Hospital Sturgis, MI

Three Rivers Health

Three Rivers Health in Three Rivers, MI publishes cash prices for 268 common procedures listed here, from its own machine-readable price file updated Jan 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Michigan median for 173 of 267 procedures and below it for 92. By typical cash price it ranks #67 of 98 Michigan hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

701 S HEALTH PARKWAY, THREE RIVERS, MI 49093 Collected Sep 28, 2026 Source price file Check a bill from this hospital (269) 273-9602

Acute care hospital Government-owned hospital No emergency department CMS star rating 2 of 5 CCN 230015 · CMS hospital register NPI 1568739423

Financial assistance

Public hospital: ask for its charity care or sliding-scale discount

Three Rivers Health is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 1 action for a hospital named Three Rivers Health in Three Rivers, MI:

May 1, 2026 Warning notice

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen W W-O Contrast	$2,141.75	$3,295.00	$659.00–$3,295.00	37% above	35%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen W W-O Contrast	$2,141.75	$3,295.00	$659.00–$3,295.00	—	35%
Abdominal X-ray, 2 views CPT 74019 DX--ABDOMEN 2 VIEWS	$254.15	$391.00	$78.20–$391.00	22% above	35%
Abdominal X-ray, 2 views inpatient CPT 74019 DX--ABDOMEN 2 VIEWS	$254.15	$391.00	$78.20–$391.00	—	35%
Ankle X-ray, complete, 3 or more views one side CPT 73610 DX Ankle Three Views LT	$190.45	$293.00	$58.60–$293.00	11% below	35%
Ankle X-ray, complete, 3 or more views one side CPT 73610 DX Ankle Three Views RT	$190.45	$293.00	$58.60–$293.00	11% below	35%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 DX Ankle Three Views RT	$190.45	$293.00	$58.60–$293.00	—	35%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 DX Ankle Three Views LT	$190.45	$293.00	$58.60–$293.00	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 LTD BILAT PHYS STDY UP/LOW EXTREM	$437.45	$673.00	$134.60–$673.00	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 LIMITED UNILAT PHYSIOLOGIC STUDIES EXT	$189.80	$292.00	$58.40–$292.00	41% below	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 LTD BILAT PHYS STDY UP/LOW EXTREM	$437.45	$673.00	$134.60–$673.00	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 LIMITED UNILAT PHYSIOLOGIC STUDIES EXT	$189.80	$292.00	$58.40–$292.00	—	35%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity W-O Contrast LT	$1,207.05	$1,857.00	$371.40–$1,857.00	20% above	35%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity W-O Contrast RT	$1,207.05	$1,857.00	$371.40–$1,857.00	20% above	35%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity W-O Contrast RT	$1,207.05	$1,857.00	$371.40–$1,857.00	—	35%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity W-O Contrast LT	$1,207.05	$1,857.00	$371.40–$1,857.00	—	35%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Scan Total Body	$1,272.70	$1,958.00	$391.60–$1,958.00	28% above	35%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Scan Total Body	$1,272.70	$1,958.00	$391.60–$1,958.00	—	35%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete RT	$235.95	$363.00	$72.60–$363.00	24% below	35%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete LT	$235.95	$363.00	$72.60–$363.00	24% below	35%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete RT	$235.95	$363.00	$72.60–$363.00	—	35%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete LT	$235.95	$363.00	$72.60–$363.00	—	35%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast (ER or IP ONLY) RT	$156.00	$240.00	$48.00–$240.00	42% below	35%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast (ER or IP ONLY) LT	$156.00	$240.00	$48.00–$240.00	42% below	35%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast (ER or IP ONLY) RT	$156.00	$240.00	$48.00–$240.00	—	35%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast (ER or IP ONLY) LT	$156.00	$240.00	$48.00–$240.00	—	35%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA Abd/Pelvis for Dissection	$2,337.40	$3,596.00	$719.20–$3,596.00	6% below	35%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA Abd/Pelvis for Dissection	$2,337.40	$3,596.00	$719.20–$3,596.00	—	35%
CT angiography (CTA) of the head CPT 70496 CT Venogram Brain	$1,780.35	$2,739.00	$547.80–$2,739.00	15% above	35%
CT angiography (CTA) of the head inpatient CPT 70496 CT Venogram Brain	$1,780.35	$2,739.00	$547.80–$2,739.00	—	35%
CT angiography (CTA) of the neck CPT 70498 CTA Neck	$1,132.30	$1,742.00	$348.40–$1,742.00	25% below	35%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA Neck	$1,132.30	$1,742.00	$348.40–$1,742.00	—	35%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest Dissection	$1,695.85	$2,609.00	$521.80–$2,609.00	1% above	35%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest Dissection	$1,695.85	$2,609.00	$521.80–$2,609.00	—	35%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Cardiac Scoring	$72.15	$111.00	$22.20–$111.00	52% below	35%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Cardiac Scoring	$72.15	$111.00	$22.20–$111.00	—	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd Pelvis W-O Contrast Renal Stone	$2,224.30	$3,422.00	$684.40–$3,422.00	25% above	35%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd Pelvis W-O Contrast Renal Stone	$2,224.30	$3,422.00	$684.40–$3,422.00	—	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis W-Contrast	$3,235.70	$4,978.00	$995.60–$4,978.00	15% above	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis W-Contrast	$3,235.70	$4,978.00	$995.60–$4,978.00	—	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen Pelvis W W-O Contrast	$3,665.35	$5,639.00	$1,127.80–$5,639.00	40% above	35%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen Pelvis W W-O Contrast	$3,665.35	$5,639.00	$1,127.80–$5,639.00	—	35%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen W-Contrast	$1,883.70	$2,898.00	$579.60–$2,898.00	28% above	35%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen W-Contrast	$1,883.70	$2,898.00	$579.60–$2,898.00	—	35%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen W-O Contrast	$1,140.75	$1,755.00	$351.00–$1,755.00	23% above	35%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen W-O Contrast	$1,140.75	$1,755.00	$351.00–$1,755.00	—	35%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial Area W-O Contrast	$966.55	$1,487.00	$297.40–$1,487.00	5% below	35%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial Area W-O Contrast	$966.55	$1,487.00	$297.40–$1,487.00	—	35%
CT scan of the head or brain, no contrast dye CPT 70450 CT Brain W-O Contrast AIS	$892.45	$1,373.00	$274.60–$1,373.00	at median	35%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain W-O Contrast AIS	$892.45	$1,373.00	$274.60–$1,373.00	—	35%
CT scan of the head with contrast CPT 70460 CT Brain W-Contrast	$1,220.05	$1,877.00	$375.40–$1,877.00	1% below	35%
CT scan of the head with contrast inpatient CPT 70460 CT Brain W-Contrast	$1,220.05	$1,877.00	$375.40–$1,877.00	—	35%
CT scan of the head without and with contrast CPT 70470 CT Brain W W-O Contrast	$1,584.05	$2,437.00	$487.40–$2,437.00	1% above	35%
CT scan of the head without and with contrast inpatient CPT 70470 CT Brain W W-O Contrast	$1,584.05	$2,437.00	$487.40–$2,437.00	—	35%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Lumbar Spine W-O Contrast	$1,083.55	$1,667.00	$333.40–$1,667.00	at median	35%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Lumbar Spine W-O Contrast	$1,083.55	$1,667.00	$333.40–$1,667.00	—	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Cervical Spine W-O Contrast	$1,611.35	$2,479.00	$495.80–$2,479.00	45% above	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Cervical Spine W-O Contrast	$1,611.35	$2,479.00	$495.80–$2,479.00	—	35%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W-Contrast	$1,764.10	$2,714.00	$542.80–$2,714.00	30% above	35%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis W-Contrast	$1,764.10	$2,714.00	$542.80–$2,714.00	—	35%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Doppler Complete Bilateral	$622.70	$958.00	$191.60–$958.00	—	35%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Doppler Complete Bilateral	$622.70	$958.00	$191.60–$958.00	—	35%
Chest CT scan without and with contrast CPT 71270 CT Esophagus W W-O Contrast 71270	$1,847.30	$2,842.00	$568.40–$2,842.00	6% above	35%
Chest CT scan without and with contrast inpatient CPT 71270 CT Esophagus W W-O Contrast 71270	$1,847.30	$2,842.00	$568.40–$2,842.00	—	35%
Chest X-ray, 2 views CPT 71046 DX CHEST INSPIRATION & EXPIRATION ONLY	$196.30	$302.00	$60.40–$302.00	10% above	35%
Chest X-ray, 2 views inpatient CPT 71046 DX CHEST INSPIRATION & EXPIRATION ONLY	$196.30	$302.00	$60.40–$302.00	—	35%
Chest X-ray, single view CPT 71045 DX Chest-KUB Neonate Portable	$220.35	$339.00	$67.80–$339.00	43% above	35%
Chest X-ray, single view one side CPT 71045 DX CHEST LEFT LATERAL DECUB	$220.35	$339.00	$67.80–$339.00	43% above	35%
Chest X-ray, single view one side CPT 71045 DX CHEST RIGHT LATERAL DECUB	$220.35	$339.00	$67.80–$339.00	43% above	35%
Chest X-ray, single view inpatient CPT 71045 DX Chest-KUB Neonate Portable	$220.35	$339.00	$67.80–$339.00	—	35%
Chest X-ray, single view inpatient one side CPT 71045 DX CHEST RIGHT LATERAL DECUB	$220.35	$339.00	$67.80–$339.00	—	35%
Chest X-ray, single view inpatient one side CPT 71045 DX CHEST LEFT LATERAL DECUB	$220.35	$339.00	$67.80–$339.00	—	35%
Collarbone (clavicle) X-ray, complete one side CPT 73000 DX Clavicle RT	$187.85	$289.00	$57.80–$289.00	7% above	35%
Collarbone (clavicle) X-ray, complete one side CPT 73000 DX Clavicle LT	$187.85	$289.00	$57.80–$289.00	7% above	35%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 DX Clavicle LT	$187.85	$289.00	$57.80–$289.00	—	35%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 DX Clavicle RT	$187.85	$289.00	$57.80–$289.00	—	35%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$585.65	$901.00	$180.20–$901.00	3% below	35%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$585.65	$901.00	$180.20–$901.00	—	35%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Densitometry Axial	$217.10	$334.00	$66.80–$334.00	30% below	35%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Densitometry Axial	$217.10	$334.00	$66.80–$334.00	—	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD--BONE DENSITY DXA APPENDICULAR	$84.50	$130.00	$26.00–$130.00	34% below	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD--BONE DENSITY DXA APPENDICULAR	$84.50	$130.00	$26.00–$130.00	—	35%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Esophagus W-O Contrast 71250	$1,207.05	$1,857.00	$371.40–$1,857.00	20% above	35%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Esophagus W-O Contrast 71250	$1,207.05	$1,857.00	$371.40–$1,857.00	—	35%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Esophagus W-Contrast 71260	$1,659.45	$2,553.00	$510.60–$2,553.00	26% above	35%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Esophagus W-Contrast 71260	$1,659.45	$2,553.00	$510.60–$2,553.00	—	35%
Diagnostic mammogram, both breasts CPT 77066 MA Digital Diagnostic Mammo	$473.85	$729.00	$145.80–$729.00	52% above	35%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA Digital Diagnostic Mammo	$473.85	$729.00	$145.80–$729.00	—	35%
Diagnostic mammogram, one breast one side CPT 77065 MA Digital Diagnostic Mammo LT	$364.00	$560.00	$112.00–$560.00	17% above	35%
Diagnostic mammogram, one breast one side CPT 77065 MA Digital Diagnostic Mammo RT	$364.00	$560.00	$112.00–$560.00	17% above	35%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Digital Diagnostic Mammo RT	$364.00	$560.00	$112.00–$560.00	—	35%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Digital Diagnostic Mammo LT	$364.00	$560.00	$112.00–$560.00	—	35%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Venous Doppler Lower Ext Bilat	$698.75	$1,075.00	$215.00–$1,075.00	—	35%
Duplex ultrasound of the leg veins, both legs CPT 93970 DUPLEX SCAN EXT VEINS COMPLETE BIL	$868.40	$1,336.00	$267.20–$1,336.00	41% above	35%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Venous Doppler Lower Ext Bilat	$698.75	$1,075.00	$215.00–$1,075.00	—	35%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 DUPLEX SCAN EXT VEINS COMPLETE BIL	$868.40	$1,336.00	$267.20–$1,336.00	—	35%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 COMPLETE ECHO W/COLOR FLOW DOPPLR CHG ONLY	$1,372.80	$2,112.00	$422.40–$2,112.00	1% below	35%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 COMPLETE ECHO W/COLOR FLOW DOPPLR CHG ONLY	$1,372.80	$2,112.00	$422.40–$2,112.00	—	35%
Elbow X-ray, 2 views one side CPT 73070 DX Elbow 2 Views LT	$176.80	$272.00	$54.40–$272.00	32% above	35%
Elbow X-ray, 2 views one side CPT 73070 DX Elbow 2 Views RT	$176.80	$272.00	$54.40–$272.00	32% above	35%
Elbow X-ray, 2 views inpatient one side CPT 73070 DX Elbow 2 Views RT	$176.80	$272.00	$54.40–$272.00	—	35%
Elbow X-ray, 2 views inpatient one side CPT 73070 DX Elbow 2 Views LT	$176.80	$272.00	$54.40–$272.00	—	35%
Elbow X-ray, complete, 3 or more views one side CPT 73080 DX Elbow Complete RT	$209.95	$323.00	$64.60–$323.00	11% above	35%
Elbow X-ray, complete, 3 or more views one side CPT 73080 DX Elbow Complete LT	$209.95	$323.00	$64.60–$323.00	11% above	35%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 DX Elbow Complete LT	$209.95	$323.00	$64.60–$323.00	—	35%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 DX Elbow Complete RT	$209.95	$323.00	$64.60–$323.00	—	35%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Post Fossa-Orbit-Sella W-O Contrast	$989.95	$1,523.00	$304.60–$1,523.00	2% below	35%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Post Fossa-Orbit-Sella W-O Contrast	$989.95	$1,523.00	$304.60–$1,523.00	—	35%
Facial bones X-ray, complete, 3 or more views CPT 70150 DX Facial Bones Complete	$273.00	$420.00	$84.00–$420.00	5% above	35%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 DX Facial Bones Complete	$273.00	$420.00	$84.00–$420.00	—	35%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 DX Forearm RT	$188.50	$290.00	$58.00–$290.00	6% above	35%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 DX Forearm LT	$188.50	$290.00	$58.00–$290.00	6% above	35%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 DX Forearm LT	$188.50	$290.00	$58.00–$290.00	—	35%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 DX Forearm RT	$188.50	$290.00	$58.00–$290.00	—	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary Scan W-O Pharmaceutical	$843.05	$1,297.00	$259.40–$1,297.00	10% below	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary Scan W-O Pharmaceutical	$843.05	$1,297.00	$259.40–$1,297.00	—	35%
Hand X-ray, 2 views one side CPT 73120 DX Hand 2 Views RT	$184.60	$284.00	$56.80–$284.00	26% above	35%
Hand X-ray, 2 views one side CPT 73120 DX Hand 2 Views LT	$184.60	$284.00	$56.80–$284.00	26% above	35%
Hand X-ray, 2 views inpatient one side CPT 73120 DX Hand 2 Views RT	$184.60	$284.00	$56.80–$284.00	—	35%
Hand X-ray, 2 views inpatient one side CPT 73120 DX Hand 2 Views LT	$184.60	$284.00	$56.80–$284.00	—	35%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 DX OS Calcis Heel LT	$180.70	$278.00	$55.60–$278.00	17% above	35%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 DX OS Calcis Heel RT	$180.70	$278.00	$55.60–$278.00	17% above	35%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 DX OS Calcis Heel LT	$180.70	$278.00	$55.60–$278.00	—	35%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 DX OS Calcis Heel RT	$180.70	$278.00	$55.60–$278.00	—	35%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 RC Sleep Study Unatt & Resp	$439.40	$676.00	$135.20–$676.00	20% below	35%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 RC Sleep Study Unatt & Resp	$439.40	$676.00	$135.20–$676.00	—	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 COMBINED SLEEP STUDY	$3,831.10	$5,894.00	$1,178.80–$5,894.00	10% above	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 RC CPAP Titration-Sleep Lab	$3,831.10	$5,894.00	$1,178.80–$5,894.00	10% above	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 COMBINED SLEEP STUDY	$3,831.10	$5,894.00	$1,178.80–$5,894.00	—	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 RC CPAP Titration-Sleep Lab	$3,831.10	$5,894.00	$1,178.80–$5,894.00	—	35%
Knee X-ray, 3 views one side CPT 73562 DX Knee Minimum Three Views LT	$210.60	$324.00	$64.80–$324.00	9% above	35%
Knee X-ray, 3 views one side CPT 73562 DX Knee Minimum Three Views RT	$210.60	$324.00	$64.80–$324.00	9% above	35%
Knee X-ray, 3 views inpatient one side CPT 73562 DX Knee Minimum Three Views LT	$210.60	$324.00	$64.80–$324.00	—	35%
Knee X-ray, 3 views inpatient one side CPT 73562 DX Knee Minimum Three Views RT	$210.60	$324.00	$64.80–$324.00	—	35%
Knee X-ray, complete, 4 or more views one side CPT 73564 DX Knee Complete- 4 or More Views RT	$243.10	$374.00	$74.80–$374.00	14% above	35%
Knee X-ray, complete, 4 or more views one side CPT 73564 DX Knee Complete- 4 or More Views LT	$243.10	$374.00	$74.80–$374.00	14% above	35%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 DX Knee Complete- 4 or More Views RT	$243.10	$374.00	$74.80–$374.00	—	35%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 DX Knee Complete- 4 or More Views LT	$243.10	$374.00	$74.80–$374.00	—	35%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity W-O Contrast RT	$1,207.05	$1,857.00	$371.40–$1,857.00	10% above	35%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity W-O Contrast LT	$1,207.05	$1,857.00	$371.40–$1,857.00	10% above	35%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity W-O Contrast LT	$1,207.05	$1,857.00	$371.40–$1,857.00	—	35%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity W-O Contrast RT	$1,207.05	$1,857.00	$371.40–$1,857.00	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen LTD	$417.30	$642.00	$128.40–$642.00	10% below	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen LTD	$417.30	$642.00	$128.40–$642.00	—	35%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Non-Vasc Limited RT 76882	$388.05	$597.00	$119.40–$597.00	7% above	35%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Non-Vasc Limited LT 76882	$388.05	$597.00	$119.40–$597.00	7% above	35%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Non-Vasc Limited LT 76882	$388.05	$597.00	$119.40–$597.00	—	35%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Non-Vasc Limited RT 76882	$388.05	$597.00	$119.40–$597.00	—	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Chest Lung Screen	$141.70	$218.00	$43.60–$218.00	59% below	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Chest Lung Screen	$141.70	$218.00	$43.60–$218.00	—	35%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 DX Tibia - Fibula RT	$193.05	$297.00	$59.40–$297.00	5% above	35%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 DX Tibia - Fibula LT	$193.05	$297.00	$59.40–$297.00	5% above	35%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 DX Tibia - Fibula LT	$193.05	$297.00	$59.40–$297.00	—	35%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 DX Tibia - Fibula RT	$193.05	$297.00	$59.40–$297.00	—	35%
MR angiography (MRA) of the head without contrast CPT 70544 MRV Brain W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	15% below	35%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV Brain W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Lower Ext Joint W-O Contrast RT	$1,320.80	$2,032.00	$406.40–$2,032.00	18% below	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Lower Ext Joint W-O Contrast LT	$1,320.80	$2,032.00	$406.40–$2,032.00	18% below	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Lower Ext Joint W-O Contrast RT	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Lower Ext Joint W-O Contrast LT	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Lower Ext Joint W W-O Contrast RT	$1,651.65	$2,541.00	$508.20–$2,541.00	34% below	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Lower Ext Joint W W-O Contrast LT	$1,651.65	$2,541.00	$508.20–$2,541.00	34% below	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Lower Ext Joint W W-O Contrast RT	$1,651.65	$2,541.00	$508.20–$2,541.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Lower Ext Joint W W-O Contrast LT	$1,651.65	$2,541.00	$508.20–$2,541.00	—	35%
MRI of the abdomen without contrast CPT 74181 MR Abdomen W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	23% below	35%
MRI of the abdomen without contrast inpatient CPT 74181 MR Abdomen W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR Abdomen W W-O Contrast	$1,651.65	$2,541.00	$508.20–$2,541.00	47% below	35%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR Abdomen W W-O Contrast	$1,651.65	$2,541.00	$508.20–$2,541.00	—	35%
MRI of the brain, no contrast dye CPT 70551 MR Brain W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	22% below	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MR Brain W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
MRI of the brain, with and without contrast dye CPT 70553 MR Brain Perfusion W W/O Contrast	$1,651.65	$2,541.00	$508.20–$2,541.00	41% below	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Brain Perfusion W W/O Contrast	$1,651.65	$2,541.00	$508.20–$2,541.00	—	35%
MRI of the lower back, no contrast dye CPT 72148 MR Lumbar Spine W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	27% below	35%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR Lumbar Spine W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
MRI of the lower back, without and then with contrast dye CPT 72158 MR Lumbar Spine W W-O Contrast	$1,651.65	$2,541.00	$508.20–$2,541.00	40% below	35%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR Lumbar Spine W W-O Contrast	$1,651.65	$2,541.00	$508.20–$2,541.00	—	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR Thoracic Spine W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	23% below	35%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR Thoracic Spine W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR Cervical Spine W W-O Contrast	$1,651.65	$2,541.00	$508.20–$2,541.00	41% below	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR Cervical Spine W W-O Contrast	$1,651.65	$2,541.00	$508.20–$2,541.00	—	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR Cervical Spine W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	25% below	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR Cervical Spine W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
MRI of the pelvis without and with contrast CPT 72197 MR Pelvis W W-O Contrast	$1,651.65	$2,541.00	$508.20–$2,541.00	41% below	35%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR Pelvis W W-O Contrast	$1,651.65	$2,541.00	$508.20–$2,541.00	—	35%
MRI of the pelvis, no contrast dye CPT 72195 MR Pelvis W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	22% below	35%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR Pelvis W-O Contrast	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR Upper Ext Joint W-O Contrast LT (LTD)	$1,320.80	$2,032.00	$406.40–$2,032.00	30% below	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR Upper Ext Joint W-O Contrast RT (LTD)	$1,320.80	$2,032.00	$406.40–$2,032.00	30% below	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR Upper Ext Joint W-O Contrast RT (LTD)	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR Upper Ext Joint W-O Contrast LT (LTD)	$1,320.80	$2,032.00	$406.40–$2,032.00	—	35%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 DX Spine Cervical 4 Views	$325.65	$501.00	$100.20–$501.00	14% above	35%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 DX Spine Cervical 4 Views	$325.65	$501.00	$100.20–$501.00	—	35%
Neck soft tissue CT scan with contrast CPT 70491 CT Neck Soft Tissue W-Contrast	$1,591.85	$2,449.00	$489.80–$2,449.00	20% above	35%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Neck Soft Tissue W-Contrast	$1,591.85	$2,449.00	$489.80–$2,449.00	—	35%
Neck soft tissue CT scan without contrast CPT 70490 CT Neck Soft Tissue W-O Contrast	$1,207.05	$1,857.00	$371.40–$1,857.00	19% above	35%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Neck Soft Tissue W-O Contrast	$1,207.05	$1,857.00	$371.40–$1,857.00	—	35%
Neck soft tissue X-ray CPT 70360 DX Neck Soft Tissue Examination	$147.55	$227.00	$45.40–$227.00	16% below	35%
Neck soft tissue X-ray inpatient CPT 70360 DX Neck Soft Tissue Examination	$147.55	$227.00	$45.40–$227.00	—	35%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocard Perfusion Spect (Stress)	$2,490.80	$3,832.00	$766.40–$3,832.00	13% below	35%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocard Perfusion Spect (Stress)	$2,490.80	$3,832.00	$766.40–$3,832.00	—	35%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET-CT PSMA (Prostate CA)	$4,245.15	$6,531.00	$1,306.20–$6,531.00	23% below	35%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET-CT PSMA (Prostate CA)	$4,245.15	$6,531.00	$1,306.20–$6,531.00	—	35%
Pelvic CT scan without contrast CPT 72192 CT Cystogram Pelvis Only	$1,080.95	$1,663.00	$332.60–$1,663.00	10% above	35%
Pelvic CT scan without contrast inpatient CPT 72192 CT Cystogram Pelvis Only	$1,080.95	$1,663.00	$332.60–$1,663.00	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic LTD	$235.95	$363.00	$72.60–$363.00	30% below	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic LTD	$235.95	$363.00	$72.60–$363.00	—	35%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Complete	$464.10	$714.00	$142.80–$714.00	17% below	35%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Complete	$464.10	$714.00	$142.80–$714.00	—	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Greater Than 14 Wks	$401.05	$617.00	$123.40–$617.00	29% below	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Greater Than 14 Wks	$401.05	$617.00	$123.40–$617.00	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB Less Than 14 Wks Gest	$458.25	$705.00	$141.00–$705.00	17% below	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB Less Than 14 Wks Gest	$458.25	$705.00	$141.00–$705.00	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited	$303.55	$467.00	$93.40–$467.00	5% below	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Done	$303.55	$467.00	$93.40–$467.00	5% below	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited	$303.55	$467.00	$93.40–$467.00	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Done	$303.55	$467.00	$93.40–$467.00	—	35%
Rib X-ray, one side, 2 views one side CPT 71100 DX Ribs RT	$199.55	$307.00	$61.40–$307.00	1% above	35%
Rib X-ray, one side, 2 views one side CPT 71100 DX Ribs LT	$199.55	$307.00	$61.40–$307.00	1% above	35%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 DX Ribs RT	$199.55	$307.00	$61.40–$307.00	—	35%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 DX Ribs LT	$199.55	$307.00	$61.40–$307.00	—	35%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 DX Ribs RT and PA Chest	$260.00	$400.00	$80.00–$400.00	10% above	35%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 DX Ribs LT and PA Chest	$260.00	$400.00	$80.00–$400.00	10% above	35%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 DX Ribs RT and PA Chest	$260.00	$400.00	$80.00–$400.00	—	35%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 DX Ribs LT and PA Chest	$260.00	$400.00	$80.00–$400.00	—	35%
Screening mammogram, both breasts CPT 77067 MA Digital Screening Mammo	$322.40	$496.00	$99.20–$496.00	13% above	35%
Screening mammogram, both breasts inpatient CPT 77067 MA Digital Screening Mammo	$322.40	$496.00	$99.20–$496.00	—	35%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 DX Shoulder Complete LT	$197.60	$304.00	$60.80–$304.00	2% below	35%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 DX Shoulder Complete RT	$197.60	$304.00	$60.80–$304.00	2% below	35%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 DX Shoulder Complete LT	$197.60	$304.00	$60.80–$304.00	—	35%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 DX Shoulder Complete RT	$197.60	$304.00	$60.80–$304.00	—	35%
Sinus X-ray, complete, 3 or more views CPT 70220 DX Sinuses Paranasal Complete	$247.00	$380.00	$76.00–$380.00	8% above	35%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 DX Sinuses Paranasal Complete	$247.00	$380.00	$76.00–$380.00	—	35%
Skull X-ray, fewer than 4 views CPT 70250 DX--SKULL PARTIAL	$182.00	$280.00	$56.00–$280.00	12% below	35%
Skull X-ray, fewer than 4 views inpatient CPT 70250 DX--SKULL PARTIAL	$182.00	$280.00	$56.00–$280.00	—	35%
Sleep study in a lab (polysomnography) CPT 95810 DIAGNOSTIC SLEEP STUDY	$3,555.50	$5,470.00	$1,094.00–$5,470.00	10% above	35%
Sleep study in a lab (polysomnography) inpatient CPT 95810 DIAGNOSTIC SLEEP STUDY	$3,555.50	$5,470.00	$1,094.00–$5,470.00	—	35%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 DX Femur RT 2 View	$204.10	$314.00	$62.80–$314.00	5% below	35%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 DX Femur LT 2 View	$204.10	$314.00	$62.80–$314.00	5% below	35%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 DX Femur RT 2 View	$204.10	$314.00	$62.80–$314.00	—	35%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 DX Femur LT 2 View	$204.10	$314.00	$62.80–$314.00	—	35%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Thoracic Spine W-O Contrast	$1,574.95	$2,423.00	$484.60–$2,423.00	55% above	35%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Thoracic Spine W-O Contrast	$1,574.95	$2,423.00	$484.60–$2,423.00	—	35%
Toe X-ray, 2 or more views one side CPT 73660 DX Toes LT	$160.55	$247.00	$49.40–$247.00	28% above	35%
Toe X-ray, 2 or more views one side CPT 73660 DX Toes RT	$160.55	$247.00	$49.40–$247.00	28% above	35%
Toe X-ray, 2 or more views inpatient one side CPT 73660 DX Toes RT	$160.55	$247.00	$49.40–$247.00	—	35%
Toe X-ray, 2 or more views inpatient one side CPT 73660 DX Toes LT	$160.55	$247.00	$49.40–$247.00	—	35%
Transvaginal pelvic ultrasound CPT 76830 US--Transvaginal Non OB	$406.90	$626.00	$125.20–$626.00	24% below	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 US--Transvaginal Non OB	$406.90	$626.00	$125.20–$626.00	—	35%
Transvaginal ultrasound during pregnancy CPT 76817 US--OB Transvaginal	$458.25	$705.00	$141.00–$705.00	5% above	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US--OB Transvaginal	$458.25	$705.00	$141.00–$705.00	—	35%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$666.90	$1,026.00	$205.20–$1,026.00	at median	35%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$666.90	$1,026.00	$205.20–$1,026.00	—	35%
Ultrasound of the scrotum and testicles CPT 76870 US Testicular	$568.10	$874.00	$174.80–$874.00	8% above	35%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Testicular	$568.10	$874.00	$174.80–$874.00	—	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid Head Neck	$352.95	$543.00	$108.60–$543.00	26% below	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid Head Neck	$352.95	$543.00	$108.60–$543.00	—	35%
Upper arm X-ray (humerus), 2 views one side CPT 73060 DX Humerus RT	$186.55	$287.00	$57.40–$287.00	2% above	35%
Upper arm X-ray (humerus), 2 views one side CPT 73060 DX Humerus LT	$186.55	$287.00	$57.40–$287.00	2% above	35%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 DX Humerus RT	$186.55	$287.00	$57.40–$287.00	—	35%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 DX Humerus LT	$186.55	$287.00	$57.40–$287.00	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 DUPLEX SCAN EXT VEINS UNI OR LIMITED	$423.15	$651.00	$130.20–$651.00	20% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Doppler Lower Ext RT	$381.55	$587.00	$117.40–$587.00	28% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Doppler Lower Ext LT	$381.55	$587.00	$117.40–$587.00	28% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 DUPLEX SCAN EXT VEINS UNI OR LIMITED	$423.15	$651.00	$130.20–$651.00	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Doppler Lower Ext LT	$381.55	$587.00	$117.40–$587.00	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Doppler Lower Ext RT	$381.55	$587.00	$117.40–$587.00	—	35%
Wrist X-ray, 2 views one side CPT 73100 DX Wrist 2 Views LT	$172.25	$265.00	$53.00–$265.00	23% above	35%
Wrist X-ray, 2 views one side CPT 73100 DX Wrist 2 Views RT	$172.25	$265.00	$53.00–$265.00	23% above	35%
Wrist X-ray, 2 views inpatient one side CPT 73100 DX Wrist 2 Views RT	$172.25	$265.00	$53.00–$265.00	—	35%
Wrist X-ray, 2 views inpatient one side CPT 73100 DX Wrist 2 Views LT	$172.25	$265.00	$53.00–$265.00	—	35%
Wrist X-ray, complete, 3 or more views one side CPT 73110 DX Wrist Complete RT	$203.45	$313.00	$62.60–$313.00	6% above	35%
Wrist X-ray, complete, 3 or more views one side CPT 73110 DX Wrist Complete LT	$203.45	$313.00	$62.60–$313.00	6% above	35%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 DX Wrist Complete LT	$203.45	$313.00	$62.60–$313.00	—	35%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 DX Wrist Complete RT	$203.45	$313.00	$62.60–$313.00	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 DX Hip Unilateral Complete RT	$187.85	$289.00	$57.80–$289.00	8% below	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 DX Hip Unilateral Complete LT	$187.85	$289.00	$57.80–$289.00	8% below	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 DX Hip Unilateral Complete RT	$187.85	$289.00	$57.80–$289.00	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 DX Hip Unilateral Complete LT	$187.85	$289.00	$57.80–$289.00	—	35%
X-ray of the abdomen, 1 view CPT 74018 DX--Abdomen AP (KUB)	$179.40	$276.00	$55.20–$276.00	13% above	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 DX--Abdomen AP (KUB)	$179.40	$276.00	$55.20–$276.00	—	35%
X-ray of the ankle, 2 views one side CPT 73600 DX Ankle 2 Views RT	$159.90	$246.00	$49.20–$246.00	9% below	35%
X-ray of the ankle, 2 views one side CPT 73600 DX Ankle 2 Views LT	$159.90	$246.00	$49.20–$246.00	9% below	35%
X-ray of the ankle, 2 views inpatient one side CPT 73600 DX Ankle 2 Views RT	$159.90	$246.00	$49.20–$246.00	—	35%
X-ray of the ankle, 2 views inpatient one side CPT 73600 DX Ankle 2 Views LT	$159.90	$246.00	$49.20–$246.00	—	35%
X-ray of the finger(s), 2 or more views one side CPT 73140 DX Fingers RT	$160.55	$247.00	$49.40–$247.00	22% above	35%
X-ray of the finger(s), 2 or more views one side CPT 73140 DX Fingers LT	$160.55	$247.00	$49.40–$247.00	22% above	35%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 DX Fingers RT	$160.55	$247.00	$49.40–$247.00	—	35%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 DX Fingers LT	$160.55	$247.00	$49.40–$247.00	—	35%
X-ray of the foot, 2 views one side CPT 73620 DX Foot Two Views RT	$141.70	$218.00	$43.60–$218.00	11% below	35%
X-ray of the foot, 2 views one side CPT 73620 DX Foot Two Views LT	$141.70	$218.00	$43.60–$218.00	11% below	35%
X-ray of the foot, 2 views inpatient one side CPT 73620 DX Foot Two Views RT	$141.70	$218.00	$43.60–$218.00	—	35%
X-ray of the foot, 2 views inpatient one side CPT 73620 DX Foot Two Views LT	$141.70	$218.00	$43.60–$218.00	—	35%
X-ray of the foot, complete, 3 or more views one side CPT 73630 DX Foot Complete RT	$190.45	$293.00	$58.60–$293.00	6% above	35%
X-ray of the foot, complete, 3 or more views one side CPT 73630 DX Foot Complete LT	$190.45	$293.00	$58.60–$293.00	6% above	35%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 DX Foot Complete RT	$190.45	$293.00	$58.60–$293.00	—	35%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 DX Foot Complete LT	$190.45	$293.00	$58.60–$293.00	—	35%
X-ray of the hand, 3 or more views one side CPT 73130 DX Hand Complete LT	$203.45	$313.00	$62.60–$313.00	11% above	35%
X-ray of the hand, 3 or more views one side CPT 73130 DX Hand Complete RT	$203.45	$313.00	$62.60–$313.00	11% above	35%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 DX Hand Complete LT	$203.45	$313.00	$62.60–$313.00	—	35%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 DX Hand Complete RT	$203.45	$313.00	$62.60–$313.00	—	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 DX Knee 1 or 2 Views RT	$181.35	$279.00	$55.80–$279.00	17% above	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 DX Knee 1 or 2 Views LT	$181.35	$279.00	$55.80–$279.00	17% above	35%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 DX Knee 1 or 2 Views RT	$181.35	$279.00	$55.80–$279.00	—	35%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 DX Knee 1 or 2 Views LT	$181.35	$279.00	$55.80–$279.00	—	35%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 DX Spine Lumbar AP-Lat	$280.80	$432.00	$86.40–$432.00	31% above	35%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 DX Spine Lumbar AP-Lat	$280.80	$432.00	$86.40–$432.00	—	35%
X-ray of the lower back, 4 or more views CPT 72110 DX Spine Lumbar 4 Views	$337.35	$519.00	$103.80–$519.00	9% above	35%
X-ray of the lower back, 4 or more views inpatient CPT 72110 DX Spine Lumbar 4 Views	$337.35	$519.00	$103.80–$519.00	—	35%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 DX Spine Thoracic AP-LAT NO Swim	$185.90	$286.00	$57.20–$286.00	1% above	35%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 DX Spine Thoracic AP-LAT NO Swim	$185.90	$286.00	$57.20–$286.00	—	35%
X-ray of the nasal bones, 3 or more views CPT 70160 DX Nasal Bones	$189.15	$291.00	$58.20–$291.00	10% above	35%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 DX Nasal Bones	$189.15	$291.00	$58.20–$291.00	—	35%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 DX Spine Cervical 2VW FLEX/EXT	$201.50	$310.00	$62.00–$310.00	13% below	35%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 DX Spine Cervical 2VW FLEX/EXT	$201.50	$310.00	$62.00–$310.00	—	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 DX Pelvis 1 or 2 Views	$163.80	$252.00	$50.40–$252.00	at median	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 DX Pelvis 1 or 2 Views	$163.80	$252.00	$50.40–$252.00	—	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 DX Sacrum and Coccyx	$196.30	$302.00	$60.40–$302.00	14% above	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 DX Sacrum and Coccyx	$196.30	$302.00	$60.40–$302.00	—	35%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SPGT)	$50.70	$78.00	$15.60–$78.00	111% above	35%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (SPGT)	$50.70	$78.00	$15.60–$78.00	—	35%
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT AST Blood	$55.25	$85.00	$17.00–$85.00	151% above	35%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT AST Blood	$55.25	$85.00	$17.00–$85.00	—	35%
Albumin blood test CPT 82040 Albumin Serum	$63.70	$98.00	$19.60–$98.00	218% above	35%
Albumin blood test inpatient CPT 82040 Albumin Serum	$63.70	$98.00	$19.60–$98.00	—	35%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$59.15	$91.00	$18.20–$91.00	182% above	35%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$59.15	$91.00	$18.20–$91.00	—	35%
Ammonia blood test CPT 82140 Ammonia Plasma	$66.95	$103.00	$20.60–$103.00	3% above	35%
Ammonia blood test inpatient CPT 82140 Ammonia Plasma	$66.95	$103.00	$20.60–$103.00	—	35%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide (CCP) Abs. IgA IgG ELISA	$6.58	$10.12	$2.02–$10.12	88% below	35%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptide (CCP) Abs. IgA IgG ELISA	$6.58	$10.12	$2.02–$10.12	—	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Screen w/Rflx to 12 Plus Profile (RDL)	$16.25	$25.00	$5.00–$25.00	71% below	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Screen w/Rflx to 12 Plus Profile (RDL)	$16.25	$25.00	$5.00–$25.00	—	35%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT pro BNP	$70.20	$108.00	$21.60–$108.00	11% below	35%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT pro BNP	$70.20	$108.00	$21.60–$108.00	—	35%
Basic metabolic panel (blood test) CPT 80048 BMP Basic Metabolic Panel	$76.70	$118.00	$23.60–$118.00	42% above	35%
Basic metabolic panel (blood test) inpatient CPT 80048 BMP Basic Metabolic Panel	$76.70	$118.00	$23.60–$118.00	—	35%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$52.00	$80.00	$16.00–$80.00	129% above	35%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$52.00	$80.00	$16.00–$80.00	—	35%
Blood culture for bacteria CPT 87040 Culture Blood Routine Low Volume	$108.55	$167.00	$33.40–$167.00	72% above	35%
Blood culture for bacteria CPT 87040 SPECIMEN - BLOOD CULTURE	$109.85	$169.00	$33.80–$169.00	74% above	35%
Blood culture for bacteria inpatient CPT 87040 Culture Blood Routine Low Volume	$108.55	$167.00	$33.40–$167.00	—	35%
Blood culture for bacteria inpatient CPT 87040 SPECIMEN - BLOOD CULTURE	$109.85	$169.00	$33.80–$169.00	—	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Done	$20.15	$31.00	$6.20–$31.00	56% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only Venipuncture Collection Fee EGH	$20.15	$31.00	$6.20–$31.00	56% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Per RN/Assistant #Venous	$20.15	$31.00	$6.20–$31.00	56% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only 36415 Venipuncture	$20.15	$31.00	$6.20–$31.00	56% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Phlebotomy Draw	$88.40	$136.00	$27.20–$136.00	586% above	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Per RN/Assistant #Venous	$20.15	$31.00	$6.20–$31.00	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Done	$20.15	$31.00	$6.20–$31.00	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only Venipuncture Collection Fee EGH	$20.15	$31.00	$6.20–$31.00	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only 36415 Venipuncture	$20.15	$31.00	$6.20–$31.00	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Phlebotomy Draw	$88.40	$136.00	$27.20–$136.00	—	35%
Blood glucose (sugar) test CPT 82947 82947 ASSAY GLUCOSE BLOOD QUANT	$55.25	$85.00	$17.00–$85.00	130% above	35%
Blood glucose (sugar) test CPT 82947 82947 I-STAT GLUCOSE	$55.25	$85.00	$17.00–$85.00	130% above	35%
Blood glucose (sugar) test inpatient CPT 82947 82947 I-STAT GLUCOSE	$55.25	$85.00	$17.00–$85.00	—	35%
Blood glucose (sugar) test inpatient CPT 82947 82947 ASSAY GLUCOSE BLOOD QUANT	$55.25	$85.00	$17.00–$85.00	—	35%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 hCG Qualitative Pregnancy Serum	$74.75	$115.00	$23.00–$115.00	102% above	35%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 hCG Qualitative Pregnancy Serum	$74.75	$115.00	$23.00–$115.00	—	35%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO and Rh Type Neonate Less than 4 Months	$409.50	$630.00	$126.00–$630.00	1857% above	35%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO and Rh Type Neonate Less than 4 Months	$409.50	$630.00	$126.00–$630.00	—	35%
Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen Blood	$42.90	$66.00	$13.20–$66.00	139% above	35%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen Blood	$42.90	$66.00	$13.20–$66.00	—	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C Reactive Protein Quantitative	$18.20	$28.00	$5.60–$28.00	46% below	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C Reactive Protein Quantitative	$18.20	$28.00	$5.60–$28.00	—	35%
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium difficile Toxin Gene by NAAT with Reflex to Toxins A and B by EIA Feces	$81.25	$125.00	$25.00–$125.00	30% below	35%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Clostridium difficile Toxin Gene by NAAT with Reflex to Toxins A and B by EIA Feces	$81.25	$125.00	$25.00–$125.00	—	35%
Calcium blood test, total CPT 82310 Calcium Blood	$36.40	$56.00	$11.20–$56.00	79% above	35%
Calcium blood test, total inpatient CPT 82310 Calcium Blood	$36.40	$56.00	$11.20–$56.00	—	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 87491 CHYLMD TRACH DNA AMP PROBE	$98.80	$152.00	$30.40–$152.00	34% above	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 87491 CHYLMD TRACH DNA AMP PROBE	$98.80	$152.00	$30.40–$152.00	—	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel with LDL Cholesterol Direct Measurement, if Indicated	$59.15	$91.00	$18.20–$91.00	16% above	35%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel with LDL Cholesterol Direct Measurement, if Indicated	$59.15	$91.00	$18.20–$91.00	—	35%
Complete blood count (CBC) with differential CPT 85025 CBC wDiff	$154.70	$238.00	$47.60–$238.00	277% above	35%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC wDiff	$154.70	$238.00	$47.60–$238.00	—	35%
Complete blood count (CBC), no differential CPT 85027 CBC	$49.40	$76.00	$15.20–$76.00	70% above	35%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC	$49.40	$76.00	$15.20–$76.00	—	35%
Comprehensive metabolic panel (blood test) CPT 80053 Metabolic PanelComprehensive	$149.50	$230.00	$46.00–$230.00	100% above	35%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Metabolic PanelComprehensive	$149.50	$230.00	$46.00–$230.00	—	35%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase with MB if Indicated	$47.45	$73.00	$14.60–$73.00	58% above	35%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase with MB if Indicated	$47.45	$73.00	$14.60–$73.00	—	35%
Creatinine blood test CPT 82565 Creatinine Serum	$50.70	$78.00	$15.60–$78.00	109% above	35%
Creatinine blood test inpatient CPT 82565 Creatinine Serum	$50.70	$78.00	$15.60–$78.00	—	35%
D-dimer blood test (blood clot marker) CPT 85379 D Dimer Quantitative Plasma	$64.35	$99.00	$19.80–$99.00	50% above	35%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D Dimer Quantitative Plasma	$64.35	$99.00	$19.80–$99.00	—	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 10 With Reflex Confirmation (AMP,BAR,BZO,COC,PCP,THC,OPI,OXY,MD,PPX), Serum	$33.80	$52.00	$10.40–$52.00	42% below	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Comprehensive Umbilical Cord Drug Screen (USDTL)	$89.05	$137.00	$27.40–$137.00	53% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Blood Alcohol	$212.55	$327.00	$65.40–$327.00	265% above	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 9 (Triage Meter) w/ Rflx to Confirmations, Urine (TRH Lab)	$212.55	$327.00	$65.40–$327.00	265% above	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 10 With Reflex Confirmation (AMP,BAR,BZO,COC,PCP,THC,OPI,OXY,MD,PPX), Serum	$33.80	$52.00	$10.40–$52.00	—	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Comprehensive Umbilical Cord Drug Screen (USDTL)	$89.05	$137.00	$27.40–$137.00	—	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Blood Alcohol	$212.55	$327.00	$65.40–$327.00	—	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 9 (Triage Meter) w/ Rflx to Confirmations, Urine (TRH Lab)	$212.55	$327.00	$65.40–$327.00	—	35%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel Venous	$83.20	$128.00	$25.60–$128.00	160% above	35%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte Panel Venous	$83.20	$128.00	$25.60–$128.00	—	35%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-Barr Virus (EBV) Antibodies to Viral Capsid Antigen (VCA) IgM	$7.15	$11.00	$2.20–$11.00	89% below	35%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-Barr Virus (EBV) Antibodies to Viral Capsid Antigen (VCA) IgM	$7.15	$11.00	$2.20–$11.00	—	35%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$102.05	$157.00	$31.40–$157.00	70% above	35%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$102.05	$157.00	$31.40–$157.00	—	35%
Folate (folic acid) blood test CPT 82746 Folate Serum	$106.60	$164.00	$32.80–$164.00	36% above	35%
Folate (folic acid) blood test inpatient CPT 82746 Folate Serum	$106.60	$164.00	$32.80–$164.00	—	35%
Free T3 thyroid hormone test CPT 84481 T3 Free	$47.45	$73.00	$14.60–$73.00	29% below	35%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free	$47.45	$73.00	$14.60–$73.00	—	35%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Thyroxine Free, Dialysis Mass Spectrometry	$83.20	$128.00	$25.60–$128.00	168% above	35%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 Thyroxine Free, Dialysis Mass Spectrometry	$83.20	$128.00	$25.60–$128.00	—	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 1 Hr Challenge 50 G Gestational	$55.90	$86.00	$17.20–$86.00	156% above	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 82950 GLUCOSE TEST	$55.90	$86.00	$17.20–$86.00	156% above	35%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 82950 GLUCOSE TEST	$55.90	$86.00	$17.20–$86.00	—	35%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 1 Hr Challenge 50 G Gestational	$55.90	$86.00	$17.20–$86.00	—	35%
Glucose tolerance test, 3 samples CPT 82951 GTT 2 Hr Gestational (24-28 wks) Glucose Tolerance Test 75gm	$185.90	$286.00	$57.20–$286.00	224% above	35%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 2 Hr Gestational (24-28 wks) Glucose Tolerance Test 75gm	$185.90	$286.00	$57.20–$286.00	—	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 N.GONORRHOEAE DNA AMP PROB	$98.80	$152.00	$30.40–$152.00	4% above	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591 N.GONORRHOEAE DNA AMP PROB	$98.80	$152.00	$30.40–$152.00	—	35%
H. pylori stool antigen test CPT 87338 Fec H pyl RL	$14.95	$23.00	$4.60–$23.00	76% below	35%
H. pylori stool antigen test inpatient CPT 87338 Fec H pyl RL	$14.95	$23.00	$4.60–$23.00	—	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV p24 Ag/Ab Combo w/ Rflx to Confirmation	$70.85	$109.00	$21.80–$109.00	44% above	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV p24 Ag/Ab Combo w/ Rflx to Confirmation	$70.85	$109.00	$21.80–$109.00	—	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C (w/ Est Avg Glucose)	$88.40	$136.00	$27.20–$136.00	119% above	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C (w/ Est Avg Glucose)	$88.40	$136.00	$27.20–$136.00	—	35%
Hemoglobin blood test CPT 85018 85018 IH HEMOGLOBIN	$22.10	$34.00	$6.80–$34.00	38% above	35%
Hemoglobin blood test inpatient CPT 85018 85018 IH HEMOGLOBIN	$22.10	$34.00	$6.80–$34.00	—	35%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Virus (HBV) Surface Antigen w Reflex to HBs Ag Neutralization	$41.60	$64.00	$12.80–$64.00	10% below	35%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Virus (HBV) Surface Antigen w Reflex to HBs Ag Neutralization	$41.60	$64.00	$12.80–$64.00	—	35%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Virus (HCV) Antibody Cascade to Quant PCR and Genotyping	$42.25	$65.00	$13.00–$65.00	12% below	35%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Virus (HCV) Antibody Cascade to Quant PCR and Genotyping	$42.25	$65.00	$13.00–$65.00	—	35%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C (HCV) Quant PCR w/ Rflx to Genotyping (Nongraphical)	$35.75	$55.00	$11.00–$55.00	73% below	35%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 REFLEX: HCV RT-PCR, Quant (Non-Graph) 55036	$32.50	$50.00	$10.00–$50.00	75% below	35%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C (HCV) Quant PCR w/ Rflx to Genotyping (Nongraphical)	$35.75	$55.00	$11.00–$55.00	—	35%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 REFLEX: HCV RT-PCR, Quant (Non-Graph) 55036	$32.50	$50.00	$10.00–$50.00	—	35%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Virus (HSV) Type 2-Specific Abs, IgG	$9.75	$15.00	$3.00–$15.00	81% below	35%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Virus (HSV) Type 2-Specific Abs, IgG	$9.75	$15.00	$3.00–$15.00	—	35%
Iron blood test (serum iron) CPT 83540 83540 IRON BINDING CAPACITY	$27.30	$42.00	$8.40–$42.00	7% below	35%
Iron blood test (serum iron) inpatient CPT 83540 83540 IRON BINDING CAPACITY	$27.30	$42.00	$8.40–$42.00	—	35%
Iron-binding capacity (TIBC) test CPT 83550 83550 IRON BINDING TEST	$38.35	$59.00	$11.80–$59.00	4% below	35%
Iron-binding capacity (TIBC) test inpatient CPT 83550 83550 IRON BINDING TEST	$38.35	$59.00	$11.80–$59.00	—	35%
Kidney function blood test panel CPT 80069 Renal	$91.00	$140.00	$28.00–$140.00	47% above	35%
Kidney function blood test panel inpatient CPT 80069 Renal	$91.00	$140.00	$28.00–$140.00	—	35%
Lactate (lactic acid) blood test CPT 83605 REFLEX: Lactic Acid 3hr	$60.45	$93.00	$18.60–$93.00	34% above	35%
Lactate (lactic acid) blood test inpatient CPT 83605 REFLEX: Lactic Acid 3hr	$60.45	$93.00	$18.60–$93.00	—	35%
Lactate dehydrogenase (LDH) blood test CPT 83615 Ld Total Serum	$46.15	$71.00	$14.20–$71.00	92% above	35%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Ld Total Serum	$46.15	$71.00	$14.20–$71.00	—	35%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Serum	$107.90	$166.00	$33.20–$166.00	248% above	35%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Serum	$107.90	$166.00	$33.20–$166.00	—	35%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$149.50	$230.00	$46.00–$230.00	219% above	35%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$149.50	$230.00	$46.00–$230.00	—	35%
Lyme disease antibody test CPT 86618 Lyme Disease Total Antibody w/ Rflx to Immunoassay	$6.50	$10.00	$2.00–$10.00	75% below	35%
Lyme disease antibody test CPT 86618 Borrelia burgdorferi (Lyme) IgG Antibody, Plasma	$41.60	$64.00	$12.80–$64.00	60% above	35%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Total Antibody w/ Rflx to Immunoassay	$6.50	$10.00	$2.00–$10.00	—	35%
Lyme disease antibody test inpatient CPT 86618 Borrelia burgdorferi (Lyme) IgG Antibody, Plasma	$41.60	$64.00	$12.80–$64.00	—	35%
Magnesium blood test CPT 83735 Mg Magnesium Blood	$21.45	$33.00	$6.60–$33.00	7% above	35%
Magnesium blood test inpatient CPT 83735 Mg Magnesium Blood	$21.45	$33.00	$6.60–$33.00	—	35%
Mono test (heterophile antibody, Monospot) CPT 86308 Infectious Mononucleosis Screen Blood w/ Reflex EBV	$68.90	$106.00	$21.20–$106.00	70% above	35%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Infectious Mononucleosis Screen Blood w/ Reflex EBV	$68.90	$106.00	$21.20–$106.00	—	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Prostate Specific Antigen Total Diagnostic	$143.65	$221.00	$44.20–$221.00	180% above	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Prostate Specific Antigen Total Screening	$143.65	$221.00	$44.20–$221.00	180% above	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Prostate Specific Antigen Total Screening	$143.65	$221.00	$44.20–$221.00	—	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Prostate Specific Antigen Total Diagnostic	$143.65	$221.00	$44.20–$221.00	—	35%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap Test (IG) w/ Rflx to HPV if ASC-U, w/ Genotypes 16+18,45 (LC 199340)	$13.00	$20.00	$4.00–$20.00	82% below	35%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap Test (IG) w/ Rflx to HPV if ASC-U, w/ Genotypes 16+18,45 (LC 199340)	$13.00	$20.00	$4.00–$20.00	—	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$46.15	$71.00	$14.20–$71.00	49% above	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$46.15	$71.00	$14.20–$71.00	—	35%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Serum	$42.90	$66.00	$13.20–$66.00	104% above	35%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Serum	$42.90	$66.00	$13.20–$66.00	—	35%
Potassium blood test CPT 84132 84132 ASSAY OF SERUM POTASSIUM	$37.05	$57.00	$11.40–$57.00	55% above	35%
Potassium blood test inpatient CPT 84132 84132 ASSAY OF SERUM POTASSIUM	$37.05	$57.00	$11.40–$57.00	—	35%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MaterniT21 PLUS Core+ESS+SCA	$226.85	$349.00	$69.80–$349.00	24% below	35%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 MaterniT21 PLUS Core+ESS+SCA	$226.85	$349.00	$69.80–$349.00	—	35%
Prothrombin time (PT/INR) clotting test CPT 85610 PT Prothrombin Time w/ INR	$37.70	$58.00	$11.60–$58.00	93% above	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT Prothrombin Time w/ INR	$37.70	$58.00	$11.60–$58.00	—	35%
Rh blood typing CPT 86901 86901 Blood Typng Serologic RH(D)	$99.45	$153.00	$30.60–$153.00	380% above	35%
Rh blood typing inpatient CPT 86901 86901 Blood Typng Serologic RH(D)	$99.45	$153.00	$30.60–$153.00	—	35%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibodies IgG	$85.80	$132.00	$26.40–$132.00	68% above	35%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibodies IgG	$85.80	$132.00	$26.40–$132.00	—	35%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate	$39.00	$60.00	$12.00–$60.00	62% above	35%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sedimentation Rate	$39.00	$60.00	$12.00–$60.00	—	35%
Sodium blood test CPT 84295 84295 ASSAY OF SERUM SODIUM	$38.35	$59.00	$11.80–$59.00	84% above	35%
Sodium blood test inpatient CPT 84295 84295 ASSAY OF SERUM SODIUM	$38.35	$59.00	$11.80–$59.00	—	35%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Screen Feces KIT (3 Cards)	$42.90	$66.00	$13.20–$66.00	144% above	35%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Screen Feces KIT (3 Cards)	$42.90	$66.00	$13.20–$66.00	—	35%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis: Treponemal Abs w/ Rflx to RPR and RPR Titer, Reverse Screening and Dx Algorithm	$39.00	$60.00	$12.00–$60.00	17% below	35%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis: Treponemal Abs w/ Rflx to RPR and RPR Titer, Reverse Screening and Dx Algorithm	$39.00	$60.00	$12.00–$60.00	—	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis: RPR w/ Rflx to RPR Titer and Treponemal Abs, Traditional Screening and Dx Algorithm	$37.05	$57.00	$11.40–$57.00	116% above	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis: RPR w/ Rflx to RPR Titer and Treponemal Abs, Traditional Screening and Dx Algorithm	$37.05	$57.00	$11.40–$57.00	—	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Cascade Profile	$78.00	$120.00	$24.00–$120.00	21% above	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH (Thyroid Stimulating Hormone) Sensitive w/Rflx to Free T4	$80.60	$124.00	$24.80–$124.00	25% above	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Cascade Profile	$78.00	$120.00	$24.00–$120.00	—	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH (Thyroid Stimulating Hormone) Sensitive w/Rflx to Free T4	$80.60	$124.00	$24.80–$124.00	—	35%
Total cholesterol blood test CPT 82465 Cholesterol Total Blood	$50.70	$78.00	$15.60–$78.00	154% above	35%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Total Blood	$50.70	$78.00	$15.60–$78.00	—	35%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis by PCR, Swab or Urine (Xpert Kit, Beacon Labs)	$98.80	$152.00	$30.40–$152.00	34% above	35%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis by PCR, Swab or Urine (Xpert Kit, Beacon Labs)	$98.80	$152.00	$30.40–$152.00	—	35%
Triglycerides blood test CPT 84478 Triglycerides	$59.15	$91.00	$18.20–$91.00	207% above	35%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$59.15	$91.00	$18.20–$91.00	—	35%
Troponin test, quantitative CPT 84484 REFLEX: Troponin T 1hr	$98.15	$151.00	$30.20–$151.00	131% above	35%
Troponin test, quantitative CPT 84484 iStat Troponin I-High Sensitivity	$98.15	$151.00	$30.20–$151.00	131% above	35%
Troponin test, quantitative inpatient CPT 84484 iStat Troponin I-High Sensitivity	$98.15	$151.00	$30.20–$151.00	—	35%
Troponin test, quantitative inpatient CPT 84484 REFLEX: Troponin T 1hr	$98.15	$151.00	$30.20–$151.00	—	35%
Uric acid blood test CPT 84550 Uric Acid Serum	$59.15	$91.00	$18.20–$91.00	162% above	35%
Uric acid blood test inpatient CPT 84550 Uric Acid Serum	$59.15	$91.00	$18.20–$91.00	—	35%
Urinalysis with microscope exam, automated CPT 81001 UA Scrn w/Micro + Cult if Ind	$46.80	$72.00	$14.40–$72.00	134% above	35%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA Scrn w/Micro + Cult if Ind	$46.80	$72.00	$14.40–$72.00	—	35%
Urinalysis with microscope exam, manual CPT 81000 Done	$7.15	$11.00	$2.20–$11.00	52% below	35%
Urinalysis with microscope exam, manual inpatient CPT 81000 Done	$7.15	$11.00	$2.20–$11.00	—	35%
Urinalysis without microscope exam, automated CPT 81003 UA Macro	$5.20	$8.00	$1.60–$8.00	60% below	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA Macro	$5.20	$8.00	$1.60–$8.00	—	35%
Urinalysis without microscope exam, manual CPT 81002 URINE DIB STICK	$118.95	$183.00	$36.60–$183.00	680% above	35%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIB STICK	$118.95	$183.00	$36.60–$183.00	—	35%
Urine microalbumin (albumin) test CPT 82043 82043 IH MICROALBUMIN QUANTITATIVE	$16.90	$26.00	$5.20–$26.00	35% below	35%
Urine microalbumin (albumin) test inpatient CPT 82043 82043 IH MICROALBUMIN QUANTITATIVE	$16.90	$26.00	$5.20–$26.00	—	35%
Urine pregnancy test, read by color change CPT 81025 Surg Pregnancy Test	$41.60	$64.00	$12.80–$64.00	81% above	35%
Urine pregnancy test, read by color change CPT 81025 UCG Qualitative Pregnancy Test Urine	$41.60	$64.00	$12.80–$64.00	81% above	35%
Urine pregnancy test, read by color change CPT 81025 BEDSIDE PREG TEST-URINE	$41.60	$64.00	$12.80–$64.00	81% above	35%
Urine pregnancy test, read by color change inpatient CPT 81025 Surg Pregnancy Test	$41.60	$64.00	$12.80–$64.00	—	35%
Urine pregnancy test, read by color change inpatient CPT 81025 BEDSIDE PREG TEST-URINE	$41.60	$64.00	$12.80–$64.00	—	35%
Urine pregnancy test, read by color change inpatient CPT 81025 UCG Qualitative Pregnancy Test Urine	$41.60	$64.00	$12.80–$64.00	—	35%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$61.10	$94.00	$18.80–$94.00	3% above	35%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$61.10	$94.00	$18.80–$94.00	—	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy	$156.00	$240.00	$48.00–$240.00	76% above	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy	$156.00	$240.00	$48.00–$240.00	—	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 hCG Quantitative Serum	$226.85	$349.00	$69.80–$349.00	364% above	35%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 hCG Quantitative Serum	$226.85	$349.00	$69.80–$349.00	—	35%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Elective Arrhythmia External	$754.00	$1,160.00	$232.00–$1,160.00	23% below	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ECC	$754.00	$1,160.00	$232.00–$1,160.00	23% below	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ECC	$754.00	$1,160.00	$232.00–$1,160.00	—	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Elective Arrhythmia External	$754.00	$1,160.00	$232.00–$1,160.00	—	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Mogan	$572.65	$881.00	$176.20–$881.00	66% below	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Mogan	$572.65	$881.00	$176.20–$881.00	—	35%
Circumcision, surgical, older than a newborn CPT 54160 Plastibell	$561.60	$864.00	$172.80–$864.00	41% below	35%
Circumcision, surgical, older than a newborn inpatient CPT 54160 Plastibell	$561.60	$864.00	$172.80–$864.00	—	35%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EARWAX UNI	$232.05	$357.00	$71.40–$357.00	128% above	35%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EARWAX UNI	$232.05	$357.00	$71.40–$357.00	—	35%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX	$232.05	$357.00	$71.40–$357.00	147% above	35%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX	$232.05	$357.00	$71.40–$357.00	—	35%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$432.90	$666.00	$133.20–$666.00	59% above	35%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE SKIN ABSCESS	$607.10	$934.00	$186.80–$934.00	122% above	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS	$432.90	$666.00	$133.20–$666.00	—	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE SKIN ABSCESS	$607.10	$934.00	$186.80–$934.00	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT TEND SHEATH LIGAMENT CYST	$1,014.00	$1,560.00	$312.00–$1,560.00	157% above	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECT TEND SHEATH LIGAMENT CYST	$1,014.00	$1,560.00	$312.00–$1,560.00	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIR/INJ JOINT/BURSA/CYST-MAJOR	$274.95	$423.00	$84.60–$423.00	35% below	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIR/INJ JOINT/BURSA/CYST-MAJOR	$274.95	$423.00	$84.60–$423.00	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIR-INJ JNT-BURSA CYST-INTERMED	$258.05	$397.00	$79.40–$397.00	21% below	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspiration and/or injection of fluid from medium join	$258.05	$397.00	$79.40–$397.00	21% below	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Aspiration and/or injection of fluid from medium join	$258.05	$397.00	$79.40–$397.00	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASPIR-INJ JNT-BURSA CYST-INTERMED	$258.05	$397.00	$79.40–$397.00	—	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPIRAT INJECT JOINT BURSA CYST	$1,014.00	$1,560.00	$312.00–$1,560.00	200% above	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASPIRAT INJECT JOINT BURSA CYST	$1,014.00	$1,560.00	$312.00–$1,560.00	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSURE WOUNDS .1-2.5 CM	$1,129.05	$1,737.00	$347.40–$1,737.00	202% above	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSURE WOUNDS .1-2.5 CM	$1,129.05	$1,737.00	$347.40–$1,737.00	—	35%
Nail removal (partial or complete), one nail CPT 11730 RC AVULSION OF NAIL PLATE	$464.75	$715.00	$143.00–$715.00	127% above	35%
Nail removal (partial or complete), one nail CPT 11730 Avulsion of Nail Plate	$520.00	$800.00	$160.00–$800.00	154% above	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 RC AVULSION OF NAIL PLATE	$464.75	$715.00	$143.00–$715.00	—	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion of Nail Plate	$520.00	$800.00	$160.00–$800.00	—	35%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$2,631.20	$4,048.00	$809.60–$4,048.00	116% above	35%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING	$2,631.20	$4,048.00	$809.60–$4,048.00	—	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL	$404.95	$623.00	$124.60–$623.00	22% below	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 PERMANENT NAIL REMOVAL	$546.00	$840.00	$168.00–$840.00	5% above	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL	$404.95	$623.00	$124.60–$623.00	—	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 PERMANENT NAIL REMOVAL	$546.00	$840.00	$168.00–$840.00	—	35%
Removal of a foreign object under the skin, simple CPT 10120 INCIS REMOVE FOREIGN BODY-SUBCUT	$314.60	$484.00	$96.80–$484.00	15% below	35%
Removal of a foreign object under the skin, simple CPT 10120 I&R FB SQ SMPL	$341.25	$525.00	$105.00–$525.00	8% below	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCIS REMOVE FOREIGN BODY-SUBCUT	$314.60	$484.00	$96.80–$484.00	—	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 I&R FB SQ SMPL	$341.25	$525.00	$105.00–$525.00	—	35%
Short arm splint (forearm and hand) CPT 29125 APPLICATION-FOREARM SPLINT	$435.50	$670.00	$134.00–$670.00	133% above	35%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION-FOREARM SPLINT	$435.50	$670.00	$134.00–$670.00	—	35%
Short leg cast (below the knee) CPT 29405 PT 29405 Short Leg Cast	$235.95	$363.00	$72.60–$363.00	14% below	35%
Short leg cast (below the knee) inpatient CPT 29405 PT 29405 Short Leg Cast	$235.95	$363.00	$72.60–$363.00	—	35%
Short leg splint (calf to foot) CPT 29515 APPLICATION-SHORT LEG SPLINT	$560.30	$862.00	$172.40–$862.00	249% above	35%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION-SHORT LEG SPLINT	$560.30	$862.00	$172.40–$862.00	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR SUPERFIC WOUNDS -1 2-5 CM	$249.60	$384.00	$76.80–$384.00	18% above	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR S/N/AX/GEN/TRNK 2.5CM/<	$325.00	$500.00	$100.00–$500.00	54% above	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR SUPERFIC WOUNDS -1 2-5 CM	$249.60	$384.00	$76.80–$384.00	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR S/N/AX/GEN/TRNK 2.5CM/<	$325.00	$500.00	$100.00–$500.00	—	35%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SKIN SINGLE LESION	$1,126.45	$1,733.00	$346.60–$1,733.00	208% above	35%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY SKIN SINGLE LESION	$1,126.45	$1,733.00	$346.60–$1,733.00	—	35%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS	$699.40	$1,076.00	$215.20–$1,076.00	300% above	35%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS	$699.40	$1,076.00	$215.20–$1,076.00	—	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture - Diagnostic	$1,994.85	$3,069.00	$613.80–$3,069.00	133% above	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE-LUMBAR/DIAGNOSTIC	$2,071.55	$3,187.00	$637.40–$3,187.00	142% above	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar Puncture - Diagnostic	$1,994.85	$3,069.00	$613.80–$3,069.00	—	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE-LUMBAR/DIAGNOSTIC	$2,071.55	$3,187.00	$637.40–$3,187.00	—	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR SUPERFIC WOUNDS 2.6-7.5 CM	$347.75	$535.00	$107.00–$535.00	44% 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 REPAIR SUPERFIC WOUNDS 2.6-7.5 CM	$347.75	$535.00	$107.00–$535.00	—	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR SUPERFIC WOUNDS -1 2-5 C/1	$213.20	$328.00	$65.60–$328.00	10% below	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR SUPERFIC WOUNDS -1 2-5 C/1	$213.20	$328.00	$65.60–$328.00	—	35%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIA BX SKIN SINGL LESION	$625.95	$963.00	$192.60–$963.00	118% above	35%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIA BX SKIN SINGL LESION	$625.95	$963.00	$192.60–$963.00	—	35%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT	$1,014.00	$1,560.00	$312.00–$1,560.00	179% above	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT	$1,014.00	$1,560.00	$312.00–$1,560.00	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 MA--Bx Brst 1st Lesion US Imag RT	$4,065.75	$6,255.00	$1,251.00–$6,255.00	120% above	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 MA--Bx Brst 1st Lesion US Imag LT	$4,065.75	$6,255.00	$1,251.00–$6,255.00	120% above	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 MA--Bx Brst 1st Lesion US Imag RT	$4,065.75	$6,255.00	$1,251.00–$6,255.00	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 MA--Bx Brst 1st Lesion US Imag LT	$4,065.75	$6,255.00	$1,251.00–$6,255.00	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE TISSUE UP TO 20CM	$920.40	$1,416.00	$283.20–$1,416.00	65% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement, skin/subcu. Tissue	$1,069.25	$1,645.00	$329.00–$1,645.00	92% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE TISSUE UP TO 20CM	$920.40	$1,416.00	$283.20–$1,416.00	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debridement, skin/subcu. Tissue	$1,069.25	$1,645.00	$329.00–$1,645.00	—	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 Blood Transfusion-FFP	$646.10	$994.00	$198.80–$994.00	14% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 O/P Blood Transfusion 7-12 Hrs	$646.10	$994.00	$198.80–$994.00	14% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 Given	$646.10	$994.00	$198.80–$994.00	14% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion-Platelets	$646.10	$994.00	$198.80–$994.00	14% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 O/P Blood Transfusion 0-6 Hrs	$646.10	$994.00	$198.80–$994.00	14% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion-Packed RBC	$646.10	$994.00	$198.80–$994.00	14% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION	$737.75	$1,135.00	$227.00–$1,135.00	2% below	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion-FFP	$646.10	$994.00	$198.80–$994.00	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion-Platelets	$646.10	$994.00	$198.80–$994.00	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Given	$646.10	$994.00	$198.80–$994.00	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion-Packed RBC	$646.10	$994.00	$198.80–$994.00	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 O/P Blood Transfusion 7-12 Hrs	$646.10	$994.00	$198.80–$994.00	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 O/P Blood Transfusion 0-6 Hrs	$646.10	$994.00	$198.80–$994.00	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION	$737.75	$1,135.00	$227.00–$1,135.00	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 High Flow # NC 0-24 hr	$246.35	$379.00	$75.80–$379.00	45% above	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 High Flow # NC 0-24 hr	$246.35	$379.00	$75.80–$379.00	—	35%
Chemotherapy IV infusion, first hour CPT 96413 Given	$711.10	$1,094.00	$218.80–$1,094.00	35% above	35%
Chemotherapy IV infusion, first hour CPT 96413 Chemo Admin - Infusion Up to 1 Hr	$971.75	$1,495.00	$299.00–$1,495.00	85% above	35%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Given	$711.10	$1,094.00	$218.80–$1,094.00	—	35%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo Admin - Infusion Up to 1 Hr	$971.75	$1,495.00	$299.00–$1,495.00	—	35%
Critical care, first 30 to 74 minutes CPT 99291 ED Critical Care (Face to Face ) Initial 30-74 Min	$1,336.40	$2,056.00	$411.20–$2,056.00	32% below	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED Critical Care (Face to Face ) Initial 30-74 Min	$1,336.40	$2,056.00	$411.20–$2,056.00	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Request	$115.05	$177.00	$35.40–$177.00	12% below	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram (EKG) charge	$119.60	$184.00	$36.80–$184.00	8% below	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Charge - ECC	$119.60	$184.00	$36.80–$184.00	8% below	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Request	$115.05	$177.00	$35.40–$177.00	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Charge - ECC	$119.60	$184.00	$36.80–$184.00	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram (EKG) charge	$119.60	$184.00	$36.80–$184.00	—	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED Level 1 (Brief) (1-2)	$232.70	$358.00	$71.60–$358.00	25% above	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED Level 1 (Brief) (1-2)	$232.70	$358.00	$71.60–$358.00	—	35%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED Level 2 (Limited) (3-5)	$304.20	$468.00	$93.60–$468.00	10% below	35%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED Level 2 (Limited) (3-5)	$304.20	$468.00	$93.60–$468.00	—	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED Level 3 (Intermediate) (6-8)	$499.85	$769.00	$153.80–$769.00	22% below	35%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED Level 3 (Intermediate) (6-8)	$499.85	$769.00	$153.80–$769.00	—	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED Level 4 (Extended) (9-13)	$773.50	$1,190.00	$238.00–$1,190.00	27% below	35%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED Level 4 (Extended) (9-13)	$773.50	$1,190.00	$238.00–$1,190.00	—	35%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED Level 5 (Comprehensive) (>/=14)	$798.20	$1,228.00	$245.60–$1,228.00	53% below	35%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED Level 5 (Comprehensive) (>/=14)	$798.20	$1,228.00	$245.60–$1,228.00	—	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 Diagnostic Exercise Test	$640.25	$985.00	$197.00–$985.00	12% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 Diagnostic Stress Exercise Treadmill MHSB	$640.25	$985.00	$197.00–$985.00	12% below	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Diagnostic Stress Exercise Treadmill MHSB	$640.25	$985.00	$197.00–$985.00	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Diagnostic Exercise Test	$640.25	$985.00	$197.00–$985.00	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hydration IV-ER-1st hour	$547.30	$842.00	$168.40–$842.00	110% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Done	$572.00	$880.00	$176.00–$880.00	119% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 O/P Hydration Infusion - 1st. hr	$572.00	$880.00	$176.00–$880.00	119% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hydration IV-ER-1st hour	$547.30	$842.00	$168.40–$842.00	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 O/P Hydration Infusion - 1st. hr	$572.00	$880.00	$176.00–$880.00	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Done	$572.00	$880.00	$176.00–$880.00	—	35%
IV infusion of a medicine, first hour CPT 96365 Infusion Therapy-ER-1st hour	$502.45	$773.00	$154.60–$773.00	67% above	35%
IV infusion of a medicine, first hour CPT 96365 O/P Infusion Therapy-1St Hr	$572.00	$880.00	$176.00–$880.00	90% above	35%
IV infusion of a medicine, first hour CPT 96365 Given	$572.00	$880.00	$176.00–$880.00	90% above	35%
IV infusion of a medicine, first hour inpatient CPT 96365 Infusion Therapy-ER-1st hour	$502.45	$773.00	$154.60–$773.00	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 Given	$572.00	$880.00	$176.00–$880.00	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 O/P Infusion Therapy-1St Hr	$572.00	$880.00	$176.00–$880.00	—	35%
IV push of a medicine, first drug CPT 96374 IV push, Initial 0-15 mins	$310.05	$477.00	$95.40–$477.00	63% above	35%
IV push of a medicine, first drug CPT 96374 Intravenous Injection-Ther/Prop/Diag	$572.00	$880.00	$176.00–$880.00	201% above	35%
IV push of a medicine, first drug CPT 96374 Given	$572.00	$880.00	$176.00–$880.00	201% above	35%
IV push of a medicine, first drug inpatient CPT 96374 IV push, Initial 0-15 mins	$310.05	$477.00	$95.40–$477.00	—	35%
IV push of a medicine, first drug inpatient CPT 96374 Given	$572.00	$880.00	$176.00–$880.00	—	35%
IV push of a medicine, first drug inpatient CPT 96374 Intravenous Injection-Ther/Prop/Diag	$572.00	$880.00	$176.00–$880.00	—	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Drug SC/IM-Each Seq Diff Drug	$174.20	$268.00	$53.60–$268.00	91% above	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Subq/Intramusc Inject-Ther/Prop/Diag	$174.20	$268.00	$53.60–$268.00	91% above	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection SQ or IM (non-vaccine)	$208.00	$320.00	$64.00–$320.00	129% above	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 WOUND CLINIC INJECTION IM/SQ	$217.10	$334.00	$66.80–$334.00	139% above	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Subq/Intramusc Inject-Ther/Prop/Diag	$174.20	$268.00	$53.60–$268.00	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Drug SC/IM-Each Seq Diff Drug	$174.20	$268.00	$53.60–$268.00	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection SQ or IM (non-vaccine)	$208.00	$320.00	$64.00–$320.00	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 WOUND CLINIC INJECTION IM/SQ	$217.10	$334.00	$66.80–$334.00	—	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCHIATRIC EVAL	$513.50	$790.00	$158.00–$790.00	129% above	35%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCHIATRIC EVAL	$513.50	$790.00	$158.00–$790.00	—	35%
New patient office visit, about 30 minutes CPT 99203 E&M New Pt Level 3 (FAC)	$289.25	$445.00	$89.00–$445.00	159% above	35%
New patient office visit, about 30 minutes CPT 99203 Wound Clinic Level 3-New	$410.15	$631.00	$126.20–$631.00	267% above	35%
New patient office visit, about 30 minutes inpatient CPT 99203 E&M New Pt Level 3 (FAC)	$289.25	$445.00	$89.00–$445.00	—	35%
New patient office visit, about 30 minutes inpatient CPT 99203 Wound Clinic Level 3-New	$410.15	$631.00	$126.20–$631.00	—	35%
New patient office visit, about 45 minutes CPT 99204 E&M New Pt Level 4 (FAC)	$488.80	$752.00	$150.40–$752.00	314% above	35%
New patient office visit, about 45 minutes CPT 99204 WOUND CLINIC LEVEL 4 - NEW	$527.80	$812.00	$162.40–$812.00	347% above	35%
New patient office visit, about 45 minutes inpatient CPT 99204 E&M New Pt Level 4 (FAC)	$488.80	$752.00	$150.40–$752.00	—	35%
New patient office visit, about 45 minutes inpatient CPT 99204 WOUND CLINIC LEVEL 4 - NEW	$527.80	$812.00	$162.40–$812.00	—	35%
New patient office visit, about 60 minutes CPT 99205 E&M New Pt Level 5 (FAC)	$571.35	$879.00	$175.80–$879.00	316% above	35%
New patient office visit, about 60 minutes CPT 99205 WOUND CLINIC LEVEL 5 - NEW	$634.40	$976.00	$195.20–$976.00	361% above	35%
New patient office visit, about 60 minutes inpatient CPT 99205 E&M New Pt Level 5 (FAC)	$571.35	$879.00	$175.80–$879.00	—	35%
New patient office visit, about 60 minutes inpatient CPT 99205 WOUND CLINIC LEVEL 5 - NEW	$634.40	$976.00	$195.20–$976.00	—	35%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 E&M New Pt Level 1 (FAC)	$207.35	$319.00	$63.80–$319.00	149% above	35%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Wound Clinic Level 2-New	$302.90	$466.00	$93.20–$466.00	264% above	35%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 E&M New Pt Level 1 (FAC)	$207.35	$319.00	$63.80–$319.00	—	35%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Wound Clinic Level 2-New	$302.90	$466.00	$93.20–$466.00	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 INITIAL MNT-DB	$29.25	$45.00	$9.00–$45.00	36% below	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 INITIAL MNT-DB	$29.25	$45.00	$9.00–$45.00	—	35%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION ADVISED 3 MIN OR GREAT	$126.10	$194.00	$38.80–$194.00	208% above	35%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION ADVISED 3 MIN OR GREAT	$126.10	$194.00	$38.80–$194.00	—	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E&M Established Pt Level 5 (FAC)	$419.25	$645.00	$129.00–$645.00	153% above	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 WOUND CLINIC LEVEL 5	$543.40	$836.00	$167.20–$836.00	228% above	35%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E&M Established Pt Level 5 (FAC)	$419.25	$645.00	$129.00–$645.00	—	35%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 WOUND CLINIC LEVEL 5	$543.40	$836.00	$167.20–$836.00	—	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M Established Pt Level 3 (FAC)	$193.05	$297.00	$59.40–$297.00	101% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 WOUND CLINIC LEVEL 3	$312.00	$480.00	$96.00–$480.00	225% above	35%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M Established Pt Level 3 (FAC)	$193.05	$297.00	$59.40–$297.00	—	35%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 WOUND CLINIC LEVEL 3	$312.00	$480.00	$96.00–$480.00	—	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M Established Pt Level 4 (FAC)	$296.40	$456.00	$91.20–$456.00	149% above	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 WOUND CLINIC LEVEL 4	$410.15	$631.00	$126.20–$631.00	244% above	35%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E&M Established Pt Level 4 (FAC)	$296.40	$456.00	$91.20–$456.00	—	35%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 WOUND CLINIC LEVEL 4	$410.15	$631.00	$126.20–$631.00	—	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M Established Pt Level 2 (FAC)	$166.40	$256.00	$51.20–$256.00	145% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 WOUND CLINIC LEVEL 2	$312.00	$480.00	$96.00–$480.00	359% above	35%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M Established Pt Level 2 (FAC)	$166.40	$256.00	$51.20–$256.00	—	35%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 WOUND CLINIC LEVEL 2	$312.00	$480.00	$96.00–$480.00	—	35%
Spirometry (breathing test) CPT 94010 MHSB # Bedside PFT	$297.05	$457.00	$91.40–$457.00	46% above	35%
Spirometry (breathing test) CPT 94010 PEAK FLOW - ECC	$297.05	$457.00	$91.40–$457.00	46% above	35%
Spirometry (breathing test) inpatient CPT 94010 MHSB # Bedside PFT	$297.05	$457.00	$91.40–$457.00	—	35%
Spirometry (breathing test) inpatient CPT 94010 PEAK FLOW - ECC	$297.05	$457.00	$91.40–$457.00	—	35%
Spirometry before and after a bronchodilator CPT 94060 Pre and Post Spirometry	$831.35	$1,279.00	$255.80–$1,279.00	112% above	35%
Spirometry before and after a bronchodilator inpatient CPT 94060 Pre and Post Spirometry	$831.35	$1,279.00	$255.80–$1,279.00	—	35%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Done	$382.85	$589.00	$117.80–$589.00	64% above	35%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Done	$382.85	$589.00	$117.80–$589.00	—	35%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 diphtheria/tetanus/pertussis (DTaP) (PED) 15 units-5 units-23 mcg/0.5 mL (Daptacel) Susp	$102.05	$157.00	$31.40–$157.00	163% above	35%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 diphtheria/tetanus/pertussis (DTaP) (PED) 15 units-5 units-23 mcg/0.5 mL (Daptacel) Susp	$102.05	$157.00	$31.40–$157.00	—	35%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 hepatitis B pediatric vaccine 5 mcg/0.5 mL IM Inj	$95.55	$147.00	$29.40–$147.00	195% above	35%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 hepatitis B pediatric vaccine 5 mcg/0.5 mL IM Inj	$95.55	$147.00	$29.40–$147.00	—	35%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles/mumps/rubella virus vaccine SubQ Inj	$325.00	$500.00	$100.00–$500.00	140% above	35%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles/mumps/rubella virus vaccine SubQ Inj	$325.00	$500.00	$100.00–$500.00	—	35%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal groups A, C, W, and Y vaccine - tetanus toxoid conjugate quad 0.5 mL Inj	$586.30	$902.00	$180.40–$902.00	182% above	35%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal groups A, C, W, and Y vaccine - tetanus toxoid conjugate quad 0.5 mL Inj	$586.30	$902.00	$180.40–$902.00	—	35%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 nirsevimab-alip vaccine PF 50 mg/0.5 mL Inj (weight less than 5 kg)	$1,824.55	$2,807.00	$561.40–$2,807.00	146% above	35%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 nirsevimab-alip vaccine PF 50 mg/0.5 mL Inj (weight less than 5 kg)	$1,824.55	$2,807.00	$561.40–$2,807.00	—	35%
Rabies vaccine, one dose CPT 90675 rabies vaccine, chick embryo 2.5 intl units IM Inj (RabAvert)	$1,453.40	$2,236.00	$447.20–$2,236.00	182% above	35%
Rabies vaccine, one dose CPT 90675 rabies vaccine, human diploid cell 2.5 intl units IM Inj (Imovax)	$1,522.95	$2,343.00	$468.60–$2,343.00	195% above	35%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, chick embryo 2.5 intl units IM Inj (RabAvert)	$1,453.40	$2,236.00	$447.20–$2,236.00	—	35%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, human diploid cell 2.5 intl units IM Inj (Imovax)	$1,522.95	$2,343.00	$468.60–$2,343.00	—	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphtheria toxoids (Td) adult/adolescent 5 units-2 units/0.5 mL IM Inj 0.5 mL	$129.35	$199.00	$39.80–$199.00	140% above	35%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphtheria toxoids (Td) adult/adolescent 5 units-2 units/0.5 mL IM Inj 0.5 mL	$129.35	$199.00	$39.80–$199.00	—	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertussis (Adacel Tdap) IM Inj 0.5 mL	$167.05	$257.00	$51.40–$257.00	130% above	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertussis (Adacel Tdap) IM Inj 0.5 mL	$167.05	$257.00	$51.40–$257.00	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RC Immunization Adm 1 Vaccine	$70.20	$108.00	$21.60–$108.00	205% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Done	$70.20	$108.00	$21.60–$108.00	205% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin, 1 Vaccine	$74.10	$114.00	$22.80–$114.00	222% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Done	$70.20	$108.00	$21.60–$108.00	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RC Immunization Adm 1 Vaccine	$70.20	$108.00	$21.60–$108.00	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin, 1 Vaccine	$74.10	$114.00	$22.80–$114.00	—	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Each add'l vaccine	$20.80	$32.00	$6.40–$32.00	5% above	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 RC Immunization Adm EA Addl Vac	$20.80	$32.00	$6.40–$32.00	5% above	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin, Ea Addl Vaccine	$44.20	$68.00	$13.60–$68.00	123% above	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 RC Immunization Adm EA Addl Vac	$20.80	$32.00	$6.40–$32.00	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Each add'l vaccine	$20.80	$32.00	$6.40–$32.00	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin, Ea Addl Vaccine	$44.20	$68.00	$13.60–$68.00	—	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.beaconhealthsystem.org/wp-content/uploads/2026/05/451257972_Three-Rivers-Health_standardcharges.csv?v=4