ProMedica Charles and Virginia Hickman Hospital

Adrian, MI

Posts prices for 30 of the 66 common shoppable procedures we track. Price file retrieved 2026-10-07.

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ProcedurePosted cashPosted gross× Medicare
Epidural injection, lumbar/sacral (with imaging) (62322) $1,652.95 $2,543 1.8×
CT head/brain without contrast (70450) $1,858.35 $2,859 17.3×
MRI brain without contrast (70551) $1,974.05 $3,037 8.1×
MRI brain with contrast (70552) $1,881.10 $2,894 5.2×
MRI brain without and with contrast (70553) $2,901.60 $4,464 8.1×
X-ray lower spine, 4+ views (72110) $475.80 $732 4.4×
MRI lumbar spine without contrast (72148) $1,974.05 $3,037 8.1×
CT pelvis with contrast (72193) $1,858.35 $2,859 10.3×
MRI lower-extremity joint without contrast (73721) $1,974.05 $3,037 8.1×
CT abdomen and pelvis with contrast (74177) $3,716.70 $5,718 10.4×
Ultrasound, abdomen complete (76700) $537.55 $827 5.0×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $653.25 $1,005 6.1×
Ultrasound, transvaginal (76830) $444.60 $684 4.1×
Mammography, one breast (diagnostic) (77065) $553.15 $851 6.4×
Mammography, both breasts (diagnostic) (77066) $675.35 $1,039 6.1×
Mammography, screening (bilateral) (77067) $581.75 $895 6.4×
Basic metabolic panel (80048) $161.20 $248 19.1×
Comprehensive metabolic panel (80053) $281.45 $433 26.7×
Lipid panel (80061) $143.65 $221 10.7×
Renal function panel (80069) $38.35 $59 4.4×
Hepatic function panel (80076) $61.10 $94 7.5×
Urinalysis, non-automated, without microscopy (81002) $12.35 $19 3.5×
PSA, total (84153) $111.15 $171 6.0×
Thyroid stimulating hormone (TSH) (84443) $127.40 $196 7.6×
CBC with automated differential (85025) $81.90 $126 10.5×
CBC, automated (85027) $40.95 $63 6.3×
Prothrombin time (PT) (85610) $40.95 $63 9.5×
Partial thromboplastin time (PTT) (85730) $40.95 $63 6.8×
Sleep study (attended polysomnography) (95810) $4,806.10 $7,394 5.4×
Physical therapy, therapeutic exercise (per 15 min) (97110) $127.40 $196 4.4×

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