Hospital

Aspirus Iron River Hospital

Aspirus Iron River Hospital in Iron River, MI publishes cash prices for 468 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Michigan median for 359 of 461 procedures and below it for 78. By typical cash price it ranks #77 of 98 Michigan hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

1400 W Ice Lake Road, Iron River, MI 49935 Collected Sep 23, 2026 Source price file Check a bill from this hospital (906) 265-6121

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 231318 · CMS hospital register NPI 1497750830

Financial assistance

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

Aspirus Iron River 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 Abdomen CT Scan Without/With Contrst	$2,826.20	$4,348.00	—	80% above	35%
Abdominal CT scan without and with contrast inpatient CPT 74170 Abdomen CT Scan Without/With Contrst	$2,826.20	$4,348.00	—	—	35%
Abdominal X-ray, 2 views CPT 74019 Fac Chg Radiologic Exam Abdomen 2 Views	$211.25	$325.00	—	1% above	35%
Abdominal X-ray, 2 views inpatient CPT 74019 Fac Chg Radiologic Exam Abdomen 2 Views	$211.25	$325.00	—	—	35%
Ankle X-ray, complete, 3 or more views CPT 73610 Ankle Minimum 3 Views	$224.25	$345.00	—	5% above	35%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Ankle Minimum 3 Views	$224.25	$345.00	—	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Vas Upper Ext Art-Single Level Bilateral	$315.25	$485.00	—	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 Vas Upper Ext Art-Single Level Bilateral	$315.25	$485.00	—	—	35%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT Extremity Upper Without Contrast	$1,790.10	$2,754.00	—	78% above	35%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT Extremity Upper Without Contrast	$1,790.10	$2,754.00	—	—	35%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Esophagram	$575.25	$885.00	—	99% above	35%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Esophagram	$575.25	$885.00	—	—	35%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Scan Whole Body	$1,872.65	$2,881.00	—	88% above	35%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Scan Whole Body	$1,872.65	$2,881.00	—	—	35%
Breast ultrasound, complete, one breast both sides CPT 76641 Fac US Breast Uni Real Time With Image Complete\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$795.60	$1,224.00	—	—	35%
Breast ultrasound, complete, one breast CPT 76641 Fac US Breast Uni Real Time With Image Complete	$530.40	$816.00	—	71% above	35%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 Fac US Breast Uni Real Time With Image Complete\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$795.60	$1,224.00	—	—	35%
Breast ultrasound, complete, one breast inpatient CPT 76641 Fac US Breast Uni Real Time With Image Complete	$530.40	$816.00	—	—	35%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 Fac US Breast Uni Real Time With Image Limited\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$561.60	$864.00	—	—	35%
Breast ultrasound, limited (one breast or one area) CPT 76642 Fac US Breast Uni Real Time With Image Limited	$374.40	$576.00	—	39% above	35%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 Fac US Breast Uni Real Time With Image Limited\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$561.60	$864.00	—	—	35%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Fac US Breast Uni Real Time With Image Limited	$374.40	$576.00	—	—	35%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Abd Pelvis Endovascular Protocol	$4,514.90	$6,946.00	—	82% above	35%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Abd Pelvis Endovascular Protocol	$4,514.90	$6,946.00	—	—	35%
CT angiography (CTA) of the head CPT 70496 CT Angio Head	$2,764.45	$4,253.00	—	78% above	35%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Head	$2,764.45	$4,253.00	—	—	35%
CT angiography (CTA) of the neck CPT 70498 CT Angio Neck	$2,636.40	$4,056.00	—	75% above	35%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Angio Neck	$2,636.40	$4,056.00	—	—	35%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest Non-Coronary	$2,308.15	$3,551.00	—	37% above	35%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest Non-Coronary	$2,308.15	$3,551.00	—	—	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Coronary Angio	$3,681.60	$5,664.00	—	176% above	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT Coronary Angio	$3,681.60	$5,664.00	—	—	35%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Coronary Calcium Scoring	$64.35	$99.00	—	57% below	35%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Coronary Calcium Scoring	$64.35	$99.00	—	—	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd Pelvis W/O Contrast	$2,511.60	$3,864.00	—	41% above	35%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd Pelvis W/O Contrast	$2,511.60	$3,864.00	—	—	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd Pelvis W/Contrast	$3,208.40	$4,936.00	—	14% above	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abd Pelvis W/Contrast	$3,208.40	$4,936.00	—	—	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abd Pelvis W/O & W/Contrast	$3,731.00	$5,740.00	—	43% above	35%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abd Pelvis W/O & W/Contrast	$3,731.00	$5,740.00	—	—	35%
CT scan of the abdomen with contrast CPT 74160 Fac CT Abdomen W/Dye	$2,358.85	$3,629.00	—	60% above	35%
CT scan of the abdomen with contrast inpatient CPT 74160 Fac CT Abdomen W/Dye	$2,358.85	$3,629.00	—	—	35%
CT scan of the abdomen without contrast CPT 74150 Fac CT Abdomen W/O Dye	$1,262.30	$1,942.00	—	36% above	35%
CT scan of the abdomen without contrast inpatient CPT 74150 Fac CT Abdomen W/O Dye	$1,262.30	$1,942.00	—	—	35%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Limited Sinus Without Contrast	$1,392.30	$2,142.00	—	37% above	35%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Limited Sinus Without Contrast	$1,392.30	$2,142.00	—	—	35%
CT scan of the head or brain, no contrast dye CPT 70450 Fac CT Head/Brain W/O Dye	$1,288.30	$1,982.00	—	44% above	35%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 Fac CT Head/Brain W/O Dye	$1,288.30	$1,982.00	—	—	35%
CT scan of the head with contrast CPT 70460 Fac CT Head/Brain W/Dye	$1,543.10	$2,374.00	—	25% above	35%
CT scan of the head with contrast inpatient CPT 70460 Fac CT Head/Brain W/Dye	$1,543.10	$2,374.00	—	—	35%
CT scan of the head without and with contrast CPT 70470 Head CT Scn Without/With Contrst	$1,838.85	$2,829.00	—	17% above	35%
CT scan of the head without and with contrast inpatient CPT 70470 Head CT Scn Without/With Contrst	$1,838.85	$2,829.00	—	—	35%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 L Spine CT Without Contrast	$1,855.75	$2,855.00	—	71% above	35%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 L Spine CT Without Contrast	$1,855.75	$2,855.00	—	—	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 C Spine CT Without Contrast	$1,565.85	$2,409.00	—	41% above	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 C Spine CT Without Contrast	$1,565.85	$2,409.00	—	—	35%
CT scan of the pelvis, with contrast dye CPT 72193 Pelvis CT Scan With Contrast	$2,367.95	$3,643.00	—	75% above	35%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 Pelvis CT Scan With Contrast	$2,367.95	$3,643.00	—	—	35%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Carotid Duplex Scan	$986.70	$1,518.00	—	14% above	35%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 Carotid Duplex Scan	$986.70	$1,518.00	—	—	35%
Chest CT scan without and with contrast CPT 71270 Chest CT Scan Without/With Contrast	$2,303.60	$3,544.00	—	32% above	35%
Chest CT scan without and with contrast inpatient CPT 71270 Chest CT Scan Without/With Contrast	$2,303.60	$3,544.00	—	—	35%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 View	$214.50	$330.00	—	21% above	35%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 View	$214.50	$330.00	—	—	35%
Chest X-ray, single view CPT 71045 Fac Chg Radiologic Exam Chest Single View	$161.85	$249.00	—	5% above	35%
Chest X-ray, single view inpatient CPT 71045 Fac Chg Radiologic Exam Chest Single View	$161.85	$249.00	—	—	35%
Collarbone (clavicle) X-ray, complete CPT 73000 Clavicle	$188.50	$290.00	—	8% above	35%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 Clavicle	$188.50	$290.00	—	—	35%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Retroperitoneal Complete US	$549.25	$845.00	—	9% below	35%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Retroperitoneal Complete US	$549.25	$845.00	—	—	35%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Bone Density Spine/Hips	$398.45	$613.00	—	28% above	35%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Bone Density Spine/Hips	$398.45	$613.00	—	—	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Bone Density Peripheral Skeleton	$286.00	$440.00	—	123% above	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 Bone Density Peripheral Skeleton	$286.00	$440.00	—	—	35%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB US Detailed Single Fetus	$685.75	$1,055.00	—	5% below	35%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 OB US Detailed Single Fetus	$685.75	$1,055.00	—	—	35%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Fac Diagnostic Computed Tomography Thorax W/O Cntrst	$1,435.20	$2,208.00	—	43% above	35%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Fac Diagnostic Computed Tomography Thorax W/O Cntrst	$1,435.20	$2,208.00	—	—	35%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Fac Diagnostic Computed Tomography Thorax W/Contrast	$1,903.20	$2,928.00	—	45% above	35%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Fac Diagnostic Computed Tomography Thorax W/Contrast	$1,903.20	$2,928.00	—	—	35%
Diagnostic mammogram, both breasts both sides CPT 77066 Fac Diagnostic Mammography Computer-Aided Detcj Bi	$544.05	$837.00	—	—	35%
Diagnostic mammogram, both breasts both sides CPT 77066 Fac Diagnostic Mammography Computer-Aided Detcj Bi\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$816.08	$1,255.50	—	—	35%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Fac Diagnostic Mammography Computer-Aided Detcj Bi	$544.05	$837.00	—	—	35%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Fac Diagnostic Mammography Computer-Aided Detcj Bi\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$816.08	$1,255.50	—	—	35%
Diagnostic mammogram, one breast one side CPT 77065 Mm Dm Rt Diag Post Procedure Images Wwo Cad-C	$426.40	$656.00	—	37% above	35%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Mm Dm Rt Diag Post Procedure Images Wwo Cad-C	$426.40	$656.00	—	—	35%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Duplex Bypass Graft - Bilateral	$1,102.40	$1,696.00	—	—	35%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Duplex Bypass Graft - Bilateral	$1,102.40	$1,696.00	—	—	35%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Venous Duplex Scan/Dvt-Bilateral	$916.50	$1,410.00	—	—	35%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Venous Duplex Scan/Dvt-Bilateral	$916.50	$1,410.00	—	—	35%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Fac Echo Heart Xthoracic,Complete W Doppler	$1,754.35	$2,699.00	—	27% above	35%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Fac Echo Heart Xthoracic,Complete W Doppler	$1,754.35	$2,699.00	—	—	35%
Elbow X-ray, 2 views CPT 73070 Elbow 2 Views	$172.25	$265.00	—	29% above	35%
Elbow X-ray, 2 views inpatient CPT 73070 Elbow 2 Views	$172.25	$265.00	—	—	35%
Elbow X-ray, complete, 3 or more views CPT 73080 Elbow Min 3 Views	$191.75	$295.00	—	1% above	35%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 Elbow Min 3 Views	$191.75	$295.00	—	—	35%
Eye socket (orbit) CT scan without contrast CPT 70480 Orbits CT Without Contrast	$2,293.20	$3,528.00	—	126% above	35%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Orbits CT Without Contrast	$2,293.20	$3,528.00	—	—	35%
Facial bones X-ray, complete, 3 or more views CPT 70150 Facial Bones Min 3 Views Complete	$300.30	$462.00	—	16% above	35%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Facial Bones Min 3 Views Complete	$300.30	$462.00	—	—	35%
Forearm X-ray (radius and ulna), 2 views CPT 73090 Forearm--2 Views	$178.10	$274.00	—	at median	35%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 Forearm--2 Views	$178.10	$274.00	—	—	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary Imaging Including Gb	$2,241.85	$3,449.00	—	140% above	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary Imaging Including Gb	$2,241.85	$3,449.00	—	—	35%
Hand X-ray, 2 views CPT 73120 Hand, 2 Views	$188.50	$290.00	—	29% above	35%
Hand X-ray, 2 views inpatient CPT 73120 Hand, 2 Views	$188.50	$290.00	—	—	35%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 Os Calcis or Heel Min 2 Views	$167.05	$257.00	—	8% above	35%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 Os Calcis or Heel Min 2 Views	$167.05	$257.00	—	—	35%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Fac Sleep Std Vntj Respir Ecg/Hrt Rate&O2 Sat Unattn	$613.60	$944.00	—	12% above	35%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Fac Sleep Std Vntj Respir Ecg/Hrt Rate&O2 Sat Unattn	$613.60	$944.00	—	—	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Fac Polysomnography W/Cpap	$3,665.35	$5,639.00	—	6% above	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Fac Polysomnography W/Cpap	$3,665.35	$5,639.00	—	—	35%
Knee X-ray, 3 views CPT 73562 Knee (Any 3 Views)	$254.15	$391.00	—	32% above	35%
Knee X-ray, 3 views inpatient CPT 73562 Knee (Any 3 Views)	$254.15	$391.00	—	—	35%
Knee X-ray, complete, 4 or more views CPT 73564 Knee Four or More Views	$276.90	$426.00	—	29% above	35%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 Knee Four or More Views	$276.90	$426.00	—	—	35%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Extremity Lower W/O Contrast	$1,855.75	$2,855.00	—	69% above	35%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Extremity Lower W/O Contrast	$1,855.75	$2,855.00	—	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Liver US	$408.20	$628.00	—	12% below	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Liver US	$408.20	$628.00	—	—	35%
Limited ultrasound of an arm or leg (non-vascular) both sides CPT 76882 US Extremity Non Vascular Limited\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$395.85	$609.00	—	—	35%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US Extremity Non Vascular Limited	$263.90	$406.00	—	27% below	35%
Limited ultrasound of an arm or leg (non-vascular) inpatient both sides CPT 76882 US Extremity Non Vascular Limited\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$395.85	$609.00	—	—	35%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US Extremity Non Vascular Limited	$263.90	$406.00	—	—	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Fac Computed Tomography Thorax Lw Dose Lng Ca Scr C-	$2,246.40	$3,456.00	—	543% above	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Fac Computed Tomography Thorax Lw Dose Lng Ca Scr C-	$2,246.40	$3,456.00	—	—	35%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 Tibia/Fibula (Lower Leg) 2 Views	$195.65	$301.00	—	6% above	35%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 Tibia/Fibula (Lower Leg) 2 Views	$195.65	$301.00	—	—	35%
MR angiography (MRA) of the head without contrast CPT 70544 Head MR Angiography W/O Contr	$3,752.45	$5,773.00	—	142% above	35%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Head MR Angiography W/O Contr	$3,752.45	$5,773.00	—	—	35%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 Fac MRI Breast Without&With Contrast W/Cad Bilateral	$4,833.40	$7,436.00	—	—	35%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 Fac MRI Breast Without&With Contrast W/Cad Bilateral	$4,833.40	$7,436.00	—	—	35%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 Rt Joint Lower Ext MRI W/O Contrast\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$3,980.92	$6,124.50	—	—	35%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Rt Joint Lower Ext MRI W/O Contrast	$2,653.95	$4,083.00	—	64% above	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 Rt Joint Lower Ext MRI W/O Contrast\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$3,980.92	$6,124.50	—	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Rt Joint Lower Ext MRI W/O Contrast	$2,653.95	$4,083.00	—	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Rt Joint Low Ext MRI W/O &W/Contrast	$5,423.60	$8,344.00	—	117% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Rt Joint Low Ext MRI W/O &W/Contrast	$5,423.60	$8,344.00	—	—	35%
MRI of the abdomen without contrast CPT 74181 Abdomen MRI Without Contrast	$3,163.55	$4,867.00	—	84% above	35%
MRI of the abdomen without contrast inpatient CPT 74181 Abdomen MRI Without Contrast	$3,163.55	$4,867.00	—	—	35%
MRI of the abdomen, without and then with contrast dye CPT 74183 Abdomen MRI W/O & With Contrast	$4,664.40	$7,176.00	—	48% above	35%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Abdomen MRI W/O & With Contrast	$4,664.40	$7,176.00	—	—	35%
MRI of the brain, no contrast dye CPT 70551 Brain MRI Without Contrast	$2,962.70	$4,558.00	—	75% above	35%
MRI of the brain, no contrast dye inpatient CPT 70551 Brain MRI Without Contrast	$2,962.70	$4,558.00	—	—	35%
MRI of the brain, with and without contrast dye CPT 70553 Brain MRI Without and With Contrast	$4,596.80	$7,072.00	—	63% above	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 Brain MRI Without and With Contrast	$4,596.80	$7,072.00	—	—	35%
MRI of the lower back, no contrast dye CPT 72148 L Spine MRI Without Contrast	$2,948.40	$4,536.00	—	63% above	35%
MRI of the lower back, no contrast dye inpatient CPT 72148 L Spine MRI Without Contrast	$2,948.40	$4,536.00	—	—	35%
MRI of the lower back, without and then with contrast dye CPT 72158 L Spine MRI Without & With Contrast	$4,320.55	$6,647.00	—	58% above	35%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 L Spine MRI Without & With Contrast	$4,320.55	$6,647.00	—	—	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 T Spine MRI Without Contrast	$3,409.90	$5,246.00	—	100% above	35%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 T Spine MRI Without Contrast	$3,409.90	$5,246.00	—	—	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 C Spine MRI Without & With Contrast	$4,564.30	$7,022.00	—	62% above	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 C Spine MRI Without & With Contrast	$4,564.30	$7,022.00	—	—	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 C Spine MRI Without Contrast	$3,138.20	$4,828.00	—	77% above	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 C Spine MRI Without Contrast	$3,138.20	$4,828.00	—	—	35%
MRI of the pelvis without and with contrast CPT 72197 Pelvis MRI Without and With Contrast	$4,941.30	$7,602.00	—	77% above	35%
MRI of the pelvis without and with contrast inpatient CPT 72197 Pelvis MRI Without and With Contrast	$4,941.30	$7,602.00	—	—	35%
MRI of the pelvis, no contrast dye CPT 72195 Pelvis MRI Without Contrast	$3,107.00	$4,780.00	—	83% above	35%
MRI of the pelvis, no contrast dye inpatient CPT 72195 Pelvis MRI Without Contrast	$3,107.00	$4,780.00	—	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Rt Joint Upper Extrem W/O Contrast	$2,653.95	$4,083.00	—	41% above	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 Rt Joint Upper Extrem W/O Contrast	$2,653.95	$4,083.00	—	—	35%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Xr Cervical Spine 4 or 5 Views	$317.20	$488.00	—	12% above	35%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Xr Cervical Spine 4 or 5 Views	$317.20	$488.00	—	—	35%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft T Neck With Contrast	$1,912.95	$2,943.00	—	45% above	35%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Soft T Neck With Contrast	$1,912.95	$2,943.00	—	—	35%
Neck soft tissue CT scan without contrast CPT 70490 CT Soft T Neck W/O Contrast	$1,422.20	$2,188.00	—	40% above	35%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Soft T Neck W/O Contrast	$1,422.20	$2,188.00	—	—	35%
Neck soft tissue X-ray CPT 70360 Neck, Soft Tissue 1 or 2 Views	$209.95	$323.00	—	19% above	35%
Neck soft tissue X-ray inpatient CPT 70360 Neck, Soft Tissue 1 or 2 Views	$209.95	$323.00	—	—	35%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial Perf Spect Mult	$3,089.45	$4,753.00	—	7% above	35%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Myocardial Perf Spect Mult	$3,089.45	$4,753.00	—	—	35%
OCT scan of the retina (optical coherence tomography) CPT 92134 Fac Computerized Ophthalmic Imaging Retina	$37.70	$58.00	—	82% below	35%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 Fac Computerized Ophthalmic Imaging Retina	$37.70	$58.00	—	—	35%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet Imaging W/CT Skull to Mid-Thigh	$6,215.95	$9,563.00	—	13% above	35%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet Imaging W/CT Skull to Mid-Thigh	$6,215.95	$9,563.00	—	—	35%
Pelvic CT scan without contrast CPT 72192 Pelvis CT Scan Without Contrast	$1,277.25	$1,965.00	—	30% above	35%
Pelvic CT scan without contrast inpatient CPT 72192 Pelvis CT Scan Without Contrast	$1,277.25	$1,965.00	—	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Hernia US	$400.40	$616.00	—	19% above	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Hernia US	$400.40	$616.00	—	—	35%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Pelvic US	$419.90	$646.00	—	25% below	35%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Pelvic US	$419.90	$646.00	—	—	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB Greater or Equal to 14wks US	$484.90	$746.00	—	14% below	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB Greater or Equal to 14wks US	$484.90	$746.00	—	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB Less Than 14 Wks 1st Tri US	$427.05	$657.00	—	23% below	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB Less Than 14 Wks 1st Tri US	$427.05	$657.00	—	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB Limited 1 or More Fetuses US	$319.80	$492.00	—	at median	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB Limited 1 or More Fetuses US	$319.80	$492.00	—	—	35%
Rib X-ray, one side, 2 views one side CPT 71100 Ribs Unilateral (No Pa Cxr)	$224.25	$345.00	—	13% above	35%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Ribs Unilateral (No Pa Cxr)	$224.25	$345.00	—	—	35%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Ribs Unilateral (Includes Pa Chest)	$235.30	$362.00	—	at median	35%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Ribs Unilateral (Includes Pa Chest)	$235.30	$362.00	—	—	35%
Screening mammogram, both breasts both sides CPT 77067 Fac Screening Mammography Bi 2-View Breast Inc Cad	$343.20	$528.00	—	—	35%
Screening mammogram, both breasts inpatient both sides CPT 77067 Fac Screening Mammography Bi 2-View Breast Inc Cad	$343.20	$528.00	—	—	35%
Shoulder X-ray, complete, 2 or more views CPT 73030 Shoulder Minimum of 2 Views	$234.65	$361.00	—	16% above	35%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 Shoulder Minimum of 2 Views	$234.65	$361.00	—	—	35%
Sinus X-ray, complete, 3 or more views CPT 70220 Sinuses Min 3 Views Complete	$255.45	$393.00	—	11% above	35%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Sinuses Min 3 Views Complete	$255.45	$393.00	—	—	35%
Skull X-ray, fewer than 4 views CPT 70250 Skull Less Than 4 Views	$244.40	$376.00	—	18% above	35%
Skull X-ray, fewer than 4 views inpatient CPT 70250 Skull Less Than 4 Views	$244.40	$376.00	—	—	35%
Sleep study in a lab (polysomnography) CPT 95810 Fac Polysomnography, 4 or More	$3,408.60	$5,244.00	—	6% above	35%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Fac Polysomnography, 4 or More	$3,408.60	$5,244.00	—	—	35%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Videofluoroscopic Swallow Study	$950.30	$1,462.00	—	152% above	35%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Videofluoroscopic Swallow Study	$950.30	$1,462.00	—	—	35%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 Fac Radiologic Examination Femur Minimum 2 Views	$221.65	$341.00	—	3% above	35%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 Fac Radiologic Examination Femur Minimum 2 Views	$221.65	$341.00	—	—	35%
Thoracic spine (mid back) CT scan without contrast CPT 72128 T Spine CT Without Contrast	$1,830.40	$2,816.00	—	80% above	35%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 T Spine CT Without Contrast	$1,830.40	$2,816.00	—	—	35%
Toe X-ray, 2 or more views CPT 73660 Toe(S) Min 2 Views	$201.50	$310.00	—	61% above	35%
Toe X-ray, 2 or more views inpatient CPT 73660 Toe(S) Min 2 Views	$201.50	$310.00	—	—	35%
Transvaginal pelvic ultrasound CPT 76830 Transvaginal Non OB	$445.25	$685.00	—	17% below	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal Non OB	$445.25	$685.00	—	—	35%
Transvaginal ultrasound during pregnancy CPT 76817 OB Transvaginal US	$341.25	$525.00	—	22% below	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 OB Transvaginal US	$341.25	$525.00	—	—	35%
Ultrasound of the abdomen, complete CPT 76700 Abdomen Complete US	$590.20	$908.00	—	11% below	35%
Ultrasound of the abdomen, complete inpatient CPT 76700 Abdomen Complete US	$590.20	$908.00	—	—	35%
Ultrasound of the scrotum and testicles CPT 76870 Scrotal US	$453.70	$698.00	—	14% below	35%
Ultrasound of the scrotum and testicles inpatient CPT 76870 Scrotal US	$453.70	$698.00	—	—	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Thyroid/Parathyroid US	$448.50	$690.00	—	6% below	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Thyroid/Parathyroid US	$448.50	$690.00	—	—	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Fac Radiologic Exam Upr GI Trc Single Contrast Study	$1,327.30	$2,042.00	—	230% above	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Fac Radiologic Exam Upr GI Trc Single Contrast Study	$1,327.30	$2,042.00	—	—	35%
Upper arm X-ray (humerus), 2 views CPT 73060 Humerus Min 2 Views	$198.25	$305.00	—	8% above	35%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 Humerus Min 2 Views	$198.25	$305.00	—	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous Duplex Scan/Dvt-Unilateral	$562.25	$865.00	—	6% above	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Venous Duplex Scan/Dvt-Unilateral	$562.25	$865.00	—	—	35%
Wrist X-ray, 2 views CPT 73100 Wrist 2 Views	$215.80	$332.00	—	54% above	35%
Wrist X-ray, 2 views inpatient CPT 73100 Wrist 2 Views	$215.80	$332.00	—	—	35%
Wrist X-ray, complete, 3 or more views CPT 73110 Wrist Min 3 Views	$254.15	$391.00	—	32% above	35%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Wrist Min 3 Views	$254.15	$391.00	—	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Fac Radex Hip Unilateral With Pelvis 2-3 Views	$291.20	$448.00	—	42% above	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Fac Radex Hip Unilateral With Pelvis 2-3 Views	$291.20	$448.00	—	—	35%
X-ray of the abdomen, 1 view CPT 74018 Fac Chg Radiologic Exam Abdomen 1 View	$210.60	$324.00	—	33% above	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 Fac Chg Radiologic Exam Abdomen 1 View	$210.60	$324.00	—	—	35%
X-ray of the ankle, 2 views CPT 73600 Ankle 2 Views	$198.90	$306.00	—	13% above	35%
X-ray of the ankle, 2 views inpatient CPT 73600 Ankle 2 Views	$198.90	$306.00	—	—	35%
X-ray of the finger(s), 2 or more views CPT 73140 Finger(S) Min 2 Views	$244.40	$376.00	—	85% above	35%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 Finger(S) Min 2 Views	$244.40	$376.00	—	—	35%
X-ray of the foot, 2 views CPT 73620 Foot 2 Views	$175.50	$270.00	—	11% above	35%
X-ray of the foot, 2 views inpatient CPT 73620 Foot 2 Views	$175.50	$270.00	—	—	35%
X-ray of the foot, complete, 3 or more views CPT 73630 Foot Min 3 Views	$241.15	$371.00	—	34% above	35%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 Foot Min 3 Views	$241.15	$371.00	—	—	35%
X-ray of the hand, 3 or more views both sides CPT 73130 Hand Min 3 Views\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$351.98	$541.50	—	—	35%
X-ray of the hand, 3 or more views CPT 73130 Hand Min 3 Views	$234.65	$361.00	—	28% above	35%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 Hand Min 3 Views\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$351.98	$541.50	—	—	35%
X-ray of the hand, 3 or more views inpatient CPT 73130 Hand Min 3 Views	$234.65	$361.00	—	—	35%
X-ray of the knee, 1 or 2 views CPT 73560 Knee 1 or 2 Views	$211.90	$326.00	—	36% above	35%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 Knee 1 or 2 Views	$211.90	$326.00	—	—	35%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Lumbar Spine 2 or 3 Views	$291.20	$448.00	—	36% above	35%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Lumbar Spine 2 or 3 Views	$291.20	$448.00	—	—	35%
X-ray of the lower back, 4 or more views CPT 72110 Lumbar Spine,Min 4 Views	$324.35	$499.00	—	5% above	35%
X-ray of the lower back, 4 or more views inpatient CPT 72110 Lumbar Spine,Min 4 Views	$324.35	$499.00	—	—	35%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Thoracic/Dorsal Spine,2 Views	$208.65	$321.00	—	13% above	35%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Thoracic/Dorsal Spine,2 Views	$208.65	$321.00	—	—	35%
X-ray of the nasal bones, 3 or more views CPT 70160 Nasal Bones Min 3 Views Complete	$242.45	$373.00	—	41% above	35%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Nasal Bones Min 3 Views Complete	$242.45	$373.00	—	—	35%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xr Cervical Spine 3 Views or Less	$230.75	$355.00	—	at median	35%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Xr Cervical Spine 3 Views or Less	$230.75	$355.00	—	—	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 Pelvis 1 or 2 Views	$221.65	$341.00	—	35% above	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Pelvis 1 or 2 Views	$221.65	$341.00	—	—	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum/Coccyx Min 2 Views	$198.25	$305.00	—	15% above	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Sacrum/Coccyx Min 2 Views	$198.25	$305.00	—	—	35%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
ACTH blood test CPT 82024 Fac Assay of Acth	$236.60	$364.00	—	152% above	35%
ACTH blood test inpatient CPT 82024 Fac Assay of Acth	$236.60	$364.00	—	—	35%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Fac Alanine Amino (Alt) (Sgpt)	$42.25	$65.00	—	76% above	35%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Fac Alanine Amino (Alt) (Sgpt)	$42.25	$65.00	—	—	35%
AST (aspartate aminotransferase) enzyme test CPT 84450 Fac Transferase (Ast) (Sgot)	$47.45	$73.00	—	116% above	35%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Fac Transferase (Ast) (Sgot)	$47.45	$73.00	—	—	35%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Fac Acute Hepatitis Panel	$290.55	$447.00	—	71% above	35%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Fac Acute Hepatitis Panel	$290.55	$447.00	—	—	35%
Albumin blood test CPT 82040 Fac Assay of Serum Albumin	$41.60	$64.00	—	108% above	35%
Albumin blood test inpatient CPT 82040 Fac Assay of Serum Albumin	$41.60	$64.00	—	—	35%
Aldosterone blood test CPT 82088 Fac Assay of Aldosterone	$244.40	$376.00	—	344% above	35%
Aldosterone blood test CPT 82088 Aldosterone Beaker1	$244.40	$376.00	—	344% above	35%
Aldosterone blood test inpatient CPT 82088 Aldosterone Beaker1	$244.40	$376.00	—	—	35%
Aldosterone blood test inpatient CPT 82088 Fac Assay of Aldosterone	$244.40	$376.00	—	—	35%
Alkaline phosphatase (ALP) blood test CPT 84075 Fac Assay Alkaline Phosphatase	$48.75	$75.00	—	132% above	35%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Fac Assay Alkaline Phosphatase	$48.75	$75.00	—	—	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen 1 Beaker1	$26.00	$40.00	—	308% above	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen 1 Beaker1	$26.00	$40.00	—	—	35%
Alpha-fetoprotein (AFP) blood test CPT 82105 Fac Alpha-Fetoprotein, Serum	$127.40	$196.00	—	150% above	35%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Fac Alpha-Fetoprotein, Serum	$127.40	$196.00	—	—	35%
Ammonia blood test CPT 82140 Fac Assay of Ammonia	$90.35	$139.00	—	39% above	35%
Ammonia blood test inpatient CPT 82140 Fac Assay of Ammonia	$90.35	$139.00	—	—	35%
Amylase blood test CPT 82150 Fac Assay of Amylase	$61.75	$95.00	—	187% above	35%
Amylase blood test inpatient CPT 82150 Fac Assay of Amylase	$61.75	$95.00	—	—	35%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Fac CCP Antibody	$139.75	$215.00	—	151% above	35%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Fac CCP Antibody	$139.75	$215.00	—	—	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA	$67.60	$104.00	—	21% above	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA	$67.60	$104.00	—	—	35%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Fac Natriuretic Peptide	$202.15	$311.00	—	157% above	35%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Fac Natriuretic Peptide	$202.15	$311.00	—	—	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture, Aerobic - Routine . Beaker1	$77.35	$119.00	—	46% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Fac Culture, Bacteria, Other	$77.35	$119.00	—	46% above	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Fac Culture, Bacteria, Other	$77.35	$119.00	—	—	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture, Aerobic - Routine . Beaker1	$77.35	$119.00	—	—	35%
Basic metabolic panel (blood test) CPT 80048 Fac Metabolic Panel Total Ca	$92.30	$142.00	—	71% above	35%
Basic metabolic panel (blood test) inpatient CPT 80048 Fac Metabolic Panel Total Ca	$92.30	$142.00	—	—	35%
Bilirubin blood test, total CPT 82247 Bilirubin, Total Beaker1	$46.80	$72.00	—	106% above	35%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin, Total Beaker1	$46.80	$72.00	—	—	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Fac Surgical Path Level 4	$215.80	$332.00	—	98% above	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Fac Tissue Exam by Pathologist	$215.80	$332.00	—	98% above	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Path Level IV 88305 Initial -Tech-Mh	$215.80	$332.00	—	98% above	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Fac Surgical Path Level 4	$215.80	$332.00	—	—	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Fac Tissue Exam by Pathologist	$215.80	$332.00	—	—	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Path Level IV 88305 Initial -Tech-Mh	$215.80	$332.00	—	—	35%
Blood culture for bacteria CPT 87040 Fac Blood Culture for Bacteria	$87.10	$134.00	—	38% above	35%
Blood culture for bacteria inpatient CPT 87040 Fac Blood Culture for Bacteria	$87.10	$134.00	—	—	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture	$24.05	$37.00	—	87% above	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture	$24.05	$37.00	—	—	35%
Blood glucose (sugar) test CPT 82947 Fac Assay, Glucose, Blood Quant	$43.55	$67.00	—	81% above	35%
Blood glucose (sugar) test inpatient CPT 82947 Fac Assay, Glucose, Blood Quant	$43.55	$67.00	—	—	35%
Blood lead test CPT 83655 Fac Assay of Lead	$77.35	$119.00	—	911% above	35%
Blood lead test inpatient CPT 83655 Fac Assay of Lead	$77.35	$119.00	—	—	35%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Fac Chorionic Gonadotropin Assay	$80.60	$124.00	—	118% above	35%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Fac Chorionic Gonadotropin Assay	$80.60	$124.00	—	—	35%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Fac Blood Typing, Abo	$39.65	$61.00	—	89% above	35%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Fac Blood Typing, Abo	$39.65	$61.00	—	—	35%
Blood urea nitrogen (BUN) test CPT 84520 Fac Assay of Urea Nitrogen	$46.80	$72.00	—	161% above	35%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Fac Assay of Urea Nitrogen	$46.80	$72.00	—	—	35%
C-peptide blood test CPT 84681 Fac Assay of C-Peptide	$151.45	$233.00	—	115% above	35%
C-peptide blood test inpatient CPT 84681 Fac Assay of C-Peptide	$151.45	$233.00	—	—	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C Reactive Protein Quant	$54.60	$84.00	—	61% above	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Fac C-Reactive Protein	$54.60	$84.00	—	61% above	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 Fac C-Reactive Protein	$54.60	$84.00	—	—	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C Reactive Protein Quant	$54.60	$84.00	—	—	35%
C. difficile toxin gene test (stool PCR) CPT 87493 Fac Cytomed, Dna, Amp Probe	$217.10	$334.00	—	87% above	35%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Fac Cytomed, Dna, Amp Probe	$217.10	$334.00	—	—	35%
CA 19-9 blood test (tumor marker) CPT 86301 Fac Immunoassay, Tumor, Ca 19-9	$148.85	$229.00	—	59% above	35%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Fac Immunoassay, Tumor, Ca 19-9	$148.85	$229.00	—	—	35%
CA-125 blood test (ovarian cancer marker) CPT 86304 Fac Immunoassay, Tumor, Ca 125	$158.60	$244.00	—	57% above	35%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Fac Immunoassay, Tumor, Ca 125	$158.60	$244.00	—	—	35%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Fac Iadna Sars-Cov-2 Covid-19 Amplified Probe Tq	$180.05	$277.00	—	67% above	35%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Fac Iadna Sars-Cov-2 Covid-19 Amplified Probe Tq	$180.05	$277.00	—	—	35%
Calcium blood test, total CPT 82310 Fac Assay of Calcium	$53.30	$82.00	—	163% above	35%
Calcium blood test, total inpatient CPT 82310 Fac Assay of Calcium	$53.30	$82.00	—	—	35%
Carcinoembryonic antigen (CEA) test CPT 82378 Fac Carcinoembryonic Antigen	$135.85	$209.00	—	64% above	35%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Fac Carcinoembryonic Antigen	$135.85	$209.00	—	—	35%
Chickenpox (varicella) immunity blood test CPT 86787 Fac Varicella-Zoster Antibody	$84.50	$130.00	—	110% above	35%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Fac Varicella-Zoster Antibody	$84.50	$130.00	—	—	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Fac Chlamydia, Amplified	$212.55	$327.00	—	187% above	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Fac Chylmd Trach, Dna, Amp Probe	$212.55	$327.00	—	187% above	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Fac Chlamydia, Amplified	$212.55	$327.00	—	—	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Fac Chylmd Trach, Dna, Amp Probe	$212.55	$327.00	—	—	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Fac Lipid Panel	$107.25	$165.00	—	111% above	35%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Fac Lipid Panel	$107.25	$165.00	—	—	35%
Complete blood count (CBC) with differential CPT 85025 Fac Complete Cbc W/Auto Diff Wbc	$79.95	$123.00	—	95% above	35%
Complete blood count (CBC) with differential inpatient CPT 85025 Fac Complete Cbc W/Auto Diff Wbc	$79.95	$123.00	—	—	35%
Complete blood count (CBC), no differential CPT 85027 Fac Complete Cbc, Automated	$61.10	$94.00	—	111% above	35%
Complete blood count (CBC), no differential inpatient CPT 85027 Fac Complete Cbc, Automated	$61.10	$94.00	—	—	35%
Comprehensive metabolic panel (blood test) CPT 80053 Fac Comprehen Metabolic Panel	$113.75	$175.00	—	52% above	35%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Fac Comprehen Metabolic Panel	$113.75	$175.00	—	—	35%
Cortisol blood test, total CPT 82533 Fac Total Cortisol	$135.20	$208.00	—	297% above	35%
Cortisol blood test, total inpatient CPT 82533 Fac Total Cortisol	$135.20	$208.00	—	—	35%
Creatine kinase (CK) blood test, total CPT 82550 Fac Assay of CK (Cpk)	$63.70	$98.00	—	112% above	35%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Fac Assay of CK (Cpk)	$63.70	$98.00	—	—	35%
Creatinine blood test CPT 82565 Fac Assay of Creatinine	$48.75	$75.00	—	101% above	35%
Creatinine blood test inpatient CPT 82565 Fac Assay of Creatinine	$48.75	$75.00	—	—	35%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus Antibody, Igg Beaker1	$104.00	$160.00	—	139% above	35%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus Antibody, Igg Beaker1	$104.00	$160.00	—	—	35%
D-dimer blood test (blood clot marker) CPT 85379 Fac Fibrin Degradation, Quant	$135.20	$208.00	—	214% above	35%
D-dimer blood test (blood clot marker) inpatient CPT 85379 Fac Fibrin Degradation, Quant	$135.20	$208.00	—	—	35%
DHEA sulfate (DHEA-S) blood test CPT 82627 Fac Dehydroepiandrosterone	$148.85	$229.00	—	131% above	35%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Fac Dehydroepiandrosterone	$148.85	$229.00	—	—	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Fac Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$269.10	$414.00	—	362% above	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Fac Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$269.10	$414.00	—	—	35%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Fac Electrolyte Panel	$104.00	$160.00	—	225% above	35%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Fac Electrolyte Panel	$104.00	$160.00	—	—	35%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-Barr Virus, Antibody to Viral Capsid Antigen - Igg Beaker1	$106.60	$164.00	—	67% above	35%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-Barr Virus, Antibody to Viral Capsid Antigen - Igg Beaker1	$106.60	$164.00	—	—	35%
Estradiol blood test CPT 82670 Fac Assay of Total Estradiol	$172.90	$266.00	—	121% above	35%
Estradiol blood test inpatient CPT 82670 Fac Assay of Total Estradiol	$172.90	$266.00	—	—	35%
FSH (follicle-stimulating hormone) test CPT 83001 Fac Gonadotropin (Fsh)	$115.70	$178.00	—	45% above	35%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Fac Gonadotropin (Fsh)	$115.70	$178.00	—	—	35%
Fecal calprotectin (stool inflammation test) CPT 83993 Fac Calprotectin Fecal	$213.85	$329.00	—	237% above	35%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Fac Calprotectin Fecal	$213.85	$329.00	—	—	35%
Ferritin blood test (iron stores) CPT 82728 Fac Assay of Ferritin	$90.35	$139.00	—	51% above	35%
Ferritin blood test (iron stores) inpatient CPT 82728 Fac Assay of Ferritin	$90.35	$139.00	—	—	35%
Fibrinogen blood test CPT 85384 Fac Fibrinogen	$79.30	$122.00	—	173% above	35%
Fibrinogen blood test inpatient CPT 85384 Fac Fibrinogen	$79.30	$122.00	—	—	35%
Folate (folic acid) blood test CPT 82746 Folic Acid Beaker1	$98.80	$152.00	—	26% above	35%
Folate (folic acid) blood test inpatient CPT 82746 Folic Acid Beaker1	$98.80	$152.00	—	—	35%
Free T3 thyroid hormone test CPT 84481 Fac Free Assay (Ft-3)	$146.90	$226.00	—	120% above	35%
Free T3 thyroid hormone test inpatient CPT 84481 Fac Free Assay (Ft-3)	$146.90	$226.00	—	—	35%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Fac Assay of Free Thyroxine	$70.85	$109.00	—	129% above	35%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Fac Assay of Free Thyroxine	$70.85	$109.00	—	—	35%
Free testosterone test CPT 84402 Fac Assay of Testosterone	$151.45	$233.00	—	313% above	35%
Free testosterone test inpatient CPT 84402 Fac Assay of Testosterone	$151.45	$233.00	—	—	35%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Fac Assay of Ggt	$53.30	$82.00	—	74% above	35%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Fac Assay of Ggt	$53.30	$82.00	—	—	35%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel -Mh	$157.95	$243.00	—	12% below	35%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel -Mh	$157.95	$243.00	—	—	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Fac Glucose Test	$46.80	$72.00	—	115% above	35%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Fac Glucose Test	$46.80	$72.00	—	—	35%
Glucose tolerance test, 3 samples CPT 82951 Fac Glucose Tolerance Test (Gtt)	$85.80	$132.00	—	50% above	35%
Glucose tolerance test, 3 samples inpatient CPT 82951 Fac Glucose Tolerance Test (Gtt)	$85.80	$132.00	—	—	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Fac Gonorrhea Chlamydia Testing	$212.55	$327.00	—	123% above	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae, Amplified Beaker1	$212.55	$327.00	—	123% above	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae, Amplified Beaker1	$212.55	$327.00	—	—	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Fac Gonorrhea Chlamydia Testing	$212.55	$327.00	—	—	35%
H. pylori stool antigen test CPT 87338 Fac Iaad Ia Hpylori Stool	$129.35	$199.00	—	104% above	35%
H. pylori stool antigen test inpatient CPT 87338 Fac Iaad Ia Hpylori Stool	$129.35	$199.00	—	—	35%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Fac Hiv-1, Dna, Quant	$525.85	$809.00	—	188% above	35%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Fac Hiv-1, Dna, Quant	$525.85	$809.00	—	—	35%
HIV-1 and HIV-2 antibody test CPT 86703 Hiv Ermh	$79.95	$123.00	—	70% above	35%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Hiv Ermh	$79.95	$123.00	—	—	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Fac Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$148.85	$229.00	—	203% above	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Fac Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$148.85	$229.00	—	—	35%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Fac Iadna Human Papillomavirus High-Risk Types	$212.55	$327.00	—	187% above	35%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Fac Hpv, High Risk Types	$212.55	$327.00	—	187% above	35%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Fac Iadna Human Papillomavirus High-Risk Types	$212.55	$327.00	—	—	35%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Fac Hpv, High Risk Types	$212.55	$327.00	—	—	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Fac Glycosylated Hemoglobin Test	$68.90	$106.00	—	71% above	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Fac Glycosylated Hemoglobin Test	$68.90	$106.00	—	—	35%
Hemoglobin blood test CPT 85018 Hemoglobin Beaker1	$35.75	$55.00	—	123% above	35%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin Beaker1	$35.75	$55.00	—	—	35%
Hepatitis B core antibody test (total) CPT 86704 Fac Hep B Core Antibody, Total	$84.50	$130.00	—	91% above	35%
Hepatitis B core antibody test (total) inpatient CPT 86704 Fac Hep B Core Antibody, Total	$84.50	$130.00	—	—	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Fac Hep B Surface Antibody	$74.10	$114.00	—	76% above	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Fac Hep B Surface Antibody	$74.10	$114.00	—	—	35%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Fac Iaad Ia Hepatitis B Surface Antigen	$65.00	$100.00	—	40% above	35%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Fac Iaad Ia Hepatitis B Surface Antigen	$65.00	$100.00	—	—	35%
Hepatitis C antibody blood test (screening) CPT 86803 Fac Hepatitis C Ab Test	$115.70	$178.00	—	141% above	35%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Fac Hepatitis C Ab Test	$115.70	$178.00	—	—	35%
Hepatitis C viral load (HCV RNA) test CPT 87522 Fac Hepatitis C, Rna, Quant	$265.20	$408.00	—	102% above	35%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Fac Hepatitis C, Rna, Quant	$265.20	$408.00	—	—	35%
Herpes blood test, HSV-1 antibody CPT 86695 Fac Herpes Simplex Test	$97.50	$150.00	—	134% above	35%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Fac Herpes Simplex Test	$97.50	$150.00	—	—	35%
Herpes blood test, HSV-2 antibody CPT 86696 Hsv 2 G Specific Lgg Beaker1	$118.95	$183.00	—	132% above	35%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Hsv 2 G Specific Lgg Beaker1	$118.95	$183.00	—	—	35%
High-sensitivity CRP (hs-CRP) test CPT 86141 Fac C-Reactive Protein, Hs	$120.25	$185.00	—	109% above	35%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 Fac C-Reactive Protein, Hs	$120.25	$185.00	—	—	35%
Homocysteine blood test CPT 83090 Fac Assay of Homocystine	$118.30	$182.00	—	54% above	35%
Homocysteine blood test inpatient CPT 83090 Fac Assay of Homocystine	$118.30	$182.00	—	—	35%
Insulin blood test CPT 83525 Fac Assay of Insulin	$115.05	$177.00	—	214% above	35%
Insulin blood test inpatient CPT 83525 Fac Assay of Insulin	$115.05	$177.00	—	—	35%
Iron blood test (serum iron) CPT 83540 Fac Assay of Iron	$53.30	$82.00	—	82% above	35%
Iron blood test (serum iron) inpatient CPT 83540 Fac Assay of Iron	$53.30	$82.00	—	—	35%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity Beaker1	$54.60	$84.00	—	37% above	35%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity Beaker1	$54.60	$84.00	—	—	35%
Kidney function blood test panel CPT 80069 Fac Renal Function Panel	$102.70	$158.00	—	66% above	35%
Kidney function blood test panel inpatient CPT 80069 Fac Renal Function Panel	$102.70	$158.00	—	—	35%
LH (luteinizing hormone) test CPT 83002 Fac Gonadotropin (Lh)	$115.05	$177.00	—	51% above	35%
LH (luteinizing hormone) test inpatient CPT 83002 Fac Gonadotropin (Lh)	$115.05	$177.00	—	—	35%
Lactate (lactic acid) blood test CPT 83605 Fac Assay of Lactic Acid	$93.60	$144.00	—	108% above	35%
Lactate (lactic acid) blood test inpatient CPT 83605 Fac Assay of Lactic Acid	$93.60	$144.00	—	—	35%
Lactate dehydrogenase (LDH) blood test CPT 83615 Fac Lactate (Ld) (Ldh) Enzyme	$52.00	$80.00	—	117% above	35%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Fac Lactate (Ld) (Ldh) Enzyme	$52.00	$80.00	—	—	35%
Lipase blood test (pancreas enzyme) CPT 83690 Fac Assay of Lipase	$67.60	$104.00	—	118% above	35%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Fac Assay of Lipase	$67.60	$104.00	—	—	35%
Liver function blood test panel CPT 80076 Fac Hepatic Function Panel	$102.05	$157.00	—	117% above	35%
Liver function blood test panel inpatient CPT 80076 Fac Hepatic Function Panel	$102.05	$157.00	—	—	35%
Lyme disease antibody test CPT 86618 Fac Lyme Disease Antibody	$116.35	$179.00	—	348% above	35%
Lyme disease antibody test inpatient CPT 86618 Fac Lyme Disease Antibody	$116.35	$179.00	—	—	35%
Magnesium blood test CPT 83735 Fac Assay of Magnesium	$53.30	$82.00	—	166% above	35%
Magnesium blood test inpatient CPT 83735 Fac Assay of Magnesium	$53.30	$82.00	—	—	35%
Measles (rubeola) antibody test CPT 86765 Fac Rubeola Antibody	$89.70	$138.00	—	264% above	35%
Measles (rubeola) antibody test inpatient CPT 86765 Fac Rubeola Antibody	$89.70	$138.00	—	—	35%
Mono test (heterophile antibody, Monospot) CPT 86308 Fac Heterophile Antibodies	$55.25	$85.00	—	36% above	35%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Fac Heterophile Antibodies	$55.25	$85.00	—	—	35%
Mumps immunity blood test CPT 86735 Fac Mumps Antibody	$85.80	$132.00	—	242% above	35%
Mumps immunity blood test inpatient CPT 86735 Fac Mumps Antibody	$85.80	$132.00	—	—	35%
Obstetric blood test panel CPT 80055 Fac Obstetric Panel	$316.55	$487.00	—	81% above	35%
Obstetric blood test panel inpatient CPT 80055 Fac Obstetric Panel	$316.55	$487.00	—	—	35%
PSA (prostate-specific antigen) blood test, free CPT 84154 Fac Assay of Psa, Free	$114.40	$176.00	—	99% above	35%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Fac Assay of Psa, Free	$114.40	$176.00	—	—	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 Fac Assay of Psa, Total	$118.30	$182.00	—	131% above	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Fac Assay of Psa, Total	$118.30	$182.00	—	—	35%
Pap test (liquid-based, automated screening with review) CPT 88175 Fac Cytpath C/V Auto Fluid Redo	$163.15	$251.00	—	120% above	35%
Pap test (liquid-based, automated screening with review) CPT 88175 Fac Cytopath C/V Auto Fluid Redo	$171.60	$264.00	—	131% above	35%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Fac Cytpath C/V Auto Fluid Redo	$163.15	$251.00	—	—	35%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Fac Cytopath C/V Auto Fluid Redo	$171.60	$264.00	—	—	35%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Fac Cytopath, C/V, Thin Layer	$148.20	$228.00	—	91% above	35%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Fac Cytopath,Auto Thnprep Pap	$148.20	$228.00	—	91% above	35%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Fac Cytopath, C/V, Thin Layer	$148.20	$228.00	—	—	35%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Fac Cytopath,Auto Thnprep Pap	$148.20	$228.00	—	—	35%
Parathyroid hormone (PTH) blood test CPT 83970 Fac Assay of Parathormone	$254.80	$392.00	—	89% above	35%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Fac Assay of Parathormone	$254.80	$392.00	—	—	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt, Partial Thromboplastin Beaker1	$65.00	$100.00	—	110% above	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 Fac Thromboplastin Time, Partial	$65.00	$100.00	—	110% above	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Ptt, Partial Thromboplastin Beaker1	$65.00	$100.00	—	—	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Fac Thromboplastin Time, Partial	$65.00	$100.00	—	—	35%
Phosphorus (phosphate) blood test CPT 84100 Fac Assay of Phosphorus	$41.60	$64.00	—	98% above	35%
Phosphorus (phosphate) blood test inpatient CPT 84100 Fac Assay of Phosphorus	$41.60	$64.00	—	—	35%
Potassium blood test CPT 84132 Fac Assay of Serum Potassium	$43.55	$67.00	—	82% above	35%
Potassium blood test inpatient CPT 84132 Fac Assay of Serum Potassium	$43.55	$67.00	—	—	35%
Progesterone blood test CPT 84144 Fac Assay of Progesterone	$120.90	$186.00	—	90% above	35%
Progesterone blood test inpatient CPT 84144 Fac Assay of Progesterone	$120.90	$186.00	—	—	35%
Prolactin blood test CPT 84146 Fac Assay of Prolactin	$120.90	$186.00	—	65% above	35%
Prolactin blood test inpatient CPT 84146 Fac Assay of Prolactin	$120.90	$186.00	—	—	35%
Prothrombin time (PT/INR) clotting test CPT 85610 Fac Prothrombin Tm	$46.15	$71.00	—	137% above	35%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time Beaker1	$46.15	$71.00	—	137% above	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time Beaker1	$46.15	$71.00	—	—	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Fac Prothrombin Tm	$46.15	$71.00	—	—	35%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Fac Drug Test Prsmv Read Direct Optical Obs PR Date	$57.20	$88.00	—	52% above	35%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Fac Drug Test Prsmv Read Direct Optical Obs PR Date	$57.20	$88.00	—	—	35%
Rapid flu test (influenza antigen) CPT 87804 Fac Iaadiadoo Influenza	$76.05	$117.00	—	58% above	35%
Rapid flu test (influenza antigen) inpatient CPT 87804 Fac Iaadiadoo Influenza	$76.05	$117.00	—	—	35%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Fac Iaadiadoo Streptococcus Group A	$76.70	$118.00	—	43% above	35%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Fac Iaadiadoo Streptococcus Group A	$76.70	$118.00	—	—	35%
Renin blood test CPT 84244 Fac Assay of Renin	$174.20	$268.00	—	318% above	35%
Renin blood test inpatient CPT 84244 Fac Assay of Renin	$174.20	$268.00	—	—	35%
Rh blood typing CPT 86901 Fac Blood Typing, Rh (D)	$39.65	$61.00	—	91% above	35%
Rh blood typing inpatient CPT 86901 Fac Blood Typing, Rh (D)	$39.65	$61.00	—	—	35%
Rheumatoid factor (RF) test CPT 86431 Fac Rheumatoid Factor, Quant	$58.50	$90.00	—	71% above	35%
Rheumatoid factor (RF) test inpatient CPT 86431 Fac Rheumatoid Factor, Quant	$58.50	$90.00	—	—	35%
Rubella antibody test (immunity check) CPT 86762 Fac Rubella Antibody	$89.05	$137.00	—	75% above	35%
Rubella antibody test (immunity check) inpatient CPT 86762 Fac Rubella Antibody	$89.05	$137.00	—	—	35%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Fac RBC Sed Rate, Automated	$41.60	$64.00	—	73% above	35%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Fac RBC Sed Rate, Automated	$41.60	$64.00	—	—	35%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Fac Semen Anal Vol/Count/Mot	$175.50	$270.00	—	91% above	35%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Fac Semen Anal Vol/Count/Mot	$175.50	$270.00	—	—	35%
Sodium blood test CPT 84295 Fac Assay of Serum Sodium	$42.25	$65.00	—	103% above	35%
Sodium blood test inpatient CPT 84295 Fac Assay of Serum Sodium	$42.25	$65.00	—	—	35%
Stool ova and parasites exam CPT 87177 Fac Ova and Parasites Smears	$107.90	$166.00	—	147% above	35%
Stool ova and parasites exam inpatient CPT 87177 Fac Ova and Parasites Smears	$107.90	$166.00	—	—	35%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Fac Test of Stool to Detect Blood	$26.00	$40.00	—	48% above	35%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Fac Test of Stool to Detect Blood	$26.00	$40.00	—	—	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fac Assay Test for Blood, Fecal	$98.15	$151.00	—	108% above	35%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Fac Assay Test for Blood, Fecal	$98.15	$151.00	—	—	35%
Syphilis antibody test (Treponema pallidum) CPT 86780 Fac Antibody Treponema Pallidum	$74.10	$114.00	—	58% above	35%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Fac Antibody Treponema Pallidum	$74.10	$114.00	—	—	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Fac Blood Serology, Qualitative	$39.65	$61.00	—	131% above	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Fac Blood Serology, Qualitative	$39.65	$61.00	—	—	35%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Fac TB Test, Cell Immun Measure	$291.85	$449.00	—	130% above	35%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Fac TB Test, Cell Immun Measure	$291.85	$449.00	—	—	35%
Testosterone blood test, total (not free testosterone) CPT 84403 Fac Assay of Total Testosterone	$155.35	$239.00	—	336% above	35%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Fac Assay of Total Testosterone	$155.35	$239.00	—	—	35%
Thyroid peroxidase (TPO) antibody test CPT 86376 Fac Microsomal Antibody	$97.50	$150.00	—	111% above	35%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Fac Microsomal Antibody	$97.50	$150.00	—	—	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Fac Thyr Stimulating Horm	$112.45	$173.00	—	75% above	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Fac Thyr Stimulating Horm	$112.45	$173.00	—	—	35%
Total IgE blood test CPT 82785 Immunoglobulin E Beaker1	$102.05	$157.00	—	130% above	35%
Total IgE blood test inpatient CPT 82785 Immunoglobulin E Beaker1	$102.05	$157.00	—	—	35%
Total cholesterol blood test CPT 82465 Fac Assay, Bld/Serum Cholesterol	$35.75	$55.00	—	79% above	35%
Total cholesterol blood test inpatient CPT 82465 Fac Assay, Bld/Serum Cholesterol	$35.75	$55.00	—	—	35%
Total thyroxine (T4) blood test CPT 84436 Fac Assay of Total Thyroxine	$52.00	$80.00	—	70% above	35%
Total thyroxine (T4) blood test inpatient CPT 84436 Fac Assay of Total Thyroxine	$52.00	$80.00	—	—	35%
Total triiodothyronine (T3) blood test CPT 84480 Fac Triiodothyro9 T3 Tot	$107.25	$165.00	—	132% above	35%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Fac Triiodothyro9 T3 Tot	$107.25	$165.00	—	—	35%
Transferrin blood test CPT 84466 Fac Assay of Transferrin	$113.10	$174.00	—	98% above	35%
Transferrin blood test inpatient CPT 84466 Fac Assay of Transferrin	$113.10	$174.00	—	—	35%
Trichomonas test (NAAT) CPT 87661 Fac Iadna Trichomonas Vaginalis Amplified Probe Tech	$217.10	$334.00	—	195% above	35%
Trichomonas test (NAAT) inpatient CPT 87661 Fac Iadna Trichomonas Vaginalis Amplified Probe Tech	$217.10	$334.00	—	—	35%
Triglycerides blood test CPT 84478 Fac Assay of Triglycerides	$53.95	$83.00	—	180% above	35%
Triglycerides blood test inpatient CPT 84478 Fac Assay of Triglycerides	$53.95	$83.00	—	—	35%
Troponin test, quantitative CPT 84484 Fac Assay of Troponin, Quant	$98.80	$152.00	—	132% above	35%
Troponin test, quantitative inpatient CPT 84484 Fac Assay of Troponin, Quant	$98.80	$152.00	—	—	35%
Uric acid blood test CPT 84550 Fac Assay of Blood/Uric Acid	$50.70	$78.00	—	125% above	35%
Uric acid blood test inpatient CPT 84550 Fac Assay of Blood/Uric Acid	$50.70	$78.00	—	—	35%
Urinalysis with microscope exam, automated CPT 81001 Urine Macro and Microscopic Beaker1	$40.30	$62.00	—	102% above	35%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urine Macro and Microscopic Beaker1	$40.30	$62.00	—	—	35%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick,Nonautomated (Clini	$30.55	$47.00	—	135% above	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick,Nonautomated (Clini	$30.55	$47.00	—	—	35%
Urinalysis without microscope exam, manual CPT 81002 Fac Urinalysis Nonauto W/O Scope	$30.55	$47.00	—	100% above	35%
Urinalysis without microscope exam, manual inpatient CPT 81002 Fac Urinalysis Nonauto W/O Scope	$30.55	$47.00	—	—	35%
Urine culture for bacteria, with colony count CPT 87086 Fac Urine Culture/Colony Count	$75.40	$116.00	—	37% above	35%
Urine culture for bacteria, with colony count inpatient CPT 87086 Fac Urine Culture/Colony Count	$75.40	$116.00	—	—	35%
Urine microalbumin (albumin) test CPT 82043 Fac Urine Albumin Quantitative	$93.60	$144.00	—	260% above	35%
Urine microalbumin (albumin) test inpatient CPT 82043 Fac Urine Albumin Quantitative	$93.60	$144.00	—	—	35%
Urine pregnancy test, read by color change CPT 81025 Fac Urine Pregnancy Tst Vis Color Cmprsn Meths	$65.00	$100.00	—	183% above	35%
Urine pregnancy test, read by color change inpatient CPT 81025 Fac Urine Pregnancy Tst Vis Color Cmprsn Meths	$65.00	$100.00	—	—	35%
Vitamin B12 (cobalamin) blood test CPT 82607 Fac Vitamin B-12	$110.50	$170.00	—	86% above	35%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Fac Vitamin B-12	$110.50	$170.00	—	—	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Fac Assay of Vitamin D	$178.10	$274.00	—	101% above	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Fac Assay of Vitamin D	$178.10	$274.00	—	—	35%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Fac Assay of Dihydroxyvitamin D	$238.55	$367.00	—	202% above	35%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Fac Assay of Dihydroxyvitamin D	$238.55	$367.00	—	—	35%
Zinc blood test CPT 84630 Fac Assay of Zinc	$104.00	$160.00	—	337% above	35%
Zinc blood test CPT 84630 Assay of Zinc-Pbb	$104.00	$160.00	—	337% above	35%
Zinc blood test inpatient CPT 84630 Fac Assay of Zinc	$104.00	$160.00	—	—	35%
Zinc blood test inpatient CPT 84630 Assay of Zinc-Pbb	$104.00	$160.00	—	—	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Fac Chorionic Gonadotropin Test	$117.65	$181.00	—	140% above	35%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Fac Chorionic Gonadotropin Test	$117.65	$181.00	—	—	35%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Balloon dilation of the maxillary sinus opening, one side CPT 31295 Fac Nasal/Sinus Ndsc Surg W/Dilation Maxillary Sinus	$654.55	$1,007.00	—	77% below	35%
Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 Fac Nasal/Sinus Ndsc Surg W/Dilation Maxillary Sinus	$654.55	$1,007.00	—	—	35%
Botox injections for chronic migraine CPT 64615 Chemodervate Facial/Trigem/Cerv Musc Migraine Pbb	$986.70	$1,518.00	—	73% above	35%
Botox injections for chronic migraine inpatient CPT 64615 Chemodervate Facial/Trigem/Cerv Musc Migraine Pbb	$986.70	$1,518.00	—	—	35%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Fac Bx Breast W Device 1st Lesion Stereotactic Guide	$3,924.05	$6,037.00	—	73% above	35%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Fac Bx Breast W Device 1st Lesion Stereotactic Guide	$3,924.05	$6,037.00	—	—	35%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Fac Cltx Dstl Fibular Fx Lat Malls W/O Mnpj	$1,050.40	$1,616.00	—	184% above	35%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Fac Cltx Dstl Fibular Fx Lat Malls W/O Mnpj	$1,050.40	$1,616.00	—	—	35%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Fracture Metatarsal W/O Manip Each - Mh	$1,592.50	$2,450.00	—	327% above	35%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Fracture Metatarsal W/O Manip Each - Mh	$1,592.50	$2,450.00	—	—	35%
Bunion correction with removal of part of the big toe joint CPT 28292 Fac Corrj Hallux Valgus W/Sesmdc W/Rescj Prox Phal	$6,332.95	$9,743.00	—	41% above	35%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 Fac Corrj Hallux Valgus W/Sesmdc W/Rescj Prox Phal	$6,332.95	$9,743.00	—	—	35%
Cardiac catheterization with coronary angiogram CPT 93458 Fac Cath Plmt L Hrt & Arts W/Njx & Angio Img S&I	$9,938.50	$15,290.00	—	at median	35%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 Fac Cath Plmt L Hrt & Arts W/Njx & Angio Img S&I	$9,938.50	$15,290.00	—	—	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Fac Cardioversion Elective Arrhythmia External	$984.75	$1,515.00	—	at median	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Fac Cardioversion Elective Arrhythmia External	$984.75	$1,515.00	—	—	35%
Catheter ablation for atrial fibrillation CPT 93656 Fac Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation	$17,708.60	$27,244.00	—	51% below	35%
Catheter ablation for atrial fibrillation inpatient CPT 93656 Fac Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation	$17,708.60	$27,244.00	—	—	35%
Cervical biopsy CPT 57500 Fac Biopsy of Cervix	$1,263.60	$1,944.00	—	43% above	35%
Cervical biopsy inpatient CPT 57500 Fac Biopsy of Cervix	$1,263.60	$1,944.00	—	—	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Fac Circumcision W/Regionl Block	$520.00	$800.00	—	69% below	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Fac Circumcision W/Regionl Block	$520.00	$800.00	—	—	35%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Fracture Distal Radius Closed W/O Manip - Mh	$615.55	$947.00	—	62% above	35%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Fracture Distal Radius Closed W/O Manip - Mh	$615.55	$947.00	—	—	35%
Colonoscopy with endoscopic ultrasound CPT 45391 Fac Colsc Flx W/Ndsc US Xm Rctm Et Al Lmtd&Adj Strux	$2,501.85	$3,849.00	—	52% above	35%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Fac Colsc Flx W/Ndsc US Xm Rctm Et Al Lmtd&Adj Strux	$2,501.85	$3,849.00	—	—	35%
Colonoscopy with polyp removal CPT 45385 Fac Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$2,533.05	$3,897.00	—	48% above	35%
Colonoscopy with polyp removal inpatient CPT 45385 Fac Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$2,533.05	$3,897.00	—	—	35%
Colonoscopy with tissue sample CPT 45380 Fac Colonoscopy W/Biopsy Single/Multiple	$2,092.35	$3,219.00	—	18% above	35%
Colonoscopy with tissue sample inpatient CPT 45380 Fac Colonoscopy W/Biopsy Single/Multiple	$2,092.35	$3,219.00	—	—	35%
Colonoscopy, diagnostic CPT 45378 Fac Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$1,922.70	$2,958.00	—	81% above	35%
Colonoscopy, diagnostic inpatient CPT 45378 Fac Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$1,922.70	$2,958.00	—	—	35%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Fac Colposcopy Cervix Vag Loop Eltrd Bx Cervix	$859.95	$1,323.00	—	79% below	35%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 Fac Colposcopy Cervix Vag Loop Eltrd Bx Cervix	$859.95	$1,323.00	—	—	35%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Fac Colposcopy Cervix Bx Cervix&Endocrv Certg	$453.05	$697.00	—	20% above	35%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 Fac Colposcopy Cervix Bx Cervix&Endocrv Certg	$453.05	$697.00	—	—	35%
Coronary stent placement, one artery CPT 92928 Fac Prq Trluml Coronary Stent W/Angio One Art/Brnch	$7,832.50	$12,050.00	—	40% below	35%
Coronary stent placement, one artery inpatient CPT 92928 Fac Prq Trluml Coronary Stent W/Angio One Art/Brnch	$7,832.50	$12,050.00	—	—	35%
Cystoscopy with ureteral stent placement both sides CPT 52332 Fac Cystoscopy and Treatment\|BILATERAL PROCEDURE	$6,535.42	$10,054.50	—	—	35%
Cystoscopy with ureteral stent placement CPT 52332 Fac Cystoscopy and Treatment	$4,356.95	$6,703.00	—	at median	35%
Cystoscopy with ureteral stent placement inpatient both sides CPT 52332 Fac Cystoscopy and Treatment\|BILATERAL PROCEDURE	$6,535.42	$10,054.50	—	—	35%
Cystoscopy with ureteral stent placement inpatient CPT 52332 Fac Cystoscopy and Treatment	$4,356.95	$6,703.00	—	—	35%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystourethroscopy; Temp Stent Placement	$992.55	$1,527.00	—	15% above	35%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystourethroscopy; Temp Stent Placement	$992.55	$1,527.00	—	—	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Fac Dstrj All Prmlg 1st Les	$362.70	$558.00	—	89% above	35%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Fac Dstrj All Prmlg 1st Les	$362.70	$558.00	—	—	35%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 Fac Tympanostomy Local/Topical Anesthesia	$522.60	$804.00	—	60% above	35%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 Fac Tympanostomy Local/Topical Anesthesia	$522.60	$804.00	—	—	35%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 Fac Removal Impacted Cerumen Irrigation/Lvg Unilat\|BILATERAL PROCEDURE	$158.92	$244.50	—	—	35%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Fac Removal Impacted Cerumen Irrigation/Lvg Unilat	$105.95	$163.00	—	4% above	35%
Earwax removal by irrigation (rinsing), one ear inpatient both sides CPT 69209 Fac Removal Impacted Cerumen Irrigation/Lvg Unilat\|BILATERAL PROCEDURE	$158.92	$244.50	—	—	35%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Fac Removal Impacted Cerumen Irrigation/Lvg Unilat	$105.95	$163.00	—	—	35%
Earwax removal with instruments, one ear both sides CPT 69210 Fac Rmvl Impacted Cerumen Spx 1/Bth Ears\|BILATERAL PROCEDURE	$125.78	$193.50	—	—	35%
Earwax removal with instruments, one ear both sides CPT 69210 Removal Impacted Cerumen -Mh\|BILATERAL PROCEDURE	$127.72	$196.50	—	—	35%
Earwax removal with instruments, one ear CPT 69210 Fac Rmvl Impacted Cerumen Spx 1/Bth Ears	$83.85	$129.00	—	11% below	35%
Earwax removal with instruments, one ear CPT 69210 Removal Impacted Cerumen -Mh	$85.15	$131.00	—	9% below	35%
Earwax removal with instruments, one ear inpatient both sides CPT 69210 Fac Rmvl Impacted Cerumen Spx 1/Bth Ears\|BILATERAL PROCEDURE	$125.78	$193.50	—	—	35%
Earwax removal with instruments, one ear inpatient both sides CPT 69210 Removal Impacted Cerumen -Mh\|BILATERAL PROCEDURE	$127.72	$196.50	—	—	35%
Earwax removal with instruments, one ear inpatient CPT 69210 Fac Rmvl Impacted Cerumen Spx 1/Bth Ears	$83.85	$129.00	—	—	35%
Earwax removal with instruments, one ear inpatient CPT 69210 Removal Impacted Cerumen -Mh	$85.15	$131.00	—	—	35%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Fac Biopsy of Uterus Lining	$271.70	$418.00	—	15% above	35%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Fac Biopsy of Uterus Lining	$271.70	$418.00	—	—	35%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Fac Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn	$1,325.35	$2,039.00	—	37% above	35%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Fac Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn	$1,325.35	$2,039.00	—	—	35%
Eye injection into the vitreous (intravitreal injection) CPT 67028 Fac Intravitreal Njx Pharmacologic Agt Spx	$404.95	$623.00	—	35% below	35%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 Fac Intravitreal Njx Pharmacologic Agt Spx	$404.95	$623.00	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 CT Lumb/Sacr Inj Single Level\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$2,939.62	$4,522.50	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 CT Lumb/Sacr Inj Single Level\|BILATERAL PROCEDURE	$2,939.62	$4,522.50	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 CT Lumb/Sacr Inj Single Level	$1,959.75	$3,015.00	—	81% above	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 CT Lumb/Sacr Inj Single Level\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$2,939.62	$4,522.50	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 CT Lumb/Sacr Inj Single Level\|BILATERAL PROCEDURE	$2,939.62	$4,522.50	—	—	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 CT Lumb/Sacr Inj Single Level	$1,959.75	$3,015.00	—	—	35%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Fac Scope of Sigmoid Colon Only for Diagnosis	$762.45	$1,173.00	—	68% below	35%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Fac Scope of Sigmoid Colon Only for Diagnosis	$762.45	$1,173.00	—	—	35%
Gallbladder removal, laparoscopic CPT 47562 Fac Laparoscopic Cholecystectomy	$9,250.80	$14,232.00	—	14% above	35%
Gallbladder removal, laparoscopic inpatient CPT 47562 Fac Laparoscopic Cholecystectomy	$9,250.80	$14,232.00	—	—	35%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Fac Laparo Cholecystectomy/Graph	$9,354.15	$14,391.00	—	13% above	35%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 Fac Laparo Cholecystectomy/Graph	$9,354.15	$14,391.00	—	—	35%
Hemorrhoid banding (rubber band ligation) CPT 46221 Fac Hemorrhoidectomy Smpl Ligature	$2,747.55	$4,227.00	—	92% above	35%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Fac Hemorrhoidectomy Smpl Ligature	$2,747.55	$4,227.00	—	—	35%
Hemorrhoidectomy (internal and external), one area CPT 46255 Fac Hrhc Smpl	$3,613.35	$5,559.00	—	3% below	35%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 Fac Hrhc Smpl	$3,613.35	$5,559.00	—	—	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Inj Proc Hysterosalphingram	$258.70	$398.00	—	48% below	35%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Inj Proc Hysterosalphingram	$258.70	$398.00	—	—	35%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Fac Hystsc Bx Endometrium&/Polypc +-D&C	$3,609.45	$5,553.00	—	19% below	35%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 Fac Hystsc Bx Endometrium&/Polypc +-D&C	$3,609.45	$5,553.00	—	—	35%
IUD insertion (the device itself billed separately) CPT 58300 Fac Insert Intrauterine Device	$304.20	$468.00	—	8% below	35%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Fac Insert Intrauterine Device	$304.20	$468.00	—	—	35%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Abscess Simple or Single	$404.30	$622.00	—	48% above	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Abscess Simple or Single	$404.30	$622.00	—	—	35%
Inguinal (groin) hernia repair, age 5 or older both sides CPT 49505 Fac Prp I/Hern Init Reduc >5 Yr\|BILATERAL PROCEDURE	$10,578.75	$16,275.00	—	—	35%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Fac Prp I/Hern Init Reduc >5 Yr	$7,052.50	$10,850.00	—	26% above	35%
Inguinal (groin) hernia repair, age 5 or older inpatient both sides CPT 49505 Fac Prp I/Hern Init Reduc >5 Yr\|BILATERAL PROCEDURE	$10,578.75	$16,275.00	—	—	35%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Fac Prp I/Hern Init Reduc >5 Yr	$7,052.50	$10,850.00	—	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 ED Fac Inject Tendon/Lig/Gangl	$474.50	$730.00	—	20% above	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 ED Fac Inject Tendon/Lig/Gangl	$474.50	$730.00	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 CT Guided Aspir &/or Inj Major Jt\|BILATERAL PROCEDURE	$650.32	$1,000.50	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 CT Guided Aspir &/or Inj Major Jt	$433.55	$667.00	—	3% above	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 CT Guided Aspir &/or Inj Major Jt\|BILATERAL PROCEDURE	$650.32	$1,000.50	—	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 CT Guided Aspir &/or Inj Major Jt	$433.55	$667.00	—	—	35%
Insertion of a drug-delivery implant, such as the arm birth control implant both sides CPT 11981 Fac Insertion Drug Delivery Implant\|BILATERAL PROCEDURE	$486.52	$748.50	—	—	35%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Fac Insertion Drug Delivery Implant	$324.35	$499.00	—	95% above	35%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient both sides CPT 11981 Fac Insertion Drug Delivery Implant\|BILATERAL PROCEDURE	$486.52	$748.50	—	—	35%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Fac Insertion Drug Delivery Implant	$324.35	$499.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 CT Guided Aspir &/or Inj Interm Jt\|BILATERAL PROCEDURE	$487.50	$750.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 CT Guided Aspir &/or Inj Interm Jt	$325.00	$500.00	—	at median	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient both sides CPT 20605 CT Guided Aspir &/or Inj Interm Jt\|BILATERAL PROCEDURE	$487.50	$750.00	—	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 CT Guided Aspir &/or Inj Interm Jt	$325.00	$500.00	—	—	35%
Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 CT Guided Aspir &/or Inj Small Jt\|BILATERAL PROCEDURE	$594.75	$915.00	—	—	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 CT Guided Aspir &/or Inj Small Jt	$396.50	$610.00	—	17% above	35%
Joint injection or drainage, small joint (fingers, toes) inpatient both sides CPT 20600 CT Guided Aspir &/or Inj Small Jt\|BILATERAL PROCEDURE	$594.75	$915.00	—	—	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 CT Guided Aspir &/or Inj Small Jt	$396.50	$610.00	—	—	35%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Fac Arthroscopy Knee W/Meniscus Rmedial/Lateral	$6,950.45	$10,693.00	—	at median	35%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 Fac Arthroscopy Knee W/Meniscus Rmedial/Lateral	$6,950.45	$10,693.00	—	—	35%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Fac Laparoscopy, Appendectomy	$8,484.45	$13,053.00	—	at median	35%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 Fac Laparoscopy, Appendectomy	$8,484.45	$13,053.00	—	—	35%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 Fac Laps Surg Esopg/Gstr Fundoplasty	$2,742.35	$4,219.00	—	at median	35%
Laparoscopic fundoplication (anti-reflux surgery) inpatient CPT 43280 Fac Laps Surg Esopg/Gstr Fundoplasty	$2,742.35	$4,219.00	—	—	35%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Fac Post-Cataract Laser Surgery	$1,175.20	$1,808.00	—	23% below	35%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Fac Post-Cataract Laser Surgery	$1,175.20	$1,808.00	—	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Laceration Repair Trk Ext Intermediate </= 2.5 Cm - Mh	$607.10	$934.00	—	62% above	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Laceration Repair Trk Ext Intermediate </= 2.5 Cm - Mh	$607.10	$934.00	—	—	35%
Left heart catheterization, diagnostic CPT 93452 Fac L Hrt Cath W/Njx L Ventriculography Img S&I	$6,824.35	$10,499.00	—	2% below	35%
Left heart catheterization, diagnostic inpatient CPT 93452 Fac L Hrt Cath W/Njx L Ventriculography Img S&I	$6,824.35	$10,499.00	—	—	35%
Lower-back epidural injection, with imaging guidance CPT 62323 Fac Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$1,303.90	$2,006.00	—	27% above	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Fac Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$1,303.90	$2,006.00	—	—	35%
Lower-back epidural injection, without imaging guidance CPT 62322 Fac Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn	$824.85	$1,269.00	—	27% below	35%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Fac Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn	$824.85	$1,269.00	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 Transfor Epidural L/S Single Lvl-CT\|BILATERAL PROCEDURE	$1,603.88	$2,467.50	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 Transfor Epidural L/S Single Lvl-CT\|BILATERAL PROCEDURE\|DISC OP HOSP/AMB SURGR CENT (ASC) PROC AFTER ADMIN OF ANESTHES	$1,603.88	$2,467.50	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 Transfor Epidural L/S Single Lvl-CT\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$1,603.88	$2,467.50	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Transfor Epidural L/S Single Lvl-CT	$1,069.25	$1,645.00	—	at median	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 Transfor Epidural L/S Single Lvl-CT\|BILATERAL PROCEDURE\|DISC OP HOSP/AMB SURGR CENT (ASC) PROC AFTER ADMIN OF ANESTHES	$1,603.88	$2,467.50	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 Transfor Epidural L/S Single Lvl-CT\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$1,603.88	$2,467.50	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 Transfor Epidural L/S Single Lvl-CT\|BILATERAL PROCEDURE	$1,603.88	$2,467.50	—	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Transfor Epidural L/S Single Lvl-CT	$1,069.25	$1,645.00	—	—	35%
Lumbar discectomy or laminotomy to free a nerve root, one level both sides CPT 63030 Fac Laminotomy Dcmprn Nrv Root 1 Ntrspc Lumbar\|BILATERAL PROCEDURE	$23,517.98	$36,181.50	—	—	35%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 Fac Laminotomy Dcmprn Nrv Root 1 Ntrspc Lumbar	$15,678.65	$24,121.00	—	52% above	35%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient both sides CPT 63030 Fac Laminotomy Dcmprn Nrv Root 1 Ntrspc Lumbar\|BILATERAL PROCEDURE	$23,517.98	$36,181.50	—	—	35%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 Fac Laminotomy Dcmprn Nrv Root 1 Ntrspc Lumbar	$15,678.65	$24,121.00	—	—	35%
Lumbar laminectomy (spinal decompression), one level both sides CPT 63047 Fac Removal of Spinal Lamina\|BILATERAL PROCEDURE	$18,260.78	$28,093.50	—	—	35%
Lumbar laminectomy (spinal decompression), one level CPT 63047 Fac Removal of Spinal Lamina	$12,173.85	$18,729.00	—	16% above	35%
Lumbar laminectomy (spinal decompression), one level inpatient both sides CPT 63047 Fac Removal of Spinal Lamina\|BILATERAL PROCEDURE	$18,260.78	$28,093.50	—	—	35%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 Fac Removal of Spinal Lamina	$12,173.85	$18,729.00	—	—	35%
Mastectomy (total removal of the breast) both sides CPT 19303 Fac Mast, Simple, Complete\|BILATERAL PROCEDURE	$13,123.50	$20,190.00	—	—	35%
Mastectomy (total removal of the breast) CPT 19303 Fac Mast, Simple, Complete	$8,749.00	$13,460.00	—	at median	35%
Mastectomy (total removal of the breast) inpatient both sides CPT 19303 Fac Mast, Simple, Complete\|BILATERAL PROCEDURE	$13,123.50	$20,190.00	—	—	35%
Mastectomy (total removal of the breast) inpatient CPT 19303 Fac Mast, Simple, Complete	$8,749.00	$13,460.00	—	—	35%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 Chmsrg Mohs Mg Tq H/N/H/F/G 1st Stag 5 Blocks	$1,556.10	$2,394.00	—	21% above	35%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 Chmsrg Mohs Mg Tq H/N/H/F/G 1st Stag 5 Blocks	$1,556.10	$2,394.00	—	—	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Fac Exc B9 Les Mrgn Xcp Sk Tg T/a/L 0.5 Cm/<	$348.40	$536.00	—	48% below	35%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Fac Exc B9 Les Mrgn Xcp Sk Tg T/a/L 0.5 Cm/<	$348.40	$536.00	—	—	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Fac Exc Face-Mm B9+Marg 0.5 < Cm	$822.25	$1,265.00	—	11% above	35%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Fac Exc Face-Mm B9+Marg 0.5 < Cm	$822.25	$1,265.00	—	—	35%
Nail removal (partial or complete), one nail CPT 11730 Removal Toenail Simple, Single - Mh	$273.00	$420.00	—	33% above	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 Removal Toenail Simple, Single - Mh	$273.00	$420.00	—	—	35%
Occipital nerve block (injection for headaches) both sides CPT 64405 Injection Anes Greater Occipital Area\|BILATERAL PROCEDURE	$693.22	$1,066.50	—	—	35%
Occipital nerve block (injection for headaches) CPT 64405 Injection Anes Greater Occipital Area	$462.15	$711.00	—	11% below	35%
Occipital nerve block (injection for headaches) inpatient both sides CPT 64405 Injection Anes Greater Occipital Area\|BILATERAL PROCEDURE	$693.22	$1,066.50	—	—	35%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Injection Anes Greater Occipital Area	$462.15	$711.00	—	—	35%
Pacemaker implant (dual chamber) CPT 33208 Fac Ins New/Rplcmt Prm Pm W/Transv Eltrd Atrial&Vent	$6,340.10	$9,754.00	—	61% below	35%
Pacemaker implant (dual chamber) inpatient CPT 33208 Fac Ins New/Rplcmt Prm Pm W/Transv Eltrd Atrial&Vent	$6,340.10	$9,754.00	—	—	35%
Paracentesis with imaging guidance CPT 49083 US Abdominal Paracentesis Inc Imaging	$1,287.65	$1,981.00	—	6% above	35%
Paracentesis with imaging guidance inpatient CPT 49083 US Abdominal Paracentesis Inc Imaging	$1,287.65	$1,981.00	—	—	35%
Permanent removal of a nail and nail root (partial or complete) both sides CPT 11750 Fac Exc Nail Matrix Prm Rmvl\|BILATERAL PROCEDURE	$489.45	$753.00	—	—	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Fac Exc Nail Matrix Prm Rmvl	$326.30	$502.00	—	37% below	35%
Permanent removal of a nail and nail root (partial or complete) inpatient both sides CPT 11750 Fac Exc Nail Matrix Prm Rmvl\|BILATERAL PROCEDURE	$489.45	$753.00	—	—	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Fac Exc Nail Matrix Prm Rmvl	$326.30	$502.00	—	—	35%
Prostate biopsy CPT 55700 Fac Biopsy of Prostate	$1,526.85	$2,349.00	—	at median	35%
Prostate biopsy inpatient CPT 55700 Fac Biopsy of Prostate	$1,526.85	$2,349.00	—	—	35%
Radiofrequency ablation of facet joint nerves, lower back, one level both sides CPT 64635 Xr Destruction of L S Facet Nerve Jts\|BILATERAL PROCEDURE	$3,739.12	$5,752.50	—	—	35%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Xr Destruction of L S Facet Nerve Jts	$2,492.75	$3,835.00	—	3% above	35%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient both sides CPT 64635 Xr Destruction of L S Facet Nerve Jts\|BILATERAL PROCEDURE	$3,739.12	$5,752.50	—	—	35%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Xr Destruction of L S Facet Nerve Jts	$2,492.75	$3,835.00	—	—	35%
Removal of a foreign object under the skin, simple CPT 10120 Fac Remove Foreign Body	$414.05	$637.00	—	12% above	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Fac Remove Foreign Body	$414.05	$637.00	—	—	35%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Fac Colonoscopy Ca Scrn Not Hi Rsk Ind	$1,922.70	$2,958.00	—	92% above	35%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Fac Colonoscopy Ca Scrn Not Hi Rsk Ind	$1,922.70	$2,958.00	—	—	35%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Fac Colorectal Scrn, Hi Risk Ind	$1,886.95	$2,903.00	—	89% above	35%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Fac Colorectal Scrn, Hi Risk Ind	$1,886.95	$2,903.00	—	—	35%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Fac Fragmenting of Kidney Stone	$9,651.20	$14,848.00	—	49% above	35%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 Fac Fragmenting of Kidney Stone	$9,651.20	$14,848.00	—	—	35%
Short arm cast (elbow to hand) CPT 29075 Appl Cst Elbw Fngr Short Arm -Urgent Care	$380.90	$586.00	—	54% above	35%
Short arm cast (elbow to hand) inpatient CPT 29075 Appl Cst Elbw Fngr Short Arm -Urgent Care	$380.90	$586.00	—	—	35%
Short arm splint (forearm and hand) both sides CPT 29125 Application of Short Arm Splint Static\|BILATERAL PROCEDURE	$332.48	$511.50	—	—	35%
Short arm splint (forearm and hand) CPT 29125 Application of Short Arm Splint Static	$221.65	$341.00	—	19% above	35%
Short arm splint (forearm and hand) inpatient both sides CPT 29125 Application of Short Arm Splint Static\|BILATERAL PROCEDURE	$332.48	$511.50	—	—	35%
Short arm splint (forearm and hand) inpatient CPT 29125 Application of Short Arm Splint Static	$221.65	$341.00	—	—	35%
Short leg cast (below the knee) CPT 29405 Fac Appl Short Leg Cst Belw Kne-Toe	$416.00	$640.00	—	52% above	35%
Short leg cast (below the knee) inpatient CPT 29405 Fac Appl Short Leg Cst Belw Kne-Toe	$416.00	$640.00	—	—	35%
Short leg splint (calf to foot) both sides CPT 29515 Fac Appl Short Leg Splnt Calf Foot\|BILATERAL PROCEDURE	$201.82	$310.50	—	—	35%
Short leg splint (calf to foot) CPT 29515 Fac Appl Short Leg Splnt Calf Foot	$134.55	$207.00	—	16% below	35%
Short leg splint (calf to foot) inpatient both sides CPT 29515 Fac Appl Short Leg Splnt Calf Foot\|BILATERAL PROCEDURE	$201.82	$310.50	—	—	35%
Short leg splint (calf to foot) inpatient CPT 29515 Fac Appl Short Leg Splnt Calf Foot	$134.55	$207.00	—	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Fac Smpl Rpr Supfc S/N/Ax/G/T 2.5cm/<	$421.85	$649.00	—	100% above	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Fac Smpl Rpr Supfc S/N/Ax/G/T 2.5cm/<	$421.85	$649.00	—	—	35%
Skin biopsy, punch, one lesion CPT 11104 Fac Punch Biopsy Skin Single Lesion	$178.75	$275.00	—	51% below	35%
Skin biopsy, punch, one lesion inpatient CPT 11104 Fac Punch Biopsy Skin Single Lesion	$178.75	$275.00	—	—	35%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Fac Exc Mal Les W/Mrgn T/a/L 0.5 Cm/<	$367.25	$565.00	—	11% above	35%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Fac Exc Mal Les W/Mrgn T/a/L 0.5 Cm/<	$367.25	$565.00	—	—	35%
Skin tag removal, up to 15 tags CPT 11200 Wound Removal of Skin Tags	$121.55	$187.00	—	31% below	35%
Skin tag removal, up to 15 tags inpatient CPT 11200 Wound Removal of Skin Tags	$121.55	$187.00	—	—	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Puncture, Lumbar, Diagnostic	$846.95	$1,303.00	—	1% below	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Puncture, Lumbar, Diagnostic	$846.95	$1,303.00	—	—	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Fac Smpl Rpr Supfc S/N/Ax/G/T 2.6cm-7.5cm	$360.10	$554.00	—	49% above	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Fac Smpl Rpr Supfc S/N/Ax/G/T 2.6cm-7.5cm	$360.10	$554.00	—	—	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Fac Smpl Rpr Supfc F/E/E/N/L/M 2.5cm/<	$309.40	$476.00	—	31% above	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Fac Smpl Rpr Supfc F/E/E/N/L/M 2.5cm/<	$309.40	$476.00	—	—	35%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Fac Tangential Biopsy Skin Single Lesion	$135.20	$208.00	—	53% below	35%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Fac Tangential Biopsy Skin Single Lesion	$135.20	$208.00	—	—	35%
Thoracentesis with imaging guidance both sides CPT 32555 US Thoracentesis for Aspiration Only\|BILATERAL PROCEDURE	$2,423.85	$3,729.00	—	—	35%
Thoracentesis with imaging guidance CPT 32555 US Thoracentesis for Aspiration Only	$1,615.90	$2,486.00	—	48% above	35%
Thoracentesis with imaging guidance inpatient both sides CPT 32555 US Thoracentesis for Aspiration Only\|BILATERAL PROCEDURE	$2,423.85	$3,729.00	—	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 US Thoracentesis for Aspiration Only	$1,615.90	$2,486.00	—	—	35%
Trigger point injections, 1 or 2 muscles both sides CPT 20552 Injection Single/Multiple Trigger Points - Mh\|BILATERAL PROCEDURE	$536.25	$825.00	—	—	35%
Trigger point injections, 1 or 2 muscles CPT 20552 Injection Single/Multiple Trigger Points - Mh	$357.50	$550.00	—	2% below	35%
Trigger point injections, 1 or 2 muscles inpatient both sides CPT 20552 Injection Single/Multiple Trigger Points - Mh\|BILATERAL PROCEDURE	$536.25	$825.00	—	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injection Single/Multiple Trigger Points - Mh	$357.50	$550.00	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion both sides CPT 19083 Fac Bx Breast W Device 1st Lesion Ultrasound Guide\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$5,894.85	$9,069.00	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Fac Bx Breast W Device 1st Lesion Ultrasound Guide	$3,929.90	$6,046.00	—	112% above	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient both sides CPT 19083 Fac Bx Breast W Device 1st Lesion Ultrasound Guide\|TECHNICAL COMPONENT\|BILATERAL PROCEDURE	$5,894.85	$9,069.00	—	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Fac Bx Breast W Device 1st Lesion Ultrasound Guide	$3,929.90	$6,046.00	—	—	35%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Fac Egd Balloon Dilation Esophagus <30 Mm Diam	$2,656.55	$4,087.00	—	17% above	35%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Fac Egd Balloon Dilation Esophagus <30 Mm Diam	$2,656.55	$4,087.00	—	—	35%
Upper endoscopy (EGD) with biopsy CPT 43239 Fac Egd Transoral Biopsy Single/Multiple	$1,580.80	$2,432.00	—	27% above	35%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Fac Egd Transoral Biopsy Single/Multiple	$1,580.80	$2,432.00	—	—	35%
Upper endoscopy (EGD) with injection into the lining CPT 43236 Fac Esophagogastroduodenoscopy Submucosal Injection	$1,522.95	$2,343.00	—	10% above	35%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 Fac Esophagogastroduodenoscopy Submucosal Injection	$1,522.95	$2,343.00	—	—	35%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Fac Egd Removal Tumor Polyp/Other Lesion Snare Tech	$2,211.95	$3,403.00	—	7% above	35%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 Fac Egd Removal Tumor Polyp/Other Lesion Snare Tech	$2,211.95	$3,403.00	—	—	35%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Fac Egd Insert Guide Wire Dilator Passage Esophagus	$1,853.15	$2,851.00	—	26% above	35%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Fac Egd Insert Guide Wire Dilator Passage Esophagus	$1,853.15	$2,851.00	—	—	35%
Upper endoscopy (EGD), diagnostic CPT 43235 Fac Esophagogastroduodenoscopy Transoral Diagnostic	$1,446.90	$2,226.00	—	83% above	35%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Fac Esophagogastroduodenoscopy Transoral Diagnostic	$1,446.90	$2,226.00	—	—	35%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 Fac Egd Transoral Transmural Drainage Pseudocyst	$3,546.40	$5,456.00	—	at median	35%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 Fac Egd Transoral Transmural Drainage Pseudocyst	$3,546.40	$5,456.00	—	—	35%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 Fac Removal of Sperm Duct(S)\|BILATERAL PROCEDURE	$1,355.25	$2,085.00	—	—	35%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Fac Removal of Sperm Duct(S)	$903.50	$1,390.00	—	73% below	35%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 Fac Removal of Sperm Duct(S)\|BILATERAL PROCEDURE	$1,355.25	$2,085.00	—	—	35%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 Fac Removal of Sperm Duct(S)	$903.50	$1,390.00	—	—	35%
Vein ablation, radiofrequency, first vein both sides CPT 36475 Fac Endoven Abltj Incmptnt Vein Xtr Rf 1st Vein\|BILATERAL PROCEDURE	$4,458.68	$6,859.50	—	—	35%
Vein ablation, radiofrequency, first vein CPT 36475 Fac Endoven Abltj Incmptnt Vein Xtr Rf 1st Vein	$2,972.45	$4,573.00	—	21% below	35%
Vein ablation, radiofrequency, first vein inpatient both sides CPT 36475 Fac Endoven Abltj Incmptnt Vein Xtr Rf 1st Vein\|BILATERAL PROCEDURE	$4,458.68	$6,859.50	—	—	35%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 Fac Endoven Abltj Incmptnt Vein Xtr Rf 1st Vein	$2,972.45	$4,573.00	—	—	35%
Wart removal, up to 14 warts CPT 17110 Fac Destruction Benign Lesions Up to 14	$271.05	$417.00	—	34% above	35%
Wart removal, up to 14 warts inpatient CPT 17110 Fac Destruction Benign Lesions Up to 14	$271.05	$417.00	—	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement Skin and Subcutaneous Tissue - Mh	$893.10	$1,374.00	—	60% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debridement Skin and Subcutaneous Tissue - Mh	$893.10	$1,374.00	—	—	35%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Bld Transfus > Hrs	$583.70	$898.00	—	22% below	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Bld Transfus > Hrs	$583.70	$898.00	—	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Sputum Collection - Lh	$86.45	$133.00	—	49% below	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Sputum Collection - Lh	$86.45	$133.00	—	—	35%
Chemotherapy IV infusion, first hour CPT 96413 Fac Chemo, IV Infusion, 1 Hr	$596.05	$917.00	—	14% above	35%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Fac Chemo, IV Infusion, 1 Hr	$596.05	$917.00	—	—	35%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 Fac Oph Svcs Medical Xm&Eval Compre New Pt 1/> Vst	$201.50	$310.00	—	37% above	35%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 Fac Oph Svcs Medical Xm&Eval Compre New Pt 1/> Vst	$201.50	$310.00	—	—	35%
Comprehensive eye exam, returning patient CPT 92014 Fac Oph Svcs Medical Xm&Eval Compre Est Pt 1/>Vst	$168.35	$259.00	—	20% above	35%
Comprehensive eye exam, returning patient inpatient CPT 92014 Fac Oph Svcs Medical Xm&Eval Compre Est Pt 1/>Vst	$168.35	$259.00	—	—	35%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Fac Compre Audiometry Threshold Eval Sp Recognij	$213.20	$328.00	—	at median	35%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 Fac Compre Audiometry Threshold Eval Sp Recognij	$213.20	$328.00	—	—	35%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care First 30-74 Min -Mh	$1,928.55	$2,967.00	—	2% below	35%
Critical care, first 30 to 74 minutes CPT 99291 Fac Cc E/M Critically Ill/Injured 1st 30-74 Min	$1,928.55	$2,967.00	—	2% below	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care First 30-74 Min -Mh	$1,928.55	$2,967.00	—	—	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Fac Cc E/M Critically Ill/Injured 1st 30-74 Min	$1,928.55	$2,967.00	—	—	35%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Fac Eeg W/Rec Awake&Drowsy	$620.10	$954.00	—	20% below	35%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Fac Eeg W/Rec Awake&Drowsy	$620.10	$954.00	—	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Fac Electrocardiogram, Tracing	$130.65	$201.00	—	at median	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Fac Electrocardiogram, Tracing	$130.65	$201.00	—	—	35%
Electroconvulsive therapy (ECT), one session CPT 90870 Fac Electroconvulsive Therapy	$731.25	$1,125.00	—	12% below	35%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 Fac Electroconvulsive Therapy	$731.25	$1,125.00	—	—	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Fac Emergency Level I	$215.15	$331.00	—	15% above	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Fac Emergency Level I	$215.15	$331.00	—	—	35%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Fac Emergency Level II	$410.15	$631.00	—	21% above	35%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Fac Emergency Level II	$410.15	$631.00	—	—	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Fac Emergency Level III	$644.80	$992.00	—	1% above	35%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Fac Emergency Level III	$644.80	$992.00	—	—	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Fac Emergency Level IV	$1,055.60	$1,624.00	—	at median	35%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Fac Emergency Level IV	$1,055.60	$1,624.00	—	—	35%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Trauma 3 Activation W/O Pre-ED Notiification Lvl 1 -W/O Critical Care	$1,466.40	$2,256.00	—	13% below	35%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Trauma 3 Activation W/O Pre-ED Notiification Lvl 1 -W/O Critical Care	$1,466.40	$2,256.00	—	—	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 Fac Cv Strs Tst Xers&/or Rx Cont Ecg Trcg Only	$792.35	$1,219.00	—	9% above	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Fac Cv Strs Tst Xers&/or Rx Cont Ecg Trcg Only	$792.35	$1,219.00	—	—	35%
Eye exam, returning patient, intermediate CPT 92012 Fac Oph Medical Xm&Eval Intrm Est Pt	$119.60	$184.00	—	at median	35%
Eye exam, returning patient, intermediate inpatient CPT 92012 Fac Oph Medical Xm&Eval Intrm Est Pt	$119.60	$184.00	—	—	35%
Family therapy with the patient, 50 minutes CPT 90847 Fac Family Psychotherapy W/Patient Present 50 Mins	$189.80	$292.00	—	44% above	35%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Fac Family Psychotherapy W/Patient Present 50 Mins	$189.80	$292.00	—	—	35%
Family therapy without the patient, 50 minutes CPT 90846 Fac Family Psychotherapy W/O Patient Present 50 Mins	$182.65	$281.00	—	24% above	35%
Family therapy without the patient, 50 minutes inpatient CPT 90846 Fac Family Psychotherapy W/O Patient Present 50 Mins	$182.65	$281.00	—	—	35%
Group psychotherapy session CPT 90853 Grp Psyctx Pbb	$31.20	$48.00	—	47% below	35%
Group psychotherapy session inpatient CPT 90853 Grp Psyctx Pbb	$31.20	$48.00	—	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Fac IV Infusion, Hydration, 31-60 Min	$285.35	$439.00	—	9% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Fac IV Infusion, Hydration, 31-60 Min	$285.35	$439.00	—	—	35%
IV infusion of a medicine, first hour CPT 96365 Fac IV Infusion, Therap/Proph/Diagnost,Initial,1st Hour	$313.95	$483.00	—	4% above	35%
IV infusion of a medicine, first hour inpatient CPT 96365 Fac IV Infusion, Therap/Proph/Diagnost,Initial,1st Hour	$313.95	$483.00	—	—	35%
IV push of a medicine, first drug CPT 96374 Fac Injection,Therap/Proph/Diagnost, IV Push, Initial Drug	$165.10	$254.00	—	13% below	35%
IV push of a medicine, first drug inpatient CPT 96374 Fac Injection,Therap/Proph/Diagnost, IV Push, Initial Drug	$165.10	$254.00	—	—	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection,Subcut or Intramuscular	$92.95	$143.00	—	2% above	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection,Subcut or Intramuscular	$92.95	$143.00	—	—	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Fac Psychiatric Diagnostic Evaluation	$178.75	$275.00	—	20% below	35%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Fac Psychiatric Diagnostic Evaluation	$178.75	$275.00	—	—	35%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 Fac Motor &/Sens 7-8 Nrv Cndj Preconf Eltrode Limb	$1,017.25	$1,565.00	—	35% above	35%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 Fac Motor &/Sens 7-8 Nrv Cndj Preconf Eltrode Limb	$1,017.25	$1,565.00	—	—	35%
Neuromuscular re-education, 15 minutes CPT 97112 Ot Neuromuscular Re-ED 15 Min	$97.50	$150.00	—	3% above	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Ot Neuromuscular Re-ED 15 Min	$97.50	$150.00	—	—	35%
New patient office visit, about 30 minutes CPT 99203 Fac Office/Outpatient New Low Mdm	$257.40	$396.00	—	130% above	35%
New patient office visit, about 30 minutes inpatient CPT 99203 Fac Office/Outpatient New Low Mdm	$257.40	$396.00	—	—	35%
New patient office visit, about 45 minutes CPT 99204 Fac Office/Outpatient New Moderate Mdm	$351.65	$541.00	—	198% above	35%
New patient office visit, about 45 minutes inpatient CPT 99204 Fac Office/Outpatient New Moderate Mdm	$351.65	$541.00	—	—	35%
New patient office visit, about 60 minutes CPT 99205 Fac Office/Outpatient New High Mdm	$487.50	$750.00	—	255% above	35%
New patient office visit, about 60 minutes inpatient CPT 99205 Fac Office/Outpatient New High Mdm	$487.50	$750.00	—	—	35%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Fac Office/Outpatient New Sf Mdm	$130.65	$201.00	—	57% above	35%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Fac Office/Outpatient New Sf Mdm	$130.65	$201.00	—	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Fac Medical Nutrition, Indiv, In	$97.50	$150.00	—	112% above	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Fac Medical Nutrition, Indiv, In	$97.50	$150.00	—	—	35%
Occupational therapy evaluation, low complexity CPT 97165 Fac Occupational Therapy Eval Low Complex	$215.80	$332.00	—	4% above	35%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Fac Occupational Therapy Eval Low Complex	$215.80	$332.00	—	—	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Fac Physical Therapy Evaluation High Complex	$274.30	$422.00	—	17% above	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Fac Physical Therapy Evaluation High Complex	$274.30	$422.00	—	—	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Fac Physical Therapy Evaluation Low Complex	$215.80	$332.00	—	10% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Fac Physical Therapy Evaluation Low Complex	$215.80	$332.00	—	—	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Fac Physical Therapy Evaluation Mod Complex	$224.90	$346.00	—	at median	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Fac Physical Therapy Evaluation Mod Complex	$224.90	$346.00	—	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot Manual Therapy 15 Min	$96.85	$149.00	—	at median	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Ot Manual Therapy 15 Min	$96.85	$149.00	—	—	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Fac Therapeutic Exercises	$96.85	$149.00	—	4% above	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Fac Therapeutic Exercises	$96.85	$149.00	—	—	35%
Preventive checkup, returning patient aged 18–39 CPT 99395 Fac Preventive Visit, Est, Age 18-39	$155.35	$239.00	—	4% above	35%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Fac Preventive Visit, Est, Age 18-39	$155.35	$239.00	—	—	35%
Preventive checkup, returning patient aged 40–64 CPT 99396 Fac Preventive Visit, Est, Age 40-64	$168.35	$259.00	—	3% above	35%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 Fac Preventive Visit, Est, Age 40-64	$168.35	$259.00	—	—	35%
Psychiatric evaluation with medical services CPT 90792 Fac Psychiatric Diagnostic Eval W/Medical Services	$276.25	$425.00	—	39% above	35%
Psychiatric evaluation with medical services inpatient CPT 90792 Fac Psychiatric Diagnostic Eval W/Medical Services	$276.25	$425.00	—	—	35%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 Fac Psychological Tst Eval Svc Phys/Qhp First Hour	$325.65	$501.00	—	25% below	35%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 Fac Psychological Tst Eval Svc Phys/Qhp First Hour	$325.65	$501.00	—	—	35%
Psychotherapy for crisis, first 60 minutes CPT 90839 Fac Psychotherapy for Crisis Initial 60 Minutes	$245.70	$378.00	—	141% above	35%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 Fac Psychotherapy for Crisis Initial 60 Minutes	$245.70	$378.00	—	—	35%
Psychotherapy session, 30 minutes CPT 90832 Fac Psychotherapy W/Patient 30 Minutes	$77.35	$119.00	—	60% below	35%
Psychotherapy session, 30 minutes inpatient CPT 90832 Fac Psychotherapy W/Patient 30 Minutes	$77.35	$119.00	—	—	35%
Psychotherapy session, 45 minutes CPT 90834 Fac Psychotherapy W/Patient 45 Minutes	$102.05	$157.00	—	52% below	35%
Psychotherapy session, 45 minutes inpatient CPT 90834 Fac Psychotherapy W/Patient 45 Minutes	$102.05	$157.00	—	—	35%
Psychotherapy session, 60 minutes CPT 90837 Fac Psychotherapy W/Patient 60 Minutes	$152.75	$235.00	—	34% below	35%
Psychotherapy session, 60 minutes inpatient CPT 90837 Fac Psychotherapy W/Patient 60 Minutes	$152.75	$235.00	—	—	35%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Fac Tobacco Use Cessation Intermediate 3-10 Minutes	$21.45	$33.00	—	48% below	35%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Fac Tobacco Use Cessation Intermediate 3-10 Minutes	$21.45	$33.00	—	—	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Fac Office/Outpatient Established High Mdm	$396.50	$610.00	—	139% above	35%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Fac Office/Outpatient Established High Mdm	$396.50	$610.00	—	—	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Fac Office/Outpatient Established Low Mdm	$174.20	$268.00	—	81% above	35%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Fac Office/Outpatient Established Low Mdm	$174.20	$268.00	—	—	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Fac Office/Outpatient Established Mod Mdm	$259.35	$399.00	—	118% above	35%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Fac Office/Outpatient Established Mod Mdm	$259.35	$399.00	—	—	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Fac Office/Outpatient Established Sf Mdm	$124.80	$192.00	—	83% above	35%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Fac Office/Outpatient Established Sf Mdm	$124.80	$192.00	—	—	35%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Fac Office/OP Consltj New/Est Pt Low Mdm 30 Minutes	$200.20	$308.00	—	7% above	35%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Fac Office/OP Consltj New/Est Pt Low Mdm 30 Minutes	$200.20	$308.00	—	—	35%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Fac Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes	$320.45	$493.00	—	42% above	35%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Fac Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes	$320.45	$493.00	—	—	35%
Speech and language evaluation CPT 92523 Fac Eval Speech Sound Product Language Comprehension	$557.05	$857.00	—	48% above	35%
Speech and language evaluation inpatient CPT 92523 Fac Eval Speech Sound Product Language Comprehension	$557.05	$857.00	—	—	35%
Speech therapy session, individual CPT 92507 St Speech Therapy 16-30 Minutes -Mh	$253.50	$390.00	—	19% above	35%
Speech therapy session, individual inpatient CPT 92507 St Speech Therapy 16-30 Minutes -Mh	$253.50	$390.00	—	—	35%
Spirometry (breathing test) CPT 94010 Fac Breathing Capacity Test	$279.50	$430.00	—	38% above	35%
Spirometry (breathing test) inpatient CPT 94010 Fac Breathing Capacity Test	$279.50	$430.00	—	—	35%
Spirometry before and after a bronchodilator CPT 94060 Fac Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn	$486.20	$748.00	—	24% above	35%
Spirometry before and after a bronchodilator inpatient CPT 94060 Fac Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn	$486.20	$748.00	—	—	35%
TMS (transcranial magnetic stimulation), first session with mapping CPT 90867 Fac Repet Tms Tx Initial W/Map/Motr Threshld/Del&M	$401.70	$618.00	—	at median	35%
TMS (transcranial magnetic stimulation), first session with mapping inpatient CPT 90867 Fac Repet Tms Tx Initial W/Map/Motr Threshld/Del&M	$401.70	$618.00	—	—	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Ther Activit W/Exer	$84.50	$130.00	—	5% above	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Pt Ther Activit W/Exer	$84.50	$130.00	—	—	35%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Fac Phlebotomy	$258.70	$398.00	—	11% above	35%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Fac Phlebotomy	$258.70	$398.00	—	—	35%
Visual field test, extended both sides CPT 92083 Fac Vis Fld Xm Uni/Bi I&R Extnd Xm	$91.00	$140.00	—	—	35%
Visual field test, extended inpatient both sides CPT 92083 Fac Vis Fld Xm Uni/Bi I&R Extnd Xm	$91.00	$140.00	—	—	35%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Fac Sarscov2 Vac 50 Mcg/0.5ml Im	$167.05	$257.00	—	40% below	35%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM (INPT)	$568.16	$874.09	—	104% above	35%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Fac Sarscov2 Vac 50 Mcg/0.5ml Im	$167.05	$257.00	—	—	35%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM (INPT)	$568.16	$874.09	—	—	35%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Fac Chicken Pox Vaccine, Sc	$163.80	$252.00	—	19% below	35%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Fac Chicken Pox Vaccine, Sc	$163.80	$252.00	—	—	35%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 Fac Dtap-Ipv, Im, Age 4-6 Year	$61.75	$95.00	—	at median	35%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 Fac Dtap-Ipv, Im, Age 4-6 Year	$61.75	$95.00	—	—	35%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Fac Dtap Vaccine, < 7 Yrs, Im	$65.65	$101.00	—	69% above	35%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	$121.45	$186.84	—	213% above	35%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Fac Dtap Vaccine, < 7 Yrs, Im	$65.65	$101.00	—	—	35%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	$121.45	$186.84	—	—	35%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Fac Dtap-Hep B-Ipv Vaccine, Im	$138.45	$213.00	—	11% above	35%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP-HEPATITIS B RECOMB-IPV IM SUSY	$443.09	$681.68	—	255% above	35%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 Fac Dtap-Hep B-Ipv Vaccine, Im	$138.45	$213.00	—	—	35%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP-HEPATITIS B RECOMB-IPV IM SUSY	$443.09	$681.68	—	—	35%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 Fac Dtap-Ipv/Hib Vaccine for Intramuscular Use	$156.65	$241.00	—	at median	35%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 Fac Dtap-Ipv/Hib Vaccine for Intramuscular Use	$156.65	$241.00	—	—	35%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 Fac Influenza Recombinant P-Free Im	$74.75	$115.00	—	32% below	35%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 Fac Influenza Recombinant P-Free Im	$74.75	$115.00	—	—	35%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Fac Iiv3 Vacc Preservative Free 0.5 Ml Dosage Im Use	$26.00	$40.00	—	18% below	35%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$83.15	$127.93	—	162% above	35%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Fac Iiv3 Vacc Preservative Free 0.5 Ml Dosage Im Use	$26.00	$40.00	—	—	35%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$83.15	$127.93	—	—	35%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Fac 9vhpv Vacc 2/3 Dose Sched Im Use	$141.70	$218.00	—	58% below	35%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Fac 9vhpv Vacc 2/3 Dose Sched Im Use	$141.70	$218.00	—	—	35%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Fac Hep a/Hep B Vacc, Adult Im	$191.75	$295.00	—	11% above	35%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Fac Hep a/Hep B Vacc, Adult Im	$191.75	$295.00	—	—	35%
Hepatitis A vaccine, adult dose CPT 90632 Fac Hep a Vaccine, Adult Im	$138.45	$213.00	—	18% above	35%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Fac Hep a Vaccine, Adult Im	$138.45	$213.00	—	—	35%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Fac Hep a Vacc, Ped/Adol, 2 Dose	$75.40	$116.00	—	at median	35%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Fac Hep a Vacc, Ped/Adol, 2 Dose	$75.40	$116.00	—	—	35%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Fac Hep B Vaccine, Adult, Im	$137.15	$211.00	—	63% above	35%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML INJECTION (INPT)	$300.41	$462.17	—	258% above	35%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Fac Hep B Vaccine, Adult, Im	$137.15	$211.00	—	—	35%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML INJECTION (INPT)	$300.41	$462.17	—	—	35%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 Fac Hepb Vaccine Adult 2/4 Dose Schedule for Im Use	$213.85	$329.00	—	55% above	35%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 Fac Hepb Vaccine Adult 2/4 Dose Schedule for Im Use	$213.85	$329.00	—	—	35%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Fac Hepb Vaccine Ped/Adolesc 3 Dose Schedule Im	$80.60	$124.00	—	149% above	35%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML INJECTION (INPT)	$120.13	$184.82	—	271% above	35%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Fac Hepb Vaccine Ped/Adolesc 3 Dose Schedule Im	$80.60	$124.00	—	—	35%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML INJECTION (INPT)	$120.13	$184.82	—	—	35%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Fac Hemophilus Influenza B Vaccine Prp-Omp 3 Dose Im	$55.90	$86.00	—	14% above	35%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP	$125.61	$193.24	—	155% above	35%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 Fac Hemophilus Influenza B Vaccine Prp-Omp 3 Dose Im	$55.90	$86.00	—	—	35%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP	$125.61	$193.24	—	—	35%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR	$55.24	$84.99	—	34% above	35%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Fac Hib Prp-T Vaccine 4 Dose Schedule Im Use	$55.90	$86.00	—	36% above	35%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR	$55.24	$84.99	—	—	35%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Fac Hib Prp-T Vaccine 4 Dose Schedule Im Use	$55.90	$86.00	—	—	35%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fac Influenza Vaccine Splt Prsrv Free Inc Antigen Im	$74.75	$115.00	—	6% below	35%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY	$345.01	$530.78	—	333% above	35%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fac Influenza Vaccine Splt Prsrv Free Inc Antigen Im	$74.75	$115.00	—	—	35%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY	$345.01	$530.78	—	—	35%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 Fac Japanese Encephalitis Vaccine Inactivated Im	$235.30	$362.00	—	47% below	35%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule inpatient CPT 90738 Fac Japanese Encephalitis Vaccine Inactivated Im	$235.30	$362.00	—	—	35%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Fac Mmr Vaccine, Sc	$156.00	$240.00	—	15% above	35%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC SC SUSR	$391.12	$601.73	—	189% above	35%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Fac Mmr Vaccine, Sc	$156.00	$240.00	—	—	35%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC SC SUSR	$391.12	$601.73	—	—	35%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 Fac Mmrv Vaccine, Sc	$253.50	$390.00	—	29% below	35%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 Fac Mmrv Vaccine, Sc	$253.50	$390.00	—	—	35%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Fac Menacwyd/Menacwy-CRM Conj Vacc Grps Acwy Im Use	$180.05	$277.00	—	13% below	35%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR	$707.53	$1,088.51	—	241% above	35%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Fac Menacwyd/Menacwy-CRM Conj Vacc Grps Acwy Im Use	$180.05	$277.00	—	—	35%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR	$707.53	$1,088.51	—	—	35%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 Fac Menacwy-Tt Conj Vacc Serogroups Acwy for Im Use	$162.50	$250.00	—	31% below	35%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 Fac Menacwy-Tt Conj Vacc Serogroups Acwy for Im Use	$162.50	$250.00	—	—	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Fac Menb-4c Recombnt Prot & Outer Memb Vesic Vacc Im	$158.60	$244.00	—	51% below	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	$1,006.43	$1,548.36	—	209% above	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Fac Menb-4c Recombnt Prot & Outer Memb Vesic Vacc Im	$158.60	$244.00	—	—	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	$1,006.43	$1,548.36	—	—	35%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Fac Pneumococcal Conj Vaccine 13 Valent Im	$292.50	$450.00	—	8% above	35%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Fac Pneumococcal Conj Vaccine 13 Valent Im	$292.50	$450.00	—	—	35%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 Fac Pcv15 Vaccine for Intramuscular Use	$292.50	$450.00	—	58% below	35%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 Fac Pcv15 Vaccine for Intramuscular Use	$292.50	$450.00	—	—	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Fac Pcv20 Vaccine for Intramuscular Use	$292.50	$450.00	—	23% below	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY	$589.63	$907.12	—	55% above	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Fac Pcv20 Vaccine for Intramuscular Use	$292.50	$450.00	—	—	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY	$589.63	$907.12	—	—	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Fac Pneumococcal Vaccine	$141.05	$217.00	—	11% below	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY	$223.77	$344.26	—	41% above	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Fac Pneumococcal Vaccine	$141.05	$217.00	—	—	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY	$223.77	$344.26	—	—	35%
Polio vaccine, inactivated (IPV) CPT 90713 Fac Poliovirus Vaccine Inactivated Subq/Im	$59.80	$92.00	—	2% below	35%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 Fac Poliovirus Vaccine Inactivated Subq/Im	$59.80	$92.00	—	—	35%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Fac Rsv Monoclonal Antb Seasonal Dose 1 Ml Im Use	$1,023.75	$1,575.00	—	38% above	35%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML IM SOSY	$1,137.29	$1,749.67	—	53% above	35%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Fac Rsv Monoclonal Antb Seasonal Dose 1 Ml Im Use	$1,023.75	$1,575.00	—	—	35%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 NIRSEVIMAB-ALIP 100 MG/ML IM SOSY	$1,137.29	$1,749.67	—	—	35%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Fac Rsv Monoclonal Antb Seasonal Dose 0.5ml Im Use	$1,023.75	$1,575.00	—	38% above	35%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY	$1,137.29	$1,749.67	—	53% above	35%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Fac Rsv Monoclonal Antb Seasonal Dose 0.5ml Im Use	$1,023.75	$1,575.00	—	—	35%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY	$1,137.29	$1,749.67	—	—	35%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Fac Rsv Vaccine Pref Subunit Bivalent for Im Use	$566.80	$872.00	—	19% above	35%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 Fac Rsv Vaccine Pref Subunit Bivalent for Im Use	$566.80	$872.00	—	—	35%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 Fac Rsv Vacc Pref Recombinant Adjuvanted for Im Use	$544.05	$837.00	—	30% above	35%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSVPREF3 VAC RECOMB ADJUVANTED 120 MCG/0.5ML IM SUSR	$1,227.47	$1,888.41	—	192% above	35%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 Fac Rsv Vacc Pref Recombinant Adjuvanted for Im Use	$544.05	$837.00	—	—	35%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 RSVPREF3 VAC RECOMB ADJUVANTED 120 MCG/0.5ML IM SUSR	$1,227.47	$1,888.41	—	—	35%
Rabies vaccine, one dose CPT 90675 Fac Rabies Vaccine, Im	$344.50	$530.00	—	33% below	35%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR	$830.63	$1,277.89	—	61% above	35%
Rabies vaccine, one dose inpatient CPT 90675 Fac Rabies Vaccine, Im	$344.50	$530.00	—	—	35%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR	$830.63	$1,277.89	—	—	35%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 Fac Rotovirus Vaccine, Human Attenuated, 2 Dose, Oral	$152.10	$234.00	—	24% below	35%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 Fac Rotovirus Vaccine, Human Attenuated, 2 Dose, Oral	$152.10	$234.00	—	—	35%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Fac Rv5 Vaccine 3 Dose Schedule Live for Oral Use	$152.75	$235.00	—	85% above	35%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Fac Rv5 Vaccine 3 Dose Schedule Live for Oral Use	$152.75	$235.00	—	—	35%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Fac Hzv Zoster Vacc Recombinant Adjuvanted Im Njx	$144.30	$222.00	—	26% below	35%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR	$940.34	$1,446.68	—	383% above	35%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Fac Hzv Zoster Vacc Recombinant Adjuvanted Im Njx	$144.30	$222.00	—	—	35%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR	$940.34	$1,446.68	—	—	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Fac Td Vaccine No Prsrv >/= 7 Im	$39.00	$60.00	—	28% below	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Fac Td Vaccine No Prsrv >/= 7 Im	$39.00	$60.00	—	—	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Fac Tdap Vaccine 7 Yr + Im	$81.90	$126.00	—	13% above	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM INJECTION (INPT)	$199.40	$306.77	—	174% above	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Fac Tdap Vaccine 7 Yr + Im	$81.90	$126.00	—	—	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM INJECTION (INPT)	$199.40	$306.77	—	—	35%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Fac Typhoid Vaccine, Im	$124.15	$191.00	—	18% below	35%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Fac Typhoid Vaccine, Im	$124.15	$191.00	—	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Fac Immunization Admin	$48.10	$74.00	—	109% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Fac Immunization Admin	$48.10	$74.00	—	—	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Fac Immunization Admin, Each Add	$32.50	$50.00	—	64% above	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Fac Immunization Admin, Each Add	$32.50	$50.00	—	—	35%
Yellow fever vaccine, live CPT 90717 Fac Yellow Fever Vaccine, Sc	$172.25	$265.00	—	27% below	35%
Yellow fever vaccine, live inpatient CPT 90717 Fac Yellow Fever Vaccine, Sc	$172.25	$265.00	—	—	35%

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.aspirus.org/Uploads/Public/Documents/PriceEstimate/TransparencyFY27/383236977_1497750830_aspirus-iron-river-hospital_standardcharges.json