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Fallon SmartShopper gives you real-time health care cost comparisons. Now you can shop for the right health care providers for you based on cost and location.

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The Fallon SmartShopper cost transparency tool from Sapphire Digital is available to all Fallon commercial members. Eligibility for the incentive rewards varies by employer, plan and product.

As health care evolves and costs continue to rise, you are being asked to share more of the expense. But do you know the difference in cost between a visit to the doctor’s office and a trip to an urgent care center? How about the average cost for a hospital stay? Do you know what portion of those costs (if any) that you'll be responsible for paying?

Cost sharing

We negotiate and contract with plan providers to get you discounted rates for your covered health care services. Depending on your plan type, you may be responsible for paying a portion of the cost of your health care service. This is called "cost-sharing." Your cost-sharing may be in the form of copayments, coinsurance and/or deductibles.

  • A copayment is the dollar amount that you need to pay for a covered service, usually when you get the service. For example, if your plan has a $20 copayment for doctor office visits, you'll pay $20 when you visit the doctor.
  • Coinsurance is the percent that you need to pay for a covered service. For example, if you have a 20% coinsurance for a covered benefit, you pay 20% of the cost and the plan pays the rest.
  • A deductible is the dollar amount that you pay before the plan starts to pay for certain services. For example, if you have a $1,000 deductible, you must pay up to $1,000 for certain services before your plan will start paying for them.

Costs for some common health care services*

The tables below show cost ranges for some common health care services. Depending on your plan design and where you are in your deductible (if you have one), you may be responsible for paying all, some or none of these costs. To find out what your specific copayments, coinsurance and deductibles are, you can check your Summary of Benefits, Member Handbook or your other plan materials.

Office visits, hospital visits and other facility visits

Service Cost range
Doctor office visit $53–$344
normal delivery, including doctor’s fees
c-section delivery, including doctor’s fees
Emergency room visit, minor injury $75–$903
Urgent care center visit $78–$425


Tests, imaging and labs

Service Cost range in a non-hospital setting Cost range in a hospital setting
Blood tests
Costs vary based on test requested.
$6–$24 $1–$280
Chest x-ray $32–$70 $62–$273
Mammogram $221–$302 $180–$414
MRI $414–$3,368 $977–$5,883
CT scan–head/brain $129–$302 $340–$1,766
CT scan–thorax $165–$479 $416–$2,131
CT scan–abdomen $245–$681 $440–$2,514


When you need immediate care

If you can't get in to see your doctor, review this guide for help in identifying your best and most convenient option for care, based on your symptoms or situation.

Costs for other health care services

If you have questions about costs for medical services that aren't listed on this page, you can:

Things to consider when completing the Request for Good Faith Estimate of Medical Services form

  • The accuracy of the estimate depends on how accurate the information is on the form.
  • To avoid delays in getting your estimate, please provide as much information as possible about the exact service you'll be receiving. Also, please include information about any procedures, services or tests that are associated with the service. Some examples are:
  • anesthesia
  • facility
  • pathology
  • tests or screenings
  • radiology
  • Make sure to choose how you'll like us to send the cost estimate to you. You can have it emailed or sent through regular mail. Email will be delivered in 2 business days. Mail will be sent out in 2 business days to your address we have in our records. Mail delivery is dependent on the postal service.


* This section illustrates examples of the average costs for the indicated services. However, individual experiences and costs may vary. Please remember:

  • This information should not replace your health care provider’s advice and direction. You should work with your doctor and health care provider to explore all of your treatment options to make an informed decision about your health care.
  • These examples are based on average costs charged by Fallon Health network providers.
  • Unusually high-cost or low-cost cases are not included.
  • Actual out-of-pocket costs will depend on services received, benefits, negotiated rates for a hospital or professional provider and the billed charges for a hospital or professional provider.
  • This information does not suggest that any health care service or treatment approach is necessary or unnecessary, nor better or worse than any other service or treatment approach.
  • These figures do not list a specific, actual cost for any specific service or episode of care. Facility and professional billed charges vary from provider to provider.



Important information

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* This tool is currently showing tiers for FY2021. Tiers will be updated for FY2022 on July 1.