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PricedCare

Promedica Charles and Virginia Hickman Hospital

5640 N Adrian Highway, Adrian, MI 49221 · (517) 265-0900

Acute Care HospitalsVoluntary non-profit - PrivateCMS rating 3/5Adrian, MI metroPart of Promedica Health System · 3 hospitalsWebsite ↗

Price file

Prices published

File dated 2026-03-25

2,284 price rows for 36 procedures

Published prices

cash · negotiated range · list
Basic metabolic panel (blood test)

CPT 80048 · lowest of 2 lines · metro median $161

$161
cash
CT scan of the abdomen and pelvis, with contrast

CPT 74177 · lowest of 2 lines · metro median $3,717

$3,717
cash
CT scan of the head, no contrast

CPT 70450 · lowest of 2 lines · metro median $1,858

$1,858
cash
CT scan of the pelvis, with contrast

CPT 72193 · lowest of 2 lines · metro median $1,858

$1,858
cash
Cesarean section hospital stay, no complications

MS-DRG 788

—
cash
Chlamydia test (DNA)

CPT 87491 · lowest of 2 lines · metro median $174

$174
cash
Complete blood count (CBC) with differential

CPT 85025 · lowest of 2 lines · metro median $82

$82
cash
Comprehensive metabolic panel (blood test)

CPT 80053 · lowest of 2 lines · metro median $281

$281
cash
Diagnostic mammogram (both breasts)

CPT 77066 · lowest of 2 lines · metro median $675

$675
cash
Established patient office visit (about 40 minutes)

CPT 99215 · lowest of 8 lines · metro median $100

$100
cash
Gonorrhea test (DNA)

CPT 87591 · lowest of 2 lines · metro median $161

$161
cash
Hip or knee replacement, no major complications

MS-DRG 470

—
cash
Hospital stay for digestive disorders, no complications

MS-DRG 392

—
cash
Hysterectomy for non-cancer reasons, no complications

MS-DRG 743

—
cash
Lipid panel (cholesterol test)

CPT 80061 · lowest of 2 lines · metro median $144

$144
cash
Liver function panel

CPT 80076 · lowest of 2 lines · metro median $61

$61
cash
MRI of the brain, with and without contrast

CPT 70553 · lowest of 2 lines · metro median $2,902

$2,902
cash
MRI of the knee or other lower joint, no contrast

CPT 73721 · lowest of 2 lines · metro median $1,974

$1,974
cash
MRI of the lower back (lumbar spine), no contrast

CPT 72148 · lowest of 2 lines · metro median $1,974

$1,974
cash
MRI of the neck (cervical spine), no contrast

CPT 72141 · lowest of 2 lines · metro median $1,974

$1,974
cash
Neck (cervical) spinal fusion, no complications

MS-DRG 473

—
cash
PSA test (prostate)

CPT 84153 · lowest of 4 lines · metro median $111

$111
cash
Partial thromboplastin time (blood clotting test)

CPT 85730 · lowest of 2 lines · metro median $41

$41
cash
Physical therapy, therapeutic exercise (15 minutes)

CPT 97110 · lowest of 6 lines · metro median $127

$127
cash
Pregnancy ultrasound (after first trimester)

CPT 76805 · lowest of 2 lines · metro median $653

$653
cash
Prothrombin time (blood clotting test)

CPT 85610 · lowest of 4 lines · metro median $41

$41
cash
Screening mammogram (both breasts)

CPT 77067 · lowest of 4 lines · metro median $582

$582
cash
Sleep study (overnight, attended)

CPT 95810 · lowest of 4 lines · metro median $4,806

$4,806
cash
Spinal fusion (not neck), no complications

MS-DRG 460

—
cash
Spinal injection, lower back, no imaging guidance

CPT 62322 · lowest of 2 lines · metro median $1,653

$1,653
cash
TSH test (thyroid)

CPT 84443 · lowest of 2 lines · metro median $127

$127
cash
Transvaginal ultrasound

CPT 76830 · lowest of 2 lines · metro median $445

$445
cash
Ultrasound of the abdomen (complete)

CPT 76700 · lowest of 2 lines · metro median $538

$538
cash
Urinalysis with microscope

CPT 81001 · lowest of 2 lines · metro median $49

$49
cash
Vaginal delivery hospital stay, no complications

MS-DRG 807

—
cash
X-ray of the lower spine (4 or more views)

CPT 72110 · lowest of 2 lines · metro median $476

$476
cash

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.