Hospital Grand Rapids-Wyoming-Kentwood, MI

Sheridan Community Hospital

Sheridan Community Hospital in Sheridan, MI publishes cash prices for 281 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Michigan median for 206 of 279 procedures and below it for 73. Click a procedure to compare it with other hospitals nearby.

301 N Main Street, Sheridan, MI, 48884 Collected Sep 28, 2026 Source price file

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS XRAY	$314.40	$393.00	$52.86–$347.02	25% above	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS XRAY	$314.40	$393.00	$52.86–$347.02	—	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMP LT	$585.60	$732.00	$31.51–$646.36	98% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMP RT	$585.60	$732.00	$31.51–$646.36	98% above	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMP LT	$585.60	$732.00	$31.51–$646.36	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMP RT	$585.60	$732.00	$31.51–$646.36	—	20%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST LTD	$442.40	$553.00	$26.23–$488.30	104% above	20%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST LTD	$442.40	$553.00	$26.23–$488.30	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT CTA CHEST THORAC AORTA 3D	$2,590.40	$3,238.00	$52.86–$2,859.15	90% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT CTA CHEST THORAC AORTA 3D	$2,590.40	$3,238.00	$52.86–$2,859.15	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT SCAN ABD PELVIS WO CON	$2,174.40	$2,718.00	$71.91–$2,399.99	27% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT SCAN ABD PELVIS WO CON	$2,174.40	$2,718.00	$71.91–$2,399.99	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT SCAN ABD PELVIS W CONT	$3,941.60	$4,927.00	$105.15–$4,350.54	69% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT SCAN ABD PELVIS W CONT	$3,941.60	$4,927.00	$105.15–$4,350.54	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT SCAN UROGRAM	$2,776.00	$3,470.00	$105.15–$3,064.01	20% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT SCAN ABD PELVIS W WO C	$2,813.60	$3,517.00	$105.15–$3,105.51	22% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT SCAN UROGRAM	$2,776.00	$3,470.00	$105.15–$3,064.01	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT SCAN ABD PELVIS W WO C	$2,813.60	$3,517.00	$105.15–$3,105.51	—	20%
CT scan of the abdomen with contrast CPT 74160 CT SCAN ABDOMEN W CONTRAS	$2,296.00	$2,870.00	$52.86–$2,534.21	76% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT SCAN ABDOMEN W CONTRAS	$2,296.00	$2,870.00	$52.86–$2,534.21	—	20%
CT scan of the abdomen without contrast CPT 74150 CT SCAN ABDOMEN WO CONTRA	$1,120.80	$1,401.00	$31.51–$1,237.08	26% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT SCAN ABDOMEN WO CONTRA	$1,120.80	$1,401.00	$31.51–$1,237.08	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SCAN MAXILLOFACIAL W/O	$1,246.40	$1,558.00	$31.51–$1,375.71	28% above	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SCAN SINUS	$1,246.40	$1,558.00	$31.51–$1,375.71	28% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SCAN SINUS	$1,246.40	$1,558.00	$31.51–$1,375.71	—	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SCAN MAXILLOFACIAL W/O	$1,246.40	$1,558.00	$31.51–$1,375.71	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT SCAN HEAD WO CONTRAST	$1,202.40	$1,503.00	$31.51–$1,327.15	48% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT SCAN HEAD WO CONTRAST	$1,202.40	$1,503.00	$31.51–$1,327.15	—	20%
CT scan of the head with contrast CPT 70460 CT SCAN HEAD W CONTRAST	$1,163.20	$1,454.00	$52.86–$1,283.88	5% below	20%
CT scan of the head with contrast inpatient CPT 70460 CT SCAN HEAD W CONTRAST	$1,163.20	$1,454.00	$52.86–$1,283.88	—	20%
CT scan of the head without and with contrast CPT 70470 CT SCAN HEAD W/WO CONTRAS	$1,459.20	$1,824.00	$52.86–$1,610.59	12% above	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT SCAN HEAD W/WO CONTRAS	$1,459.20	$1,824.00	$52.86–$1,610.59	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SCAN SPINE/LUMBAR WO C	$1,257.60	$1,572.00	$31.51–$1,388.08	31% above	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SCAN SPINE/LUMBAR WO MAZOR	$1,257.60	$1,572.00	$31.51–$1,388.08	31% above	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SCAN SPINE/LUMBAR WO MAZOR	$1,257.60	$1,572.00	$31.51–$1,388.08	—	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SCAN SPINE/LUMBAR WO C	$1,257.60	$1,572.00	$31.51–$1,388.08	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SCAN SPINE/CERVICAL WO	$1,090.40	$1,363.00	$31.51–$1,203.53	14% above	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SCAN SPINE/CERVICAL WO	$1,090.40	$1,363.00	$31.51–$1,203.53	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT SCAN PELVIS W CONTRAST	$1,403.20	$1,754.00	$52.86–$1,548.78	14% above	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT SCAN PELVIS W CONTRAST	$1,403.20	$1,754.00	$52.86–$1,548.78	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CAROTID DUPLEX BILATERAL	$604.80	$756.00	$71.91–$667.55	—	20%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID BIL	$535.20	$669.00	$71.91–$590.73	38% below	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CAROTID DUPLEX BILATERAL	$604.80	$756.00	$71.91–$667.55	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID BIL	$535.20	$669.00	$71.91–$590.73	—	20%
Chest X-ray, 2 views CPT 71046 CHEST XRAY 2 VIEW	$256.80	$321.00	$26.23–$283.44	62% above	20%
Chest X-ray, 2 views inpatient CPT 71046 CHEST XRAY 2 VIEW	$256.80	$321.00	$26.23–$283.44	—	20%
Chest X-ray, single view CPT 71045 PORTABLE CHEST 1 VIEW	$138.40	$173.00	$23.36–$152.76	1% below	20%
Chest X-ray, single view CPT 71045 CHEST XRAY 1 VIEW	$199.20	$249.00	$23.36–$219.87	42% above	20%
Chest X-ray, single view inpatient CPT 71045 PORTABLE CHEST 1 VIEW	$138.40	$173.00	$23.36–$152.76	—	20%
Chest X-ray, single view inpatient CPT 71045 CHEST XRAY 1 VIEW	$199.20	$249.00	$23.36–$219.87	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERIT COMPLETE WITH DUPLEX	$708.00	$885.00	$31.51–$781.46	30% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERIT COMPLETE	$708.00	$885.00	$31.51–$781.46	30% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERIT COMPLETE WITH DUPLEX	$708.00	$885.00	$31.51–$781.46	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERIT COMPLETE	$708.00	$885.00	$31.51–$781.46	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD DEXA SPINE BIL HIP	$330.40	$413.00	$31.51–$364.68	9% above	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD DEXA SPINE BIL HIP	$330.40	$413.00	$31.51–$364.68	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA FOREARM	$79.20	$99.00	$26.23–$87.42	37% below	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA FOREARM	$79.20	$99.00	$26.23–$87.42	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT SCAN CHEST WO CONTRAST	$1,295.20	$1,619.00	$31.51–$1,429.58	45% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT SCAN CHEST WO CONTRAST	$1,295.20	$1,619.00	$31.51–$1,429.58	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT SCAN CHEST W CONTRAST	$1,644.00	$2,055.00	$52.86–$1,814.56	34% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT SCAN CHEST W CONTRAST	$1,644.00	$2,055.00	$52.86–$1,814.56	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MM MAMM DIGITAL BILATERAL DIAGNOSTIC	$904.00	$1,130.00	$29.82–$997.79	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MM TOMO DIGITAL BILATERAL DIAGNOSTIC	$1,808.00	$2,260.00	$29.82–$1,995.58	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MM MAMM DIGITAL BILATERAL DIAGNOSTIC	$904.00	$1,130.00	$29.82–$997.79	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MM TOMO DIGITAL BILATERAL DIAGNOSTIC	$1,808.00	$2,260.00	$29.82–$1,995.58	—	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US ARTERIAL LE BIL	$405.60	$507.00	$71.91–$447.68	44% below	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 DUPLEX OF GRAFT BIL LOWER	$846.40	$1,058.00	$71.91–$934.21	18% above	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 ART DUP/GRAFT LOWER BIL	$952.00	$1,190.00	$71.91–$1,050.77	32% above	20%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US ARTERIAL LE BIL	$405.60	$507.00	$71.91–$447.68	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 DUPLEX OF GRAFT BIL LOWER	$846.40	$1,058.00	$71.91–$934.21	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 ART DUP/GRAFT LOWER BIL	$952.00	$1,190.00	$71.91–$1,050.77	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Extremity Study- Complete Bilateral	$447.20	$559.00	$71.91–$493.60	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS DUPLEX BILATERAL EXT	$726.40	$908.00	$71.91–$801.76	—	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 US VENOUS DOP BIL	$666.40	$833.00	$71.91–$735.54	8% above	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Extremity Study- Complete Bilateral	$447.20	$559.00	$71.91–$493.60	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VENOUS DUPLEX BILATERAL EXT	$726.40	$908.00	$71.91–$801.76	—	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VENOUS DOP BIL	$666.40	$833.00	$71.91–$735.54	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO W SPECTRAL & COLOR DOPPLER	$1,480.80	$1,851.00	$164.68–$1,634.43	13% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO W SPECTRAL & COLOR DOPPLER	$1,480.80	$1,851.00	$164.68–$1,634.43	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY W/CPAP	$3,182.40	$3,978.00	$258.82–$3,512.57	6% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY W/CPAP	$3,182.40	$3,978.00	$258.82–$3,512.57	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED WITH DUPLEX	$708.00	$885.00	$31.51–$781.46	73% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED	$708.00	$885.00	$31.51–$781.46	73% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED	$708.00	$885.00	$31.51–$781.46	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED WITH DUPLEX	$708.00	$885.00	$31.51–$781.46	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCREENING	$172.00	$215.00	$31.51–$189.84	37% below	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT SCAN LUNG CANCER SCREENING	$264.80	$331.00	$31.51–$292.27	3% below	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCREENING	$172.00	$215.00	$31.51–$189.84	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT SCAN LUNG CANCER SCREENING	$264.80	$331.00	$31.51–$292.27	—	20%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST BILATERAL WWO CONTRAST	$1,496.80	$1,871.00	$311.44–$1,652.09	—	20%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BREAST BILATERAL WWO CONTRAST	$1,496.80	$1,871.00	$311.44–$1,652.09	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LE (JOINT) WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	17% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE (JOINT) RT WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	17% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE (JOINT) LT WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	17% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LE (JOINT) WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE (JOINT) LT WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE (JOINT) RT WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE (JOINT) RT WWO CONTRAST	$1,810.40	$2,263.00	$105.15–$1,998.23	9% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE (JOINT) LT WWO CONTRAST	$1,810.40	$2,263.00	$105.15–$1,998.23	9% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE (JOINT) LT WWO CONTRAST	$1,810.40	$2,263.00	$105.15–$1,998.23	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE (JOINT) RT WWO CONTRAST	$1,810.40	$2,263.00	$105.15–$1,998.23	—	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WO CONTRAST	$1,683.20	$2,104.00	$71.91–$1,857.83	13% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WO CONTRAST	$1,683.20	$2,104.00	$71.91–$1,857.83	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WWO CONTRAST	$2,608.80	$3,261.00	$105.15–$2,879.46	8% below	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WWO CONTRAST	$2,608.80	$3,261.00	$105.15–$2,879.46	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST	$1,823.20	$2,279.00	$71.91–$2,012.36	23% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST	$1,823.20	$2,279.00	$71.91–$2,012.36	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WWO CONTRAST	$2,633.60	$3,292.00	$105.15–$2,906.84	18% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WWO CONTRAST	$2,633.60	$3,292.00	$105.15–$2,906.84	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR WO CONTRAST	$1,819.20	$2,274.00	$71.91–$2,007.94	19% above	20%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR MODIC WO	$1,819.20	$2,274.00	$71.91–$2,007.94	19% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR MODIC WO	$1,819.20	$2,274.00	$71.91–$2,007.94	—	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR WO CONTRAST	$1,819.20	$2,274.00	$71.91–$2,007.94	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR MODIC WWO	$2,701.60	$3,377.00	$105.15–$2,981.89	2% above	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR WWO CONTRAST	$2,701.60	$3,377.00	$105.15–$2,981.89	2% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR MODIC WWO	$2,701.60	$3,377.00	$105.15–$2,981.89	—	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR WWO CONTRAST	$2,701.60	$3,377.00	$105.15–$2,981.89	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC WO CONTRAST	$1,616.00	$2,020.00	$71.91–$1,783.66	5% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC WO CONTRAST	$1,616.00	$2,020.00	$71.91–$1,783.66	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL WWO CONTRAST	$2,581.60	$3,227.00	$105.15–$2,849.44	2% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL WWO CONTRAST	$2,581.60	$3,227.00	$105.15–$2,849.44	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL WO CONTRAST	$1,788.00	$2,235.00	$71.91–$1,973.50	17% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL WO CONTRAST	$1,788.00	$2,235.00	$71.91–$1,973.50	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WWO CONTRAST	$2,607.20	$3,259.00	$105.15–$2,877.70	1% below	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WWO CONTRAST	$2,607.20	$3,259.00	$105.15–$2,877.70	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO CONTRAST	$1,040.80	$1,301.00	$71.91–$1,148.78	23% below	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO CONTRAST	$1,040.80	$1,301.00	$71.91–$1,148.78	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UE (JOINT) WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	7% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE (JOINT) RT WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	7% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE (JOINT) LT WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	7% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UE (JOINT) WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE (JOINT) RT WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE (JOINT) LT WO CONTRAST	$1,736.80	$2,171.00	$71.91–$1,916.99	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Ht muscle image spect mult	$4,276.80	$5,346.00	$388.25–$4,720.52	72% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Ht muscle image spect mult	$4,276.80	$5,346.00	$388.25–$4,720.52	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER	$419.20	$524.00	$31.51–$462.69	70% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LTD TV WITH DUPLEX	$527.20	$659.00	$31.51–$581.90	114% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED	$527.20	$659.00	$31.51–$581.90	114% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LTD TRANSVAG	$527.20	$659.00	$31.51–$581.90	114% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER	$419.20	$524.00	$31.51–$462.69	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LTD TRANSVAG	$527.20	$659.00	$31.51–$581.90	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LTD TV WITH DUPLEX	$527.20	$659.00	$31.51–$581.90	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED	$527.20	$659.00	$31.51–$581.90	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS COMP	$613.60	$767.00	$31.51–$677.26	24% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS COMP WITH DUPLEX	$613.60	$767.00	$31.51–$677.26	24% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS COMP	$613.60	$767.00	$31.51–$677.26	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS COMP WITH DUPLEX	$613.60	$767.00	$31.51–$677.26	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PELVIS COMP OB LATE	$793.60	$992.00	$31.51–$875.94	73% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PELVIS COMP OB LATE	$793.60	$992.00	$31.51–$875.94	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PELVIS OB EARLY	$595.20	$744.00	$31.51–$656.95	49% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PELVIS OB EARLY	$595.20	$744.00	$31.51–$656.95	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PELVIS LIMITED PREG	$560.00	$700.00	$31.51–$618.10	82% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PELVIS LIMITED PREG	$560.00	$700.00	$31.51–$618.10	—	20%
Screening mammogram, both breasts CPT 77067 MM MAMM DIGITAL SCREENING BIL	$428.00	$535.00	$24.58–$472.40	66% above	20%
Screening mammogram, both breasts CPT 77067 MM TOMO DIGITAL SCREENING BIL	$854.40	$1,068.00	$24.58–$943.04	231% above	20%
Screening mammogram, both breasts inpatient CPT 77067 MM MAMM DIGITAL SCREENING BIL	$428.00	$535.00	$24.58–$472.40	—	20%
Screening mammogram, both breasts inpatient CPT 77067 MM TOMO DIGITAL SCREENING BIL	$854.40	$1,068.00	$24.58–$943.04	—	20%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY	$3,000.00	$3,750.00	$258.82–$3,311.25	3% below	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY	$3,000.00	$3,750.00	$258.82–$3,311.25	—	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress tte complete	$1,864.80	$2,331.00	$164.68–$2,058.27	86% above	20%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Stress tte complete	$1,864.80	$2,331.00	$164.68–$2,058.27	—	20%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$604.80	$756.00	$31.51–$667.55	68% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$604.80	$756.00	$31.51–$667.55	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 US TV PREGNANT	$437.60	$547.00	$31.51–$483.00	42% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US TV PREGNANT	$437.60	$547.00	$31.51–$483.00	—	20%
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE	$793.60	$992.00	$31.51–$875.94	41% above	20%
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE WITH DUPLEX	$793.60	$992.00	$31.51–$875.94	41% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE WITH DUPLEX	$793.60	$992.00	$31.51–$875.94	—	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE	$793.60	$992.00	$31.51–$875.94	—	20%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM COMPLETE WITH DUPLEX	$524.80	$656.00	$31.51–$579.25	6% above	20%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$524.80	$656.00	$31.51–$579.25	6% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM COMPLETE WITH DUPLEX	$524.80	$656.00	$31.51–$579.25	—	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$524.80	$656.00	$31.51–$579.25	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD NECK	$484.00	$605.00	$31.51–$534.22	12% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD NECK	$484.00	$605.00	$31.51–$534.22	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI W/O KUB	$508.80	$636.00	$52.86–$561.59	41% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI W/O KUB	$508.80	$636.00	$52.86–$561.59	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Extremity study- Unilateral/Limited	$288.80	$361.00	$31.51–$318.76	41% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Extremity study- Unilateral/Limited	$288.80	$361.00	$31.51–$318.76	—	20%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN AP	$178.40	$223.00	$26.23–$196.91	26% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN AP	$178.40	$223.00	$26.23–$196.91	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBOSACRAL 2 OR 3 VIEW	$312.00	$390.00	$31.51–$344.37	56% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBOSACRAL 2 OR 3 VIEW	$312.00	$390.00	$31.51–$344.37	—	20%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBOSACRAL	$382.40	$478.00	$31.51–$422.07	30% above	20%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR 4 VIEW MINIMUM	$603.20	$754.00	$31.51–$665.78	104% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBOSACRAL	$382.40	$478.00	$31.51–$422.07	—	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR 4 VIEW MINIMUM	$603.20	$754.00	$31.51–$665.78	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE THORACIC AP/LAT	$230.40	$288.00	$30.30–$254.30	35% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE THORACIC AP/LAT	$230.40	$288.00	$30.30–$254.30	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES XRAY 3 VIEW	$228.80	$286.00	$26.23–$252.54	47% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES XRAY 3 VIEW	$228.80	$286.00	$26.23–$252.54	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 2 OR 3 VIEW	$335.20	$419.00	$26.23–$369.98	79% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 2 OR 3 VIEW	$335.20	$419.00	$26.23–$369.98	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS XRAY	$274.40	$343.00	$25.72–$302.87	72% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS XRAY	$274.40	$343.00	$25.72–$302.87	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM AND COCCYX XRAY 2V	$192.00	$240.00	$26.23–$211.92	22% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM AND COCCYX XRAY 2V	$192.00	$240.00	$26.23–$211.92	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINOTRANSFERASE	$41.60	$52.00	$3.83–$45.92	86% above	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 .FIBROSURE ALT	$120.00	$150.00	$3.83–$132.45	436% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINOTRANSFERASE	$41.60	$52.00	$3.83–$45.92	—	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 .FIBROSURE ALT	$120.00	$150.00	$3.83–$132.45	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 ASPARTATE AMINOTRANSFERASE	$39.20	$49.00	$3.75–$43.27	78% above	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 ASPARTATE AMINOTRANSFERASE	$39.20	$49.00	$3.75–$43.27	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL ACUTE WITH CONFIRM	$272.00	$340.00	$34.43–$300.22	60% above	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$299.20	$374.00	$34.43–$330.24	76% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL ACUTE WITH CONFIRM	$272.00	$340.00	$34.43–$300.22	—	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$299.20	$374.00	$34.43–$330.24	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 GIANT RAGWEED (W3) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MAPLE (T1) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 JUNE GRASS (G8) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ELM (T8) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 BIRCH (T3) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 BERMUDA GRASS (G2) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CAT DANDER (E1) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 DOG DANDER (E5) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALTERNARIA ALTERNATA (M6) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS NIGER (M207) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CLADOSPORIUM HERBARUM (M2) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIUM NOTATUM (M1) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HELMINTHOSPORIUM HALODES (M8) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ROUGH PIGWEED (W14) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COMMON RAGWEED (W1) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 OAK (T7) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MUGWORT (W6) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 STEMPHYLIUM BOTRYOSUM (M10) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 DERMATOPHAGOIDES PTERONYSSINUS (D1) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 DERMATOPHAGOIDES FARINAE (D2) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 TIMOTHY GRASS (G6) IGE	$9.60	$12.00	$3.77–$10.60	58% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LAMB'S QUARTERS (W10) IGE	$35.20	$44.00	$3.77–$38.85	479% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ENGLISH PLANTAIN (W9) IGE	$35.20	$44.00	$3.77–$38.85	479% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ORCHARD GRASS (G3) IGE	$35.20	$44.00	$3.77–$38.85	479% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 WHITE ASH (T15) IGE	$35.20	$44.00	$3.77–$38.85	479% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COTTONWOOD (T14) IGE	$35.20	$44.00	$3.77–$38.85	479% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COCKROACH (I6) IGE	$35.20	$44.00	$3.77–$38.85	479% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE EPITHELIA (E71) IGE	$35.20	$44.00	$3.77–$38.85	479% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE (E88) IGE	$35.20	$44.00	$3.77–$38.85	479% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE URINE PROTEINS (E72) IGE	$35.20	$44.00	$3.77–$38.85	479% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 EPICOCCUM PURPURASCENS (M14) IGE	$35.20	$44.00	$3.77–$38.85	479% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 STRAWBERRY (F44) IGE	$40.00	$50.00	$3.77–$44.15	558% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 STACHYBOTRYS CHARTARUM/ATRA IGE	$40.00	$50.00	$3.77–$44.15	558% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN YELLOW FACED HORNET IGE	$40.00	$50.00	$3.77–$44.15	558% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN YELLOW JACKET VENOM IGE	$40.00	$50.00	$3.77–$44.15	558% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN WHITE FACED HORNET IGE	$40.00	$50.00	$3.77–$44.15	558% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PAPER WASP IGE	$40.00	$50.00	$3.77–$44.15	558% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN BOTRYTIS CINEREA IGE	$40.00	$50.00	$3.77–$44.15	558% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COWS MILK IGE	$42.40	$53.00	$3.77–$46.80	597% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 YEAST IGE	$42.40	$53.00	$3.77–$46.80	597% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LATEX IGE	$42.40	$53.00	$3.77–$46.80	597% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 GLUTEN (F79) IGE	$42.40	$53.00	$3.77–$46.80	597% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FUMIGATUS (M3) IGE	$42.40	$53.00	$3.77–$46.80	597% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 EGG MIX IGE	$42.40	$53.00	$3.77–$46.80	597% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 .ALLERGEN TESTING IGE	$49.60	$62.00	$3.77–$54.75	716% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE EA	$49.60	$62.00	$3.77–$54.75	716% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CAT DANDER COMPONENT PANEL	$72.00	$90.00	$3.77–$79.47	1084% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 DOG DANDER (E5) IGE W/RFLX TO COMP PANEL	$179.20	$224.00	$3.77–$197.79	2847% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CAT DANDER (E1) IGE W/RFLX TO COMP PANEL	$179.20	$224.00	$3.77–$197.79	2847% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY PANEL 14 PEDIATRIC GROUP	$199.20	$249.00	$3.77–$219.87	3176% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY PROFILE FOOD AND TREE NUT	$596.00	$745.00	$3.77–$657.84	9703% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY PROFILE FOOD WITH REFLEXES	$596.00	$745.00	$3.77–$657.84	9703% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY PROFILE CHILDHOOD FOOD & ENVIRO	$635.20	$794.00	$3.77–$701.10	10347% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY PROFILE RESPIRATORY	$952.80	$1,191.00	$3.77–$1,051.65	15571% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAPLE (T1) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CLADOSPORIUM HERBARUM (M2) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DERMATOPHAGOIDES FARINAE (D2) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ASPERGILLUS NIGER (M207) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 STEMPHYLIUM BOTRYOSUM (M10) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OAK (T7) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HELMINTHOSPORIUM HALODES (M8) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 JUNE GRASS (G8) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DERMATOPHAGOIDES PTERONYSSINUS (D1) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COMMON RAGWEED (W1) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PENICILLIUM NOTATUM (M1) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALTERNARIA ALTERNATA (M6) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TIMOTHY GRASS (G6) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DOG DANDER (E5) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ELM (T8) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CAT DANDER (E1) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BIRCH (T3) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MUGWORT (W6) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ROUGH PIGWEED (W14) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BERMUDA GRASS (G2) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GIANT RAGWEED (W3) IGE	$9.60	$12.00	$3.77–$10.60	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WHITE ASH (T15) IGE	$35.20	$44.00	$3.77–$38.85	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LAMB'S QUARTERS (W10) IGE	$35.20	$44.00	$3.77–$38.85	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUSE URINE PROTEINS (E72) IGE	$35.20	$44.00	$3.77–$38.85	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ORCHARD GRASS (G3) IGE	$35.20	$44.00	$3.77–$38.85	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUSE (E88) IGE	$35.20	$44.00	$3.77–$38.85	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUSE EPITHELIA (E71) IGE	$35.20	$44.00	$3.77–$38.85	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 EPICOCCUM PURPURASCENS (M14) IGE	$35.20	$44.00	$3.77–$38.85	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COCKROACH (I6) IGE	$35.20	$44.00	$3.77–$38.85	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COTTONWOOD (T14) IGE	$35.20	$44.00	$3.77–$38.85	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ENGLISH PLANTAIN (W9) IGE	$35.20	$44.00	$3.77–$38.85	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN WHITE FACED HORNET IGE	$40.00	$50.00	$3.77–$44.15	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 STACHYBOTRYS CHARTARUM/ATRA IGE	$40.00	$50.00	$3.77–$44.15	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PAPER WASP IGE	$40.00	$50.00	$3.77–$44.15	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN YELLOW JACKET VENOM IGE	$40.00	$50.00	$3.77–$44.15	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 STRAWBERRY (F44) IGE	$40.00	$50.00	$3.77–$44.15	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN BOTRYTIS CINEREA IGE	$40.00	$50.00	$3.77–$44.15	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN YELLOW FACED HORNET IGE	$40.00	$50.00	$3.77–$44.15	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ASPERGILLUS FUMIGATUS (M3) IGE	$42.40	$53.00	$3.77–$46.80	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COWS MILK IGE	$42.40	$53.00	$3.77–$46.80	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 YEAST IGE	$42.40	$53.00	$3.77–$46.80	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GLUTEN (F79) IGE	$42.40	$53.00	$3.77–$46.80	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 EGG MIX IGE	$42.40	$53.00	$3.77–$46.80	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LATEX IGE	$42.40	$53.00	$3.77–$46.80	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE EA	$49.60	$62.00	$3.77–$54.75	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 .ALLERGEN TESTING IGE	$49.60	$62.00	$3.77–$54.75	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CAT DANDER COMPONENT PANEL	$72.00	$90.00	$3.77–$79.47	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DOG DANDER (E5) IGE W/RFLX TO COMP PANEL	$179.20	$224.00	$3.77–$197.79	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CAT DANDER (E1) IGE W/RFLX TO COMP PANEL	$179.20	$224.00	$3.77–$197.79	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY PANEL 14 PEDIATRIC GROUP	$199.20	$249.00	$3.77–$219.87	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY PROFILE FOOD WITH REFLEXES	$596.00	$745.00	$3.77–$657.84	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY PROFILE FOOD AND TREE NUT	$596.00	$745.00	$3.77–$657.84	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY PROFILE CHILDHOOD FOOD & ENVIRO	$635.20	$794.00	$3.77–$701.10	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY PROFILE RESPIRATORY	$952.80	$1,191.00	$3.77–$1,051.65	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE IGG AB	$116.00	$145.00	$9.37–$128.04	124% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE IGG AB	$116.00	$145.00	$9.37–$128.04	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA SCREEN, W/ REFLEX TITER	$94.40	$118.00	$8.74–$104.19	63% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA, IGG W/ REFLEX TO ADDITIONAL TESTING	$94.40	$118.00	$8.74–$104.19	63% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA CASCADE AND RA PANEL 2 WITH REFLEXES	$137.60	$172.00	$8.74–$151.88	138% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA SCREEN, W/ REFLEX TO DS-DNA	$137.60	$172.00	$8.74–$151.88	138% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA CASCADE	$137.60	$172.00	$8.74–$151.88	138% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA SCREEN, W/ REFLEX TITER	$94.40	$118.00	$8.74–$104.19	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA, IGG W/ REFLEX TO ADDITIONAL TESTING	$94.40	$118.00	$8.74–$104.19	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA CASCADE AND RA PANEL 2 WITH REFLEXES	$137.60	$172.00	$8.74–$151.88	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA CASCADE	$137.60	$172.00	$8.74–$151.88	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA SCREEN, W/ REFLEX TO DS-DNA	$137.60	$172.00	$8.74–$151.88	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-PROBNP	$188.80	$236.00	$28.37–$208.39	170% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 PRO BNP	$188.80	$236.00	$28.37–$208.39	170% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 PRO BNP	$188.80	$236.00	$28.37–$208.39	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-PROBNP	$188.80	$236.00	$28.37–$208.39	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$95.20	$119.00	$6.11–$105.08	61% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$95.20	$119.00	$6.11–$105.08	—	20%
Blood culture for bacteria CPT 87040 CULTURE BLOOD MANUAL	$120.80	$151.00	$7.46–$133.33	95% above	20%
Blood culture for bacteria CPT 87040 CULTURE BLOOD	$120.80	$151.00	$7.46–$133.33	95% above	20%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD MANUAL	$120.80	$151.00	$7.46–$133.33	—	20%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD	$120.80	$151.00	$7.46–$133.33	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 RHC VENIPUNCTURE	$9.60	$12.00	$4.00–$10.60	25% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD COLLECT NON LEGAL	$22.40	$28.00	$6.57–$24.72	74% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD COLLECTION LEGAL	$23.20	$29.00	$6.57–$25.61	80% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$23.20	$29.00	$6.57–$25.61	80% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 RHC VENIPUNCTURE	$9.60	$12.00	$4.00–$10.60	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD COLLECT NON LEGAL	$22.40	$28.00	$6.57–$24.72	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD COLLECTION LEGAL	$23.20	$29.00	$6.57–$25.61	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$23.20	$29.00	$6.57–$25.61	—	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE LEVEL	$48.80	$61.00	$2.85–$53.86	103% above	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE LEVEL	$48.80	$61.00	$2.85–$53.86	—	20%
Blood lead test CPT 83655 LEAD BLOOD	$52.80	$66.00	$8.76–$58.28	277% above	20%
Blood lead test CPT 83655 LEAD RANDOM URINE	$216.80	$271.00	$8.76–$239.29	1449% above	20%
Blood lead test CPT 83655 LEAD 24 HR URINE	$216.80	$271.00	$8.76–$239.29	1449% above	20%
Blood lead test inpatient CPT 83655 LEAD BLOOD	$52.80	$66.00	$8.76–$58.28	—	20%
Blood lead test inpatient CPT 83655 LEAD 24 HR URINE	$216.80	$271.00	$8.76–$239.29	—	20%
Blood lead test inpatient CPT 83655 LEAD RANDOM URINE	$216.80	$271.00	$8.76–$239.29	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 BHCG SERUM QUALITATIVE	$68.80	$86.00	$5.44–$75.94	86% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 BHCG SERUM QUALITATIVE	$68.80	$86.00	$5.44–$75.94	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 .BB BLD TYP ABO	$93.60	$117.00	$2.16–$103.31	172% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 .BB BLD TYP ABO	$93.60	$117.00	$2.16–$103.31	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$56.00	$70.00	$3.75–$61.81	65% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 .IBD SEROLOGY 86140	$72.80	$91.00	$3.75–$80.35	114% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$56.00	$70.00	$3.75–$61.81	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 .IBD SEROLOGY 86140	$72.80	$91.00	$3.75–$80.35	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 CLOSTRIDIUM DIFFICILE TOXIN	$168.80	$211.00	$26.94–$186.31	61% above	20%
C. difficile toxin gene test (stool PCR) CPT 87493 .C DIFF TOXIN B PCR	$247.20	$309.00	$26.94–$272.85	136% above	20%
C. difficile toxin gene test (stool PCR) CPT 87493 CLOSTRIDIUM DIFFICILE TOXIN B PCR	$247.20	$309.00	$26.94–$272.85	136% above	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CLOSTRIDIUM DIFFICILE TOXIN	$168.80	$211.00	$26.94–$186.31	—	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CLOSTRIDIUM DIFFICILE TOXIN B PCR	$247.20	$309.00	$26.94–$272.85	—	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 .C DIFF TOXIN B PCR	$247.20	$309.00	$26.94–$272.85	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$144.80	$181.00	$15.04–$159.82	97% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$144.80	$181.00	$15.04–$159.82	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$132.80	$166.00	$15.04–$146.58	61% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$132.80	$166.00	$15.04–$146.58	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 PCR	$144.00	$180.00	$37.09–$158.94	64% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 PCR	$144.00	$180.00	$37.09–$158.94	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS RNA THROAT	$108.00	$135.00	$25.36–$119.20	46% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 .CHLAMYDIA TRACHOMATIS RNA CONJUNCTIVA	$108.00	$135.00	$25.36–$119.20	46% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS RNA UROGENITAL	$128.00	$160.00	$25.36–$141.28	73% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 .CHLAMYDIA TRACHOMATIS RNA CONJUNCTIVA	$108.00	$135.00	$25.36–$119.20	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS RNA THROAT	$108.00	$135.00	$25.36–$119.20	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS RNA UROGENITAL	$128.00	$160.00	$25.36–$141.28	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$116.00	$145.00	$9.68–$128.04	128% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$116.00	$145.00	$9.68–$128.04	—	20%
Complete blood count (CBC) with differential CPT 85025 .CBC W/AUTO DIFF CHG	$65.60	$82.00	$5.61–$72.41	56% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 .CBC W/AUTO DIFF CHG	$65.60	$82.00	$5.61–$72.41	—	20%
Complete blood count (CBC), no differential CPT 85027 CBC W/O DIFF	$59.20	$74.00	$4.67–$65.34	104% above	20%
Complete blood count (CBC), no differential CPT 85027 .HEMOGRAM CHG (CBC)	$59.20	$74.00	$4.67–$65.34	104% above	20%
Complete blood count (CBC), no differential CPT 85027 PBC (CBC NO DIFF)	$59.20	$74.00	$4.67–$65.34	104% above	20%
Complete blood count (CBC), no differential CPT 85027 .HEMAGRAM CHARGE	$112.00	$140.00	$4.67–$123.62	286% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 PBC (CBC NO DIFF)	$59.20	$74.00	$4.67–$65.34	—	20%
Complete blood count (CBC), no differential inpatient CPT 85027 .HEMOGRAM CHG (CBC)	$59.20	$74.00	$4.67–$65.34	—	20%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC W/O DIFF	$59.20	$74.00	$4.67–$65.34	—	20%
Complete blood count (CBC), no differential inpatient CPT 85027 .HEMAGRAM CHARGE	$112.00	$140.00	$4.67–$123.62	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$140.80	$176.00	$7.63–$155.41	79% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$140.80	$176.00	$7.63–$155.41	—	20%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$199.20	$249.00	$7.36–$219.87	482% above	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER	$199.20	$249.00	$7.36–$219.87	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE	$119.20	$149.00	$16.07–$131.57	85% above	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE	$119.20	$149.00	$16.07–$131.57	—	20%
Estradiol blood test CPT 82670 ESTRADIOL ULTRASENSITIVE LC/MS	$175.20	$219.00	$20.20–$193.38	146% above	20%
Estradiol blood test CPT 82670 ESTRADIOL FREE	$175.20	$219.00	$20.20–$193.38	146% above	20%
Estradiol blood test CPT 82670 ESTRADIOL	$175.20	$219.00	$20.20–$193.38	146% above	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$175.20	$219.00	$20.20–$193.38	—	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL FREE	$175.20	$219.00	$20.20–$193.38	—	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL ULTRASENSITIVE LC/MS	$175.20	$219.00	$20.20–$193.38	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$120.00	$150.00	$13.43–$132.45	52% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$120.00	$150.00	$13.43–$132.45	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN-FECAL	$197.60	$247.00	$14.19–$218.10	224% above	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN-FECAL	$197.60	$247.00	$14.19–$218.10	—	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$98.40	$123.00	$9.86–$108.61	64% above	20%
Ferritin blood test (iron stores) CPT 82728 .FERRITIN (5102234)	$98.40	$123.00	$9.86–$108.61	64% above	20%
Ferritin blood test (iron stores) inpatient CPT 82728 .FERRITIN (5102234)	$98.40	$123.00	$9.86–$108.61	—	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$98.40	$123.00	$9.86–$108.61	—	20%
Folate (folic acid) blood test CPT 82746 FOLATE SERUM	$112.80	$141.00	$10.62–$124.50	44% above	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE SERUM	$112.80	$141.00	$10.62–$124.50	—	20%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$111.20	$139.00	$12.25–$122.74	75% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$111.20	$139.00	$12.25–$122.74	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4	$97.60	$122.00	$6.52–$107.73	206% above	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE DIRECT DIALYSIS	$97.60	$122.00	$6.52–$107.73	206% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE DIRECT DIALYSIS	$97.60	$122.00	$6.52–$107.73	—	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4	$97.60	$122.00	$6.52–$107.73	—	20%
Free testosterone test CPT 84402 TESTOSTERONE FREE, FEMALES & CHILDREN	$99.20	$124.00	$18.41–$109.49	151% above	20%
Free testosterone test CPT 84402 TESTOSTERONE FREE (M/F)	$99.20	$124.00	$18.41–$109.49	151% above	20%
Free testosterone test CPT 84402 TESTOSTERONE BIO AVAILABLE	$99.20	$124.00	$18.41–$109.49	151% above	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE (M/F)	$99.20	$124.00	$18.41–$109.49	—	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE, FEMALES & CHILDREN	$99.20	$124.00	$18.41–$109.49	—	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE BIO AVAILABLE	$99.20	$124.00	$18.41–$109.49	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 .GENERAL HEALTH PANEL (CMP, CBC, TSH)	$416.80	$521.00	$173.60–$460.04	164% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 .GENERAL HEALTH PANEL (CMP, CBC, TSH)	$416.80	$521.00	$173.60–$460.04	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 1 HOUR GESTATIONAL OGTT	$42.40	$53.00	$3.44–$46.80	90% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 1 HOUR GESTATIONAL OGTT	$42.40	$53.00	$3.44–$46.80	—	20%
Glucose tolerance test, 3 samples CPT 82951 LACTOSE TOLERANCE TEST	$52.80	$66.00	$9.30–$58.28	7% below	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 LACTOSE TOLERANCE TEST	$52.80	$66.00	$9.30–$58.28	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE RNA THROAT	$108.00	$135.00	$25.36–$119.20	18% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 .NEISSERIA GONORRHOEAE RNA CONJUNCTIVA	$108.00	$135.00	$25.36–$119.20	18% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE UROGENITAL	$136.80	$171.00	$25.36–$150.99	49% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE RNA THROAT	$108.00	$135.00	$25.36–$119.20	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 .NEISSERIA GONORRHOEAE RNA CONJUNCTIVA	$108.00	$135.00	$25.36–$119.20	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE UROGENITAL	$136.80	$171.00	$25.36–$150.99	—	20%
H. pylori antibody blood test CPT 86677 H PYLORI ANTIBODY BLOOD	$121.60	$152.00	$12.19–$134.22	115% above	20%
H. pylori antibody blood test CPT 86677 H PYLORI IGG SERUM	$123.20	$154.00	$12.19–$135.98	118% above	20%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI ANTIBODY BLOOD	$121.60	$152.00	$12.19–$134.22	—	20%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI IGG SERUM	$123.20	$154.00	$12.19–$135.98	—	20%
H. pylori stool antigen test CPT 87338 H PYLORI ANTIGEN STOOL	$155.20	$194.00	$10.39–$171.30	150% above	20%
H. pylori stool antigen test inpatient CPT 87338 H PYLORI ANTIGEN STOOL	$155.20	$194.00	$10.39–$171.30	—	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA W/RFLX GENOTYPE	$107.20	$134.00	$44.65–$118.32	38% below	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA QUANT PCR RFLX GENOTYPES	$107.20	$134.00	$44.65–$118.32	38% below	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA W/ RFLX GENO PANEL	$107.20	$134.00	$44.65–$118.32	38% below	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA QUANT PCR	$340.80	$426.00	$61.51–$376.16	96% above	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA QUANT PCR RFLX GENOTYPES	$107.20	$134.00	$44.65–$118.32	—	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA W/ RFLX GENO PANEL	$107.20	$134.00	$44.65–$118.32	—	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA W/RFLX GENOTYPE	$107.20	$134.00	$44.65–$118.32	—	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA QUANT PCR	$340.80	$426.00	$61.51–$376.16	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK SCREEN	$232.80	$291.00	$25.36–$256.95	215% above	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH RISK SCREEN	$232.80	$291.00	$25.36–$256.95	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C CONFIRMATION	$81.60	$102.00	$7.02–$90.07	94% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C	$81.60	$102.00	$7.02–$90.07	94% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C	$81.60	$102.00	$7.02–$90.07	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C CONFIRMATION	$81.60	$102.00	$7.02–$90.07	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB QUALITATIVE	$69.60	$87.00	$7.77–$76.82	73% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB QUALITATIVE	$69.60	$87.00	$7.77–$76.82	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN W/ CONFIRM	$63.20	$79.00	$7.47–$69.76	64% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGEN W/ CONFIRM	$63.20	$79.00	$7.47–$69.76	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HCV AB RFLX TO QUANT RFLX TO GENOTYPE	$100.00	$125.00	$10.31–$110.38	108% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB RFLX TO HCV RNA QUANT	$100.00	$125.00	$10.31–$110.38	108% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB RFLX TO HCV RNA QUANT	$100.00	$125.00	$10.31–$110.38	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV AB RFLX TO QUANT RFLX TO GENOTYPE	$100.00	$125.00	$10.31–$110.38	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA QUANTITATIVE REAL TIME PCR	$213.60	$267.00	$30.97–$235.76	151% above	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 .HCV RNA, QUANT PCR	$213.60	$267.00	$30.97–$235.76	151% above	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA, QN PCR W/REFL TO GENOTYPE	$213.60	$267.00	$30.97–$235.76	151% above	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA QUANTITATIVE REAL TIME PCR	$213.60	$267.00	$30.97–$235.76	—	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA, QN PCR W/REFL TO GENOTYPE	$213.60	$267.00	$30.97–$235.76	—	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 .HCV RNA, QUANT PCR	$213.60	$267.00	$30.97–$235.76	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IGG	$73.60	$92.00	$9.53–$81.24	77% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 .HSV 1 IGM ANTIBODY TITER	$76.80	$96.00	$9.53–$84.77	85% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 .HSV 1 IGM ANTIBODY	$76.80	$96.00	$9.53–$84.77	85% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX 1 AB IGG	$216.80	$271.00	$9.53–$239.29	421% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IGG	$73.60	$92.00	$9.53–$81.24	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 .HSV 1 IGM ANTIBODY TITER	$76.80	$96.00	$9.53–$84.77	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 .HSV 1 IGM ANTIBODY	$76.80	$96.00	$9.53–$84.77	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX 1 AB IGG	$216.80	$271.00	$9.53–$239.29	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 .HSV 2 IGM ANTIBODY TITER	$76.80	$96.00	$13.99–$84.77	85% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 .HSV 2 IGM ANTIBODY	$76.80	$96.00	$13.99–$84.77	85% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGG WITH REFLEX	$92.80	$116.00	$13.99–$102.43	123% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 .HSV 2 IGG INHIBITION	$92.80	$116.00	$13.99–$102.43	123% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX VIRUS 2 IGG INHIBITION	$92.80	$116.00	$13.99–$102.43	123% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX 2 AB IGG	$216.80	$271.00	$13.99–$239.29	421% above	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 .HSV 2 IGM ANTIBODY	$76.80	$96.00	$13.99–$84.77	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 .HSV 2 IGM ANTIBODY TITER	$76.80	$96.00	$13.99–$84.77	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IGG WITH REFLEX	$92.80	$116.00	$13.99–$102.43	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 .HSV 2 IGG INHIBITION	$92.80	$116.00	$13.99–$102.43	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX VIRUS 2 IGG INHIBITION	$92.80	$116.00	$13.99–$102.43	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX 2 AB IGG	$216.80	$271.00	$13.99–$239.29	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HIGH SENSITIVITY	$85.60	$107.00	$9.37–$94.48	88% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HIGH SENSITIVITY	$85.60	$107.00	$9.37–$94.48	—	20%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$131.20	$164.00	$12.96–$144.81	98% above	20%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE	$131.20	$164.00	$12.96–$144.81	—	20%
Insulin blood test CPT 83525 INSULIN	$90.40	$113.00	$8.27–$99.78	124% above	20%
Insulin blood test inpatient CPT 83525 INSULIN	$90.40	$113.00	$8.27–$99.78	—	20%
Iron blood test (serum iron) CPT 83540 IRON SERUM	$64.80	$81.00	$4.67–$71.52	122% above	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON SERUM	$64.80	$81.00	$4.67–$71.52	—	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$100.80	$126.00	$6.28–$111.26	62% above	20%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$100.80	$126.00	$6.28–$111.26	—	20%
LH (luteinizing hormone) test CPT 83002 LH	$137.60	$172.00	$13.39–$151.88	81% above	20%
LH (luteinizing hormone) test inpatient CPT 83002 LH	$137.60	$172.00	$13.39–$151.88	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE PERITONEAL FLUID	$31.20	$39.00	$4.98–$34.44	11% above	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$68.80	$86.00	$4.98–$75.94	146% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE PERITONEAL FLUID	$31.20	$39.00	$4.98–$34.44	—	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$68.80	$86.00	$4.98–$75.94	—	20%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$88.00	$110.00	$5.90–$97.13	77% above	20%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$88.00	$110.00	$5.90–$97.13	—	20%
Lyme disease antibody test CPT 86618 LYME DISEASE AB W/REFL TO IMMUNOASSAY	$193.60	$242.00	$12.31–$213.69	638% above	20%
Lyme disease antibody test CPT 86618 LYME DISEASE AB W/REFL TO BLOT (IGG IGM)	$193.60	$242.00	$12.31–$213.69	638% above	20%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB W/REFL TO BLOT (IGG IGM)	$193.60	$242.00	$12.31–$213.69	—	20%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB W/REFL TO IMMUNOASSAY	$193.60	$242.00	$12.31–$213.69	—	20%
Magnesium blood test CPT 83735 MAGNESIUM	$54.40	$68.00	$4.85–$60.04	172% above	20%
Magnesium blood test CPT 83735 MAGNESIUM RANDOM URINE	$54.40	$68.00	$4.85–$60.04	172% above	20%
Magnesium blood test CPT 83735 .KSS-URINE MAGNESIUM	$54.40	$68.00	$4.85–$60.04	172% above	20%
Magnesium blood test CPT 83735 MAGNESIUM, 24-HOUR URINE W/O CREAT	$54.40	$68.00	$4.85–$60.04	172% above	20%
Magnesium blood test CPT 83735 MAGNESIUM RBC	$92.00	$115.00	$4.85–$101.54	360% above	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$54.40	$68.00	$4.85–$60.04	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM RANDOM URINE	$54.40	$68.00	$4.85–$60.04	—	20%
Magnesium blood test inpatient CPT 83735 .KSS-URINE MAGNESIUM	$54.40	$68.00	$4.85–$60.04	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, 24-HOUR URINE W/O CREAT	$54.40	$68.00	$4.85–$60.04	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM RBC	$92.00	$115.00	$4.85–$101.54	—	20%
Measles (rubeola) antibody test CPT 86765 MEASLES IGM	$105.60	$132.00	$9.31–$116.56	349% above	20%
Measles (rubeola) antibody test CPT 86765 MEASLES IGG	$105.60	$132.00	$9.31–$116.56	349% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES IGG	$105.60	$132.00	$9.31–$116.56	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES IGM	$105.60	$132.00	$9.31–$116.56	—	20%
Obstetric blood test panel CPT 80055 PRENATAL/OB PROFILE	$384.80	$481.00	$34.56–$424.72	157% above	20%
Obstetric blood test panel inpatient CPT 80055 PRENATAL/OB PROFILE	$384.80	$481.00	$34.56–$424.72	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 .FREE PSA	$104.00	$130.00	$13.30–$114.79	81% above	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 .PSA FREE	$104.00	$130.00	$13.30–$114.79	81% above	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA-FREE AND TOTAL	$122.40	$153.00	$13.30–$135.10	114% above	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 .FREE PSA	$104.00	$130.00	$13.30–$114.79	—	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 .PSA FREE	$104.00	$130.00	$13.30–$114.79	—	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA-FREE AND TOTAL	$122.40	$153.00	$13.30–$135.10	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 .PSA TOTAL (SEND OUT)	$113.60	$142.00	$13.30–$125.39	135% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAGNOSTIC	$113.60	$142.00	$13.30–$125.39	135% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 .TOTAL PSA	$113.60	$142.00	$13.30–$125.39	135% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA DIAGNOSTIC	$113.60	$142.00	$13.30–$125.39	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 .TOTAL PSA	$113.60	$142.00	$13.30–$125.39	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 .PSA TOTAL (SEND OUT)	$113.60	$142.00	$13.30–$125.39	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP SMEAR THIN PREP	$108.80	$136.00	$19.23–$120.09	51% above	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP SMEAR THIN PREP	$108.80	$136.00	$19.23–$120.09	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH-SEND OUT	$152.00	$190.00	$29.84–$167.77	21% above	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT WITH IONIZED CALCIUM	$228.80	$286.00	$29.84–$252.54	82% above	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT WITH CALCIUM	$228.80	$286.00	$29.84–$252.54	82% above	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT WITHOUT CALCIUM	$228.80	$286.00	$29.84–$252.54	82% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH-SEND OUT	$152.00	$190.00	$29.84–$167.77	—	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT WITHOUT CALCIUM	$228.80	$286.00	$29.84–$252.54	—	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT WITH CALCIUM	$228.80	$286.00	$29.84–$252.54	—	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT WITH IONIZED CALCIUM	$228.80	$286.00	$29.84–$252.54	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 LUPUS ANTI PHOSPHOLIPID	$30.40	$38.00	$4.35–$33.55	2% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT-LA WITH REFLEX TO HEX PHASE CONFIRM	$52.00	$65.00	$4.35–$57.40	68% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$72.00	$90.00	$4.35–$79.47	132% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LUPUS ANTI PHOSPHOLIPID	$30.40	$38.00	$4.35–$33.55	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT-LA WITH REFLEX TO HEX PHASE CONFIRM	$52.00	$65.00	$4.35–$57.40	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$72.00	$90.00	$4.35–$79.47	—	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 PRENATAL GENETIC SCREEN	$3,307.20	$4,134.00	$548.68–$3,650.32	1002% above	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 PRENATAL GENETIC SCREEN	$3,307.20	$4,134.00	$548.68–$3,650.32	—	20%
Progesterone blood test CPT 84144 PROGESTERONE	$111.20	$139.00	$15.08–$122.74	84% above	20%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$111.20	$139.00	$15.08–$122.74	—	20%
Prolactin blood test CPT 84146 PROLACTIN-SO	$80.00	$100.00	$14.00–$88.30	13% above	20%
Prolactin blood test CPT 84146 PROLACTIN	$175.20	$219.00	$14.00–$193.38	147% above	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN-SO	$80.00	$100.00	$14.00–$88.30	—	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$175.20	$219.00	$14.00–$193.38	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PT INR	$72.00	$90.00	$3.10–$79.47	422% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PT INR DAILY DRAW	$108.00	$135.00	$3.10–$119.20	683% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT INR	$72.00	$90.00	$3.10–$79.47	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT INR DAILY DRAW	$108.00	$135.00	$3.10–$119.20	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 RAPID STREP SCREEN	$102.40	$128.00	$11.95–$113.02	110% above	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RAPID STREP SCREEN	$102.40	$128.00	$11.95–$113.02	—	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$56.00	$70.00	$4.09–$61.81	69% above	20%
Rheumatoid factor (RF) test CPT 86431 .RF QUANT	$56.00	$70.00	$4.09–$61.81	69% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$56.00	$70.00	$4.09–$61.81	—	20%
Rheumatoid factor (RF) test inpatient CPT 86431 .RF QUANT	$56.00	$70.00	$4.09–$61.81	—	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG	$72.80	$91.00	$10.40–$80.35	75% above	20%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGG	$72.80	$91.00	$10.40–$80.35	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE	$44.00	$55.00	$1.96–$48.56	86% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE- SEND OUT	$46.40	$58.00	$1.96–$51.21	96% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE	$44.00	$55.00	$1.96–$48.56	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE- SEND OUT	$46.40	$58.00	$1.96–$51.21	—	20%
Stool ova and parasites exam CPT 87177 O&P CONCENTRATED EXAM	$25.60	$32.00	$6.43–$28.26	33% below	20%
Stool ova and parasites exam CPT 87177 .OVA & PARASITE	$64.00	$80.00	$6.43–$70.64	67% above	20%
Stool ova and parasites exam inpatient CPT 87177 O&P CONCENTRATED EXAM	$25.60	$32.00	$6.43–$28.26	—	20%
Stool ova and parasites exam inpatient CPT 87177 .OVA & PARASITE	$64.00	$80.00	$6.43–$70.64	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 .RPR SCREEN	$48.00	$60.00	$3.08–$52.98	176% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR (DX) W/REFL TITER AND CONFIRMATION	$48.00	$60.00	$3.08–$52.98	176% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR (MONITOR) W/REFLEX TITER	$48.00	$60.00	$3.08–$52.98	176% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR (MONITOR) W/REFLEX TITER	$48.00	$60.00	$3.08–$52.98	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 .RPR SCREEN	$48.00	$60.00	$3.08–$52.98	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR (DX) W/REFL TITER AND CONFIRMATION	$48.00	$60.00	$3.08–$52.98	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON(R)-TB GOLD PLUS, 4T	$234.40	$293.00	$44.80–$258.72	85% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD PLUS	$234.40	$293.00	$44.80–$258.72	85% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD PLUS	$234.40	$293.00	$44.80–$258.72	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON(R)-TB GOLD PLUS, 4T	$234.40	$293.00	$44.80–$258.72	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL (MALE ONLY)	$135.20	$169.00	$18.66–$149.23	106% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 .TESTOSTERONE TOTAL (MALE ONLY)	$135.20	$169.00	$18.66–$149.23	106% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 .TESTOSTERONE TOTAL	$135.20	$169.00	$18.66–$149.23	106% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE FREE AND TOTAL (M/F)	$135.20	$169.00	$18.66–$149.23	106% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL (M/F)	$135.20	$169.00	$18.66–$149.23	106% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 .TESTOSTERONE TOTAL (M/F)	$135.20	$169.00	$18.66–$149.23	106% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 .TESTOSTERONE TOTAL (MALE ONLY)	$135.20	$169.00	$18.66–$149.23	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 .TESTOSTERONE TOTAL (M/F)	$135.20	$169.00	$18.66–$149.23	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL (MALE ONLY)	$135.20	$169.00	$18.66–$149.23	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 .TESTOSTERONE TOTAL	$135.20	$169.00	$18.66–$149.23	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE FREE AND TOTAL (M/F)	$135.20	$169.00	$18.66–$149.23	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL (M/F)	$135.20	$169.00	$18.66–$149.23	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE (TPO) ANTIBODY	$83.20	$104.00	$10.52–$91.83	88% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER-KIDNEY MICROSOME AB	$83.20	$104.00	$10.52–$91.83	88% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER-KIDNEY MICROSOME AB	$83.20	$104.00	$10.52–$91.83	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE (TPO) ANTIBODY	$83.20	$104.00	$10.52–$91.83	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$124.00	$155.00	$12.14–$136.86	93% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH FREE T4 IF INDICATED	$124.00	$155.00	$12.14–$136.86	93% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH FREE T4 IF INDICATED	$124.00	$155.00	$12.14–$136.86	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$124.00	$155.00	$12.14–$136.86	—	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, RNA, QL (M/F UR OR F SWAB)	$258.40	$323.00	$25.36–$285.21	305% above	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, RNA, QUAL (M SWAB ONLY)	$258.40	$323.00	$25.36–$285.21	305% above	20%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS, RNA, QL (M/F UR OR F SWAB)	$258.40	$323.00	$25.36–$285.21	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS, RNA, QUAL (M SWAB ONLY)	$258.40	$323.00	$25.36–$285.21	—	20%
Uric acid blood test CPT 84550 URIC ACID	$44.80	$56.00	$3.27–$49.45	95% above	20%
Uric acid blood test inpatient CPT 84550 URIC ACID	$44.80	$56.00	$3.27–$49.45	—	20%
Urinalysis with microscope exam, automated CPT 81001 .UA W/MICRO CHG	$25.60	$32.00	$2.29–$28.26	22% above	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 .UA W/MICRO CHG	$25.60	$32.00	$2.29–$28.26	—	20%
Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY URINE	$10.40	$13.00	$1.63–$11.48	20% below	20%
Urinalysis without microscope exam, automated CPT 81003 PH URINE	$11.20	$14.00	$1.63–$12.36	14% below	20%
Urinalysis without microscope exam, automated CPT 81003 DRUG SCREEN ADULTERANTS URINE	$18.40	$23.00	$1.63–$20.31	42% above	20%
Urinalysis without microscope exam, automated CPT 81003 .UA W/O MICRO CHG	$18.40	$23.00	$1.63–$20.31	42% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY URINE	$10.40	$13.00	$1.63–$11.48	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 PH URINE	$11.20	$14.00	$1.63–$12.36	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 DRUG SCREEN ADULTERANTS URINE	$18.40	$23.00	$1.63–$20.31	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 .UA W/O MICRO CHG	$18.40	$23.00	$1.63–$20.31	—	20%
Urinalysis without microscope exam, manual CPT 81002 RHC UA WO MICRO MANUAL	$28.80	$36.00	$2.51–$31.79	113% above	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 RHC UA WO MICRO MANUAL	$28.80	$36.00	$2.51–$31.79	—	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE ROUTINE	$77.60	$97.00	$5.83–$85.65	41% above	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE SPECIAL	$77.60	$97.00	$5.83–$85.65	41% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE ROUTINE	$77.60	$97.00	$5.83–$85.65	—	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE SPECIAL	$77.60	$97.00	$5.83–$85.65	—	20%
Urine pregnancy test, read by color change CPT 81025 BHCG URINE QUALITATIVE	$60.80	$76.00	$6.22–$67.11	177% above	20%
Urine pregnancy test, read by color change inpatient CPT 81025 BHCG URINE QUALITATIVE	$60.80	$76.00	$6.22–$67.11	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$112.80	$141.00	$10.90–$124.50	95% above	20%
Vitamin B12 (cobalamin) blood test CPT 82607 ACTIVE B-12	$143.20	$179.00	$10.90–$158.06	148% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$112.80	$141.00	$10.90–$124.50	—	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 ACTIVE B-12	$143.20	$179.00	$10.90–$158.06	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY D2 AND D3	$116.80	$146.00	$21.40–$128.92	32% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY TOTAL	$160.00	$200.00	$21.40–$176.60	81% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 OH SEND OUT	$160.00	$200.00	$21.40–$176.60	81% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY D2 AND D3	$116.80	$146.00	$21.40–$128.92	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 OH SEND OUT	$160.00	$200.00	$21.40–$176.60	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY TOTAL	$160.00	$200.00	$21.40–$176.60	—	20%
Zinc blood test CPT 84630 ZINC RBC	$62.40	$78.00	$8.23–$68.87	297% above	20%
Zinc blood test CPT 84630 ZINC PLASMA	$62.40	$78.00	$8.23–$68.87	297% above	20%
Zinc blood test inpatient CPT 84630 ZINC RBC	$62.40	$78.00	$8.23–$68.87	—	20%
Zinc blood test inpatient CPT 84630 ZINC PLASMA	$62.40	$78.00	$8.23–$68.87	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 .MSI QUAD HCG	$42.40	$53.00	$10.89–$46.80	28% below	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BHCG QUANTITATIVE	$115.20	$144.00	$10.89–$127.15	97% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANT TUMOR MARKER	$115.20	$144.00	$10.89–$127.15	97% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG BETA, QUANT- SEND OUT	$115.20	$144.00	$10.89–$127.15	97% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 .MSI QUAD HCG	$42.40	$53.00	$10.89–$46.80	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANT TUMOR MARKER	$115.20	$144.00	$10.89–$127.15	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG BETA, QUANT- SEND OUT	$115.20	$144.00	$10.89–$127.15	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BHCG QUANTITATIVE	$115.20	$144.00	$10.89–$127.15	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 Arthrd ant ntrbdy cervical	$4,640.00	$5,800.00	$1,563.67–$5,800.00	28% above	20%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 PF Arthrd ant ntrbdy cervical	$4,825.60	$6,032.00	$1,563.67–$6,032.00	34% above	20%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 ANTERIOR INTERBODY INCLUD DISC SPACE	$8,239.00	$8,239.00	$1,563.67–$8,239.00	128% above	—
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 ANTERIOR INTERBODY W/ DISC SPACE PREP	$8,239.00	$8,239.00	$1,563.67–$8,239.00	128% above	—
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 ANTERIOR INTERBODY INCLUDE DISC SPACE	$8,239.00	$8,239.00	$1,563.67–$8,239.00	128% above	—
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 Arthrd ant ntrbdy cervical	$4,640.00	$5,800.00	$1,563.67–$5,800.00	—	20%
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 PF Arthrd ant ntrbdy cervical	$4,825.60	$6,032.00	$1,563.67–$6,032.00	—	20%
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 ANTERIOR INTERBODY W/ DISC SPACE PREP	$8,239.00	$8,239.00	$1,563.67–$8,239.00	—	—
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 ANTERIOR INTERBODY INCLUDE DISC SPACE	$8,239.00	$8,239.00	$1,563.67–$8,239.00	—	—
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 ANTERIOR INTERBODY INCLUD DISC SPACE	$8,239.00	$8,239.00	$1,563.67–$8,239.00	—	—
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPY FOR RUPT APPENDIX W PERITONITIS	$1,692.80	$2,116.00	$804.45–$1,868.43	3% below	20%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 APPY FOR RUPT APPENDIX W PERITONITIS	$1,692.80	$2,116.00	$804.45–$1,868.43	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Treatment of ankle fracture	$825.60	$1,032.00	$74.34–$911.26	136% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Treatment of ankle fracture	$825.60	$1,032.00	$74.34–$911.26	—	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Treat metatarsal fracture	$567.20	$709.00	$74.34–$626.05	67% above	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Treat metatarsal fracture	$567.20	$709.00	$74.34–$626.05	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion electric ext	$378.40	$473.00	$144.98–$473.00	58% below	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion electric ext	$378.40	$473.00	$144.98–$473.00	—	20%
Colonoscopy with polyp removal CPT 45385 LESION REMOVAL COLONOSCOPY	$3,779.50	$4,724.38	$360.66–$4,171.63	232% above	20%
Colonoscopy with polyp removal inpatient CPT 45385 LESION REMOVAL COLONOSCOPY	$3,779.50	$4,724.38	$360.66–$4,171.63	—	20%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY & BIOPSY	$900.00	$1,125.00	$197.62–$993.38	21% below	20%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY & BIOPSY	$900.00	$1,125.00	$197.62–$993.38	—	20%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$800.00	$1,000.00	$183.18–$883.00	8% below	20%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTICS COLONOSCOPY	$3,832.00	$4,790.00	$280.28–$4,229.57	339% above	20%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY	$800.00	$1,000.00	$183.18–$883.00	—	20%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTICS COLONOSCOPY	$3,832.00	$4,790.00	$280.28–$4,229.57	—	20%
Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY W INSERT URETERAL STENT	$395.20	$494.00	$155.59–$494.00	82% below	20%
Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTOSCOPY W INSERT URETERAL STENT	$395.20	$494.00	$155.59–$494.00	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY DIAGNOSTIC	$207.20	$259.00	$79.71–$259.00	72% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY DIAGNOSTIC	$207.20	$259.00	$79.71–$259.00	—	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 D&C DIAGNOSTIC OR THERAP NOT OB	$500.00	$625.00	$232.58–$625.00	46% below	20%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 D&C DIAGNOSTIC OR THERAP NOT OB	$500.00	$625.00	$232.58–$625.00	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION ANY METHOD 1ST LESION	$99.20	$124.00	$51.57–$124.00	9% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION ANY METHOD 1ST LESION	$99.20	$124.00	$51.57–$124.00	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Remove impacted ear wax uni	$39.20	$49.00	$15.31–$43.27	47% below	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Remove impacted ear wax uni	$39.20	$49.00	$15.31–$43.27	—	20%
Earwax removal with instruments, one ear CPT 69210 Remove impacted ear wax uni	$121.60	$152.00	$17.78–$134.22	45% above	20%
Earwax removal with instruments, one ear inpatient CPT 69210 Remove impacted ear wax uni	$121.60	$152.00	$17.78–$134.22	—	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ DX OR TX PARAVERT F JNT L/S 1 Lev	$329.60	$412.00	$89.85–$412.00	70% below	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ DX OR TX PARAVERT F JNT L/S 1 Lev	$329.60	$412.00	$89.85–$412.00	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$362.40	$453.00	$59.00–$453.00	46% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$362.40	$453.00	$59.00–$453.00	—	20%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$1,298.40	$1,623.00	$613.38–$1,623.00	53% below	20%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$1,298.40	$1,623.00	$613.38–$1,623.00	—	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPAROSCOPIC CHOLECYSTECTOMY GRAPH	$1,499.20	$1,874.00	$664.97–$1,874.00	25% below	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPAROSCOPIC CHOLECYSTECTOMY GRAPH	$1,499.20	$1,874.00	$664.97–$1,874.00	—	20%
Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY	$2,016.80	$2,521.00	$983.30–$2,226.04	4% above	20%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 CHOLECYSTECTOMY	$2,016.80	$2,521.00	$983.30–$2,226.04	—	20%
Hammertoe correction surgery CPT 28285 Repair of hammertoe	$1,452.00	$1,815.00	$510.71–$1,815.00	73% above	20%
Hammertoe correction surgery inpatient CPT 28285 Repair of hammertoe	$1,452.00	$1,815.00	$510.71–$1,815.00	—	20%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY INT/EXT SINGLE COLUMN	$663.20	$829.00	$384.11–$829.00	42% below	20%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY INT/EXT SINGLE COLUMN	$663.20	$829.00	$384.11–$829.00	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE ABSCESS SIMPLE	$497.60	$622.00	$60.47–$549.23	94% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 Incision & Drainage Abscess (Simple)	$497.60	$622.00	$60.47–$549.23	94% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 PRO FEES Inc & Dra Abs Simple	$497.60	$622.00	$60.47–$549.23	94% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision & Drainage Abscess (Simple)	$497.60	$622.00	$60.47–$549.23	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE ABSCESS SIMPLE	$497.60	$622.00	$60.47–$549.23	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 PRO FEES Inc & Dra Abs Simple	$497.60	$622.00	$60.47–$549.23	—	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR INITIAL INGUINAL HERNIA 5>	$1,298.40	$1,623.00	$491.15–$1,623.00	7% above	20%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR INITIAL INGUINAL HERNIA 5>	$1,298.40	$1,623.00	$491.15–$1,623.00	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj tendon sheath/ligament	$148.00	$185.00	$56.81–$185.00	60% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj tendon sheath/ligament	$148.00	$185.00	$56.81–$185.00	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insertion drug dlvr implant	$256.00	$320.00	$40.10–$282.56	67% above	20%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insertion drug dlvr implant	$256.00	$320.00	$40.10–$282.56	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR INTMD WND 2.5CM OR LESS S/A/T/EXT	$280.80	$351.00	$122.52–$309.93	27% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intmd rpr s/a/t/ext 2.5 cm/<	$673.60	$842.00	$122.52–$743.49	76% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REPAIR INTMD WND 2.5CM OR LESS S/A/T/EXT	$280.80	$351.00	$122.52–$309.93	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Intmd rpr s/a/t/ext 2.5 cm/<	$673.60	$842.00	$122.52–$743.49	—	20%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ INTERLAMINAR LMBR/SAC	$480.80	$601.00	$98.90–$530.68	34% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX AA$/STRD TFRM EPI C/T 1	$496.00	$620.00	$98.90–$547.46	32% below	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ INTERLAMINAR LMBR/SAC	$480.80	$601.00	$98.90–$530.68	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX AA$/STRD TFRM EPI C/T 1	$496.00	$620.00	$98.90–$547.46	—	20%
Lower-back epidural injection, without imaging guidance CPT 62322 INJ ANESTH; SPINAL LUMBAR/SACRAL (CD)	$294.40	$368.00	$82.47–$368.00	69% below	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ ANESTH; SPINAL LUMBAR/SACRAL (CD)	$294.40	$368.00	$82.47–$368.00	—	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJECT Tran Epid Single Level	$353.60	$442.00	$109.86–$442.00	67% below	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJECT Tran Epid Single Level	$353.60	$442.00	$109.86–$442.00	—	20%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 DISECTOMY LAMI W/ DECOMP OF NERVE	$12,527.20	$15,659.00	$864.08–$13,826.90	244% above	20%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 LAMINOTOMY W/ DECOMPRESSION OF NERVE	$20,786.40	$25,983.00	$864.08–$22,942.99	471% above	20%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 DISECTOMY LAMI W/ DECOMP OF NERVE	$12,527.20	$15,659.00	$864.08–$13,826.90	—	20%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 LAMINOTOMY W/ DECOMPRESSION OF NERVE	$20,786.40	$25,983.00	$864.08–$22,942.99	—	20%
Lumbar laminectomy (spinal decompression), one level CPT 63047 LAMINECTOMY FACETECTOMY AND FORAMINOTOMY	$11,049.60	$13,812.00	$1,030.53–$12,196.00	155% above	20%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 LAMINECTOMY FACETECTOMY AND FORAMINOTOMY	$11,049.60	$13,812.00	$1,030.53–$12,196.00	—	20%
Lumbar spinal fusion (posterior), one level CPT 22612 LUMBAR W/ LATERAL TRANSVERSE TECHNIQUE	$6,528.80	$8,161.00	$1,425.28–$8,161.00	51% above	20%
Lumbar spinal fusion (posterior), one level inpatient CPT 22612 LUMBAR W/ LATERAL TRANSVERSE TECHNIQUE	$6,528.80	$8,161.00	$1,425.28–$8,161.00	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC LESION TRUNK 0.5 CM OR LESS	$150.40	$188.00	$82.48–$188.00	73% below	20%
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<	$317.60	$397.00	$117.75–$397.00	43% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC LESION TRUNK 0.5 CM OR LESS	$150.40	$188.00	$82.48–$188.00	—	20%
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<	$317.60	$397.00	$117.75–$397.00	—	20%
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 0.5CM/<	$165.60	$207.00	$104.94–$207.00	71% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC BENIGN FACE EARS EYELIDS 0.5 - LESS	$189.60	$237.00	$104.94–$237.00	66% below	20%
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 0.5CM/<	$165.60	$207.00	$104.94–$207.00	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC BENIGN FACE EARS EYELIDS 0.5 - LESS	$189.60	$237.00	$104.94–$237.00	—	20%
Nail removal (partial or complete), one nail CPT 11730 Removal of nail plate	$284.00	$355.00	$60.47–$313.46	40% above	20%
Nail removal (partial or complete), one nail CPT 11730 Remove Nail Plate	$478.40	$598.00	$60.47–$528.03	137% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 Removal of nail plate	$284.00	$355.00	$60.47–$313.46	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 Remove Nail Plate	$478.40	$598.00	$60.47–$528.03	—	20%
Occipital nerve block (injection for headaches) CPT 64405 Njx aa&/strd gr ocpl nrv	$193.60	$242.00	$74.64–$221.09	55% below	20%
Occipital nerve block (injection for headaches) CPT 64405 PF Njx aa&/strd gr ocpl nrv	$201.60	$252.00	$52.15–$222.52	54% below	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Njx aa&/strd gr ocpl nrv	$193.60	$242.00	$74.64–$221.09	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 PF Njx aa&/strd gr ocpl nrv	$201.60	$252.00	$52.15–$222.52	—	20%
Pacemaker implant (dual chamber) CPT 33208 Insrt heart pm atrial & vent	$19,509.60	$24,387.00	$445.38–$21,533.72	36% above	20%
Pacemaker implant (dual chamber) inpatient CPT 33208 Insrt heart pm atrial & vent	$19,509.60	$24,387.00	$445.38–$21,533.72	—	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$309.60	$387.00	$103.64–$387.00	74% below	20%
Paracentesis with imaging guidance CPT 49083 US GUIDED PARACENTESIS	$1,720.80	$2,151.00	$261.36–$1,899.33	47% above	20%
Paracentesis with imaging guidance CPT 49083 CT SCAN GUIDED PARACENTESIS	$1,812.00	$2,265.00	$261.36–$2,000.00	55% above	20%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING	$309.60	$387.00	$103.64–$387.00	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 US GUIDED PARACENTESIS	$1,720.80	$2,151.00	$261.36–$1,899.33	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 CT SCAN GUIDED PARACENTESIS	$1,812.00	$2,265.00	$261.36–$2,000.00	—	20%
Partial knee replacement (one compartment) CPT 27446 Revision of knee joint	$3,004.80	$3,756.00	$1,009.71–$3,756.00	32% below	20%
Partial knee replacement (one compartment) inpatient CPT 27446 Revision of knee joint	$3,004.80	$3,756.00	$1,009.71–$3,756.00	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Permanent Nail Removal	$921.60	$1,152.00	$122.52–$1,017.22	85% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Permanent Nail Removal	$921.60	$1,152.00	$122.52–$1,017.22	—	20%
Prostate biopsy CPT 55700 PROSTATE BX	$335.20	$419.00	$139.07–$419.00	75% below	20%
Prostate biopsy inpatient CPT 55700 PROSTATE BX	$335.20	$419.00	$139.07–$419.00	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 PR FEE DEST LUMB/SACR SINGLE FACET	$636.80	$796.00	$190.99–$796.00	64% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 PR FEE DEST LUMB/SACR SINGLE FACET	$636.80	$796.00	$190.99–$796.00	—	20%
Removal of a breast lump, open surgery CPT 19120 EXC CYST, TUMOR, BENIGN OR MAL BREAST	$848.00	$1,060.00	$450.32–$1,060.00	70% below	20%
Removal of a breast lump, open surgery inpatient CPT 19120 EXC CYST, TUMOR, BENIGN OR MAL BREAST	$848.00	$1,060.00	$450.32–$1,060.00	—	20%
Removal of a foreign object under the skin, simple CPT 10120 Inc&rmvl fb subq smpl	$377.60	$472.00	$122.52–$416.78	6% above	20%
Removal of a foreign object under the skin, simple CPT 10120 Incision & removal of Foreign Body Simpl	$958.40	$1,198.00	$110.20–$1,057.83	168% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Inc&rmvl fb subq smpl	$377.60	$472.00	$122.52–$416.78	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & removal of Foreign Body Simpl	$958.40	$1,198.00	$110.20–$1,057.83	—	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 SCREENING COLONOSCOPY	$800.00	$1,000.00	$183.61–$883.00	8% below	20%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 SCREENING COLONOSCOPY	$800.00	$1,000.00	$183.61–$883.00	—	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 SCREENING COLONOSCOPY HIGH RISK	$800.00	$1,000.00	$183.18–$883.00	8% below	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 SCREENING COLONOSCOPY HIGH RISK	$800.00	$1,000.00	$183.18–$883.00	—	20%
Short arm cast (elbow to hand) CPT 29075 APPLICATION OF SHORT ARM CAST	$212.00	$265.00	$64.08–$234.00	2% below	20%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION OF SHORT ARM CAST	$212.00	$265.00	$64.08–$234.00	—	20%
Short arm splint (forearm and hand) CPT 29125 Apply forearm splint	$181.60	$227.00	$40.10–$200.44	3% above	20%
Short arm splint (forearm and hand) CPT 29125 APPLICATION OF SHORT ARM SPLINT	$181.60	$227.00	$40.10–$200.44	3% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION OF SHORT ARM SPLINT	$181.60	$227.00	$40.10–$200.44	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 Apply forearm splint	$181.60	$227.00	$40.10–$200.44	—	20%
Short leg cast (below the knee) CPT 29405 APPLICATION OF SHORT LEG CAST	$204.00	$255.00	$61.00–$225.16	25% below	20%
Short leg cast (below the knee) CPT 29405 Appl short leg cast	$226.40	$283.00	$81.74–$249.89	17% below	20%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION OF SHORT LEG CAST	$204.00	$255.00	$61.00–$225.16	—	20%
Short leg cast (below the knee) inpatient CPT 29405 Appl short leg cast	$226.40	$283.00	$81.74–$249.89	—	20%
Short leg splint (calf to foot) CPT 29515 Application lower leg splint	$189.60	$237.00	$48.98–$209.27	19% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 Application lower leg splint	$189.60	$237.00	$48.98–$209.27	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Repair Superf Wnd 2.5 cm or less	$254.40	$318.00	$60.47–$280.79	21% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair Superficial Wound 2.5 cm or less	$478.40	$598.00	$60.47–$528.03	128% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple Repair Superf Wnd 2.5 cm or less	$254.40	$318.00	$60.47–$280.79	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Repair Superficial Wound 2.5 cm or less	$478.40	$598.00	$60.47–$528.03	—	20%
Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy of Skin, 1 Lesion	$921.60	$1,152.00	$111.43–$1,017.22	191% above	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Biopsy of Skin, 1 Lesion	$921.60	$1,152.00	$111.43–$1,017.22	—	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS UP TO 15 ANY AREA	$90.40	$113.00	$60.47–$113.00	51% below	20%
Skin tag removal, up to 15 tags CPT 11200 REM SKIN TAGS; <=15 LESIONS	$155.20	$194.00	$60.47–$171.30	15% below	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS UP TO 15 ANY AREA	$90.40	$113.00	$60.47–$113.00	—	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 REM SKIN TAGS; <=15 LESIONS	$155.20	$194.00	$60.47–$171.30	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP DIAGNOSTIC	$141.60	$177.00	$66.74–$177.00	82% below	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL FLUID TAP DIAGNOSTIC	$141.60	$177.00	$66.74–$177.00	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple Repair Superf Wnd 2.6 cm - 7.5cm	$308.80	$386.00	$60.47–$340.84	28% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Repair Superficial Wound 2.6 cm - 7.5cm	$478.40	$598.00	$60.47–$528.03	99% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Simple Repair Superf Wnd 2.6 cm - 7.5cm	$308.80	$386.00	$60.47–$340.84	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Repair Superficial Wound 2.6 cm - 7.5cm	$478.40	$598.00	$60.47–$528.03	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Rpr f/e/e/n/l/m 2.5 cm/<	$303.20	$379.00	$60.47–$334.66	28% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Rpr f/e/e/n/l/m 2.5 cm/<	$303.20	$379.00	$60.47–$334.66	—	20%
TURP (transurethral resection of the prostate) CPT 52601 PF-Trurl elctrosurg resc bleed complete	$1,444.00	$1,805.00	$507.37–$1,805.00	43% below	20%
TURP (transurethral resection of the prostate) CPT 52601 PF-Trurl Electrosurg Resc Bleed Complete	$1,444.00	$1,805.00	$507.37–$1,805.00	43% below	20%
TURP (transurethral resection of the prostate) inpatient CPT 52601 PF-Trurl elctrosurg resc bleed complete	$1,444.00	$1,805.00	$507.37–$1,805.00	—	20%
TURP (transurethral resection of the prostate) inpatient CPT 52601 PF-Trurl Electrosurg Resc Bleed Complete	$1,444.00	$1,805.00	$507.37–$1,805.00	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential Biop of Skin,1 lesion	$478.40	$598.00	$87.72–$528.03	103% above	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential Biop of Skin,1 lesion	$478.40	$598.00	$87.72–$528.03	—	20%
Total knee replacement CPT 27447 Total knee arthroplasty	$10,528.80	$13,161.00	$1,120.16–$11,621.16	87% above	20%
Total knee replacement one side CPT 27447 PF ARTHROPLASTY TOTAL KNEE MED & LAT LT	$1,007.20	$1,259.00	$1,017.40–$1,288.18	82% below	20%
Total knee replacement one side CPT 27447 ARTHROPLASTY TOTAL KNEE MED & LAT RT	$2,769.00	$2,769.00	$922.63–$2,769.00	51% below	—
Total knee replacement inpatient CPT 27447 Total knee arthroplasty	$10,528.80	$13,161.00	$1,120.16–$11,621.16	—	20%
Total knee replacement inpatient one side CPT 27447 PF ARTHROPLASTY TOTAL KNEE MED & LAT LT	$1,007.20	$1,259.00	$1,017.40–$1,288.18	—	20%
Total knee replacement inpatient one side CPT 27447 ARTHROPLASTY TOTAL KNEE MED & LAT RT	$2,769.00	$2,769.00	$922.63–$2,769.00	—	—
Trigger finger release surgery CPT 26055 Incise finger tendon sheath	$1,863.20	$2,329.00	$484.63–$2,056.51	14% above	20%
Trigger finger release surgery inpatient CPT 26055 Incise finger tendon sheath	$1,863.20	$2,329.00	$484.63–$2,056.51	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION TRIGGER POINT 1 OR 2 MUSCLE	$68.80	$86.00	$39.44–$86.00	82% below	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION TRIGGER POINT 1 OR 2 MUSCLE	$68.80	$86.00	$39.44–$86.00	—	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD W TRANS BALLON DIL OF ESOPHAGUS	$243.20	$304.00	$151.17–$304.00	86% below	20%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 EGD W TRANS BALLON DIL OF ESOPHAGUS	$243.20	$304.00	$151.17–$304.00	—	20%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY	$900.00	$1,125.00	$136.98–$993.38	4% above	20%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD GASTROINTEST UNIT	$2,555.20	$3,194.00	$273.36–$2,820.30	195% above	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY	$900.00	$1,125.00	$136.98–$993.38	—	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD GASTROINTEST UNIT	$2,555.20	$3,194.00	$273.36–$2,820.30	—	20%
Upper endoscopy (EGD) with injection into the lining CPT 43236 EGD TRANSORAL W DIRECT SUBMUCOSAL INJECT	$485.60	$607.00	$136.98–$607.00	24% above	20%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 EGD TRANSORAL W DIRECT SUBMUCOSAL INJECT	$485.60	$607.00	$136.98–$607.00	—	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD TRANSORAL W REM TUMOR POLYPS SNARE	$409.60	$512.00	$192.27–$512.00	64% below	20%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD TRANSORAL W REM TUMOR POLYPS SNARE	$409.60	$512.00	$192.27–$512.00	—	20%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC	$500.00	$625.00	$122.39–$625.00	42% below	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC	$500.00	$625.00	$122.39–$625.00	—	20%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOSCOPY W LITHOTRIPSY	$1,003.20	$1,254.00	$334.92–$1,254.00	30% above	20%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTOSCOPY W LITHOTRIPSY	$1,003.20	$1,254.00	$334.92–$1,254.00	—	20%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTOSCOPY W LITHOTRIPSY & STENT INSERT	$1,061.60	$1,327.00	$356.07–$1,327.00	47% below	20%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTOSCOPY W LITHOTRIPSY & STENT INSERT	$1,061.60	$1,327.00	$356.07–$1,327.00	—	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY UNI OR BIL W/SEMEN EXAM	$897.60	$1,122.00	$238.61–$1,122.00	70% below	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY UNI OR BIL INC SEMEN EXAM	$924.80	$1,156.00	$238.61–$1,156.00	69% below	20%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY UNI OR BIL W/SEMEN EXAM	$897.60	$1,122.00	$238.61–$1,122.00	—	20%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY UNI OR BIL INC SEMEN EXAM	$924.80	$1,156.00	$238.61–$1,156.00	—	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESION 1-14	$127.20	$159.00	$60.47–$144.51	30% below	20%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LESION 1-14	$127.20	$159.00	$60.47–$144.51	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride, subq tissue - 1st 20 sq. cm	$948.00	$1,185.00	$61.66–$1,046.36	108% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debr,sub tissue - 1st 20 sq. cm	$958.40	$1,198.00	$122.35–$1,057.83	110% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 PRO FEE Debr,sub tissue - 1st 20 sq. cm	$958.40	$1,198.00	$61.66–$1,057.83	110% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride, Subq tissue - 1st 20 sq. cm	$958.40	$1,198.00	$61.66–$1,057.83	110% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride, subq tissue - 1st 20 sq. cm	$948.00	$1,185.00	$61.66–$1,046.36	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride, Subq tissue - 1st 20 sq. cm	$958.40	$1,198.00	$61.66–$1,057.83	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 PRO FEE Debr,sub tissue - 1st 20 sq. cm	$958.40	$1,198.00	$61.66–$1,057.83	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debr,sub tissue - 1st 20 sq. cm	$958.40	$1,198.00	$122.35–$1,057.83	—	20%

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 ADMIN	$104.00	$130.00	$42.65–$130.00	83% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion bld/bld compnt	$104.00	$130.00	$42.65–$130.00	83% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION OA	$1,013.60	$1,267.00	$42.65–$1,118.76	62% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION ER	$1,054.40	$1,318.00	$42.65–$1,163.79	68% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion bld/bld compnt	$104.00	$130.00	$42.65–$130.00	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION ADMIN	$104.00	$130.00	$42.65–$130.00	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION OA	$1,013.60	$1,267.00	$42.65–$1,118.76	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION ER	$1,054.40	$1,318.00	$42.65–$1,163.79	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM INDUCTION SUB	$60.80	$76.00	$7.84–$76.00	64% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM COLLECTION W/WO TX INITIAL	$63.20	$79.00	$7.84–$79.00	63% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI TX SUB	$74.40	$93.00	$7.84–$93.00	56% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI 2ND TREATMENT	$74.40	$93.00	$7.84–$93.00	56% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI 4TH TREATMENT	$74.40	$93.00	$7.84–$93.00	56% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI 3RD TREATMENT	$74.40	$93.00	$7.84–$93.00	56% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB INITIAL	$78.40	$98.00	$7.84–$98.00	54% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB SUB	$78.40	$98.00	$7.84–$98.00	54% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB SUB	$85.60	$107.00	$7.84–$107.00	50% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB 4TH TREATMENT	$85.60	$107.00	$7.84–$107.00	50% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB 3RD TREATMENT	$85.60	$107.00	$7.84–$107.00	50% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB 2ND TREATMENT	$85.60	$107.00	$7.84–$107.00	50% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB TX INITIAL	$99.20	$124.00	$7.84–$124.00	42% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM INDUCTION SUB	$60.80	$76.00	$7.84–$76.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM COLLECTION W/WO TX INITIAL	$63.20	$79.00	$7.84–$79.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI 2ND TREATMENT	$74.40	$93.00	$7.84–$93.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI TX SUB	$74.40	$93.00	$7.84–$93.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI 3RD TREATMENT	$74.40	$93.00	$7.84–$93.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI 4TH TREATMENT	$74.40	$93.00	$7.84–$93.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB SUB	$78.40	$98.00	$7.84–$98.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB INITIAL	$78.40	$98.00	$7.84–$98.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB 2ND TREATMENT	$85.60	$107.00	$7.84–$107.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB 3RD TREATMENT	$85.60	$107.00	$7.84–$107.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB 4TH TREATMENT	$85.60	$107.00	$7.84–$107.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB SUB	$85.60	$107.00	$7.84–$107.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB TX INITIAL	$99.20	$124.00	$7.84–$124.00	—	20%
Chemotherapy IV infusion, first hour CPT 96413 IV CHEMO THERAPY 1ST HR	$860.00	$1,075.00	$99.55–$949.22	84% above	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 IV CHEMO THERAPY 1ST HR	$860.00	$1,075.00	$99.55–$949.22	—	20%
Critical care, first 30 to 74 minutes CPT 99291 PF CRITICAL CARE FIRST HOUR	$579.20	$724.00	$223.31–$639.29	65% below	20%
Critical care, first 30 to 74 minutes CPT 99291 OBS PROF SERV CRITICAL CARE	$579.20	$724.00	$223.31–$639.29	65% below	20%
Critical care, first 30 to 74 minutes CPT 99291 OBS CRITICAL CARE	$2,066.40	$2,583.00	$248.96–$2,280.79	25% above	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR	$2,408.80	$3,011.00	$248.96–$2,658.71	46% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 OBS PROF SERV CRITICAL CARE	$579.20	$724.00	$223.31–$639.29	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 PF CRITICAL CARE FIRST HOUR	$579.20	$724.00	$223.31–$639.29	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 OBS CRITICAL CARE	$2,066.40	$2,583.00	$248.96–$2,280.79	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FIRST HOUR	$2,408.80	$3,011.00	$248.96–$2,658.71	—	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG awake and drowsy	$604.80	$756.00	$65.08–$667.55	10% below	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG NP	$669.60	$837.00	$65.08–$739.07	1% below	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG awake and drowsy	$604.80	$756.00	$65.08–$667.55	—	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG NP	$669.60	$837.00	$65.08–$739.07	—	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Ht muscle image spect mult	$110.40	$138.00	$14.38–$121.85	474% above	20%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Ht muscle image spect mult	$110.40	$138.00	$14.38–$121.85	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 RHC EKG WITH RHY	$124.00	$155.00	$6.35–$136.86	1% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$272.00	$340.00	$6.35–$300.22	121% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 RHC EKG WITH RHY	$124.00	$155.00	$6.35–$136.86	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$272.00	$340.00	$6.35–$300.22	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 SCREENING EXAM/EMTALA	$110.40	$138.00	$10.79–$121.85	16% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY LEVEL I	$114.40	$143.00	$10.79–$126.27	13% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 PF EMERGENCY LEVEL I	$114.40	$143.00	$10.79–$126.27	13% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 SCREENING EXAM/EMTALA	$110.40	$138.00	$10.79–$121.85	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 PF EMERGENCY LEVEL I	$114.40	$143.00	$10.79–$126.27	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY LEVEL I	$114.40	$143.00	$10.79–$126.27	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PF EMERGENCY LEVEL II	$176.80	$221.00	$39.59–$195.14	44% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY LEVEL II	$545.60	$682.00	$39.59–$602.21	72% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 PF EMERGENCY LEVEL II	$176.80	$221.00	$39.59–$195.14	—	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY LEVEL II	$545.60	$682.00	$39.59–$602.21	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 PF EMERGENCY LEVEL III	$303.20	$379.00	$68.13–$334.66	43% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY LEVEL III	$934.40	$1,168.00	$68.13–$1,031.34	77% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 PF EMERGENCY LEVEL III	$303.20	$379.00	$68.13–$334.66	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY LEVEL III	$934.40	$1,168.00	$68.13–$1,031.34	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PF EMERGENCY LEVEL IV	$639.20	$799.00	$116.07–$705.52	29% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY LEVEL IV	$1,487.20	$1,859.00	$116.07–$1,641.50	66% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 PF EMERGENCY LEVEL IV	$639.20	$799.00	$116.07–$705.52	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY LEVEL IV	$1,487.20	$1,859.00	$116.07–$1,641.50	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 PF EMERGENCY LEVEL V	$1,014.40	$1,268.00	$168.10–$1,119.64	18% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY LEVEL V	$2,149.60	$2,687.00	$168.10–$2,372.62	74% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 PF EMERGENCY LEVEL V	$1,014.40	$1,268.00	$168.10–$1,119.64	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY LEVEL V	$2,149.60	$2,687.00	$168.10–$2,372.62	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 ECG STRESS	$878.40	$1,098.00	$35.10–$969.53	14% above	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST TRACE	$878.40	$1,098.00	$35.10–$969.53	14% above	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 ECG STRESS	$878.40	$1,098.00	$35.10–$969.53	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVASCULAR STRESS TEST TRACE	$878.40	$1,098.00	$35.10–$969.53	—	20%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCH W/PT PRESENT (COJOINT)	$685.60	$857.00	$53.50–$756.73	420% above	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCH W/PT PRESENT (COJOINT)	$685.60	$857.00	$53.50–$756.73	—	20%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCH W/O PAT. PRESENT	$636.80	$796.00	$53.50–$702.87	372% above	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCH W/O PAT. PRESENT	$636.80	$796.00	$53.50–$702.87	—	20%
Group psychotherapy session CPT 90853 PSYCHOTHERAPY GROUP 60 MINUTES	$109.60	$137.00	$29.17–$120.97	87% above	20%
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY	$819.20	$1,024.00	$29.17–$904.19	1300% above	20%
Group psychotherapy session inpatient CPT 90853 PSYCHOTHERAPY GROUP 60 MINUTES	$109.60	$137.00	$29.17–$120.97	—	20%
Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY	$819.20	$1,024.00	$29.17–$904.19	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 1ST HOUR	$534.40	$668.00	$30.44–$589.84	112% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION THER 1ST HR	$534.40	$668.00	$30.44–$589.84	112% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION THER 1ST HR	$534.40	$668.00	$30.44–$589.84	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 1ST HOUR	$534.40	$668.00	$30.44–$589.84	—	20%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION 1ST HOUR	$534.40	$668.00	$60.95–$589.84	83% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY 1ST HOUR	$534.40	$668.00	$60.95–$589.84	83% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY 1ST HOUR	$534.40	$668.00	$60.95–$589.84	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION 1ST HOUR	$534.40	$668.00	$60.95–$589.84	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 TX/DX INJ SQ OR IM	$89.60	$112.00	$14.30–$98.90	2% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ SQ OR IM	$89.60	$112.00	$14.30–$98.90	2% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 TX/DX SQ OR IM	$89.60	$112.00	$14.30–$98.90	2% below	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 TX/DX SQ OR IM	$89.60	$112.00	$14.30–$98.90	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ SQ OR IM	$89.60	$112.00	$14.30–$98.90	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 TX/DX INJ SQ OR IM	$89.60	$112.00	$14.30–$98.90	—	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$260.00	$325.00	$53.50–$286.98	16% above	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$260.00	$325.00	$53.50–$286.98	—	20%
New patient office visit, about 30 minutes CPT 99203 PF NEW SPECIALTY MODERATE	$202.40	$253.00	$80.09–$223.40	84% above	20%
New patient office visit, about 30 minutes CPT 99203 Office o/p new low 30 min	$202.40	$253.00	$84.30–$223.40	84% above	20%
New patient office visit, about 30 minutes CPT 99203 CLINIC LEVEL C NEW PT	$202.40	$253.00	$84.30–$223.40	84% above	20%
New patient office visit, about 30 minutes CPT 99203 NEW SPECIALTY MODERATE	$202.40	$253.00	$84.30–$223.40	84% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 CLINIC LEVEL C NEW PT	$202.40	$253.00	$84.30–$223.40	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 PF NEW SPECIALTY MODERATE	$202.40	$253.00	$80.09–$223.40	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 Office o/p new low 30 min	$202.40	$253.00	$84.30–$223.40	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW SPECIALTY MODERATE	$202.40	$253.00	$84.30–$223.40	—	20%
New patient office visit, about 45 minutes CPT 99204 Office o/p new mod 45 min	$308.80	$386.00	$128.62–$340.84	161% above	20%
New patient office visit, about 45 minutes CPT 99204 CLINIC LEVEL D NEW PT	$308.80	$386.00	$128.62–$340.84	161% above	20%
New patient office visit, about 45 minutes CPT 99204 NEW SPECIALTY EXTENDED	$308.80	$386.00	$128.62–$340.84	161% above	20%
New patient office visit, about 45 minutes CPT 99204 PF NEW SPECIALTY EXTENDED	$308.80	$386.00	$130.75–$340.84	161% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW SPECIALTY EXTENDED	$308.80	$386.00	$128.62–$340.84	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 CLINIC LEVEL D NEW PT	$308.80	$386.00	$128.62–$340.84	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 Office o/p new mod 45 min	$308.80	$386.00	$128.62–$340.84	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 PF NEW SPECIALTY EXTENDED	$308.80	$386.00	$130.75–$340.84	—	20%
New patient office visit, about 60 minutes CPT 99205 Office o/p new hi 60 min	$220.00	$275.00	$91.63–$242.82	49% above	20%
New patient office visit, about 60 minutes CPT 99205 PF NEW SPECIALTY COMPREHENSIVE	$390.40	$488.00	$179.35–$430.90	165% above	20%
New patient office visit, about 60 minutes CPT 99205 NEW SPECIALTY COMPREHENSIVE	$390.40	$488.00	$162.60–$430.90	165% above	20%
New patient office visit, about 60 minutes CPT 99205 CLINIC LEVEL E NEW PT	$390.40	$488.00	$162.60–$430.90	165% above	20%
New patient office visit, about 60 minutes inpatient CPT 99205 Office o/p new hi 60 min	$220.00	$275.00	$91.63–$242.82	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW SPECIALTY COMPREHENSIVE	$390.40	$488.00	$162.60–$430.90	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 CLINIC LEVEL E NEW PT	$390.40	$488.00	$162.60–$430.90	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 PF NEW SPECIALTY COMPREHENSIVE	$390.40	$488.00	$179.35–$430.90	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 PF NEW SPECIALTY MINOR	$143.20	$179.00	$45.89–$158.06	91% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office o/p new sf 15 min	$143.20	$179.00	$59.64–$158.06	91% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 CLINIC LEVEL B NEW PT	$143.20	$179.00	$59.64–$158.06	91% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW SPECIALTY MINOR	$143.20	$179.00	$59.64–$158.06	91% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW SPECIALTY MINOR	$143.20	$179.00	$59.64–$158.06	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office o/p new sf 15 min	$143.20	$179.00	$59.64–$158.06	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 PF NEW SPECIALTY MINOR	$143.20	$179.00	$45.89–$158.06	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 CLINIC LEVEL B NEW PT	$143.20	$179.00	$59.64–$158.06	—	20%
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY INDIVIDUAL 16-37 MINUTES	$121.60	$152.00	$50.65–$134.22	14% below	20%
Psychotherapy session, 30 minutes CPT 90832 PSYTX W PT 30 MINUTES	$126.40	$158.00	$52.65–$139.51	11% below	20%
Psychotherapy session, 30 minutes CPT 90832 16-37 MINUTES INDIVIDUAL PSYCHOTHERAPY	$452.80	$566.00	$53.50–$499.78	220% above	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY INDIVIDUAL 16-37 MINUTES	$121.60	$152.00	$50.65–$134.22	—	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX W PT 30 MINUTES	$126.40	$158.00	$52.65–$139.51	—	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 16-37 MINUTES INDIVIDUAL PSYCHOTHERAPY	$452.80	$566.00	$53.50–$499.78	—	20%
Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY INDIVIDUAL 38-52 MINUTES	$186.40	$233.00	$53.50–$205.74	6% above	20%
Psychotherapy session, 45 minutes CPT 90834 PSYTX W PT 45 MINUTES	$200.80	$251.00	$53.50–$221.63	14% above	20%
Psychotherapy session, 45 minutes CPT 90834 38-52 MINUTES INDIVIDUAL PSYCHOTHERAPY	$552.00	$690.00	$53.50–$609.27	213% above	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY INDIVIDUAL 38-52 MINUTES	$186.40	$233.00	$53.50–$205.74	—	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX W PT 45 MINUTES	$200.80	$251.00	$53.50–$221.63	—	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 38-52 MINUTES INDIVIDUAL PSYCHOTHERAPY	$552.00	$690.00	$53.50–$609.27	—	20%
Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY INDIVIDUAL 53+ MINUTES	$241.60	$302.00	$53.50–$266.67	12% above	20%
Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES	$260.00	$325.00	$53.50–$286.98	20% above	20%
Psychotherapy session, 60 minutes CPT 90837 53-67 MINUTES INDIVIDUAL PSYCHOTHERAPY	$711.20	$889.00	$53.50–$784.99	229% above	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY INDIVIDUAL 53+ MINUTES	$241.60	$302.00	$53.50–$266.67	—	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MINUTES	$260.00	$325.00	$53.50–$286.98	—	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 53-67 MINUTES INDIVIDUAL PSYCHOTHERAPY	$711.20	$889.00	$53.50–$784.99	—	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco Use Cess Cnslng 3-10 min risk fa	$72.80	$91.00	$11.29–$80.35	129% above	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Behav chng smoking 3-10 min	$72.80	$91.00	$11.29–$80.35	129% above	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco Use Cess Cnslng 3-10 min risk fa	$72.80	$91.00	$11.29–$80.35	—	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Behav chng smoking 3-10 min	$72.80	$91.00	$11.29–$80.35	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 CLINIC LEVEL E1 EST PT	$287.20	$359.00	$119.62–$317.00	143% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST SPECIALTY COMPREHENSIVE	$287.20	$359.00	$119.62–$317.00	143% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PF EST SPECIALTY COMPREHENSIVE	$287.20	$359.00	$140.10–$317.00	143% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office o/p est hi 40 min	$287.20	$359.00	$119.62–$317.00	143% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PF EST SPECIALTY COMPREHENSIVE	$287.20	$359.00	$140.10–$317.00	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office o/p est hi 40 min	$287.20	$359.00	$119.62–$317.00	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST SPECIALTY COMPREHENSIVE	$287.20	$359.00	$119.62–$317.00	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 CLINIC LEVEL E1 EST PT	$287.20	$359.00	$119.62–$317.00	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CLINIC LEVEL C1 EST PT	$148.00	$185.00	$61.64–$163.36	60% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office o/p est low 20 min	$148.00	$185.00	$61.64–$163.36	60% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PF EST SPECIALTYMODERATE	$148.00	$185.00	$64.10–$163.36	60% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST SPECIALTYMODERATE	$148.00	$185.00	$61.64–$163.36	60% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office o/p est low 20 min	$148.00	$185.00	$61.64–$163.36	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 CLINIC LEVEL C1 EST PT	$148.00	$185.00	$61.64–$163.36	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST SPECIALTYMODERATE	$148.00	$185.00	$61.64–$163.36	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PF EST SPECIALTYMODERATE	$148.00	$185.00	$64.10–$163.36	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CLINIC LEVEL D1 EST PT	$214.40	$268.00	$89.30–$236.64	81% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office o/p est mod 30 min	$214.40	$268.00	$89.30–$236.64	81% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PF EST SPECIALTY EXTENDED	$214.40	$268.00	$94.37–$236.64	81% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST SPECIALTY EXTENDED	$214.40	$268.00	$89.30–$236.64	81% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST SPECIALTY EXTENDED	$214.40	$268.00	$89.30–$236.64	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PF EST SPECIALTY EXTENDED	$214.40	$268.00	$94.37–$236.64	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office o/p est mod 30 min	$214.40	$268.00	$89.30–$236.64	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 CLINIC LEVEL D1 EST PT	$214.40	$268.00	$89.30–$236.64	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PF EST SPECIALTY MINOR	$93.60	$117.00	$34.74–$103.31	110% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST SPECIALTY MINOR	$93.60	$117.00	$38.98–$103.31	110% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CLINIC LEVEL B1 EST PT	$93.60	$117.00	$38.98–$103.31	110% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office o/p est sf 10 min	$93.60	$117.00	$38.98–$103.31	110% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 CLINIC LEVEL B1 EST PT	$93.60	$117.00	$38.98–$103.31	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST SPECIALTY MINOR	$93.60	$117.00	$38.98–$103.31	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PF EST SPECIALTY MINOR	$93.60	$117.00	$34.74–$103.31	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office o/p est sf 10 min	$93.60	$117.00	$38.98–$103.31	—	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY W/MVV	$155.20	$194.00	$27.22–$171.30	17% below	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY NO BRONCHOLDIL	$155.20	$194.00	$27.22–$171.30	17% below	20%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY W/MVV	$155.20	$194.00	$27.22–$171.30	—	20%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY NO BRONCHOLDIL	$155.20	$194.00	$27.22–$171.30	—	20%
Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY WITH BRONCHODI	$428.80	$536.00	$39.59–$473.29	9% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY WITH BRONCHODI	$428.80	$536.00	$39.59–$473.29	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY PROCEDURE	$250.40	$313.00	$40.10–$276.38	19% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY PROCEDURE	$250.40	$313.00	$40.10–$276.38	—	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 Cardiovascular stress test	$761.60	$952.00	$68.11–$840.62	659% above	20%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 Cardiovascular stress test	$761.60	$952.00	$68.11–$840.62	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACC LIVE	$641.52	$801.90	$267.20–$708.08	218% above	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACC LIVE	$641.52	$801.90	$267.20–$708.08	—	20%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 50U/1ML ADULT	$262.40	$328.00	$72.07–$289.62	141% above	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE 50U/1ML ADULT	$262.40	$328.00	$72.07–$289.62	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B (ENGERIX) VACCINE ADULT	$292.00	$365.00	$73.64–$322.30	264% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B (ENGERIX) VACCINE ADULT	$292.00	$365.00	$73.64–$322.30	—	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VACCINE (FLUZONE) HIGH-DOSE	$204.80	$256.00	$85.30–$226.05	203% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VACCINE (FLUZONE) HIGH-DOSE	$204.80	$256.00	$85.30–$226.05	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES/MUMPS/RUBELLA VACC	$351.44	$439.30	$146.37–$387.90	171% above	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES/MUMPS/RUBELLA VACC	$351.44	$439.30	$146.37–$387.90	—	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOC VACC ACY W-135 DIP	$184.00	$230.00	$76.64–$203.09	2% above	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOC VACC ACY W-135 DIP	$184.00	$230.00	$76.64–$203.09	—	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 BEXSERO 0.5ML MENINGOCOCCAL B	$828.32	$1,035.40	$345.00–$914.26	181% above	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 BEXSERO 0.5ML MENINGOCOCCAL B	$828.32	$1,035.40	$345.00–$914.26	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL (PNEUMOVAX 23) VACC.	$419.32	$524.15	$130.80–$462.82	191% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL (PNEUMOVAX 23) VACC.	$419.32	$524.15	$130.80–$462.82	—	20%
Rabies vaccine, one dose CPT 90675 IMOVAX RABIES 2.5U	$894.40	$1,118.00	$92.99–$987.19	73% above	20%
Rabies vaccine, one dose inpatient CPT 90675 IMOVAX RABIES 2.5U	$894.40	$1,118.00	$92.99–$987.19	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS DIPHTHER TOXOID ADULT	$172.60	$215.75	$38.19–$190.51	230% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS DIPHTHER TOXOID ADULT	$172.60	$215.75	$38.19–$190.51	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET/DIPHTH/PERTUSS (ADACEL) VAC	$200.08	$250.10	$38.90–$220.84	203% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET DIPHTH PERTUSS (BOOSTRIX) VACC	$204.96	$256.20	$38.90–$226.22	210% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET/DIPHTH/PERTUSS (ADACEL) VAC	$200.08	$250.10	$38.90–$220.84	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET DIPHTH PERTUSS (BOOSTRIX) VACC	$204.96	$256.20	$38.90–$226.22	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN ADMN ONE VACCINE	$89.60	$112.00	$20.28–$98.90	289% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN ADMIN OVER 18 INJ SQ OR IM	$89.60	$112.00	$20.28–$98.90	289% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMN ONE VACCINE	$89.60	$112.00	$20.28–$98.90	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMIN OVER 18 INJ SQ OR IM	$89.60	$112.00	$20.28–$98.90	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN ADMN EACH ADDTNAL	$20.00	$25.00	$8.33–$22.08	2% above	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADMN EACH ADDTNAL	$20.00	$25.00	$8.33–$22.08	—	20%

Source file: https://sheridanhospital.com/wp-content/uploads/2026/04/381369796_sheridan-community-hospital_standardcharges.csv