Hospital

McKenzie Memorial Hospital

McKenzie Memorial Hospital in Sandusky, MI publishes cash prices for 339 common procedures listed here, from its own machine-readable price file updated May 31, 2025. Compared with other hospitals in the state, its outpatient cash prices are below the Michigan median for 203 of 336 procedures and above it for 126. By typical cash price it ranks #32 of 98 Michigan hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

120_N._Delaware_St_Sandusky_MI_48471 Collected Nov 8, 2026 Source price file Check a bill from this hospital (810) 648-3770

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 231314 · CMS hospital register

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

McKenzie Memorial Hospital is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W , W/O CONTRAST+	$1,608.00	$2,010.00	$168.06–$1,820.06	3% above	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W , W/O CONTRAST+	$1,608.00	$2,010.00	$168.06–$1,820.06	—	20%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN 2 VIEW FREQ	$134.40	$168.00	$23.64–$152.12	36% below	20%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN 2 VIEW	$134.40	$168.00	$23.64–$152.12	36% below	20%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN 2 VIEW	$134.40	$168.00	$23.64–$152.12	—	20%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN 2 VIEW FREQ	$134.40	$168.00	$23.64–$152.12	—	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE 3 VIEW RIGHT	$116.80	$146.00	$23.22–$132.20	45% below	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE 3 VIEW LEFT	$116.80	$146.00	$23.22–$132.20	45% below	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE 3 VIEW RIGHT	$116.80	$146.00	$23.22–$132.20	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE 3 VIEW LEFT	$116.80	$146.00	$23.22–$132.20	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI, EXTREMITY ARTERIAL STUDIES	$438.40	$548.00	$52.19–$496.21	36% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABI, EXTREMITY ARTERIAL STUDIES	$438.40	$548.00	$52.19–$496.21	—	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPPER EXT RIGHT W/O CONTRAST+	$997.60	$1,247.00	$104.16–$1,129.16	1% below	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPPER EXT LEFT W/O CONTRAST+	$997.60	$1,247.00	$104.16–$1,129.16	1% below	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXT LEFT W/O CONTRAST+	$997.60	$1,247.00	$104.16–$1,129.16	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXT RIGHT W/O CONTRAST+	$997.60	$1,247.00	$104.16–$1,129.16	—	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS	$337.60	$422.00	$61.34–$382.12	17% above	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS	$337.60	$422.00	$61.34–$382.12	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SCAN WHOLE BODY+	$1,327.20	$1,659.00	$168.70–$1,502.22	34% above	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE SCAN WHOLE BODY+	$1,327.20	$1,659.00	$168.70–$1,502.22	—	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE LEFT	$534.40	$668.00	$65.18–$604.87	72% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE RIGHT	$534.40	$668.00	$65.18–$604.87	72% above	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE LEFT	$534.40	$668.00	$65.18–$604.87	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE RIGHT	$534.40	$668.00	$65.18–$604.87	—	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED LEFT	$440.00	$550.00	$54.10–$498.03	63% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED RIGHT	$440.00	$550.00	$54.10–$498.03	63% above	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED LEFT	$440.00	$550.00	$54.10–$498.03	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED RIGHT	$440.00	$550.00	$54.10–$498.03	—	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABDOMEN/PELVIS W W/O CONTRAST+	$2,384.00	$2,980.00	$246.44–$2,698.39	4% below	20%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABDOMEN/PELVIS W W/O CONTRAST+	$2,384.00	$2,980.00	$246.44–$2,698.39	—	20%
CT angiography (CTA) of the neck CPT 70498 CTA NECK W , W/O CONTRAST+	$1,801.60	$2,252.00	$179.13–$2,039.19	20% above	20%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W , W/O CONTRAST+	$1,801.60	$2,252.00	$179.13–$2,039.19	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA THORAX+	$1,840.00	$2,300.00	$182.97–$2,082.65	10% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA THORAX+	$1,840.00	$2,300.00	$182.97–$2,082.65	—	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA HEART ANGIOGRAPHY W 3D IMAGING+	$1,464.00	$1,830.00	$209.59–$1,657.07	10% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA HEART ANGIOGRAPHY W 3D IMAGING+	$1,464.00	$1,830.00	$209.59–$1,657.07	—	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART W/O CONTRAST W QUANT EVAL	$264.00	$330.00	$65.18–$298.82	76% above	20%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HEART W/O CONTRAST W QUANT EVAL	$264.00	$330.00	$65.18–$298.82	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD / PELVIS WITHOUT CONTRAST	$1,240.80	$1,551.00	$119.07–$1,404.43	31% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/ ORAL CONTRAST	$1,240.80	$1,551.00	$119.07–$1,404.43	31% below	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD / PELVIS WITHOUT CONTRAST	$1,240.80	$1,551.00	$119.07–$1,404.43	—	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/ ORAL CONTRAST	$1,240.80	$1,551.00	$119.07–$1,404.43	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELVIS WITH IV CONTRAST ONLY+	$1,910.40	$2,388.00	$195.75–$2,162.33	32% below	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD /PELVIS W ORAL / IV CONTRAST+	$1,910.40	$2,388.00	$195.75–$2,162.33	32% below	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELVIS WITH IV CONTRAST ONLY+	$1,910.40	$2,388.00	$195.75–$2,162.33	—	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD /PELVIS W ORAL / IV CONTRAST+	$1,910.40	$2,388.00	$195.75–$2,162.33	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD / PELVIS WITH , W/O CONTRAST+	$2,165.60	$2,707.00	$219.18–$2,451.19	17% below	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD / PELVIS WITH , W/O CONTRAST+	$2,165.60	$2,707.00	$219.18–$2,451.19	—	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W ORAL , IV CONTRAST+	$1,414.40	$1,768.00	$149.53–$1,600.92	4% below	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ IV CONTRAST ONLY+	$1,414.40	$1,768.00	$149.53–$1,600.92	4% below	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ IV CONTRAST ONLY+	$1,414.40	$1,768.00	$149.53–$1,600.92	—	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W ORAL , IV CONTRAST+	$1,414.40	$1,768.00	$149.53–$1,600.92	—	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/ ORAL CONTRAST	$924.80	$1,156.00	$88.40–$1,046.76	at median	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$924.80	$1,156.00	$88.40–$1,046.76	at median	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/ ORAL CONTRAST	$924.80	$1,156.00	$88.40–$1,046.76	—	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$924.80	$1,156.00	$88.40–$1,046.76	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL/SINUS W/O	$860.80	$1,076.00	$83.07–$974.32	15% below	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL/SINUS W/O	$860.80	$1,076.00	$83.07–$974.32	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CONTRAST	$716.80	$896.00	$69.23–$811.33	20% below	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CONTRAST	$716.80	$896.00	$69.23–$811.33	—	20%
CT scan of the head with contrast CPT 70460 CT HEAD WITH CONTRAST+	$996.00	$1,245.00	$96.28–$1,127.35	20% below	20%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD WITH CONTRAST+	$996.00	$1,245.00	$96.28–$1,127.35	—	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/W/O CONTRAST+	$1,181.60	$1,477.00	$112.46–$1,337.42	24% below	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/W/O CONTRAST+	$1,181.60	$1,477.00	$112.46–$1,337.42	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$997.60	$1,247.00	$83.92–$1,129.16	8% below	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$997.60	$1,247.00	$83.92–$1,129.16	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERV SP W/O CONTRAST	$1,020.80	$1,276.00	$84.34–$1,155.42	8% below	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERV SP W/O CONTRAST	$1,020.80	$1,276.00	$84.34–$1,155.42	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ ORAL , IV CONTRAST+	$1,385.60	$1,732.00	$146.97–$1,568.33	2% above	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ IV CONTRAST ONLY+	$1,385.60	$1,732.00	$146.97–$1,568.33	2% above	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ ORAL , IV CONTRAST+	$1,385.60	$1,732.00	$146.97–$1,568.33	—	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ IV CONTRAST ONLY+	$1,385.60	$1,732.00	$146.97–$1,568.33	—	20%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID VERBR DUPLEX	$943.20	$1,179.00	$119.71–$1,067.58	9% above	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID VERBR DUPLEX	$943.20	$1,179.00	$119.71–$1,067.58	—	20%
Chest CT scan without and with contrast CPT 71270 CT THORAX W/WO CONTRAST+	$1,684.80	$2,106.00	$127.16–$1,906.98	4% below	20%
Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX W/WO CONTRAST+	$1,684.80	$2,106.00	$127.16–$1,906.98	—	20%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEW XRAY FREQ	$105.60	$132.00	$21.51–$119.53	41% below	20%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEW XRAY	$105.60	$132.00	$21.51–$119.53	41% below	20%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEW XRAY FREQ	$105.60	$132.00	$21.51–$119.53	—	20%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEW XRAY	$105.60	$132.00	$21.51–$119.53	—	20%
Chest X-ray, single view CPT 71045 CHEST 1V XRAY	$87.20	$109.00	$16.61–$98.70	43% below	20%
Chest X-ray, single view CPT 71045 CHEST 1V XRAY FREQ	$87.20	$109.00	$16.61–$98.70	43% below	20%
Chest X-ray, single view inpatient CPT 71045 CHEST 1V XRAY FREQ	$87.20	$109.00	$16.61–$98.70	—	20%
Chest X-ray, single view inpatient CPT 71045 CHEST 1V XRAY	$87.20	$109.00	$16.61–$98.70	—	20%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE LEFT	$104.00	$130.00	$20.87–$117.72	41% below	20%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE RIGHT	$104.00	$130.00	$20.87–$117.72	41% below	20%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE RIGHT	$104.00	$130.00	$20.87–$117.72	—	20%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE LEFT	$104.00	$130.00	$20.87–$117.72	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPLETE	$561.60	$702.00	$66.80–$635.66	7% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMPLETE	$561.60	$702.00	$66.80–$635.66	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY AXIAL SKELETON	$156.80	$196.00	$25.13–$177.48	49% below	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY AXIAL SKELETON	$156.80	$196.00	$25.13–$177.48	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BONE DENSITY PERIPHERAL EXTREMITY	$106.40	$133.00	$20.45–$120.43	17% below	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BONE DENSITY PERIPHERAL EXTREMITY	$106.40	$133.00	$20.45–$120.43	—	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE+	$917.60	$1,147.00	$113.32–$1,038.61	27% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMPLETE+	$917.60	$1,147.00	$113.32–$1,038.61	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX W/O CONTRAST	$1,003.20	$1,254.00	$86.27–$1,135.50	at median	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX W/O CONTRAST	$1,003.20	$1,254.00	$86.27–$1,135.50	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX W/CONTRAST+	$1,405.60	$1,757.00	$86.27–$1,590.96	7% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX W/CONTRAST+	$1,405.60	$1,757.00	$86.27–$1,590.96	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 DIGITAL MAMM DIAGNOSTIC BILATERAL	$645.60	$807.00	$101.18–$730.74	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIGITAL MAMM DIAGNOSTIC BILATERAL	$645.60	$807.00	$101.18–$730.74	—	20%
Diagnostic mammogram, one breast one side CPT 77065 DIGITAL MAMM DIAGNOSTIC UNILATERAL	$512.80	$641.00	$80.30–$580.43	65% above	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 DIGITAL MAMM DIAGNOSTIC UNILATERAL	$512.80	$641.00	$80.30–$580.43	—	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US ARTERIAL DUPLEX BIL	$937.60	$1,172.00	$150.80–$1,061.25	31% above	20%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US ARTERIAL DUPLEX BIL	$937.60	$1,172.00	$150.80–$1,061.25	—	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 US VENOUS DUPL BIL	$916.00	$1,145.00	$117.79–$1,036.80	48% above	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VENOUS DUPL BIL	$916.00	$1,145.00	$117.79–$1,036.80	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAPHY +	$1,358.40	$1,698.00	$123.75–$1,537.54	2% below	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAPHY +	$1,358.40	$1,698.00	$123.75–$1,537.54	—	20%
Elbow X-ray, 2 views one side CPT 73070 ELBOW 2 VIEW LEFT	$102.40	$128.00	$18.74–$115.90	24% below	20%
Elbow X-ray, 2 views one side CPT 73070 ELBOW 2 VIEW RIGHT	$102.40	$128.00	$18.74–$115.90	24% below	20%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW 2 VIEW RIGHT	$102.40	$128.00	$18.74–$115.90	—	20%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW 2 VIEW LEFT	$102.40	$128.00	$18.74–$115.90	—	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW 3 VIEW RIGHT	$117.60	$147.00	$20.87–$133.11	38% below	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW 3 VIEW LEFT	$117.60	$147.00	$20.87–$133.11	38% below	20%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW 3 VIEW LEFT	$117.60	$147.00	$20.87–$133.11	—	20%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW 3 VIEW RIGHT	$117.60	$147.00	$20.87–$133.11	—	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT MASTOIDS W/O CONTRAST	$1,088.80	$1,361.00	$103.09–$1,232.39	7% above	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC WO CONTRAST	$1,088.80	$1,361.00	$103.09–$1,232.39	7% above	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT W/O CONTRAST	$1,088.80	$1,361.00	$103.09–$1,232.39	7% above	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT MASTOIDS W/O CONTRAST	$1,088.80	$1,361.00	$103.09–$1,232.39	—	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IAC WO CONTRAST	$1,088.80	$1,361.00	$103.09–$1,232.39	—	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT W/O CONTRAST	$1,088.80	$1,361.00	$103.09–$1,232.39	—	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES COMPLETE	$156.80	$196.00	$29.82–$177.48	40% below	20%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES COMPLETE	$156.80	$196.00	$29.82–$177.48	—	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM XR 2 VIEW RIGHT	$97.60	$122.00	$18.74–$110.47	45% below	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM XR 2 VIEW LEFT	$97.60	$122.00	$18.74–$110.47	45% below	20%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM XR 2 VIEW RIGHT	$97.60	$122.00	$18.74–$110.47	—	20%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM XR 2 VIEW LEFT	$97.60	$122.00	$18.74–$110.47	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBIL IMAG W/O FUNCTION	$1,740.00	$2,175.00	$185.31–$1,969.46	86% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBIL IMAG W/O FUNCTION	$1,740.00	$2,175.00	$185.31–$1,969.46	—	20%
Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEW LEFT	$99.20	$124.00	$20.02–$112.28	32% below	20%
Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEW RIGHT	$99.20	$124.00	$20.02–$112.28	32% below	20%
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEW RIGHT	$99.20	$124.00	$20.02–$112.28	—	20%
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEW LEFT	$99.20	$124.00	$20.02–$112.28	—	20%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 OSCALCIS LEFT	$102.40	$128.00	$18.11–$115.90	34% below	20%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 OSCALCIS RIGHT	$102.40	$128.00	$18.11–$115.90	34% below	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 OSCALCIS RIGHT	$102.40	$128.00	$18.11–$115.90	—	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 OSCALCIS LEFT	$102.40	$128.00	$18.11–$115.90	—	20%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEW RIGHT	$136.00	$170.00	$25.99–$153.94	30% below	20%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEW LEFT	$136.00	$170.00	$25.99–$153.94	30% below	20%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEW RIGHT	$136.00	$170.00	$25.99–$153.94	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEW LEFT	$136.00	$170.00	$25.99–$153.94	—	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE RIGHT 4 VIEW	$148.80	$186.00	$30.25–$168.42	30% below	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE LEFT 4 VIEW	$148.80	$186.00	$30.25–$168.42	30% below	20%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE LEFT 4 VIEW	$148.80	$186.00	$30.25–$168.42	—	20%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE RIGHT 4 VIEW	$148.80	$186.00	$30.25–$168.42	—	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXT LEFT W/O CONTRAST+	$997.60	$1,247.00	$84.14–$1,129.16	9% below	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXT RIGHT W/O CONTRAST+	$997.60	$1,247.00	$84.14–$1,129.16	9% below	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXT RIGHT W/O CONTRAST+	$997.60	$1,247.00	$84.14–$1,129.16	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXT LEFT W/O CONTRAST+	$997.60	$1,247.00	$84.14–$1,129.16	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED	$346.40	$433.00	$55.38–$392.08	26% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SOFT TISSUE, LOWER BACK	$346.40	$433.00	$55.38–$392.08	26% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SOFT TISSUE, ABD WALL	$346.40	$433.00	$55.38–$392.08	26% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SOFT TISSUE, ABD WALL	$346.40	$433.00	$55.38–$392.08	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED	$346.40	$433.00	$55.38–$392.08	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SOFT TISSUE, LOWER BACK	$346.40	$433.00	$55.38–$392.08	—	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US SOFT TISSUE, GROIN	$346.40	$433.00	$41.11–$392.08	5% below	20%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US SOFT TIS LIMITED LEFT	$184.00	$230.00	$41.11–$208.27	49% below	20%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US SOFT TISSUE LIMITED RT	$184.00	$230.00	$41.11–$208.27	49% below	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US SOFT TISSUE, GROIN	$346.40	$433.00	$41.11–$392.08	—	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US SOFT TISSUE LIMITED RT	$184.00	$230.00	$41.11–$208.27	—	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US SOFT TIS LIMITED LEFT	$184.00	$230.00	$41.11–$208.27	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LOW DOSE LUNG CANCER SCREENING	$398.40	$498.00	$89.25–$450.94	14% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LOW DOSE LUNG CANCER SCREENING	$398.40	$498.00	$89.25–$450.94	—	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA AND FIBULA LEFT	$107.20	$134.00	$20.24–$121.34	42% below	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA AND FIBULA RIGHT	$107.20	$134.00	$20.24–$121.34	42% below	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA AND FIBULA RIGHT	$107.20	$134.00	$20.24–$121.34	—	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA AND FIBULA LEFT	$107.20	$134.00	$20.24–$121.34	—	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRV HEAD W/O CONTRAST	$1,992.00	$2,490.00	$139.73–$2,254.70	28% above	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRA BRAIN/HEAD WO CONTRAST	$1,992.00	$2,490.00	$139.73–$2,254.70	28% above	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV HEAD W/O CONTRAST	$1,992.00	$2,490.00	$139.73–$2,254.70	—	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA BRAIN/HEAD WO CONTRAST	$1,992.00	$2,490.00	$139.73–$2,254.70	—	20%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST W/W/O CONTRAST BILATERAL	$4,883.20	$6,104.00	$221.73–$5,527.17	—	20%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BREAST W/W/O CONTRAST BILATERAL	$4,883.20	$6,104.00	$221.73–$5,527.17	—	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE WO CONTRAST LEFT	$1,992.00	$2,490.00	$131.85–$2,254.70	23% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$131.85–$2,254.70	23% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$131.85–$2,254.70	23% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST LEFT	$1,992.00	$2,490.00	$131.85–$2,254.70	23% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOWER JOINT W/O CONTRAST LEFT	$1,992.00	$2,490.00	$131.85–$2,254.70	23% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOWER JOINT W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$131.85–$2,254.70	23% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST LEFT	$1,992.00	$2,490.00	$131.85–$2,254.70	23% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE WO CONTRAST RIGHT	$1,992.00	$2,490.00	$131.85–$2,254.70	23% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LOWER JOINT W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$131.85–$2,254.70	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE WO CONTRAST RIGHT	$1,992.00	$2,490.00	$131.85–$2,254.70	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$131.85–$2,254.70	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST LEFT	$1,992.00	$2,490.00	$131.85–$2,254.70	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$131.85–$2,254.70	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST LEFT	$1,992.00	$2,490.00	$131.85–$2,254.70	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE WO CONTRAST LEFT	$1,992.00	$2,490.00	$131.85–$2,254.70	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LOWER JOINT W/O CONTRAST LEFT	$1,992.00	$2,490.00	$131.85–$2,254.70	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOWER JOINT W/W/O CONTRAST LEFT	$3,906.40	$4,883.00	$248.57–$4,421.56	56% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/W/O CONTRAST LEFT	$3,906.40	$4,883.00	$248.57–$4,421.56	56% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/&W/O CONTRAST RIGHT	$3,906.40	$4,883.00	$248.57–$4,421.56	56% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/&W/O CONTRAST RIGHT	$3,906.40	$4,883.00	$248.57–$4,421.56	56% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOWER JOINT W/W/O CONTRAST RIGHT	$3,906.40	$4,883.00	$248.57–$4,421.56	56% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/W/O CONTRAST LEFT	$3,906.40	$4,883.00	$248.57–$4,421.56	56% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/W/O CONTRAST RIGHT	$3,906.40	$4,883.00	$248.57–$4,421.56	56% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE WWO CONTRAST LEFT	$3,906.40	$4,883.00	$248.57–$4,421.56	56% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/W/O CONTRAST RIGHT	$3,906.40	$4,883.00	$248.57–$4,421.56	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/&W/O CONTRAST RIGHT	$3,906.40	$4,883.00	$248.57–$4,421.56	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/&W/O CONTRAST RIGHT	$3,906.40	$4,883.00	$248.57–$4,421.56	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/W/O CONTRAST LEFT	$3,906.40	$4,883.00	$248.57–$4,421.56	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LOWER JOINT W/W/O CONTRAST RIGHT	$3,906.40	$4,883.00	$248.57–$4,421.56	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LOWER JOINT W/W/O CONTRAST LEFT	$3,906.40	$4,883.00	$248.57–$4,421.56	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/W/O CONTRAST LEFT	$3,906.40	$4,883.00	$248.57–$4,421.56	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE WWO CONTRAST LEFT	$3,906.40	$4,883.00	$248.57–$4,421.56	—	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,992.00	$2,490.00	$126.74–$2,254.70	16% above	20%
MRI of the abdomen without contrast CPT 74181 MRI MRCP ABDOMEN W/O CONTRAST	$1,992.00	$2,490.00	$126.74–$2,254.70	16% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,992.00	$2,490.00	$126.74–$2,254.70	—	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP ABDOMEN W/O CONTRAST	$1,992.00	$2,490.00	$126.74–$2,254.70	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/W/O CONTRAST	$3,906.40	$4,883.00	$218.96–$4,421.56	24% above	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI MRCP ABDOMEN W/WO CONTRAST	$3,906.40	$4,883.00	$218.96–$4,421.56	24% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/W/O CONTRAST	$3,906.40	$4,883.00	$218.96–$4,421.56	—	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI MRCP ABDOMEN W/WO CONTRAST	$3,906.40	$4,883.00	$218.96–$4,421.56	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI IAC W/O CONTRAST	$1,992.00	$2,490.00	$127.37–$2,254.70	18% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$1,992.00	$2,490.00	$127.37–$2,254.70	18% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONT HYDROCEPHALUS SCRN	$1,992.00	$2,490.00	$127.37–$2,254.70	18% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI PITUITARY W/O CONTRAST	$1,992.00	$2,490.00	$127.37–$2,254.70	18% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST STROKE PROTOCOL	$1,992.00	$2,490.00	$127.37–$2,254.70	18% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI PITUITARY W/O CONTRAST	$1,992.00	$2,490.00	$127.37–$2,254.70	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$1,992.00	$2,490.00	$127.37–$2,254.70	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST STROKE PROTOCOL	$1,992.00	$2,490.00	$127.37–$2,254.70	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI IAC W/O CONTRAST	$1,992.00	$2,490.00	$127.37–$2,254.70	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONT HYDROCEPHALUS SCRN	$1,992.00	$2,490.00	$127.37–$2,254.70	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI PITUITARY W/W/O CONTRAST	$3,906.40	$4,883.00	$206.82–$4,421.56	38% above	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI IAC W/W/O CONTRAST	$3,906.40	$4,883.00	$206.82–$4,421.56	38% above	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/W/O CONTRAST	$3,906.40	$4,883.00	$206.82–$4,421.56	38% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/W/O CONTRAST	$3,906.40	$4,883.00	$206.82–$4,421.56	—	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI IAC W/W/O CONTRAST	$3,906.40	$4,883.00	$206.82–$4,421.56	—	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI PITUITARY W/W/O CONTRAST	$3,906.40	$4,883.00	$206.82–$4,421.56	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE LUMBAR W/O CONTRAST	$1,992.00	$2,490.00	$123.97–$2,254.70	10% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINE LUMBAR W/O CONTRAST	$1,992.00	$2,490.00	$123.97–$2,254.70	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINE LUMBAR W/W/O CONTRAST	$3,906.40	$4,883.00	$207.04–$4,421.56	43% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI SPINE LUMBAR W/W/O CONTRAST	$3,906.40	$4,883.00	$207.04–$4,421.56	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINE THORACIC W/O CONTRAST	$1,992.00	$2,490.00	$123.75–$2,254.70	17% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI SPINE THORACIC W/O CONTRAST	$1,992.00	$2,490.00	$123.75–$2,254.70	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINE CERVICAL W/W/O CONTRAST	$3,906.40	$4,883.00	$207.46–$4,421.56	38% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI SPINE CERVICAL W/W/O CONTRAST	$3,906.40	$4,883.00	$207.46–$4,421.56	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SPINE CERVICAL W/O CONTRAST	$1,992.00	$2,490.00	$123.54–$2,254.70	13% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI SPINE CERVICAL W/O CONTRAST	$1,992.00	$2,490.00	$123.54–$2,254.70	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/W/O CONTRAST	$3,906.40	$4,883.00	$218.11–$4,421.56	40% above	20%
MRI of the pelvis without and with contrast CPT 72197 MRI SACRUM/SI JTS W/W/O CONTRAST	$3,906.40	$4,883.00	$218.11–$4,421.56	40% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI SACRUM/SI JTS W/W/O CONTRAST	$3,906.40	$4,883.00	$218.11–$4,421.56	—	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/W/O CONTRAST	$3,906.40	$4,883.00	$218.11–$4,421.56	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI SACRUM/SI JTS W/O CONTRAST	$1,992.00	$2,490.00	$147.82–$2,254.70	17% above	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$1,992.00	$2,490.00	$147.82–$2,254.70	17% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI SACRUM/SI JTS W/O CONTRAST	$1,992.00	$2,490.00	$147.82–$2,254.70	—	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$1,992.00	$2,490.00	$147.82–$2,254.70	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST LEFT	$1,992.00	$2,490.00	$132.06–$2,254.70	6% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST LEFT	$1,992.00	$2,490.00	$132.06–$2,254.70	6% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$132.06–$2,254.70	6% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$132.06–$2,254.70	6% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UPPER JOINT W/O CONTRAST LEFT	$1,992.00	$2,490.00	$132.06–$2,254.70	6% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UPPER JOINT W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$132.06–$2,254.70	6% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$132.06–$2,254.70	6% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST LEFT	$1,992.00	$2,490.00	$132.06–$2,254.70	6% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$132.06–$2,254.70	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UPPER JOINT W/O CONTRAST LEFT	$1,992.00	$2,490.00	$132.06–$2,254.70	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UPPER JOINT W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$132.06–$2,254.70	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW W/O CONTRAST LEFT	$1,992.00	$2,490.00	$132.06–$2,254.70	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$132.06–$2,254.70	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER W/O CONTRAST LEFT	$1,992.00	$2,490.00	$132.06–$2,254.70	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER W/O CONTRAST RIGHT	$1,992.00	$2,490.00	$132.06–$2,254.70	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST W/O CONTRAST LEFT	$1,992.00	$2,490.00	$132.06–$2,254.70	—	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERV SPINE COMPLETE	$171.20	$214.00	$34.51–$193.78	40% below	20%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERV SPINE COMPLETE	$171.20	$214.00	$34.51–$193.78	—	20%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/CONTRAST+	$1,447.20	$1,809.00	$119.28–$1,638.05	10% above	20%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/CONTRAST+	$1,447.20	$1,809.00	$119.28–$1,638.05	—	20%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST	$1,088.80	$1,361.00	$97.34–$1,232.39	7% above	20%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST	$1,088.80	$1,361.00	$97.34–$1,232.39	—	20%
Neck soft tissue X-ray CPT 70360 SOFT TISS NECK XRAY	$106.40	$133.00	$20.02–$120.43	40% below	20%
Neck soft tissue X-ray inpatient CPT 70360 SOFT TISS NECK XRAY	$106.40	$133.00	$20.02–$120.43	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM DOBUTAMINE STRESS	$2,486.40	$3,108.00	$269.23–$2,814.29	14% below	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 EQUUM NM STRESS CARDIOLITE+	$2,486.40	$3,108.00	$269.23–$2,814.29	14% below	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM STRESS CARDIOL 1 DAY REST /STRESS+	$2,486.40	$3,108.00	$269.23–$2,814.29	14% below	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 EQUUM NM STRESS CARDIOLITE+	$2,486.40	$3,108.00	$269.23–$2,814.29	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM STRESS CARDIOL 1 DAY REST /STRESS+	$2,486.40	$3,108.00	$269.23–$2,814.29	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM DOBUTAMINE STRESS	$2,486.40	$3,108.00	$269.23–$2,814.29	—	20%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/ ORAL CONTRAST	$900.00	$1,125.00	$86.27–$1,018.69	8% below	20%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST+	$900.00	$1,125.00	$86.27–$1,018.69	8% below	20%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/ ORAL CONTRAST	$900.00	$1,125.00	$86.27–$1,018.69	—	20%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST+	$900.00	$1,125.00	$86.27–$1,018.69	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US SOFT TISSUE, PERINEUM	$346.40	$433.00	$31.95–$392.08	3% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US SOFT TISSUE, BUTTOCK	$346.40	$433.00	$31.95–$392.08	3% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED	$346.40	$433.00	$31.95–$392.08	3% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US SOFT TISSUE, PELVIC WALL	$346.40	$433.00	$31.95–$392.08	3% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US SOFT TISSUE, PERINEUM	$346.40	$433.00	$31.95–$392.08	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED	$346.40	$433.00	$31.95–$392.08	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US SOFT TISSUE, PELVIC WALL	$346.40	$433.00	$31.95–$392.08	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US SOFT TISSUE, BUTTOCK	$346.40	$433.00	$31.95–$392.08	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$544.80	$681.00	$66.88–$616.65	2% below	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$544.80	$681.00	$66.88–$616.65	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB 1ST TRIM ABD+	$614.40	$768.00	$74.34–$695.42	11% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB 1ST TRIM ABD+	$614.40	$768.00	$74.34–$695.42	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED+	$420.00	$525.00	$51.55–$475.39	31% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED+	$420.00	$525.00	$51.55–$475.39	—	20%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILAT LEFT	$127.20	$159.00	$23.43–$143.97	36% below	20%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILAT RIGHT	$127.20	$159.00	$23.43–$143.97	36% below	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILAT RIGHT	$127.20	$159.00	$23.43–$143.97	—	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILAT LEFT	$127.20	$159.00	$23.43–$143.97	—	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNI W PA CHEST RIGHT	$140.00	$175.00	$26.84–$158.46	41% below	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNI W PA CHEST LEFT	$140.00	$175.00	$26.84–$158.46	41% below	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNI W PA CHEST LEFT	$140.00	$175.00	$26.84–$158.46	—	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNI W PA CHEST RIGHT	$140.00	$175.00	$26.84–$158.46	—	20%
Screening mammogram, both breasts both sides CPT 77067 DIGITAL MAMM SCREENING BILATERAL	$319.20	$399.00	$82.01–$361.29	—	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 DIGITAL MAMM SCREENING BILATERAL	$319.20	$399.00	$82.01–$361.29	—	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER COMP LEFT	$109.60	$137.00	$22.15–$124.05	46% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER COMP RIGHT	$109.60	$137.00	$22.15–$124.05	46% below	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER COMP RIGHT	$109.60	$137.00	$22.15–$124.05	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER COMP LEFT	$109.60	$137.00	$22.15–$124.05	—	20%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES PARANSAL CO	$144.00	$180.00	$24.07–$162.99	37% below	20%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES PARANSAL CO	$144.00	$180.00	$24.07–$162.99	—	20%
Skull X-ray, fewer than 4 views CPT 70250 SKULL LESS THAN 4	$137.60	$172.00	$23.00–$155.75	34% below	20%
Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL LESS THAN 4	$137.60	$172.00	$23.00–$155.75	—	20%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR LEFT	$124.00	$155.00	$22.79–$140.35	42% below	20%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR RIGHT	$124.00	$155.00	$22.79–$140.35	42% below	20%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR LEFT	$124.00	$155.00	$22.79–$140.35	—	20%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR RIGHT	$124.00	$155.00	$22.79–$140.35	—	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE W/O CONTRAST	$997.60	$1,247.00	$84.14–$1,129.16	2% below	20%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE W/O CONTRAST	$997.60	$1,247.00	$84.14–$1,129.16	—	20%
Toe X-ray, 2 or more views one side CPT 73660 TOES LEFT	$105.60	$132.00	$18.53–$119.53	16% below	20%
Toe X-ray, 2 or more views one side CPT 73660 TOES RIGHT	$105.60	$132.00	$18.53–$119.53	16% below	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOES RIGHT	$105.60	$132.00	$18.53–$119.53	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOES LEFT	$105.60	$132.00	$18.53–$119.53	—	20%
Transvaginal pelvic ultrasound CPT 76830 US PELVIC TRANSVAGINAL	$604.80	$756.00	$75.19–$684.56	13% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US PELVIC TRANSVAGINAL	$604.80	$756.00	$75.19–$684.56	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANS VAG	$486.40	$608.00	$58.58–$550.54	12% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANS VAG	$486.40	$608.00	$58.58–$550.54	—	20%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$607.20	$759.00	$73.70–$687.27	9% below	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$607.20	$759.00	$73.70–$687.27	—	20%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$337.60	$422.00	$63.69–$382.12	36% below	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$337.60	$422.00	$63.69–$382.12	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEADNECK	$575.20	$719.00	$69.86–$651.05	20% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEADNECK	$575.20	$719.00	$69.86–$651.05	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI W/O AIR CONTRAST	$433.60	$542.00	$77.11–$490.78	8% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 MODIFIED BARIUM SWALLOW	$485.60	$607.00	$77.11–$549.64	21% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI W/O AIR CONTRAST	$433.60	$542.00	$77.11–$490.78	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 MODIFIED BARIUM SWALLOW	$485.60	$607.00	$77.11–$549.64	—	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS 2 VIEWS RIGHT	$108.80	$136.00	$20.45–$123.15	41% below	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS 2 VIEWS LEFT	$108.80	$136.00	$20.45–$123.15	41% below	20%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS 2 VIEWS RIGHT	$108.80	$136.00	$20.45–$123.15	—	20%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS 2 VIEWS LEFT	$108.80	$136.00	$20.45–$123.15	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS DUPL UNI RIGHT	$596.00	$745.00	$75.40–$674.60	12% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS DUPL UNI LEFT	$596.00	$745.00	$75.40–$674.60	12% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS DUPL UNI LEFT	$596.00	$745.00	$75.40–$674.60	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS DUPL UNI RIGHT	$596.00	$745.00	$75.40–$674.60	—	20%
Wrist X-ray, 2 views one side CPT 73100 WRIST 2V XRAY LEFT	$108.80	$136.00	$21.51–$123.15	22% below	20%
Wrist X-ray, 2 views one side CPT 73100 WRIST 2V XRAY RIGHT	$108.80	$136.00	$21.51–$123.15	22% below	20%
Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST 2V XRAY LEFT	$108.80	$136.00	$21.51–$123.15	—	20%
Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST 2V XRAY RIGHT	$108.80	$136.00	$21.51–$123.15	—	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VIEW LEFT	$134.40	$168.00	$26.41–$152.12	30% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VIEW RIGHT	$134.40	$168.00	$26.41–$152.12	30% below	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VIEW RIGHT	$134.40	$168.00	$26.41–$152.12	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VIEW LEFT	$134.40	$168.00	$26.41–$152.12	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP 2 V LEFT W or W/O PELVIS	$156.80	$196.00	$30.46–$177.48	23% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP 2 RIGHT W or W/O PELVIS	$156.80	$196.00	$30.46–$177.48	23% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 2 RIGHT W or W/O PELVIS	$156.80	$196.00	$30.46–$177.48	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 2 V LEFT W or W/O PELVIS	$156.80	$196.00	$30.46–$177.48	—	20%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW FREQ	$90.40	$113.00	$19.17–$102.32	43% below	20%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW	$90.40	$113.00	$19.17–$102.32	43% below	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW	$90.40	$113.00	$19.17–$102.32	—	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW FREQ	$90.40	$113.00	$19.17–$102.32	—	20%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEW RIGHT	$112.00	$140.00	$20.45–$126.77	36% below	20%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEW LEFT	$112.00	$140.00	$20.45–$126.77	36% below	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEW LEFT	$112.00	$140.00	$20.45–$126.77	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEW RIGHT	$112.00	$140.00	$20.45–$126.77	—	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS LEFT	$117.60	$147.00	$24.50–$133.11	11% below	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS RIGHT	$117.60	$147.00	$24.50–$133.11	11% below	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGERS LEFT	$117.60	$147.00	$24.50–$133.11	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGERS RIGHT	$117.60	$147.00	$24.50–$133.11	—	20%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEW LEFT	$99.20	$124.00	$18.11–$112.28	37% below	20%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEW RIGHT	$99.20	$124.00	$18.11–$112.28	37% below	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEW RIGHT	$99.20	$124.00	$18.11–$112.28	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEW LEFT	$99.20	$124.00	$18.11–$112.28	—	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3 VIEW RIGHT	$108.80	$136.00	$21.73–$123.15	39% below	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3 VIEW LEFT	$108.80	$136.00	$21.73–$123.15	39% below	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT 3 VIEW RIGHT	$108.80	$136.00	$21.73–$123.15	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT 3 VIEW LEFT	$108.80	$136.00	$21.73–$123.15	—	20%
X-ray of the hand, 3 or more views one side CPT 73130 HAND 3 VIEW RIGHT	$116.00	$145.00	$23.86–$131.30	37% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 HAND 3 VIEW LEFT	$116.00	$145.00	$23.86–$131.30	37% below	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND 3 VIEW LEFT	$116.00	$145.00	$23.86–$131.30	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND 3 VIEW RIGHT	$116.00	$145.00	$23.86–$131.30	—	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 PATELLA LEFT	$116.80	$146.00	$21.73–$132.20	25% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 PATELLA RIGHT	$116.80	$146.00	$21.73–$132.20	25% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 2V LEFT	$116.80	$146.00	$21.73–$132.20	25% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 2V RIGHT	$116.80	$146.00	$21.73–$132.20	25% below	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 2V RIGHT	$116.80	$146.00	$21.73–$132.20	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PATELLA RIGHT	$116.80	$146.00	$21.73–$132.20	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 2V LEFT	$116.80	$146.00	$21.73–$132.20	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PATELLA LEFT	$116.80	$146.00	$21.73–$132.20	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBOSACRAL AP & LAT	$133.60	$167.00	$25.35–$151.22	38% below	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBOSACRAL AP & LAT	$133.60	$167.00	$25.35–$151.22	—	20%
X-ray of the lower back, 4 or more views CPT 72110 LUMBOSACRAL COMPLETE	$186.40	$233.00	$33.23–$210.98	40% below	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBOSACRAL COMPLETE	$186.40	$233.00	$33.23–$210.98	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE AP AND LA	$130.40	$163.00	$21.09–$147.60	29% below	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE AP AND LA	$130.40	$163.00	$21.09–$147.60	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES COMPLETE	$124.00	$155.00	$24.07–$140.35	28% below	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES COMPLETE	$124.00	$155.00	$24.07–$140.35	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERV SPINE AP & LATERAL	$88.00	$110.00	$25.35–$99.61	62% below	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERV SPINE AP & LATERAL	$88.00	$110.00	$25.35–$99.61	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS AP ONLY	$120.00	$150.00	$17.89–$135.83	27% below	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS AP ONLY	$120.00	$150.00	$17.89–$135.83	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM AND COCCYX	$106.40	$133.00	$20.87–$120.43	38% below	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM AND COCCYX	$106.40	$133.00	$20.87–$120.43	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT (ALT)	$37.60	$47.00	$4.39–$42.56	57% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT (ALT)	$37.60	$47.00	$4.39–$42.56	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST SGOT	$37.60	$47.00	$4.29–$42.56	71% above	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST SGOT	$37.60	$47.00	$4.29–$42.56	—	20%
Albumin blood test CPT 82040 ALBUMIN	$36.00	$45.00	$4.10–$40.75	80% above	20%
Albumin blood test inpatient CPT 82040 ALBUMIN	$36.00	$45.00	$4.10–$40.75	—	20%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE	$37.60	$47.00	$4.29–$42.56	79% above	20%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE	$37.60	$47.00	$4.29–$42.56	—	20%
Ammonia blood test CPT 82140 AMMONIA	$104.00	$130.00	$12.06–$117.72	60% above	20%
Ammonia blood test inpatient CPT 82140 AMMONIA	$104.00	$130.00	$12.06–$117.72	—	20%
Amylase blood test CPT 82150 AMYLASE	$44.80	$56.00	$5.36–$50.71	108% above	20%
Amylase blood test inpatient CPT 82150 AMYLASE	$44.80	$56.00	$5.36–$50.71	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT PRO BNP II	$242.40	$303.00	$32.50–$274.37	209% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT PRO BNP II	$242.40	$303.00	$32.50–$274.37	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC	$60.80	$76.00	$7.00–$68.82	13% above	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC (PICCOLO)	$60.80	$76.00	$7.00–$68.82	13% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC	$60.80	$76.00	$7.00–$68.82	—	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC (PICCOLO)	$60.80	$76.00	$7.00–$68.82	—	20%
Bilirubin blood test, total CPT 82247 NEONATAL BILIRUBIN	$36.80	$46.00	$4.16–$41.65	62% above	20%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$36.80	$46.00	$4.16–$41.65	62% above	20%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$36.80	$46.00	$4.16–$41.65	—	20%
Bilirubin blood test, total inpatient CPT 82247 NEONATAL BILIRUBIN	$36.80	$46.00	$4.16–$41.65	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE ROUTINE	$12.00	$15.00	$1.80–$14.36	7% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE COLLECTION OF BLOOD	$12.00	$15.00	$7.53–$13.58	7% below	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE COLLECTION OF BLOOD	$12.00	$15.00	$7.53–$13.58	—	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE 2HR PP	$28.80	$36.00	$3.26–$32.60	20% above	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$28.80	$36.00	$3.26–$32.60	20% above	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE 2HR PP	$28.80	$36.00	$3.26–$32.60	—	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$28.80	$36.00	$3.26–$32.60	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 SERUM PREGNANCY TEST	$40.00	$50.00	$6.23–$45.28	8% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 SERUM PREGNANCY TEST	$40.00	$50.00	$6.23–$45.28	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CHARGE ABO BLOOD GROUP	$20.80	$26.00	$2.47–$23.54	1% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB ABO BLOOD GROUP	$20.80	$26.00	$2.47–$23.54	1% below	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB ABO BLOOD GROUP	$20.80	$26.00	$2.47–$23.54	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 CHARGE ABO BLOOD GROUP	$20.80	$26.00	$2.47–$23.54	—	20%
Blood urea nitrogen (BUN) test CPT 84520 BUN	$28.80	$36.00	$3.28–$32.60	61% above	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN	$28.80	$36.00	$3.28–$32.60	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$37.60	$47.00	$4.29–$42.56	11% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$37.60	$47.00	$4.29–$42.56	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 XPERT C DIFF(S)	$248.80	$311.00	$30.86–$281.61	114% above	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 XPERT C DIFF(S)	$248.80	$311.00	$30.86–$281.61	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 PCR (Cepheid)	$326.40	$408.00	$42.49–$369.44	202% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 PCR (Cepheid)	$326.40	$408.00	$42.49–$369.44	—	20%
Calcium blood test, total CPT 82310 CALCIUM	$35.20	$44.00	$4.27–$39.84	73% above	20%
Calcium blood test, total inpatient CPT 82310 CALCIUM	$35.20	$44.00	$4.27–$39.84	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA PCR (Cepheid)	$83.20	$104.00	$29.05–$94.17	12% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA PCR (Cepheid)	$83.20	$104.00	$29.05–$94.17	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$92.00	$115.00	$11.09–$104.13	81% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$92.00	$115.00	$11.09–$104.13	—	20%
Complete blood count (CBC) with differential CPT 85025 CHARGE CBC AUTO.DIFF	$56.80	$71.00	$6.43–$64.29	39% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 CHARGE CBC AUTO.DIFF	$56.80	$71.00	$6.43–$64.29	—	20%
Complete blood count (CBC), no differential CPT 85027 CBC NO DIFFERENTIAL	$34.40	$43.00	$5.35–$38.94	19% above	20%
Complete blood count (CBC), no differential CPT 85027 CHARGE HEMOGRAM	$34.40	$43.00	$5.35–$38.94	19% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC NO DIFFERENTIAL	$34.40	$43.00	$5.35–$38.94	—	20%
Complete blood count (CBC), no differential inpatient CPT 85027 CHARGE HEMOGRAM	$34.40	$43.00	$5.35–$38.94	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 CMP	$76.00	$95.00	$8.74–$86.02	1% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP	$76.00	$95.00	$8.74–$86.02	—	20%
Creatine kinase (CK) blood test, total CPT 82550 CPK	$47.20	$59.00	$5.39–$53.42	57% above	20%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK	$47.20	$59.00	$5.39–$53.42	—	20%
Creatinine blood test CPT 82565 CREATININE SERUM	$35.20	$44.00	$4.24–$39.84	45% above	20%
Creatinine blood test inpatient CPT 82565 CREATININE SERUM	$35.20	$44.00	$4.24–$39.84	—	20%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANTITIVE	$64.00	$80.00	$8.43–$72.44	49% above	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANTITIVE	$64.00	$80.00	$8.43–$72.44	—	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL	$34.40	$43.00	$5.81–$38.94	8% above	20%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL	$34.40	$43.00	$5.81–$38.94	—	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$97.60	$122.00	$11.29–$110.47	63% above	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$97.60	$122.00	$11.29–$110.47	—	20%
Folate (folic acid) blood test CPT 82746 FOLATE	$104.80	$131.00	$12.17–$118.62	33% above	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE	$104.80	$131.00	$12.17–$118.62	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4	$64.00	$80.00	$7.47–$72.44	106% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4	$64.00	$80.00	$7.47–$72.44	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 CHARGE GENERAL HEALTH PANEL	$300.00	$375.00	$236.25–$339.56	67% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 CHARGE GENERAL HEALTH PANEL	$300.00	$375.00	$236.25–$339.56	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 1HR POST 50 GM	$32.00	$40.00	$3.94–$36.22	47% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 1HR POST 50 GM	$32.00	$40.00	$3.94–$36.22	—	20%
Glucose tolerance test, 3 samples CPT 82951 GTT 2 HOUR	$92.00	$115.00	$10.65–$104.13	60% above	20%
Glucose tolerance test, 3 samples CPT 82951 GTT 3 HOUR+	$92.00	$115.00	$10.65–$104.13	60% above	20%
Glucose tolerance test, 3 samples CPT 82951 GTT 4 HOUR+	$92.00	$115.00	$10.65–$104.13	60% above	20%
Glucose tolerance test, 3 samples CPT 82951 GTT 5 HOUR+	$92.00	$115.00	$10.65–$104.13	60% above	20%
Glucose tolerance test, 3 samples CPT 82951 GTT 6 HOUR+	$92.00	$115.00	$10.65–$104.13	60% above	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 4 HOUR+	$92.00	$115.00	$10.65–$104.13	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 5 HOUR+	$92.00	$115.00	$10.65–$104.13	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 2 HOUR	$92.00	$115.00	$10.65–$104.13	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 6 HOUR+	$92.00	$115.00	$10.65–$104.13	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 3 HOUR+	$92.00	$115.00	$10.65–$104.13	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONORRHEA PCR (Cepheid)	$83.20	$104.00	$29.05–$94.17	13% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONORRHEA PCR (Cepheid)	$83.20	$104.00	$29.05–$94.17	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOHGB	$69.60	$87.00	$8.04–$78.78	72% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOHGB	$69.60	$87.00	$8.04–$78.78	—	20%
Hemoglobin blood test CPT 85018 HEMOGLOBIN	$4.00	$5.00	$1.96–$3.31	75% below	20%
Hemoglobin blood test CPT 85018 HEMOGLOBIN	$16.00	$20.00	$1.96–$18.11	at median	20%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN	$16.00	$20.00	$1.96–$18.11	—	20%
Iron blood test (serum iron) CPT 83540 IRON	$44.80	$56.00	$5.35–$50.71	53% above	20%
Iron blood test (serum iron) CPT 83540 IRON/TIBC+	$44.80	$56.00	$5.35–$50.71	53% above	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$44.80	$56.00	$5.35–$50.71	—	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON/TIBC+	$44.80	$56.00	$5.35–$50.71	—	20%
Iron-binding capacity (TIBC) test CPT 83550 IRON BIND	$61.60	$77.00	$7.24–$69.72	55% above	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BIND	$61.60	$77.00	$7.24–$69.72	—	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$61.60	$77.00	$7.19–$69.72	at median	20%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$61.60	$77.00	$7.19–$69.72	—	20%
Lactate (lactic acid) blood test CPT 83605 LACTATE/LACTIC ACID (PICCOLO)	$41.60	$52.00	$9.58–$47.09	8% below	20%
Lactate (lactic acid) blood test CPT 83605 LACTATE/LACTIC ACID	$41.60	$52.00	$9.58–$47.09	8% below	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE/LACTIC ACID	$41.60	$52.00	$9.58–$47.09	—	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE/LACTIC ACID (PICCOLO)	$41.60	$52.00	$9.58–$47.09	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$48.80	$61.00	$5.70–$55.24	57% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$48.80	$61.00	$5.70–$55.24	—	20%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION	$34.40	$43.00	$6.76–$38.94	27% below	20%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION	$34.40	$43.00	$6.76–$38.94	—	20%
Magnesium blood test CPT 83735 MAGNESIUM	$48.00	$60.00	$5.55–$54.33	140% above	20%
Magnesium blood test CPT 83735 MAGNESIUM (PICCOLO)	$48.00	$60.00	$5.55–$54.33	140% above	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$48.00	$60.00	$5.55–$54.33	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM (PICCOLO)	$48.00	$60.00	$5.55–$54.33	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO TEST	$37.60	$47.00	$4.29–$42.56	7% below	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO TEST	$37.60	$47.00	$4.29–$42.56	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL	$132.00	$165.00	$15.23–$149.41	157% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL	$132.00	$165.00	$15.23–$149.41	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE	$295.20	$369.00	$34.18–$334.13	119% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE	$295.20	$369.00	$34.18–$334.13	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 APTT	$42.40	$53.00	$4.98–$47.99	37% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT	$42.40	$53.00	$4.98–$47.99	—	20%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS (PICCOLO)	$30.40	$38.00	$3.93–$34.41	45% above	20%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS	$30.40	$38.00	$3.93–$34.41	45% above	20%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS	$30.40	$38.00	$3.93–$34.41	—	20%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS (PICCOLO)	$30.40	$38.00	$3.93–$34.41	—	20%
Potassium blood test CPT 84132 POTASSIUM	$34.40	$43.00	$3.94–$38.94	44% above	20%
Potassium blood test inpatient CPT 84132 POTASSIUM	$34.40	$43.00	$3.94–$38.94	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$29.60	$37.00	$3.55–$33.50	52% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$29.60	$37.00	$3.55–$33.50	—	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST, PRESUMPTIVE, ANY # CLASSES	$12.00	$15.00	$5.47–$15.00	68% below	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV DIR OPT OBS	$12.00	$15.00	$5.47–$15.00	68% below	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 FENTANYL SCREEN URINE	$16.80	$21.00	$10.43–$19.02	55% below	20%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 FENTANYL SCREEN URINE	$16.80	$21.00	$10.43–$19.02	—	20%
Rh blood typing CPT 86901 CHARGE RH (D) TYPE	$20.80	$26.00	$2.47–$23.54	at median	20%
Rh blood typing CPT 86901 BB RH (D) TYPE	$20.80	$26.00	$2.47–$23.54	at median	20%
Rh blood typing inpatient CPT 86901 CHARGE RH (D) TYPE	$20.80	$26.00	$2.47–$23.54	—	20%
Rh blood typing inpatient CPT 86901 BB RH (D) TYPE	$20.80	$26.00	$2.47–$23.54	—	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$16.00	$20.00	$4.69–$18.11	53% below	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$16.00	$20.00	$4.69–$18.11	—	20%
Sodium blood test CPT 84295 SODIUM	$34.40	$43.00	$3.98–$38.94	65% above	20%
Sodium blood test inpatient CPT 84295 SODIUM	$34.40	$43.00	$3.98–$38.94	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD SCREENING	$4.80	$6.00	$3.46–$4.38	73% below	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD HEMOSURE DIAGNOSTIC	$113.60	$142.00	$13.18–$128.58	141% above	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD HEMOSURE DIAGNOSTIC	$113.60	$142.00	$13.18–$128.58	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH W/ REFLEX TO FT4	$119.20	$149.00	$13.91–$134.92	85% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$119.20	$149.00	$13.91–$134.92	85% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH W/ REFLEX TO FT4	$119.20	$149.00	$13.91–$134.92	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$119.20	$149.00	$13.91–$134.92	—	20%
Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL	$32.80	$41.00	$3.61–$37.13	64% above	20%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL TOTAL	$32.80	$41.00	$3.61–$37.13	—	20%
Trichomonas test (NAAT) CPT 87661 TV (S)	$60.00	$75.00	$29.05–$67.91	18% below	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS (CEPHEID)	$80.80	$101.00	$29.05–$91.46	10% above	20%
Trichomonas test (NAAT) inpatient CPT 87661 TV (S)	$60.00	$75.00	$29.05–$67.91	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS (CEPHEID)	$80.80	$101.00	$29.05–$91.46	—	20%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$40.80	$51.00	$4.76–$46.18	112% above	20%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES	$40.80	$51.00	$4.76–$46.18	—	20%
Troponin test, quantitative CPT 84484 TROPONIN-I	$69.60	$87.00	$10.32–$78.78	64% above	20%
Troponin test, quantitative CPT 84484 TROPONIN-I (Triage)	$69.60	$87.00	$10.32–$78.78	64% above	20%
Troponin test, quantitative inpatient CPT 84484 TROPONIN-I	$69.60	$87.00	$10.32–$78.78	—	20%
Troponin test, quantitative inpatient CPT 84484 TROPONIN-I (Triage)	$69.60	$87.00	$10.32–$78.78	—	20%
Uric acid blood test CPT 84550 URIC ACID	$33.60	$42.00	$3.74–$38.03	49% above	20%
Uric acid blood test inpatient CPT 84550 URIC ACID	$33.60	$42.00	$3.74–$38.03	—	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS CHG	$23.20	$29.00	$2.62–$26.26	16% above	20%
Urinalysis with microscope exam, automated CPT 81001 UA PERFORM MICROSCOPIC	$23.20	$29.00	$2.62–$26.26	16% above	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS CHG	$23.20	$29.00	$2.62–$26.26	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA PERFORM MICROSCOPIC	$23.20	$29.00	$2.62–$26.26	—	20%
Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY	$14.40	$18.00	$1.87–$16.30	11% above	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS W/O MICRO	$14.40	$18.00	$1.87–$16.30	11% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS W/O MICRO	$14.40	$18.00	$1.87–$16.30	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY	$14.40	$18.00	$1.87–$16.30	—	20%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS DIP STICK	$4.00	$5.00	$2.88–$3.57	74% below	20%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN	$40.00	$50.00	$4.78–$45.28	54% above	20%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN	$40.00	$50.00	$4.78–$45.28	—	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$8.80	$11.00	$7.13–$8.84	62% below	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$44.00	$55.00	$7.13–$49.80	91% above	20%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST	$44.00	$55.00	$7.13–$49.80	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$43.20	$54.00	$11.31–$20.07	27% below	20%
Vitamin B12 (cobalamin) blood test CPT 82607 B12	$107.20	$134.00	$12.48–$121.34	81% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 B12	$107.20	$134.00	$12.48–$121.34	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-OH	$211.20	$264.00	$24.51–$239.05	139% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25-OH	$211.20	$264.00	$24.51–$239.05	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG	$148.00	$185.00	$12.47–$167.52	203% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG	$148.00	$185.00	$12.47–$167.52	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 REMOVAL OF ADENOIDS	$346.40	$433.00	$139.09–$1,705.95	88% below	20%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 ARTHROSCY AIDED ANTERIOR CRUC LIGAMENT	$1,721.60	$2,152.00	$630.48–$5,993.87	85% below	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHROS SHOULDER WROTA CUFF REPAIR	$1,718.40	$2,148.00	$691.61–$5,034.12	57% below	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHROS SHOULDER W ROTOR CUFF	$1,718.40	$2,148.00	$691.61–$5,034.12	57% below	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLOS TX PROXIMAL DISTAL FIB FX W/O MANIP	$373.60	$467.00	$192.34–$456.45	1% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLOS TX DIST FIBULAR FX W/O MANIP	$427.20	$534.00	$210.23–$498.69	15% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLOS TX DIST FIBULAR FX WO MANIP	$427.20	$534.00	$210.23–$498.69	15% above	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLOS TX METATARSAL FRAC W/O MANIP EA	$264.80	$331.00	$136.96–$324.65	29% below	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLS TX METATARSAL FX W/O MANIP EACH	$299.20	$374.00	$145.05–$344.50	20% below	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLS TX METATARSAL FX WO MANIP EACH	$299.20	$374.00	$145.05–$344.50	20% below	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLS TX METATARSAL FRAC W/O MANIP EA	$1,006.40	$1,258.00	$136.96–$1,139.12	170% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE ELECT CONV EXT	$304.80	$381.00	$97.55–$225.09	69% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECT ELECTR CONV EXT	$940.00	$1,175.00	$68.37–$1,063.96	5% below	20%
Carpal tunnel release, open surgery CPT 64721 NEUROPLASTY MEDIAN NERVE CARPAL TUN	$710.40	$888.00	$292.24–$1,658.04	74% below	20%
Carpal tunnel release, open surgery CPT 64721 NEUROPLASTY MEDIAN NERVE @CARPAL TUNNEL	$710.40	$888.00	$292.24–$1,658.04	74% below	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLS TX DISTAL RADIAL FRACTURE W/O MANIP	$410.40	$513.00	$220.03–$518.03	8% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOS TX DISTAL RADIAL WO MANIP	$444.00	$555.00	$229.40–$541.43	17% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOS TX DISTAL RADIAL W/O MANIP	$444.00	$555.00	$229.40–$541.43	17% above	20%
Colonoscopy with polyp removal CPT 45385 COLONSCOPY REM TUMOR,POLY,LES SNARE	$724.80	$906.00	$286.70–$1,011.37	58% below	20%
Colonoscopy with tissue sample CPT 45380 COLONSCOPY W BIOPSY	$691.20	$864.00	$273.07–$974.97	61% below	20%
Colonoscopy with tissue sample CPT 45380 COLONSCOPY WITH BIOPSY	$691.20	$864.00	$273.07–$974.97	61% below	20%
Colonoscopy, diagnostic CPT 45378 COLONSCOPY DIAGNOSTIC	$542.40	$678.00	$215.77–$807.93	49% below	20%
Colonoscopy, diagnostic CPT 45378 COLONSCOPY	$542.40	$678.00	$215.77–$807.93	49% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALIG LESION 1ST LESION	$136.00	$170.00	$43.67–$92.11	29% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT BENIGN LESION 1ST LESION	$136.00	$170.00	$43.67–$92.11	29% below	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING	$253.60	$317.00	$103.31–$902.16	88% below	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 CREATE EARDRUM OPENING	$256.80	$321.00	$128.65–$297.18	21% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACTED EAR BY WASHING	$21.60	$27.00	$10.01–$25.56	79% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX	$23.20	$29.00	$10.01–$25.56	77% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$23.20	$29.00	$10.01–$25.56	77% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACTED EAR WAX BY WASHING	$56.00	$70.00	$10.01–$63.39	45% below	20%
Earwax removal with instruments, one ear CPT 69210 REM IMPACTED CERUMEN 1 OR 2 EAR(S)	$44.80	$56.00	$20.45–$51.17	52% below	20%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HRN 1ST 3-10 RDC	$913.60	$1,142.00	$367.43–$2,644.79	89% below	20%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HRN 1ST > 10 RDC	$1,228.80	$1,536.00	$495.44–$2,997.97	86% below	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC	$539.20	$674.00	$219.60–$2,233.14	89% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDSCOPY DIAGNOSTIC FLEXIBLE	$457.60	$572.00	$118.64–$333.50	81% below	20%
Gallbladder removal, laparoscopic CPT 47562 LAP CHOLECYSTECTOMY	$1,044.00	$1,305.00	$427.28–$3,893.58	87% below	20%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$1,061.60	$1,327.00	$427.28–$3,893.58	87% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 INC&DRAIN ABCESS SIMPLE OR SINGLE	$132.00	$165.00	$69.01–$145.39	52% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE OR SINGLE	$160.80	$201.00	$81.79–$172.93	41% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D OF ABSCESS SIMPLE OR SINGLE	$160.80	$201.00	$81.79–$172.93	41% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 INC&DRAIN ABSCESS SIMPLE OR SINGLE	$535.20	$669.00	$69.01–$605.78	96% above	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR INIT HERNIA INGUINAL 5YR OR OVER	$830.40	$1,038.00	$339.52–$2,565.44	85% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION TENDON SHEATH, LIGAMENT, MUSC	$56.00	$70.00	$24.92–$59.02	86% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATHLIGAMENT	$73.60	$92.00	$37.28–$88.54	81% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SINGLE TENDON SHEATH OR LIGAMENT	$73.60	$92.00	$37.28–$88.54	81% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT TENDON SHEATH, LIGAMENT, MUSC MEM	$270.40	$338.00	$24.92–$306.06	31% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENT ASP&/OR INJ MAJOR JOINT/BURSA	$71.20	$89.00	$28.97–$70.11	83% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAININJ MAJOR JOINTBURSA	$82.40	$103.00	$41.75–$99.73	80% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION/INJECTION, JOINT OR JOINT CAP	$117.60	$147.00	$28.97–$133.11	72% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIRATION/INJECTION, JOINT OR JOINT CAP	$117.60	$147.00	$28.97–$133.11	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS INTERMED JOINT OR BURSA	$56.00	$70.00	$23.43–$56.99	83% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAININJECT INTERMED JOINTBURSA	$70.40	$88.00	$35.15–$84.48	78% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS INTERMED JOINT	$70.40	$88.00	$35.15–$84.48	78% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATION/INJECTION, JOINT OR JOINT CAP	$101.60	$127.00	$23.43–$115.00	69% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS INTMED JOINT OR BURSA	$231.20	$289.00	$23.43–$261.69	29% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASPIRATION/INJECTION, JOINT OR JOINT CAP	$101.60	$127.00	$23.43–$115.00	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS/ASPIRATION/INJECT, SMALL	$52.00	$65.00	$22.79–$54.45	85% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTETIS SMALL JOINT	$67.20	$84.00	$34.51–$82.44	80% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAININJ SMALL JOINTBURSA	$67.20	$84.00	$34.51–$82.44	80% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS, ASPIRATION/INJECT, SMALL	$220.00	$275.00	$22.79–$249.01	35% below	20%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 ARTHROS KNEE SURG WMENISUC REP MEDLAT	$1,223.20	$1,529.00	$449.00–$2,582.27	82% below	20%
Knee arthroscopy with meniscus trim CPT 29881 ARTHROS KNEE W MENISCECTOMY	$964.80	$1,206.00	$354.43–$2,358.36	79% below	20%
Knee arthroscopy with meniscus trim CPT 29881 ARTHROS KNEE WMENISCECTOMY M OR L	$964.80	$1,206.00	$354.43–$2,358.36	79% below	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ARTHROSCOPY KNEE W MENISCETOMY	$1,002.40	$1,253.00	$367.64–$2,389.92	78% below	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ARTHROS KNEE WMENISCECTOMY M & L	$1,002.40	$1,253.00	$367.64–$2,389.92	78% below	20%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY SURGICAL APPENDECTOMY	$968.80	$1,211.00	$389.58–$1,084.61	89% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REP WOUNDS 2.5 OR< INTM EXCL HANDS/FEET	$206.40	$258.00	$97.34–$234.21	45% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REP WOUNDS 2.5 OR< INTM EXCL HANDSFEET	$336.00	$420.00	$166.57–$357.14	10% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REP INTM WOUNDS 2.5 OR< EXCL HANDS/FEET	$336.00	$420.00	$166.57–$357.14	10% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BENIGN 0.5CM OR<TRUNK,ARMS,LEGS	$164.00	$205.00	$81.79–$174.73	76% 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 OR <	$164.00	$205.00	$81.79–$174.73	76% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC B9+MARG FACE 0.5 OR LESS	$183.20	$229.00	$90.95–$195.50	75% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC B9 <0.5 FACE,EARS.EYEL,NOSE,LIPS,MM	$183.20	$229.00	$90.95–$195.50	75% below	20%
Nail removal (partial or complete), one nail CPT 11730 NAIL PLATE AVULSION PART/COMP SING/SIMPL	$86.40	$108.00	$34.29–$94.29	58% below	20%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE PART,COMP SINGLE	$140.80	$176.00	$72.85–$156.22	31% below	20%
Nail removal (partial or complete), one nail CPT 11730 NAILPLATE AVULSION PARTIAL,COMP, SINGLE	$140.80	$176.00	$72.85–$156.22	31% below	20%
Nail removal (partial or complete), one nail CPT 11730 SEPERATION OF NAIL PLATE FROM NAIL BED	$211.20	$264.00	$34.29–$239.05	3% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 SEPERATION OF NAIL PLATE FROM NAIL BED	$211.20	$264.00	$34.29–$239.05	—	20%
Occipital nerve block (injection for headaches) CPT 64405 INJ ANES GREATER OCCIPITAL NERVE	$97.60	$122.00	$33.87–$98.06	81% below	20%
Occipital nerve block (injection for headaches) CPT 64405 INJ ANES AGENT GREATER OCCIPITAL NERVE	$462.40	$578.00	$33.87–$523.38	11% below	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS WITH IMAGING GUIDE	$504.80	$631.00	$67.10–$302.02	59% below	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS, W IMAGING GUIDE	$1,464.80	$1,831.00	$67.10–$1,657.97	20% above	20%
Paracentesis with imaging guidance CPT 49083 US ABD PARACENTESIS W IMAGING GUIDANCE	$1,464.80	$1,831.00	$67.10–$1,657.97	20% above	20%
Paracentesis with imaging guidance inpatient CPT 49083 US ABD PARACENTESIS W IMAGING GUIDANCE	$1,464.80	$1,831.00	$67.10–$1,657.97	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 NAIL MATRIX EXCISION PARTIAL OR COMPLETE	$188.80	$236.00	$65.39–$214.97	64% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC OF NAIL PERMANENT REMOVAL	$275.20	$344.00	$102.24–$218.53	47% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL & MATRIX PARTIAL OR COMPLETE	$275.20	$344.00	$102.24–$218.53	47% below	20%
Removal of a breast lump, open surgery CPT 19120 EXC TUMOR BREAST, 1 OR MORE LESIONS	$838.40	$1,048.00	$336.11–$837.78	84% below	20%
Removal of a foreign object under the skin, simple CPT 10120 INC&REM F/BODY SUBCUT TISSUES SIMPLE	$158.40	$198.00	$68.16–$169.90	57% below	20%
Removal of a foreign object under the skin, simple CPT 10120 INC&REM FBODY SUBCUT TISSUE SIMPLE	$248.00	$310.00	$96.92–$244.46	33% below	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONOSCOPY SCREENING LOW RISK	$304.00	$380.00	$215.98–$807.93	70% below	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONSCOPY SCREENING LOW RISK	$304.00	$380.00	$215.98–$807.93	70% below	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLOREC CANCER SCREENING; FLEXSIG	$290.40	$363.00	$215.77–$807.93	71% below	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY SCREENING HIGH RISK	$346.40	$433.00	$215.77–$807.93	65% below	20%
Septoplasty to straighten the nasal septum CPT 30520 REPAIR OF NASAL SEPTUM	$1,088.00	$1,360.00	$430.47–$2,265.61	58% below	20%
Short arm cast (elbow to hand) CPT 29075 APPL CAST ELBOW TO FINGER (SHORT ARM)	$80.80	$101.00	$41.11–$96.17	67% below	20%
Short arm cast (elbow to hand) CPT 29075 CAST APP ELBOW-FINGER(SHORT ARM)	$117.60	$147.00	$58.58–$136.88	52% below	20%
Short arm splint (forearm and hand) CPT 29125 SPLINT APP SHORT ARM FOREARM TO HAND	$60.80	$76.00	$26.20–$64.98	67% below	20%
Short arm splint (forearm and hand) CPT 29125 APPLICATION OF SPLINT (SHORT ARM)	$121.60	$152.00	$26.20–$137.64	35% below	20%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$130.40	$163.00	$44.30–$109.18	30% below	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION OF SPLINT (SHORT ARM)	$121.60	$152.00	$26.20–$137.64	—	20%
Short leg splint (calf to foot) CPT 29515 SPLINT APPL SHORT LEG (CALF-FOOT)	$76.00	$95.00	$32.38–$79.89	53% below	20%
Short leg splint (calf to foot) CPT 29515 SPLINT APP SHORT LEG CALF TO FOOT	$113.60	$142.00	$48.14–$117.70	29% below	20%
Short leg splint (calf to foot) CPT 29515 APPLY SHORT LEG SPLINT CALF TO FOOT	$113.60	$142.00	$48.14–$117.70	29% below	20%
Short leg splint (calf to foot) CPT 29515 SPLINT APPL SHORT LEG (CALF-FOOT)	$331.20	$414.00	$32.38–$374.88	106% above	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 ARTHOSCOPY SH CLAVIC MUMFORD	$1,204.80	$1,506.00	$442.40–$2,566.49	17% below	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 ARTHROSCOPY SH CLAVIC MUMFORD PROC	$1,204.80	$1,506.00	$442.40–$2,566.49	17% below	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 DECOMPRESS SUBCROMINAL SPACE WPARTIAL ADD ON	$284.80	$356.00	$109.70–$744.52	at median	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 DECOMPRESS SUBCROMINAL SPACE W PARTIAL	$284.80	$356.00	$109.70–$744.52	at median	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REP SUPERFIC WOUNDS 2.5 OR< EXCL FACE	$132.00	$165.00	$28.54–$109.36	37% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REP SUPRFIC WOUNDS 2.5 OR< EXCL FACE	$149.60	$187.00	$60.07–$155.71	29% below	20%
Skin biopsy, punch, one lesion CPT 11104 REP SUPRFIC WOUNDS 2.5 OR< EXCL FACE	$160.80	$201.00	$78.60–$169.77	56% below	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$160.80	$201.00	$78.60–$169.77	56% below	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MALIG LES T,A,L .05 OR LESS	$314.40	$393.00	$125.88–$316.90	5% below	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MALIGNANT <0.5 TRUNK,ARMS,LEGS	$314.40	$393.00	$125.88–$316.90	5% below	20%
Skin tag removal, up to 15 tags CPT 11200 REM SKIN TAGS UP TO &INCL 15 LESIONS	$116.80	$146.00	$59.43–$125.97	33% below	20%
Skin tag removal, up to 15 tags CPT 11200 SKIN TAG REMOVAL	$116.80	$146.00	$59.43–$125.97	33% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC	$159.20	$199.00	$41.11–$156.67	81% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REP SUPERFIC WOUNDS 2.6-7.5 EXCL FACE	$140.80	$176.00	$37.49–$121.89	42% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REP 2.6-7.5 CM WOUNDS SIMPLE EXCL FACE	$180.80	$226.00	$73.06–$183.21	25% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REP SIMPLE WOUNDS 2.6- 7.5CM EXCL FACE	$180.80	$226.00	$73.06–$183.21	25% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REP SPRF WOUNDS 2.5OR< FACE,EARS,EYELID	$140.00	$175.00	$35.57–$113.13	41% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REP WOUNDS 2.5OR< SIMP FACE,EARS,EYELID	$179.20	$224.00	$71.78–$180.02	24% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REP SIMP WOUNDS 2.5OR< FACE,EARS,EYELID	$179.20	$224.00	$71.78–$180.02	24% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REP SPRF WOUNDS 2.5OR< FACE,EARS,EYELID	$496.80	$621.00	$35.57–$562.32	111% above	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$129.60	$162.00	$63.05–$136.36	55% below	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN	$129.60	$162.00	$63.05–$136.36	55% below	20%
Thoracentesis with imaging guidance CPT 32555 REMOVAL FLUID FROM CHEST, WITH IMAGING G	$580.80	$726.00	$68.37–$657.39	47% below	20%
Thoracentesis with imaging guidance CPT 32555 REMOVAL FLUID FROM CHEST W IMAGING GUIDE	$692.00	$865.00	$68.37–$633.92	37% below	20%
Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVE TONSILS AND ADENOIDS	$492.80	$616.00	$197.45–$1,870.01	86% below	20%
Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS	$472.00	$590.00	$189.36–$3,288.49	86% below	20%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 TONSILLECTOMY PRIM OR SEC 12 OR OVER	$414.40	$518.00	$166.57–$1,782.91	90% below	20%
Total hip replacement CPT 27130 TOTAL HIP ARTHROPLAS WWO AUTOGRAFT	$2,232.80	$2,791.00	$829.21–$11,203.42	89% below	20%
Total knee replacement CPT 27447 ARTHROPLASTY TOTAL KNEE M&L COMPARTMENTS	$2,231.20	$2,789.00	$828.14–$11,011.05	87% below	20%
Trigger finger release surgery CPT 26055 TENDON SHEATH INCISION	$947.20	$1,184.00	$375.09–$1,275.89	49% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION OF TRIGGER POINTS, 1 OR 2 MUSC	$58.40	$73.00	$23.22–$58.59	84% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PT(S) 1-2 MUSCLE(S)	$89.60	$112.00	$33.44–$84.15	75% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 12 MUSCLE(S)	$89.60	$112.00	$33.44–$84.15	75% below	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG	$241.60	$302.00	$306.72–$788.25	87% below	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US GUIDED CORE BX BREAST+	$3,320.00	$4,150.00	$96.49–$3,757.83	79% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US GUIDED CORE BX BREAST+	$3,320.00	$4,150.00	$96.49–$3,757.83	—	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD FLEXIBLE TRANSORAL W BALLOON DIL	$232.80	$291.00	$180.41–$1,706.45	90% below	20%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY W/BIOPSY	$216.80	$271.00	$87.33–$348.66	83% below	20%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY W BIOPSY	$600.80	$751.00	$235.15–$872.95	52% below	20%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY WBIOPSY	$600.80	$751.00	$235.15–$872.95	52% below	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 UPPER GI ENDO REM TUMORPOLYS BY SNARE	$788.00	$985.00	$227.46–$882.36	62% below	20%
Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GI ENDOSCOPY DIAGNOSTIC	$457.60	$572.00	$181.90–$514.86	42% below	20%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD	$457.60	$572.00	$181.90–$477.66	42% below	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION UP TO 14 LESIONS	$144.80	$181.00	$72.42–$154.88	29% below	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCT BENIGN LESIONS UP TO 14	$144.80	$181.00	$72.42–$154.88	29% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN & SUBCUT TISSUE	$95.20	$119.00	$38.77–$107.34	83% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SKIN & SUBCUTANEOUS	$204.00	$255.00	$76.75–$207.71	63% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 REMOVAL OF SKIN AND TISSUE	$240.00	$300.00	$38.77–$271.65	57% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 REMOVAL OF SKIN AND TISSUE	$240.00	$300.00	$38.77–$271.65	—	20%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPEN TX DIST RAD EX-ARTICULAR WFIX	$1,818.40	$2,273.00	$487.13–$5,899.08	81% below	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 BLOOD OR BLD COMPONENTS	$168.00	$210.00	$27.48–$190.16	78% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 BB TRANSFUSION SERV CHARGE	$168.80	$211.00	$27.48–$191.06	78% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 TX RM BLOOD ADMIN, 1 UNIT	$519.20	$649.00	$408.87–$587.67	31% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 TX RM BLOOD ADMIN, 2 OR MORE UNITS	$856.80	$1,071.00	$674.73–$969.79	14% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 CIS BLOOD ADMIN	$1,032.80	$1,291.00	$813.33–$1,169.00	37% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BB TRANSFUSION SERV CHARGE	$168.80	$211.00	$27.48–$191.06	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TX RM BLOOD ADMIN, 1 UNIT	$519.20	$649.00	$408.87–$587.67	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TX RM BLOOD ADMIN, 2 OR MORE UNITS	$856.80	$1,071.00	$674.73–$969.79	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB TX - INITIAL NEUBLIZER	$27.20	$34.00	$5.11–$17.28	84% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHALATION THERAPY	$69.60	$87.00	$5.11–$78.78	59% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB TX - INITIAL NEUBLIZER	$27.20	$34.00	$5.11–$17.28	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION THERAPY	$69.60	$87.00	$5.11–$78.78	—	20%
Chemotherapy IV infusion, first hour CPT 96413 IV INFUSION,SINGLE/INT,CHEMO/COMPLEX/BIO	$259.20	$324.00	$78.60–$293.38	51% below	20%
Chemotherapy IV infusion, first hour CPT 96413 INFUSION, INTIAL, CHEMO/COMPLEX	$259.20	$324.00	$78.60–$293.38	51% below	20%
Chemotherapy IV infusion, first hour CPT 96413 CIS IV INFUSION,SINGLE/INT,CHEMO/COMPLEX	$806.40	$1,008.00	$78.60–$912.74	54% above	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 IV INFUSION,SINGLE/INT,CHEMO/COMPLEX/BIO	$259.20	$324.00	$78.60–$293.38	—	20%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 COMPREHENSIVE HEARING TEST	$58.40	$73.00	$23.22–$60.94	73% below	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE E&M 1ST 30-74 MINUTES	$336.00	$420.00	$174.87–$414.84	83% below	20%
Critical care, first 30 to 74 minutes CPT 99291 PHYS CRIT C EVAL&MGMT1ST 30-74 MIN	$416.80	$521.00	$0.08–$435.67	79% below	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE E&M UP TO 74 MINUTES	$848.00	$1,060.00	$135.47–$959.83	57% below	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ECG W/INTERPRETATION&REPORT	$27.20	$34.00	$9.16–$31.16	68% below	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ECG WINTERPRETATION&REPORT	$27.20	$34.00	$9.16–$31.16	68% below	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG+	$111.20	$139.00	$9.16–$125.86	30% above	20%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG+	$111.20	$139.00	$9.16–$125.86	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG+	$97.60	$122.00	$4.05–$110.47	25% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EQUUM EKG	$97.60	$122.00	$4.05–$110.47	25% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EQUUM EKG	$97.60	$122.00	$4.05–$110.47	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG+	$97.60	$122.00	$4.05–$110.47	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 PHYS CHRG ER LIMITED OR MINOR	$63.20	$79.00	$0.08–$105.73	66% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER ROOM 99281	$154.40	$193.00	$105.73–$174.76	17% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PHYS CHG ER LOW TO MODERATE	$104.80	$131.00	$0.08–$105.73	69% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER ROOM 99282	$220.00	$275.00	$105.73–$249.01	35% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 PHYS CHG ER MODERATE SEVERITY	$164.00	$205.00	$0.08–$114.00	74% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER DEPT VISIT MOD COMPLEXITY & SEVERITY	$164.00	$205.00	$60.42–$114.00	74% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER ROOM 99283	$368.00	$460.00	$105.73–$416.53	42% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER DEPT VISIT MOD COMPLEXHIGH SEVERITY	$237.60	$297.00	$114.21–$203.10	77% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PHYS CHG ER MOD COMPLX-DETAIL EXAM	$237.60	$297.00	$0.08–$203.10	77% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER ROOM 99284	$593.60	$742.00	$105.73–$671.88	44% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER PHYSICIAN 99285	$260.80	$326.00	$165.75–$299.15	85% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 PHYS CHG ER HIGH SEVERITY	$359.20	$449.00	$0.08–$299.15	79% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER ROOM 99285	$762.40	$953.00	$105.73–$862.94	55% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST	$550.40	$688.00	$433.44–$622.98	25% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 EQUUM STRESS TEST	$550.40	$688.00	$433.44–$622.98	25% below	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS TEST	$550.40	$688.00	$433.44–$622.98	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 EQUUM STRESS TEST	$550.40	$688.00	$433.44–$622.98	—	20%
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 HOLTER <48HRS Record Scan Interpret	$773.60	$967.00	$44.94–$875.62	710% above	20%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 HOLTER <48HRS Record Scan Interpret	$773.60	$967.00	$44.94–$875.62	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INITIAL - 31 MIN TO 1 HR	$252.00	$315.00	$198.45–$285.23	3% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION INIT HYDRATION 31 MIN -1 HR	$252.00	$315.00	$198.45–$285.23	3% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 CIS IV HYDRATION INITIAL-31 MIN TO 1 HR	$510.40	$638.00	$19.81–$577.71	96% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION INITIAL - 31 MIN TO 1 HR	$252.00	$315.00	$198.45–$285.23	—	20%
IV infusion of a medicine, first hour CPT 96365 IV INF THERAPY PROPHL, DX TO 1 HR	$306.40	$383.00	$38.13–$346.81	2% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY 1ST HOUR	$306.40	$383.00	$38.13–$346.81	2% above	20%
IV infusion of a medicine, first hour CPT 96365 CIS IV THERAPY 1ST HOUR	$510.40	$638.00	$38.13–$577.71	70% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY 1ST HOUR	$306.40	$383.00	$38.13–$346.81	—	20%
IV push of a medicine, first drug CPT 96374 INJ IV PUSH SINGLE OR INITIAL	$251.20	$314.00	$22.37–$284.33	32% above	20%
IV push of a medicine, first drug CPT 96374 INJ IV PUSH SINGLE OR INITIAL	$251.20	$314.00	$22.37–$284.33	32% above	20%
IV push of a medicine, first drug CPT 96374 IVP SINGLE OR INITIAL SUB/DRUG	$251.20	$314.00	$22.37–$284.33	32% above	20%
IV push of a medicine, first drug CPT 96374 CIS INJ IV PUSH SINGLE OR INITIAL	$510.40	$638.00	$22.37–$577.71	169% above	20%
IV push of a medicine, first drug inpatient CPT 96374 IVP SINGLE OR INITIAL SUB/DRUG	$251.20	$314.00	$22.37–$284.33	—	20%
IV push of a medicine, first drug inpatient CPT 96374 INJ IV PUSH SINGLE OR INITIAL	$251.20	$314.00	$22.37–$284.33	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION, THER, PROPH OR DIAGNOSTIC	$14.40	$18.00	$9.16–$23.49	84% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC,PROPH OR DIAG INJECTION	$24.00	$30.00	$9.16–$23.49	74% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ EA IM/SQ THER/PROPH OR DIAG	$111.20	$139.00	$9.16–$125.86	22% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ DIAG/THERA/PROP SUBCUT/INTRAMUSCULAR	$111.20	$139.00	$9.16–$125.86	22% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 CIS INJ DIAG/THERA/PROP SUBCUT/INTRAMUSC	$168.00	$210.00	$9.16–$190.16	85% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ DIAG/THERA/PROP SUBCUT/INTRAMUSCULAR	$111.20	$139.00	$9.16–$125.86	—	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$219.20	$274.00	$94.15–$226.62	2% below	20%
New patient office visit, about 30 minutes CPT 99203 OV NEW PATIENT LEVEL 3 DETAILED 30 MIN	$132.00	$165.00	$71.78–$125.29	18% above	20%
New patient office visit, about 30 minutes CPT 99203 OV NEW PATIENT DETAILED 30 MIN	$132.00	$165.00	$0.08–$125.29	18% above	20%
New patient office visit, about 45 minutes CPT 99204 OV NEW PATIENT LEVEL 4 COMPREH 45 MIN	$200.00	$250.00	$107.57–$187.74	69% above	20%
New patient office visit, about 45 minutes CPT 99204 OV NEW MOD-HI 45 MINUTES	$200.00	$250.00	$0.08–$187.74	69% above	20%
New patient office visit, about 60 minutes CPT 99205 OV NEW PATIENT LEVEL 5 MOD-HI 60 MIN	$256.00	$320.00	$142.07–$248.02	86% above	20%
New patient office visit, about 60 minutes CPT 99205 OV NEW MOD-HI 60 MINUTES	$256.00	$320.00	$0.08–$248.02	86% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OV NEW LOW-MOD 20 MINUTES	$96.00	$120.00	$0.08–$82.88	15% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OV NEW PATIENT LEVEL 2 LOW-MOD 20 MIN	$96.00	$120.00	$46.01–$82.88	15% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITIONAL, INDIV	$57.60	$72.00	$0.01–$58.05	25% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NUTRITION THER, INITIAL ASSMT,PER 15 MIN	$72.00	$90.00	$56.70–$81.50	57% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NUTRITION THER, INITIAL ASSMT,PER 15 MIN	$72.00	$90.00	$56.70–$81.50	—	20%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV MED NEW PATIENT 18-39 YRS	$164.00	$205.00	$0.08–$169.72	3% above	20%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV MED NEW PATIENT 40-64 YRS OLD	$188.00	$235.00	$0.08–$195.60	at median	20%
Preventive checkup, new patient aged 65 or older CPT 99387 PREV MED NEW PAT 65 OR OVER	$208.00	$260.00	$0.08–$212.27	2% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV MED ESTB 18-39 YRS OF AGE	$148.00	$185.00	$0.08–$153.06	1% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV MED ESTB 40-64 YRS OF AGE	$156.00	$195.00	$0.08–$162.72	5% below	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 PREV MED ESTB 65 YRS & OLDER	$168.00	$210.00	$0.08–$174.99	12% below	20%
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAG EVAL W/MED SRVCS	$246.40	$308.00	$107.78–$244.44	24% above	20%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYCHOTHERAPY IN CRISIS, 1st 60 MINUTES	$196.80	$246.00	$85.84–$222.75	93% above	20%
Psychotherapy session, 30 minutes CPT 90832 PSYTX PT&/FAMILY 30 MINUTES	$99.20	$124.00	$46.37–$98.70	48% below	20%
Psychotherapy session, 45 minutes CPT 90834 PSYTX PT&/FAMILY 45 MINUTES	$130.40	$163.00	$61.15–$130.20	39% below	20%
Psychotherapy session, 60 minutes CPT 90837 PSYTX PT&/FAMILY 60 MINUTES	$192.00	$240.00	$88.61–$191.94	16% below	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING/TOBAC CESSATION <3MIN UPTO 10MIN	$13.60	$17.00	$9.16–$15.71	67% below	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION >3 MIN & UP TO 10 MIN	$21.60	$27.00	$0.08–$19.75	47% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTAB PATIENT VISIT LEVEL 5	$192.00	$240.00	$115.66–$202.70	16% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OV ESTAB HIGH 40 MINUTES	$192.00	$240.00	$0.08–$202.70	16% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OV ESTAB LOW-MOD 15 MINUTES	$96.00	$120.00	$0.08–$102.09	at median	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTAB PATIENT VISIT LEVEL 3	$96.00	$120.00	$58.58–$102.09	at median	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OV ESTAB MOD-HIGH 25 MINUTES	$140.00	$175.00	$0.08–$143.99	17% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTAB PATIENT VISIT LEVEL 4	$140.00	$175.00	$82.43–$143.99	17% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTAB PATIENT VISIT LEVEL 2	$64.00	$80.00	$36.21–$63.58	6% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OV ESTAB LTD 10 MINUTES	$64.00	$80.00	$0.08–$63.58	6% below	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE CONSULT DETAILED 40 MIN	$186.40	$233.00	$0.08–$179.49	at median	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICEOP CONSULT LEVEL 3	$186.40	$233.00	$71.99–$179.49	at median	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE CONSULT MOD-HI 60 MIN	$279.20	$349.00	$0.08–$256.18	24% above	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICEOP CONSULT LEVEL 4	$279.20	$349.00	$102.45–$256.18	24% above	20%
Spirometry (breathing test) CPT 94010 PFT	$53.60	$67.00	$21.48–$43.67	74% below	20%
Spirometry (breathing test) CPT 94010 PFT BASIC	$141.60	$177.00	$21.48–$160.27	30% below	20%
Spirometry (breathing test) inpatient CPT 94010 PFT	$53.60	$67.00	$21.48–$43.67	—	20%
Spirometry (breathing test) inpatient CPT 94010 PFT BASIC	$141.60	$177.00	$21.48–$160.27	—	20%
Spirometry before and after a bronchodilator CPT 94060 BRONC EVAL BEFORE &AFTER DILATION	$89.60	$112.00	$24.92–$85.70	77% below	20%
Spirometry before and after a bronchodilator CPT 94060 PFT COMPLETE+	$236.80	$296.00	$24.92–$268.03	40% below	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONC EVAL BEFORE &AFTER DILATION	$89.60	$112.00	$24.92–$85.70	—	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT COMPLETE+	$236.80	$296.00	$24.92–$268.03	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 CIS PHLEBOTOMY THERAPEUTIC	$304.00	$380.00	$57.30–$344.09	30% above	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC (SEPARATE PROC)	$440.00	$550.00	$57.30–$498.03	88% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC (SEPARATE PROC)	$440.00	$550.00	$57.30–$498.03	—	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 CARDIO STRESS W/PHYS W/INTER& REPORT	$140.00	$175.00	$46.65–$130.17	57% below	20%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 CARDIO STRESS W/PHYS W/INTER& REPORT	$140.00	$175.00	$46.65–$130.17	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Varivax (MHS)	$174.40	$218.00	$116.00–$219.45	14% below	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARIVAX VACC 1VLW/DIL FZN DSHP	$348.00	$435.00	$193.19–$393.89	72% above	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARIVAX VACC 1VLW/DIL FZN DSHP	$348.00	$435.00	$193.19–$393.89	—	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 KINRIX	$60.00	$75.00	$49.50–$74.79	3% below	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 KINRIX (MHS FEE SCHEDULE)	$60.00	$75.00	$49.50–$74.79	3% below	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 KINRIX (DTAP-IPV/HIB(DIPH/TET/PERT/POL)	$106.40	$133.00	$83.79–$120.43	72% above	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 KINRIX (DTAP-IPV/HIB(DIPH/TET/PERT/POL)	$106.40	$133.00	$83.79–$120.43	—	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP VACCINE	$35.20	$44.00	$20.00–$35.38	9% below	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP UNDER 7YRS INTRAMUSCULAR	$35.20	$44.00	$20.00–$35.38	9% below	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 INFANRIX (DTaP) INJ, UP TO 7 YRS	$50.40	$63.00	$39.69–$57.05	30% above	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 INFANRIX (DTaP) INJ, UP TO 7 YRS	$50.40	$63.00	$39.69–$57.05	—	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 PEDIARIX VACCINE	$88.80	$111.00	$78.00–$120.42	29% below	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 PEDIARIX VACCINE (MHS FEE SCHEDULE)	$90.40	$113.00	$78.00–$120.42	27% below	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 PEDIARIX 0.5ML(syringe)(DIPTH/TET/HEPB/P	$167.20	$209.00	$131.67–$189.25	34% above	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 PEDIARIX 0.5ML(syringe)(DIPTH/TET/HEPB/P	$167.20	$209.00	$131.67–$189.25	—	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP HIB IPV INTRAMUSCULAR USE	$109.60	$137.00	$75.00–$134.99	30% below	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTaP-Hib-IPV Pentacel (MHS)	$110.40	$138.00	$75.00–$134.99	30% below	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 PENTACEL VACCINE	$218.40	$273.00	$171.99–$247.20	39% above	20%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 PENTACEL VACCINE	$218.40	$273.00	$171.99–$247.20	—	20%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 VAXELIS (DTAP/IPV/HIB/HEPB) INJ	$332.80	$416.00	$262.08–$376.69	24% below	20%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 DTAP-IPV-HIB-HEPB VACCINE IM	$332.80	$416.00	$134.39–$187.04	24% below	20%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 VAXELIS (DTAP/IPV/HIB/HEPB) INJ	$332.80	$416.00	$262.08–$376.69	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Fluzone Preservative Free 6 months and older	$32.00	$40.00	$0.01–$24.43	1% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA SPLIT VIRUS VACCINE 3YRS & UP	$32.00	$40.00	$0.01–$24.43	1% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE(FLUZONE)>6 MO CLINIC 2024-25	$32.00	$40.00	$22.35–$36.22	1% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE HOSP >3YRS(AFLURIA) 2024-25	$43.20	$54.00	$22.35–$48.90	36% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE(FLUZONE)>6 MO CLINIC 2024-25	$32.00	$40.00	$22.35–$36.22	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE HOSP >3YRS(AFLURIA) 2024-25	$43.20	$54.00	$22.35–$48.90	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV9 (MHS) (MHS FEE SCHEDULE)	$277.60	$347.00	$197.38–$368.98	17% below	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 GARDASIL 9 (HUMAN PAPIL 9-VAL VACCINE)	$545.60	$682.00	$325.27–$617.55	63% above	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 GARDASIL 9 (HUMAN PAPIL 9-VAL VACCINE)	$545.60	$682.00	$325.27–$617.55	—	20%
Hepatitis A vaccine, adult dose CPT 90632 Hep A Adult (MHS)	$83.20	$104.00	$47.00–$96.30	29% below	20%
Hepatitis A vaccine, adult dose CPT 90632 HEPA A ADULT DOSE	$83.20	$104.00	$47.00–$96.30	29% below	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A VACCINE PEDIATRIC	$56.80	$71.00	$27.00–$41.98	25% below	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A PEDS (MHS FEE SCHEDULE)	$82.40	$103.00	$27.00–$41.98	9% above	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HAVRIX (HEP A VAC)PEDS. 25U/0.5ML VAQTA	$149.60	$187.00	$117.81–$169.33	98% above	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HAVRIX (HEP A VAC)PEDS. 25U/0.5ML VAQTA	$149.60	$187.00	$117.81–$169.33	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPA B ADULT BCBSM	$73.60	$92.00	$58.00–$80.74	12% below	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B Adult (MHS FEE SCHEDULE)	$73.60	$92.00	$58.00–$80.74	12% below	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 ENGERIX-B ADULT 20MCG/ML (HEPATITIS B)	$119.20	$149.00	$70.38–$134.92	42% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 ENGERIX-B ADULT 20MCG/ML (HEPATITIS B)	$119.20	$149.00	$70.38–$134.92	—	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B PED (MHS FEE SCHEDULE)	$40.80	$51.00	$25.00–$35.62	26% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B PEDIATRIC	$40.80	$51.00	$25.00–$35.62	26% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 ENGERIX-B 10MCG/0.5ML PEDIATRIC	$46.00	$57.50	$31.67–$52.07	42% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 ENGERIX-B 10MCG/0.5ML PEDIATRIC	$46.00	$57.50	$31.67–$52.07	—	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Hib 3 dose PRP-OMP (MHS)	$28.80	$36.00	$23.00–$36.54	41% below	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HIB (VACCINE)	$28.80	$36.00	$23.00–$36.54	41% below	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 PEDVAXHIB (HAEMOPHILUS B VAC) 0.5ML VL	$56.80	$71.00	$31.62–$64.29	15% above	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 PEDVAXHIB (HAEMOPHILUS B VAC) 0.5ML VL	$56.80	$71.00	$31.62–$64.29	—	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 ACTHIB (HAEMOPH B/CONJ-TET TOX) VIAL 5CT	$21.60	$27.00	$13.42–$24.45	48% below	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 ACTHIB	$42.40	$53.00	$12.77–$22.75	3% above	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB ACT 4 Doses (MHS FEE SCHEDULE)	$42.40	$53.00	$12.77–$22.75	3% above	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 ACTHIB (HAEMOPH B/CONJ-TET TOX) VIAL 5CT	$21.60	$27.00	$13.42–$24.45	—	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACCINE HIGH DOSE 65+ YRS 2024-25	$116.00	$145.00	$83.49–$131.30	46% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HIGH DOSE PFS	$116.00	$145.00	$29.00–$87.88	46% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VIRUS VACCINE - HIGH DOSE (MHS FEE SCHEDULE)	$116.00	$145.00	$29.00–$87.88	46% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VACCINE HIGH DOSE 65+ YRS 2024-25	$116.00	$145.00	$83.49–$131.30	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE, SC (MHS FEE SCHEDULE)	$88.80	$111.00	$55.00–$112.17	34% below	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR INJECTION	$88.80	$111.00	$55.00–$112.17	34% below	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 M-M-R II VACC/DILU VIALS	$172.00	$215.00	$95.65–$194.68	27% above	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 M-M-R II VACC/DILU VIALS	$172.00	$215.00	$95.65–$194.68	—	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MMRV VARICELLA VACCINE	$258.40	$323.00	$193.00–$333.19	27% below	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MMRV VARICELLA VACCINE (MHS FEE SCHEDULE)	$270.40	$338.00	$193.00–$333.19	24% below	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 PROQUAD VACCINE (MEASL/MUMPS/RUB/VARICE)	$540.80	$676.00	$425.88–$612.12	52% above	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 PROQUAD VACCINE (MEASL/MUMPS/RUB/VARICE)	$540.80	$676.00	$425.88–$612.12	—	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL/MENACTRA VACCINE	$147.20	$184.00	$105.00–$192.70	29% below	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MCV4 Menactra (MHS)	$150.40	$188.00	$105.00–$192.70	28% below	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACTRA VACCINE[MENINGOCCOCAL/DIPTH]	$223.20	$279.00	$166.00–$252.63	8% above	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENVEO VACCINE >10 yr -55 yr (1 vial)	$273.60	$342.00	$166.00–$309.68	32% above	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENACTRA VACCINE[MENINGOCCOCAL/DIPTH]	$223.20	$279.00	$166.00–$252.63	—	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENVEO VACCINE >10 yr -55 yr (1 vial)	$273.60	$342.00	$166.00–$309.68	—	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 BEXSERO (mhs)	$199.20	$249.00	$170.10–$284.40	39% below	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 BEXSERO VACCINE(MENINGOCOCCAL B)	$372.80	$466.00	$236.38–$421.96	15% above	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 BEXSERO VACCINE(MENINGOCOCCAL B)	$372.80	$466.00	$236.38–$421.96	—	20%
Meningococcal B vaccine (Trumenba) CPT 90621 MENINGOCOCCAL RECOMBINANT PROTEIN AND OUTER MEMBRNE VERSICLE VCCINE TRUMENBA (MHS)	$169.60	$212.00	$122.00–$247.71	9% below	20%
Meningococcal B vaccine (Trumenba) CPT 90621 TRUMENBA INTRAMUSCULAR SUSP 120MCG/0.5ML	$350.40	$438.00	$200.88–$396.61	89% above	20%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 TRUMENBA INTRAMUSCULAR SUSP 120MCG/0.5ML	$350.40	$438.00	$200.88–$396.61	—	20%
Nasal spray flu vaccine, live (FluMist) CPT 90660 INFLUENZA VIRUS VACCINE INTRANASAL	$23.20	$29.00	$0.01–$38.87	15% below	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR 13	$269.60	$337.00	$180.00–$271.57	at median	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR 13 (MHS FEE SCHEDULE)	$270.40	$338.00	$180.00–$271.57	at median	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR 13 VACCINE (PNEUMONIA)	$399.20	$499.00	$257.99–$451.84	48% above	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PREVNAR 13 VACCINE (PNEUMONIA)	$399.20	$499.00	$257.99–$451.84	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR VACCINE	$300.00	$375.00	$268.79–$333.62	21% below	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar 20	$300.00	$375.00	$268.79–$333.62	21% below	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 PFS 0.5ML VACCINE	$481.60	$602.00	$312.90–$545.11	26% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 PFS 0.5ML VACCINE	$481.60	$602.00	$312.90–$545.11	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 ADMIN FOR PNEUM IMMUNIZATION	$88.00	$110.00	$69.30–$133.47	44% below	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE P23	$218.40	$273.00	$65.77–$140.50	38% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCCAL VACCINE RHC	$218.40	$273.00	$65.77–$140.50	38% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOVAX 23 VACCINE (PNEUMONIA)	$220.00	$275.00	$133.47–$249.01	39% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOVAX 23 VACCINE (PNEUMONIA)	$220.00	$275.00	$133.47–$249.01	—	20%
Polio vaccine, inactivated (IPV) CPT 90713 IPV polio (MHS)	$40.80	$51.00	$28.00–$53.53	33% below	20%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VAC IPV	$40.80	$51.00	$28.00–$53.53	33% below	20%
Polio vaccine, inactivated (IPV) CPT 90713 IPOL 5ML 10DOSE (OFFICE USE)	$77.60	$97.00	$46.62–$87.83	27% above	20%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 IPOL 5ML 10DOSE (OFFICE USE)	$77.60	$97.00	$46.62–$87.83	—	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 BEYFORTUS PFS 50MG/0.5ML (RSV VACCINE)	$965.60	$1,207.00	$760.41–$1,092.94	30% above	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 BEYFORTUS PFS 50MG/0.5ML (RSV VACCINE)	$965.60	$1,207.00	$760.41–$1,092.94	—	20%
Rabies vaccine, one dose CPT 90675 RABAVERT 2.5 UNITS/ 1ML VACCINE INJ	$718.40	$898.00	$317.67–$813.14	39% above	20%
Rabies vaccine, one dose inpatient CPT 90675 RABAVERT 2.5 UNITS/ 1ML VACCINE INJ	$718.40	$898.00	$317.67–$813.14	—	20%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTARIX	$129.60	$162.00	$90.00–$176.27	35% below	20%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTARIX (MHS FEE SCHEDULE)	$129.60	$162.00	$90.00–$176.27	35% below	20%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTARIX ORAL VACCINE NSA	$230.40	$288.00	$181.44–$260.78	16% above	20%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTARIX ORAL VACCINE NSA	$230.40	$288.00	$181.44–$260.78	—	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 RV5 Rotateq (MHS)	$92.00	$115.00	$77.00–$118.43	12% above	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VACCINE	$92.00	$115.00	$77.00–$118.43	12% above	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTATEQ VACCINE[ROTAVIRUS LIVE, ORAL]	$182.40	$228.00	$143.64–$206.45	121% above	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTATEQ VACCINE[ROTAVIRUS LIVE, ORAL]	$182.40	$228.00	$143.64–$206.45	—	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingrix Single Dose (MHS)	$176.80	$221.00	$147.00–$258.61	9% below	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACCINE, NO PRESERVATIVE >1 = 7 IM	$35.20	$44.00	$18.83–$47.30	35% below	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACCINE NO PRSRV >/= 7 IM (MHS FEE SCHEDULE)	$37.60	$47.00	$18.83–$47.30	30% below	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS SYRINGE (DECAVAC)0.5ML	$68.00	$85.00	$33.96–$76.97	26% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TENIVAC (Td) >7 YR OLD	$72.80	$91.00	$33.96–$82.40	35% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS SYRINGE (DECAVAC)0.5ML	$68.00	$85.00	$33.96–$76.97	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TENIVAC (Td) >7 YR OLD	$72.80	$91.00	$33.96–$82.40	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX (Tdap) VL TETANUS, DIPTH,PERTUS	$78.40	$98.00	$39.07–$88.74	8% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL INJECTION -P SYRINGE	$86.40	$108.00	$39.07–$116.00	19% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL (Tdap) VACCINE, >ADOLESCENT-ADULT	$99.20	$124.00	$39.07–$112.28	36% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX (Tdap) VL TETANUS, DIPTH,PERTUS	$78.40	$98.00	$39.07–$88.74	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 ADACEL (Tdap) VACCINE, >ADOLESCENT-ADULT	$99.20	$124.00	$39.07–$112.28	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMN SINGLE VACCINE	$23.20	$29.00	$16.13–$28.95	1% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INJECTION SINGLE	$36.00	$45.00	$12.00–$28.95	56% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADM INJECTION SINGLE	$36.00	$45.00	$12.00–$28.95	56% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION CLINIC ROOM	$111.20	$139.00	$16.13–$125.86	383% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN FOR IMMUNIZATION	$111.20	$139.00	$16.13–$125.86	383% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION	$111.20	$139.00	$16.13–$125.86	383% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION CLINIC ROOM	$111.20	$139.00	$16.13–$125.86	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION	$111.20	$139.00	$16.13–$125.86	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION EA ADDITIONAL	$24.00	$30.00	$7.00–$19.91	21% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN IMMUNIZATION, EACH ADDITIONAL	$56.80	$71.00	$16.13–$64.29	187% above	20%

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

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

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

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

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

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

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

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

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

Source file: https://www.mckenziehealth.org/documents/content/standard%20charges/381738615_McKenzie-Memorial-Hospital_standardcharges.csv