercial: $134 Consociate — Commercial: $113.90 Current Health — Commercial: $120.60 Health Alliance — Commercial: $119.26 Healthlink — Commercial: $125.96 HFN — Commercial: $120.60
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 84153 PSA Total + % Free LC	$134	$80.40	$109.88 – $134
PSA (prostate specific antigen) blood test: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $134 Consociate — Commercial: $113.90 Current Health — Commercial: $120.60 Healthlink — Commercial: $120.60 HFN — Commercial: $120.60 Humana — Commercial: $120.60 Preferred Plan — Commercial: $127.30 Springfield Health — Commercial: $109.88 Trilogy — Commercial: $113.90 United Healthcare — Commercial: $120.60
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay of psa total	Not listed in the file	Not listed in the file	$12.17
PSA (prostate specific antigen) blood test: 10 of 18 insurance plan rates Aetna — Medicare: $18.39 Health Alliance — Medicare: $18.39 Humana — Medicare: $18.39 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $12.17 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $12.17 Medicaid Countycare Claims — Medicaid Countycare Claims: $12.17 Medicaid Health Alliance — Medicaid Health Alliance: $12.17 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $12.17 Medicaid Illinois — Medicaid Illinois: $12.17 Medicaid Meridian — Medicaid Meridian: $12.17
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay thyroid stim hormone	Not listed in the file	Not listed in the file	$13.43
Thyroid stimulating hormone (TSH) test: 10 of 18 insurance plan rates Aetna — Medicare: $16.80 Health Alliance — Medicare: $16.80 Humana — Medicare: $16.80 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $13.43 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $13.43 Medicaid Countycare Claims — Medicaid Countycare Claims: $13.43 Medicaid Health Alliance — Medicaid Health Alliance: $13.43 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $13.43 Medicaid Illinois — Medicaid Illinois: $13.43 Medicaid Meridian — Medicaid Meridian: $13.43
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: TSH	$140	$30	$33.60 – $140
Thyroid stimulating hormone (TSH) test: 10 of 19 insurance plan rates Aetna — Commercial: $119 Aetna — Medicaid: $140 Aetna — Medicare: $33.60 Blue Choice — Commercial: $126 Blue Cross Blue Shield — Commercial: $140 Consociate — Commercial: $119 Current Health — Commercial: $126 Health Alliance — Commercial: $124.60 Healthlink — Commercial: $131.60 HFN — Commercial: $126
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: TSH w/ Reflex to FT4	$140	$81.60	$33.60 – $140
Thyroid stimulating hormone (TSH) test: 10 of 19 insurance plan rates Aetna — Commercial: $119 Aetna — Medicaid: $140 Aetna — Medicare: $33.60 Blue Choice — Commercial: $126 Blue Cross Blue Shield — Commercial: $140 Consociate — Commercial: $119 Current Health — Commercial: $126 Health Alliance — Commercial: $124.60 Healthlink — Commercial: $131.60 HFN — Commercial: $126
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Automated Differential Standard	$57	$25	$13.68 – $57
Complete blood count (CBC) with differential: 10 of 19 insurance plan rates Aetna — Commercial: $48.45 Aetna — Medicaid: $57 Aetna — Medicare: $13.68 Blue Choice — Commercial: $51.30 Blue Cross Blue Shield — Commercial: $57 Consociate — Commercial: $48.45 Current Health — Commercial: $51.30 Health Alliance — Commercial: $50.73 Healthlink — Commercial: $53.58 HFN — Commercial: $51.30
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Automated Differential Standard	$57	$25	$46.74 – $57
Complete blood count (CBC) with differential: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $57 Consociate — Commercial: $48.45 Current Health — Commercial: $51.30 Healthlink — Commercial: $51.30 HFN — Commercial: $51.30 Humana — Commercial: $51.30 Preferred Plan — Commercial: $54.15 Springfield Health — Commercial: $46.74 Trilogy — Commercial: $48.45 United Healthcare — Commercial: $51.30
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc w/auto diff wbc	Not listed in the file	Not listed in the file	$6.04
Complete blood count (CBC) with differential: 10 of 18 insurance plan rates Aetna — Medicare: $7.77 Health Alliance — Medicare: $7.77 Humana — Medicare: $7.77 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $6.04 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $6.04 Medicaid Countycare Claims — Medicaid Countycare Claims: $6.04 Medicaid Health Alliance — Medicaid Health Alliance: $6.04 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $6.04 Medicaid Illinois — Medicaid Illinois: $6.04 Medicaid Meridian — Medicaid Meridian: $6.04
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Blood count; complete (CBC) automated	$47	$28.20	$11.28 – $47
Complete blood count (CBC), automated: 10 of 19 insurance plan rates Aetna — Commercial: $39.95 Aetna — Medicaid: $47 Aetna — Medicare: $11.28 Blue Choice — Commercial: $42.30 Blue Cross Blue Shield — Commercial: $47 Consociate — Commercial: $39.95 Current Health — Commercial: $42.30 Health Alliance — Commercial: $41.83 Healthlink — Commercial: $44.18 HFN — Commercial: $42.30
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Blood count; complete (CBC) automated	$47	$28.20	$38.54 – $47
Complete blood count (CBC), automated: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $47 Consociate — Commercial: $39.95 Current Health — Commercial: $42.30 Healthlink — Commercial: $42.30 HFN — Commercial: $42.30 Humana — Commercial: $42.30 Preferred Plan — Commercial: $44.65 Springfield Health — Commercial: $38.54 Trilogy — Commercial: $39.95 United Healthcare — Commercial: $42.30
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc automated	Not listed in the file	Not listed in the file	$6.04
Complete blood count (CBC), automated: 10 of 18 insurance plan rates Aetna — Medicare: $6.47 Health Alliance — Medicare: $6.47 Humana — Medicare: $6.47 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $6.04 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $6.04 Medicaid Countycare Claims — Medicaid Countycare Claims: $6.04 Medicaid Health Alliance — Medicaid Health Alliance: $6.04 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $6.04 Medicaid Illinois — Medicaid Illinois: $6.04 Medicaid Meridian — Medicaid Meridian: $6.04
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin time	Not listed in the file	Not listed in the file	$4.51
Blood clotting time test (prothrombin time, PT): 10 of 18 insurance plan rates Aetna — Medicare: $4.29 Health Alliance — Medicare: $4.29 Humana — Medicare: $4.29 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $4.51 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $4.51 Medicaid Countycare Claims — Medicaid Countycare Claims: $4.51 Medicaid Health Alliance — Medicaid Health Alliance: $4.51 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $4.51 Medicaid Illinois — Medicaid Illinois: $4.51 Medicaid Meridian — Medicaid Meridian: $4.51
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: PT	$31	$35	$7.44 – $31
Blood clotting time test (prothrombin time, PT): 10 of 19 insurance plan rates Aetna — Commercial: $26.35 Aetna — Medicaid: $31 Aetna — Medicare: $7.44 Blue Choice — Commercial: $27.90 Blue Cross Blue Shield — Commercial: $31 Consociate — Commercial: $26.35 Current Health — Commercial: $27.90 Health Alliance — Commercial: $27.59 Healthlink — Commercial: $29.14 HFN — Commercial: $27.90
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: Prothrombin Time	$31	$18.60	$7.44 – $31
Blood clotting time test (prothrombin time, PT): 10 of 19 insurance plan rates Aetna — Commercial: $26.35 Aetna — Medicaid: $31 Aetna — Medicare: $7.44 Blue Choice — Commercial: $27.90 Blue Cross Blue Shield — Commercial: $31 Consociate — Commercial: $26.35 Current Health — Commercial: $27.90 Health Alliance — Commercial: $27.59 Healthlink — Commercial: $29.14 HFN — Commercial: $27.90
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: APTT	$45	$27	$10.80 – $45
Blood clotting test (partial thromboplastin time, PTT): 10 of 19 insurance plan rates Aetna — Commercial: $38.25 Aetna — Medicaid: $45 Aetna — Medicare: $10.80 Blue Choice — Commercial: $40.50 Blue Cross Blue Shield — Commercial: $45 Consociate — Commercial: $38.25 Current Health — Commercial: $40.50 Health Alliance — Commercial: $40.05 Healthlink — Commercial: $42.30 HFN — Commercial: $40.50
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: APTT	$45	$27	$36.90 – $45
Blood clotting test (partial thromboplastin time, PTT): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $45 Consociate — Commercial: $38.25 Current Health — Commercial: $40.50 Healthlink — Commercial: $40.50 HFN — Commercial: $40.50 Humana — Commercial: $40.50 Preferred Plan — Commercial: $42.75 Springfield Health — Commercial: $36.90 Trilogy — Commercial: $38.25 United Healthcare — Commercial: $40.50
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin time partial	Not listed in the file	Not listed in the file	$4.51
Blood clotting test (partial thromboplastin time, PTT): 10 of 18 insurance plan rates Aetna — Medicare: $6.01 Health Alliance — Medicare: $6.01 Humana — Medicare: $6.01 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $4.51 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $4.51 Medicaid Countycare Claims — Medicaid Countycare Claims: $4.51 Medicaid Health Alliance — Medicaid Health Alliance: $4.51 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $4.51 Medicaid Illinois — Medicaid Illinois: $4.51 Medicaid Meridian — Medicaid Meridian: $4.51

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct head/brain w/o dye	Not listed in the file	Not listed in the file	$381.53
CT scan of the head or brain, without contrast: 10 of 18 insurance plan rates Aetna — Medicare: $118.72 Health Alliance — Medicare: $118.72 Humana — Medicare: $118.72 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $381.53 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $381.53 Medicaid Countycare Claims — Medicaid Countycare Claims: $381.53 Medicaid Health Alliance — Medicaid Health Alliance: $381.53 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $381.53 Medicaid Illinois — Medicaid Illinois: $381.53 Medicaid Meridian — Medicaid Meridian: $381.53
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CT Head or Brain w/o Contrast - Report	$294	$176.40	$70.56 – $294
CT scan of the head or brain, without contrast: 10 of 19 insurance plan rates Aetna — Commercial: $249.90 Aetna — Medicaid: $294 Aetna — Medicare: $70.56 Blue Choice — Commercial: $264.60 Blue Cross Blue Shield — Commercial: $294 Consociate — Commercial: $249.90 Current Health — Commercial: $264.60 Health Alliance — Commercial: $261.66 Healthlink — Commercial: $276.36 HFN — Commercial: $264.60
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CT Brain for Stroke - Report	$294	$176.40	$70.56 – $294
CT scan of the head or brain, without contrast: 10 of 19 insurance plan rates Aetna — Commercial: $249.90 Aetna — Medicaid: $294 Aetna — Medicare: $70.56 Blue Choice — Commercial: $264.60 Blue Cross Blue Shield — Commercial: $294 Consociate — Commercial: $249.90 Current Health — Commercial: $264.60 Health Alliance — Commercial: $261.66 Healthlink — Commercial: $276.36 HFN — Commercial: $264.60
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri brain stem w/o & w/dye	Not listed in the file	Not listed in the file	$510.96
MRI of the brain, before and after contrast: 10 of 18 insurance plan rates Aetna — Medicare: $398.71 Health Alliance — Medicare: $398.71 Humana — Medicare: $398.71 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $510.96 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $510.96 Medicaid Countycare Claims — Medicaid Countycare Claims: $510.96 Medicaid Health Alliance — Medicaid Health Alliance: $510.96 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $510.96 Medicaid Illinois — Medicaid Illinois: $510.96 Medicaid Meridian — Medicaid Meridian: $510.96
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: MRI Brain w/ + w/o Contrast - Report	$673	$403.80	$161.52 – $673
MRI of the brain, before and after contrast: 10 of 19 insurance plan rates Aetna — Commercial: $572.05 Aetna — Medicaid: $673 Aetna — Medicare: $161.52 Blue Choice — Commercial: $605.70 Blue Cross Blue Shield — Commercial: $673 Consociate — Commercial: $572.05 Current Health — Commercial: $605.70 Health Alliance — Commercial: $598.97 Healthlink — Commercial: $632.62 HFN — Commercial: $605.70
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: MRI Pituitary/IAC w/ and w/o Contrast - Report	$673	$403.80	$161.52 – $673
MRI of the brain, before and after contrast: 10 of 19 insurance plan rates Aetna — Commercial: $572.05 Aetna — Medicaid: $673 Aetna — Medicare: $161.52 Blue Choice — Commercial: $605.70 Blue Cross Blue Shield — Commercial: $673 Consociate — Commercial: $572.05 Current Health — Commercial: $605.70 Health Alliance — Commercial: $598.97 Healthlink — Commercial: $632.62 HFN — Commercial: $605.70
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam chest 2 views	Not listed in the file	Not listed in the file	$70.48
Chest X-ray, 2 views: 10 of 18 insurance plan rates Aetna — Medicare: $98.30 Health Alliance — Medicare: $98.30 Humana — Medicare: $98.30 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $70.48 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $70.48 Medicaid Countycare Claims — Medicaid Countycare Claims: $70.48 Medicaid Health Alliance — Medicaid Health Alliance: $70.48 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $70.48 Medicaid Illinois — Medicaid Illinois: $70.48 Medicaid Meridian — Medicaid Meridian: $70.48
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: XR Chest 2 Views - Report	$59	$35.40	$14.16 – $59
Chest X-ray, 2 views: 10 of 19 insurance plan rates Aetna — Commercial: $50.15 Aetna — Medicaid: $59 Aetna — Medicare: $14.16 Blue Choice — Commercial: $53.10 Blue Cross Blue Shield — Commercial: $59 Consociate — Commercial: $50.15 Current Health — Commercial: $53.10 Health Alliance — Commercial: $52.51 Healthlink — Commercial: $55.46 HFN — Commercial: $53.10
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: XR PICC Line w/ Fluoro - Report	$59	$35.40	$14.16 – $59
Chest X-ray, 2 views: 10 of 19 insurance plan rates Aetna — Commercial: $50.15 Aetna — Medicaid: $59 Aetna — Medicare: $14.16 Blue Choice — Commercial: $53.10 Blue Cross Blue Shield — Commercial: $59 Consociate — Commercial: $50.15 Current Health — Commercial: $53.10 Health Alliance — Commercial: $52.51 Healthlink — Commercial: $55.46 HFN — Commercial: $53.10
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam l-2 spine 4/>vws	Not listed in the file	Not listed in the file	$70.48
X-ray of the lower spine, at least 4 views: 10 of 18 insurance plan rates Aetna — Medicare: $118.72 Health Alliance — Medicare: $118.72 Humana — Medicare: $118.72 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $70.48 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $70.48 Medicaid Countycare Claims — Medicaid Countycare Claims: $70.48 Medicaid Health Alliance — Medicaid Health Alliance: $70.48 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $70.48 Medicaid Illinois — Medicaid Illinois: $70.48 Medicaid Meridian — Medicaid Meridian: $70.48
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: XR Spine Lumbosacral Min 4 Views - Report	$107	$64.20	$25.68 – $107
X-ray of the lower spine, at least 4 views: 10 of 19 insurance plan rates Aetna — Commercial: $90.95 Aetna — Medicaid: $107 Aetna — Medicare: $25.68 Blue Choice — Commercial: $96.30 Blue Cross Blue Shield — Commercial: $107 Consociate — Commercial: $90.95 Current Health — Commercial: $96.30 Health Alliance — Commercial: $95.23 Healthlink — Commercial: $100.58 HFN — Commercial: $96.30
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: XR Spine Lumbosacral Minimum 4 Views	$646	$387.60	$155.04 – $646
X-ray of the lower spine, at least 4 views: 10 of 19 insurance plan rates Aetna — Commercial: $549.10 Aetna — Medicaid: $646 Aetna — Medicare: $155.04 Blue Choice — Commercial: $581.40 Blue Cross Blue Shield — Commercial: $646 Consociate — Commercial: $549.10 Current Health — Commercial: $581.40 Health Alliance — Commercial: $574.94 Healthlink — Commercial: $607.24 HFN — Commercial: $581.40
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri lumbar spine w/o dye	Not listed in the file	Not listed in the file	$302.84
MRI of the lower back (lumbar spine), without contrast: 10 of 18 insurance plan rates Aetna — Medicare: $269.86 Health Alliance — Medicare: $269.86 Humana — Medicare: $269.86 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $302.84 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $302.84 Medicaid Countycare Claims — Medicaid Countycare Claims: $302.84 Medicaid Health Alliance — Medicaid Health Alliance: $302.84 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $302.84 Medicaid Illinois — Medicaid Illinois: $302.84 Medicaid Meridian — Medicaid Meridian: $302.84
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: MRI Spine Lumbar w/o Contrast - Report	$478	$286.80	$114.72 – $478
MRI of the lower back (lumbar spine), without contrast: 10 of 19 insurance plan rates Aetna — Commercial: $406.30 Aetna — Medicaid: $478 Aetna — Medicare: $114.72 Blue Choice — Commercial: $430.20 Blue Cross Blue Shield — Commercial: $478 Consociate — Commercial: $406.30 Current Health — Commercial: $430.20 Health Alliance — Commercial: $425.42 Healthlink — Commercial: $449.32 HFN — Commercial: $430.20
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI Spine Lumbar w/o Contrast	$3,910	$2,346	$938.40 – $3,910
MRI of the lower back (lumbar spine), without contrast: 10 of 19 insurance plan rates Aetna — Commercial: $3,323.50 Aetna — Medicaid: $3,910 Aetna — Medicare: $938.40 Blue Choice — Commercial: $3,519 Blue Cross Blue Shield — Commercial: $3,910 Consociate — Commercial: $3,323.50 Current Health — Commercial: $3,519 Health Alliance — Commercial: $3,479.90 Healthlink — Commercial: $3,675.40 HFN — Commercial: $3,519
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct pelvis w/dye	Not listed in the file	Not listed in the file	$381.53
CT scan of the pelvis, with contrast: 10 of 18 insurance plan rates Aetna — Medicare: $198.74 Health Alliance — Medicare: $198.74 Humana — Medicare: $198.74 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $381.53 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $381.53 Medicaid Countycare Claims — Medicaid Countycare Claims: $381.53 Medicaid Health Alliance — Medicaid Health Alliance: $381.53 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $381.53 Medicaid Illinois — Medicaid Illinois: $381.53 Medicaid Meridian — Medicaid Meridian: $381.53
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CT Pelvis w/ Contrast - Report	$347	$208.20	$83.28 – $347
CT scan of the pelvis, with contrast: 10 of 19 insurance plan rates Aetna — Commercial: $294.95 Aetna — Medicaid: $347 Aetna — Medicare: $83.28 Blue Choice — Commercial: $312.30 Blue Cross Blue Shield — Commercial: $347 Consociate — Commercial: $294.95 Current Health — Commercial: $312.30 Health Alliance — Commercial: $308.83 Healthlink — Commercial: $326.18 HFN — Commercial: $312.30
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT Pelvis w/ Contrast	$3,140	$1,884	$753.60 – $3,140
CT scan of the pelvis, with contrast: 10 of 19 insurance plan rates Aetna — Commercial: $2,669 Aetna — Medicaid: $3,140 Aetna — Medicare: $753.60 Blue Choice — Commercial: $2,826 Blue Cross Blue Shield — Commercial: $3,140 Consociate — Commercial: $2,669 Current Health — Commercial: $2,826 Health Alliance — Commercial: $2,794.60 Healthlink — Commercial: $2,951.60 HFN — Commercial: $2,826
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	Not listed in the file	$302.84
MRI of a leg joint (such as the knee), without contrast: 10 of 18 insurance plan rates Aetna — Medicare: $269.86 Health Alliance — Medicare: $269.86 Humana — Medicare: $269.86 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $302.84 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $302.84 Medicaid Countycare Claims — Medicaid Countycare Claims: $302.84 Medicaid Health Alliance — Medicaid Health Alliance: $302.84 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $302.84 Medicaid Illinois — Medicaid Illinois: $302.84 Medicaid Meridian — Medicaid Meridian: $302.84
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier LT\|26 In the file: MRI Ankle w/o Contrast Left - Report	$380	$228	$91.20 – $380
MRI of a leg joint (such as the knee), without contrast: 10 of 19 insurance plan rates Aetna — Commercial: $323 Aetna — Medicaid: $380 Aetna — Medicare: $91.20 Blue Choice — Commercial: $342 Blue Cross Blue Shield — Commercial: $380 Consociate — Commercial: $323 Current Health — Commercial: $342 Health Alliance — Commercial: $338.20 Healthlink — Commercial: $357.20 HFN — Commercial: $342
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier RT\|26 In the file: MRI Ankle w/o Contrast Right - Report	$380	$228	$91.20 – $380
MRI of a leg joint (such as the knee), without contrast: 10 of 19 insurance plan rates Aetna — Commercial: $323 Aetna — Medicaid: $380 Aetna — Medicare: $91.20 Blue Choice — Commercial: $342 Blue Cross Blue Shield — Commercial: $380 Consociate — Commercial: $323 Current Health — Commercial: $342 Health Alliance — Commercial: $338.20 Healthlink — Commercial: $357.20 HFN — Commercial: $342
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct abd & pelvis w/contrast	Not listed in the file	Not listed in the file	$381.53
CT scan of the abdomen and pelvis, with contrast: 10 of 18 insurance plan rates Aetna — Medicare: $398.71 Health Alliance — Medicare: $398.71 Humana — Medicare: $398.71 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $381.53 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $381.53 Medicaid Countycare Claims — Medicaid Countycare Claims: $381.53 Medicaid Health Alliance — Medicaid Health Alliance: $381.53 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $381.53 Medicaid Illinois — Medicaid Illinois: $381.53 Medicaid Meridian — Medicaid Meridian: $381.53
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CT Abdomen/Pelvis w/ Cont ProFee	$647	$388.20	$155.28 – $647
CT scan of the abdomen and pelvis, with contrast: 10 of 19 insurance plan rates Aetna — Commercial: $549.95 Aetna — Medicaid: $647 Aetna — Medicare: $155.28 Blue Choice — Commercial: $582.30 Blue Cross Blue Shield — Commercial: $647 Consociate — Commercial: $549.95 Current Health — Commercial: $582.30 Health Alliance — Commercial: $575.83 Healthlink — Commercial: $608.18 HFN — Commercial: $582.30
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: CT Abdomen/Pelvis w/ Contrast - Report	$647	$388.20	$155.28 – $647
CT scan of the abdomen and pelvis, with contrast: 10 of 19 insurance plan rates Aetna — Commercial: $549.95 Aetna — Medicaid: $647 Aetna — Medicare: $155.28 Blue Choice — Commercial: $582.30 Blue Cross Blue Shield — Commercial: $647 Consociate — Commercial: $549.95 Current Health — Commercial: $582.30 Health Alliance — Commercial: $575.83 Healthlink — Commercial: $608.18 HFN — Commercial: $582.30
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Us exam abdom complete	Not listed in the file	Not listed in the file	$211.36
Ultrasound of the abdomen, complete: 10 of 18 insurance plan rates Aetna — Medicare: $118.72 Health Alliance — Medicare: $118.72 Humana — Medicare: $118.72 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $211.36 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $211.36 Medicaid Countycare Claims — Medicaid Countycare Claims: $211.36 Medicaid Health Alliance — Medicaid Health Alliance: $211.36 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $211.36 Medicaid Illinois — Medicaid Illinois: $211.36 Medicaid Meridian — Medicaid Meridian: $211.36
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: US Abdomen Complete - Report	$231	$138.60	$55.44 – $231
Ultrasound of the abdomen, complete: 10 of 19 insurance plan rates Aetna — Commercial: $196.35 Aetna — Medicaid: $231 Aetna — Medicare: $55.44 Blue Choice — Commercial: $207.90 Blue Cross Blue Shield — Commercial: $231 Consociate — Commercial: $196.35 Current Health — Commercial: $207.90 Health Alliance — Commercial: $205.59 Healthlink — Commercial: $217.14 HFN — Commercial: $207.90
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US Abdomen Complete	$1,145	$687	$274.80 – $1,145
Ultrasound of the abdomen, complete: 10 of 19 insurance plan rates Aetna — Commercial: $973.25 Aetna — Medicaid: $1,145 Aetna — Medicare: $274.80 Blue Choice — Commercial: $1,030.50 Blue Cross Blue Shield — Commercial: $1,145 Consociate — Commercial: $973.25 Current Health — Commercial: $1,030.50 Health Alliance — Commercial: $1,019.05 Healthlink — Commercial: $1,076.30 HFN — Commercial: $1,030.50
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OB US >14 WKS SINGLE Charge	$1,145	$687	$274.80 – $1,145
Pregnancy ultrasound (after the first trimester): 10 of 19 insurance plan rates Aetna — Commercial: $973.25 Aetna — Medicaid: $1,145 Aetna — Medicare: $274.80 Blue Choice — Commercial: $1,030.50 Blue Cross Blue Shield — Commercial: $1,145 Consociate — Commercial: $973.25 Current Health — Commercial: $1,030.50 Health Alliance — Commercial: $1,019.05 Healthlink — Commercial: $1,076.30 HFN — Commercial: $1,030.50
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OB US >14 WKS SINGLE Charge	$1,145	$687	$938.90 – $1,145
Pregnancy ultrasound (after the first trimester): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $1,145 Consociate — Commercial: $973.25 Current Health — Commercial: $1,030.50 Healthlink — Commercial: $1,030.50 HFN — Commercial: $1,030.50 Humana — Commercial: $1,030.50 Preferred Plan — Commercial: $1,087.75 Springfield Health — Commercial: $938.90 Trilogy — Commercial: $973.25 United Healthcare — Commercial: $1,030.50
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ob us >= 14 wks sngl fetus	Not listed in the file	Not listed in the file	$126.37
Pregnancy ultrasound (after the first trimester): 10 of 18 insurance plan rates Aetna — Medicare: $118.72 Health Alliance — Medicare: $118.72 Humana — Medicare: $118.72 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $126.37 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $126.37 Medicaid Countycare Claims — Medicaid Countycare Claims: $126.37 Medicaid Health Alliance — Medicaid Health Alliance: $126.37 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $126.37 Medicaid Illinois — Medicaid Illinois: $126.37 Medicaid Meridian — Medicaid Meridian: $126.37
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Transvaginal us non-ob	Not listed in the file	Not listed in the file	$137.18
Transvaginal ultrasound: 10 of 18 insurance plan rates Aetna — Medicare: $118.72 Health Alliance — Medicare: $118.72 Humana — Medicare: $118.72 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $137.18 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $137.18 Medicaid Countycare Claims — Medicaid Countycare Claims: $137.18 Medicaid Health Alliance — Medicaid Health Alliance: $137.18 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $137.18 Medicaid Illinois — Medicaid Illinois: $137.18 Medicaid Meridian — Medicaid Meridian: $137.18
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: US Non-OB Transvaginal Report	$217	$130.20	$52.08 – $217
Transvaginal ultrasound: 10 of 19 insurance plan rates Aetna — Commercial: $184.45 Aetna — Medicaid: $217 Aetna — Medicare: $52.08 Blue Choice — Commercial: $195.30 Blue Cross Blue Shield — Commercial: $217 Consociate — Commercial: $184.45 Current Health — Commercial: $195.30 Health Alliance — Commercial: $193.13 Healthlink — Commercial: $203.98 HFN — Commercial: $195.30
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: US Pelvic Transvaginal Only - Report	$217	$130.20	$52.08 – $217
Transvaginal ultrasound: 10 of 19 insurance plan rates Aetna — Commercial: $184.45 Aetna — Medicaid: $217 Aetna — Medicare: $52.08 Blue Choice — Commercial: $195.30 Blue Cross Blue Shield — Commercial: $217 Consociate — Commercial: $184.45 Current Health — Commercial: $195.30 Health Alliance — Commercial: $193.13 Healthlink — Commercial: $203.98 HFN — Commercial: $195.30
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$59.94
Diagnostic mammogram, one breast: 10 of 18 insurance plan rates Aetna — Medicare: $77.89 Health Alliance — Medicare: $77.89 Humana — Medicare: $77.89 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $59.94 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $59.94 Medicaid Countycare Claims — Medicaid Countycare Claims: $59.94 Medicaid Health Alliance — Medicaid Health Alliance: $59.94 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $59.94 Medicaid Illinois — Medicaid Illinois: $59.94 Medicaid Meridian — Medicaid Meridian: $59.94
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier LT\|26 In the file: MA Mammogram Digital Diagnostic Left. - Report	$109	$65.40	$26.16 – $109
Diagnostic mammogram, one breast: 10 of 19 insurance plan rates Aetna — Commercial: $92.65 Aetna — Medicaid: $109 Aetna — Medicare: $26.16 Blue Choice — Commercial: $98.10 Blue Cross Blue Shield — Commercial: $109 Consociate — Commercial: $92.65 Current Health — Commercial: $98.10 Health Alliance — Commercial: $97.01 Healthlink — Commercial: $102.46 HFN — Commercial: $98.10
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier RT\|26 In the file: MA Mammogram Digital Diagnostic Right. - Report	$109	$65.40	$26.16 – $109
Diagnostic mammogram, one breast: 10 of 19 insurance plan rates Aetna — Commercial: $92.65 Aetna — Medicaid: $109 Aetna — Medicare: $26.16 Blue Choice — Commercial: $98.10 Blue Cross Blue Shield — Commercial: $109 Consociate — Commercial: $92.65 Current Health — Commercial: $98.10 Health Alliance — Commercial: $97.01 Healthlink — Commercial: $102.46 HFN — Commercial: $98.10
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad bi	Not listed in the file	Not listed in the file	$59.94
Diagnostic mammogram, both breasts: 10 of 18 insurance plan rates Aetna — Medicare: $99.13 Health Alliance — Medicare: $99.13 Humana — Medicare: $99.13 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $59.94 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $59.94 Medicaid Countycare Claims — Medicaid Countycare Claims: $59.94 Medicaid Health Alliance — Medicaid Health Alliance: $59.94 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $59.94 Medicaid Illinois — Medicaid Illinois: $59.94 Medicaid Meridian — Medicaid Meridian: $59.94
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: MA Mammogram Digital Diagnostic Bilat. - Report	$185	$111	$44.40 – $185
Diagnostic mammogram, both breasts: 10 of 19 insurance plan rates Aetna — Commercial: $157.25 Aetna — Medicaid: $185 Aetna — Medicare: $44.40 Blue Choice — Commercial: $166.50 Blue Cross Blue Shield — Commercial: $185 Consociate — Commercial: $157.25 Current Health — Commercial: $166.50 Health Alliance — Commercial: $164.65 Healthlink — Commercial: $173.90 HFN — Commercial: $166.50
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: MA Mammogram Diagnostic Bilat w/ Tomo. - Report	$185	$111	$44.40 – $185
Diagnostic mammogram, both breasts: 10 of 19 insurance plan rates Aetna — Commercial: $157.25 Aetna — Medicaid: $185 Aetna — Medicare: $44.40 Blue Choice — Commercial: $166.50 Blue Cross Blue Shield — Commercial: $185 Consociate — Commercial: $157.25 Current Health — Commercial: $166.50 Health Alliance — Commercial: $164.65 Healthlink — Commercial: $173.90 HFN — Commercial: $166.50
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Scr mammo bi incl cad	Not listed in the file	Not listed in the file	$59.94
Screening mammogram, both breasts: 10 of 18 insurance plan rates Aetna — Medicare: $81.87 Health Alliance — Medicare: $81.87 Humana — Medicare: $81.87 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $59.94 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $59.94 Medicaid Countycare Claims — Medicaid Countycare Claims: $59.94 Medicaid Health Alliance — Medicaid Health Alliance: $59.94 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $59.94 Medicaid Illinois — Medicaid Illinois: $59.94 Medicaid Meridian — Medicaid Meridian: $59.94
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26\|52 In the file: MA Mammogram Screening Left w/ Tomo. - Report	$113	$67.80	$27.12 – $113
Screening mammogram, both breasts: 10 of 19 insurance plan rates Aetna — Commercial: $96.05 Aetna — Medicaid: $113 Aetna — Medicare: $27.12 Blue Choice — Commercial: $101.70 Blue Cross Blue Shield — Commercial: $113 Consociate — Commercial: $96.05 Current Health — Commercial: $101.70 Health Alliance — Commercial: $100.57 Healthlink — Commercial: $106.22 HFN — Commercial: $101.70
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26\|52 In the file: MA Mammogram Screening Right w/ Tomo. - Report	$113	$67.80	$27.12 – $113
Screening mammogram, both breasts: 10 of 19 insurance plan rates Aetna — Commercial: $96.05 Aetna — Medicaid: $113 Aetna — Medicare: $27.12 Blue Choice — Commercial: $101.70 Blue Cross Blue Shield — Commercial: $113 Consociate — Commercial: $96.05 Current Health — Commercial: $101.70 Health Alliance — Commercial: $100.57 Healthlink — Commercial: $106.22 HFN — Commercial: $101.70

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Electrocardiogram complete	Not listed in the file	Not listed in the file	$8.08 – $13.47
Electrocardiogram (ECG/EKG) with reading: 10 of 14 insurance plan rates Aetna — Medicaid: $13.47 Aetna — Medicare: $13.47 Health Alliance — Commercial: $8.08 Health Alliance — Medicare: $13.47 HFN — Commercial: $12.65 Humana — Medicare: $13.47 Medicaid — Medicaid Illinois: $13.47 Medicare — Medicare: $13.47 Meridian — Medicaid Illinois: $13.47 Molina — Medicaid Illinois: $13.47
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Electrocardiogram complete	Not listed in the file	Not listed in the file	$32.27
Electrocardiogram (ECG/EKG) with reading: 10 of 11 insurance plan rates Medicaid Aetna Better Health — Medicaid Aetna Better Health: $32.27 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $32.27 Medicaid Countycare Claims — Medicaid Countycare Claims: $32.27 Medicaid Health Alliance — Medicaid Health Alliance: $32.27 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $32.27 Medicaid Illinois — Medicaid Illinois: $32.27 Medicaid Meridian — Medicaid Meridian: $32.27 Medicaid Molina — Medicaid Molina: $32.27 Medicaid Wellcare — Medicaid Wellcare: $32.27 Medicaid Youth Care — Medicaid Youth Care: $32.27
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$3,027.80
Left heart catheterization (diagnostic): 10 of 18 insurance plan rates Aetna — Medicare: $3,590.91 Health Alliance — Medicare: $3,590.91 Humana — Medicare: $3,590.91 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $3,027.80 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $3,027.80 Medicaid Countycare Claims — Medicaid Countycare Claims: $3,027.80 Medicaid Health Alliance — Medicaid Health Alliance: $3,027.80 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $3,027.80 Medicaid Illinois — Medicaid Illinois: $3,027.80 Medicaid Meridian — Medicaid Meridian: $3,027.80
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$137.20 – $228.66
Left heart catheterization (diagnostic): 10 of 14 insurance plan rates Aetna — Medicaid: $228.66 Aetna — Medicare: $228.66 Health Alliance — Commercial: $137.20 Health Alliance — Medicare: $228.66 HFN — Commercial: $211.91 Humana — Medicare: $228.66 Medicaid — Medicaid Illinois: $228.66 Medicare — Medicare: $228.66 Meridian — Medicaid Illinois: $228.66 Molina — Medicaid Illinois: $228.66
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier TC In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$332.59 – $560.64
Left heart catheterization (diagnostic): 10 of 14 insurance plan rates Aetna — Medicaid: $554.32 Aetna — Medicare: $554.32 Health Alliance — Commercial: $332.59 Health Alliance — Medicare: $554.32 HFN — Commercial: $560.64 Humana — Medicare: $554.32 Medicaid — Medicaid Illinois: $554.32 Medicare — Medicare: $554.32 Meridian — Medicaid Illinois: $554.32 Molina — Medicaid Illinois: $554.32
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive ep evaluation	Not listed in the file	Not listed in the file	$7,996.15
Heart rhythm study (electrophysiology evaluation): 10 of 18 insurance plan rates Aetna — Medicare: $8,471.60 Health Alliance — Medicare: $8,471.60 Humana — Medicare: $8,471.60 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $7,996.15 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $7,996.15 Medicaid Countycare Claims — Medicaid Countycare Claims: $7,996.15 Medicaid Health Alliance — Medicaid Health Alliance: $7,996.15 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $7,996.15 Medicaid Illinois — Medicaid Illinois: $7,996.15 Medicaid Meridian — Medicaid Meridian: $7,996.15
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: Comprehensive ep evaluation	Not listed in the file	Not listed in the file	$221.69 – $369.48
Heart rhythm study (electrophysiology evaluation): 10 of 14 insurance plan rates Aetna — Medicaid: $369.48 Aetna — Medicare: $369.48 Health Alliance — Commercial: $221.69 Health Alliance — Medicare: $369.48 HFN — Commercial: $347.42 Humana — Medicare: $369.48 Medicaid — Medicaid Illinois: $369.48 Medicare — Medicare: $369.48 Meridian — Medicaid Illinois: $369.48 Molina — Medicaid Illinois: $369.48
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier TC In the file: Comprehensive ep evaluation	Not listed in the file	Not listed in the file	$183.43 – $305.72
Heart rhythm study (electrophysiology evaluation): 10 of 14 insurance plan rates Aetna — Medicaid: $305.72 Aetna — Medicare: $305.72 Health Alliance — Commercial: $183.43 Health Alliance — Medicare: $305.72 HFN — Commercial: $275.15 Humana — Medicare: $305.72 Medicaid — Medicaid Illinois: $305.72 Medicare — Medicare: $305.72 Meridian — Medicaid Illinois: $305.72 Molina — Medicaid Illinois: $305.72
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Compre ep eval abltj atr fib	Not listed in the file	Not listed in the file	$21,935.79
Heart rhythm study with ablation for atrial fibrillation: 10 of 18 insurance plan rates Aetna — Medicare: $27,388.64 Health Alliance — Medicare: $27,388.64 Humana — Medicare: $27,388.64 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $21,935.79 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $21,935.79 Medicaid Countycare Claims — Medicaid Countycare Claims: $21,935.79 Medicaid Health Alliance — Medicaid Health Alliance: $21,935.79 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $21,935.79 Medicaid Illinois — Medicaid Illinois: $21,935.79 Medicaid Meridian — Medicaid Meridian: $21,935.79
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Compre ep eval abltj atr fib	Not listed in the file	Not listed in the file	$554.36 – $923.93
Heart rhythm study with ablation for atrial fibrillation: 10 of 14 insurance plan rates Aetna — Medicaid: $923.93 Aetna — Medicare: $923.93 Health Alliance — Commercial: $554.36 Health Alliance — Medicare: $923.93 HFN — Commercial: $867.37 Humana — Medicare: $923.93 Medicaid — Medicaid Illinois: $923.93 Medicare — Medicare: $923.93 Meridian — Medicaid Illinois: $923.93 Molina — Medicaid Illinois: $923.93
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Sleep Study	$6,026	$3,615.60	$1,446.24 – $6,026
Sleep study (overnight, in a sleep lab): 10 of 19 insurance plan rates Aetna — Commercial: $5,122.10 Aetna — Medicaid: $6,026 Aetna — Medicare: $1,446.24 Blue Choice — Commercial: $5,423.40 Blue Cross Blue Shield — Commercial: $6,026 Consociate — Commercial: $5,122.10 Current Health — Commercial: $5,423.40 Health Alliance — Commercial: $5,363.14 Healthlink — Commercial: $5,664.44 HFN — Commercial: $5,423.40
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POLYSOMNOGRAPH Charge	$6,026	$3,615.60	$1,446.24 – $6,026
Sleep study (overnight, in a sleep lab): 10 of 19 insurance plan rates Aetna — Commercial: $5,122.10 Aetna — Medicaid: $6,026 Aetna — Medicare: $1,446.24 Blue Choice — Commercial: $5,423.40 Blue Cross Blue Shield — Commercial: $6,026 Consociate — Commercial: $5,122.10 Current Health — Commercial: $5,423.40 Health Alliance — Commercial: $5,363.14 Healthlink — Commercial: $5,664.44 HFN — Commercial: $5,423.40
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 95810 Night One	$6,026	$3,615.60	$1,446.24 – $6,026
Sleep study (overnight, in a sleep lab): 10 of 19 insurance plan rates Aetna — Commercial: $5,122.10 Aetna — Medicaid: $6,026 Aetna — Medicare: $1,446.24 Blue Choice — Commercial: $5,423.40 Blue Cross Blue Shield — Commercial: $6,026 Consociate — Commercial: $5,122.10 Current Health — Commercial: $5,423.40 Health Alliance — Commercial: $5,363.14 Healthlink — Commercial: $5,664.44 HFN — Commercial: $5,423.40

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Therapeutic exercises	Not listed in the file	Not listed in the file	$45.25
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 18 insurance plan rates Aetna — Medicare: $27.69 Health Alliance — Medicare: $27.69 Humana — Medicare: $27.69 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $45.25 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $45.25 Medicaid Countycare Claims — Medicaid Countycare Claims: $45.25 Medicaid Health Alliance — Medicaid Health Alliance: $45.25 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $45.25 Medicaid Illinois — Medicaid Illinois: $45.25 Medicaid Meridian — Medicaid Meridian: $45.25
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Therapeutic exercises	Not listed in the file	Not listed in the file	$16.61 – $27.69
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 14 insurance plan rates Aetna — Medicaid: $27.69 Aetna — Medicare: $27.69 Health Alliance — Commercial: $16.61 Health Alliance — Medicare: $27.69 HFN — Commercial: $25.79 Humana — Medicare: $27.69 Medicaid — Medicaid Illinois: $27.69 Medicare — Medicare: $27.69 Meridian — Medicaid Illinois: $27.69 Molina — Medicaid Illinois: $27.69
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: Therapeutic Exercise Charges	$156	$93.60	$37.44 – $156
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 19 insurance plan rates Aetna — Commercial: $132.60 Aetna — Medicaid: $156 Aetna — Medicare: $37.44 Blue Choice — Commercial: $140.40 Blue Cross Blue Shield — Commercial: $156 Consociate — Commercial: $132.60 Current Health — Commercial: $140.40 Health Alliance — Commercial: $138.84 Healthlink — Commercial: $146.64 HFN — Commercial: $140.40
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$237.86
Physical therapy evaluation (low complexity): 10 of 18 insurance plan rates Aetna — Medicare: $94.38 Health Alliance — Medicare: $94.38 Humana — Medicare: $94.38 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $237.86 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $237.86 Medicaid Countycare Claims — Medicaid Countycare Claims: $237.86 Medicaid Health Alliance — Medicaid Health Alliance: $237.86 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $237.86 Medicaid Illinois — Medicaid Illinois: $237.86 Medicaid Meridian — Medicaid Meridian: $237.86
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$56.63 – $94.38
Physical therapy evaluation (low complexity): 10 of 14 insurance plan rates Aetna — Medicaid: $94.38 Aetna — Medicare: $94.38 Health Alliance — Commercial: $56.63 Health Alliance — Medicare: $94.38 HFN — Commercial: $88.03 Humana — Medicare: $94.38 Medicaid — Medicaid Illinois: $94.38 Medicare — Medicare: $94.38 Meridian — Medicaid Illinois: $94.38 Molina — Medicaid Illinois: $94.38
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP\|95\|GT\|95 In the file: 97161 Telehealth PT Low Complex Units	$224	$134.40	$53.76 – $224
Physical therapy evaluation (low complexity): 10 of 19 insurance plan rates Aetna — Commercial: $190.40 Aetna — Medicaid: $224 Aetna — Medicare: $53.76 Blue Choice — Commercial: $201.60 Blue Cross Blue Shield — Commercial: $224 Consociate — Commercial: $190.40 Current Health — Commercial: $201.60 Health Alliance — Commercial: $199.36 Healthlink — Commercial: $210.56 HFN — Commercial: $201.60
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval mod complex 30 min	Not listed in the file	Not listed in the file	$237.86
Physical therapy evaluation (moderate complexity): 10 of 18 insurance plan rates Aetna — Medicare: $94.38 Health Alliance — Medicare: $94.38 Humana — Medicare: $94.38 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $237.86 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $237.86 Medicaid Countycare Claims — Medicaid Countycare Claims: $237.86 Medicaid Health Alliance — Medicaid Health Alliance: $237.86 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $237.86 Medicaid Illinois — Medicaid Illinois: $237.86 Medicaid Meridian — Medicaid Meridian: $237.86
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval mod complex 30 min	Not listed in the file	Not listed in the file	$56.63 – $94.38
Physical therapy evaluation (moderate complexity): 10 of 14 insurance plan rates Aetna — Medicaid: $94.38 Aetna — Medicare: $94.38 Health Alliance — Commercial: $56.63 Health Alliance — Medicare: $94.38 HFN — Commercial: $88.03 Humana — Medicare: $94.38 Medicaid — Medicaid Illinois: $94.38 Medicare — Medicare: $94.38 Meridian — Medicaid Illinois: $94.38 Molina — Medicaid Illinois: $94.38
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP\|95\|GT\|95 In the file: 97162 Telehealth PT Moderate Complex Units	$342	$205.20	$82.08 – $342
Physical therapy evaluation (moderate complexity): 10 of 19 insurance plan rates Aetna — Commercial: $290.70 Aetna — Medicaid: $342 Aetna — Medicare: $82.08 Blue Choice — Commercial: $307.80 Blue Cross Blue Shield — Commercial: $342 Consociate — Commercial: $290.70 Current Health — Commercial: $307.80 Health Alliance — Commercial: $304.38 Healthlink — Commercial: $321.48 HFN — Commercial: $307.80
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$237.86
Physical therapy evaluation (high complexity): 10 of 18 insurance plan rates Aetna — Medicare: $94.38 Health Alliance — Medicare: $94.38 Humana — Medicare: $94.38 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $237.86 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $237.86 Medicaid Countycare Claims — Medicaid Countycare Claims: $237.86 Medicaid Health Alliance — Medicaid Health Alliance: $237.86 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $237.86 Medicaid Illinois — Medicaid Illinois: $237.86 Medicaid Meridian — Medicaid Meridian: $237.86
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$56.63 – $94.38
Physical therapy evaluation (high complexity): 10 of 14 insurance plan rates Aetna — Medicaid: $94.38 Aetna — Medicare: $94.38 Health Alliance — Commercial: $56.63 Health Alliance — Medicare: $94.38 HFN — Commercial: $88.03 Humana — Medicare: $94.38 Medicaid — Medicaid Illinois: $94.38 Medicare — Medicare: $94.38 Meridian — Medicaid Illinois: $94.38 Molina — Medicaid Illinois: $94.38
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP\|95\|GT\|95 In the file: 97163 Telehealth PT High Complex Units	$394	$236.40	$94.56 – $394
Physical therapy evaluation (high complexity): 10 of 19 insurance plan rates Aetna — Commercial: $334.90 Aetna — Medicaid: $394 Aetna — Medicare: $94.56 Blue Choice — Commercial: $354.60 Blue Cross Blue Shield — Commercial: $394 Consociate — Commercial: $334.90 Current Health — Commercial: $354.60 Health Alliance — Commercial: $350.66 Healthlink — Commercial: $370.36 HFN — Commercial: $354.60
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90832 PSYCHOTHERAPY PT AND/OR FAMILY 30 MIN CHARGE	$313	$187.80	$75.12 – $313
Psychotherapy, 30 minutes: 10 of 19 insurance plan rates Aetna — Commercial: $266.05 Aetna — Medicaid: $313 Aetna — Medicare: $75.12 Blue Choice — Commercial: $281.70 Blue Cross Blue Shield — Commercial: $313 Consociate — Commercial: $266.05 Current Health — Commercial: $281.70 Health Alliance — Commercial: $278.57 Healthlink — Commercial: $294.22 HFN — Commercial: $281.70
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 90832 PSYCHOTHERAPY PT AND/OR FAMILY 30 MIN CHARGE	$313	$187.80	$256.66 – $313
Psychotherapy, 30 minutes: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $313 Consociate — Commercial: $266.05 Current Health — Commercial: $281.70 Healthlink — Commercial: $281.70 HFN — Commercial: $281.70 Humana — Commercial: $281.70 Preferred Plan — Commercial: $297.35 Springfield Health — Commercial: $256.66 Trilogy — Commercial: $266.05 United Healthcare — Commercial: $281.70
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 30 minutes	Not listed in the file	Not listed in the file	$162.33
Psychotherapy, 30 minutes: 10 of 18 insurance plan rates Aetna — Medicare: $179.38 Health Alliance — Medicare: $179.38 Humana — Medicare: $179.38 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $162.33 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $162.33 Medicaid Countycare Claims — Medicaid Countycare Claims: $162.33 Medicaid Health Alliance — Medicaid Health Alliance: $162.33 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $162.33 Medicaid Illinois — Medicaid Illinois: $162.33 Medicaid Meridian — Medicaid Meridian: $162.33
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90834 PSYCHOTHERAPY PT AND/OR FAMILY 45 MIN CHARGE	$313	$187.80	$75.12 – $313
Psychotherapy, 45 minutes: 10 of 19 insurance plan rates Aetna — Commercial: $266.05 Aetna — Medicaid: $313 Aetna — Medicare: $75.12 Blue Choice — Commercial: $281.70 Blue Cross Blue Shield — Commercial: $313 Consociate — Commercial: $266.05 Current Health — Commercial: $281.70 Health Alliance — Commercial: $278.57 Healthlink — Commercial: $294.22 HFN — Commercial: $281.70
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 90834 PSYCHOTHERAPY PT AND/OR FAMILY 45 MIN CHARGE	$313	$187.80	$256.66 – $313
Psychotherapy, 45 minutes: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $313 Consociate — Commercial: $266.05 Current Health — Commercial: $281.70 Healthlink — Commercial: $281.70 HFN — Commercial: $281.70 Humana — Commercial: $281.70 Preferred Plan — Commercial: $297.35 Springfield Health — Commercial: $256.66 Trilogy — Commercial: $266.05 United Healthcare — Commercial: $281.70
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 45 minutes	Not listed in the file	Not listed in the file	$193.96
Psychotherapy, 45 minutes: 10 of 18 insurance plan rates Aetna — Medicare: $179.38 Health Alliance — Medicare: $179.38 Humana — Medicare: $179.38 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $193.96 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $193.96 Medicaid Countycare Claims — Medicaid Countycare Claims: $193.96 Medicaid Health Alliance — Medicaid Health Alliance: $193.96 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $193.96 Medicaid Illinois — Medicaid Illinois: $193.96 Medicaid Meridian — Medicaid Meridian: $193.96
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90837 PSYCHOTHERAPY PT AND/OR FAMILY 60 MIN CHARGE	$313	$187.80	$75.12 – $313
Psychotherapy, 60 minutes: 10 of 19 insurance plan rates Aetna — Commercial: $266.05 Aetna — Medicaid: $313 Aetna — Medicare: $75.12 Blue Choice — Commercial: $281.70 Blue Cross Blue Shield — Commercial: $313 Consociate — Commercial: $266.05 Current Health — Commercial: $281.70 Health Alliance — Commercial: $278.57 Healthlink — Commercial: $294.22 HFN — Commercial: $281.70
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 90837 PSYCHOTHERAPY PT AND/OR FAMILY 60 MIN CHARGE	$313	$187.80	$256.66 – $313
Psychotherapy, 60 minutes: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $313 Consociate — Commercial: $266.05 Current Health — Commercial: $281.70 Healthlink — Commercial: $281.70 HFN — Commercial: $281.70 Humana — Commercial: $281.70 Preferred Plan — Commercial: $297.35 Springfield Health — Commercial: $256.66 Trilogy — Commercial: $266.05 United Healthcare — Commercial: $281.70
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 60 minutes	Not listed in the file	Not listed in the file	$193.96
Psychotherapy, 60 minutes: 10 of 18 insurance plan rates Aetna — Medicare: $179.38 Health Alliance — Medicare: $179.38 Humana — Medicare: $179.38 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $193.96 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $193.96 Medicaid Countycare Claims — Medicaid Countycare Claims: $193.96 Medicaid Health Alliance — Medicaid Health Alliance: $193.96 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $193.96 Medicaid Illinois — Medicaid Illinois: $193.96 Medicaid Meridian — Medicaid Meridian: $193.96
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90846 FAMILY PSYCHOTHERAPY W/O PT CHARGE	$313	$187.80	$75.12 – $313
Family psychotherapy, without the patient: 10 of 19 insurance plan rates Aetna — Commercial: $266.05 Aetna — Medicaid: $313 Aetna — Medicare: $75.12 Blue Choice — Commercial: $281.70 Blue Cross Blue Shield — Commercial: $313 Consociate — Commercial: $266.05 Current Health — Commercial: $281.70 Health Alliance — Commercial: $278.57 Healthlink — Commercial: $294.22 HFN — Commercial: $281.70
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 90846 FAMILY PSYCHOTHERAPY W/O PT CHARGE	$313	$187.80	$256.66 – $313
Family psychotherapy, without the patient: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $313 Consociate — Commercial: $266.05 Current Health — Commercial: $281.70 Healthlink — Commercial: $281.70 HFN — Commercial: $281.70 Humana — Commercial: $281.70 Preferred Plan — Commercial: $297.35 Springfield Health — Commercial: $256.66 Trilogy — Commercial: $266.05 United Healthcare — Commercial: $281.70
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$211.54
Family psychotherapy, without the patient: 10 of 18 insurance plan rates Aetna — Medicare: $179.38 Health Alliance — Medicare: $179.38 Humana — Medicare: $179.38 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $211.54 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $211.54 Medicaid Countycare Claims — Medicaid Countycare Claims: $211.54 Medicaid Health Alliance — Medicaid Health Alliance: $211.54 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $211.54 Medicaid Illinois — Medicaid Illinois: $211.54 Medicaid Meridian — Medicaid Meridian: $211.54
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90847 FAMILY PSYCHOTHERAPY W/ PT CHARGE	$313	$187.80	$75.12 – $313
Family psychotherapy, with the patient: 10 of 19 insurance plan rates Aetna — Commercial: $266.05 Aetna — Medicaid: $313 Aetna — Medicare: $75.12 Blue Choice — Commercial: $281.70 Blue Cross Blue Shield — Commercial: $313 Consociate — Commercial: $266.05 Current Health — Commercial: $281.70 Health Alliance — Commercial: $278.57 Healthlink — Commercial: $294.22 HFN — Commercial: $281.70
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 90847 FAMILY PSYCHOTHERAPY W/ PT CHARGE	$313	$187.80	$256.66 – $313
Family psychotherapy, with the patient: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $313 Consociate — Commercial: $266.05 Current Health — Commercial: $281.70 Healthlink — Commercial: $281.70 HFN — Commercial: $281.70 Humana — Commercial: $281.70 Preferred Plan — Commercial: $297.35 Springfield Health — Commercial: $256.66 Trilogy — Commercial: $266.05 United Healthcare — Commercial: $281.70
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/pt 50 min	Not listed in the file	Not listed in the file	$211.54
Family psychotherapy, with the patient: 10 of 18 insurance plan rates Aetna — Medicare: $179.38 Health Alliance — Medicare: $179.38 Humana — Medicare: $179.38 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $211.54 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $211.54 Medicaid Countycare Claims — Medicaid Countycare Claims: $211.54 Medicaid Health Alliance — Medicaid Health Alliance: $211.54 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $211.54 Medicaid Illinois — Medicaid Illinois: $211.54 Medicaid Meridian — Medicaid Meridian: $211.54
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90853 GROUP PSYCHOTHERAPY CHARGE	$163	$97.80	$39.12 – $163
Group psychotherapy: 10 of 19 insurance plan rates Aetna — Commercial: $138.55 Aetna — Medicaid: $163 Aetna — Medicare: $39.12 Blue Choice — Commercial: $146.70 Blue Cross Blue Shield — Commercial: $163 Consociate — Commercial: $138.55 Current Health — Commercial: $146.70 Health Alliance — Commercial: $145.07 Healthlink — Commercial: $153.22 HFN — Commercial: $146.70
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 90853 GROUP PSYCHOTHERAPY 60 MIN CHARGE	$163	$97.80	$39.12 – $163
Group psychotherapy: 10 of 19 insurance plan rates Aetna — Commercial: $138.55 Aetna — Medicaid: $163 Aetna — Medicare: $39.12 Blue Choice — Commercial: $146.70 Blue Cross Blue Shield — Commercial: $163 Consociate — Commercial: $138.55 Current Health — Commercial: $146.70 Health Alliance — Commercial: $145.07 Healthlink — Commercial: $153.22 HFN — Commercial: $146.70
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Hospital (facility) fee In the file: 90853 GROUP PSYCHOTHERAPY CHARGE	$163	$97.80	$133.66 – $163
Group psychotherapy: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $163 Consociate — Commercial: $138.55 Current Health — Commercial: $146.70 Healthlink — Commercial: $146.70 HFN — Commercial: $146.70 Humana — Commercial: $146.70 Preferred Plan — Commercial: $154.85 Springfield Health — Commercial: $133.66 Trilogy — Commercial: $138.55 United Healthcare — Commercial: $146.70

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$1,669.70
Removal of breast growth (open surgery): 10 of 19 insurance plan rates Aetna — Medicare: $4,275.13 Health Alliance — Medicare: $4,275.13 Humana — Medicare: $4,275.13 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $1,669.70 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $1,669.70 Medicaid Countycare Claims — Medicaid Countycare Claims: $1,669.70 Medicaid Health Alliance — Medicaid Health Alliance: $1,669.70 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $1,669.70 Medicaid Illinois — Medicaid Illinois: $1,669.70 Medicaid Meridian — Medicaid Meridian: $1,669.70
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$373.88 – $623.13
Removal of breast growth (open surgery): 10 of 14 insurance plan rates Aetna — Medicaid: $623.13 Aetna — Medicare: $623.13 Health Alliance — Commercial: $373.88 Health Alliance — Medicare: $623.13 HFN — Commercial: $571.40 Humana — Medicare: $623.13 Medicaid — Medicaid Illinois: $623.13 Medicare — Medicare: $623.13 Meridian — Medicaid Illinois: $623.13 Molina — Medicaid Illinois: $623.13
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$176.97 – $294.95
Removal of breast growth (open surgery): 10 of 14 insurance plan rates Aetna — Medicaid: $294.95 Aetna — Medicare: $294.95 Health Alliance — Commercial: $176.97 Health Alliance — Medicare: $294.95 HFN — Commercial: $270.46 Humana — Medicare: $294.95 Medicaid — Medicaid Illinois: $294.95 Medicare — Medicare: $294.95 Meridian — Medicaid Illinois: $294.95 Molina — Medicaid Illinois: $294.95
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$11,907.88
Total hip replacement: 10 of 19 insurance plan rates Aetna — Medicare: $14,364.93 Health Alliance — Medicare: $14,364.93 Humana — Medicare: $14,364.93 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $11,907.88 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $11,907.88 Medicaid Countycare Claims — Medicaid Countycare Claims: $11,907.88 Medicaid Health Alliance — Medicaid Health Alliance: $11,907.88 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $11,907.88 Medicaid Illinois — Medicaid Illinois: $11,907.88 Medicaid Meridian — Medicaid Meridian: $11,907.88
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$1,138.28 – $1,897.14
Total hip replacement: 10 of 14 insurance plan rates Aetna — Medicaid: $1,897.14 Aetna — Medicare: $1,897.14 Health Alliance — Commercial: $1,138.28 Health Alliance — Medicare: $1,897.14 HFN — Commercial: $1,747.31 Humana — Medicare: $1,897.14 Medicaid — Medicaid Illinois: $1,897.14 Medicare — Medicare: $1,897.14 Meridian — Medicaid Illinois: $1,897.14 Molina — Medicaid Illinois: $1,897.14
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$523.61 – $872.68
Total hip replacement: 10 of 14 insurance plan rates Aetna — Medicaid: $872.68 Aetna — Medicare: $872.68 Health Alliance — Commercial: $523.61 Health Alliance — Medicare: $872.68 HFN — Commercial: $803.76 Humana — Medicare: $872.68 Medicaid — Medicaid Illinois: $872.68 Medicare — Medicare: $872.68 Meridian — Medicaid Illinois: $872.68 Molina — Medicaid Illinois: $872.68
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$11,907.88
Total knee replacement: 10 of 19 insurance plan rates Aetna — Medicare: $14,364.93 Health Alliance — Medicare: $14,364.93 Humana — Medicare: $14,364.93 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $11,907.88 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $11,907.88 Medicaid Countycare Claims — Medicaid Countycare Claims: $11,907.88 Medicaid Health Alliance — Medicaid Health Alliance: $11,907.88 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $11,907.88 Medicaid Illinois — Medicaid Illinois: $11,907.88 Medicaid Meridian — Medicaid Meridian: $11,907.88
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$1,136.82 – $1,894.70
Total knee replacement: 10 of 14 insurance plan rates Aetna — Medicaid: $1,894.70 Aetna — Medicare: $1,894.70 Health Alliance — Commercial: $1,136.82 Health Alliance — Medicare: $1,894.70 HFN — Commercial: $1,745.48 Humana — Medicare: $1,894.70 Medicaid — Medicaid Illinois: $1,894.70 Medicare — Medicare: $1,894.70 Meridian — Medicaid Illinois: $1,894.70 Molina — Medicaid Illinois: $1,894.70
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$522.94 – $871.56
Total knee replacement: 10 of 14 insurance plan rates Aetna — Medicaid: $871.56 Aetna — Medicare: $871.56 Health Alliance — Commercial: $522.94 Health Alliance — Medicare: $871.56 HFN — Commercial: $802.92 Humana — Medicare: $871.56 Medicaid — Medicaid Illinois: $871.56 Medicare — Medicare: $871.56 Meridian — Medicaid Illinois: $871.56 Molina — Medicaid Illinois: $871.56
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$2,684.67
Shoulder arthroscopy: shaving of shoulder bone: 10 of 11 insurance plan rates Medicaid Aetna Better Health — Medicaid Aetna Better Health: $2,684.67 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $2,684.67 Medicaid Countycare Claims — Medicaid Countycare Claims: $2,684.67 Medicaid Health Alliance — Medicaid Health Alliance: $2,684.67 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $2,684.67 Medicaid Illinois — Medicaid Illinois: $2,684.67 Medicaid Meridian — Medicaid Meridian: $2,684.67 Medicaid Molina — Medicaid Molina: $2,684.67 Medicaid Wellcare — Medicaid Wellcare: $2,684.67 Medicaid Youth Care — Medicaid Youth Care: $2,684.67
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$152.48 – $254.13
Shoulder arthroscopy: shaving of shoulder bone: 10 of 14 insurance plan rates Aetna — Medicaid: $254.13 Aetna — Medicare: $254.13 Health Alliance — Commercial: $152.48 Health Alliance — Medicare: $254.13 HFN — Commercial: $235.10 Humana — Medicare: $254.13 Medicaid — Medicaid Illinois: $254.13 Medicare — Medicare: $254.13 Meridian — Medicaid Illinois: $254.13 Molina — Medicaid Illinois: $254.13
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80\|81\|82 In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$16.26 – $27.11
Shoulder arthroscopy: shaving of shoulder bone: 10 of 14 insurance plan rates Aetna — Medicaid: $27.11 Aetna — Medicare: $27.11 Health Alliance — Commercial: $16.26 Health Alliance — Medicare: $27.11 HFN — Commercial: $25.08 Humana — Medicare: $27.11 Medicaid — Medicaid Illinois: $27.11 Medicare — Medicare: $27.11 Meridian — Medicaid Illinois: $27.11 Molina — Medicaid Illinois: $27.11
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Knee arthroscopy/surgery	Not listed in the file	Not listed in the file	$2,684.67
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 19 insurance plan rates Aetna — Medicare: $3,622.39 Health Alliance — Medicare: $3,622.39 Humana — Medicare: $3,622.39 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $2,684.67 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $2,684.67 Medicaid Countycare Claims — Medicaid Countycare Claims: $2,684.67 Medicaid Health Alliance — Medicaid Health Alliance: $2,684.67 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $2,684.67 Medicaid Illinois — Medicaid Illinois: $2,684.67 Medicaid Meridian — Medicaid Meridian: $2,684.67
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Knee arthroscopy/surgery	Not listed in the file	Not listed in the file	$478.78 – $797.97
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 14 insurance plan rates Aetna — Medicaid: $797.97 Aetna — Medicare: $797.97 Health Alliance — Commercial: $478.78 Health Alliance — Medicare: $797.97 HFN — Commercial: $732.65 Humana — Medicare: $797.97 Medicaid — Medicaid Illinois: $797.97 Medicare — Medicare: $797.97 Meridian — Medicaid Illinois: $797.97 Molina — Medicaid Illinois: $797.97
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Knee arthroscopy/surgery	Not listed in the file	Not listed in the file	$220.24 – $367.07
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 14 insurance plan rates Aetna — Medicaid: $367.07 Aetna — Medicare: $367.07 Health Alliance — Commercial: $220.24 Health Alliance — Medicare: $367.07 HFN — Commercial: $337.02 Humana — Medicare: $367.07 Medicaid — Medicaid Illinois: $367.07 Medicare — Medicare: $367.07 Meridian — Medicaid Illinois: $367.07 Molina — Medicaid Illinois: $367.07
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$2,491.07
Removal of tonsils and adenoids (under age 12): 10 of 19 insurance plan rates Aetna — Medicare: $6,604.43 Health Alliance — Medicare: $6,604.43 Humana — Medicare: $6,604.43 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $2,491.07 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $2,491.07 Medicaid Countycare Claims — Medicaid Countycare Claims: $2,491.07 Medicaid Health Alliance — Medicaid Health Alliance: $2,491.07 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $2,491.07 Medicaid Illinois — Medicaid Illinois: $2,491.07 Medicaid Meridian — Medicaid Meridian: $2,491.07
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$137.79 – $229.65
Removal of tonsils and adenoids (under age 12): 10 of 14 insurance plan rates Aetna — Medicaid: $229.65 Aetna — Medicare: $229.65 Health Alliance — Commercial: $137.79 Health Alliance — Medicare: $229.65 HFN — Commercial: $211.93 Humana — Medicare: $229.65 Medicaid — Medicaid Illinois: $229.65 Medicare — Medicare: $229.65 Meridian — Medicaid Illinois: $229.65 Molina — Medicaid Illinois: $229.65
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Uppr Gi Endoscopy Diagnosis	$1,594	$956.40	$382.56 – $1,594
Upper GI endoscopy (diagnostic): 10 of 19 insurance plan rates Aetna — Commercial: $1,354.90 Aetna — Medicaid: $1,594 Aetna — Medicare: $382.56 Blue Choice — Commercial: $1,434.60 Blue Cross Blue Shield — Commercial: $1,594 Consociate — Commercial: $1,354.90 Current Health — Commercial: $1,434.60 Health Alliance — Commercial: $1,418.66 Healthlink — Commercial: $1,498.36 HFN — Commercial: $1,434.60
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Uppr Gi Endoscopy Diagnosis	$1,594	$956.40	$1,307.08 – $1,594
Upper GI endoscopy (diagnostic): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $1,594 Consociate — Commercial: $1,354.90 Current Health — Commercial: $1,434.60 Healthlink — Commercial: $1,434.60 HFN — Commercial: $1,434.60 Humana — Commercial: $1,434.60 Preferred Plan — Commercial: $1,514.30 Springfield Health — Commercial: $1,307.08 Trilogy — Commercial: $1,354.90 United Healthcare — Commercial: $1,434.60
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Egd diagnostic brush wash	Not listed in the file	Not listed in the file	$1,210.47
Upper GI endoscopy (diagnostic): 10 of 19 insurance plan rates Aetna — Medicare: $1,046.72 Health Alliance — Medicare: $1,046.72 Humana — Medicare: $1,046.72 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $1,210.47 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $1,210.47 Medicaid Countycare Claims — Medicaid Countycare Claims: $1,210.47 Medicaid Health Alliance — Medicaid Health Alliance: $1,210.47 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $1,210.47 Medicaid Illinois — Medicaid Illinois: $1,210.47 Medicaid Meridian — Medicaid Meridian: $1,210.47
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Upper Gi Endoscopy Biopsy	$2,073	$1,243.80	$497.52 – $2,073
Upper GI endoscopy with biopsy: 10 of 19 insurance plan rates Aetna — Commercial: $1,762.05 Aetna — Medicaid: $2,073 Aetna — Medicare: $497.52 Blue Choice — Commercial: $1,865.70 Blue Cross Blue Shield — Commercial: $2,073 Consociate — Commercial: $1,762.05 Current Health — Commercial: $1,865.70 Health Alliance — Commercial: $1,844.97 Healthlink — Commercial: $1,948.62 HFN — Commercial: $1,865.70
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Upper Gi Endoscopy Biopsy	$2,073	$1,243.80	$1,699.86 – $2,073
Upper GI endoscopy with biopsy: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $2,073 Consociate — Commercial: $1,762.05 Current Health — Commercial: $1,865.70 Healthlink — Commercial: $1,865.70 HFN — Commercial: $1,865.70 Humana — Commercial: $1,865.70 Preferred Plan — Commercial: $1,969.35 Springfield Health — Commercial: $1,699.86 Trilogy — Commercial: $1,762.05 United Healthcare — Commercial: $1,865.70
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Egd biopsy single/multiple	Not listed in the file	Not listed in the file	$1,210.47
Upper GI endoscopy with biopsy: 10 of 19 insurance plan rates Aetna — Medicare: $1,046.72 Health Alliance — Medicare: $1,046.72 Humana — Medicare: $1,046.72 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $1,210.47 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $1,210.47 Medicaid Countycare Claims — Medicaid Countycare Claims: $1,210.47 Medicaid Health Alliance — Medicaid Health Alliance: $1,210.47 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $1,210.47 Medicaid Illinois — Medicaid Illinois: $1,210.47 Medicaid Meridian — Medicaid Meridian: $1,210.47
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Diagnostic colonoscopy	$1,898	$1,138.80	$455.52 – $1,898
Colonoscopy (diagnostic): 10 of 19 insurance plan rates Aetna — Commercial: $1,613.30 Aetna — Medicaid: $1,898 Aetna — Medicare: $455.52 Blue Choice — Commercial: $1,708.20 Blue Cross Blue Shield — Commercial: $1,898 Consociate — Commercial: $1,613.30 Current Health — Commercial: $1,708.20 Health Alliance — Commercial: $1,689.22 Healthlink — Commercial: $1,784.12 HFN — Commercial: $1,708.20
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Diagnostic colonoscopy	$1,898	$1,138.80	$1,556.36 – $1,898
Colonoscopy (diagnostic): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $1,898 Consociate — Commercial: $1,613.30 Current Health — Commercial: $1,708.20 Healthlink — Commercial: $1,708.20 HFN — Commercial: $1,708.20 Humana — Commercial: $1,708.20 Preferred Plan — Commercial: $1,803.10 Springfield Health — Commercial: $1,556.36 Trilogy — Commercial: $1,613.30 United Healthcare — Commercial: $1,708.20
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Diagnostic colonoscopy	Not listed in the file	Not listed in the file	$1,236.88
Colonoscopy (diagnostic): 10 of 19 insurance plan rates Aetna — Medicare: $1,017.86 Health Alliance — Medicare: $1,017.86 Humana — Medicare: $1,017.86 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $1,236.88 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $1,236.88 Medicaid Countycare Claims — Medicaid Countycare Claims: $1,236.88 Medicaid Health Alliance — Medicaid Health Alliance: $1,236.88 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $1,236.88 Medicaid Illinois — Medicaid Illinois: $1,236.88 Medicaid Meridian — Medicaid Meridian: $1,236.88
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy flexible; with biopsy single or multiple	$2,376	$1,425.60	$570.24 – $2,376
Colonoscopy with biopsy: 10 of 19 insurance plan rates Aetna — Commercial: $2,019.60 Aetna — Medicaid: $2,376 Aetna — Medicare: $570.24 Blue Choice — Commercial: $2,138.40 Blue Cross Blue Shield — Commercial: $2,376 Consociate — Commercial: $2,019.60 Current Health — Commercial: $2,138.40 Health Alliance — Commercial: $2,114.64 Healthlink — Commercial: $2,233.44 HFN — Commercial: $2,138.40
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) · Doctor (professional) fee In the file: Colonoscopy flexible; with biopsy single or multiple	$2,376	$1,425.60	$1,948.32 – $2,376
Colonoscopy with biopsy: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $2,376 Consociate — Commercial: $2,019.60 Current Health — Commercial: $2,138.40 Healthlink — Commercial: $2,138.40 HFN — Commercial: $2,138.40 Humana — Commercial: $2,138.40 Preferred Plan — Commercial: $2,257.20 Springfield Health — Commercial: $1,948.32 Trilogy — Commercial: $2,019.60 United Healthcare — Commercial: $2,138.40
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy and biopsy	Not listed in the file	Not listed in the file	$1,236.88
Colonoscopy with biopsy: 10 of 19 insurance plan rates Aetna — Medicare: $1,316.36 Health Alliance — Medicare: $1,316.36 Humana — Medicare: $1,316.36 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $1,236.88 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $1,236.88 Medicaid Countycare Claims — Medicaid Countycare Claims: $1,236.88 Medicaid Health Alliance — Medicaid Health Alliance: $1,236.88 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $1,236.88 Medicaid Illinois — Medicaid Illinois: $1,236.88 Medicaid Meridian — Medicaid Meridian: $1,236.88
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 45385 Colonoscopy; snare tech; polyp or tumor	$2,531	$1,518.60	$607.44 – $2,531
Colonoscopy with removal of polyps (snare): 10 of 19 insurance plan rates Aetna — Commercial: $2,151.35 Aetna — Medicaid: $2,531 Aetna — Medicare: $607.44 Blue Choice — Commercial: $2,277.90 Blue Cross Blue Shield — Commercial: $2,531 Consociate — Commercial: $2,151.35 Current Health — Commercial: $2,277.90 Health Alliance — Commercial: $2,252.59 Healthlink — Commercial: $2,379.14 HFN — Commercial: $2,277.90
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Doctor (professional) fee In the file: 45385 Colonoscopy; snare tech; polyp or tumor	$2,531	$1,518.60	$2,075.42 – $2,531
Colonoscopy with removal of polyps (snare): rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $2,531 Consociate — Commercial: $2,151.35 Current Health — Commercial: $2,277.90 Healthlink — Commercial: $2,277.90 HFN — Commercial: $2,277.90 Humana — Commercial: $2,277.90 Preferred Plan — Commercial: $2,404.45 Springfield Health — Commercial: $2,075.42 Trilogy — Commercial: $2,151.35 United Healthcare — Commercial: $2,277.90
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/lesion removal	Not listed in the file	Not listed in the file	$1,236.88
Colonoscopy with removal of polyps (snare): 10 of 19 insurance plan rates Aetna — Medicare: $1,316.36 Health Alliance — Medicare: $1,316.36 Humana — Medicare: $1,316.36 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $1,236.88 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $1,236.88 Medicaid Countycare Claims — Medicaid Countycare Claims: $1,236.88 Medicaid Health Alliance — Medicaid Health Alliance: $1,236.88 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $1,236.88 Medicaid Illinois — Medicaid Illinois: $1,236.88 Medicaid Meridian — Medicaid Meridian: $1,236.88
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/endoscope us	Not listed in the file	Not listed in the file	$1,236.88
Ultrasound of the lower bowel by endoscope: 10 of 19 insurance plan rates Aetna — Medicare: $1,316.36 Health Alliance — Medicare: $1,316.36 Humana — Medicare: $1,316.36 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $1,236.88 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $1,236.88 Medicaid Countycare Claims — Medicaid Countycare Claims: $1,236.88 Medicaid Health Alliance — Medicaid Health Alliance: $1,236.88 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $1,236.88 Medicaid Illinois — Medicaid Illinois: $1,236.88 Medicaid Meridian — Medicaid Meridian: $1,236.88
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy w/endoscope us	Not listed in the file	Not listed in the file	$147.53 – $245.89
Ultrasound of the lower bowel by endoscope: 10 of 14 insurance plan rates Aetna — Medicaid: $245.89 Aetna — Medicare: $245.89 Health Alliance — Commercial: $147.53 Health Alliance — Medicare: $245.89 HFN — Commercial: $228.83 Humana — Medicare: $245.89 Medicaid — Medicaid Illinois: $245.89 Medicare — Medicare: $245.89 Meridian — Medicaid Illinois: $245.89 Molina — Medicaid Illinois: $245.89
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$1,236.88
Screening colonoscopy (not high risk): 10 of 18 insurance plan rates Aetna — Medicare: $1,017.86 Health Alliance — Medicare: $1,017.86 Humana — Medicare: $1,017.86 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $1,236.88 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $1,236.88 Medicaid Countycare Claims — Medicaid Countycare Claims: $1,236.88 Medicaid Health Alliance — Medicaid Health Alliance: $1,236.88 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $1,236.88 Medicaid Illinois — Medicaid Illinois: $1,236.88 Medicaid Meridian — Medicaid Meridian: $1,236.88
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 53 In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$94.52 – $157.54
Screening colonoscopy (not high risk): 10 of 14 insurance plan rates Aetna — Medicaid: $157.54 Aetna — Medicare: $157.54 Health Alliance — Commercial: $94.52 Health Alliance — Medicare: $157.54 HFN — Commercial: $148.72 Humana — Medicare: $157.54 Medicaid — Medicaid Illinois: $157.54 Medicare — Medicare: $157.54 Meridian — Medicaid Illinois: $157.54 Molina — Medicaid Illinois: $157.54
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$4,309.30
Gallbladder removal by laparoscope: 10 of 19 insurance plan rates Aetna — Medicare: $6,513.67 Health Alliance — Medicare: $6,513.67 Humana — Medicare: $6,513.67 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $4,309.30 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $4,309.30 Medicaid Countycare Claims — Medicaid Countycare Claims: $4,309.30 Medicaid Health Alliance — Medicaid Health Alliance: $4,309.30 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $4,309.30 Medicaid Illinois — Medicaid Illinois: $4,309.30 Medicaid Meridian — Medicaid Meridian: $4,309.30
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$321.40 – $535.67
Gallbladder removal by laparoscope: 10 of 14 insurance plan rates Aetna — Medicaid: $535.67 Aetna — Medicare: $535.67 Health Alliance — Commercial: $321.40 Health Alliance — Medicare: $535.67 HFN — Commercial: $491.35 Humana — Medicare: $535.67 Medicaid — Medicaid Illinois: $535.67 Medicare — Medicare: $535.67 Meridian — Medicaid Illinois: $535.67 Molina — Medicaid Illinois: $535.67
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80\|81\|82 In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$63.49 – $105.81
Gallbladder removal by laparoscope: 10 of 14 insurance plan rates Aetna — Medicaid: $105.81 Aetna — Medicare: $105.81 Health Alliance — Commercial: $63.49 Health Alliance — Medicare: $105.81 HFN — Commercial: $97.06 Humana — Medicare: $105.81 Medicaid — Medicaid Illinois: $105.81 Medicare — Medicare: $105.81 Meridian — Medicaid Illinois: $105.81 Molina — Medicaid Illinois: $105.81
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$4,422.60
Groin (inguinal) hernia repair, age 5 or older: 10 of 19 insurance plan rates Aetna — Medicare: $3,939.95 Health Alliance — Medicare: $3,939.95 Humana — Medicare: $3,939.95 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $4,422.60 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $4,422.60 Medicaid Countycare Claims — Medicaid Countycare Claims: $4,422.60 Medicaid Health Alliance — Medicaid Health Alliance: $4,422.60 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $4,422.60 Medicaid Illinois — Medicaid Illinois: $4,422.60 Medicaid Meridian — Medicaid Meridian: $4,422.60
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$470.77 – $784.62
Groin (inguinal) hernia repair, age 5 or older: 10 of 14 insurance plan rates Aetna — Medicaid: $784.62 Aetna — Medicare: $784.62 Health Alliance — Commercial: $470.77 Health Alliance — Medicare: $784.62 HFN — Commercial: $720.84 Humana — Medicare: $784.62 Medicaid — Medicaid Illinois: $784.62 Medicare — Medicare: $784.62 Meridian — Medicaid Illinois: $784.62 Molina — Medicaid Illinois: $784.62
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$254.22 – $423.69
Groin (inguinal) hernia repair, age 5 or older: 10 of 14 insurance plan rates Aetna — Medicaid: $423.69 Aetna — Medicare: $423.69 Health Alliance — Commercial: $254.22 Health Alliance — Medicare: $423.69 HFN — Commercial: $389.25 Humana — Medicare: $423.69 Medicaid — Medicaid Illinois: $423.69 Medicare — Medicare: $423.69 Meridian — Medicaid Illinois: $423.69 Molina — Medicaid Illinois: $423.69
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Biopsy of prostate	Not listed in the file	Not listed in the file	$2,136.67
Prostate biopsy: 10 of 19 insurance plan rates Aetna — Medicare: $2,287.02 Health Alliance — Medicare: $2,287.02 Humana — Medicare: $2,287.02 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $2,136.67 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $2,136.67 Medicaid Countycare Claims — Medicaid Countycare Claims: $2,136.67 Medicaid Health Alliance — Medicaid Health Alliance: $2,136.67 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $2,136.67 Medicaid Illinois — Medicaid Illinois: $2,136.67 Medicaid Meridian — Medicaid Meridian: $2,136.67
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Biopsy of prostate	Not listed in the file	Not listed in the file	$75.23 – $125.39
Prostate biopsy: 10 of 14 insurance plan rates Aetna — Medicaid: $125.39 Aetna — Medicare: $125.39 Health Alliance — Commercial: $75.23 Health Alliance — Medicare: $125.39 HFN — Commercial: $116.07 Humana — Medicare: $125.39 Medicaid — Medicaid Illinois: $125.39 Medicare — Medicare: $125.39 Meridian — Medicaid Illinois: $125.39 Molina — Medicaid Illinois: $125.39
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laps surg prst8ect rpbic rad	Not listed in the file	Not listed in the file	$5,523.29
Prostate removal by laparoscope (radical prostatectomy): 10 of 19 insurance plan rates Aetna — Medicare: $11,623.42 Health Alliance — Medicare: $11,623.42 Humana — Medicare: $11,623.42 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $5,523.29 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $5,523.29 Medicaid Countycare Claims — Medicaid Countycare Claims: $5,523.29 Medicaid Health Alliance — Medicaid Health Alliance: $5,523.29 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $5,523.29 Medicaid Illinois — Medicaid Illinois: $5,523.29 Medicaid Meridian — Medicaid Meridian: $5,523.29
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Laps surg prst8ect rpbic rad	Not listed in the file	Not listed in the file	$577.89 – $963.15
Prostate removal by laparoscope (radical prostatectomy): 10 of 14 insurance plan rates Aetna — Medicaid: $963.15 Aetna — Medicare: $963.15 Health Alliance — Commercial: $577.89 Health Alliance — Medicare: $963.15 HFN — Commercial: $887.30 Humana — Medicare: $963.15 Medicaid — Medicaid Illinois: $963.15 Medicare — Medicare: $963.15 Meridian — Medicaid Illinois: $963.15 Molina — Medicaid Illinois: $963.15
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80\|81\|82 In the file: Laps surg prst8ect rpbic rad	Not listed in the file	Not listed in the file	$111.40 – $185.67
Prostate removal by laparoscope (radical prostatectomy): 10 of 14 insurance plan rates Aetna — Medicaid: $185.67 Aetna — Medicare: $185.67 Health Alliance — Commercial: $111.40 Health Alliance — Medicare: $185.67 HFN — Commercial: $171.05 Humana — Medicare: $185.67 Medicaid — Medicaid Illinois: $185.67 Medicare — Medicare: $185.67 Meridian — Medicaid Illinois: $185.67 Molina — Medicaid Illinois: $185.67
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$2,917.03
Hysteroscopy with biopsy of the uterus lining: 10 of 19 insurance plan rates Aetna — Medicare: $3,549.72 Health Alliance — Medicare: $3,549.72 Humana — Medicare: $3,549.72 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $2,917.03 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $2,917.03 Medicaid Countycare Claims — Medicaid Countycare Claims: $2,917.03 Medicaid Health Alliance — Medicaid Health Alliance: $2,917.03 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $2,917.03 Medicaid Illinois — Medicaid Illinois: $2,917.03 Medicaid Meridian — Medicaid Meridian: $2,917.03
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 62 In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$84.58 – $140.97
Hysteroscopy with biopsy of the uterus lining: 10 of 14 insurance plan rates Aetna — Medicaid: $140.97 Aetna — Medicare: $140.97 Health Alliance — Commercial: $84.58 Health Alliance — Medicare: $140.97 HFN — Commercial: $130.58 Humana — Medicare: $140.97 Medicaid — Medicaid Illinois: $140.97 Medicare — Medicare: $140.97 Meridian — Medicaid Illinois: $140.97 Molina — Medicaid Illinois: $140.97
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: 62323 ESI Lumbar with Imaging	$1,416	$849.60	$339.84 – $1,416
Spinal injection, lower back (epidural), with imaging guidance: 10 of 19 insurance plan rates Aetna — Commercial: $1,203.60 Aetna — Medicaid: $1,416 Aetna — Medicare: $339.84 Blue Choice — Commercial: $1,274.40 Blue Cross Blue Shield — Commercial: $1,416 Consociate — Commercial: $1,203.60 Current Health — Commercial: $1,274.40 Health Alliance — Commercial: $1,260.24 Healthlink — Commercial: $1,331.04 HFN — Commercial: $1,274.40
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Injection Sing (Not Indwell Cath)Not Incl Neurolyt SubstWwo Contrast; lumbar	$1,898	$1,138.80	$455.52 – $1,898
Spinal injection, lower back (epidural), with imaging guidance: 10 of 19 insurance plan rates Aetna — Commercial: $1,613.30 Aetna — Medicaid: $1,898 Aetna — Medicare: $455.52 Blue Choice — Commercial: $1,708.20 Blue Cross Blue Shield — Commercial: $1,898 Consociate — Commercial: $1,613.30 Current Health — Commercial: $1,708.20 Health Alliance — Commercial: $1,689.22 Healthlink — Commercial: $1,784.12 HFN — Commercial: $1,708.20
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 62323 Lumbar/Sacral epidural with guidance	$1,898	$1,138.80	$455.52 – $1,898
Spinal injection, lower back (epidural), with imaging guidance: 10 of 19 insurance plan rates Aetna — Commercial: $1,613.30 Aetna — Medicaid: $1,898 Aetna — Medicare: $455.52 Blue Choice — Commercial: $1,708.20 Blue Cross Blue Shield — Commercial: $1,898 Consociate — Commercial: $1,613.30 Current Health — Commercial: $1,708.20 Health Alliance — Commercial: $1,689.22 Healthlink — Commercial: $1,784.12 HFN — Commercial: $1,708.20
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Injection Anesthetic Agent And/Or Steroid Transforaminal Epidural; Lumbar Or Sacral Single	$2,407	$1,444.20	$577.68 – $2,407
Nerve root injection, lower back, with imaging guidance: 10 of 19 insurance plan rates Aetna — Commercial: $2,045.95 Aetna — Medicaid: $2,407 Aetna — Medicare: $577.68 Blue Choice — Commercial: $2,166.30 Blue Cross Blue Shield — Commercial: $2,407 Consociate — Commercial: $2,045.95 Current Health — Commercial: $2,166.30 Health Alliance — Commercial: $2,142.23 Healthlink — Commercial: $2,262.58 HFN — Commercial: $2,166.30
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: 64483 Lumbar/Sacral transforaminal single level..	$2,407	$1,444.20	$577.68 – $2,407
Nerve root injection, lower back, with imaging guidance: 10 of 19 insurance plan rates Aetna — Commercial: $2,045.95 Aetna — Medicaid: $2,407 Aetna — Medicare: $577.68 Blue Choice — Commercial: $2,166.30 Blue Cross Blue Shield — Commercial: $2,407 Consociate — Commercial: $2,045.95 Current Health — Commercial: $2,166.30 Health Alliance — Commercial: $2,142.23 Healthlink — Commercial: $2,262.58 HFN — Commercial: $2,166.30
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Injection Anesthetic Agent And/Or Steroid Transforaminal Epidural; Lumbar Or Sacral Single	$2,407	$1,444.20	$1,973.74 – $2,407
Nerve root injection, lower back, with imaging guidance: rates for 10 insurance plans Blue Cross Blue Shield — Commercial: $2,407 Consociate — Commercial: $2,045.95 Current Health — Commercial: $2,166.30 Healthlink — Commercial: $2,166.30 HFN — Commercial: $2,166.30 Humana — Commercial: $2,166.30 Preferred Plan — Commercial: $2,286.65 Springfield Health — Commercial: $1,973.74 Trilogy — Commercial: $2,045.95 United Healthcare — Commercial: $2,166.30
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Carpal tunnel surgery	Not listed in the file	Not listed in the file	$1,689.88
Carpal tunnel release: 10 of 19 insurance plan rates Aetna — Medicare: $2,180.14 Health Alliance — Medicare: $2,180.14 Humana — Medicare: $2,180.14 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $1,689.88 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $1,689.88 Medicaid Countycare Claims — Medicaid Countycare Claims: $1,689.88 Medicaid Health Alliance — Medicaid Health Alliance: $1,689.88 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $1,689.88 Medicaid Illinois — Medicaid Illinois: $1,689.88 Medicaid Meridian — Medicaid Meridian: $1,689.88
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Carpal tunnel surgery	Not listed in the file	Not listed in the file	$384.41 – $640.68
Carpal tunnel release: 10 of 14 insurance plan rates Aetna — Medicaid: $640.68 Aetna — Medicare: $640.68 Health Alliance — Commercial: $384.41 Health Alliance — Medicare: $640.68 HFN — Commercial: $587.16 Humana — Medicare: $640.68 Medicaid — Medicaid Illinois: $640.68 Medicare — Medicare: $640.68 Meridian — Medicaid Illinois: $640.68 Molina — Medicaid Illinois: $640.68
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Carpal tunnel surgery	Not listed in the file	Not listed in the file	$194.77 – $324.61
Carpal tunnel release: 10 of 14 insurance plan rates Aetna — Medicaid: $324.61 Aetna — Medicare: $324.61 Health Alliance — Commercial: $194.77 Health Alliance — Medicare: $324.61 HFN — Commercial: $297.49 Humana — Medicare: $324.61 Medicaid — Medicaid Illinois: $324.61 Medicare — Medicare: $324.61 Meridian — Medicaid Illinois: $324.61 Molina — Medicaid Illinois: $324.61
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: After cataract laser surgery	Not listed in the file	Not listed in the file	$714.21
Laser treatment of clouding after cataract surgery: 10 of 19 insurance plan rates Aetna — Medicare: $612.48 Health Alliance — Medicare: $612.48 Humana — Medicare: $612.48 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $714.21 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $714.21 Medicaid Countycare Claims — Medicaid Countycare Claims: $714.21 Medicaid Health Alliance — Medicaid Health Alliance: $714.21 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $714.21 Medicaid Illinois — Medicaid Illinois: $714.21 Medicaid Meridian — Medicaid Meridian: $714.21
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: After cataract laser surgery	Not listed in the file	Not listed in the file	$257.50 – $429.17
Laser treatment of clouding after cataract surgery: 10 of 14 insurance plan rates Aetna — Medicaid: $429.17 Aetna — Medicare: $429.17 Health Alliance — Commercial: $257.50 Health Alliance — Medicare: $429.17 HFN — Commercial: $401.43 Humana — Medicare: $429.17 Medicaid — Medicaid Illinois: $429.17 Medicare — Medicare: $429.17 Meridian — Medicaid Illinois: $429.17 Molina — Medicaid Illinois: $429.17
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: After cataract laser surgery	Not listed in the file	Not listed in the file	$120.17 – $200.28
Laser treatment of clouding after cataract surgery: 10 of 14 insurance plan rates Aetna — Medicaid: $200.28 Aetna — Medicare: $200.28 Health Alliance — Commercial: $120.17 Health Alliance — Medicare: $200.28 HFN — Commercial: $187.33 Humana — Medicare: $200.28 Medicaid — Medicaid Illinois: $200.28 Medicare — Medicare: $200.28 Meridian — Medicaid Illinois: $200.28 Molina — Medicaid Illinois: $200.28
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	Not listed in the file	$2,142.17
Cataract removal with lens implant: 10 of 19 insurance plan rates Aetna — Medicare: $2,546.28 Health Alliance — Medicare: $2,546.28 Humana — Medicare: $2,546.28 Medicaid Aetna Better Health — Medicaid Aetna Better Health: $2,142.17 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $2,142.17 Medicaid Countycare Claims — Medicaid Countycare Claims: $2,142.17 Medicaid Health Alliance — Medicaid Health Alliance: $2,142.17 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $2,142.17 Medicaid Illinois — Medicaid Illinois: $2,142.17 Medicaid Meridian — Medicaid Meridian: $2,142.17
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	Not listed in the file	$454.59 – $757.65
Cataract removal with lens implant: 10 of 14 insurance plan rates Aetna — Medicaid: $757.65 Aetna — Medicare: $757.65 Health Alliance — Commercial: $454.59 Health Alliance — Medicare: $757.65 HFN — Commercial: $706.04 Humana — Medicare: $757.65 Medicaid — Medicaid Illinois: $757.65 Medicare — Medicare: $757.65 Meridian — Medicaid Illinois: $757.65 Molina — Medicaid Illinois: $757.65
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	Not listed in the file	$212.14 – $353.57
Cataract removal with lens implant: 10 of 14 insurance plan rates Aetna — Medicaid: $353.57 Aetna — Medicare: $353.57 Health Alliance — Commercial: $212.14 Health Alliance — Medicare: $353.57 HFN — Commercial: $329.48 Humana — Medicare: $353.57 Medicaid — Medicaid Illinois: $353.57 Medicare — Medicare: $353.57 Meridian — Medicaid Illinois: $353.57 Molina — Medicaid Illinois: $353.57

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Obstetrical care	Not listed in the file	Not listed in the file	$1,443.68 – $2,406.13
Vaginal delivery, with care before and after: 10 of 14 insurance plan rates Aetna — Medicaid: $2,406.13 Aetna — Medicare: $2,406.13 Health Alliance — Commercial: $1,443.68 Health Alliance — Medicare: $2,406.13 HFN — Commercial: $2,208.30 Humana — Medicare: $2,406.13 Medicaid — Medicaid Illinois: $2,406.13 Medicare — Medicare: $2,406.13 Meridian — Medicaid Illinois: $2,406.13 Molina — Medicaid Illinois: $2,406.13
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetrical care	Not listed in the file	Not listed in the file	$2,703.15
Vaginal delivery, with care before and after: 10 of 11 insurance plan rates Medicaid Aetna Better Health — Medicaid Aetna Better Health: $2,703.15 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $2,703.15 Medicaid Countycare Claims — Medicaid Countycare Claims: $2,703.15 Medicaid Health Alliance — Medicaid Health Alliance: $2,703.15 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $2,703.15 Medicaid Illinois — Medicaid Illinois: $2,703.15 Medicaid Meridian — Medicaid Meridian: $2,703.15 Medicaid Molina — Medicaid Molina: $2,703.15 Medicaid Wellcare — Medicaid Wellcare: $2,703.15 Medicaid Youth Care — Medicaid Youth Care: $2,703.15
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Cesarean delivery	Not listed in the file	Not listed in the file	$1,613.82 – $2,689.70
Cesarean delivery (C-section), with care before and after: 10 of 14 insurance plan rates Aetna — Medicaid: $2,689.70 Aetna — Medicare: $2,689.70 Health Alliance — Commercial: $1,613.82 Health Alliance — Medicare: $2,689.70 HFN — Commercial: $2,455.57 Humana — Medicare: $2,689.70 Medicaid — Medicaid Illinois: $2,689.70 Medicare — Medicare: $2,689.70 Meridian — Medicaid Illinois: $2,689.70 Molina — Medicaid Illinois: $2,689.70
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cesarean delivery	Not listed in the file	Not listed in the file	$3,246.64
Cesarean delivery (C-section), with care before and after: 10 of 11 insurance plan rates Medicaid Aetna Better Health — Medicaid Aetna Better Health: $3,246.64 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $3,246.64 Medicaid Countycare Claims — Medicaid Countycare Claims: $3,246.64 Medicaid Health Alliance — Medicaid Health Alliance: $3,246.64 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $3,246.64 Medicaid Illinois — Medicaid Illinois: $3,246.64 Medicaid Meridian — Medicaid Meridian: $3,246.64 Medicaid Molina — Medicaid Molina: $3,246.64 Medicaid Wellcare — Medicaid Wellcare: $3,246.64 Medicaid Youth Care — Medicaid Youth Care: $3,246.64
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Vbac delivery	Not listed in the file	Not listed in the file	$1,523.13 – $2,538.55
Vaginal delivery after a previous C-section, with care before and after: 10 of 14 insurance plan rates Aetna — Medicaid: $2,538.55 Aetna — Medicare: $2,538.55 Health Alliance — Commercial: $1,523.13 Health Alliance — Medicare: $2,538.55 HFN — Commercial: $2,325.80 Humana — Medicare: $2,538.55 Medicaid — Medicaid Illinois: $2,538.55 Medicare — Medicare: $2,538.55 Meridian — Medicaid Illinois: $2,538.55 Molina — Medicaid Illinois: $2,538.55
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Vbac delivery	Not listed in the file	Not listed in the file	$2,703.15
Vaginal delivery after a previous C-section, with care before and after: 10 of 11 insurance plan rates Medicaid Aetna Better Health — Medicaid Aetna Better Health: $2,703.15 Medicaid Blue Cross Community Family Health Plan XXL / XOG — Medicaid Blue Cross Community Family Health Plan XXL / XOG: $2,703.15 Medicaid Countycare Claims — Medicaid Countycare Claims: $2,703.15 Medicaid Health Alliance — Medicaid Health Alliance: $2,703.15 Medicaid Humana Health Plan — Medicaid Humana Health Plan: $2,703.15 Medicaid Illinois — Medicaid Illinois: $2,703.15 Medicaid Meridian — Medicaid Meridian: $2,703.15 Medicaid Molina — Medicaid Molina: $2,703.15 Medicaid Wellcare — Medicaid Wellcare: $2,703.15 Medicaid Youth Care — Medicaid Youth Care: $2,703.15

Source: MC Donough District Hospital’s standard charges file (mdh.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on March 25, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Acute Care Hospital
Address	525 East Grant Street, Macomb, IL 61455
County	McDonough County
State	Illinois
Phone	(309) 833‑4101
Emergency services	Yes
Ownership	Government - Hospital District or Authority
Medicare overall rating	3 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	140089
Name in Medicare records	MC DONOUGH DISTRICT HOSPITAL
Profile level	Medicare data + hospital website
Name on the hospital’s website	McDonough District Hospital
Official website	mdh.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-10-26, retrieved 2026-11-13
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

Our Services - McDonough District Hospital — mdh.org
About Us - McDonough District Hospital — mdh.org

MC Donough District Hospital

Summary

Profile from official sources

At a glance