Munson Healthcare Charlevoix Hospital
Munson Healthcare Charlevoix Hospital in Charlevoix, MI publishes cash prices for 46 common procedures listed here, from its own machine-readable price file updated Apr 17, 2026. Click a procedure to compare it with other hospitals nearby.
14700 Lake Shore Drive, Charlevoix, MI 49720 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV) | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 93077 CT ABD PELV W/ IV CONT | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 93079 CT ABD PELV W/ IV+ORAL CONT | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD + PELVIS W/IV CONT (NO ORAL) | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV) | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST ABD PELVIS W/IV CONT (NO ORAL) | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT VENOGRAM ABD + PEL W/ CONTRAST | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Exams | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ENTEROGRAPHY | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ENTEROGRAPHY | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Exams | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT VENOGRAM ABD + PEL W/ CONTRAST | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD + PELVIS W/IV CONT (NO ORAL) | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV) | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST ABD PELVIS W/IV CONT (NO ORAL) | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV) | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 93077 CT ABD PELV W/ IV CONT | $2,204.90 | $2,594.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 93079 CT ABD PELV W/ IV+ORAL CONT | $2,204.90 | $2,594.00 | 15% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST | $870.40 | $1,024.00 | 15% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Exams | $870.40 | $1,024.00 | 15% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST | $870.40 | $1,024.00 | 15% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Exams | $870.40 | $1,024.00 | 15% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Exams | $1,103.30 | $1,298.00 | 15% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST (ORAL + IV) | $1,103.30 | $1,298.00 | 15% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ IV CONTRAST (NO ORAL CONT) | $1,103.30 | $1,298.00 | 15% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST (ORAL + IV) | $1,103.30 | $1,298.00 | 15% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Exams | $1,103.30 | $1,298.00 | 15% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ IV CONTRAST (NO ORAL CONT) | $1,103.30 | $1,298.00 | 15% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA FFD MAMM DIAGNOSTIC BILAT | $299.20 | $352.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA FFD MAMM DIAGNOSTIC W/ CONT BIL | $290.70 | $342.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DIAGNOSTIC W/ CONT BIL | $290.70 | $342.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DIAGNOSTIC BIL | $299.20 | $352.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA Exams | $299.20 | $352.00 | 15% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA FFD MAMM DIAGNOSTIC BILAT | $299.20 | $352.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DIAGNOSTIC W/ CONT BIL | $290.70 | $342.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD MAMM DIAGNOSTIC W/ CONT BIL | $290.70 | $342.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DIAGNOSTIC BIL | $299.20 | $352.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA Exams | $299.20 | $352.00 | 15% |
| Diagnostic mammogram, one breast CPT 77065 MA Exams | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT LT | $243.10 | $286.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT LT | $243.10 | $286.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT RT | $243.10 | $286.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT RT | $243.10 | $286.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD DX FOLLOW PROCEDURE RT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD DX FOLLOW PROCEDURE LT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE RT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE LT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI RT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC RT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC LT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI LT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast inpatient CPT 77065 MA Exams | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT RT | $243.10 | $286.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT LT | $243.10 | $286.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT LT | $243.10 | $286.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT RT | $243.10 | $286.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI LT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE RT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE LT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC RT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC LT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI RT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD DX FOLLOW PROCEDURE RT | $250.75 | $295.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD DX FOLLOW PROCEDURE LT | $250.75 | $295.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Exams | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST LT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST RT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST RT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST LT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST RT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST LT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Exams | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST RT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST RT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST LT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST LT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST RT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST LT | $2,068.90 | $2,434.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Exams | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/ + W/O CONTRAST RT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/ + W/O CONTRAST LT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/ + W/O CONTRAST RT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST RT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST LT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/ + W/O CONTRAST LT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Exams | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/ + W/O CONTRAST RT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST RT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST LT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/ + W/O CONTRAST RT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/ + W/O CONTRAST LT | $3,726.40 | $4,384.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/ + W/O CONTRAST LT | $3,726.40 | $4,384.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MR Exams | $2,402.95 | $2,827.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $2,402.95 | $2,827.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST | $2,402.95 | $2,827.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Exams | $2,402.95 | $2,827.00 | 15% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Exams | $4,936.80 | $5,808.00 | 15% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/ + W/O CONTRAST | $4,936.80 | $5,808.00 | 15% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/ + W/O CONTRAST | $4,936.80 | $5,808.00 | 15% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Exams | $4,936.80 | $5,808.00 | 15% |
| MRI of the lower back, no contrast dye CPT 72148 MR Exams | $2,040.85 | $2,401.00 | 15% |
| MRI of the lower back, no contrast dye CPT 72148 MRI INCOMPLETE LUMBAR SPINE | $2,040.85 | $2,401.00 | 15% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST | $2,040.85 | $2,401.00 | 15% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST | $2,040.85 | $2,401.00 | 15% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR Exams | $2,040.85 | $2,401.00 | 15% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI INCOMPLETE LUMBAR SPINE | $2,040.85 | $2,401.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Exams | $564.40 | $664.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE- | $564.40 | $664.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE | $564.40 | $664.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Exams | $564.40 | $664.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE | $564.40 | $664.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE- | $564.40 | $664.00 | 15% |
| Screening mammogram, both breasts both sides CPT 77067 MA FFD MAMM SCREEN BILATERAL | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts CPT 77067 MA MAMM 3D SCREENING BIL | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts CPT 77067 MA Exams | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA MAMM 3D SCREENING LT | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA FFD MAMM SCREEN LT UNI | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA FFD MAMM SCREEN RT UNI | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA MAMM 3D SCREENING RT | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MA FFD MAMM SCREEN BILATERAL | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts inpatient CPT 77067 MA MAMM 3D SCREENING BIL | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts inpatient CPT 77067 MA Exams | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMM 3D SCREENING RT | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA FFD MAMM SCREEN LT UNI | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA FFD MAMM SCREEN RT UNI | $289.85 | $341.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMM 3D SCREENING LT | $289.85 | $341.00 | 15% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM 95810 | $2,859.40 | $3,364.00 | 15% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysom 6/> Yrs 4/> par RDC 95810 | $2,859.40 | $3,364.00 | 15% |
| Sleep study in a lab (polysomnography) CPT 95810 PSG Study (C) | $2,859.40 | $3,364.00 | 15% |
| Sleep study in a lab (polysomnography) CPT 95810 PSG Study Reduced Serv (C) | $2,859.40 | $3,364.00 | 15% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom 6/> Yrs 4/> par RDC 95810 | $2,859.40 | $3,364.00 | 15% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/> YRS 4/> PARAM 95810 | $2,859.40 | $3,364.00 | 15% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG Study Reduced Serv (C) | $2,859.40 | $3,364.00 | 15% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG Study (C) | $2,859.40 | $3,364.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US Pelvis Non-OB 76830 | $282.20 | $332.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 4611 US TRANSVAGINAL NON OB | $282.20 | $332.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US Pelvis Complete 76856 READ | $282.20 | $332.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB W/ DOPPLER | $282.20 | $332.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB | $290.70 | $342.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US Exams | $290.70 | $342.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB W/ DOPPLER | $282.20 | $332.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Pelvis Non-OB 76830 | $282.20 | $332.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Pelvis Complete 76856 READ | $282.20 | $332.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 4611 US TRANSVAGINAL NON OB | $282.20 | $332.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB | $290.70 | $342.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Exams | $290.70 | $342.00 | 15% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE | $564.40 | $664.00 | 15% |
| Ultrasound of the abdomen, complete CPT 76700 US Exams | $564.40 | $664.00 | 15% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Exams | $564.40 | $664.00 | 15% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE | $564.40 | $664.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR MIN 4 V | $207.40 | $244.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 GD Exams | $207.40 | $244.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR AP + LAT W/ FLEX + EXT | $207.40 | $244.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 GD Exams | $207.40 | $244.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR AP + LAT W/ FLEX + EXT | $207.40 | $244.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR MIN 4 V | $207.40 | $244.00 | 15% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $62.05 | $73.00 | 15% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $62.05 | $73.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $73.95 | $87.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $73.95 | $87.00 | 15% |
| Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential | $56.10 | $66.00 | 15% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Differential | $56.10 | $66.00 | 15% |
| Complete blood count (CBC), no differential CPT 85027 CBC without Differential | $45.05 | $53.00 | 15% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential | $45.05 | $53.00 | 15% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $103.70 | $122.00 | 15% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $103.70 | $122.00 | 15% |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $80.75 | $95.00 | 15% |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $80.75 | $95.00 | 15% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $40.80 | $48.00 | 15% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel | $40.80 | $48.00 | 15% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate Health Index Rflx, Serum | $57.35 | $67.47 | 15% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free and Total | $64.60 | $76.00 | 15% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free | $64.60 | $76.00 | 15% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Prostate Health Index Rflx, Serum | $57.35 | $67.47 | 15% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free | $64.60 | $76.00 | 15% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free and Total | $64.60 | $76.00 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Health Index Reflex, Serum | $10.66 | $12.53 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate-Specific Antigen (PSA) Ultrasensitive, Serum | $34.81 | $40.95 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 84153 4727 | $119.85 | $141.00 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 84153 4140 | $119.85 | $141.00 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic | $119.85 | $141.00 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Health Index Reflex, Serum | $10.66 | $12.53 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate-Specific Antigen (PSA) Ultrasensitive, Serum | $34.81 | $40.95 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 84153 4140 | $119.85 | $141.00 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic | $119.85 | $141.00 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 84153 4727 | $119.85 | $141.00 | 15% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 85730 6787 | $39.24 | $46.16 | 15% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $53.55 | $63.00 | 15% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time Heparin Protocol | $53.55 | $63.00 | 15% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 6787 | $39.24 | $46.16 | 15% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $53.55 | $63.00 | 15% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time Heparin Protocol | $53.55 | $63.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610 4832 | $8.27 | $9.72 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR (POCT) | $37.40 | $44.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME BCE | $44.20 | $52.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $44.20 | $52.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR POC | $44.20 | $52.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR | $44.20 | $52.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610 4832 | $8.27 | $9.72 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR (POCT) | $37.40 | $44.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $44.20 | $52.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR | $44.20 | $52.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR POC | $44.20 | $52.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME BCE | $44.20 | $52.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid-Stimulating Hormone-Sensitive (s-TSH), Serum | $28.25 | $33.23 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $112.20 | $132.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Function Cascade | $112.20 | $132.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH with Reflex to FT4 | $112.20 | $132.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid-Stimulating Hormone-Sensitive (s-TSH), Serum | $28.25 | $33.23 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH with Reflex to FT4 | $112.20 | $132.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Function Cascade | $112.20 | $132.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $112.20 | $132.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Microscopic | $17.00 | $20.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Culture if Indicated | $22.95 | $27.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis Dipstick auto w/ Micro POC | $40.80 | $48.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Microscopic | $17.00 | $20.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Culture if Indicated | $22.95 | $27.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Dipstick auto w/ Micro POC | $40.80 | $48.00 | 15% |
| Urinalysis with microscope exam, manual CPT 81000 Urinalysis Dipstick non-auto with Micro POC | $36.55 | $43.00 | 15% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis Dipstick non-auto with Micro POC | $36.55 | $43.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick (POCT) | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 pH Urine | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 POC Urinalysis Dipstick auto - UC | $39.95 | $47.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Ketones Urine | $39.95 | $47.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick auto POC - UC | $39.95 | $47.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick auto POC | $39.95 | $47.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 pH Urine | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick (POCT) | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POC Urinalysis Dipstick auto - UC | $39.95 | $47.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick auto POC | $39.95 | $47.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick auto POC - UC | $39.95 | $47.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Ketones Urine | $39.95 | $47.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Dipstick non-auto POC | $30.60 | $36.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Dipstick non-auto POC - UC | $30.60 | $36.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 DIPSTICK URINE BCE | $30.60 | $36.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 81002 URINALYSIS NONAUTO W/O SCOP BCE | $30.60 | $36.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 N-AUTOM URINALYS WO MICRO | $35.70 | $42.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Dipstick non-auto POC - UC | $30.60 | $36.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 DIPSTICK URINE BCE | $30.60 | $36.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Dipstick non-auto POC | $30.60 | $36.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 81002 URINALYSIS NONAUTO W/O SCOP BCE | $30.60 | $36.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 N-AUTOM URINALYS WO MICRO | $35.70 | $42.00 | 15% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy, diagnostic CPT 45378 Colonoscopy High G0105 45378 | $634.95 | $747.00 | 15% |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy Low G0121 45378 | $649.40 | $764.00 | 15% |
| Colonoscopy, diagnostic inpatient CPT 45378 Colonoscopy High G0105 45378 | $634.95 | $747.00 | 15% |
| Colonoscopy, diagnostic inpatient CPT 45378 Colonoscopy Low G0121 45378 | $649.40 | $764.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Epidural Interlaminar Lumbar/Sacral | $805.80 | $948.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Epidural Interlaminar Lumbar/Sacral | $805.80 | $948.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 62322 NJX INTERLAMINAR LMBR/SAC | $684.25 | $805.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTER LMBR/SAC MAT BCE | $684.25 | $805.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 62322 NJX INTERLAMINAR LMBR/SAC | $684.25 | $805.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTER LMBR/SAC MAT BCE | $684.25 | $805.00 | 15% |
| Prostate biopsy CPT 55700 Prostate Biopsy Needle/Punch-1 or more 55700 | $1,887.00 | $2,220.00 | 15% |
| Prostate biopsy inpatient CPT 55700 Prostate Biopsy Needle/Punch-1 or more 55700 | $1,887.00 | $2,220.00 | 15% |
| Removal of a breast lump, open surgery CPT 19120 Biopsy 19120 | $5,502.90 | $6,474.00 | 15% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Biopsy 19120 | $5,502.90 | $6,474.00 | 15% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000 | $85.85 | $101.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG - UC 93000 | $85.85 | $101.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM COMPLETE | $131.75 | $155.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000 | $85.85 | $101.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG - UC 93000 | $85.85 | $101.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM COMPLETE | $131.75 | $155.00 | 15% |
| Family therapy with the patient, 50 minutes CPT 90847 Family Therapy 50 Min 90847 | $250.75 | $295.00 | 15% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Therapy 50 Min 90847 | $250.75 | $295.00 | 15% |
| New patient office visit, about 30 minutes CPT 99203 Office Visit Level 3 New 99203 | $115.60 | $136.00 | 15% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit Level 3 New 99203 | $115.60 | $136.00 | 15% |
| New patient office visit, about 45 minutes CPT 99204 Office Visit Level 4 New 99204 | $115.60 | $136.00 | 15% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit Level 4 New 99204 | $115.60 | $136.00 | 15% |
| New patient office visit, about 60 minutes CPT 99205 Office Visit Level 5 New 99205 | $115.60 | $136.00 | 15% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office Visit Level 5 New 99205 | $115.60 | $136.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THER EX FACE 15 MIN IP | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 OT IP | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 COTA Therapeutic Exercise 15min | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise 15min | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise 15 min - OT | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 OT THERAPEUTIC EX 15 MIN CO | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 PT IP | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise 15min | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA Therapeutic Exercise 15min | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 ST 97110 ST THER EX FACE 15 MIN | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise 15 min - PT MMC | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 PT THERAPEUTIC EX 15 MIN CQ | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT 97110 PTM THERAPEUTIC EX 15 MIN | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THERAPEUTIC EXERCISE IP | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THERAPEUTIC EXERCISE | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THERAPEUTIC EXERCISE IP | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT 97110 PTM THERAPEUTIC EX 15 MIN | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 PT THERAPEUTIC EX 15 MIN CQ | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise 15min | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 PT IP | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 OT THERAPEUTIC EX 15 MIN CO | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise 15 min - OT | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 ST 97110 ST THER EX FACE 15 MIN | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise 15min | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 COTA Therapeutic Exercise 15min | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise 15 min - PT MMC | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA Therapeutic Exercise 15min | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 OT IP | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THERAPEUTIC EXERCISE | $68.85 | $81.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THER EX FACE 15 MIN IP | $68.85 | $81.00 | 15% |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy 30 Mins 90832 | $192.10 | $226.00 | 15% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy 30 Mins 90832 | $192.10 | $226.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 VIDEO Psychotherapy 45 Mins 90834 | $237.15 | $279.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 Psych THPY 45 Min PO 90834 | $237.15 | $279.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy 45 Mins 90834 | $237.15 | $279.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 Psych Thpy 45 Min 90834 | $237.15 | $279.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psych Thpy 45 Min 90834 | $237.15 | $279.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psych THPY 45 Min PO 90834 | $237.15 | $279.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy 45 Mins 90834 | $237.15 | $279.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 VIDEO Psychotherapy 45 Mins 90834 | $237.15 | $279.00 | 15% |
| Psychotherapy session, 60 minutes CPT 90837 VIDEO Psychotherapy 60 Mins 90837 | $223.55 | $263.00 | 15% |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy 60 Mins 90837 | $223.55 | $263.00 | 15% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy 60 Mins 90837 | $223.55 | $263.00 | 15% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 VIDEO Psychotherapy 60 Mins 90837 | $223.55 | $263.00 | 15% |