Evanston Regional Hospital

Cash price

$107

$92 – $152

3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION; NOT REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION

76376

Cash price

$128

$139 – $181

5% DEXTROSE IN LACTATED RINGERS INFUSION, UP TO 1000 CC

J7121

Cash price

$21

$22 – $29

58160-0890-52 - influenza virus vaccine, inactivated preservative-free quadrivalent Sus [MEMO]

90675

Cash price

$401

$408 – $603

ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE

49083

Cash price

$1,072

$1,127 – $1,562

ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [35100]

J0132

Cash price

$3.26

$3.53 – $4.62

ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBODY (86709) HEPATITIS B CORE ANTIBODY (HBCAB), IGM ANTIBODY (86705) HEPATITIS B SURFACE ANTIGEN (HBSAG) (87340) HEPATITIS C ANTIBODY (86803)

80074

Cash price

$181

$144 – $256

ADALIMUMAB CONC & ABS (LCP 503890)

80145

Cash price

$104

$67 – $148

ADAPTOR/EXTENSION, PACING LEAD OR NEUROSTIMULATOR LEAD (IMPLANTABLE)

C1883

Cash price

$4,055

$4,392 – $5,744

ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PELVIC SLING

L2580

Cash price

$2,573

$2,787 – $3,644

ADMINISTRATION OF HEPATITIS B VACCINE

G0010

Cash price

$40

$43 – $56

ADMINISTRATION OF INFLUENZA VIRUS VACCINE

G0008

Cash price

$38

$39 – $54

ADMINISTRATION OF PNEUMOCOCCAL VACCINE

G0009

Cash price

$41

$43 – $59

ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL

82024

Cash price

$122

$78 – $172

AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS CARINII PNEUMONIA TREATMENT OR PROPHYLAXIS

94642

Cash price

$242

$262 – $343

AFP TETRA (LCP 017319)(ESTRIOL)

82677

Cash price

$50

$20 – $71

AFP TETRA (LCP 017319)(INHIBIN A)

86336

Cash price

$66

$17 – $94

AGGLUTININS, FEBRILE (EG, BRUCELLA, FRANCISELLA, MURINE TYPHUS, Q FEVER, ROCKY MOUNTAIN SPOTTED FEVER, SCRUB TYPHUS), EACH ANTIGEN

86000

Cash price

$18

$2.04 – $25

ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION

P9047

Cash price

$154

$167 – $218

ALBUMN HUM 5 PERC 250ML 12.5GM 250ML IV

P9045

Cash price

$124

$134 – $175

ALLERGEN SPECIFIC IGE; QUALITATIVE, MULTIALLERGEN SCREEN (EG, DISK, SPONGE, CARD)

86005

Cash price

$36

$4.8 – $51

ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, CRUDE ALLERGEN EXTRACT, EACH

86003

Cash price

$39

$3.43 – $56

ALPHA-1-ANTITRYPSIN (PROTEIN) BLOOD TEST, PHENOTYPE

82104

Cash price

$28

$6.71 – $39

ALPHA-FETOPROTEIN (AFP); AFP-L3 FRACTION ISOFORM AND TOTAL AFP (INCLUDING RATIO)

82107

Cash price

$142

$153 – $201

ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [19101]

J2997

Cash price

$108

$101 – $173

AMINO ACIDS, 2 TO 5 AMINO ACIDS, QUANTITATIVE, EACH SPECIMEN

82136

Cash price

$171

$56 – $242

AMINO ACIDS, 6 OR MORE AMINO ACIDS, QUANTITATIVE, EACH SPECIMEN

82139

Cash price

$171

$48 – $242

AMINOPHYLLINE 25 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000723]

J0280

Cash price

$18

$15 – $30

AMPICILLIN 500 MG SOLUTION FOR INJECTION [13513]

J0290

Cash price

$7.06

$6.26 – $11

AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [14372]

J0295

Cash price

$7.61

$7.71 – $11

ANALYSIS FOR ANTIBODY (IGM) TO CYTOMEGALOVIRUS (CMV)

86645

Cash price

$78

$22 – $111

ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA)

86618

Cash price

$56

$16 – $79

ANALYSIS FOR ANTIBODY TO CYTOMEGALOVIRUS (CMV)

86644

Cash price

$62

$15 – $88

ANALYSIS FOR ANTIBODY TO EHRLICHIA (BACTERIA TRANSMITTED BY TICKS)

86666

Cash price

$24

$4.15 – $35

ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONONUCLEOSIS VIRUS), NUCLEAR ANTIGEN

86664

Cash price

$57

$15 – $81

ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONONUCLEOSIS VIRUS), VIRAL CAPSID

86665

Cash price

$95

$29 – $135

ANALYSIS FOR ANTIBODY TO HEPATITIS D VIRUS

86692

Cash price

$70

$20 – $99

ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 1

86695

Cash price

$68

$15 – $97

ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 2

86696

Cash price

$62

$20 – $88

ANALYSIS FOR ANTIBODY TO LEGIONELLA (WATERBORNE BACTERIA)

86713

Cash price

$74

$19 – $105

ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS)

86762

Cash price

$30

$7.09 – $42

ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX)

86787

Cash price

$47

$10 – $67

ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT AND CHEMICAL )REACTION

82397

Cash price

$45

$11 – $64

ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE)

C1713

Cash price

$2,218

$30 – $13,986

ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION

75710

Cash price

$3,253

$3,524 – $4,608

ANTIBODY ELUTION (RBC), EACH ELUTION

86860

Cash price

$80

$100 – $200

ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES

86021

Cash price

$70

$17 – $99

ANTIBODY IDENTIFICATION, RBC ANTIBODIES, EACH PANEL FOR EACH SERUM TECHNIQUE

86870

Cash price

$68

$85 – $169

ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) CONFIRMATORY TEST (EG, WESTERN BLOT OR IMMUNOBLOT)

86617

Cash price

$46

$12 – $65

ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA)

86663

Cash price

$52

$11 – $73