INTRODUCTION: Inflammatory bowel diseases (IBD) are costly chronic illnesses with routine services both inpatient and outpatient, preventative care, and costly biologic pharmaceuticals. Recent mandates require US hospitals to publish healthcare system financial charges. As many as 10-15% of IBD patients are uninsured and as such, are accountable for the entirety of their healthcare charges. We aimed to assess the variability in healthcare charges for standard tests and procedures routinely utilized in IBD care. METHODS: Financial charges from 25 geographically diverse healthcare systems were obtained and queried. Serum studies included metabolic, nutritional, inflammation, and infectious screening studies Stool studies included infectious testings and fecal calprotectin. Imaging studies included CT and MRI abdomen; endoscopy included EGD and colonoscopy with biopsy. Lab studies were divided into Basic (e.g., CBC, CMP, CRP) and Extended categories (e.g., EBV serology) to express differing views on the routine testing extent. Diagnosis-related groups for commonly billed encounters for IBD patients (DRG 329-331) were also examined. RESULTS: Most centers reported data on all serum, stool, and imaging studies queried; however, reporting on colonoscopy with biopsy (n = 14/25) and DRG charges (range 8-14) was inconsistent. There was significant variability in the charges for routine laboratory, imaging, and endoscopic evaluation across the healthcare systems (Figure 1). The median sum charge for Basic labs was $2,105 (IQR $1,576-3,522), Extended labs $4,596 (IQR $3,877-7,341), and rose to $9,671 (IQR $7677-12,051) and $13,085 (IQR $10,481-15,511) with the addition of CT plus colonoscopy, respectively. DRGs for inflammatory bowel disease demonstrated less variability (Figure 2). Median charge for IBD without complication or comorbidity was $64,268 (IQR $52,296-76,377), with complication/comorbidity $96,588 (IQR $71,962-109,674, and rose to $181,675 (IQR $133,962-235,744) with a major complication or comorbidity. The most inexpensive healthcare system averaged charges 65% below than the median, and the most costly averaged 232% higher. CONCLUSION: There is significant variability across healthcare systems in financial charges for commonly ordered tests and procedures in IBD patients that can reach staggering sums. Uniformity and transparency in healthcare pricing structures is desperately needed to ease the financial burden, particularly for uninsured populations.