Hospital Detroit-Warren-Dearborn, MI

VHS Detroit Receiving Hospital

VHS Detroit Receiving Hospital in Detroit, MI publishes cash prices for 359 common procedures listed here, from its own machine-readable price file updated Apr 7, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Michigan median for 302 of 354 procedures and below it for 50. By typical cash price it ranks #97 of 97 Michigan hospitals and #31 of 31 hospitals in the Detroit, MI area, cheapest first. Select a procedure to compare it with other hospitals nearby.

4201 St Antoine, Detroit, MI 48201 Collected Sep 23, 2026 Source price file Check a bill from this hospital (313) 745-2941

Acute care hospital For-profit hospital Emergency department CMS star rating 1 of 5 CCN 230273 · CMS hospital register NPI 1619289998

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN WO/W CM	$6,228.00	$8,304.00	—	298% above	25%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN WO/W CM	$6,228.00	$8,304.00	—	—	25%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN 2 VIEWS	$518.25	$691.00	—	148% above	25%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN 2 VIEWS	$518.25	$691.00	—	—	25%
Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE 3 VIEWS MINIMUM	$725.25	$967.00	—	240% above	25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE 3 VIEWS MINIMUM	$725.25	$967.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UE/LE ART STUD LTD 1-2LV	$990.75	$1,321.00	—	221% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UE/LE ART STUD LTD 1-2LV	$990.75	$1,321.00	—	—	25%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTRMTY W/O CM	$3,536.25	$4,715.00	—	250% above	25%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTRMTY W/O CM	$3,536.25	$4,715.00	—	—	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 X-RAY ESOPHAGUS SNGL CM STDY	$618.00	$824.00	—	118% above	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-RAY ESOPHAGUS SNGL CM STDY	$618.00	$824.00	—	—	25%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE IMAGING WHOLE BODY	$3,446.25	$4,595.00	—	266% above	25%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE IMAGING WHOLE BODY	$3,446.25	$4,595.00	—	—	25%
Breast ultrasound, complete, one breast CPT 76641 US BREAST UNI COMPLETE	$261.00	$348.00	—	14% below	25%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST UNI COMPLETE	$261.00	$348.00	—	—	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST UNI LTD	$261.00	$348.00	—	2% below	25%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST UNI LTD	$261.00	$348.00	—	—	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD/PEL W CONTRAST	$6,276.75	$8,369.00	—	153% above	25%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD/PEL W CONTRAST	$6,276.75	$8,369.00	—	—	25%
CT angiography (CTA) of the head CPT 70496 CTA HEAD W CONTRAST ONLY	$10,755.00	$14,340.00	—	594% above	25%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD W CONTRAST ONLY	$10,755.00	$14,340.00	—	—	25%
CT angiography (CTA) of the neck CPT 70498 CTA NECK W CONTRAST ONLY	$7,142.25	$9,523.00	—	376% above	25%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W CONTRAST ONLY	$7,142.25	$9,523.00	—	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST (NONCOR) W CM	$7,114.50	$9,486.00	—	328% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST (NONCOR) W CM	$7,114.50	$9,486.00	—	—	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA HEART W CONTRAST	$2,367.75	$3,157.00	—	77% above	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA HEART W CONTRAST	$2,367.75	$3,157.00	—	—	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CARD SCORING WO CONT	$137.25	$183.00	—	8% below	25%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CARD SCORING WO CONT	$137.25	$183.00	—	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CM	$3,870.00	$5,160.00	—	117% above	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CM	$3,870.00	$5,160.00	—	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CM	$4,393.50	$5,858.00	—	53% above	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CM	$4,393.50	$5,858.00	—	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELVIS WO/W CM	$5,019.75	$6,693.00	—	91% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS WO/W CM	$5,019.75	$6,693.00	—	—	25%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CM	$3,915.75	$5,221.00	—	166% above	25%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ CM	$3,915.75	$5,221.00	—	—	25%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CM	$3,590.25	$4,787.00	—	286% above	25%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CM	$3,590.25	$4,787.00	—	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS W/O CONTRAST	$4,617.00	$6,156.00	—	341% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CM	$4,617.00	$6,156.00	—	341% above	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS W/O CONTRAST	$4,617.00	$6,156.00	—	—	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CM	$4,617.00	$6,156.00	—	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN WO CONTRST	$3,630.75	$4,841.00	—	290% above	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN WO CONTRST	$3,630.75	$4,841.00	—	—	25%
CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W CONTRAST	$4,183.50	$5,578.00	—	236% above	25%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN W CONTRAST	$4,183.50	$5,578.00	—	—	25%
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN WO/W CONTR	$5,603.25	$7,471.00	—	258% above	25%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN WO/W CONTR	$5,603.25	$7,471.00	—	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE LUMBAR W/O CM	$3,630.75	$4,841.00	—	233% above	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SPINE LUMBAR W/O CM	$3,630.75	$4,841.00	—	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERVICAL W/O CM	$3,426.75	$4,569.00	—	208% above	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SPINE CERVICAL W/O CM	$3,426.75	$4,569.00	—	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS WITH CONTRAST	$3,735.00	$4,980.00	—	179% above	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS WITH CONTRAST	$3,735.00	$4,980.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUPLEX CAROTID BI/COMP	$1,236.75	$1,649.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUPLEX CAROTID BI/COMP	$1,236.75	$1,649.00	—	—	25%
Chest CT scan without and with contrast CPT 71270 CT THORAX WO/W CONTRAST	$6,928.50	$9,238.00	—	296% above	25%
Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX WO/W CONTRAST	$6,928.50	$9,238.00	—	—	25%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS	$389.25	$519.00	—	119% above	25%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS	$389.25	$519.00	—	—	25%
Chest X-ray, single view CPT 71045 CHEST 1 VIEW	$321.00	$428.00	—	103% above	25%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW	$321.00	$428.00	—	—	25%
Collarbone (clavicle) X-ray, complete CPT 73000 CLAVICLE COMPLETE	$564.75	$753.00	—	213% above	25%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 CLAVICLE COMPLETE	$564.75	$753.00	—	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMP	$1,449.75	$1,933.00	—	134% above	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMP	$1,449.75	$1,933.00	—	—	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA AXIAL SKELTON	$905.25	$1,207.00	—	191% above	25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA AXIAL SKELTON	$905.25	$1,207.00	—	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX W/O CONTRAST	$4,617.00	$6,156.00	—	363% above	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX W/O CONTRAST	$4,617.00	$6,156.00	—	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX WITH CONTRAST	$4,947.75	$6,597.00	—	277% above	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX WITH CONTRAST	$4,947.75	$6,597.00	—	—	25%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO+CAD BILAT	$666.75	$889.00	—	—	25%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO+CAD BILAT	$666.75	$889.00	—	—	25%
Diagnostic mammogram, one breast one side CPT 77065 DX MAMMO+CAD UNILAT	$497.25	$663.00	—	60% above	25%
Diagnostic mammogram, one breast inpatient one side CPT 77065 DX MAMMO+CAD UNILAT	$497.25	$663.00	—	—	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 LE ART IMAGING COMP BILAT	$324.75	$433.00	—	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 LE ART IMAGING COMP BILAT	$324.75	$433.00	—	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 UE/LE IMG VEINS COMP BILAT	$1,979.25	$2,639.00	—	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 UE/LE IMG VEINS COMP BILAT	$1,979.25	$2,639.00	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO2D SPECTR/COLOR FLO	$1,735.50	$2,314.00	—	22% above	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO2D DOP/COLFL W/CONTR	$3,776.25	$5,035.00	—	165% above	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO2D SPECTR/COLOR FLO	$1,735.50	$2,314.00	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO2D DOP/COLFL W/CONTR	$3,776.25	$5,035.00	—	—	25%
Elbow X-ray, 2 views CPT 73070 ELBOW 2 VIEWS	$399.00	$532.00	—	198% above	25%
Elbow X-ray, 2 views inpatient CPT 73070 ELBOW 2 VIEWS	$399.00	$532.00	—	—	25%
Elbow X-ray, complete, 3 or more views CPT 73080 ELBOW 3 VIEW MINIMUM	$545.25	$727.00	—	186% above	25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 ELBOW 3 VIEW MINIMUM	$545.25	$727.00	—	—	25%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORB/EAR/FOSSA W/O CM	$4,356.00	$5,808.00	—	334% above	25%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORB/EAR/FOSSA W/O CM	$4,356.00	$5,808.00	—	—	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES 3VW MIN	$809.25	$1,079.00	—	211% above	25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES 3VW MIN	$809.25	$1,079.00	—	—	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 FOREARM 2 VIEWS	$572.25	$763.00	—	221% above	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 FOREARM 2 VIEWS	$572.25	$763.00	—	—	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYSTEM IMG	$1,570.50	$2,094.00	—	68% above	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SYSTEM IMG	$1,570.50	$2,094.00	—	—	25%
Hand X-ray, 2 views CPT 73120 HAND 2 VIEWS	$420.00	$560.00	—	188% above	25%
Hand X-ray, 2 views inpatient CPT 73120 HAND 2 VIEWS	$420.00	$560.00	—	—	25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 OS CALCIS 2 VIEWS	$408.00	$544.00	—	165% above	25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 OS CALCIS 2 VIEWS	$408.00	$544.00	—	—	25%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT & RESP EFFT	$499.50	$666.00	—	9% below	25%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATT & RESP EFFT	$499.50	$666.00	—	—	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY CPAP 4	$9,970.50	$13,294.00	—	187% above	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY CPAP 4	$9,970.50	$13,294.00	—	—	25%
Knee X-ray, 3 views CPT 73562 KNEE 3 VIEWS	$545.25	$727.00	—	174% above	25%
Knee X-ray, 3 views inpatient CPT 73562 KNEE 3 VIEWS	$545.25	$727.00	—	—	25%
Knee X-ray, complete, 4 or more views CPT 73564 KNEE COMP 4 VW MIN	$669.00	$892.00	—	213% above	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 KNEE COMP 4 VW MIN	$669.00	$892.00	—	—	25%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTRMTY W/O CM	$3,426.75	$4,569.00	—	211% above	25%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTRMTY W/O CM	$3,426.75	$4,569.00	—	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LTD SNGLE/QUAD/FU	$804.75	$1,073.00	—	71% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LTD SNGLE/QUAD/FU	$804.75	$1,073.00	—	—	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US XTR JOINT LMTD	$292.50	$390.00	—	20% below	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US XTR SOFT TISSUE LMTD	$845.25	$1,127.00	—	131% above	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US XTR JOINT LMTD	$292.50	$390.00	—	—	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US XTR SOFT TISSUE LMTD	$845.25	$1,127.00	—	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING	$261.00	$348.00	—	25% below	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREENING	$261.00	$348.00	—	—	25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 TIBIA/FIBULA 2 VIEWS	$674.25	$899.00	—	265% above	25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 TIBIA/FIBULA 2 VIEWS	$674.25	$899.00	—	—	25%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST	$6,297.75	$8,397.00	—	306% above	25%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRAST	$6,297.75	$8,397.00	—	—	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWR EXT JNT W/O CM	$3,941.25	$5,255.00	—	146% above	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWR EXT JNT W/O CM	$3,941.25	$5,255.00	—	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LE JNT WO/W CM	$6,906.75	$9,209.00	—	178% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LE JNT WO/W CM	$6,906.75	$9,209.00	—	—	25%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CM	$3,649.50	$4,866.00	—	116% above	25%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CM	$3,649.50	$4,866.00	—	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO/W CM	$6,303.75	$8,405.00	—	102% above	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO/W CM	$6,303.75	$8,405.00	—	—	25%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$5,909.25	$7,879.00	—	255% above	25%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$5,909.25	$7,879.00	—	—	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO/W CONTRAST	$11,486.25	$15,315.00	—	307% above	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO/W CONTRAST	$11,486.25	$15,315.00	—	—	25%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE LUMBAR W/O CM	$3,935.25	$5,247.00	—	119% above	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINE LUMBAR W/O CM	$3,935.25	$5,247.00	—	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINE LUMBAR WO/W CM	$6,687.00	$8,916.00	—	148% above	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI SPINE LUMBAR WO/W CM	$6,687.00	$8,916.00	—	—	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINE THORAC W/O CM	$4,053.00	$5,404.00	—	151% above	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI SPINE THORAC W/O CM	$4,053.00	$5,404.00	—	—	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINE CERV WO/W CM	$8,826.00	$11,768.00	—	213% above	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI SPINE CERV WO/W CM	$8,826.00	$11,768.00	—	—	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SPINE CERVICL W/O CM	$4,053.00	$5,404.00	—	131% above	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI SPINE CERVICL W/O CM	$4,053.00	$5,404.00	—	—	25%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WO/W CONTRAST	$6,303.75	$8,405.00	—	128% above	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WO/W CONTRAST	$6,303.75	$8,405.00	—	—	25%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$3,854.25	$5,139.00	—	126% above	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$3,854.25	$5,139.00	—	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UP EXT JNT W/O CM	$5,522.25	$7,363.00	—	196% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UP EXT JNT W/O CM	$5,522.25	$7,363.00	—	—	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 SPINE CERVICAL 4 OR 5 VW	$960.00	$1,280.00	—	227% above	25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 SPINE CERVICAL 4 OR 5 VW	$960.00	$1,280.00	—	—	25%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISS NECK W CM	$4,456.50	$5,942.00	—	238% above	25%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISS NECK W CM	$4,456.50	$5,942.00	—	—	25%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISS NECK WO CM	$3,894.00	$5,192.00	—	284% above	25%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISS NECK WO CM	$3,894.00	$5,192.00	—	—	25%
Neck soft tissue X-ray CPT 70360 NECK FOR SOFT TISSUES	$303.75	$405.00	—	72% above	25%
Neck soft tissue X-ray inpatient CPT 70360 NECK FOR SOFT TISSUES	$303.75	$405.00	—	—	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MC PERF SPECT WM EF MULT	$4,595.25	$6,127.00	—	57% above	25%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MC PERF SPECT WM EF MULT	$4,595.25	$6,127.00	—	—	25%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST	$3,426.75	$4,569.00	—	243% above	25%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST	$3,426.75	$4,569.00	—	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LTD/FU	$882.00	$1,176.00	—	162% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LTD/FU	$882.00	$1,176.00	—	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$1,136.25	$1,515.00	—	100% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$1,136.25	$1,515.00	—	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB-US EVAL>14 WEEKS	$975.75	$1,301.00	—	74% above	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMP>14WK SGL GEST	$1,168.50	$1,558.00	—	108% above	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB-US EVAL>14 WEEKS	$975.75	$1,301.00	—	—	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMP>14WK SGL GEST	$1,168.50	$1,558.00	—	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB COMP<14WKS 1STGEST	$1,111.50	$1,482.00	—	116% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB COMP<14WKS 1STGEST	$1,111.50	$1,482.00	—	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ANT-US LMTD 1 OR MORE FETUS	$669.75	$893.00	—	109% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LTD 1OR> FETUS	$827.25	$1,103.00	—	158% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ANT-US LMTD 1 OR MORE FETUS	$669.75	$893.00	—	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LTD 1OR> FETUS	$827.25	$1,103.00	—	—	25%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILAT 2VW	$706.50	$942.00	—	256% above	25%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILAT 2VW	$706.50	$942.00	—	—	25%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 RIBS UNI 3V MIN W/PA CXR	$741.75	$989.00	—	215% above	25%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 RIBS UNI 3V MIN W/PA CXR	$741.75	$989.00	—	—	25%
Screening mammogram, both breasts both sides CPT 77067 SCRN MAMMO+CAD BILAT	$539.25	$719.00	—	—	25%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCRN MAMMO+CAD BILAT	$539.25	$719.00	—	—	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER 2 VWS MINIMUM	$553.50	$738.00	—	159% above	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 SHOULDER 2 VWS MINIMUM	$553.50	$738.00	—	—	25%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES 3VW MIN	$874.50	$1,166.00	—	274% above	25%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES 3VW MIN	$874.50	$1,166.00	—	—	25%
Skull X-ray, fewer than 4 views CPT 70250 SKULL < 4 VIEWS	$516.00	$688.00	—	146% above	25%
Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL < 4 VIEWS	$516.00	$688.00	—	—	25%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY	$9,970.50	$13,294.00	—	209% above	25%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY	$9,970.50	$13,294.00	—	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 SWAL FUNC W/CINE/VIDEO+CM STDY	$1,326.75	$1,769.00	—	252% above	25%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWAL FUNC W/CINE/VIDEO+CM STDY	$1,326.75	$1,769.00	—	—	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 FEMUR 2 VIEWS MIN	$217.50	$290.00	—	1% above	25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 FEMUR 2 VIEWS MIN	$217.50	$290.00	—	—	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT SPINE THORACIC W/O CM	$3,426.75	$4,569.00	—	225% above	25%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT SPINE THORACIC W/O CM	$3,426.75	$4,569.00	—	—	25%
Toe X-ray, 2 or more views CPT 73660 TOE(S) 2 VIEWS	$425.25	$567.00	—	238% above	25%
Toe X-ray, 2 or more views inpatient CPT 73660 TOE(S) 2 VIEWS	$425.25	$567.00	—	—	25%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NOT OB	$1,073.25	$1,431.00	—	103% above	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NOT OB	$1,073.25	$1,431.00	—	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 ANT-US TRANSVAG-PREG UTERUS	$859.50	$1,146.00	—	98% above	25%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL	$1,073.25	$1,431.00	—	147% above	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 ANT-US TRANSVAG-PREG UTERUS	$859.50	$1,146.00	—	—	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANSVAGINAL	$1,073.25	$1,431.00	—	—	25%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$1,272.75	$1,697.00	—	91% above	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$1,272.75	$1,697.00	—	—	25%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM CONTENTS	$1,199.25	$1,599.00	—	128% above	25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM CONTENTS	$1,199.25	$1,599.00	—	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD/NECK	$865.50	$1,154.00	—	82% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD/NECK	$865.50	$1,154.00	—	—	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI W/SNGL CM STDY	$1,356.75	$1,809.00	—	238% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI W/SNGL CM STDY	$1,356.75	$1,809.00	—	—	25%
Upper arm X-ray (humerus), 2 views CPT 73060 HUMERUS 2 VIEW MINIMUM	$533.25	$711.00	—	189% above	25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HUMERUS 2 VIEW MINIMUM	$533.25	$711.00	—	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 UE/LE IMG VEINS UNI/LTD	$951.00	$1,268.00	—	79% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 UE/LE IMG VEINS UNI/LTD	$951.00	$1,268.00	—	—	25%
Wrist X-ray, 2 views CPT 73100 WRIST 2 VIEWS	$444.75	$593.00	—	217% above	25%
Wrist X-ray, 2 views inpatient CPT 73100 WRIST 2 VIEWS	$444.75	$593.00	—	—	25%
Wrist X-ray, complete, 3 or more views CPT 73110 WRIST 3 VIEWS MINIMUM	$545.25	$727.00	—	179% above	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST 3 VIEWS MINIMUM	$545.25	$727.00	—	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP UNI W/PELV 2-3 VWS	$231.00	$308.00	—	12% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HIP UNI W/PELV 2-3 VWS	$231.00	$308.00	—	—	25%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW	$407.25	$543.00	—	157% above	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW	$407.25	$543.00	—	—	25%
X-ray of the ankle, 2 views CPT 73600 ANKLE 2 VIEWS	$594.00	$792.00	—	238% above	25%
X-ray of the ankle, 2 views inpatient CPT 73600 ANKLE 2 VIEWS	$594.00	$792.00	—	—	25%
X-ray of the finger(s), 2 or more views CPT 73140 FINGER(S) 2 VIEWS	$425.25	$567.00	—	220% above	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 FINGER(S) 2 VIEWS	$425.25	$567.00	—	—	25%
X-ray of the foot, 2 views CPT 73620 FOOT 2 VIEWS	$442.50	$590.00	—	179% above	25%
X-ray of the foot, 2 views inpatient CPT 73620 FOOT 2 VIEWS	$442.50	$590.00	—	—	25%
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT 3 VIEWS MINIMUM	$545.25	$727.00	—	203% above	25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT 3 VIEWS MINIMUM	$545.25	$727.00	—	—	25%
X-ray of the hand, 3 or more views CPT 73130 HAND 3 VIEWS MINIMUM	$546.00	$728.00	—	197% above	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 HAND 3 VIEWS MINIMUM	$546.00	$728.00	—	—	25%
X-ray of the knee, 1 or 2 views CPT 73560 KNEE 1-2 VIEWS	$453.75	$605.00	—	192% above	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE 1-2 VIEWS	$453.75	$605.00	—	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR 2 VIEWS	$583.50	$778.00	—	173% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR 3 VIEWS	$765.75	$1,021.00	—	258% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR 2 VIEWS	$583.50	$778.00	—	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR 3 VIEWS	$765.75	$1,021.00	—	—	25%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR MIN 4VWS	$820.50	$1,094.00	—	166% above	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR MIN 4VWS	$820.50	$1,094.00	—	—	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE THORACIC 2 VIEWS	$696.00	$928.00	—	276% above	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE THORACIC 2 VIEWS	$696.00	$928.00	—	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES 3VW MIN	$375.00	$500.00	—	114% above	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES 3VW MIN	$375.00	$500.00	—	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 3 VIEWS	$712.50	$950.00	—	209% above	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 2 VIEWS	$777.00	$1,036.00	—	237% above	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 3 VIEWS	$712.50	$950.00	—	—	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 2 VIEWS	$777.00	$1,036.00	—	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 VIEW	$497.25	$663.00	—	202% above	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 2 VIEWS	$596.25	$795.00	—	263% above	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 VIEW	$497.25	$663.00	—	—	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 2 VIEWS	$596.25	$795.00	—	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM COCCYX 2 VWS	$492.00	$656.00	—	182% above	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM COCCYX 2 VWS	$492.00	$656.00	—	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
ACTH blood test CPT 82024 ACTH	$495.75	$661.00	—	429% above	25%
ACTH blood test inpatient CPT 82024 ACTH	$495.75	$661.00	—	—	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSAMINASE-SGPT (ALT)	$21.75	$29.00	—	9% below	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSAMINASE-SGPT (ALT)	$21.75	$29.00	—	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSTERASE AST(SGOT)	$21.75	$29.00	—	1% below	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSTERASE AST(SGOT)	$21.75	$29.00	—	—	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$378.75	$505.00	—	123% above	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$378.75	$505.00	—	—	25%
Albumin blood test CPT 82040 ALBUMIN SERUM	$21.75	$29.00	—	9% above	25%
Albumin blood test inpatient CPT 82040 ALBUMIN SERUM	$21.75	$29.00	—	—	25%
Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE ALKALINE	$102.00	$136.00	—	386% above	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 PHOSPHATASE ALKALINE	$102.00	$136.00	—	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE F423-ARA H 2	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE POPPY SEED	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE F427-ARA H 9	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE GOAT EPITHELIUM	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE ALDER TREE	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE ALFALFA	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE LINSEED	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE BAY LEAF	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE SUNFLOWER POLLEN	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE BENTGRASS	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE F424-ARA H 3	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE CHICKEN FEATHERS	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE F352-ARA H 8	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE HOPS	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE TOBACCO	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE SHEEP EPITHELIUM	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE VANILLA	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE WHEAT	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLGN IGE PENICILLIN G (MAJOR)	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE HONEY	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE SUNFLOWER SEED	$2.45	$3.26	—	62% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE TURKEY FEATHERS	$2.45	$3.26	—	62% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLRGN SPEC IGE EA	$2.45	$3.26	—	62% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE F422-ARA H 1	$3.00	$4.00	—	53% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE SAFFLOWER	$10.50	$14.00	—	65% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE A FUMIGATUS	$12.00	$16.00	—	88% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE POMEGRANATE	$13.50	$18.00	—	112% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST EACH ALLERGEN	$15.00	$20.00	—	135% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE NECTARINE SPEC	$17.25	$23.00	—	171% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLGN SPEC IGE EA ALLERG	$17.25	$23.00	—	171% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLGN IGE EA ALLERG	$21.75	$29.00	—	241% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE GELATIN PORCINE	$30.00	$40.00	—	371% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE WALNUT	$30.75	$41.00	—	383% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE PUMPKIN SEED	$50.25	$67.00	—	689% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE COTTON SEED	$50.25	$67.00	—	689% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE RAT URINE	$60.00	$80.00	—	842% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE MOUSE URINE	$60.00	$80.00	—	842% above	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE F424-ARA H 3	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE LINSEED	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE HOPS	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE HONEY	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE GOAT EPITHELIUM	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE ALDER TREE	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE ALFALFA	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE BAY LEAF	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE BENTGRASS	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE CHICKEN FEATHERS	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE F352-ARA H 8	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLGN IGE PENICILLIN G (MAJOR)	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE WHEAT	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE POPPY SEED	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE F427-ARA H 9	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE F423-ARA H 2	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE VANILLA	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE TOBACCO	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE SUNFLOWER POLLEN	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE SHEEP EPITHELIUM	$2.25	$3.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE SUNFLOWER SEED	$2.45	$3.26	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE TURKEY FEATHERS	$2.45	$3.26	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLRGN SPEC IGE EA	$2.45	$3.26	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE F422-ARA H 1	$3.00	$4.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE SAFFLOWER	$10.50	$14.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE A FUMIGATUS	$12.00	$16.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE POMEGRANATE	$13.50	$18.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST EACH ALLERGEN	$15.00	$20.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE NECTARINE SPEC	$17.25	$23.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLGN SPEC IGE EA ALLERG	$17.25	$23.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLGN IGE EA ALLERG	$21.75	$29.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE GELATIN PORCINE	$30.00	$40.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE WALNUT	$30.75	$41.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE PUMPKIN SEED	$50.25	$67.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE COTTON SEED	$50.25	$67.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE RAT URINE	$60.00	$80.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE MOUSE URINE	$60.00	$80.00	—	—	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA FETO PROTEIN SERUM	$198.75	$265.00	—	290% above	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA FETO PROTEIN SERUM	$198.75	$265.00	—	—	25%
Ammonia blood test CPT 82140 AMMONIA	$176.25	$235.00	—	171% above	25%
Ammonia blood test inpatient CPT 82140 AMMONIA	$176.25	$235.00	—	—	25%
Amylase blood test CPT 82150 AMYLASE	$85.50	$114.00	—	326% above	25%
Amylase blood test inpatient CPT 82150 AMYLASE	$85.50	$114.00	—	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYC CITRULLINATED PEP AB	$101.25	$135.00	—	82% above	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYC CITRULLINATED PEP AB	$101.25	$135.00	—	—	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB(ANA)	$159.75	$213.00	—	186% above	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB(ANA)	$159.75	$213.00	—	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYP NATRIURETC PEPTIDE	$280.50	$374.00	—	263% above	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYP NATRIURETC PEPTIDE	$280.50	$374.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE OTHER SOURCE	$225.00	$300.00	—	325% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE OTHER SOURCE	$225.00	$300.00	—	—	25%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$389.25	$519.00	—	672% above	25%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$389.25	$519.00	—	—	25%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$37.50	$50.00	—	65% above	25%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$37.50	$50.00	—	—	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATH LEVEL IV	$290.25	$387.00	—	166% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PROSTATE NEEDLE BX	$1,555.50	$2,074.00	—	1326% above	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH LEVEL IV	$290.25	$387.00	—	—	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PROSTATE NEEDLE BX	$1,555.50	$2,074.00	—	—	25%
Blood culture for bacteria CPT 87040 CULT BLOOD AERO/ANAERO	$148.50	$198.00	—	136% above	25%
Blood culture for bacteria inpatient CPT 87040 CULT BLOOD AERO/ANAERO	$148.50	$198.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$10.50	$14.00	—	19% below	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 RESEARCH PT BLOOD DRAW	$21.00	$28.00	—	63% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW BY VENIPUNCTURE	$21.00	$28.00	—	63% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$10.50	$14.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 RESEARCH PT BLOOD DRAW	$21.00	$28.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW BY VENIPUNCTURE	$21.00	$28.00	—	—	25%
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANT BLOOD	$91.50	$122.00	—	281% above	25%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD	$91.50	$122.00	—	—	25%
Blood lead test CPT 83655 LEAD HEAVY METAL	$63.75	$85.00	—	733% above	25%
Blood lead test CPT 83655 LEAD QUANTITATIVE	$66.75	$89.00	—	773% above	25%
Blood lead test inpatient CPT 83655 LEAD HEAVY METAL	$63.75	$85.00	—	—	25%
Blood lead test inpatient CPT 83655 LEAD QUANTITATIVE	$66.75	$89.00	—	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADTOPN CHRONC(HCG)QL	$166.50	$222.00	—	350% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADTOPN CHRONC(HCG)QL	$166.50	$222.00	—	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLD TYPE ABO ONLY	$139.50	$186.00	—	563% above	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLD TYPE ABO ONLY	$139.50	$186.00	—	—	25%
Blood urea nitrogen (BUN) test CPT 84520 BLD UREA NITROGEN QUAN	$45.75	$61.00	—	158% above	25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BLD UREA NITROGEN QUAN	$45.75	$61.00	—	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN QN	$142.50	$190.00	—	319% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN QN	$142.50	$190.00	—	—	25%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOXIN AMP PROBE	$101.25	$135.00	—	13% below	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF TOXIN AMP PROBE	$101.25	$135.00	—	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$147.00	$196.00	—	57% above	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$147.00	$196.00	—	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$120.75	$161.00	—	20% above	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$120.75	$161.00	—	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARSCOV2 COVID19 AMP PRB	$38.48	$51.31	—	64% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARSCOV2 COVID19 AMP PRB	$38.48	$51.31	—	—	25%
Calcium blood test, total CPT 82310 CALCIUM	$60.75	$81.00	—	204% above	25%
Calcium blood test, total inpatient CPT 82310 CALCIUM	$60.75	$81.00	—	—	25%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINO-EMBRYONIC AG	$348.75	$465.00	—	320% above	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINO-EMBRYONIC AG	$348.75	$465.00	—	—	25%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB	$34.00	$45.33	—	16% below	25%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB IGG	$93.00	$124.00	—	131% above	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB	$34.00	$45.33	—	—	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB IGG	$93.00	$124.00	—	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA DNA AMP PROBE	$364.50	$486.00	—	393% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA DNA AMP PROBE	$364.50	$486.00	—	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$412.50	$550.00	—	710% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$412.50	$550.00	—	—	25%
Complete blood count (CBC) with differential CPT 85025 CBC/PLT/AUTO DIFF (5)	$60.75	$81.00	—	51% above	25%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC/PLT/AUTO DIFF (5)	$60.75	$81.00	—	—	25%
Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFF	$56.25	$75.00	—	94% above	25%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFF	$56.25	$75.00	—	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$446.25	$595.00	—	497% above	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL	$446.25	$595.00	—	—	25%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL	$166.50	$222.00	—	389% above	25%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL	$166.50	$222.00	—	—	25%
Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE TOTAL	$72.75	$97.00	—	142% above	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATINE KINASE TOTAL	$72.75	$97.00	—	—	25%
Creatinine blood test CPT 82565 CREATININE BLOOD	$148.50	$198.00	—	523% above	25%
Creatinine blood test inpatient CPT 82565 CREATININE BLOOD	$148.50	$198.00	—	—	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS AB	$10.50	$14.00	—	76% below	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV AB	$241.50	$322.00	—	455% above	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS AB	$10.50	$14.00	—	—	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV AB	$241.50	$322.00	—	—	25%
D-dimer blood test (blood clot marker) CPT 85379 FDP D-DIMER QNT	$279.00	$372.00	—	549% above	25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FDP D-DIMER QNT	$279.00	$372.00	—	—	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDRST SULFATE	$246.00	$328.00	—	282% above	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDRST SULFATE	$246.00	$328.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 COCAINE MECON	$55.50	$74.00	—	5% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN/MECONIUM	$60.00	$80.00	—	3% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN QUAL	$90.00	$120.00	—	55% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCRN TRIAGE 10 PN	$94.50	$126.00	—	62% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN EACH CLASS	$101.25	$135.00	—	74% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 TRICYCLIC DRUGS QUAL	$131.25	$175.00	—	125% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ALCOHOL ETHYL	$166.50	$222.00	—	186% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/2	$519.75	$693.00	—	793% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$533.25	$711.00	—	816% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 OPIATES	$533.25	$711.00	—	816% above	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 COCAINE MECON	$55.50	$74.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN/MECONIUM	$60.00	$80.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN QUAL	$90.00	$120.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCRN TRIAGE 10 PN	$94.50	$126.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN EACH CLASS	$101.25	$135.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 TRICYCLIC DRUGS QUAL	$131.25	$175.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ALCOHOL ETHYL	$166.50	$222.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/2	$519.75	$693.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 OPIATES	$533.25	$711.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$533.25	$711.00	—	—	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL	$234.00	$312.00	—	631% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL	$234.00	$312.00	—	—	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV IGM VCA	$183.00	$244.00	—	187% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR VIRUS VCA AB	$183.00	$244.00	—	187% above	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR VIRUS VCA AB	$183.00	$244.00	—	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV IGM VCA	$183.00	$244.00	—	—	25%
Estradiol blood test CPT 82670 ESTRADIOL	$250.50	$334.00	—	220% above	25%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$250.50	$334.00	—	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMLAT HORMONE	$310.50	$414.00	—	289% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMLAT HORMONE	$310.50	$414.00	—	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL	$41.25	$55.00	—	35% below	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN FECAL	$41.25	$55.00	—	—	25%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$575.25	$767.00	—	859% above	25%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$575.25	$767.00	—	—	25%
Fibrinogen blood test CPT 85384 FIBRINOGEN ACTIVITY	$109.50	$146.00	—	278% above	25%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN ACTIVITY	$109.50	$146.00	—	—	25%
Folate (folic acid) blood test CPT 82746 FOLIC ACID	$180.00	$240.00	—	144% above	25%
Folate (folic acid) blood test CPT 82746 FIBRINOGEN ACTIVITY	$276.00	$368.00	—	274% above	25%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID	$180.00	$240.00	—	—	25%
Folate (folic acid) blood test inpatient CPT 82746 FIBRINOGEN ACTIVITY	$276.00	$368.00	—	—	25%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$261.00	$348.00	—	291% above	25%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$261.00	$348.00	—	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE	$246.75	$329.00	—	709% above	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE	$246.75	$329.00	—	—	25%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$279.00	$372.00	—	660% above	25%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$279.00	$372.00	—	—	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GLUTAMYLTRANSERASE GGT	$9.75	$13.00	—	68% below	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT	$48.00	$64.00	—	56% above	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GLUTAMYLTRANSERASE GGT	$9.75	$13.00	—	—	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT	$48.00	$64.00	—	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST DOSE	$130.50	$174.00	—	504% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST DOSE	$130.50	$174.00	—	—	25%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3SPEC	$229.50	$306.00	—	303% above	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 3SPEC	$229.50	$306.00	—	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N GONOR AMP PROBE	$364.50	$486.00	—	276% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N GONOR AMP PROBE	$364.50	$486.00	—	—	25%
H. pylori stool antigen test CPT 87338 H. PYLORI STOOL AG	$159.75	$213.00	—	152% above	25%
H. pylori stool antigen test inpatient CPT 87338 H. PYLORI STOOL AG	$159.75	$213.00	—	—	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT	$41.25	$55.00	—	77% below	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV/RNA BY PCR	$288.75	$385.00	—	58% above	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 QUANT RNA/DNA	$996.00	$1,328.00	—	446% above	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT	$41.25	$55.00	—	—	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV/RNA BY PCR	$288.75	$385.00	—	—	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 QUANT RNA/DNA	$996.00	$1,328.00	—	—	25%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 SCREEN	$98.25	$131.00	—	109% above	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1/HIV-2 SCREEN	$98.25	$131.00	—	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV I AG HIV I HIV II AB	$242.25	$323.00	—	394% above	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV I AG HIV I HIV II AB	$242.25	$323.00	—	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCATED	$178.50	$238.00	—	360% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCATED	$178.50	$238.00	—	—	25%
Hemoglobin blood test CPT 85018 BLOOD HEMOGLBN	$124.50	$166.00	—	678% above	25%
Hemoglobin blood test inpatient CPT 85018 BLOOD HEMOGLBN	$124.50	$166.00	—	—	25%
Hepatitis B core antibody test (total) CPT 86704 HEP B CORE AB TOTAL	$165.75	$221.00	—	275% above	25%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE AB TOTAL	$165.75	$221.00	—	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURF AB	$119.25	$159.00	—	184% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURF AB	$119.25	$159.00	—	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$144.75	$193.00	—	202% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$144.75	$193.00	—	—	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C QUANT	$37.50	$50.00	—	72% below	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C QUANT PCR	$708.75	$945.00	—	439% above	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C QUANT	$37.50	$50.00	—	—	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C QUANT PCR	$708.75	$945.00	—	—	25%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES I AB IGG	$76.50	$102.00	—	84% above	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES I AB IGG	$76.50	$102.00	—	—	25%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES AB SMPLX TYPE 2	$7.50	$10.00	—	85% below	25%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES II AB IGG	$142.50	$190.00	—	178% above	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES AB SMPLX TYPE 2	$7.50	$10.00	—	—	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES II AB IGG	$142.50	$190.00	—	—	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP HI SENSITIVITY	$44.25	$59.00	—	23% below	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HI SENSITIVITY	$44.25	$59.00	—	—	25%
Homocysteine blood test CPT 83090 HOMOCYSTEINE QUANT	$246.75	$329.00	—	222% above	25%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE QUANT	$246.75	$329.00	—	—	25%
Insulin blood test CPT 83525 INSULIN TOTAL	$131.25	$175.00	—	259% above	25%
Insulin blood test inpatient CPT 83525 INSULIN TOTAL	$131.25	$175.00	—	—	25%
Iron blood test (serum iron) CPT 83540 IRON	$45.75	$61.00	—	56% above	25%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$45.75	$61.00	—	—	25%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPCTY	$87.75	$117.00	—	121% above	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPCTY	$87.75	$117.00	—	—	25%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$294.75	$393.00	—	377% above	25%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$294.75	$393.00	—	—	25%
LH (luteinizing hormone) test CPT 83002 LUTEINING HORMONE	$298.50	$398.00	—	293% above	25%
LH (luteinizing hormone) test inpatient CPT 83002 LUTEINING HORMONE	$298.50	$398.00	—	—	25%
Lactate (lactic acid) blood test CPT 83605 LACTATE(LACTIC ACID)	$172.50	$230.00	—	283% above	25%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE(LACTIC ACID)	$172.50	$230.00	—	—	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH-LACTIC DEHYDROGENASE	$67.50	$90.00	—	181% above	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH-LACTIC DEHYDROGENASE	$67.50	$90.00	—	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE, URINE	$63.75	$85.00	—	111% above	25%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$117.00	$156.00	—	287% above	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE, URINE	$63.75	$85.00	—	—	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$117.00	$156.00	—	—	25%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$83.25	$111.00	—	77% above	25%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$83.25	$111.00	—	—	25%
Lyme disease antibody test CPT 86618 LYME DISEASE	$7.50	$10.00	—	71% below	25%
Lyme disease antibody test CPT 86618 LYME DISEASE AB	$31.50	$42.00	—	21% above	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE	$7.50	$10.00	—	—	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB	$31.50	$42.00	—	—	25%
Magnesium blood test CPT 83735 MAGNESIUM	$133.50	$178.00	—	568% above	25%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$133.50	$178.00	—	—	25%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB	$94.50	$126.00	—	283% above	25%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA AB	$94.50	$126.00	—	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE AB SCREEN	$97.50	$130.00	—	135% above	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE AB SCREEN	$97.50	$130.00	—	—	25%
Mumps immunity blood test CPT 86735 MUMPS AB	$105.75	$141.00	—	321% above	25%
Mumps immunity blood test inpatient CPT 86735 MUMPS AB	$105.75	$141.00	—	—	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$131.25	$175.00	—	129% above	25%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$131.25	$175.00	—	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA SCREEN TEST	$192.00	$256.00	—	280% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL	$518.25	$691.00	—	925% above	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA SCREEN TEST	$192.00	$256.00	—	—	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL	$518.25	$691.00	—	—	25%
Pap test (liquid-based, automated screening with review) CPT 88175 SCREENING CYTOPATHOLOGY	$105.00	$140.00	—	41% above	25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 SCREENING CYTOPATHOLOGY	$105.00	$140.00	—	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP SMEAR SCREENING	$158.25	$211.00	—	103% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP SMEAR SCREENING	$158.25	$211.00	—	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PTH)	$183.00	$244.00	—	37% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT	$354.75	$473.00	—	165% above	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PTH)	$183.00	$244.00	—	—	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT	$354.75	$473.00	—	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$178.50	$238.00	—	476% above	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$178.50	$238.00	—	—	25%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS	$83.25	$111.00	—	296% above	25%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS	$83.25	$111.00	—	—	25%
Potassium blood test CPT 84132 POTASSIUM SERUM	$76.50	$102.00	—	230% above	25%
Potassium blood test CPT 84132 POTASSIUM	$88.50	$118.00	—	281% above	25%
Potassium blood test inpatient CPT 84132 POTASSIUM SERUM	$76.50	$102.00	—	—	25%
Potassium blood test inpatient CPT 84132 POTASSIUM	$88.50	$118.00	—	—	25%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 FETAL INFORMA SEQ XY SEQUENCE	$300.00	$400.00	—	at median	25%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 FETAL INFORMA SEQ XY SEQUENCE	$300.00	$400.00	—	—	25%
Progesterone blood test CPT 84144 PROGESTERONE	$267.00	$356.00	—	319% above	25%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$267.00	$356.00	—	—	25%
Prolactin blood test CPT 84146 PROLACTIN	$229.50	$306.00	—	212% above	25%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$229.50	$306.00	—	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME/INR (WAIVED)	$10.50	$14.00	—	45% below	25%
Prothrombin time (PT/INR) clotting test CPT 85610 POC PROTHROMBIN TIME	$83.25	$111.00	—	332% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$91.50	$122.00	—	375% above	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME/INR (WAIVED)	$10.50	$14.00	—	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 POC PROTHROMBIN TIME	$83.25	$111.00	—	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$91.50	$122.00	—	—	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A IA DIRECT OBS	$119.25	$159.00	—	123% above	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A IA DIRECT OBS	$119.25	$159.00	—	—	25%
Rh blood typing CPT 86901 BLD TYPE RHO(D)ONLY	$76.50	$102.00	—	269% above	25%
Rh blood typing inpatient CPT 86901 BLD TYPE RHO(D)ONLY	$76.50	$102.00	—	—	25%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$87.75	$117.00	—	154% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT	$87.75	$117.00	—	—	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB	$87.75	$117.00	—	72% above	25%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB	$87.75	$117.00	—	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE AUTO	$44.25	$59.00	—	84% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE AUTO	$44.25	$59.00	—	—	25%
Sodium blood test CPT 84295 SODIUM BLOOD	$54.00	$72.00	—	160% above	25%
Sodium blood test CPT 84295 SODIUM	$94.50	$126.00	—	354% above	25%
Sodium blood test inpatient CPT 84295 SODIUM BLOOD	$54.00	$72.00	—	—	25%
Sodium blood test inpatient CPT 84295 SODIUM	$94.50	$126.00	—	—	25%
Stool ova and parasites exam CPT 87177 OVA&PARASITES SMEARS	$170.25	$227.00	—	290% above	25%
Stool ova and parasites exam inpatient CPT 87177 OVA&PARASITES SMEARS	$170.25	$227.00	—	—	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLD STL 1-3	$78.00	$104.00	—	344% above	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLD STL 1-3	$78.00	$104.00	—	—	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 POC IMMUNO FECAL OCCULT BLOOD	$93.00	$124.00	—	104% above	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HGB FECAL IA	$93.00	$124.00	—	104% above	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HGB FECAL IA	$93.00	$124.00	—	—	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 POC IMMUNO FECAL OCCULT BLOOD	$93.00	$124.00	—	—	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM AB	$71.25	$95.00	—	52% above	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM AB	$71.25	$95.00	—	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL-CSF	$32.25	$43.00	—	88% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL/RPR QUAL	$142.50	$190.00	—	729% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL-CSF	$32.25	$43.00	—	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL/RPR QUAL	$142.50	$190.00	—	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL AG RESPONSE	$30.00	$40.00	—	76% below	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TUBERCULOSIS AG RESPONSE	$78.75	$105.00	—	38% below	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL AG RESPONSE	$30.00	$40.00	—	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TUBERCULOSIS AG RESPONSE	$78.75	$105.00	—	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$244.50	$326.00	—	586% above	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$244.50	$326.00	—	—	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EA	$9.37	$12.49	—	80% below	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB	$85.50	$114.00	—	85% above	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY EA	$9.37	$12.49	—	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AB	$85.50	$114.00	—	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$412.50	$550.00	—	541% above	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$412.50	$550.00	—	—	25%
Total IgE blood test CPT 82785 IMMUNOGLOBULINS E SERUM	$42.00	$56.00	—	5% below	25%
Total IgE blood test CPT 82785 IGE SERUM	$212.25	$283.00	—	379% above	25%
Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULINS E SERUM	$42.00	$56.00	—	—	25%
Total IgE blood test inpatient CPT 82785 IGE SERUM	$212.25	$283.00	—	—	25%
Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL	$71.25	$95.00	—	256% above	25%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL TOTAL	$71.25	$95.00	—	—	25%
Total thyroxine (T4) blood test CPT 84436 THYROXINE TOTAL	$129.75	$173.00	—	291% above	25%
Total thyroxine (T4) blood test inpatient CPT 84436 THYROXINE TOTAL	$129.75	$173.00	—	—	25%
Total triiodothyronine (T3) blood test CPT 84480 TRIIODTHYRNIN TOTAL T3	$159.75	$213.00	—	246% above	25%
Total triiodothyronine (T3) blood test inpatient CPT 84480 TRIIODTHYRNIN TOTAL T3	$159.75	$213.00	—	—	25%
Transferrin blood test CPT 84466 TRANSFERRIN	$164.25	$219.00	—	188% above	25%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$164.25	$219.00	—	—	25%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS AMP PROBE	$76.50	$102.00	—	4% above	25%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS AMP PROBE	$76.50	$102.00	—	—	25%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$98.25	$131.00	—	427% above	25%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES	$98.25	$131.00	—	—	25%
Troponin test, quantitative CPT 84484 TROPONIN QUAN	$15.27	$20.36	—	64% below	25%
Troponin test, quantitative CPT 84484 TROPONIN - I	$294.75	$393.00	—	594% above	25%
Troponin test, quantitative inpatient CPT 84484 TROPONIN QUAN	$15.27	$20.36	—	—	25%
Troponin test, quantitative inpatient CPT 84484 TROPONIN - I	$294.75	$393.00	—	—	25%
Uric acid blood test CPT 84550 URIC ACID BLOOD	$91.50	$122.00	—	318% above	25%
Uric acid blood test inpatient CPT 84550 URIC ACID BLOOD	$91.50	$122.00	—	—	25%
Urinalysis with microscope exam, automated CPT 81001 UA AUTO W/MICRO	$36.00	$48.00	—	80% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA AUTO W/MICRO	$36.00	$48.00	—	—	25%
Urinalysis without microscope exam, automated CPT 81003 URINE W/O MICRO AUTO	$25.50	$34.00	—	96% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE W/O MICRO AUTO	$25.50	$34.00	—	—	25%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK (OUTPT CLINIC)	$3.75	$5.00	—	76% below	25%
Urinalysis without microscope exam, manual CPT 81002 UA NON-AUTO W/O MICRO	$10.50	$14.00	—	34% below	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK (OUTPT CLINIC)	$3.75	$5.00	—	—	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA NON-AUTO W/O MICRO	$10.50	$14.00	—	—	25%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE COLONY CT	$159.75	$213.00	—	190% above	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE COLONY CT	$159.75	$213.00	—	—	25%
Urine microalbumin (albumin) test CPT 82043 MICRO ALBUMIN URINE QNT	$150.75	$201.00	—	480% above	25%
Urine microalbumin (albumin) test inpatient CPT 82043 MICRO ALBUMIN URINE QNT	$150.75	$201.00	—	—	25%
Urine pregnancy test, read by color change CPT 81025 URINE PREG TEST QUAL	$170.25	$227.00	—	586% above	25%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREG TEST QUAL	$170.25	$227.00	—	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBLMN(VIT B12)	$192.00	$256.00	—	220% above	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBLMN(VIT B12)	$192.00	$256.00	—	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D/25 HYDROXY	$279.00	$372.00	—	216% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D/25 HYDROXY	$279.00	$372.00	—	—	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D1 25-DIHYDROXY	$102.00	$136.00	—	29% above	25%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D1 25-DIHYDROXY	$102.00	$136.00	—	—	25%
Zinc blood test CPT 84630 ZINC QUANTITATIVE URINE	$7.50	$10.00	—	69% below	25%
Zinc blood test CPT 84630 ZINC QUANTITATIVE	$78.75	$105.00	—	231% above	25%
Zinc blood test CPT 84630 ZINC RBC	$112.50	$150.00	—	372% above	25%
Zinc blood test inpatient CPT 84630 ZINC QUANTITATIVE URINE	$7.50	$10.00	—	—	25%
Zinc blood test inpatient CPT 84630 ZINC QUANTITATIVE	$78.75	$105.00	—	—	25%
Zinc blood test inpatient CPT 84630 ZINC RBC	$112.50	$150.00	—	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADTOPN CHORNC(HCG)QNT	$117.00	$156.00	—	143% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADTOPN CHORNC(HCG)QNT	$117.00	$156.00	—	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Cardiac catheterization with coronary angiogram CPT 93458 CATH L HRT ARTERY/VENTR	$21,557.25	$28,743.00	—	117% above	25%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 CATH L HRT ARTERY/VENTR	$21,557.25	$28,743.00	—	—	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVRT ELECTRC/ELECTV	$5,747.25	$7,663.00	—	484% above	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELEC/SCHED	$6,262.50	$8,350.00	—	536% above	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVRT ELECTRC/ELECTV	$5,747.25	$7,663.00	—	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELEC/SCHED	$6,262.50	$8,350.00	—	—	25%
Catheter ablation for atrial fibrillation CPT 93656 CMP EP ABL INTRAAFIB PVI EP3D	$73,338.00	$97,784.00	—	104% above	25%
Catheter ablation for atrial fibrillation inpatient CPT 93656 CMP EP ABL INTRAAFIB PVI EP3D	$73,338.00	$97,784.00	—	—	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 COLPOSCOPY WITH LEEP CERVIX	$8,418.75	$11,225.00	—	101% above	25%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 COLPOSCOPY WITH LEEP CERVIX	$8,418.75	$11,225.00	—	—	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY CERV W/BX & ENDOC	$443.25	$591.00	—	17% above	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY CERVIX & ECC	$669.00	$892.00	—	77% above	25%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY CERV W/BX & ENDOC	$443.25	$591.00	—	—	25%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY CERVIX & ECC	$669.00	$892.00	—	—	25%
Coronary stent placement, one artery CPT 92928 COR STNT ANGIO INIT	$24,226.50	$32,302.00	—	87% above	25%
Coronary stent placement, one artery CPT 92928 PERC COR DRUG-ELUT STNT	$32,641.50	$43,522.00	—	151% above	25%
Coronary stent placement, one artery inpatient CPT 92928 COR STNT ANGIO INIT	$24,226.50	$32,302.00	—	—	25%
Coronary stent placement, one artery inpatient CPT 92928 PERC COR DRUG-ELUT STNT	$32,641.50	$43,522.00	—	—	25%
Earwax removal with instruments, one ear CPT 69210 REMVL IMPAC CERUMEN W/ INST	$391.50	$522.00	—	307% above	25%
Earwax removal with instruments, one ear inpatient CPT 69210 REMVL IMPAC CERUMEN W/ INST	$391.50	$522.00	—	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETIRAL SAMPLE W/OR WO BX	$441.00	$588.00	—	86% above	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETIRAL SAMPLE W/OR WO BX	$441.00	$588.00	—	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE	$443.25	$591.00	—	62% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMP/SNGL	$498.75	$665.00	—	83% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABSCESS SINGLE/SIMPLE	$572.25	$763.00	—	110% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 ORTHO-I&D ABSCESS/CYST SIMPLE	$806.25	$1,075.00	—	195% above	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE	$443.25	$591.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMP/SNGL	$498.75	$665.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D ABSCESS SINGLE/SIMPLE	$572.25	$763.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ORTHO-I&D ABSCESS/CYST SIMPLE	$806.25	$1,075.00	—	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SINGLE TENDON SHEATH/LIGA	$942.75	$1,257.00	—	135% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ/S SING TENDON SHEATH/LIGAM	$1,084.50	$1,446.00	—	170% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 ORTHO-INJ TENDON/SHEETH/LIGA	$1,131.75	$1,509.00	—	182% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ SINGLE TENDON SHEATH/LIGA	$942.75	$1,257.00	—	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ/S SING TENDON SHEATH/LIGAM	$1,084.50	$1,446.00	—	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 ORTHO-INJ TENDON/SHEETH/LIGA	$1,131.75	$1,509.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS MAJOR JOINT	$525.00	$700.00	—	23% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENT-ASP/INJ LARGE JOINT	$1,207.50	$1,610.00	—	182% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS MAJOR JOINT	$525.00	$700.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENT-ASP/INJ LARGE JOINT	$1,207.50	$1,610.00	—	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENT-ASP/INJ INTERM JNT	$1,117.50	$1,490.00	—	244% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENT-ASP/INJ INTERM JNT	$1,117.50	$1,490.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPIRATION-SM JOINT	$474.75	$633.00	—	40% above	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHRO ASP / INJ SM JOINT	$865.50	$1,154.00	—	156% above	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$993.00	$1,324.00	—	194% above	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENT-ASP/INJ SMALL JOINT	$993.00	$1,324.00	—	194% above	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASPIRATION-SM JOINT	$474.75	$633.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHRO ASP / INJ SM JOINT	$865.50	$1,154.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENT-ASP/INJ SMALL JOINT	$993.00	$1,324.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$993.00	$1,324.00	—	—	25%
Left heart catheterization, diagnostic one side CPT 93452 CATH LT HRT W/LTVENT	$13,363.50	$17,818.00	—	93% above	25%
Left heart catheterization, diagnostic inpatient one side CPT 93452 CATH LT HRT W/LTVENT	$13,363.50	$17,818.00	—	—	25%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ EPID LUMB/CAUD	$3,515.25	$4,687.00	—	241% above	25%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ EPID LUMB/CAUD	$3,515.25	$4,687.00	—	—	25%
Lower-back epidural injection, without imaging guidance CPT 62322 INJ DIAG/THERAP LUMBAR SACRAL	$2,931.75	$3,909.00	—	161% above	25%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ DIAG/THERAP LUMBAR SACRAL	$2,931.75	$3,909.00	—	—	25%
Nail removal (partial or complete), one nail CPT 11730 ORTHO-REMOVE NAIL PLATE-SIMPLE	$675.00	$900.00	—	229% above	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 ORTHO-REMOVE NAIL PLATE-SIMPLE	$675.00	$900.00	—	—	25%
Occipital nerve block (injection for headaches) CPT 64405 INJ ANESTH OCCIPTL NERVE	$1,378.50	$1,838.00	—	167% above	25%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJ ANESTH OCCIPTL NERVE	$1,378.50	$1,838.00	—	—	25%
Pacemaker implant (dual chamber) CPT 33208 INS/RPL PMW/TRNSV LD A-V	$32,849.25	$43,799.00	—	101% above	25%
Pacemaker implant (dual chamber) inpatient CPT 33208 INS/RPL PMW/TRNSV LD A-V	$32,849.25	$43,799.00	—	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCIS NAIL/MATRIX PARTIAL/COMP	$1,835.25	$2,447.00	—	249% above	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCIS NAIL/MATRIX PARTIAL/COMP	$1,835.25	$2,447.00	—	—	25%
Removal of a foreign object under the skin, simple CPT 10120 INCIS/REMOVE FOREIG BOD SQ	$1,156.50	$1,542.00	—	210% above	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCIS/REMOVE FOREIG BOD SQ	$1,156.50	$1,542.00	—	—	25%
Short arm cast (elbow to hand) CPT 29075 ORTHO-CAST APP,SHORT-ARM	$457.50	$610.00	—	84% above	25%
Short arm cast (elbow to hand) inpatient CPT 29075 ORTHO-CAST APP,SHORT-ARM	$457.50	$610.00	—	—	25%
Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT	$170.25	$227.00	—	11% below	25%
Short arm splint (forearm and hand) CPT 29125 APPL SHORT ARM SPLINT ST	$185.25	$247.00	—	3% below	25%
Short arm splint (forearm and hand) CPT 29125 ORTHO-SPLINT,SHORT ARM STATIC	$229.50	$306.00	—	20% above	25%
Short arm splint (forearm and hand) CPT 29125 APP OF SHORT ARM SPLINT STAT	$552.75	$737.00	—	189% above	25%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION SHORT ARM SPLINT	$170.25	$227.00	—	—	25%
Short arm splint (forearm and hand) inpatient CPT 29125 APPL SHORT ARM SPLINT ST	$185.25	$247.00	—	—	25%
Short arm splint (forearm and hand) inpatient CPT 29125 ORTHO-SPLINT,SHORT ARM STATIC	$229.50	$306.00	—	—	25%
Short arm splint (forearm and hand) inpatient CPT 29125 APP OF SHORT ARM SPLINT STAT	$552.75	$737.00	—	—	25%
Short leg cast (below the knee) CPT 29405 ORTHO-CAST APP,SHORT-LEG	$452.25	$603.00	—	66% above	25%
Short leg cast (below the knee) inpatient CPT 29405 ORTHO-CAST APP,SHORT-LEG	$452.25	$603.00	—	—	25%
Short leg splint (calf to foot) CPT 29515 ORTHO-SPLINT,SHORT LEG	$229.50	$306.00	—	41% above	25%
Short leg splint (calf to foot) inpatient CPT 29515 ORTHO-SPLINT,SHORT LEG	$229.50	$306.00	—	—	25%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$1,185.75	$1,581.00	—	221% above	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$1,185.75	$1,581.00	—	—	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTR LUMB DIAG	$2,327.25	$3,103.00	—	172% above	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTR LUMB DIAG	$2,327.25	$3,103.00	—	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$169.50	$226.00	—	41% below	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES	$169.50	$226.00	—	—	25%
Trigger point injections, 1 or 2 muscles CPT 20552 ORTHO-INJ TRIGGR PNTS1-2MUSCLS	$1,005.00	$1,340.00	—	176% above	25%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PTS 1/2 MUSC	$1,165.50	$1,554.00	—	220% above	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ORTHO-INJ TRIGGR PNTS1-2MUSCLS	$1,005.00	$1,340.00	—	—	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PTS 1/2 MUSC	$1,165.50	$1,554.00	—	—	25%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHOTRIPSY	$13,626.75	$18,169.00	—	85% above	25%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTOURETERO W/LITHOTRIPSY	$13,626.75	$18,169.00	—	—	25%
Wart removal, up to 14 warts CPT 17110 DESTRUC LESIONS 1-14	$427.50	$570.00	—	111% above	25%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUC LESIONS 1-14	$427.50	$570.00	—	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRID SUBQ 1ST 20 SQ CM OR <	$746.25	$995.00	—	34% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HBO PROCEDURE LVL	$879.00	$1,172.00	—	58% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 ORTHO-DBRIDE SUB-Q TISS<21SQCM	$1,196.25	$1,595.00	—	114% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRID SUBQ 1ST 20 SQ CM OR <	$746.25	$995.00	—	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HBO PROCEDURE LVL	$879.00	$1,172.00	—	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 ORTHO-DBRIDE SUB-Q TISS<21SQCM	$1,196.25	$1,595.00	—	—	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION	$911.25	$1,215.00	—	21% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION 2 UNITS	$966.00	$1,288.00	—	28% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION 1 UNIT	$998.25	$1,331.00	—	33% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 ADMINISTRATION OF BLOOD PRODUC	$1,236.75	$1,649.00	—	64% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD/COMPONENTS	$1,799.25	$2,399.00	—	139% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD CMP	$1,799.25	$2,399.00	—	139% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION 1-2HRS	$2,200.50	$2,934.00	—	193% above	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION	$911.25	$1,215.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION 2 UNITS	$966.00	$1,288.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION 1 UNIT	$998.25	$1,331.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ADMINISTRATION OF BLOOD PRODUC	$1,236.75	$1,649.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLD/BLD CMP	$1,799.25	$2,399.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/COMPONENTS	$1,799.25	$2,399.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION 1-2HRS	$2,200.50	$2,934.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB TX	$307.50	$410.00	—	77% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM INDUCTION	$375.75	$501.00	—	116% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TREATMENT	$375.75	$501.00	—	116% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RN NEBULIZER TX	$375.75	$501.00	—	116% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHALATION TREATMENT NEBULIZER	$375.75	$501.00	—	116% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI TREATMENT	$375.75	$501.00	—	116% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TX	$390.00	$520.00	—	125% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 2W-NEBULIZER TREATMENT	$471.00	$628.00	—	171% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB TX	$307.50	$410.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI TREATMENT	$375.75	$501.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION TREATMENT NEBULIZER	$375.75	$501.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL TREATMENT	$375.75	$501.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RN NEBULIZER TX	$375.75	$501.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM INDUCTION	$375.75	$501.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER TX	$390.00	$520.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 2W-NEBULIZER TREATMENT	$471.00	$628.00	—	—	25%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INF INT TO 1HR/INT DR	$524.25	$699.00	—	at median	25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INF INT TO 1HR/INT DR	$524.25	$699.00	—	—	25%
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE E&M 30-74 MIN	$4,949.25	$6,599.00	—	145% above	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE E&M 30-74 MIN	$4,949.25	$6,599.00	—	—	25%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE/DROWSY	$1,840.50	$2,454.00	—	137% above	25%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE/DROWSY	$1,840.50	$2,454.00	—	—	25%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG W/INTERPRET	$354.75	$473.00	—	262% above	25%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG W/INTERPRET	$354.75	$473.00	—	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 2W-EKG-TRACING ONLY	$144.75	$193.00	—	11% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 5W-EKG-TRACING ONLY	$144.75	$193.00	—	11% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING ONLY	$194.25	$259.00	—	49% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACE ONLY	$256.50	$342.00	—	96% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD TRACING	$368.25	$491.00	—	182% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 5W-EKG-TRACING ONLY	$144.75	$193.00	—	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 2W-EKG-TRACING ONLY	$144.75	$193.00	—	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING ONLY	$194.25	$259.00	—	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACE ONLY	$256.50	$342.00	—	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD TRACING	$368.25	$491.00	—	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER VISIT LVL I	$552.00	$736.00	—	195% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER VISIT LVL I	$552.00	$736.00	—	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER VISIT LVL II	$879.00	$1,172.00	—	152% above	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER VISIT LVL II	$879.00	$1,172.00	—	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER VISIT LVL III	$1,609.50	$2,146.00	—	153% above	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER VISIT LVL III	$1,609.50	$2,146.00	—	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER VISIT LVL IV	$2,877.00	$3,836.00	—	173% above	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER VISIT LVL IV	$2,877.00	$3,836.00	—	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER VISIT LVL V	$3,771.75	$5,029.00	—	123% above	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER VISIT LVL V	$3,771.75	$5,029.00	—	—	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIO STRESS TRACE ONLY	$1,431.75	$1,909.00	—	96% above	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIO STRESS TRACE ONLY	$1,431.75	$1,909.00	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 5W-IV INF HYDRATION INITL HR	$379.50	$506.00	—	45% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INF HYD INIT 31-60MIN	$427.50	$570.00	—	64% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 5W-IV INF HYDRATION INITL HR	$379.50	$506.00	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INF HYD INIT 31-60MIN	$427.50	$570.00	—	—	25%
IV infusion of a medicine, first hour CPT 96365 2W-IV INF THER/DIAG INITL HR	$414.75	$553.00	—	38% above	25%
IV infusion of a medicine, first hour CPT 96365 5W-IV INF THER/DIAG INITL HR	$414.75	$553.00	—	38% above	25%
IV infusion of a medicine, first hour CPT 96365 IV INF THER/DIAG INIT U/T 1 HR	$444.75	$593.00	—	48% above	25%
IV infusion of a medicine, first hour CPT 96365 IV INF TX INIT <=1 HR	$501.75	$669.00	—	67% above	25%
IV infusion of a medicine, first hour CPT 96365 CHEM NON CHEM DX IV TO 1HR	$524.25	$699.00	—	75% above	25%
IV infusion of a medicine, first hour CPT 96365 IV INF THR/PRP/DIA INT TO 1	$534.75	$713.00	—	78% above	25%
IV infusion of a medicine, first hour inpatient CPT 96365 2W-IV INF THER/DIAG INITL HR	$414.75	$553.00	—	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 5W-IV INF THER/DIAG INITL HR	$414.75	$553.00	—	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF THER/DIAG INIT U/T 1 HR	$444.75	$593.00	—	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF TX INIT <=1 HR	$501.75	$669.00	—	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 CHEM NON CHEM DX IV TO 1HR	$524.25	$699.00	—	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF THR/PRP/DIA INT TO 1	$534.75	$713.00	—	—	25%
IV push of a medicine, first drug CPT 96374 3W-IV PUSH INITIAL SUBS/DRUG	$242.25	$323.00	—	31% above	25%
IV push of a medicine, first drug CPT 96374 2W-IV PUSH INITIAL SUBS/DRUG	$242.25	$323.00	—	31% above	25%
IV push of a medicine, first drug CPT 96374 1WS-IV PUSH INITIAL SUBS/DRUG	$242.25	$323.00	—	31% above	25%
IV push of a medicine, first drug CPT 96374 INJ TX/PRPH/DX IVP INT	$282.00	$376.00	—	53% above	25%
IV push of a medicine, first drug CPT 96374 IV PUSH SING/INTL SUBST/DRUG	$370.50	$494.00	—	101% above	25%
IV push of a medicine, first drug CPT 96374 IV PUSH THR/PROP/DIAG INITL	$444.75	$593.00	—	141% above	25%
IV push of a medicine, first drug inpatient CPT 96374 2W-IV PUSH INITIAL SUBS/DRUG	$242.25	$323.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 3W-IV PUSH INITIAL SUBS/DRUG	$242.25	$323.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 1WS-IV PUSH INITIAL SUBS/DRUG	$242.25	$323.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 INJ TX/PRPH/DX IVP INT	$282.00	$376.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH SING/INTL SUBST/DRUG	$370.50	$494.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH THR/PROP/DIAG INITL	$444.75	$593.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 XOLAIR ADMIN	$82.50	$110.00	—	9% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTOR IM/SUBQ NON CHEMO	$101.25	$135.00	—	11% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM SUBQ THRPTC/DIAG NON CHEMO	$111.00	$148.00	—	22% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM SUBQ, THERA/DIAG, NON CHEMO	$133.50	$178.00	—	47% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION INTRAMUSCULARSUBQ IN	$232.50	$310.00	—	155% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 2W-INJ SUB-Q/IM THER/DIAG	$243.75	$325.00	—	168% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 1WR-INJ SUB-Q/IM THER/DIAG	$243.75	$325.00	—	168% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 1WS-INJ SUB-Q/IM THER DIAG	$243.75	$325.00	—	168% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROP/DIAG INJ SC OR IM	$250.50	$334.00	—	175% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ TX/PROPH/DX SQ/IM	$273.75	$365.00	—	201% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 XOLAIR ADMIN	$82.50	$110.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTOR IM/SUBQ NON CHEMO	$101.25	$135.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM SUBQ THRPTC/DIAG NON CHEMO	$111.00	$148.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM SUBQ, THERA/DIAG, NON CHEMO	$133.50	$178.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION INTRAMUSCULARSUBQ IN	$232.50	$310.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 2W-INJ SUB-Q/IM THER/DIAG	$243.75	$325.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 1WS-INJ SUB-Q/IM THER DIAG	$243.75	$325.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 1WR-INJ SUB-Q/IM THER/DIAG	$243.75	$325.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROP/DIAG INJ SC OR IM	$250.50	$334.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ TX/PROPH/DX SQ/IM	$273.75	$365.00	—	—	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAG EVAL	$672.00	$896.00	—	200% above	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAG EVAL	$672.00	$896.00	—	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 PT PED NEURO RE-ED EA15	$176.25	$235.00	—	87% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 OT NEUROMUSC RE-EDUC EA1	$203.25	$271.00	—	115% above	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT PED NEURO RE-ED EA15	$176.25	$235.00	—	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEUROMUSC RE-EDUC EA1	$203.25	$271.00	—	—	25%
New patient office visit, about 30 minutes CPT 99203 LEVEL 3 NEW PT	$273.75	$365.00	—	145% above	25%
New patient office visit, about 30 minutes CPT 99203 FACILITY FEE NEW PT LEVEL 3	$279.00	$372.00	—	150% above	25%
New patient office visit, about 30 minutes CPT 99203 F OFF VST NEW PT LOW COMPLEX	$361.50	$482.00	—	223% above	25%
New patient office visit, about 30 minutes CPT 99203 ANTI COAG-NEW PAT LEVEL 3	$387.00	$516.00	—	246% above	25%
New patient office visit, about 30 minutes CPT 99203 FACLTY NEW PAT LEVEL 3	$491.25	$655.00	—	340% above	25%
New patient office visit, about 30 minutes CPT 99203 E&M-NEW PATIENT-LVL III	$677.25	$903.00	—	506% above	25%
New patient office visit, about 30 minutes CPT 99203 OFFICE VST NEW PT LOW COMPLEX	$1,139.25	$1,519.00	—	919% above	25%
New patient office visit, about 30 minutes inpatient CPT 99203 LEVEL 3 NEW PT	$273.75	$365.00	—	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 FACILITY FEE NEW PT LEVEL 3	$279.00	$372.00	—	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 F OFF VST NEW PT LOW COMPLEX	$361.50	$482.00	—	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 ANTI COAG-NEW PAT LEVEL 3	$387.00	$516.00	—	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 FACLTY NEW PAT LEVEL 3	$491.25	$655.00	—	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 E&M-NEW PATIENT-LVL III	$677.25	$903.00	—	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VST NEW PT LOW COMPLEX	$1,139.25	$1,519.00	—	—	25%
New patient office visit, about 45 minutes CPT 99204 E&M-NEW PATIENT-LVL IV	$378.75	$505.00	—	221% above	25%
New patient office visit, about 45 minutes CPT 99204 F OFF VST NEW PT MOD COMPLEX	$444.75	$593.00	—	276% above	25%
New patient office visit, about 45 minutes CPT 99204 FACLTY NEW PAT LEVEL 4	$517.50	$690.00	—	338% above	25%
New patient office visit, about 45 minutes CPT 99204 OFFICE VST NEW PT MOD COMPLEX	$1,549.50	$2,066.00	—	1211% above	25%
New patient office visit, about 45 minutes inpatient CPT 99204 E&M-NEW PATIENT-LVL IV	$378.75	$505.00	—	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 F OFF VST NEW PT MOD COMPLEX	$444.75	$593.00	—	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 FACLTY NEW PAT LEVEL 4	$517.50	$690.00	—	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VST NEW PT MOD COMPLEX	$1,549.50	$2,066.00	—	—	25%
New patient office visit, about 60 minutes CPT 99205 F OFF VST NEW PT HIGH COMPLEX	$602.25	$803.00	—	340% above	25%
New patient office visit, about 60 minutes CPT 99205 E&M-NEW PATIENT-LVL V	$769.50	$1,026.00	—	463% above	25%
New patient office visit, about 60 minutes CPT 99205 OFFICE VST NEW PT HIGH COMPLEX	$1,651.50	$2,202.00	—	1108% above	25%
New patient office visit, about 60 minutes inpatient CPT 99205 F OFF VST NEW PT HIGH COMPLEX	$602.25	$803.00	—	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 E&M-NEW PATIENT-LVL V	$769.50	$1,026.00	—	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VST NEW PT HIGH COMPLEX	$1,651.50	$2,202.00	—	—	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 LEVEL 2 NEW PT	$172.50	$230.00	—	109% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 F OFF VST NEW PT EXP PROB FOCU	$252.00	$336.00	—	205% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E&M-NEW PATIENT-LVL II	$452.25	$603.00	—	448% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VST NEW PT EXP PROB FOC	$517.50	$690.00	—	527% above	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 LEVEL 2 NEW PT	$172.50	$230.00	—	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 F OFF VST NEW PT EXP PROB FOCU	$252.00	$336.00	—	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E&M-NEW PATIENT-LVL II	$452.25	$603.00	—	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE VST NEW PT EXP PROB FOC	$517.50	$690.00	—	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED/NUT/THER/INITIAL EA 15MIN	$94.50	$126.00	—	105% above	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRTN TH INIT 15MIN	$115.50	$154.00	—	151% above	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED/NUT/THER/INITIAL EA 15MIN	$94.50	$126.00	—	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRTN TH INIT 15MIN	$115.50	$154.00	—	—	25%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL HM/WK SITE LOW	$1,236.75	$1,649.00	—	497% above	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL HM/WK SITE LOW	$1,236.75	$1,649.00	—	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMP	$1,409.25	$1,879.00	—	501% above	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMP	$1,409.25	$1,879.00	—	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMP	$1,250.25	$1,667.00	—	536% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMP	$1,250.25	$1,667.00	—	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMP	$1,398.75	$1,865.00	—	522% above	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD COMP	$1,398.75	$1,865.00	—	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MANUAL THERAPY EA 15M	$314.25	$419.00	—	224% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUAL THERAPY EA 15M	$314.25	$419.00	—	224% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT MANUAL THERAPY EA 15M	$314.25	$419.00	—	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT MANUAL THERAPY EA 15M	$314.25	$419.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPTC EXER EA 15	$152.25	$203.00	—	63% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THER EX EA 15	$300.75	$401.00	—	222% above	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPTC EXER EA 15	$152.25	$203.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THER EX EA 15	$300.75	$401.00	—	—	25%
Psychotherapy session, 30 minutes CPT 90832 PSY THRPY 30 MIN PT	$228.00	$304.00	—	18% above	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSY THRPY 30 MIN PT	$228.00	$304.00	—	—	25%
Psychotherapy session, 45 minutes CPT 90834 PSY THRPY 45MIN PT	$447.75	$597.00	—	109% above	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSY THRPY 45MIN PT	$447.75	$597.00	—	—	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMKE/TOBAC CNSL 3-10MIN	$96.75	$129.00	—	136% above	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMKE/TOBAC CNSL 3-10MIN	$96.75	$129.00	—	—	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 LEVEL 5 ESTABLISHED PT	$279.00	$372.00	—	69% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E&M-EST. PATIENT-LVL V	$443.25	$591.00	—	169% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ANTI COAG-ESTAB PT LEVEL 5	$520.50	$694.00	—	216% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VST EST PT HIGH COMPLEX	$1,576.50	$2,102.00	—	856% above	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 LEVEL 5 ESTABLISHED PT	$279.00	$372.00	—	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E&M-EST. PATIENT-LVL V	$443.25	$591.00	—	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ANTI COAG-ESTAB PT LEVEL 5	$520.50	$694.00	—	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE VST EST PT HIGH COMPLEX	$1,576.50	$2,102.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL 3 ESTABLISHED PT	$216.00	$288.00	—	126% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 F OFF VST EST PT LOW COMPLEX	$250.50	$334.00	—	162% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 FACILITY FEE EST PT LEVEL 3	$271.50	$362.00	—	184% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ANTI COAG-ESTAB PT LEVEL 3	$312.00	$416.00	—	227% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 FACLTY ESTABLISHED PAT LEVEL 3	$359.25	$479.00	—	276% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PULM - ESTAB PT VISIT LEVEL 3	$378.75	$505.00	—	296% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ORTHO-ESTAB PT VISIT LEVEL3	$378.75	$505.00	—	296% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M-EST. PATIENT-LVL III	$392.25	$523.00	—	311% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VST EST PT LOW COMPLEX	$706.50	$942.00	—	640% above	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 LEVEL 3 ESTABLISHED PT	$216.00	$288.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 F OFF VST EST PT LOW COMPLEX	$250.50	$334.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 FACILITY FEE EST PT LEVEL 3	$271.50	$362.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ANTI COAG-ESTAB PT LEVEL 3	$312.00	$416.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 FACLTY ESTABLISHED PAT LEVEL 3	$359.25	$479.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ORTHO-ESTAB PT VISIT LEVEL3	$378.75	$505.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PULM - ESTAB PT VISIT LEVEL 3	$378.75	$505.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M-EST. PATIENT-LVL III	$392.25	$523.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE VST EST PT LOW COMPLEX	$706.50	$942.00	—	—	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LEVEL 4 ESTABLISHED PT	$218.25	$291.00	—	85% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 F OFF VST EST PT MOD COMPLEX	$363.75	$485.00	—	208% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFF VST EST PT MOD COMPLEX	$363.75	$485.00	—	208% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M-EST. PATIENT-LVL IV	$378.75	$505.00	—	221% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ANTI COAG-ESTAB PT LEVEL 4	$387.00	$516.00	—	228% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PULM - ESTAB PT VISIT LEVEL 4	$495.75	$661.00	—	320% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VST EST PT MOD COMPLEX	$1,207.50	$1,610.00	—	922% above	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 LEVEL 4 ESTABLISHED PT	$218.25	$291.00	—	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 F OFF VST EST PT MOD COMPLEX	$363.75	$485.00	—	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFF VST EST PT MOD COMPLEX	$363.75	$485.00	—	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E&M-EST. PATIENT-LVL IV	$378.75	$505.00	—	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ANTI COAG-ESTAB PT LEVEL 4	$387.00	$516.00	—	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PULM - ESTAB PT VISIT LEVEL 4	$495.75	$661.00	—	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VST EST PT MOD COMPLEX	$1,207.50	$1,610.00	—	—	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 F OFF ESTAB PT PROB FOCUS	$163.50	$218.00	—	122% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL 2 ESTABLISHED PT	$216.00	$288.00	—	193% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ANTI COAG-ESTAB PT LEVEL 2	$241.50	$322.00	—	227% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M-EST. PATIENT-LVL II	$270.75	$361.00	—	267% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 FACLTY ESTABLISHED PAT LEVEL 2	$273.00	$364.00	—	270% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PULM - ESTAB PT VISIT LEVEL 2	$273.00	$364.00	—	270% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VST EST PT PROB FOCUS	$427.50	$570.00	—	480% above	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 F OFF ESTAB PT PROB FOCUS	$163.50	$218.00	—	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 LEVEL 2 ESTABLISHED PT	$216.00	$288.00	—	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ANTI COAG-ESTAB PT LEVEL 2	$241.50	$322.00	—	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M-EST. PATIENT-LVL II	$270.75	$361.00	—	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 FACLTY ESTABLISHED PAT LEVEL 2	$273.00	$364.00	—	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PULM - ESTAB PT VISIT LEVEL 2	$273.00	$364.00	—	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE VST EST PT PROB FOCUS	$427.50	$570.00	—	—	25%
Spirometry (breathing test) CPT 94010 SPIROMETRY (AMB STAFF)	$148.50	$198.00	—	28% below	25%
Spirometry (breathing test) CPT 94010 PULM-SPIROMETRY/STANDARD FUNC	$559.50	$746.00	—	172% above	25%
Spirometry (breathing test) CPT 94010 SPIROMETRY	$819.75	$1,093.00	—	298% above	25%
Spirometry (breathing test) CPT 94010 PEAK FLOW (AMB STAFF)	$842.25	$1,123.00	—	309% above	25%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY (AMB STAFF)	$148.50	$198.00	—	—	25%
Spirometry (breathing test) inpatient CPT 94010 PULM-SPIROMETRY/STANDARD FUNC	$559.50	$746.00	—	—	25%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY	$819.75	$1,093.00	—	—	25%
Spirometry (breathing test) inpatient CPT 94010 PEAK FLOW (AMB STAFF)	$842.25	$1,123.00	—	—	25%
Spirometry before and after a bronchodilator CPT 94060 PRE/POST SPIROMETER(AMB STAFF)	$258.00	$344.00	—	37% below	25%
Spirometry before and after a bronchodilator CPT 94060 BRONCHOSPASM EVAL PRE/PS	$830.25	$1,107.00	—	103% above	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 PRE/POST SPIROMETER(AMB STAFF)	$258.00	$344.00	—	—	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHOSPASM EVAL PRE/PS	$830.25	$1,107.00	—	—	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERAPEUTC ACT EA 15	$255.00	$340.00	—	216% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPTC ACT EA 15	$255.00	$340.00	—	216% above	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THERAPTC ACT EA 15	$255.00	$340.00	—	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THERAPEUTC ACT EA 15	$255.00	$340.00	—	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEB TO 15 MIN	$143.25	$191.00	—	39% below	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEB TO 30 MIN	$200.25	$267.00	—	14% below	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEB TO 15 MIN	$143.25	$191.00	—	—	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEB TO 30 MIN	$200.25	$267.00	—	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VACIJ	$182.25	$243.00	—	10% below	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VACCINE	$459.75	$613.00	—	128% above	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VACIJ	$182.25	$243.00	—	—	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VACCINE	$459.75	$613.00	—	—	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP+IPV VACCINE 0.5 ML INJ	$111.00	$148.00	—	80% above	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV(QUADRACEL)	$271.50	$362.00	—	340% above	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP+IPV VACCINE 0.5 ML INJ	$111.00	$148.00	—	—	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IPV(QUADRACEL)	$271.50	$362.00	—	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP (INFANRIX) INJ 0.5ML DOSE	$12.00	$16.00	—	69% below	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP	$172.50	$230.00	—	345% above	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP (INFANRIX) INJ 0.5ML DOSE	$12.00	$16.00	—	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP	$172.50	$230.00	—	—	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP/HEPB/IPV	$339.00	$452.00	—	151% above	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP/HEPB/IPV	$339.00	$452.00	—	—	25%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP+IPV+HIB+VACCINE 0.5ML	$158.25	$211.00	—	1% above	25%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-HIB-IPV (PENTACEL)	$321.75	$429.00	—	105% above	25%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP+IPV+HIB+VACCINE 0.5ML	$158.25	$211.00	—	—	25%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-HIB-IPV (PENTACEL)	$321.75	$429.00	—	—	25%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 DTAP-IPV-HIB-HEPB VACC IM IJ	$476.25	$635.00	—	9% above	25%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 DTAP-IPV-HIB-HEPB VACC IM IJ	$476.25	$635.00	—	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACC, PRESERVE FREE, 3YR>	$38.25	$51.00	—	21% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUVAC IIV3>6MOS 0.5ML IJ	$44.25	$59.00	—	40% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACC, PRESERVE FREE, 3YR>	$38.25	$51.00	—	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUVAC IIV3>6MOS 0.5ML IJ	$44.25	$59.00	—	—	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VAC 9-VAL	$729.00	$972.00	—	118% above	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV VACCINE	$733.50	$978.00	—	119% above	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VAC 9-VAL	$729.00	$972.00	—	—	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV VACCINE	$733.50	$978.00	—	—	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE INACT 1440	$75.00	$100.00	—	36% below	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPA VAQTA VAC=>19Y 50 UNT/1ML	$93.00	$124.00	—	21% below	25%
Hepatitis A vaccine, adult dose CPT 90632 HEP A (VAQTA) VAC =OR>19Y	$93.00	$124.00	—	21% below	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE INJ 50 UNI	$109.50	$146.00	—	7% below	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE	$293.25	$391.00	—	149% above	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE INACT 1440	$75.00	$100.00	—	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEP A (VAQTA) VAC =OR>19Y	$93.00	$124.00	—	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPA VAQTA VAC=>19Y 50 UNT/1ML	$93.00	$124.00	—	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE INJ 50 UNI	$109.50	$146.00	—	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE	$293.25	$391.00	—	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A (VAQTA) VACCINE <19Y	$74.25	$99.00	—	3% below	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPA VAQTA VAC<19Y 25UNT/0.5ML	$74.25	$99.00	—	3% below	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE INJ 25IU/0	$111.00	$148.00	—	45% above	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A PED/ADOL HAVRIX	$183.00	$244.00	—	138% above	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A (VAQTA) VACCINE <19Y	$74.25	$99.00	—	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPA VAQTA VAC<19Y 25UNT/0.5ML	$74.25	$99.00	—	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VACCINE INJ 25IU/0	$111.00	$148.00	—	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A PED/ADOL HAVRIX	$183.00	$244.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS-B VACCINE ADULT	$76.50	$102.00	—	9% below	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP-B ADULTS 3 DOSE SCHEDULE	$279.75	$373.00	—	233% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP- B ADULT	$483.75	$645.00	—	476% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS-B VACCINE ADULT	$76.50	$102.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP-B ADULTS 3 DOSE SCHEDULE	$279.75	$373.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP- B ADULT	$483.75	$645.00	—	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS-B VACCINE PEDIATRIC	$21.00	$28.00	—	35% below	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B VAC PED/ADOL3DS IJ	$189.00	$252.00	—	483% above	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS-B VACCINE PEDIATRIC	$21.00	$28.00	—	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B VAC PED/ADOL3DS IJ	$189.00	$252.00	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 PEDVAXHIB VACCINE INJ 0.5ML DO	$63.00	$84.00	—	28% above	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HIB PRP-OMP (3 DOSE SCHEDULE)	$166.50	$222.00	—	238% above	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 PEDVAXHIB VACCINE INJ 0.5ML DO	$63.00	$84.00	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HIB PRP-OMP (3 DOSE SCHEDULE)	$166.50	$222.00	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB VACCINE ACTHIB INJ 0.5ML	$46.50	$62.00	—	11% above	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB VACCINE-HIBERIX 0.5ML DOSE	$55.50	$74.00	—	33% above	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB PRP-T (4 DOSE SCHEDULE)	$156.75	$209.00	—	275% above	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIB VACCINE ACTHIB INJ 0.5ML	$46.50	$62.00	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIB VACCINE-HIBERIX 0.5ML DOSE	$55.50	$74.00	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIB PRP-T (4 DOSE SCHEDULE)	$156.75	$209.00	—	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VIRUS VAC HIGH-DOSE	$144.00	$192.00	—	86% above	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HIGH DOSE PRODUCT	$599.25	$799.00	—	674% above	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VIRUS VAC HIGH-DOSE	$144.00	$192.00	—	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HIGH DOSE PRODUCT	$599.25	$799.00	—	—	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES/MUMPS/RUBELLA 0.5ML DO	$120.75	$161.00	—	11% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR	$329.25	$439.00	—	142% above	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES/MUMPS/RUBELLA 0.5ML DO	$120.75	$161.00	—	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR	$329.25	$439.00	—	—	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MMR-VARICELLA INJ 0.5 ML DOSE	$1,152.00	$1,536.00	—	224% above	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MMR-VARICELLA INJ 0.5 ML DOSE	$1,152.00	$1,536.00	—	—	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL VAC (MENACTRA) I	$153.75	$205.00	—	26% below	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCCOCAL VACCINE	$626.25	$835.00	—	202% above	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL VAC (MENACTRA) I	$153.75	$205.00	—	—	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCCOCAL VACCINE	$626.25	$835.00	—	—	25%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOCOCCAL-TT VAC IM IJ	$219.00	$292.00	—	7% below	25%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENINGOCOCCAL-TT VAC IM IJ	$219.00	$292.00	—	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENING B VAC IM RCMB IJ	$258.00	$344.00	—	23% below	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL GROUP B VACCINE	$423.75	$565.00	—	26% above	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGO RECOMB SEROB 2 DOES	$858.00	$1,144.00	—	155% above	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENING B VAC IM RCMB IJ	$258.00	$344.00	—	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL GROUP B VACCINE	$423.75	$565.00	—	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGO RECOMB SEROB 2 DOES	$858.00	$1,144.00	—	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL-13 CONJ VAC 0.5ML	$297.75	$397.00	—	13% above	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL - 13 CONJ VACCINE	$564.75	$753.00	—	114% above	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL-13 CONJ VAC 0.5ML	$297.75	$397.00	—	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL - 13 CONJ VACCINE	$564.75	$753.00	—	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCO20VACIJ!	$1,524.00	$2,032.00	—	300% above	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCO20VACIJ!	$1,524.00	$2,032.00	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMONIA VACC 23VALENT> 2 YRS	$118.50	$158.00	—	25% below	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 IMMUNIZATION PNEUMOVAX	$118.50	$158.00	—	25% below	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMONIA VACC 23VALENT >2 YRS	$189.00	$252.00	—	19% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPV 23	$543.00	$724.00	—	243% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMONIA VACC 23VALENT> 2 YRS	$118.50	$158.00	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 IMMUNIZATION PNEUMOVAX	$118.50	$158.00	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMONIA VACC 23VALENT >2 YRS	$189.00	$252.00	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPV 23	$543.00	$724.00	—	—	25%
Polio vaccine, inactivated (IPV) CPT 90713 POLIO VACCINE - INACTIVE INJ 0	$33.75	$45.00	—	46% below	25%
Polio vaccine, inactivated (IPV) CPT 90713 IPV	$237.00	$316.00	—	278% above	25%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIO VACCINE - INACTIVE INJ 0	$33.75	$45.00	—	—	25%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 IPV	$237.00	$316.00	—	—	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV VAC P-A P-B REC IJ	$505.50	$674.00	—	6% above	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV VAC P-A P-B REC IJ	$505.50	$674.00	—	—	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM PER 1ML	$714.00	$952.00	—	38% above	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM PER 1ML	$714.00	$952.00	—	—	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VAC-LIVE 2ML ORAL LQ	$45.00	$60.00	—	45% below	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRU VAC-LIVE 2ML ORAL LIQ	$125.25	$167.00	—	52% above	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VACCINE-LIVE LIQ 2ML	$161.25	$215.00	—	96% above	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VAC-LIVE 2ML ORAL LQ	$45.00	$60.00	—	—	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRU VAC-LIVE 2ML ORAL LIQ	$125.25	$167.00	—	—	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VACCINE-LIVE LIQ 2ML	$161.25	$215.00	—	—	25%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER VACCINE, INACTIVATED	$242.25	$323.00	—	23% above	25%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HZV VACC RECOMBINANT IM 0.5ML	$263.25	$351.00	—	33% above	25%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER VACCINE, INACTIVATED	$242.25	$323.00	—	—	25%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HZV VACC RECOMBINANT IM 0.5ML	$263.25	$351.00	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACCINE > 7YRS., IM INJ	$54.00	$72.00	—	at median	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACCINE>7YRS, IM INJ	$210.00	$280.00	—	289% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD > 7 YEARS	$219.00	$292.00	—	306% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACCINE > 7YRS., IM INJ	$54.00	$72.00	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACCINE>7YRS, IM INJ	$210.00	$280.00	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD > 7 YEARS	$219.00	$292.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE > 7 YRS., IM INJ.	$39.75	$53.00	—	45% below	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE > 7YRS., IM INJ.	$60.75	$81.00	—	16% below	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP-VACCINE-IM>7 YEARS	$93.75	$125.00	—	30% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETNUS/DIPTH/PERTUSS VACC-TDAP	$118.50	$158.00	—	64% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE > 7 YRS., IM INJ.	$39.75	$53.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE > 7YRS., IM INJ.	$60.75	$81.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP-VACCINE-IM>7 YEARS	$93.75	$125.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETNUS/DIPTH/PERTUSS VACC-TDAP	$118.50	$158.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INFLUENZA VACCINE	$64.50	$86.00	—	180% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADM. SINGLE ADULT IMMUNIZATION	$67.50	$90.00	—	193% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PNEUMOCOCCAL VACC ADMIN	$105.75	$141.00	—	359% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 INFLUENZA VACC ADMIN	$105.75	$141.00	—	359% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PULM-IMMUNIZE ADMN ID/IM/SUBQ	$111.75	$149.00	—	385% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-SINGLE DOSE	$153.00	$204.00	—	564% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN PNEUMOCCAL VACCINE	$169.50	$226.00	—	636% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HEPATITIS B VACC ADMIN	$169.50	$226.00	—	636% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADM OF HEP B VACCINE	$169.50	$226.00	—	636% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN SINGLE	$170.25	$227.00	—	639% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMM ADMIN SNGL/COMBO VAC	$178.50	$238.00	—	675% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN SINGLE ADULT IMMUNIZATIO	$217.50	$290.00	—	844% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN INFLUENZA VACCINE	$64.50	$86.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADM. SINGLE ADULT IMMUNIZATION	$67.50	$90.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 INFLUENZA VACC ADMIN	$105.75	$141.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PNEUMOCOCCAL VACC ADMIN	$105.75	$141.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PULM-IMMUNIZE ADMN ID/IM/SUBQ	$111.75	$149.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-SINGLE DOSE	$153.00	$204.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HEPATITIS B VACC ADMIN	$169.50	$226.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN PNEUMOCCAL VACCINE	$169.50	$226.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADM OF HEP B VACCINE	$169.50	$226.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN SINGLE	$170.25	$227.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMM ADMIN SNGL/COMBO VAC	$178.50	$238.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN SINGLE ADULT IMMUNIZATIO	$217.50	$290.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZ ADMIN SUB/CONCURRENT	$37.50	$50.00	—	92% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMM ADM EA ADDL VACCINE	$56.25	$75.00	—	188% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN EACH ADDL ADULT IMMUNIZA	$67.50	$90.00	—	245% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN SUBSEQUENT	$105.75	$141.00	—	441% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PULM-IMMUNIZE ADMIN EACH ADDL	$111.75	$149.00	—	472% above	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZ ADMIN SUB/CONCURRENT	$37.50	$50.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMM ADM EA ADDL VACCINE	$56.25	$75.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADMIN EACH ADDL ADULT IMMUNIZA	$67.50	$90.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN SUBSEQUENT	$105.75	$141.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PULM-IMMUNIZE ADMIN EACH ADDL	$111.75	$149.00	—	—	25%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://mrfs.hyvehealthcare.com/TenetHealth/272844942_vhs-detroit-receiving-hospital-inc_standardcharges.json