Hospital Detroit-Warren-Dearborn, MI

VHS Childrens Hospital of Michigan

VHS Childrens Hospital of Michigan in Detroit, MI publishes cash prices for 355 common procedures listed here, from its own machine-readable price file updated Apr 6, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Michigan median for 290 of 352 procedures and below it for 58. By typical cash price it ranks #93 of 97 Michigan hospitals and #27 of 31 hospitals in the Detroit, MI area, cheapest first. Select a procedure to compare it with other hospitals nearby.

3901 Beaubien St, Detroit, MI 48201 Collected Sep 23, 2026 Source price file Check a bill from this hospital (313) 745-5437

Children's hospital For-profit hospital Emergency department CCN 233300 · CMS hospital register NPI 1538471800

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	$5,077.50	$6,770.00	—	224% above	25%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN WO/W CM	$5,077.50	$6,770.00	—	—	25%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN 2 VIEWS	$271.50	$362.00	—	30% above	25%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN 2 VIEWS	$271.50	$362.00	—	—	25%
Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE 3 VIEWS MINIMUM	$262.50	$350.00	—	23% above	25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE 3 VIEWS MINIMUM	$262.50	$350.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UE/LE ART STUD LTD 1-2LV	$779.25	$1,039.00	—	152% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UE/LE ART STUD LTD 1-2LV	$779.25	$1,039.00	—	—	25%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTRMTY W/O CM	$2,849.25	$3,799.00	—	182% above	25%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTRMTY W/O CM	$2,849.25	$3,799.00	—	—	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 X-RAY ESOPHAGUS SNGL CM STDY	$792.00	$1,056.00	—	180% above	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-RAY ESOPHAGUS SNGL CM STDY	$792.00	$1,056.00	—	—	25%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE IMAGING WHOLE BODY	$1,959.75	$2,613.00	—	108% above	25%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE IMAGING WHOLE BODY	$1,959.75	$2,613.00	—	—	25%
Breast ultrasound, complete, one breast CPT 76641 US BREAST UNI COMPLETE	$235.50	$314.00	—	22% below	25%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST UNI COMPLETE	$235.50	$314.00	—	—	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST UNI LTD	$144.75	$193.00	—	46% below	25%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST UNI LTD	$144.75	$193.00	—	—	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD/PEL W CONTRAST	$6,885.75	$9,181.00	—	177% above	25%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD/PEL W CONTRAST	$6,885.75	$9,181.00	—	—	25%
CT angiography (CTA) of the head CPT 70496 CTA HEAD W CONTRAST ONLY	$7,440.75	$9,921.00	—	380% above	25%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD W CONTRAST ONLY	$7,440.75	$9,921.00	—	—	25%
CT angiography (CTA) of the neck CPT 70498 CTA NECK W CONTRAST ONLY	$4,941.75	$6,589.00	—	229% above	25%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W CONTRAST ONLY	$4,941.75	$6,589.00	—	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST (NONCOR) W CM	$8,490.75	$11,321.00	—	410% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST (NONCOR) W CM	$8,490.75	$11,321.00	—	—	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA HEART W CONTRAST	$2,538.00	$3,384.00	—	90% above	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA HEART W CONTRAST	$2,538.00	$3,384.00	—	—	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CARD SCORING WO CONT	$128.25	$171.00	—	14% below	25%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CARD SCORING WO CONT	$128.25	$171.00	—	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CM	$3,912.75	$5,217.00	—	119% above	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CM	$3,912.75	$5,217.00	—	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CM	$4,440.75	$5,921.00	—	55% above	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CM	$4,440.75	$5,921.00	—	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELVIS WO/W CM	$5,938.50	$7,918.00	—	126% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS WO/W CM	$5,938.50	$7,918.00	—	—	25%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CM	$4,420.50	$5,894.00	—	201% above	25%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ CM	$4,420.50	$5,894.00	—	—	25%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CM	$3,907.50	$5,210.00	—	320% above	25%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CM	$3,907.50	$5,210.00	—	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CM	$2,978.25	$3,971.00	—	185% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS W/O CONTRAST	$2,978.25	$3,971.00	—	185% above	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS W/O CONTRAST	$2,978.25	$3,971.00	—	—	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CM	$2,978.25	$3,971.00	—	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN WO CONTRST	$3,007.50	$4,010.00	—	223% above	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN WO CONTRST	$3,007.50	$4,010.00	—	—	25%
CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W CONTRAST	$3,435.00	$4,580.00	—	176% above	25%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN W CONTRAST	$3,435.00	$4,580.00	—	—	25%
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN WO/W CONTR	$4,352.25	$5,803.00	—	178% above	25%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN WO/W CONTR	$4,352.25	$5,803.00	—	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE LUMBAR W/O CM	$2,445.75	$3,261.00	—	124% above	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SPINE LUMBAR W/O CM	$2,445.75	$3,261.00	—	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERVICAL W/O CM	$2,904.75	$3,873.00	—	161% above	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SPINE CERVICAL W/O CM	$2,904.75	$3,873.00	—	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS WITH CONTRAST	$4,657.50	$6,210.00	—	248% above	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS WITH CONTRAST	$4,657.50	$6,210.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUPLEX CAROTID BI/COMP	$1,618.50	$2,158.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUPLEX CAROTID BI/COMP	$1,618.50	$2,158.00	—	—	25%
Chest CT scan without and with contrast CPT 71270 CT THORAX WO/W CONTRAST	$4,659.00	$6,212.00	—	166% above	25%
Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX WO/W CONTRAST	$4,659.00	$6,212.00	—	—	25%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS	$332.25	$443.00	—	87% above	25%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS	$332.25	$443.00	—	—	25%
Chest X-ray, single view CPT 71045 CHEST 1 VIEW	$263.25	$351.00	—	67% above	25%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW	$263.25	$351.00	—	—	25%
Collarbone (clavicle) X-ray, complete CPT 73000 CLAVICLE COMPLETE	$446.25	$595.00	—	148% above	25%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 CLAVICLE COMPLETE	$446.25	$595.00	—	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMP	$855.00	$1,140.00	—	38% above	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMP	$855.00	$1,140.00	—	—	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA AXIAL SKELETON	$512.25	$683.00	—	65% above	25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA AXIAL SKELETON	$512.25	$683.00	—	—	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA APPENDICULAR SKELTN	$426.00	$568.00	—	224% above	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA APPENDICULAR SKELTN	$426.00	$568.00	—	—	25%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMP W FETL ANATMY	$1,329.00	$1,772.00	—	88% above	25%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMP W FETL ANATMY	$1,329.00	$1,772.00	—	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX W/O CONTRAST	$3,373.50	$4,498.00	—	238% above	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX W/O CONTRAST	$3,373.50	$4,498.00	—	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX WITH CONTRAST	$3,950.25	$5,267.00	—	201% above	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX WITH CONTRAST	$3,950.25	$5,267.00	—	—	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 LE ART IMAGING COMP BILAT	$1,818.75	$2,425.00	—	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 LE ART IMAGING COMP BILAT	$1,818.75	$2,425.00	—	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 UE/LE IMG VEINS COMP BILAT	$1,995.75	$2,661.00	—	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 UE/LE IMG VEINS COMP BILAT	$1,995.75	$2,661.00	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE COMP-W/SPEC/COLOR DOP ECHO	$5,196.00	$6,928.00	—	264% above	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO2D SPECTR/COLOR FLO	$5,196.00	$6,928.00	—	264% above	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE COMP-W/SPEC/COLOR DOP ECHO	$5,196.00	$6,928.00	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO2D SPECTR/COLOR FLO	$5,196.00	$6,928.00	—	—	25%
Elbow X-ray, 2 views CPT 73070 ELBOW 2 VIEWS	$426.00	$568.00	—	218% above	25%
Elbow X-ray, 2 views inpatient CPT 73070 ELBOW 2 VIEWS	$426.00	$568.00	—	—	25%
Elbow X-ray, complete, 3 or more views CPT 73080 ELBOW 3 VIEW MINIMUM	$369.00	$492.00	—	94% above	25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 ELBOW 3 VIEW MINIMUM	$369.00	$492.00	—	—	25%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORB/EAR/FOSSA W/O CM	$2,721.75	$3,629.00	—	171% above	25%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORB/EAR/FOSSA W/O CM	$2,721.75	$3,629.00	—	—	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES 3VW MIN	$530.25	$707.00	—	104% above	25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES 3VW MIN	$530.25	$707.00	—	—	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 FOREARM 2 VIEWS	$365.25	$487.00	—	105% above	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 FOREARM 2 VIEWS	$365.25	$487.00	—	—	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYSTEM IMG	$2,040.75	$2,721.00	—	118% above	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SYSTEM IMG	$2,040.75	$2,721.00	—	—	25%
Hand X-ray, 2 views CPT 73120 HAND 2 VIEWS	$270.75	$361.00	—	85% above	25%
Hand X-ray, 2 views inpatient CPT 73120 HAND 2 VIEWS	$270.75	$361.00	—	—	25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 OS CALCIS 2 VIEWS	$225.75	$301.00	—	47% above	25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 OS CALCIS 2 VIEWS	$225.75	$301.00	—	—	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY CPAP 4	$8,173.50	$10,898.00	—	136% above	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY CPAP 4	$8,173.50	$10,898.00	—	—	25%
Knee X-ray, 3 views CPT 73562 KNEE 3 VIEWS	$296.25	$395.00	—	49% above	25%
Knee X-ray, 3 views inpatient CPT 73562 KNEE 3 VIEWS	$296.25	$395.00	—	—	25%
Knee X-ray, complete, 4 or more views CPT 73564 KNEE COMP 4 VW MIN	$369.00	$492.00	—	72% above	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 KNEE COMP 4 VW MIN	$369.00	$492.00	—	—	25%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTRMTY W/O CM	$1,756.50	$2,342.00	—	60% above	25%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTRMTY W/O CM	$1,756.50	$2,342.00	—	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LTD SNGLE/QUAD/FU	$931.50	$1,242.00	—	98% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LTD SNGLE/QUAD/FU	$931.50	$1,242.00	—	—	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US XTR JOINT LMTD	$282.00	$376.00	—	23% below	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US XTR SOFT TISSUE LMTD	$380.25	$507.00	—	4% above	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US XTR JOINT LMTD	$282.00	$376.00	—	—	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US XTR SOFT TISSUE LMTD	$380.25	$507.00	—	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING	$112.50	$150.00	—	68% below	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREENING	$112.50	$150.00	—	—	25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 TIBIA/FIBULA 2 VIEWS	$258.00	$344.00	—	40% above	25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 TIBIA/FIBULA 2 VIEWS	$258.00	$344.00	—	—	25%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST	$5,793.75	$7,725.00	—	274% above	25%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRAST	$5,793.75	$7,725.00	—	—	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWR EXT JNT W/O CM	$4,029.00	$5,372.00	—	152% above	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWR EXT JNT W/O CM	$4,029.00	$5,372.00	—	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LE JNT WO/W CM	$8,530.50	$11,374.00	—	243% 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	$8,530.50	$11,374.00	—	—	25%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CM	$5,679.00	$7,572.00	—	236% above	25%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CM	$5,679.00	$7,572.00	—	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO/W CM	$9,270.00	$12,360.00	—	197% above	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO/W CM	$9,270.00	$12,360.00	—	—	25%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$5,495.25	$7,327.00	—	230% above	25%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$5,495.25	$7,327.00	—	—	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO/W CONTRAST	$8,857.50	$11,810.00	—	214% above	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO/W CONTRAST	$8,857.50	$11,810.00	—	—	25%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE LUMBAR W/O CM	$5,015.25	$6,687.00	—	179% above	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINE LUMBAR W/O CM	$5,015.25	$6,687.00	—	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINE LUMBAR WO/W CM	$11,598.75	$15,465.00	—	329% above	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI SPINE LUMBAR WO/W CM	$11,598.75	$15,465.00	—	—	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINE THORAC W/O CM	$5,685.00	$7,580.00	—	252% above	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI SPINE THORAC W/O CM	$5,685.00	$7,580.00	—	—	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINE CERV WO/W CM	$8,421.00	$11,228.00	—	198% above	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI SPINE CERV WO/W CM	$8,421.00	$11,228.00	—	—	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SPINE CERVICL W/O CM	$5,685.00	$7,580.00	—	224% above	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI SPINE CERVICL W/O CM	$5,685.00	$7,580.00	—	—	25%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WO/W CONTRAST	$9,275.25	$12,367.00	—	236% above	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WO/W CONTRAST	$9,275.25	$12,367.00	—	—	25%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$5,682.00	$7,576.00	—	234% above	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$5,682.00	$7,576.00	—	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UP EXT JNT W/O CM	$4,783.50	$6,378.00	—	156% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UP EXT JNT W/O CM	$4,783.50	$6,378.00	—	—	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 SPINE CERVICAL 4 OR 5 VW	$418.50	$558.00	—	43% above	25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 SPINE CERVICAL 4 OR 5 VW	$418.50	$558.00	—	—	25%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISS NECK W CM	$2,863.50	$3,818.00	—	117% above	25%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISS NECK W CM	$2,863.50	$3,818.00	—	—	25%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISS NECK WO CM	$2,116.50	$2,822.00	—	109% above	25%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISS NECK WO CM	$2,116.50	$2,822.00	—	—	25%
Neck soft tissue X-ray CPT 70360 NECK FOR SOFT TISSUES	$246.75	$329.00	—	39% above	25%
Neck soft tissue X-ray inpatient CPT 70360 NECK FOR SOFT TISSUES	$246.75	$329.00	—	—	25%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT SKULL TO THIGH	$6,385.50	$8,514.00	—	16% above	25%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT SKULL TO THIGH	$6,385.50	$8,514.00	—	—	25%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST	$2,904.75	$3,873.00	—	191% above	25%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST	$2,904.75	$3,873.00	—	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LTD/FU	$969.00	$1,292.00	—	188% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LTD/FU	$969.00	$1,292.00	—	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$1,033.50	$1,378.00	—	82% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$1,033.50	$1,378.00	—	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMP>14WK SGL GEST	$1,082.25	$1,443.00	—	93% above	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMP>14WK SGL GEST	$1,082.25	$1,443.00	—	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB COMP<14WKS 1STGEST	$1,041.00	$1,388.00	—	102% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB COMP<14WKS 1STGEST	$1,041.00	$1,388.00	—	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LTD 1OR>FETUS	$793.50	$1,058.00	—	148% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LTD 1OR>FETUS	$793.50	$1,058.00	—	—	25%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILAT 2VW	$378.00	$504.00	—	91% above	25%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILAT 2VW	$378.00	$504.00	—	—	25%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 RIBS UNI 3V MIN W/PA CXR	$681.00	$908.00	—	189% 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	$681.00	$908.00	—	—	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER 2 VWS MINIMUM	$378.00	$504.00	—	77% above	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 SHOULDER 2 VWS MINIMUM	$378.00	$504.00	—	—	25%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES 3VW MIN	$566.25	$755.00	—	142% above	25%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES 3VW MIN	$566.25	$755.00	—	—	25%
Skull X-ray, fewer than 4 views CPT 70250 SKULL < 4 VIEWS	$541.50	$722.00	—	158% above	25%
Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL < 4 VIEWS	$541.50	$722.00	—	—	25%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY	$8,173.50	$10,898.00	—	153% above	25%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY	$8,173.50	$10,898.00	—	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 SWAL FUNC W/CINE/VIDEO+CM STDY	$723.75	$965.00	—	92% above	25%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWAL FUNC W/CINE/VIDEO+CM STDY	$723.75	$965.00	—	—	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 FEMUR 2 VIEWS MIN	$250.50	$334.00	—	17% above	25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 FEMUR 2 VIEWS MIN	$250.50	$334.00	—	—	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT SPINE THORACIC W/O CM	$2,091.75	$2,789.00	—	98% above	25%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT SPINE THORACIC W/O CM	$2,091.75	$2,789.00	—	—	25%
Toe X-ray, 2 or more views CPT 73660 TOE(S) 2 VIEWS	$213.00	$284.00	—	69% above	25%
Toe X-ray, 2 or more views inpatient CPT 73660 TOE(S) 2 VIEWS	$213.00	$284.00	—	—	25%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NOT OB	$1,222.50	$1,630.00	—	132% above	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NOT OB	$1,222.50	$1,630.00	—	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL	$945.75	$1,261.00	—	117% above	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANSVAGINAL	$945.75	$1,261.00	—	—	25%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$1,481.25	$1,975.00	—	122% above	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$1,481.25	$1,975.00	—	—	25%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM CONTENTS	$1,122.75	$1,497.00	—	114% above	25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM CONTENTS	$1,122.75	$1,497.00	—	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD/NECK	$1,320.00	$1,760.00	—	177% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD/NECK	$1,320.00	$1,760.00	—	—	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI W/SNGL CM STDY	$663.75	$885.00	—	65% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI W/SNGL CM STDY	$663.75	$885.00	—	—	25%
Upper arm X-ray (humerus), 2 views CPT 73060 HUMERUS 2 VIEW MINIMUM	$271.50	$362.00	—	47% above	25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HUMERUS 2 VIEW MINIMUM	$271.50	$362.00	—	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 UE/LE IMG VEINS UNI/LTD	$1,010.25	$1,347.00	—	90% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 UE/LE IMG VEINS UNI/LTD	$1,010.25	$1,347.00	—	—	25%
Wrist X-ray, 2 views CPT 73100 WRIST 2 VIEWS	$262.50	$350.00	—	87% above	25%
Wrist X-ray, 2 views inpatient CPT 73100 WRIST 2 VIEWS	$262.50	$350.00	—	—	25%
Wrist X-ray, complete, 3 or more views CPT 73110 WRIST 3 VIEWS MINIMUM	$328.50	$438.00	—	68% above	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST 3 VIEWS MINIMUM	$328.50	$438.00	—	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP UNI W/PELV 2-3 VWS	$214.50	$286.00	—	4% 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	$214.50	$286.00	—	—	25%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW	$235.50	$314.00	—	48% above	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW	$235.50	$314.00	—	—	25%
X-ray of the ankle, 2 views CPT 73600 ANKLE 2 VIEWS	$229.50	$306.00	—	31% above	25%
X-ray of the ankle, 2 views inpatient CPT 73600 ANKLE 2 VIEWS	$229.50	$306.00	—	—	25%
X-ray of the finger(s), 2 or more views CPT 73140 FINGER(S) 2 VIEWS	$292.50	$390.00	—	120% above	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 FINGER(S) 2 VIEWS	$292.50	$390.00	—	—	25%
X-ray of the foot, 2 views CPT 73620 FOOT 2 VIEWS	$229.50	$306.00	—	45% above	25%
X-ray of the foot, 2 views inpatient CPT 73620 FOOT 2 VIEWS	$229.50	$306.00	—	—	25%
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT 3 VIEWS MINIMUM	$299.25	$399.00	—	66% above	25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT 3 VIEWS MINIMUM	$299.25	$399.00	—	—	25%
X-ray of the hand, 3 or more views CPT 73130 HAND 3 VIEWS MINIMUM	$456.00	$608.00	—	148% above	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 HAND 3 VIEWS MINIMUM	$456.00	$608.00	—	—	25%
X-ray of the knee, 1 or 2 views CPT 73560 KNEE 1-2 VIEWS	$286.50	$382.00	—	84% above	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE 1-2 VIEWS	$286.50	$382.00	—	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR 2 VIEWS	$405.75	$541.00	—	90% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR 3 VIEWS	$520.50	$694.00	—	143% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR 2 VIEWS	$405.75	$541.00	—	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR 3 VIEWS	$520.50	$694.00	—	—	25%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR MIN 4VWS	$544.50	$726.00	—	77% above	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR MIN 4VWS	$544.50	$726.00	—	—	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE THORACIC 2 VIEWS	$366.00	$488.00	—	98% above	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE THORACIC 2 VIEWS	$366.00	$488.00	—	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES 3VW MIN	$303.75	$405.00	—	74% above	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES 3VW MIN	$303.75	$405.00	—	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 2 VIEWS	$354.75	$473.00	—	54% above	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 3 VIEWS	$437.25	$583.00	—	89% above	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 2 VIEWS	$354.75	$473.00	—	—	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 3 VIEWS	$437.25	$583.00	—	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 VIEW	$366.00	$488.00	—	123% above	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 2 VIEWS	$426.00	$568.00	—	159% above	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 VIEW	$366.00	$488.00	—	—	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 2 VIEWS	$426.00	$568.00	—	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM COCCYX 2 VWS	$380.25	$507.00	—	118% above	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM COCCYX 2 VWS	$380.25	$507.00	—	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
ACTH blood test CPT 82024 ACTH	$393.00	$524.00	—	319% above	25%
ACTH blood test inpatient CPT 82024 ACTH	$393.00	$524.00	—	—	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSAMINASE-SGPT (ALT)	$17.25	$23.00	—	28% below	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINOTRANSFERASE	$23.25	$31.00	—	3% below	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSAMINASE-SGPT (ALT)	$17.25	$23.00	—	—	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINOTRANSFERASE	$23.25	$31.00	—	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSTERASE AST(SGOT)	$17.25	$23.00	—	22% below	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSTERASE AST(SGOT)	$17.25	$23.00	—	—	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$303.75	$405.00	—	79% above	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$303.75	$405.00	—	—	25%
Albumin blood test CPT 82040 ALBUMIN SERUM	$17.25	$23.00	—	14% below	25%
Albumin blood test inpatient CPT 82040 ALBUMIN SERUM	$17.25	$23.00	—	—	25%
Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE ALKALINE	$103.50	$138.00	—	393% above	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 PHOSPHATASE ALKALINE	$103.50	$138.00	—	—	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 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 BAY LEAF	$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 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 PENICILLIN V (MINOR) IGE	$2.25	$3.00	—	65% below	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 F424-ARA H 3	$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 HONEY	$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 LINSEED	$2.25	$3.00	—	65% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 FLOUNDER IGE	$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 SHEEP EPITHELIUM	$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 TOBACCO	$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 ALLGN IGE PENICILLIN G (MAJOR)	$2.25	$3.00	—	65% 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 SUNFLOWER SEED	$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 OVALUMIN, IGE	$3.75	$5.00	—	41% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 OVOMUCOID,IGE ALLERGEN SPEC	$3.75	$5.00	—	41% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN BLACKBERRY, IGE	$3.75	$5.00	—	41% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPEC (SALMON,IGE)	$5.25	$7.00	—	18% 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 RED DYE, IGE ALLERGEN SPEC	$10.50	$14.00	—	65% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ANNATO SEED IGE	$10.50	$14.00	—	65% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE A FUMIGATUS	$11.25	$15.00	—	77% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN WINE VINEGAR, IGE	$15.00	$20.00	—	135% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE POMEGRANATE	$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 NECTARINE,IGE ALLERGEN SPEC	$18.75	$25.00	—	194% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLGN SPEC IGE EA ALLERG	$19.50	$26.00	—	206% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST EACH ALLERGEN	$19.50	$26.00	—	206% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE EPITHELIUM,IGE	$21.00	$28.00	—	230% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 BLUE MUSSEL,IGE	$21.00	$28.00	—	230% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 SCALLOP,IGE	$21.00	$28.00	—	230% 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, MSG	$22.50	$30.00	—	253% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE GELATIN PORCINE	$32.25	$43.00	—	406% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 CHEDDAR CHEESE , IGE	$36.00	$48.00	—	465% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST BEE VENOM	$39.00	$52.00	—	512% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 CATFISH ALLERGEN, IGE	$46.50	$62.00	—	630% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 CAULIFLOWER, IGE	$47.25	$63.00	—	642% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 CUCUMBER, IGE	$48.00	$64.00	—	654% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 BUCKWHEAT, IGE	$51.75	$69.00	—	712% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 MACADAMIA,IGE	$51.75	$69.00	—	712% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 CHERRY, IGE	$51.75	$69.00	—	712% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 SUNFLOWER POLLEN IGE	$54.00	$72.00	—	748% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN, HONEY, IGE	$54.75	$73.00	—	759% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE PUMPKIN SEED	$54.75	$73.00	—	759% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN, NUTMEG IGE	$54.75	$73.00	—	759% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 POPPYSEED IGE	$54.75	$73.00	—	759% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 TILAPIA ALLERGEN, IGE	$55.50	$74.00	—	771% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 OLIVE TREE ALLERGEN, IGE	$57.00	$76.00	—	795% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 RAT URINE, IGE	$60.00	$80.00	—	842% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE URINE, IGE	$60.00	$80.00	—	842% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 CINNAMON IGE	$60.75	$81.00	—	854% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE COTTON SEED	$60.75	$81.00	—	854% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 SQUID, IGE	$61.50	$82.00	—	865% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGENS, FOOD ADULT PANEL 10	$64.50	$86.00	—	913% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST-PANEL B	$132.75	$177.00	—	1984% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST-PANEL A	$277.50	$370.00	—	4256% 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 SUNFLOWER POLLEN	$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 SHEEP 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 BENTGRASS	$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 GOAT EPITHELIUM	$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 FLOUNDER IGE	$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 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 PENICILLIN V (MINOR) IGE	$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 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 VANILLA	$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 ALLERGEN IGE CHICKEN FEATHERS	$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 ALLRGN SPEC IGE EA	$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 ALLERGEN IGE SUNFLOWER SEED	$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 BLACKBERRY, IGE	$3.75	$5.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN OVALUMIN, IGE	$3.75	$5.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OVOMUCOID,IGE ALLERGEN SPEC	$3.75	$5.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPEC (SALMON,IGE)	$5.25	$7.00	—	—	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 ANNATO SEED IGE	$10.50	$14.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RED DYE, IGE ALLERGEN SPEC	$10.50	$14.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE A FUMIGATUS	$11.25	$15.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE POMEGRANATE	$15.00	$20.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN WINE VINEGAR, IGE	$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 NECTARINE,IGE ALLERGEN SPEC	$18.75	$25.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST EACH ALLERGEN	$19.50	$26.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLGN SPEC IGE EA ALLERG	$19.50	$26.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUSE EPITHELIUM,IGE	$21.00	$28.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SCALLOP,IGE	$21.00	$28.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BLUE MUSSEL,IGE	$21.00	$28.00	—	—	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, MSG	$22.50	$30.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE GELATIN PORCINE	$32.25	$43.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHEDDAR CHEESE , IGE	$36.00	$48.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST BEE VENOM	$39.00	$52.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CATFISH ALLERGEN, IGE	$46.50	$62.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CAULIFLOWER, IGE	$47.25	$63.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CUCUMBER, IGE	$48.00	$64.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHERRY, IGE	$51.75	$69.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MACADAMIA,IGE	$51.75	$69.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BUCKWHEAT, IGE	$51.75	$69.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SUNFLOWER POLLEN IGE	$54.00	$72.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 POPPYSEED IGE	$54.75	$73.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, NUTMEG IGE	$54.75	$73.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, HONEY, IGE	$54.75	$73.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE PUMPKIN SEED	$54.75	$73.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TILAPIA ALLERGEN, IGE	$55.50	$74.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OLIVE TREE ALLERGEN, IGE	$57.00	$76.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUSE URINE, IGE	$60.00	$80.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAT URINE, IGE	$60.00	$80.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE COTTON SEED	$60.75	$81.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CINNAMON IGE	$60.75	$81.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SQUID, IGE	$61.50	$82.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGENS, FOOD ADULT PANEL 10	$64.50	$86.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST-PANEL B	$132.75	$177.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST-PANEL A	$277.50	$370.00	—	—	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA FETO PROTEIN SERUM	$283.50	$378.00	—	456% above	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA FETO PROTEIN SERUM	$283.50	$378.00	—	—	25%
Ammonia blood test CPT 82140 AMMONIA	$147.00	$196.00	—	126% above	25%
Ammonia blood test inpatient CPT 82140 AMMONIA	$147.00	$196.00	—	—	25%
Amylase blood test CPT 82150 AMYLASE	$87.75	$117.00	—	338% above	25%
Amylase blood test inpatient CPT 82150 AMYLASE	$87.75	$117.00	—	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRUL PEPTIDE IGG AB	$40.50	$54.00	—	27% below	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYC CITRULLINATED PEP AB	$84.00	$112.00	—	51% above	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRUL PEPTIDE IGG AB	$40.50	$54.00	—	—	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYC CITRULLINATED PEP AB	$84.00	$112.00	—	—	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB(ANA)	$299.25	$399.00	—	435% above	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB(ANA)	$299.25	$399.00	—	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYP NATRIURETC PEPTIDE	$343.50	$458.00	—	345% above	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYP NATRIURETC PEPTIDE	$343.50	$458.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 RESPIRAT CULTURE W/GRAM STAIN	$156.75	$209.00	—	196% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE OTHER SOURCE	$185.25	$247.00	—	250% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 RESPIRAT CULTURE W/GRAM STAIN	$156.75	$209.00	—	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE OTHER SOURCE	$185.25	$247.00	—	—	25%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$443.25	$591.00	—	779% above	25%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$443.25	$591.00	—	—	25%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$87.75	$117.00	—	287% above	25%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$87.75	$117.00	—	—	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATH LEVEL IV	$185.25	$247.00	—	70% above	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH LEVEL IV	$185.25	$247.00	—	—	25%
Blood culture for bacteria CPT 87040 CULT BLOOD AERO/ANAERO	$184.50	$246.00	—	193% above	25%
Blood culture for bacteria inpatient CPT 87040 CULT BLOOD AERO/ANAERO	$184.50	$246.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 SCD DRAW STATION VENIPUNCTURE	$42.00	$56.00	—	226% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$42.00	$56.00	—	226% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNTURE	$42.00	$56.00	—	226% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNTURE	$42.00	$56.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$42.00	$56.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 SCD DRAW STATION VENIPUNCTURE	$42.00	$56.00	—	—	25%
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANT BLOOD	$65.25	$87.00	—	172% above	25%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD	$65.25	$87.00	—	—	25%
Blood lead test CPT 83655 LEAD QUANTITATIVE	$34.50	$46.00	—	351% above	25%
Blood lead test CPT 83655 LEAD HEAVY METAL	$51.00	$68.00	—	567% above	25%
Blood lead test inpatient CPT 83655 LEAD QUANTITATIVE	$34.50	$46.00	—	—	25%
Blood lead test inpatient CPT 83655 LEAD HEAVY METAL	$51.00	$68.00	—	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADTOPN CHRONC(HCG)QL	$87.00	$116.00	—	135% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADTOPN CHRONC(HCG)QL	$87.00	$116.00	—	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLD TYPE ABO ONLY	$527.25	$703.00	—	2405% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 AUTO:MULTIPHASIC-CPK	$527.25	$703.00	—	2405% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 TRANSPLANT ABO TYPE	$527.25	$703.00	—	2405% above	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 AUTO:MULTIPHASIC-CPK	$527.25	$703.00	—	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLD TYPE ABO ONLY	$527.25	$703.00	—	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 TRANSPLANT ABO TYPE	$527.25	$703.00	—	—	25%
Blood urea nitrogen (BUN) test CPT 84520 BLD UREA NITROGEN QUAN	$65.25	$87.00	—	268% above	25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BLD UREA NITROGEN QUAN	$65.25	$87.00	—	—	25%
C-peptide blood test CPT 84681 C-PEPTIDE, REFERENCE LAB	$93.00	$124.00	—	32% above	25%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE, REFERENCE LAB	$93.00	$124.00	—	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN QN	$149.25	$199.00	—	339% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN QN	$149.25	$199.00	—	—	25%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOXIN AMP PROBE	$112.50	$150.00	—	3% below	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF TOXIN AMP PROBE	$112.50	$150.00	—	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$193.50	$258.00	—	107% above	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$193.50	$258.00	—	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$176.25	$235.00	—	75% above	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$176.25	$235.00	—	—	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	$54.75	$73.00	—	174% above	25%
Calcium blood test, total inpatient CPT 82310 CALCIUM	$54.75	$73.00	—	—	25%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINO-EMBRYONIC AG	$533.25	$711.00	—	542% above	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINO-EMBRYONIC AG	$533.25	$711.00	—	—	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 IGM AB	$48.00	$64.00	—	19% above	25%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB IGG	$118.50	$158.00	—	194% 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 IGM AB	$48.00	$64.00	—	—	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB IGG	$118.50	$158.00	—	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA DNA AMP PROBE	$207.75	$277.00	—	181% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA DNA AMP PROBE	$207.75	$277.00	—	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$508.50	$678.00	—	898% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$508.50	$678.00	—	—	25%
Complete blood count (CBC) with differential CPT 85025 CBC/PLT/AUTO DIFF (5)	$144.00	$192.00	—	257% above	25%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC/PLT/AUTO DIFF (5)	$144.00	$192.00	—	—	25%
Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFF	$40.50	$54.00	—	40% above	25%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFF	$40.50	$54.00	—	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$534.00	$712.00	—	614% above	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL	$534.00	$712.00	—	—	25%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL	$280.50	$374.00	—	725% above	25%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL	$280.50	$374.00	—	—	25%
Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE TOTAL	$208.50	$278.00	—	595% above	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATINE KINASE TOTAL	$208.50	$278.00	—	—	25%
Creatinine blood test CPT 82565 CREATININE BLOOD	$54.75	$73.00	—	130% above	25%
Creatinine blood test inpatient CPT 82565 CREATININE BLOOD	$54.75	$73.00	—	—	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS AB	$10.50	$14.00	—	76% below	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV AB	$208.50	$278.00	—	379% 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	$208.50	$278.00	—	—	25%
D-dimer blood test (blood clot marker) CPT 85379 FDP D-DIMER QNT	$176.25	$235.00	—	310% above	25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FDP D-DIMER QNT	$176.25	$235.00	—	—	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE, REFERENCE LAB	$72.75	$97.00	—	13% above	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDRST SULFATE	$282.75	$377.00	—	339% above	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE, REFERENCE LAB	$72.75	$97.00	—	—	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDRST SULFATE	$282.75	$377.00	—	—	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 MECONIUM QL DRUG SCRN	$56.25	$75.00	—	3% 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 ALCOHOL ETHYL	$94.50	$126.00	—	62% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 TRICYCLIC DRUGS QUAL	$103.50	$138.00	—	78% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN EACH CLASS	$283.50	$378.00	—	387% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLZR	$501.75	$669.00	—	762% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/2	$525.00	$700.00	—	802% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 OPIATES	$538.50	$718.00	—	825% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$538.50	$718.00	—	825% 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 MECONIUM QL DRUG SCRN	$56.25	$75.00	—	—	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 ALCOHOL ETHYL	$94.50	$126.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 TRICYCLIC DRUGS QUAL	$103.50	$138.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN EACH CLASS	$283.50	$378.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLZR	$501.75	$669.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR/2	$525.00	$700.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$538.50	$718.00	—	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 OPIATES	$538.50	$718.00	—	—	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL	$235.50	$314.00	—	636% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL	$235.50	$314.00	—	—	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV IGM VCA	$99.00	$132.00	—	55% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV IGG VCA	$177.75	$237.00	—	178% above	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV IGM VCA	$99.00	$132.00	—	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV IGG VCA	$177.75	$237.00	—	—	25%
Estradiol blood test CPT 82670 ESTRADIOL	$156.75	$209.00	—	100% above	25%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$156.75	$209.00	—	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMLAT HORMONE	$296.25	$395.00	—	272% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMLAT HORMONE	$296.25	$395.00	—	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL	$41.25	$55.00	—	35% below	25%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN,STOOL	$241.50	$322.00	—	281% above	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN FECAL	$41.25	$55.00	—	—	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN,STOOL	$241.50	$322.00	—	—	25%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$147.75	$197.00	—	146% above	25%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$147.75	$197.00	—	—	25%
Fibrinogen blood test CPT 85384 FIBRINOGEN ACTIVITY	$393.75	$525.00	—	1258% above	25%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN ACTIVITY	$393.75	$525.00	—	—	25%
Folate (folic acid) blood test CPT 82746 FOLIC ACID	$242.25	$323.00	—	228% above	25%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID	$242.25	$323.00	—	—	25%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$234.75	$313.00	—	252% above	25%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$234.75	$313.00	—	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE THYROXINE INDEX	$134.25	$179.00	—	340% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4, DIRECT DIALYSIS	$140.25	$187.00	—	360% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE	$323.25	$431.00	—	960% above	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE THYROXINE INDEX	$134.25	$179.00	—	—	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4, DIRECT DIALYSIS	$140.25	$187.00	—	—	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE	$323.25	$431.00	—	—	25%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$227.25	$303.00	—	519% above	25%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$227.25	$303.00	—	—	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GLUTAMYLTRANSERASE GGT	$10.50	$14.00	—	66% below	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT	$147.00	$196.00	—	379% above	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GLUTAMYLTRANSERASE GGT	$10.50	$14.00	—	—	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT	$147.00	$196.00	—	—	25%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3SPEC	$232.50	$310.00	—	308% above	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 3SPEC	$232.50	$310.00	—	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC DNA AMP PROBE	$151.28	$201.70	—	56% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N GONOR AMP PROBE	$207.75	$277.00	—	114% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC DNA AMP PROBE	$151.28	$201.70	—	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N GONOR AMP PROBE	$207.75	$277.00	—	—	25%
H. pylori antibody blood test CPT 86677 H. PYLORI , IGA	$59.25	$79.00	—	at median	25%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI PANEL	$68.25	$91.00	—	15% above	25%
H. pylori antibody blood test CPT 86677 H.PYLORI AB,IGM	$118.50	$158.00	—	100% above	25%
H. pylori antibody blood test CPT 86677 HELICO PYLORI AB,IGG	$186.75	$249.00	—	215% above	25%
H. pylori antibody blood test inpatient CPT 86677 H. PYLORI , IGA	$59.25	$79.00	—	—	25%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI PANEL	$68.25	$91.00	—	—	25%
H. pylori antibody blood test inpatient CPT 86677 H.PYLORI AB,IGM	$118.50	$158.00	—	—	25%
H. pylori antibody blood test inpatient CPT 86677 HELICO PYLORI AB,IGG	$186.75	$249.00	—	—	25%
H. pylori stool antigen test CPT 87338 HI PLYDRI ANTIGEN STOOL	$100.50	$134.00	—	59% above	25%
H. pylori stool antigen test CPT 87338 H. PYLORI STOOL AG	$227.25	$303.00	—	259% above	25%
H. pylori stool antigen test inpatient CPT 87338 HI PLYDRI ANTIGEN STOOL	$100.50	$134.00	—	—	25%
H. pylori stool antigen test inpatient CPT 87338 H. PYLORI STOOL AG	$227.25	$303.00	—	—	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 QUANT	$126.75	$169.00	—	31% below	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV/RNA BY PCR	$230.25	$307.00	—	26% above	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 QUANT	$306.75	$409.00	—	68% above	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 QUANT RNA/DNA	$750.75	$1,001.00	—	311% 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 QUANT	$126.75	$169.00	—	—	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV/RNA BY PCR	$230.25	$307.00	—	—	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 QUANT	$306.75	$409.00	—	—	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 QUANT RNA/DNA	$750.75	$1,001.00	—	—	25%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 SCREEN	$226.50	$302.00	—	382% above	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1/HIV-2 SCREEN	$226.50	$302.00	—	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV I AG HIV I HIV II AB	$236.25	$315.00	—	382% above	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV I AG HIV I HIV II AB	$236.25	$315.00	—	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCATED	$176.25	$235.00	—	354% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCATED	$176.25	$235.00	—	—	25%
Hemoglobin blood test CPT 85018 POC HEMOGLOBIN	$111.75	$149.00	—	598% above	25%
Hemoglobin blood test CPT 85018 BLOOD HEMOGLBN	$123.00	$164.00	—	669% above	25%
Hemoglobin blood test CPT 85018 BLOOD HEMOGLOBN	$123.00	$164.00	—	669% above	25%
Hemoglobin blood test inpatient CPT 85018 POC HEMOGLOBIN	$111.75	$149.00	—	—	25%
Hemoglobin blood test inpatient CPT 85018 BLOOD HEMOGLOBN	$123.00	$164.00	—	—	25%
Hemoglobin blood test inpatient CPT 85018 BLOOD HEMOGLBN	$123.00	$164.00	—	—	25%
Hepatitis B core antibody test (total) CPT 86704 HEP B CORE AB TOTAL	$147.75	$197.00	—	234% above	25%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE AB TOTAL	$147.75	$197.00	—	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURF AB	$126.00	$168.00	—	200% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURF AB	$126.00	$168.00	—	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$134.25	$179.00	—	180% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C IGG AB	$135.75	$181.00	—	183% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$134.25	$179.00	—	—	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C IGG AB	$135.75	$181.00	—	—	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	$747.00	$996.00	—	468% 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	$747.00	$996.00	—	—	25%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES I AB IGG	$84.00	$112.00	—	102% above	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES I AB IGG	$84.00	$112.00	—	—	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	$121.50	$162.00	—	137% 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	$121.50	$162.00	—	—	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP HI SENSITIVITY	$45.00	$60.00	—	22% below	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HI SENSITIVITY	$45.00	$60.00	—	—	25%
Homocysteine blood test CPT 83090 HOMOCYSTEINE QUANT	$171.00	$228.00	—	123% above	25%
Homocysteine blood test CPT 83090 HOMOCYSTINE URINE QUANT	$180.00	$240.00	—	135% above	25%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE QUANT	$171.00	$228.00	—	—	25%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTINE URINE QUANT	$180.00	$240.00	—	—	25%
Insulin blood test CPT 83525 INSULIN	$55.50	$74.00	—	52% above	25%
Insulin blood test CPT 83525 INSULIN TOTAL	$194.25	$259.00	—	431% above	25%
Insulin blood test inpatient CPT 83525 INSULIN	$55.50	$74.00	—	—	25%
Insulin blood test inpatient CPT 83525 INSULIN TOTAL	$194.25	$259.00	—	—	25%
Iron blood test (serum iron) CPT 83540 IRON	$42.00	$56.00	—	44% above	25%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$42.00	$56.00	—	—	25%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPCTY	$138.00	$184.00	—	247% above	25%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$138.00	$184.00	—	247% above	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPCTY	$138.00	$184.00	—	—	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY	$138.00	$184.00	—	—	25%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$300.00	$400.00	—	386% above	25%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$300.00	$400.00	—	—	25%
LH (luteinizing hormone) test CPT 83002 ALPHA LH	$126.75	$169.00	—	67% above	25%
LH (luteinizing hormone) test CPT 83002 LUTEINING HORMONE	$154.50	$206.00	—	103% above	25%
LH (luteinizing hormone) test inpatient CPT 83002 ALPHA LH	$126.75	$169.00	—	—	25%
LH (luteinizing hormone) test inpatient CPT 83002 LUTEINING HORMONE	$154.50	$206.00	—	—	25%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID BODY FLUID	$125.25	$167.00	—	178% above	25%
Lactate (lactic acid) blood test CPT 83605 LACTATE(LACTIC ACID)	$149.25	$199.00	—	231% above	25%
Lactate (lactic acid) blood test CPT 83605 LACTATE (LACTIC ACID)	$160.50	$214.00	—	256% above	25%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID BODY FLUID	$125.25	$167.00	—	—	25%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE(LACTIC ACID)	$149.25	$199.00	—	—	25%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE (LACTIC ACID)	$160.50	$214.00	—	—	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH-LACTIC DEHYDROGENASE	$68.25	$91.00	—	184% above	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 LACTIC DEHYDROGENASE, LDH	$68.25	$91.00	—	184% above	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTIC DEHYDROGENASE, LDH	$68.25	$91.00	—	—	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH-LACTIC DEHYDROGENASE	$68.25	$91.00	—	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$98.25	$131.00	—	225% above	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$98.25	$131.00	—	—	25%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$121.50	$162.00	—	158% above	25%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$121.50	$162.00	—	—	25%
Lyme disease antibody test CPT 86618 LYME DISEASE PANEL	$6.75	$9.00	—	74% below	25%
Lyme disease antibody test CPT 86618 LYME DISEASE AB	$31.50	$42.00	—	21% above	25%
Lyme disease antibody test CPT 86618 LYME DISEASE	$79.50	$106.00	—	206% above	25%
Lyme disease antibody test CPT 86618 LYME ANTIBODY, CSF	$99.00	$132.00	—	281% above	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE PANEL	$6.75	$9.00	—	—	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB	$31.50	$42.00	—	—	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE	$79.50	$106.00	—	—	25%
Lyme disease antibody test inpatient CPT 86618 LYME ANTIBODY, CSF	$99.00	$132.00	—	—	25%
Magnesium blood test CPT 83735 MAGNESIUM	$64.50	$86.00	—	222% above	25%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$64.50	$86.00	—	—	25%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB	$141.75	$189.00	—	475% above	25%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA AB	$141.75	$189.00	—	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE AB SCREEN	$98.25	$131.00	—	137% above	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE AB SCREEN	$98.25	$131.00	—	—	25%
Mumps immunity blood test CPT 86735 MUMPS ANTIBODY IGM	$23.25	$31.00	—	7% below	25%
Mumps immunity blood test CPT 86735 MUMPS AB	$354.75	$473.00	—	1313% above	25%
Mumps immunity blood test inpatient CPT 86735 MUMPS ANTIBODY IGM	$23.25	$31.00	—	—	25%
Mumps immunity blood test inpatient CPT 86735 MUMPS AB	$354.75	$473.00	—	—	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$126.00	$168.00	—	120% above	25%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$126.00	$168.00	—	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL	$128.25	$171.00	—	154% above	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL	$128.25	$171.00	—	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT	$270.75	$361.00	—	102% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PTH)	$460.50	$614.00	—	244% above	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT	$270.75	$361.00	—	—	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PTH)	$460.50	$614.00	—	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$69.00	$92.00	—	123% above	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$69.00	$92.00	—	—	25%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS	$68.25	$91.00	—	225% above	25%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS	$68.25	$91.00	—	—	25%
Potassium blood test CPT 84132 POTASSIUM SERUM	$72.75	$97.00	—	214% above	25%
Potassium blood test CPT 84132 POTASSIUM	$89.25	$119.00	—	285% above	25%
Potassium blood test inpatient CPT 84132 POTASSIUM SERUM	$72.75	$97.00	—	—	25%
Potassium blood test inpatient CPT 84132 POTASSIUM	$89.25	$119.00	—	—	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	$663.75	$885.00	—	941% above	25%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$663.75	$885.00	—	—	25%
Prolactin blood test CPT 84146 PROLACTIN REF. LAB	$50.25	$67.00	—	32% below	25%
Prolactin blood test CPT 84146 PROLACTIN	$312.75	$417.00	—	326% above	25%
Prolactin blood test inpatient CPT 84146 PROLACTIN REF. LAB	$50.25	$67.00	—	—	25%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$312.75	$417.00	—	—	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 PROTHROMBIN TIME	$73.50	$98.00	—	282% 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 PROTHROMBIN TIME	$73.50	$98.00	—	—	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A IA DIRECT OBS	$87.75	$117.00	—	64% above	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A IA DIRECT OBS	$87.75	$117.00	—	—	25%
Renin blood test CPT 84244 RENIN ACTIVITY	$45.75	$61.00	—	10% above	25%
Renin blood test inpatient CPT 84244 RENIN ACTIVITY	$45.75	$61.00	—	—	25%
Rh blood typing CPT 86901 BLD TYPE RHO(D)ONLY	$36.75	$49.00	—	77% above	25%
Rh blood typing inpatient CPT 86901 BLD TYPE RHO(D)ONLY	$36.75	$49.00	—	—	25%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR, QUANT	$21.75	$29.00	—	37% below	25%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$73.50	$98.00	—	113% above	25%
Rheumatoid factor (RF) test CPT 86431 LATEX FIXATION,RA FACTOR,QTY.	$86.25	$115.00	—	150% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR, QUANT	$21.75	$29.00	—	—	25%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT	$73.50	$98.00	—	—	25%
Rheumatoid factor (RF) test inpatient CPT 86431 LATEX FIXATION,RA FACTOR,QTY.	$86.25	$115.00	—	—	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM	$82.50	$110.00	—	62% above	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB	$193.50	$258.00	—	279% above	25%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM	$82.50	$110.00	—	—	25%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB	$193.50	$258.00	—	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE AUTO	$24.00	$32.00	—	at median	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE AUTO	$24.00	$32.00	—	—	25%
Sodium blood test CPT 84295 SODIUM BLOOD	$69.00	$92.00	—	232% above	25%
Sodium blood test CPT 84295 SODIUM	$96.00	$128.00	—	362% above	25%
Sodium blood test inpatient CPT 84295 SODIUM BLOOD	$69.00	$92.00	—	—	25%
Sodium blood test inpatient CPT 84295 SODIUM	$96.00	$128.00	—	—	25%
Stool ova and parasites exam CPT 87177 O&P DIR SMR CONC & ID	$171.75	$229.00	—	294% above	25%
Stool ova and parasites exam inpatient CPT 87177 O&P DIR SMR CONC & ID	$171.75	$229.00	—	—	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLD STL 1-3	$78.75	$105.00	—	349% above	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLD STL 1-3	$78.75	$105.00	—	—	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 POC IMMUNO FECAL OCCULT BLOOD	$76.50	$102.00	—	67% above	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HGB FECAL IA	$76.50	$102.00	—	67% above	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HGB FECAL IA	$76.50	$102.00	—	—	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 POC IMMUNO FECAL OCCULT BLOOD	$76.50	$102.00	—	—	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM AB	$69.00	$92.00	—	47% above	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM AB	$69.00	$92.00	—	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL-CSF	$73.50	$98.00	—	328% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL/RPR QUAL	$108.00	$144.00	—	528% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL-CSF	$73.50	$98.00	—	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL/RPR QUAL	$108.00	$144.00	—	—	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	$81.00	$108.00	—	36% below	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 T-SPOT TB TEST	$89.25	$119.00	—	30% 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	$81.00	$108.00	—	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 T-SPOT TB TEST	$89.25	$119.00	—	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, ULTRA SENSITIVE	$51.75	$69.00	—	45% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, REFERENCE LAB	$58.50	$78.00	—	64% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$248.25	$331.00	—	597% above	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, ULTRA SENSITIVE	$51.75	$69.00	—	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, REFERENCE LAB	$58.50	$78.00	—	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$248.25	$331.00	—	—	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 ANTITHYROID PEROXIDASE A	$102.00	$136.00	—	121% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB	$112.50	$150.00	—	144% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL AB	$160.50	$214.00	—	248% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOMAL AB	$162.75	$217.00	—	253% 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 ANTITHYROID PEROXIDASE A	$102.00	$136.00	—	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AB	$112.50	$150.00	—	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL AB	$160.50	$214.00	—	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY MICROSOMAL AB	$162.75	$217.00	—	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$385.50	$514.00	—	499% above	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$385.50	$514.00	—	—	25%
Total IgE blood test CPT 82785 IGE	$23.25	$31.00	—	48% below	25%
Total IgE blood test CPT 82785 IGE SERUM	$42.00	$56.00	—	5% below	25%
Total IgE blood test CPT 82785 IMMUNOGLOBULINS E SERUM	$214.50	$286.00	—	384% above	25%
Total IgE blood test inpatient CPT 82785 IGE	$23.25	$31.00	—	—	25%
Total IgE blood test inpatient CPT 82785 IGE SERUM	$42.00	$56.00	—	—	25%
Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULINS E SERUM	$214.50	$286.00	—	—	25%
Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL	$235.50	$314.00	—	1078% above	25%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL TOTAL	$235.50	$314.00	—	—	25%
Total thyroxine (T4) blood test CPT 84436 THYROXINE TOTAL	$132.75	$177.00	—	300% above	25%
Total thyroxine (T4) blood test inpatient CPT 84436 THYROXINE TOTAL	$132.75	$177.00	—	—	25%
Total triiodothyronine (T3) blood test CPT 84480 TRIIODTHYRNIN TOTAL T3	$348.75	$465.00	—	656% above	25%
Total triiodothyronine (T3) blood test inpatient CPT 84480 TRIIODTHYRNIN TOTAL T3	$348.75	$465.00	—	—	25%
Transferrin blood test CPT 84466 TRANSFERRIN	$246.00	$328.00	—	332% above	25%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$246.00	$328.00	—	—	25%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS AMP PROBE	$78.75	$105.00	—	7% above	25%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS AMP PROBE	$78.75	$105.00	—	—	25%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$30.75	$41.00	—	65% above	25%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES	$30.75	$41.00	—	—	25%
Troponin test, quantitative CPT 84484 TROPONIN QUAN	$15.27	$20.36	—	64% below	25%
Troponin test, quantitative CPT 84484 TROPONIN - I	$286.50	$382.00	—	574% above	25%
Troponin test, quantitative inpatient CPT 84484 TROPONIN QUAN	$15.27	$20.36	—	—	25%
Troponin test, quantitative inpatient CPT 84484 TROPONIN - I	$286.50	$382.00	—	—	25%
Uric acid blood test CPT 84550 URIC ACID BLOOD	$61.50	$82.00	—	181% above	25%
Uric acid blood test inpatient CPT 84550 URIC ACID BLOOD	$61.50	$82.00	—	—	25%
Urinalysis with microscope exam, automated CPT 81001 UA AUTO W/MICRO	$24.00	$32.00	—	20% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA AUTO W/MICRO	$24.00	$32.00	—	—	25%
Urinalysis without microscope exam, automated CPT 81003 URINE W/O MICRO AUTO	$45.00	$60.00	—	246% above	25%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS (A.S.)	$49.50	$66.00	—	281% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE W/O MICRO AUTO	$45.00	$60.00	—	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS (A.S.)	$49.50	$66.00	—	—	25%
Urinalysis without microscope exam, manual CPT 81002 UA NON-AUTO W/O MICRO	$36.00	$48.00	—	127% above	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA NON-AUTO W/O MICRO	$36.00	$48.00	—	—	25%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE COLONY CT	$184.50	$246.00	—	235% above	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE COLONY CT	$184.50	$246.00	—	—	25%
Urine microalbumin (albumin) test CPT 82043 MICRO ALBUMIN URINE QNT	$156.75	$209.00	—	503% above	25%
Urine microalbumin (albumin) test inpatient CPT 82043 MICRO ALBUMIN URINE QNT	$156.75	$209.00	—	—	25%
Urine pregnancy test, read by color change CPT 81025 GONADOTROPH,CHOR,URINE,QUAL	$144.00	$192.00	—	480% above	25%
Urine pregnancy test, read by color change CPT 81025 URINE PREG TEST QUAL	$147.75	$197.00	—	495% above	25%
Urine pregnancy test, read by color change CPT 81025 URINE PREG TEST QUAL POC	$159.75	$213.00	—	543% above	25%
Urine pregnancy test, read by color change inpatient CPT 81025 GONADOTROPH,CHOR,URINE,QUAL	$144.00	$192.00	—	—	25%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREG TEST QUAL	$147.75	$197.00	—	—	25%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREG TEST QUAL POC	$159.75	$213.00	—	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBLMN(VIT B12)	$231.00	$308.00	—	285% above	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBLMN(VIT B12)	$231.00	$308.00	—	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D/25-HYDROXY	$441.00	$588.00	—	399% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D/25-HYDROXY	$441.00	$588.00	—	—	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D1 25-DIHYDROXY	$103.50	$138.00	—	31% above	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D1 25 DIHYDR	$193.50	$258.00	—	145% above	25%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D1 25-DIHYDROXY	$103.50	$138.00	—	—	25%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D1 25 DIHYDR	$193.50	$258.00	—	—	25%
Zinc blood test CPT 84630 ZINC QUANTITATIVE URINE	$8.25	$11.00	—	65% below	25%
Zinc blood test CPT 84630 ZINC, RBC	$34.50	$46.00	—	45% above	25%
Zinc blood test CPT 84630 ZINC QUANTITATIVE	$49.50	$66.00	—	108% above	25%
Zinc blood test CPT 84630 ASSAY OF ZINC, RBC	$54.00	$72.00	—	127% above	25%
Zinc blood test CPT 84630 SERUM,ZINC	$77.25	$103.00	—	224% above	25%
Zinc blood test CPT 84630 ZINC RBC	$84.00	$112.00	—	253% above	25%
Zinc blood test inpatient CPT 84630 ZINC QUANTITATIVE URINE	$8.25	$11.00	—	—	25%
Zinc blood test inpatient CPT 84630 ZINC, RBC	$34.50	$46.00	—	—	25%
Zinc blood test inpatient CPT 84630 ZINC QUANTITATIVE	$49.50	$66.00	—	—	25%
Zinc blood test inpatient CPT 84630 ASSAY OF ZINC, RBC	$54.00	$72.00	—	—	25%
Zinc blood test inpatient CPT 84630 SERUM,ZINC	$77.25	$103.00	—	—	25%
Zinc blood test inpatient CPT 84630 ZINC RBC	$84.00	$112.00	—	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG CSF TUMOR MARKER	$9.00	$12.00	—	81% below	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG, QUANT, TUMOR	$152.25	$203.00	—	217% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADTOPN CHORNC(HCG)QNT	$270.75	$361.00	—	463% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG CSF TUMOR MARKER	$9.00	$12.00	—	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG, QUANT, TUMOR	$152.25	$203.00	—	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADTOPN CHORNC(HCG)QNT	$270.75	$361.00	—	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Botox injections for chronic migraine CPT 64615 CHEMODEN FAC TRIGEM CERV SPINL	$1,314.00	$1,752.00	—	131% above	25%
Botox injections for chronic migraine CPT 64615 CHEMODEN FAC TRIGM CRV SPNL	$1,636.50	$2,182.00	—	188% above	25%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODEN FAC TRIGEM CERV SPINL	$1,314.00	$1,752.00	—	—	25%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODEN FAC TRIGM CRV SPNL	$1,636.50	$2,182.00	—	—	25%
Cardiac catheterization with coronary angiogram CPT 93458 CATH L HRT ARTERY/VENTR	$24,707.25	$32,943.00	—	149% above	25%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 CATH L HRT ARTERY/VENTR	$24,707.25	$32,943.00	—	—	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELEC	$1,471.50	$1,962.00	—	49% above	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELEC/SCHED	$2,461.50	$3,282.00	—	150% above	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELEC	$1,471.50	$1,962.00	—	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELEC/SCHED	$2,461.50	$3,282.00	—	—	25%
Catheter ablation for atrial fibrillation CPT 93656 CMP EP ABL INTRA AFIB PVI EP3D	$60,585.00	$80,780.00	—	69% above	25%
Catheter ablation for atrial fibrillation inpatient CPT 93656 CMP EP ABL INTRA AFIB PVI EP3D	$60,585.00	$80,780.00	—	—	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION BY REGIONAL BLOCK	$4,997.25	$6,663.00	—	198% above	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRC W/CLAMP/OTH DEV W/BLOCK	$5,060.25	$6,747.00	—	202% above	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION BY REGIONAL BLOCK	$4,997.25	$6,663.00	—	—	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRC W/CLAMP/OTH DEV W/BLOCK	$5,060.25	$6,747.00	—	—	25%
Coronary stent placement, one artery CPT 92928 COR STNT ANGIO INIT	$26,856.00	$35,808.00	—	107% above	25%
Coronary stent placement, one artery inpatient CPT 92928 COR STNT ANGIO INIT	$26,856.00	$35,808.00	—	—	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 CERUMEN REMOV IRRIG RIGHT	$93.75	$125.00	—	10% below	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 IMPACT WAX REMOV IRRIG LT	$99.00	$132.00	—	5% below	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 IMPACT WAX REMOV IRRIG RT	$99.00	$132.00	—	5% below	25%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 CERUMEN REMOV IRRIG RIGHT	$93.75	$125.00	—	—	25%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 IMPACT WAX REMOV IRRIG RT	$99.00	$132.00	—	—	25%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 IMPACT WAX REMOV IRRIG LT	$99.00	$132.00	—	—	25%
Earwax removal with instruments, one ear CPT 69210 IMPACT WAX REMOV INSTRMNT	$99.00	$132.00	—	3% above	25%
Earwax removal with instruments, one ear CPT 69210 RMV IMPACTED EAR WAX UNI	$369.75	$493.00	—	284% above	25%
Earwax removal with instruments, one ear one side CPT 69210 IMPACT WAX REMOV INSTRMNT LT	$99.00	$132.00	—	3% above	25%
Earwax removal with instruments, one ear one side CPT 69210 IMPACT WAX REMOV INSTRMNT RT	$99.00	$132.00	—	3% above	25%
Earwax removal with instruments, one ear inpatient CPT 69210 IMPACT WAX REMOV INSTRMNT	$99.00	$132.00	—	—	25%
Earwax removal with instruments, one ear inpatient CPT 69210 RMV IMPACTED EAR WAX UNI	$369.75	$493.00	—	—	25%
Earwax removal with instruments, one ear inpatient one side CPT 69210 IMPACT WAX REMOV INSTRMNT RT	$99.00	$132.00	—	—	25%
Earwax removal with instruments, one ear inpatient one side CPT 69210 IMPACT WAX REMOV INSTRMNT LT	$99.00	$132.00	—	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ EPID CERV/THORC	$3,770.25	$5,027.00	—	288% above	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ EPID CERV/THORC	$3,770.25	$5,027.00	—	—	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 L SP FACET INJ+IMAG LVL1	$4,079.25	$5,439.00	—	276% above	25%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 L SP FACET INJ+IMAG LVL1	$4,079.25	$5,439.00	—	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 ID ABSCESS-SIMPLE	$812.25	$1,083.00	—	198% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$1,108.50	$1,478.00	—	306% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D SIMPLE	$1,137.75	$1,517.00	—	317% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE	$1,227.00	$1,636.00	—	349% above	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ID ABSCESS-SIMPLE	$812.25	$1,083.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS	$1,108.50	$1,478.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D SIMPLE	$1,137.75	$1,517.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE	$1,227.00	$1,636.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJECTION ASPIRATION MAJOR JOI	$247.50	$330.00	—	42% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$1,843.50	$2,458.00	—	331% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIR/INJ MAJ JT WO/US	$1,995.75	$2,661.00	—	367% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJECTION ASPIRATION MAJOR JOI	$247.50	$330.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$1,843.50	$2,458.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIR/INJ MAJ JT WO/US	$1,995.75	$2,661.00	—	—	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT DEVICE	$5,188.50	$6,918.00	—	3014% above	25%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG IMPLANT DEVICE	$5,188.50	$6,918.00	—	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASP/INJ INTERM JT WO/US	$1,335.00	$1,780.00	—	311% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASP/INJ INTERM JT WO/US	$1,335.00	$1,780.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 INJECTION ASPIRATION SMALL JOI	$1,206.75	$1,609.00	—	257% above	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 INJECTION ASPIRATION SMALL JOI	$1,206.75	$1,609.00	—	—	25%
Left heart catheterization, diagnostic one side CPT 93452 CATH LT HRT W/LTVENT	$12,286.50	$16,382.00	—	77% above	25%
Left heart catheterization, diagnostic inpatient one side CPT 93452 CATH LT HRT W/LTVENT	$12,286.50	$16,382.00	—	—	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ ANESTH LUMB/CAUD SGL	$3,589.50	$4,786.00	—	236% above	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ ANESTH LUMB/CAUD SGL	$3,589.50	$4,786.00	—	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$4,412.25	$5,883.00	—	509% above	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$4,412.25	$5,883.00	—	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$4,041.75	$5,389.00	—	447% above	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$4,041.75	$5,389.00	—	—	25%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$904.50	$1,206.00	—	341% above	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE	$904.50	$1,206.00	—	—	25%
Pacemaker implant (dual chamber) CPT 33208 INS/RPL PMW/TRNSV LD A-V	$9,774.75	$13,033.00	—	40% below	25%
Pacemaker implant (dual chamber) inpatient CPT 33208 INS/RPL PMW/TRNSV LD A-V	$9,774.75	$13,033.00	—	—	25%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGE	$922.50	$1,230.00	—	24% below	25%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGE	$922.50	$1,230.00	—	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$2,790.00	$3,720.00	—	431% above	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED	$2,790.00	$3,720.00	—	—	25%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY	$2,207.25	$2,943.00	—	491% above	25%
Removal of a foreign object under the skin, simple CPT 10120 INCISE & REMOVE FOREIGN BODY	$2,515.50	$3,354.00	—	574% above	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FOREIGN BODY	$2,207.25	$2,943.00	—	—	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISE & REMOVE FOREIGN BODY	$2,515.50	$3,354.00	—	—	25%
Short arm cast (elbow to hand) CPT 29075 CAST-SHORT ARM	$451.50	$602.00	—	82% above	25%
Short arm cast (elbow to hand) CPT 29075 CAST-ULNAR GUTTER	$471.00	$628.00	—	90% above	25%
Short arm cast (elbow to hand) CPT 29075 CAST-RADIAL GUTTER	$471.00	$628.00	—	90% above	25%
Short arm cast (elbow to hand) CPT 29075 CAST-THUMB SPICA	$589.50	$786.00	—	138% above	25%
Short arm cast (elbow to hand) inpatient CPT 29075 CAST-SHORT ARM	$451.50	$602.00	—	—	25%
Short arm cast (elbow to hand) inpatient CPT 29075 CAST-ULNAR GUTTER	$471.00	$628.00	—	—	25%
Short arm cast (elbow to hand) inpatient CPT 29075 CAST-RADIAL GUTTER	$471.00	$628.00	—	—	25%
Short arm cast (elbow to hand) inpatient CPT 29075 CAST-THUMB SPICA	$589.50	$786.00	—	—	25%
Short arm splint (forearm and hand) CPT 29125 SPLINT-SHORT ARM STATIC	$175.50	$234.00	—	8% below	25%
Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT-SHORT ARM STATIC	$175.50	$234.00	—	—	25%
Short leg cast (below the knee) CPT 29405 CAST-SHORT LEG	$420.75	$561.00	—	54% above	25%
Short leg cast (below the knee) inpatient CPT 29405 CAST-SHORT LEG	$420.75	$561.00	—	—	25%
Short leg splint (calf to foot) CPT 29515 SPLINT-SHORT LEG	$175.50	$234.00	—	8% above	25%
Short leg splint (calf to foot) inpatient CPT 29515 SPLINT-SHORT LEG	$175.50	$234.00	—	—	25%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$1,080.00	$1,440.00	—	192% above	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$1,080.00	$1,440.00	—	—	25%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS (TO 15)	$812.25	$1,083.00	—	364% above	25%
Skin tag removal, up to 15 tags CPT 11200 SKIN TAGS TO 15	$812.25	$1,083.00	—	364% above	25%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS <W/15	$2,440.50	$3,254.00	—	1295% above	25%
Skin tag removal, up to 15 tags CPT 11200 RMVL SKIN TAGS UP TO&INC 15	$2,685.00	$3,580.00	—	1434% above	25%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS TO 15	$2,685.00	$3,580.00	—	1434% above	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS (TO 15)	$812.25	$1,083.00	—	—	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 SKIN TAGS TO 15	$812.25	$1,083.00	—	—	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS <W/15	$2,440.50	$3,254.00	—	—	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 RMVL SKIN TAGS UP TO&INC 15	$2,685.00	$3,580.00	—	—	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS TO 15	$2,685.00	$3,580.00	—	—	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE DIAGNOSTIC	$699.75	$933.00	—	18% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE	$1,179.75	$1,573.00	—	38% above	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE DIAGNOSTIC	$699.75	$933.00	—	—	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE	$1,179.75	$1,573.00	—	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BRST 1ST LESION US	$5,071.50	$6,762.00	—	173% above	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BRST 1ST LESION US	$5,071.50	$6,762.00	—	—	25%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14	$655.50	$874.00	—	223% above	25%
Wart removal, up to 14 warts CPT 17110 DEST WARTS TO 14	$812.25	$1,083.00	—	300% above	25%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT B9 LESION 1-14	$655.50	$874.00	—	—	25%
Wart removal, up to 14 warts inpatient CPT 17110 DEST WARTS TO 14	$812.25	$1,083.00	—	—	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 TRANSFUSION	$922.50	$1,230.00	—	23% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 ADMINISTRATION OF BLOOD PRODUC	$972.75	$1,297.00	—	29% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD COMP	$2,201.25	$2,935.00	—	193% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD/COMPONENTS	$2,960.25	$3,947.00	—	294% above	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION	$922.50	$1,230.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ADMINISTRATION OF BLOOD PRODUC	$972.75	$1,297.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLD/BLD COMP	$2,201.25	$2,935.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/COMPONENTS	$2,960.25	$3,947.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB TX	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM INDUCTION	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INTRAPULMONARY PERCUSSIVE VENT	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RESPIRATORY TREATMENTS SUBSEQ	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METER DOSE INHALER INITIAL	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TX	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METERED DOSE INHALER (SUBSEQ.)	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RN NEBULIZER TX	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHALATION TREATMENT NEBULIZER	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI TREATMENT	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RESPIRATORY TREATMENTS INITIAL	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TREATMENT	$188.25	$251.00	—	8% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RN NEBULIZER TX	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INTRAPULMONARY PERCUSSIVE VENT	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION TREATMENT NEBULIZER	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL TREATMENT	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI TREATMENT	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METER DOSE INHALER INITIAL	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METERED DOSE INHALER (SUBSEQ.)	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER TX	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RESPIRATORY TREATMENTS INITIAL	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RESPIRATORY TREATMENTS SUBSEQ	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB TX	$188.25	$251.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM INDUCTION	$188.25	$251.00	—	—	25%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV <=1H INIT	$454.50	$606.00	—	14% below	25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV <=1H INIT	$454.50	$606.00	—	—	25%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 CMP AUD THRESH EVAL & SPCH RCG	$421.50	$562.00	—	91% above	25%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 COMPREHENSIVE AUDIO	$421.50	$562.00	—	91% above	25%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 COMPREHENSIVE AUDIO	$421.50	$562.00	—	—	25%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 CMP AUD THRESH EVAL & SPCH RCG	$421.50	$562.00	—	—	25%
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE E7M 30-74 MIN	$3,631.50	$4,842.00	—	80% above	25%
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE E&M 30-74 MIN	$3,631.50	$4,842.00	—	80% above	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE E7M 30-74 MIN	$3,631.50	$4,842.00	—	—	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE E&M 30-74 MIN	$3,631.50	$4,842.00	—	—	25%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE/DROWSY	$586.50	$782.00	—	24% below	25%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE/DROWSY	$586.50	$782.00	—	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG TRACING ONLY	$270.75	$361.00	—	107% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACE ONLY	$270.75	$361.00	—	107% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD TRACING	$270.75	$361.00	—	107% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Twelve Lead Electrocardiogram	$273.00	$364.00	—	109% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD TRACING	$270.75	$361.00	—	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACE ONLY	$270.75	$361.00	—	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG TRACING ONLY	$270.75	$361.00	—	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Twelve Lead Electrocardiogram	$273.00	$364.00	—	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER VISIT LVL I	$329.25	$439.00	—	76% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER VISIT LVL I	$329.25	$439.00	—	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER VISIT LVL II	$765.00	$1,020.00	—	119% above	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER VISIT LVL II	$765.00	$1,020.00	—	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER VISIT LVL III	$1,356.75	$1,809.00	—	113% above	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER VISIT LVL III	$1,356.75	$1,809.00	—	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER VISIT LVL IV	$2,242.50	$2,990.00	—	112% above	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER VISIT LVL IV	$2,242.50	$2,990.00	—	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER VISIT LVL V	$3,172.50	$4,230.00	—	87% above	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER VISIT LVL V	$3,172.50	$4,230.00	—	—	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIO STRESS TRACE ONLY	$1,798.50	$2,398.00	—	146% above	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIO STRESS TRACE ONLY	$1,798.50	$2,398.00	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 1ST HOUR	$307.50	$410.00	—	18% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INF HYD INIT 31-60MIN	$540.00	$720.00	—	107% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 1ST HOUR	$307.50	$410.00	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INF HYD INIT 31-60MIN	$540.00	$720.00	—	—	25%
IV infusion of a medicine, first hour CPT 96365 IV INFUSE-THERA INIT TO 1 HR	$396.75	$529.00	—	32% above	25%
IV infusion of a medicine, first hour CPT 96365 IV INF TX INIT <=1 HR	$457.50	$610.00	—	53% above	25%
IV infusion of a medicine, first hour CPT 96365 IV INF TX INIT <=1HR	$774.00	$1,032.00	—	158% above	25%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSE-THERA INIT TO 1 HR	$396.75	$529.00	—	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF TX INIT <=1 HR	$457.50	$610.00	—	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF TX INIT <=1HR	$774.00	$1,032.00	—	—	25%
IV push of a medicine, first drug CPT 96374 IMMUN PNEUMOVAX	$27.75	$37.00	—	85% below	25%
IV push of a medicine, first drug CPT 96374 INJECTION INTRAMUSCULAR/SUBCUT	$91.50	$122.00	—	50% below	25%
IV push of a medicine, first drug CPT 96374 INJ TX/PROPH/DX IVP INT	$214.50	$286.00	—	16% above	25%
IV push of a medicine, first drug CPT 96374 INJ TX/PRPH/DX IVP INT	$214.50	$286.00	—	16% above	25%
IV push of a medicine, first drug CPT 96374 INJ TX/PROPH/DX IVP	$214.50	$286.00	—	16% above	25%
IV push of a medicine, first drug CPT 96374 INJ TX/PROPH/DX ART	$214.50	$286.00	—	16% above	25%
IV push of a medicine, first drug CPT 96374 INJECTION INTRAVENOUS NONCHEMO	$360.75	$481.00	—	95% above	25%
IV push of a medicine, first drug inpatient CPT 96374 IMMUN PNEUMOVAX	$27.75	$37.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 INJECTION INTRAMUSCULAR/SUBCUT	$91.50	$122.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 INJ TX/PRPH/DX IVP INT	$214.50	$286.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 INJ TX/PROPH/DX IVP INT	$214.50	$286.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 INJ TX/PROPH/DX IVP	$214.50	$286.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 INJ TX/PROPH/DX ART	$214.50	$286.00	—	—	25%
IV push of a medicine, first drug inpatient CPT 96374 INJECTION INTRAVENOUS NONCHEMO	$360.75	$481.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 PSYCHOTROPIC INJECTIONS-ADMINI	$29.25	$39.00	—	68% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ TX/PROPH/DX SQ/IM	$78.75	$105.00	—	13% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 PSYCHOTROPIC INJECTIONS/ADMINI	$291.00	$388.00	—	220% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 PSYCHOTROPIC INJECTIONS-ADMINI	$29.25	$39.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ TX/PROPH/DX SQ/IM	$78.75	$105.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 PSYCHOTROPIC INJECTIONS/ADMINI	$291.00	$388.00	—	—	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAG EVAL	$530.25	$707.00	—	137% above	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAG EVAL	$530.25	$707.00	—	—	25%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE COND STUDIES 7-8	$1,496.25	$1,995.00	—	98% above	25%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NERVE COND STUDIES 7-8	$1,496.25	$1,995.00	—	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 OT NEUROMUSC RE-EDUC EA15	$190.50	$254.00	—	102% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 OTA NEUROMUSC RE-EDUC EA1	$190.50	$254.00	—	102% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 OTA PED NEURO RE-ED EA15	$190.50	$254.00	—	102% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 PTA NEUROMUSC RE-ED EA15	$226.50	$302.00	—	140% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 PTA PED NEURO RE-ED EA15	$226.50	$302.00	—	140% above	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEUROMUSC RE-EDUC EA15	$190.50	$254.00	—	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OTA PED NEURO RE-ED EA15	$190.50	$254.00	—	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OTA NEUROMUSC RE-EDUC EA1	$190.50	$254.00	—	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PTA PED NEURO RE-ED EA15	$226.50	$302.00	—	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PTA NEUROMUSC RE-ED EA15	$226.50	$302.00	—	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED/NUT/THER/INITIAL EA 15MIN	$76.50	$102.00	—	66% above	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRTN TH INIT 15MIN	$97.50	$130.00	—	112% above	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED/NUT/THER/INITIAL EA 15MIN	$76.50	$102.00	—	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRTN TH INIT 15MIN	$97.50	$130.00	—	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PTA MANUAL THERAPY EA 15M	$226.50	$302.00	—	134% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OTA MANUAL THERAPY EA 15M	$900.75	$1,201.00	—	830% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PTA MANUAL THERAPY EA 15M	$226.50	$302.00	—	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OTA MANUAL THERAPY EA 15M	$900.75	$1,201.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA THER EX EA 15	$152.25	$203.00	—	63% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA PED THERPTC EXER EA 1	$152.25	$203.00	—	63% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OTA PED THER EXER EA 15	$161.25	$215.00	—	72% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OTA THERAPTC EXER EA 15	$161.25	$215.00	—	72% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTC REC 1:1 15MIN	$207.00	$276.00	—	121% above	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA PED THERPTC EXER EA 1	$152.25	$203.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA THER EX EA 15	$152.25	$203.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OTA PED THER EXER EA 15	$161.25	$215.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OTA THERAPTC EXER EA 15	$161.25	$215.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTC REC 1:1 15MIN	$207.00	$276.00	—	—	25%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV MED NP 18-39 YRS	$112.50	$150.00	—	27% below	25%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV MED NP 18-39 YRS	$112.50	$150.00	—	—	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV MED EP 18-39 YRS	$116.25	$155.00	—	22% below	25%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV MED EP 18-39 YRS	$116.25	$155.00	—	—	25%
Psychotherapy session, 30 minutes CPT 90832 PSY THRPY 30 MIN PT	$194.25	$259.00	—	1% above	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSY THRPY 30 MIN PT	$194.25	$259.00	—	—	25%
Psychotherapy session, 45 minutes CPT 90834 PSY THRPY 45MIN PT	$530.25	$707.00	—	148% above	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSY THRPY 45MIN PT	$530.25	$707.00	—	—	25%
Psychotherapy session, 60 minutes CPT 90837 PSY THRPY 60MIN PT	$530.25	$707.00	—	130% above	25%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSY THRPY 60MIN PT	$530.25	$707.00	—	—	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M-EST PATIENT-LVL III	$187.50	$250.00	—	96% above	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M-EST PATIENT-LVL III	$187.50	$250.00	—	—	25%
Spirometry (breathing test) CPT 94010 SPIROMETRY	$405.75	$541.00	—	97% above	25%
Spirometry (breathing test) CPT 94010 SPIROMETRY/STANDARD FUNCTION B	$637.50	$850.00	—	209% above	25%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY	$405.75	$541.00	—	—	25%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY/STANDARD FUNCTION B	$637.50	$850.00	—	—	25%
Spirometry before and after a bronchodilator CPT 94060 BRONCHOSPASM EVALUATION BO	$837.75	$1,117.00	—	105% above	25%
Spirometry before and after a bronchodilator CPT 94060 BRONCHOSPASM EVAL	$1,272.75	$1,697.00	—	212% above	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHOSPASM EVALUATION BO	$837.75	$1,117.00	—	—	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHOSPASM EVAL	$1,272.75	$1,697.00	—	—	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 PTA THER ACT EA 15	$137.25	$183.00	—	70% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 PTA PED THER ACTIVITY EA1	$147.75	$197.00	—	83% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 OTA PED THER ACT EA 15	$172.50	$230.00	—	114% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 OTA THERAPTC ACT EA 15	$172.50	$230.00	—	114% above	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PTA THER ACT EA 15	$137.25	$183.00	—	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PTA PED THER ACTIVITY EA1	$147.75	$197.00	—	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OTA PED THER ACT EA 15	$172.50	$230.00	—	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OTA THERAPTC ACT EA 15	$172.50	$230.00	—	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY/THERAPEUT	$329.25	$439.00	—	41% above	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC	$393.75	$525.00	—	68% above	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY/THERAPEUT	$329.25	$439.00	—	—	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC	$393.75	$525.00	—	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID VAC SPKVX50/0.5IJ	$288.75	$385.00	—	4% above	25%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID VAC SPKVX50/0.5IJ	$288.75	$385.00	—	—	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VACCINE INJ 0.5ML DO	$234.75	$313.00	—	16% above	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VACCINE	$281.25	$375.00	—	39% above	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VACCINE INJ 0.5ML DO	$234.75	$313.00	—	—	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VACCINE	$281.25	$375.00	—	—	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP+IPV VACCINE 0.5 ML INJ	$75.00	$100.00	—	21% above	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV(KINRIX)	$123.00	$164.00	—	99% above	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV(QUADRACEL)	$123.00	$164.00	—	99% above	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP+IPV VACCINE 0.5 ML INJ	$75.00	$100.00	—	—	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IPV(KINRIX)	$123.00	$164.00	—	—	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IPV(QUADRACEL)	$123.00	$164.00	—	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP (INFANRIX) INJ 0.5ML DOSE	$17.25	$23.00	—	55% below	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP <7YRS OLD	$134.25	$179.00	—	246% above	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP	$134.25	$179.00	—	246% above	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP (INFANRIX) INJ 0.5ML DOSE	$17.25	$23.00	—	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP <7YRS OLD	$134.25	$179.00	—	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP	$134.25	$179.00	—	—	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP/HEPATITIS-B/IPV INJ 0.5ML	$63.00	$84.00	—	53% below	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP/HEP B/IPV	$115.50	$154.00	—	15% below	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP/HEPB/IPV	$176.25	$235.00	—	30% above	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP/HEPATITIS-B/IPV INJ 0.5ML	$63.00	$84.00	—	—	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP/HEP B/IPV	$115.50	$154.00	—	—	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP/HEPB/IPV	$176.25	$235.00	—	—	25%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP+IPV+HIB+VACCINE 0.5ML	$160.50	$214.00	—	2% above	25%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-HIB-IPV (PENTACEL)	$441.00	$588.00	—	182% above	25%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP+IPV+HIB+VACCINE 0.5ML	$160.50	$214.00	—	—	25%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-HIB-IPV (PENTACEL)	$441.00	$588.00	—	—	25%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 DTAP-IPV-HIB-HEPB VACC IM IJ	$529.50	$706.00	—	21% above	25%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 DTAP-IPV-HIB-HEPB VACC IM IJ	$529.50	$706.00	—	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUVAC IIV3>6MOS 0.5ML IJ	$39.75	$53.00	—	25% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUVAC IIV3>6MOS 0.5ML IJ	$39.75	$53.00	—	—	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 GARDASIL 9 VACCINE	$568.50	$758.00	—	70% above	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VAC 9-VAL	$765.00	$1,020.00	—	129% above	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 GARDASIL 9 VACCINE	$568.50	$758.00	—	—	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VAC 9-VAL	$765.00	$1,020.00	—	—	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE INJ 50 UNI	$81.75	$109.00	—	31% below	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE INACT 1440	$123.75	$165.00	—	5% above	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE,ADULT	$129.00	$172.00	—	10% above	25%
Hepatitis A vaccine, adult dose CPT 90632 HEP A ADULT	$151.50	$202.00	—	29% above	25%
Hepatitis A vaccine, adult dose CPT 90632 SBC HEP A ADULT	$151.50	$202.00	—	29% above	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE INJ 50 UNI	$81.75	$109.00	—	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE INACT 1440	$123.75	$165.00	—	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE,ADULT	$129.00	$172.00	—	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 SBC HEP A ADULT	$151.50	$202.00	—	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEP A ADULT	$151.50	$202.00	—	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE INJ 720IU/	$66.75	$89.00	—	13% below	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE INJ 25IU/0	$118.50	$158.00	—	54% above	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A VACCINE PED/ADOLESCENT	$147.00	$196.00	—	91% above	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A PED/ADOL(2DOSE SCHEDULE)	$158.25	$211.00	—	106% above	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A PED/ADOL HAVRIX	$158.25	$211.00	—	106% above	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VACCINE INJ 720IU/	$66.75	$89.00	—	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VACCINE INJ 25IU/0	$118.50	$158.00	—	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A VACCINE PED/ADOLESCENT	$147.00	$196.00	—	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A PED/ADOL(2DOSE SCHEDULE)	$158.25	$211.00	—	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A PED/ADOL HAVRIX	$158.25	$211.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS-B VACCINE ADULT	$89.25	$119.00	—	6% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS-B VACCAINE ADULT	$96.00	$128.00	—	14% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VACCINE-ADULT AGE>=20 YR	$119.25	$159.00	—	42% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B ADULT 3DOSE	$199.50	$266.00	—	138% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B ADULT	$218.25	$291.00	—	160% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS-B VACCINE ADULT	$89.25	$119.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS-B VACCAINE ADULT	$96.00	$128.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VACCINE-ADULT AGE>=20 YR	$119.25	$159.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B ADULT 3DOSE	$199.50	$266.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B ADULT	$218.25	$291.00	—	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B VAC PED/ADOL3DS IJ	$22.50	$30.00	—	31% below	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS-B VACCINE PEDIATRIC	$24.00	$32.00	—	26% below	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B PED/ADOL	$107.25	$143.00	—	231% above	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B PED/ADOL 3DOSE	$167.25	$223.00	—	416% above	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B VAC PED/ADOL3DS IJ	$22.50	$30.00	—	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS-B VACCINE PEDIATRIC	$24.00	$32.00	—	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B PED/ADOL	$107.25	$143.00	—	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B PED/ADOL 3DOSE	$167.25	$223.00	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 PEDVAXHIB VACCINE INJ 0.5ML DO	$57.00	$76.00	—	16% above	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HIB PRP-OMP (3 DOSE SCHEDULE)	$107.25	$143.00	—	118% above	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 PEDVAXHIB VACCINE INJ 0.5ML DO	$57.00	$76.00	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HIB PRP-OMP (3 DOSE SCHEDULE)	$107.25	$143.00	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB VACCINE ACTHIB INJ 0.5ML	$43.50	$58.00	—	4% above	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HEMOP B ACTHIB	$57.00	$76.00	—	36% 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	$43.50	$58.00	—	—	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HEMOP B ACTHIB	$57.00	$76.00	—	—	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%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES/MUMPS/RUBELL VACC LIVE	$89.25	$119.00	—	34% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR	$115.50	$154.00	—	15% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES/MUMPS/RUBELLA INJ 0.5M	$134.25	$179.00	—	1% below	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES/MUMPS/RUBELL VACC LIVE	$89.25	$119.00	—	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR	$115.50	$154.00	—	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES/MUMPS/RUBELLA INJ 0.5M	$134.25	$179.00	—	—	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MMR-VARICELLA INJ 0.5 ML DOSE	$996.00	$1,328.00	—	180% above	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MMR-VARICELLA INJ 0.5 ML DOSE	$996.00	$1,328.00	—	—	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENVEO	$119.25	$159.00	—	43% below	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONJ VACCINE	$186.75	$249.00	—	10% below	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL VAC (MENACTRA) I	$196.50	$262.00	—	5% below	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCC CONJUGATE VAC MENACT	$350.25	$467.00	—	69% above	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOC MENACWY	$381.00	$508.00	—	84% above	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENVEO	$119.25	$159.00	—	—	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONJ VACCINE	$186.75	$249.00	—	—	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL VAC (MENACTRA) I	$196.50	$262.00	—	—	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCC CONJUGATE VAC MENACT	$350.25	$467.00	—	—	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOC MENACWY	$381.00	$508.00	—	—	25%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOCOCCAL-TT VAC IM IJ	$210.75	$281.00	—	11% below	25%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENINGOCOCCAL-TT VAC IM IJ	$210.75	$281.00	—	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL GROUP B VACCINE	$336.00	$448.00	—	at median	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGO RECOMB SEROB 2 DOES	$357.75	$477.00	—	6% above	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL GROUP B VACCINE	$336.00	$448.00	—	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGO RECOMB SEROB 2 DOES	$357.75	$477.00	—	—	25%
Meningococcal B vaccine (Trumenba) CPT 90621 MENING B VAC IM RCMB IJ	$279.00	$372.00	—	38% above	25%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 MENING B VAC IM RCMB IJ	$279.00	$372.00	—	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMCCAL CONJ VAC 13VAL PCV13	$209.25	$279.00	—	21% below	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL CONJ VACC, 13 VAL	$209.25	$279.00	—	21% below	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL CONJ VAC 13VAL PC	$270.75	$361.00	—	3% above	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL-13 CONJ VAC 0.5ML	$310.50	$414.00	—	18% above	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL CONJ VACC, 13 VAL	$209.25	$279.00	—	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMCCAL CONJ VAC 13VAL PCV13	$209.25	$279.00	—	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL CONJ VAC 13VAL PC	$270.75	$361.00	—	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL-13 CONJ VAC 0.5ML	$310.50	$414.00	—	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCO20VACIJ!	$2,316.75	$3,089.00	—	507% above	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCO20VACIJ!	$2,316.75	$3,089.00	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23 VALENT	$39.75	$53.00	—	75% below	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPV 23	$263.25	$351.00	—	66% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL PPSV23	$263.25	$351.00	—	66% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMONIA VACC 23VALENT >2 YRS	$1,591.50	$2,122.00	—	906% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23 VALENT	$39.75	$53.00	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPV 23	$263.25	$351.00	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL PPSV23	$263.25	$351.00	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMONIA VACC 23VALENT >2 YRS	$1,591.50	$2,122.00	—	—	25%
Polio vaccine, inactivated (IPV) CPT 90713 POLIO VACCINE - INACTIVE INJ 0	$45.75	$61.00	—	27% below	25%
Polio vaccine, inactivated (IPV) CPT 90713 IPV	$97.50	$130.00	—	55% above	25%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIO VACCINE - INACTIVE INJ 0	$45.75	$61.00	—	—	25%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 IPV	$97.50	$130.00	—	—	25%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 NIRSEVIMAB-ALIP RSV MAB 1MLIJ	$1,057.50	$1,410.00	—	42% above	25%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 NIRSEVIMAB-ALIP RSV MAB 1MLIJ	$1,057.50	$1,410.00	—	—	25%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP RSV MAB .5MLIJ	$1,057.50	$1,410.00	—	42% above	25%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP RSV MAB .5MLIJ	$1,057.50	$1,410.00	—	—	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV VAC P-A P-B REC IJ	$551.25	$735.00	—	15% above	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV VAC P-A P-B REC IJ	$551.25	$735.00	—	—	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM PER 1ML	$675.00	$900.00	—	31% above	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE	$1,519.50	$2,026.00	—	195% above	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM PER 1ML	$675.00	$900.00	—	—	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE	$1,519.50	$2,026.00	—	—	25%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTAVIRUS VACCINE-LIVE LIQ 2ML	$152.25	$203.00	—	24% below	25%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTAVIRUS VACCINE-LIVE LIQ 2ML	$152.25	$203.00	—	—	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VACCINE	$143.25	$191.00	—	74% above	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS RV5 3DOSE VACCINE	$156.75	$209.00	—	90% above	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VACCINE	$143.25	$191.00	—	—	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS RV5 3DOSE VACCINE	$156.75	$209.00	—	—	25%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HZV VACC RECOMBINANT IM 0.5ML	$336.75	$449.00	—	71% above	25%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HZV VACC RECOMBINANT IM 0.5ML	$336.75	$449.00	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD > 7 YEARS	$24.00	$32.00	—	56% below	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TENIVAC 90714	$51.00	$68.00	—	6% below	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACCINE > 7YRS., IM INJ.	$58.50	$78.00	—	8% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD > 7 YEARS	$24.00	$32.00	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TENIVAC 90714	$51.00	$68.00	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACCINE > 7YRS., IM INJ.	$58.50	$78.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE > 7YRS.,IM INJ.	$72.75	$97.00	—	at median	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP 7 YRS OR OLDER	$175.50	$234.00	—	142% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP 7 YRS/OLDER	$175.50	$234.00	—	142% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE > 7YRS.,IM INJ.	$72.75	$97.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP 7 YRS/OLDER	$175.50	$234.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP 7 YRS OR OLDER	$175.50	$234.00	—	—	25%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VACCINE (VICP'S)IM	$111.75	$149.00	—	26% below	25%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VACC IJ	$227.25	$303.00	—	50% above	25%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VACCINE (VICP'S)IM	$111.75	$149.00	—	—	25%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VACC IJ	$227.25	$303.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMM ADMIN SNGL/COMBO VAC	$24.75	$33.00	—	7% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMM ADMIN SNGL/COMBO VAC	$24.75	$33.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMM ADM EA ADDL VACCINE	$24.75	$33.00	—	27% above	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMM ADM EA ADDL VACCINE	$24.75	$33.00	—	—	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/272845064_vhs-childrens-hospital-of-michigan-inc_standardcharges.json