Does Ascension Providence Hospital, Southfield and Novi… have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Ascension Providence Hospital, Southfield and Novi…. In a medical emergency, call 911.

Where is Ascension Providence Hospital, Southfield and Novi…?

16001 W Nine Mile Rd, Southfield, MI 48075, in Oakland County, Michigan.

What is the phone number of Ascension Providence Hospital, Southfield and Novi…?

(248) 849-3000, as listed by Medicare (CMS).

What is the Medicare star rating of Ascension Providence Hospital, Southfield and Novi…?

4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Ascension Providence Hospital, Southfield and Novi…

Quick answers

Does Ascension Providence Hospital, Southfield and Novi… have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Ascension Providence Hospital, Southfield and Novi…. In a medical emergency, call 911.
Where is Ascension Providence Hospital, Southfield and Novi…?: 16001 W Nine Mile Rd, Southfield, MI 48075, in Oakland County, Michigan.
What is the phone number of Ascension Providence Hospital, Southfield and Novi…?: (248) 849-3000, as listed by Medicare (CMS).
What is the Medicare star rating of Ascension Providence Hospital, Southfield and Novi…?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4]

Conditions treated^[4][5]

Diabetes
Heart disease
High blood pressure
Heart conditions during pregnancy

Treatments^[4]

Wound care
Stroke care

Procedures^[4]

Programs and centers^[4][5]

Cardiac rehabilitation
Stroke care

Emergency care (hospital website)^[4]

Emergency room	Yes
Open 24/7	Yes

Doctors and clinicians (1,152)

1,152 doctors and other clinicians list Ascension Providence Hospital, Southfield and Novi… as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

Internal Medicine200
Family Practice123
Certified Registered Nurse Anesthetist (CRNA)107
Physician Assistant105
Emergency Medicine76
Nurse Practitioner72
Obstetrics/Gynecology54
Podiatry40
Cardiovascular Disease (Cardiology)35
Orthopedic Surgery28
Otolaryngology26
General Surgery26

And 1,128 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

Sinai-Grace Hospital2.9 mi · Detroit, MI · Acute Care Hospital
Beaumont Hospital Royal Oak4.1 mi · Royal Oak, MI · Acute Care Hospital
Beaumont Hospital - Farmington Hills6.2 mi · Farmington Hills, MI · Acute Care Hospital
Henry Ford Health Hospital8.9 mi · Detroit, MI · Acute Care Hospital
St Joe Mercy Hospital System Livonia9.5 mi · Livonia, MI · Acute Care Hospital

Other hospitals nearby

Surgeons Choice Medical Center0.2 mi · Southfield, MI · Acute Care Hospital
Straith Hospital for Special Surgery2.9 mi · Southfield, MI · Acute Care Hospital
Southeast Michigan Surgical Hospital LLC6.2 mi · Warren, MI · Acute Care Hospital

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Medilodge of Southfield1.9 mi · Southfield, MI · 1 of 5 stars
Regency Heights-Detroit2.3 mi · Detroit, MI · 4 of 5 stars
The Villa at Great Lakes Crossing2.3 mi · Detroit, MI · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Premier at Home Hospice & Palliative Care, LLC1.3 mi · Southfield, MI
St Marie's1.3 mi · Southfield, MI
Universal Hospice Care1.3 mi · Southfield, MI

All hospice providers in the state →

Home health agencies

Able Care1.2 mi · Oak Park, MI · 3 of 5 stars
Compassion Home Health Services1.2 mi · Oak Park, MI
Maple Home Health Care, Inc1.2 mi · Oak Park, MI · 4 of 5 stars

All home health agencies in the state →

Dialysis facilities

DaVita Oak Park Dialysis1.2 mi · Oak Park, MI · 2 of 5 stars
DaVita Cornerstone Dialysis1.3 mi · Southfield, MI · 2 of 5 stars
DaVita Greenview Dialysis1.3 mi · Southfield, MI · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

Specialty Surgical Center1.2 mi · Oak Park, MI
The Cataract Specialty Surgical Center, LLC2.8 mi · Berkley, MI
Southfield Surgery Center3.0 mi · Southfield, MI

All outpatient surgery centers in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

Anne Mare' Ice Pediatric Health Center0.2 mi · Southfield, MI · Community health center
Greenfield0.2 mi · Southfield, MI · Community health center
The Wellness Plan, Northwest Medical Center0.8 mi · Oak Park, MI · Community health center

Clinics and urgent care

Greenfield Urgent Care PC1.2 mi · Oak Park, MI · Urgent care center
Oak Park Urgent Care PLLC1.2 mi · Oak Park, MI · Urgent care center
Doctors Urgent Care Oakpark Southfield1.3 mi · Southfield, MI · Urgent care center

Pharmacies

Apexrx LLC1.2 mi · Oak Park, MI · Community/retail pharmacy
Bormans Inc1.2 mi · Oak Park, MI · Community/retail pharmacy
HD Pharmacy LLC1.2 mi · Oak Park, MI · Community/retail pharmacy

Assisted living nearby

Licensed homes from the official state licence list, by straight-line distance.

Admirable Ronet Care1.2 mi · Oak Park, MI
Diamond Care1.2 mi · Oak Park, MI
Graceland Residential LLC1.2 mi · Oak Park, MI
Irvine Head Injury Home1.2 mi · Oak Park, MI

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Ascension Providence Hospital, Southfield and Novi… reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	2 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	3 of 5 stars
Nurses communicated well	2 of 5 stars
Doctors communicated well	2 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	2 of 5 stars
Room and bathroom kept clean	1 of 5 stars
Quiet at night	2 of 5 stars
Rated the hospital 9 or 10 out of 10	64%National average: 72%
Would definitely recommend the hospital	65%National average: 71%
Nurses “always” communicated well	74%National average: 80%
Doctors “always” communicated well	72%National average: 80%
Staff “always” explained medicines before giving them	53%National average: 62%
Were given information about recovery at home	83%National average: 86%
Room and bathroom “always” clean	57%National average: 74%
Area around the room “always” quiet at night	49%National average: 60%
Completed surveys	1,225Response rate: 20%

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	0.732No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.34Better than the national benchmark
Surgical site infections after colon surgery	0.744No different from the national benchmark
Surgical site infections after abdominal hysterectomy	0.841No different from the national benchmark
MRSA bloodstream infections	0.266Better than the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.299Better than the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	11.1%
Deaths within 30 days: heart failure patients	8.9%
Deaths within 30 days: pneumonia patients	10.6%
Deaths within 30 days: COPD patients	7.1%
Deaths within 30 days: stroke patients	10.7%
Deaths within 30 days: coronary bypass surgery (CABG)	1.9%
Serious complications (patient safety indicator PSI-90)	0.62Better than the national rate
Complications after hip or knee replacement	4.8%

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	14%
Readmitted within 30 days: heart failure	21.1%
Readmitted within 30 days: pneumonia	16.9%
Readmitted within 30 days: COPD	19.5%
Readmitted within 30 days: coronary bypass surgery	11.3%
Readmitted within 30 days: hip or knee replacement	6.6%

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; data from July 2023 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Average (median) time patients spent in the emergency room before leaving (OP-18b)	196 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	Not reported to Medicare
Sepsis patients who got all the recommended early care (SEP-1)	64%National average: 65%

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Michigan Best hospitals in Michigan

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 85 common services exactly as Ascension Providence Hospital, Southfield and Novi… lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

$ 50 amounts are marked with “!”: they are more than 100 times higher or lower than what other hospitals list for the same service, which usually means an error or a different unit in the hospital’s file. They are shown exactly as listed; ask the hospital before relying on them.

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: OFFICE O/P NEW LOW 30 MIN	$170	$95.20	$107.15 – $150.28
New patient office visit (about 30–44 minutes): rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $10,421.85 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $10,421.85 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $107.15 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $10,421.85 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $10,421.85 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $10,421.85 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $10,421.85 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $127.46 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $127.46 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $150.28
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: OFFICE O/P NEW MOD 45 MIN	$275	$154	$107.15 – $230.12
New patient office visit (about 45–59 minutes): rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $11,069.12 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $11,069.12 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $107.15 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $11,069.12 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $11,069.12 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $11,069.12 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $11,069.12 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $195.18 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $195.18 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $230.12
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: OFFICE O/P NEW HI 60 MIN	$375	$210	$107.15 – $285.13
New patient office visit (about 60–74 minutes): rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $12,237.75 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $12,237.75 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $107.15 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $12,237.75 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $12,237.75 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $12,237.75 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $12,237.75 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $241.84 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $241.84 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $285.13
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: OFFICE O/P EST LOW 20 MIN	$135	$75.60	$72.85 – $99.81
Established patient office visit (about 20–29 minutes): rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $1,238.09 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $1,238.09 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $72.85 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $1,238.09 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $1,238.09 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $1,238.09 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,238.09 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $84.65 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $84.65 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $99.81
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: OFFICE O/P EST MOD 30 MIN	$199	$111.44	$72.85 – $147.41
Established patient office visit (about 30–39 minutes): rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $1,924.50 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $1,924.50 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $72.85 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $1,924.50 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $1,924.50 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $1,924.50 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,924.50 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $125.02 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $125.02 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $147.41
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$137.07 – $24,196.10 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Office consultation with a specialist (moderate): rates for 9 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $24,196.10 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $24,196.10 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $24,196.10 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $24,196.10 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $24,196.10 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $24,196.10 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $137.07 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $137.07 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $161.61
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$201.15 – $24,196.10
Office consultation with a specialist (moderate to high): rates for 9 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $24,196.10 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $24,196.10 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $24,196.10 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $24,196.10 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $24,196.10 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $24,196.10 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $201.15 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $201.15 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $237.17
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$45 – $50,732.81 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Preventive checkup, new patient, age 18–39: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $50,732.81 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $50,732.81 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCCCP — 980_SJPK,SJPR BCCCP 20210201: $45 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $50,732.81 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $50,732.81 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $50,732.81 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $50,732.81 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $144.99 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $144.99 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $170.95
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) In the file: PREV VISIT NEW AGE 40-64	Not listed in the file	Not listed in the file	$107.15 – $9,287.60
Preventive checkup, new patient, age 40–64: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $9,287.60 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $9,287.60 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $107.15 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $9,287.60 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $9,287.60 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $9,287.60 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $9,287.60 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $168.03 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $168.03 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $198.11
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: LDRP ED VISIT-LEVEL III	$1,271	$711.76	$69.18 – $738
Emergency room visit (moderate): rates for 9 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $497.68 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $497.68 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $497.68 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $738 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $497.68 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $497.68 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $69.18 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $69.18 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $81.57
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: ED LEVEL III W/O MOD	$1,271	$711.76	$69.18 – $738
Emergency room visit (moderate): rates for 9 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $497.68 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $497.68 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $497.68 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $738 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $497.68 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $497.68 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $69.18 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $69.18 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $81.57
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: ED LEVEL III W/ MOD	$1,271	$711.76	$69.18 – $738
Emergency room visit (moderate): rates for 9 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $497.68 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $497.68 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $497.68 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $738 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $497.68 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $497.68 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $69.18 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $69.18 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $81.57
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: LDRP ED VISIT-LEVEL IV	$2,207	$1,235.92	$132.58 – $1,588
Emergency room visit (moderately high): rates for 8 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $853.83 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $853.83 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $853.83 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $853.83 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $853.83 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $132.58 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $132.58 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $156.32
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: ED LEVEL IV W/O MOD	$2,207	$1,235.92	$132.58 – $1,588
Emergency room visit (moderately high): rates for 8 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $853.83 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $853.83 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $853.83 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $853.83 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $853.83 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $132.58 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $132.58 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $156.32
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: ED LEVEL IV W/ MOD	$2,207	$1,235.92	$132.58 – $1,588
Emergency room visit (moderately high): rates for 8 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $853.83 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $853.83 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $853.83 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $853.83 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $853.83 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $132.58 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $132.58 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $156.32
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: ED LEVEL V W/O MOD	$3,266	$1,828.96	$193.69 – $1,692.47
Emergency room visit (high): rates for 8 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $1,232.09 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $1,232.09 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $1,232.09 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $1,232.09 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,232.09 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $193.69 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $193.69 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $228.37
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: ED LEVEL V W/ MOD	$3,266	$1,828.96	$193.69 – $1,692.47
Emergency room visit (high): rates for 8 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $1,232.09 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $1,232.09 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $1,232.09 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $1,232.09 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,232.09 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $193.69 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $193.69 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $228.37
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: ED LEVEL V W/O MOD	$3,266	$1,828.96	$193.69 – $1,692.47
Emergency room visit (high): rates for 6 insurance plans BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $1,692.47 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $255.66 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $255.66 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $255.66 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $255.66 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $1,588

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: BASIC METABOLIC PANEL	$35	$19.60	$7.53 – $15.20
Basic metabolic panel (blood test): 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $10.05 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $11.27 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $11.27 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $11.27 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $11.27 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $11.27 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $11.27 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $12.89 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $12.89 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $15.20
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: BASIC METABOLIC PANEL	$35	$19.60	$7.53 – $15.20
Basic metabolic panel (blood test): rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $13.57
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: METABOLIC PANEL TOTAL CA	Not listed in the file	Not listed in the file	$4.91 – $11.67
Basic metabolic panel (blood test): 10 of 34 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $10.05 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $8.46 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $7.28 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $8.46 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $11.27 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $11.27 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $11.27 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $4.91 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $11.27 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $11.27
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: COMPREHENSIVE METABOLIC PANEL	$48	$26.88	$12.54 – $19.73
Comprehensive metabolic panel (blood test): 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $12.54 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $19.73 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $19.73 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $19.73 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $19.73 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $19.73 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $19.73 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $15.88 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $15.88 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $18.72
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: COMPREHENSIVE METABOLIC PANEL	$48	$26.88	$12.54 – $19.73
Comprehensive metabolic panel (blood test): rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $16.70
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) In the file: COMPREHENSIVE METABOLIC PANEL	$48	$26.88	$12.54 – $19.73
Comprehensive metabolic panel (blood test): rates for 1 insurance plan SMARTHEALTH NON ASSIGNED — 1074_SJPK,SJPR SMART HEALTH NON ASSIGNED 20210201: $14.24
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$27.73 – $65.98
Obstetric blood test panel: 10 of 34 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $56.77 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $47.81 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $41.12 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $47.81 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $56.23 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $56.23 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $56.23 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $27.73 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $56.23 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $56.23
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$27.73 – $65.98
Obstetric blood test panel: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $47.81 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $47.33 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $47.81 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $47.81 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $48.29 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $47.81 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $47.81 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $47.81 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $59.76 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $50.20
Obstetric blood test panel CPT 80055 · Inpatient or outpatient In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$37.56 – $76.73
Obstetric blood test panel: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $76.73
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: LIPID PANEL	$56	$31.36	$10.05 – $22.96
Cholesterol panel (lipid panel): 10 of 34 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $15.90 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $13.39 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $11.52 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $13.39 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $15.04 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $15.04 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $15.04 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $7.77 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $15.04 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $15.04
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: LIPID PANEL	$56	$31.36	$10.05 – $22.96
Cholesterol panel (lipid panel): rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $20.52
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$7.77 – $18.48
Cholesterol panel (lipid panel): 10 of 15 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $13.39 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $13.26 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $13.39 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $13.39 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $13.52 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $13.39 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $13.39 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $13.39 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $16.74 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $14.06
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL PANEL	$67	$37.52	$9.41 – $15.61
Kidney function panel: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $10.31 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $14.09 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $14.09 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $14.09 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $14.09 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $14.09 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $14.09 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $13.24 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $13.24 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $15.61
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: RENAL PANEL	$67	$37.52	$9.41 – $15.61
Kidney function panel: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $13.93
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL FUNCTION PANEL	Not listed in the file	Not listed in the file	$5.03 – $11.98
Kidney function panel: 10 of 34 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $10.31 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $8.68 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $7.46 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $8.68 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $14.09 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $14.09 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $14.09 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $5.03 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $14.09 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $14.09
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HEPATIC FUNCTION PANEL	$47	$26.32	$6.29 – $9.86
Liver function panel: 10 of 33 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $9.70 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $8.17 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $7.03 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $8.17 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $9.86 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $9.86 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $9.86 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $4.74 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $9.86 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $9.86
Liver function panel CPT 80076 · Inpatient (hospital stay) In the file: HEPATIC FUNCTION PANEL	$47	$26.32	$6.29 – $9.86
Liver function panel: 10 of 15 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $8.17 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $8.09 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $8.17 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $8.17 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $8.25 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $8.17 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $8.17 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $8.17 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $10.21 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $8.58
Liver function panel CPT 80076 · Inpatient or outpatient In the file: HEPATIC FUNCTION PANEL	$47	$26.32	$6.29 – $9.86
Liver function panel: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $7.36
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: URINALYSIS AUTO W/MICRO	$22	$12.32	$2.31 – $5.68
Urine test (automated, with microscope): 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $3.76 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $3.09 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $3.09 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $3.09 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $3.09 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $3.09 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $3.09 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $4.82 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $4.82 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $5.68
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: URINALYSIS AUTO W/MICRO	$22	$12.32	$2.31 – $5.68
Urine test (automated, with microscope): rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $5.09
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) In the file: URINALYSIS AUTO W/MICRO	$22	$12.32	$2.31 – $5.68
Urine test (automated, with microscope): rates for 1 insurance plan SMARTHEALTH NON ASSIGNED — 1074_SJPK,SJPR SMART HEALTH NON ASSIGNED 20210201: $2.31
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: UA NON-AUTO W/O MICRO	$12	$6.72	$2.12 – $4.59
Urine test (manual, without microscope): 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $4.14 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $3.39 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $3.39 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $3.39 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $3.39 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $3.39 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $3.39 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $3.89 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $3.89 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $4.59
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: URINALYSIS NON-AUTO W/O MICRO	$12	$6.72	$2.12 – $4.59
Urine test (manual, without microscope): 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $4.14 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $3.39 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $3.39 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $3.39 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $3.39 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $3.39 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $3.39 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $3.89 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $3.89 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $4.59
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: UA NON-AUTO W/O > 1	$12	$6.72	$2.29 – $4.59
Urine test (manual, without microscope): 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $4.14 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $3.39 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $3.39 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $3.39 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $3.39 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $3.39 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $3.39 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $3.89 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $3.89 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $4.59
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: URINALYSIS AUTO W/O MICRO	$15	$8.40	$1.63 – $4.04
Urine test (automated, without microscope): 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $2.67 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $2.20 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $2.20 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $2.20 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $2.20 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $2.20 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2.20 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $3.42 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $3.42 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $4.04
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: URINE KETONE	$12	$6.72	$1.51 – $4.04
Urine test (automated, without microscope): 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $2.67 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $2.20 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $2.20 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $2.20 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $2.20 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $2.20 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2.20 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $3.42 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $3.42 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $4.04
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: URINALYSIS AUTO W/O MICRO	$15	$8.40	$1.63 – $4.04
Urine test (automated, without microscope): rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $3.60
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PROSTATE SPECIFIC ANTIGEN	$84	$47.04	$13.42 – $33.08
PSA (prostate specific antigen) blood test: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $21.84 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $17.91 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $17.91 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $17.91 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $17.91 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $17.91 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $17.91 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $28.05 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $28.05 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $33.08
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: PROSTATE SPECIFIC ANTIGEN	$84	$47.04	$13.42 – $33.08
PSA (prostate specific antigen) blood test: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $29.52
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) In the file: PROSTATE SPECIFIC ANTIGEN	$84	$47.04	$13.42 – $33.08
PSA (prostate specific antigen) blood test: rates for 1 insurance plan SMARTHEALTH NON ASSIGNED — 1074_SJPK,SJPR SMART HEALTH NON ASSIGNED 20210201: $13.42
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: THYROID STIM HORMONE (TSH)	$89	$49.84	$12.25 – $30.20
Thyroid stimulating hormone (TSH) test: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $19.95 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $16.37 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $16.37 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $16.37 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $16.37 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $16.37 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $16.37 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $25.61 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $25.61 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $30.20
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: THYROID STIM HORMONE (TSH)	$89	$49.84	$12.25 – $30.20
Thyroid stimulating hormone (TSH) test: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $26.97
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) In the file: THYROID STIM HORMONE (TSH)	$89	$49.84	$12.25 – $30.20
Thyroid stimulating hormone (TSH) test: rates for 1 insurance plan SMARTHEALTH NON ASSIGNED — 1074_SJPK,SJPR SMART HEALTH NON ASSIGNED 20210201: $12.25
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: CBC W/PLT & AUTO DIFF COMPLETE	$41	$22.96	$5.24 – $13.96
Complete blood count (CBC) with differential: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $9.22 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $7.58 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $7.58 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $7.58 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $7.58 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $7.58 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $7.58 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $11.84 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $11.84 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $13.96
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: CBC W/PLT & AUTO DIFF COMPLETE	$41	$22.96	$5.24 – $13.96
Complete blood count (CBC) with differential: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $12.46
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: COMPLETE CBC W/AUTO DIFF WBC	Not listed in the file	Not listed in the file	$4.51 – $10.72
Complete blood count (CBC) with differential: 10 of 34 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $9.22 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $7.77 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $6.68 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $7.77 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $7.58 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $7.58 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $7.58 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $4.51 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $7.58 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $7.58
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: CBC W/ PLATELETS AUTO COMPLETE	$28	$15.68	$4.72 – $8.36
Complete blood count (CBC), automated: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $7.69 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $6.30 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $6.30 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $6.30 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $6.30 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $6.30 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $6.30 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $7.09 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $7.09 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $8.36
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: CBC W/ PLATELETS AUTO COMPLETE	$28	$15.68	$4.72 – $8.36
Complete blood count (CBC), automated: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $7.45
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) In the file: CBC W/ PLATELETS AUTO COMPLETE	$28	$15.68	$4.72 – $8.36
Complete blood count (CBC), automated: rates for 1 insurance plan SMARTHEALTH NON ASSIGNED — 1074_SJPK,SJPR SMART HEALTH NON ASSIGNED 20210201: $4.72
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PROTHROMBIN TIME	$23	$12.88	$2.87 – $7.06
Blood clotting time test (prothrombin time, PT): 10 of 34 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $5.10 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $4.29 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $3.69 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $4.29 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $4.19 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $4.19 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $4.19 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $2.49 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $4.19 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $4.19
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) In the file: PROTHROMBIN TIME	$23	$12.88	$2.87 – $7.06
Blood clotting time test (prothrombin time, PT): 10 of 15 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $4.29 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $4.25 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $4.29 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $4.29 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $4.33 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $4.29 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $4.29 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $4.29 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $5.36 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $4.50
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: ANTICOAGULATED PRO-TIME	$23	$12.88	$2.66 – $7.06
Blood clotting time test (prothrombin time, PT): 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $5.10 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $4.19 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $4.19 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $4.19 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $4.19 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $4.19 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $4.19 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $5.99 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $5.99 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $7.06
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: REF-FT 8 PTT	$24	$13.44	$4.38 – $10.79
Blood clotting test (partial thromboplastin time, PTT): 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $7.14 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $5.86 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $5.86 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $5.86 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $5.86 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $5.86 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $5.86 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $9.15 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $9.15 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $10.79
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: THROMBOPLSTN TIME, PAR(PTT)-LC	$14	$7.84	$4.38 – $10.79
Blood clotting test (partial thromboplastin time, PTT): 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $7.14 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $5.86 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $5.86 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $5.86 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $5.86 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $5.86 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $5.86 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $9.15 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $9.15 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $10.79
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: ANTICOAGULATED ACTIVATED PTT	$23	$12.88	$4.38 – $10.79
Blood clotting test (partial thromboplastin time, PTT): 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $7.14 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $5.86 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $5.86 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $5.86 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $5.86 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $5.86 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $5.86 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $9.15 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $9.15 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $10.79

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: HEAD/BRAIN W/O CONTRAST-CT	$1,001	$560.56	$59.17 – $215.05
CT scan of the head or brain, without contrast: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $215.05 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $144.03 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $144.03 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $144.03 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $144.03 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $144.03 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $144.03 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $127.79 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $127.79 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $150.67
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: HEAD/BRAIN W/O CONTRAST-CT	$1,001	$560.56	$59.17 – $215.05
CT scan of the head or brain, without contrast: rates for 5 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $59.17 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $59.17 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $59.17 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $59.17 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $86.03
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT HEAD/BRAIN W/O DYE	Not listed in the file	Not listed in the file	$60.43 – $143.78
CT scan of the head or brain, without contrast: 10 of 33 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $215.05 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $104.19 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $89.60 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $104.19 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $144.03 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $144.03 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $144.03 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $60.43 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $144.03 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $144.03
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: BRAIN W/STEM W/O & W/CONTR-MRI	$4,001	$2,240.56	$238.97 – $882.13
MRI of the brain, before and after contrast: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $882.13 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $484.15 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $484.15 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $484.15 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $484.15 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $484.15 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $484.15 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $483.83 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $483.83 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $570.46
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: BRAIN W/STEM W/O & W/CONTR-MRI	$4,001	$2,240.56	$238.97 – $882.13
MRI of the brain, before and after contrast: rates for 5 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $238.97 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $238.97 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $238.97 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $238.97 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $308.26
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$202.95 – $482.88
MRI of the brain, before and after contrast: 10 of 33 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $882.13 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $349.91 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $300.92 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $349.91 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $484.15 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $484.15 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $484.15 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $202.95 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $484.15 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $484.15
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: CHEST XRAY 2 VIEWS	$208	$116.48	$16.91 – $63.98
Chest X-ray, 2 views: rates for 10 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $63.98 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $45.30 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $45.30 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $45.30 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $45.30 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $45.30 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $45.30 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $16.91 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $16.91 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $19.94
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: X-RAY EXAM CHEST 2 VIEWS	Not listed in the file	Not listed in the file	$50.04 – $119.05
Chest X-ray, 2 views: 10 of 32 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $63.98 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $86.27 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $74.19 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $86.27 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $45.30 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $45.30 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $45.30 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $50.04 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $45.30 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $45.30
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) In the file: X-RAY EXAM CHEST 2 VIEWS	Not listed in the file	Not listed in the file	$50.04 – $119.05
Chest X-ray, 2 views: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $86.27 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $85.41 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $86.27 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $86.27 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $87.13 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $86.27 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $86.27 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $86.27 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $107.84 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $90.58
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: LUMBOSACRAL SPINE MIN 4 VIEWS	$327	$183.12	$32.05 – $105.92
X-ray of the lower spine, at least 4 views: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $105.92 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $75.07 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $75.07 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $75.07 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $75.07 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $75.07 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $75.07 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $32.05 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $32.05 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $37.79
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: LUMBOSACRAL SPINE MIN 4 VIEWS	$327	$183.12	$32.05 – $105.92
X-ray of the lower spine, at least 4 views: rates for 5 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $52.96 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $52.96 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $52.96 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $52.96 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $38.96
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: X-RAY EXAM L-2 SPINE 4/>VWS	Not listed in the file	Not listed in the file	$60.43 – $143.78
X-ray of the lower spine, at least 4 views: 10 of 33 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $105.92 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $104.19 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $89.60 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $104.19 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $75.07 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $75.07 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $75.07 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $60.43 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $75.07 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $75.07
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: L-SPINE W/O CONTRAST-MRI	$2,406	$1,347.36	$143.88 – $506.35
MRI of the lower back (lumbar spine), without contrast: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $506.35 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $277.91 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $277.91 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $277.91 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $277.91 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $277.92 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $277.92 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $319.91 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $319.91 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $377.19
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: L-SPINE W/O CONTRAST-MRI	$2,406	$1,347.36	$143.88 – $506.35
MRI of the lower back (lumbar spine), without contrast: rates for 5 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $143.88 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $143.88 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $143.88 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $143.88 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $174.75
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI LUMBAR SPINE W/O DYE	Not listed in the file	Not listed in the file	$137.36 – $326.83
MRI of the lower back (lumbar spine), without contrast: 10 of 33 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $506.35 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $236.83 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $203.67 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $236.83 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $277.91 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $277.91 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $277.91 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $137.36 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $277.91 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $277.92
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: PELVIS W/CONTRAST-CT	$1,443	$808.08	$124.59 – $516.83
CT scan of the pelvis, with contrast: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $516.83 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $381.36 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $381.36 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $381.36 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $381.36 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $381.36 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $381.36 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $196.29 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $196.29 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $231.43
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: PELVIS W/CONTRAST-CT	$1,443	$808.08	$124.59 – $516.83
CT scan of the pelvis, with contrast: rates for 5 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $124.59 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $124.59 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $124.59 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $124.59 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $196.83
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W/DYE	Not listed in the file	Not listed in the file	$101.16 – $240.70
CT scan of the pelvis, with contrast: 10 of 33 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $516.83 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $174.42 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $150 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $174.42 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $381.36 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $381.36 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $381.36 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $101.16 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $381.36 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $381.36
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: JOINT LOWER EXT W/O CONTR-MRI	$2,222	$1,244.32	$143.88 – $570.50
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $570.50 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $313.07 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $313.07 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $313.07 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $313.07 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $313.07 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $313.07 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $355.06 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $355.06 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $418.63
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: JOINT LOWER EXT W/O CONT BILAT	$4,418	$2,474.08	$143.88 – $570.50
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $570.50 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $313.07 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $313.07 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $313.07 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $313.07 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $313.07 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $313.07 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $355.06 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $355.06 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $418.63
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: JOINT LOWER EXT W/O CONTR-MRI	$2,222	$1,244.32	$143.88 – $570.50
MRI of a leg joint (such as the knee), without contrast: rates for 5 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $143.88 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $143.88 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $143.88 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $143.88 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $198.29
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABD/PELVIS W/ CONTRAST	$3,186	$1,784.16	$182.90 – $721.77
CT scan of the abdomen and pelvis, with contrast: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $721.77 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $483.47 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $483.47 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $483.47 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $483.47 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $483.47 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $483.47 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $241.13 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $241.13 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $284.30
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: CT ABD/PELVIS W/ CONTRAST	$3,186	$1,784.16	$182.90 – $721.77
CT scan of the abdomen and pelvis, with contrast: rates for 5 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $182.90 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $182.90 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $182.90 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $182.90 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $258.06
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$202.95 – $482.88
CT scan of the abdomen and pelvis, with contrast: 10 of 33 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $721.77 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $349.91 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $300.92 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $349.91 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $483.47 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $483.47 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $483.47 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $202.95 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $483.47 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $483.47
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: U/S ABDOMEN COMPLETE	$694	$388.64	$80.78 – $231.80
Ultrasound of the abdomen, complete: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $231.80 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $164.31 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $164.31 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $164.31 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $164.31 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $164.31 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $164.31 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $92.95 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $92.95 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $109.59
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: U/S ABDOMEN COMPLETE	$694	$388.64	$80.78 – $231.80
Ultrasound of the abdomen, complete: rates for 5 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $80.78 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $80.78 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $80.78 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $80.78 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $97.27
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US EXAM ABDOM COMPLETE	Not listed in the file	Not listed in the file	$60.43 – $143.78
Ultrasound of the abdomen, complete: 10 of 33 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $231.80 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $104.19 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $89.60 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $104.19 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $164.31 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $164.31 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $164.31 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $60.43 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $164.31 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $164.31
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: U/S OB =/> 14WKS SNGL GEST	$521	$291.76	$80.78 – $257.55
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $257.55 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $182.58 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $182.58 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $182.58 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $182.58 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $182.58 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $182.58 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $92.95 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $92.95 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $109.59
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: U/S OB =/> 14WKS SNGL GEST	$521	$291.76	$80.78 – $257.55
Pregnancy ultrasound (after the first trimester): rates for 5 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $80.78 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $80.78 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $80.78 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $80.78 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $109.35
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: OB US >= 14 WKS SNGL FETUS	Not listed in the file	Not listed in the file	$60.43 – $143.78
Pregnancy ultrasound (after the first trimester): 10 of 33 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $257.55 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $104.19 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $89.60 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $104.19 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $182.58 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $182.58 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $182.58 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $60.43 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $182.58 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $182.58
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: U/S TRANSVAGINAL NON-OB	$603	$337.68	$80.78 – $253.72
Transvaginal ultrasound: 10 of 11 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $253.72 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $179.86 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $179.86 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $179.86 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $179.86 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $179.86 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $179.86 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $85.08 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $85.08 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $100.32
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: U/S TRANSVAGINAL NON-OB	$603	$337.68	$80.78 – $253.72
Transvaginal ultrasound: rates for 5 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $80.78 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $80.78 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $80.78 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $80.78 PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $103.93
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: TRANSVAGINAL US NON-OB	Not listed in the file	Not listed in the file	$60.43 – $143.78
Transvaginal ultrasound: 10 of 33 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $253.72 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $104.19 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $89.60 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $104.19 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $179.86 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $179.86 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $179.86 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $60.43 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $179.86 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $179.86
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: DIGITAL MAMMO DIAG UNILAT	$320	$179.20	$80.62 – $249.93
Diagnostic mammogram, one breast: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $249.93 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $177.16 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $177.16 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $91.36 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $177.16 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $177.16 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $177.16 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $177.16 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $80.62 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $80.62
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: DIGITAL DIAG SAME DAY SCRN UNI	$320	$179.20	$80.62 – $249.93
Diagnostic mammogram, one breast: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $249.93 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $177.16 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $177.16 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $91.36 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $177.16 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $177.16 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $177.16 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $177.16 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $80.62 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $80.62
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: MAMMO DIAG UNI W/WO CAD	$368	$206.08	$80.62 – $249.93
Diagnostic mammogram, one breast: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $249.93 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $177.16 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $177.16 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $91.36 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $177.16 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $177.16 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $177.16 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $177.16 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $80.62 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $80.62
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: DIGITAL MAMMO DIAG BILAT	$453	$253.68	$103.08 – $319.52
Diagnostic mammogram, both breasts: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $319.52 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $226.53 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $226.53 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $116.76 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $226.53 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $226.53 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $226.53 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $226.53 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $103.08 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $103.08
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: DIGITAL DIAG SAME DAY SCRN BIL	$453	$253.68	$103.08 – $319.52
Diagnostic mammogram, both breasts: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $319.52 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $226.53 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $226.53 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $116.76 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $226.53 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $226.53 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $226.53 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $226.53 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $103.08 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $103.08
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: MAMMO DIAG BILAT W/WO CAD	$503	$281.68	$103.08 – $319.52
Diagnostic mammogram, both breasts: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $319.52 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $226.53 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $226.53 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $116.76 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $226.53 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $226.53 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $226.53 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $226.53 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $103.08 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $103.08
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: DIGITAL MAMMO SCREEN BILAT	$278	$155.68	$85.17 – $264.23
Screening mammogram, both breasts: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $264.23 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $187.30 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $187.30 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $96.58 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $187.30 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $187.30 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $187.30 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $187.30 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $85.17 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $85.17
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: MAMMO SCRN BILAT W/WO CAD	$314	$175.84	$85.17 – $264.23
Screening mammogram, both breasts: 10 of 12 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $264.23 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $187.30 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $187.30 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $96.58 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $187.30 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $187.30 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $187.30 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $187.30 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $85.17 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $85.17
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: DIGITAL MAMMO SCREEN BILAT	$278	$155.68	$85.17 – $264.23
Screening mammogram, both breasts: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $116.85

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) In the file: ELECTROCARDIOGRAM COMPLETE	Not listed in the file	Not listed in the file	$21.56 – $841.22
Electrocardiogram (ECG/EKG) with reading: rates for 10 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $28.84 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $841.22 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $841.22 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $841.22 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $841.22 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $841.22 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $841.22 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $21.56 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $21.56 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $25.42
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: LH W/WO LV	$19,611	$10,982.16	$689.70 – $14,002.25
Left heart catheterization (diagnostic): rates for 10 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $14,002.25 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $3,872.52 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $3,872.52 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $3,872.52 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $3,872.52 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $3,872.52 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $3,872.52 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $689.70 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $689.70 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $813.19
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient In the file: LH W/WO LV	$19,611	$10,982.16	$689.70 – $14,002.25
Left heart catheterization (diagnostic): rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $1,340.84 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $1,340.84 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $1,340.84 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $1,340.84
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$689.70 – $14,002.25
Left heart catheterization (diagnostic): rates for 10 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $14,002.25 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $3,872.52 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $3,872.52 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $3,872.52 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $3,872.52 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $3,872.52 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $3,872.52 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $689.70 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $689.70 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $813.19
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: EVAL RIGHT W/O INDUCTION	$14,841	$8,310.96	$354.74 – $2,471.13
Heart rhythm study (electrophysiology evaluation): rates for 9 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $1,353.60 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $1,353.60 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $1,353.60 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $1,353.60 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $1,353.60 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,353.60 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $354.74 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $354.74 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $418.26
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient In the file: EVAL RIGHT W/O INDUCTION	$14,841	$8,310.96	$354.74 – $2,471.13
Heart rhythm study (electrophysiology evaluation): rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $2,471.13 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $2,471.13 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $2,471.13 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $2,471.13
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$354.74 – $2,471.13
Heart rhythm study (electrophysiology evaluation): rates for 9 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $1,353.60 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $1,353.60 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $1,353.60 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $1,353.60 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $1,353.60 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,353.60 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $354.74 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $354.74 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $418.26
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: EVAL & ABLATE ATRIAL FIB	$47,708	$26,716.48	$61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $8,185.14
Heart rhythm study with ablation for atrial fibrillation: rates for 9 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $1,334.81 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $1,334.81 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $1,573.79
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient In the file: EVAL & ABLATE ATRIAL FIB	$47,708	$26,716.48	$61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $8,185.14
Heart rhythm study with ablation for atrial fibrillation: rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $8,185.14 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $8,185.14 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $8,185.14 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $8,185.14
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $8,185.14
Heart rhythm study with ablation for atrial fibrillation: rates for 9 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $61.43 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $1,334.81 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $1,334.81 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $1,573.79
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: POLYSOM 6/> YRS 4/> PARAM	Not listed in the file	Not listed in the file	$578.16 – $1,375.61
Sleep study (overnight, in a sleep lab): 10 of 32 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $712.25 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $996.82 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $857.27 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $996.82 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $321.49 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $321.49 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $321.49 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $578.16 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $321.49 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $321.49
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) In the file: POLYSOM 6/> YRS 4/> PARAM	Not listed in the file	Not listed in the file	$578.16 – $1,375.61
Sleep study (overnight, in a sleep lab): 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $996.82 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $986.85 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $996.82 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $996.82 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $1,006.79 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $996.82 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $996.82 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $996.82 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $1,246.03 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $1,046.66
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: POLYSOM 6/> YRS 4/> PARAM	Not listed in the file	Not listed in the file	$321.49 – $712.25
Sleep study (overnight, in a sleep lab): rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $450.49

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: THERAPEU EXERCISES EA 15MIN	$111	$62.16	$22.92 – $40.44
Physical therapy: therapeutic exercise (each 15 minutes): rates for 9 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $22.92 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $39.80 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $39.80 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $39.80 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $39.80 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $39.80 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $34 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $34 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $40.08
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: THERAPEU EXERCISES EA 15MIN	$111	$62.16	$22.92 – $40.44
Physical therapy: therapeutic exercise (each 15 minutes): rates for 1 insurance plan BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $40.44
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: THERAPEUTIC EXERCISES	Not listed in the file	Not listed in the file	$16.01 – $38.10
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 31 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $22.92 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $27.61 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $23.74 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $27.61 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $39.80 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $39.80 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $16.01 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $39.80 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $39.80 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $39.80
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: PT 1-2 ELEMENTS	$263	$147.28	$76.95 – $113.40
Physical therapy evaluation (low complexity): rates for 9 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $76.95 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $113.40 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $113.40 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $113.40 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $113.40 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $113.40 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $89.81 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $89.81 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $105.89
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: PT 1-2 ELEMENTS	$263	$147.28	$76.95 – $113.40
Physical therapy evaluation (low complexity): rates for 1 insurance plan BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $112.97
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: PT EVAL LOW COMPLEX 20 MIN	Not listed in the file	Not listed in the file	$54.55 – $129.80
Physical therapy evaluation (low complexity): 10 of 31 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $76.95 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $94.06 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $80.89 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $94.06 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $113.40 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $113.40 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $54.55 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $113.40 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $113.40 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $113.40
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: PT 1-2PF 3/>ELEMENTS	$263	$147.28	$76.95 – $113.40
Physical therapy evaluation (moderate complexity): rates for 9 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $76.95 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $113.40 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $113.40 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $113.40 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $113.40 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $113.40 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $89.81 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $89.81 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $105.89
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: PT 1-2PF 3/>ELEMENTS	$263	$147.28	$76.95 – $113.40
Physical therapy evaluation (moderate complexity): rates for 1 insurance plan BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $112.97
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: PT EVAL MOD COMPLEX 30 MIN	Not listed in the file	Not listed in the file	$54.55 – $129.80
Physical therapy evaluation (moderate complexity): 10 of 31 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $76.95 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $94.06 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $80.89 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $94.06 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $113.40 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $113.40 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $54.55 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $113.40 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $113.40 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $113.40
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: PT 3/1>PF 4/>ELEMENTS	$263	$147.28	$76.95 – $113.40
Physical therapy evaluation (high complexity): rates for 9 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $76.95 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $113.40 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $113.40 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $113.40 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $113.40 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $113.40 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $89.81 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $89.81 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $105.89
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: PT 3/1>PF 4/>ELEMENTS	$263	$147.28	$76.95 – $113.40
Physical therapy evaluation (high complexity): rates for 1 insurance plan BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $112.97
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: PT EVAL HIGH COMPLEX 45 MIN	Not listed in the file	Not listed in the file	$54.55 – $129.80
Physical therapy evaluation (high complexity): 10 of 31 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $76.95 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $94.06 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $80.89 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $94.06 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $113.40 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $113.40 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $54.55 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $113.40 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $113.40 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $113.40
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: PSYTX W PT 30 MINUTES	Not listed in the file	Not listed in the file	$91.30 – $217.24
Psychotherapy, 30 minutes: 10 of 25 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $157.42 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $135.38 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $157.42 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $91.30 GREAT LAKES- UHC COMMUNITY PLAN — 1247_SJPK,SJPR MEDICAID REPLACEMENT GREAT LAKES HEALTH PLAN : $91.30 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $62.19 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $62.19 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $73.32 HARBOR HEALTH MCD — 1243_SJPR MEDICAID REPLEACEMENT HARBOR HEALTH OUTPATIENT 202: $91.30 HEALTH PLAN OF MI MEDICAID HMO — 1262_SJPK,SJPR MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIE: $91.30
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) In the file: PSYTX W PT 30 MINUTES	Not listed in the file	Not listed in the file	$91.30 – $217.24
Psychotherapy, 30 minutes: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $157.42 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $155.85 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $157.42 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $157.42 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $158.99 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $157.42 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $157.42 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $157.42 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $196.77 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $165.29
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient In the file: PSYTX W PT 30 MINUTES	Not listed in the file	Not listed in the file	$36.64 – $73.32
Psychotherapy, 30 minutes: rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $36.64
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: PSYTX W PT 45 MINUTES	Not listed in the file	Not listed in the file	$91.30 – $217.24
Psychotherapy, 45 minutes: 10 of 25 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $157.42 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $135.38 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $157.42 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $91.30 GREAT LAKES- UHC COMMUNITY PLAN — 1247_SJPK,SJPR MEDICAID REPLACEMENT GREAT LAKES HEALTH PLAN : $91.30 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $92.18 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $92.18 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $108.69 HARBOR HEALTH MCD — 1243_SJPR MEDICAID REPLEACEMENT HARBOR HEALTH OUTPATIENT 202: $91.30 HEALTH PLAN OF MI MEDICAID HMO — 1262_SJPK,SJPR MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIE: $91.30
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) In the file: PSYTX W PT 45 MINUTES	Not listed in the file	Not listed in the file	$91.30 – $217.24
Psychotherapy, 45 minutes: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $157.42 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $155.85 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $157.42 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $157.42 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $158.99 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $157.42 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $157.42 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $157.42 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $196.77 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $165.29
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient In the file: PSYTX W PT 45 MINUTES	Not listed in the file	Not listed in the file	$65.77 – $108.69
Psychotherapy, 45 minutes: rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $65.77
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: PSYTX W PT 60 MINUTES	Not listed in the file	Not listed in the file	$91.30 – $217.24
Psychotherapy, 60 minutes: 10 of 25 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $157.42 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $135.38 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $157.42 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $91.30 GREAT LAKES- UHC COMMUNITY PLAN — 1247_SJPK,SJPR MEDICAID REPLACEMENT GREAT LAKES HEALTH PLAN : $91.30 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $108.78 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $108.78 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $128.25 HARBOR HEALTH MCD — 1243_SJPR MEDICAID REPLEACEMENT HARBOR HEALTH OUTPATIENT 202: $91.30 HEALTH PLAN OF MI MEDICAID HMO — 1262_SJPK,SJPR MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIE: $91.30
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) In the file: PSYTX W PT 60 MINUTES	Not listed in the file	Not listed in the file	$91.30 – $217.24
Psychotherapy, 60 minutes: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $157.42 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $155.85 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $157.42 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $157.42 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $158.99 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $157.42 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $157.42 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $157.42 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $196.77 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $165.29
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient In the file: PSYTX W PT 60 MINUTES	Not listed in the file	Not listed in the file	$65.77 – $128.25
Psychotherapy, 60 minutes: rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $65.77
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$91.30 – $217.24
Family psychotherapy, without the patient: 10 of 31 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $157.42 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $135.38 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $157.42 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $91,584.95 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $91,584.95 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $91,584.95 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $91.30 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $91,584.95 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $91,584.95 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $91,584.95 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$91.30 – $217.24
Family psychotherapy, without the patient: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $157.42 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $155.85 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $157.42 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $157.42 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $158.99 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $157.42 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $157.42 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $157.42 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $196.77 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $165.29
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$65.77 – $91,584.95 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Family psychotherapy, without the patient: rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $65.77
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$91.30 – $217.24
Family psychotherapy, with the patient: 10 of 31 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $157.42 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $135.38 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $157.42 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $97,243.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $97,243.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $97,243.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $91.30 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $97,243.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $97,243.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $97,243.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$91.30 – $217.24
Family psychotherapy, with the patient: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $157.42 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $155.85 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $157.42 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $157.42 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $158.99 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $157.42 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $157.42 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $157.42 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $196.77 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $165.29
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$65.77 – $97,243.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Family psychotherapy, with the patient: rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $65.77
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$52.57 – $125.07
Group psychotherapy: 10 of 31 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $90.63 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $77.94 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $90.63 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $53,197.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $53,197.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $53,197.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $52.57 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $53,197.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $53,197.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $53,197.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Group psychotherapy CPT 90853 · Inpatient (hospital stay) In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$52.57 – $125.07
Group psychotherapy: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $90.63 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $89.72 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $90.63 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $90.63 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $91.54 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $90.63 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $90.63 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $90.63 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $113.29 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $95.16
Group psychotherapy CPT 90853 · Inpatient or outpatient In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$36.64 – $53,197.82 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Group psychotherapy: rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $36.64

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$459.27 – $2,397.79
Removal of breast growth (open surgery): 10 of 11 insurance plan rates BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $2,397.79 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $2,397.79 BCCCP — 980_SJPK,SJPR BCCCP 20210201: $459.27 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $2,397.79 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $2,397.79 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $2,397.79 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2,397.79 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $568.56 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $568.56 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $670.36
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$459.27 – $2,397.79
Removal of breast growth (open surgery): rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $1,150.86 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $1,150.86 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $1,150.86 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $1,150.86
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$1,715.18 – $20,463.10
Total hip replacement: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $20,463.10 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $20,463.10 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $20,463.10 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $20,463.10 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $20,463.10 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $20,463.10 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $1,715.18 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $1,715.18 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $2,022.26 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$1,831.92 – $19,954.70
Total knee replacement: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $19,954.70 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $19,954.70 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $19,954.70 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $19,954.70 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $19,954.70 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $19,954.70 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $1,831.92 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $1,831.92 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $2,159.91 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$213.37 – $3,114.64
Shoulder arthroscopy: shaving of shoulder bone: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $3,114.64 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $3,114.64 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $679.47 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $3,114.64 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $679.47 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $679.47 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $213.37 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $213.37 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $251.57 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: KNEE ARTHROSCOPY/SURGERY	Not listed in the file	Not listed in the file	$645.07 – $3,632.06
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $2,618.80 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $2,618.80 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $3,632.06 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $2,618.80 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $3,632.06 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $3,632.06 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $645.07 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $645.07 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $760.56 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient In the file: KNEE ARTHROSCOPY/SURGERY	Not listed in the file	Not listed in the file	$645.07 – $3,632.06
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $1,260.08 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $1,260.08 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $1,260.08 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $1,260.08
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$343.88 – $15,695.05
Removal of tonsils and adenoids (under age 12): rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $2,163.30 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $2,163.30 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $15,695.05 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $2,163.30 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $15,695.05 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $15,695.05 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $343.88 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $343.88 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $405.45 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$343.88 – $15,695.05
Removal of tonsils and adenoids (under age 12): rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $850.49 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $850.49 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $850.49 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $850.49
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$532.79 – $1,267.67
Upper GI endoscopy (diagnostic): 10 of 32 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $918.60 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $790 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $918.60 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $741.53 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $741.53 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $741.53 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $532.79 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $741.53 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $741.53 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $741.53
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$532.79 – $1,267.67
Upper GI endoscopy (diagnostic): 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $918.60 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $909.41 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $918.60 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $918.60 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $927.79 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $918.60 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $918.60 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $918.60 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $1,148.25 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $964.53
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$346.05 – $741.53
Upper GI endoscopy (diagnostic): rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $392.06
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$532.79 – $1,267.67
Upper GI endoscopy with biopsy: 10 of 32 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $918.60 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $790 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $918.60 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $748.19 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $748.19 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $748.19 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $532.79 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $748.19 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $748.19 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $748.19
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$532.79 – $1,267.67
Upper GI endoscopy with biopsy: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $918.60 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $909.41 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $918.60 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $918.60 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $927.79 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $918.60 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $918.60 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $918.60 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $1,148.25 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $964.53
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$392.06 – $748.19
Upper GI endoscopy with biopsy: rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $392.06
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$518.10 – $1,232.73
Colonoscopy (diagnostic): 10 of 32 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $893.28 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $768.22 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $893.28 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $758.06 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $758.06 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $12,118.49 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $518.10 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $758.06 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $12,118.49 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $12,118.49
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$518.10 – $1,232.73
Colonoscopy (diagnostic): 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $893.28 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $884.35 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $893.28 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $893.28 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $902.21 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $893.28 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $893.28 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $893.28 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $1,116.60 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $937.94
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$395.95 – $12,118.49
Colonoscopy (diagnostic): rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $395.95
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$395.95 – $870.85
Colonoscopy with biopsy: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $870.85 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $870.85 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $870.85 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $870.85 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $870.85 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $870.85 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $548.43 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $548.43 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $646.62 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$395.95 – $870.85
Colonoscopy with biopsy: rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $395.95 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $395.95 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $395.95 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $395.95
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$395.95 – $869.31
Colonoscopy with removal of polyps (snare): rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $869.31 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $869.31 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $869.31 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $869.31 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $869.31 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $869.31 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $618.51 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $618.51 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $729.24 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$395.95 – $869.31
Colonoscopy with removal of polyps (snare): rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $395.95 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $395.95 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $395.95 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $395.95
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$351.15 – $929.95
Ultrasound of the lower bowel by endoscope: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $929.95 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $929.95 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $929.95 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $929.95 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $929.95 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $929.95 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $351.15 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $351.15 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $414.02 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$351.15 – $929.95
Ultrasound of the lower bowel by endoscope: rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $395.95 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $395.95 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $395.95 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $395.95
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$890.32 – $29,244.59
Gallbladder removal by laparoscope: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $4,362.01 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $4,362.01 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $29,244.59 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $4,362.01 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $29,244.59 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $29,244.59 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $890.32 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $890.32 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $1,049.72 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$890.32 – $29,244.59
Gallbladder removal by laparoscope: rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $2,104.60 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $2,104.60 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $2,104.60 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $2,104.60
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$615.59 – $28,809.59
Groin (inguinal) hernia repair, age 5 or older: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $2,851.22 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $2,851.22 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $28,809.59 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $2,851.22 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $28,809.59 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $28,809.59 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $615.59 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $615.59 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $725.80 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$615.59 – $28,809.59
Groin (inguinal) hernia repair, age 5 or older: rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $1,374.21 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $1,374.21 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $1,374.21 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $1,374.21
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: PROSTATE BX NEEDLE/PUNCH 1 OR>	$2,438	$1,365.28	$299.97 – $1,740.73
Prostate biopsy: rates for 8 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $1,740.73 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $1,553.74 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $1,553.74 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $1,553.74 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $1,553.74 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $1,553.74 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,553.74 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $299.97
Prostate biopsy CPT 55700 · Inpatient or outpatient In the file: PROSTATE BX NEEDLE/PUNCH 1 OR>	$2,438	$1,365.28	$299.97 – $1,740.73
Prostate biopsy: rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $792.38 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $792.38 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $792.38 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $792.38
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$254.42 – $17,196.97
Prostate biopsy: rates for 10 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $1,740.73 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $1,553.74 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $1,553.74 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $17,196.97 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $1,553.74 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $17,196.97 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $17,196.97 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $254.42 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $254.42 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $299.97
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$2,016.18 – $6,802.26
Prostate removal by laparoscope (radical prostatectomy): rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $6,802.26 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $6,802.26 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $6,802.26 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $6,802.26 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $6,802.26 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $6,802.26 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $2,016.18 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $2,016.18 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $2,377.16 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$445.37 – $2,080.92
Hysteroscopy with biopsy of the uterus lining: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $2,080.92 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $2,080.92 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $2,080.92 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $2,080.92 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $2,080.92 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2,080.92 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $445.37 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $445.37 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $525.11 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$445.37 – $2,080.92
Hysteroscopy with biopsy of the uterus lining: rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $978.98 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $978.98 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $978.98 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $978.98
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: INJ INTERLAMINAR LMBR/SAC W/IG	$1,739	$973.84	$270.33 – $1,241.65
Spinal injection, lower back (epidural), with imaging guidance: rates for 10 insurance plans AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $1,241.65 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $537.44 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $537.44 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $537.44 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $537.44 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $537.44 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $537.44 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $270.33 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $270.33 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $318.74
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$393.54 – $936.36
Spinal injection, lower back (epidural), with imaging guidance: 10 of 32 insurance plan rates AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: $1,241.65 AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $678.52 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $583.53 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $678.52 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $537.44 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $537.44 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $29,244.59 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $393.54 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $537.44 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $29,244.59
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$393.54 – $936.36
Spinal injection, lower back (epidural), with imaging guidance: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $678.52 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $671.73 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $678.52 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $678.52 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $685.31 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $678.52 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $678.52 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $678.52 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $848.15 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $712.45
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$505.93 – $1,203.76
Nerve root injection, lower back, with imaging guidance: 10 of 32 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $872.29 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $750.17 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $872.29 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $749.57 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $749.57 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $12,118.49 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $505.93 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $749.57 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $12,118.49 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $12,118.49
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$505.93 – $1,203.76
Nerve root injection, lower back, with imaging guidance: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $872.29 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $863.57 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $872.29 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $872.29 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $881.01 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $872.29 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $872.29 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $872.29 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $1,090.36 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $915.90
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$271.03 – $12,118.49
Nerve root injection, lower back, with imaging guidance: rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $307.80
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$499.31 – $1,516.07
Carpal tunnel release: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $1,516.07 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $1,516.07 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $1,516.07 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $1,516.07 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $1,516.07 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,516.07 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $499.31 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $499.31 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $588.71 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Carpal tunnel release CPT 64721 · Inpatient or outpatient In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$499.31 – $1,516.07
Carpal tunnel release: rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $732.49 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $732.49 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $732.49 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $732.49
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$311.76 – $741.76
Laser treatment of clouding after cataract surgery: 10 of 32 insurance plan rates AETNA MEDICARE — 1255_SJPK,SJPR MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $537.51 AMERIHEALTH VIP CARE MCR — 1254_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH OUTPATIENT 202: $462.26 AUTO INSURANCE — 1257_SJPK,SJPR AUTO INSURANCE OUTPATIENT 20250101: $537.51 BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $551.25 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $551.25 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $551.25 BLUE CAID MICHIGAN — 1266_SJPK,SJPR MEDICAID REPLACEMENT BLUE CAID OF MICHIGAN OU: $311.76 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $551.25 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $551.25 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $551.25
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$311.76 – $741.76
Laser treatment of clouding after cataract surgery: 10 of 14 insurance plan rates AETNA MEDICARE — 1171_SJPK,SJPR MEDICARE ADVANTAGE AETNA INPATIENT 20241001: $537.51 AMERIHEALTH VIP CARE MCR — 1174_SJPK,SJPR MEDICARE ADVANTAGE AMERIHEALTH INPATIENT 2024: $532.13 AUTO INSURANCE — 1219_SJPK,SJPR AUTO INSURANCE INPATIENT 20241001: $537.51 HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $537.51 HUMANA MCR — 1177_SJPK,SJPR MEDICARE ADVANTAGE HUMANA INPATIENT 20241001: $542.89 JVHL - MCR REPLACEMENT — 1180_SJPK,SJPR MEDICARE ADVANTAGE JVHL INPATIENT 20241001: $537.51 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $537.51 MCR REPLACEMENT — 1183_SJPK,SJPR MEDICARE ADVANTAGE HMO INPATIENT 20241001: $537.51 MERIDIAN AMBETTER — 1221_SJPK,SJPR MERIDIAN AMBETTER INPATIENT 20241001: $671.89 MERIDIAN WELLCARE — 1189_SJPK,SJPR MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIEN: $564.39
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$231.64 – $551.25
Laser treatment of clouding after cataract surgery: rates for 1 insurance plan MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $231.64
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$885.04 – $2,489.55
Cataract removal with lens implant: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $2,489.55 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $2,489.55 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $2,489.55 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $2,489.55 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $2,489.55 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2,489.55 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $885.04 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $885.04 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $1,043.50 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$885.04 – $2,489.55
Cataract removal with lens implant: rates for 4 insurance plans HEALTH PLAN OF MI MEDICAID HMO — 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001: $918.24 JVHL - MEDICAID REPLACEMENT — 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001: $918.24 JVHL - MEDICAID REPLACEMENT — 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 2025: $918.24 MOLINA HEALTH — 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT : $918.24

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$3,157.72 – $8,219.07
Vaginal delivery, with care before and after: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $8,219.07 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $8,219.07 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $8,219.07 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $8,219.07 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $8,219.07 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $8,219.07 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $3,157.72 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $3,157.72 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $3,723.07 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$3,541.29 – $9,123.06
Cesarean delivery (C-section), with care before and after: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $9,123.06 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $9,123.06 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $9,123.06 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $9,123.06 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $9,123.06 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $9,123.06 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $3,541.29 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $3,541.29 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $4,175.32 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$3,345.55 – $8,651.28
Vaginal delivery after a previous C-section, with care before and after: rates for 10 insurance plans BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $8,651.28 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $8,651.28 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $8,651.28 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $8,651.28 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $8,651.28 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $8,651.28 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $3,345.55 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $3,345.55 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $3,944.54 AETNA — 1203_SJPK,SJPR AETNA PPO 20241001: 71.4% (a percentage in the contract, not a dollar amount)

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$10,828 – $146,985.15
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 24 insurance plan rates BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $146,985.15 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $146,985.15 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $146,985.15 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $146,985.15 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $146,985.15 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $146,985.15 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $97,698.24 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $97,698.24 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $115,430.85 UHC (ASO) — 1207_SJPR,SJPK UNITED HEALTH CARE ASO 20241001: $10,828
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient or outpatient In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$10,828 – $146,985.15
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $93,298.55
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$10,828 – $35,759.15
Hip or knee replacement (major joint of the leg), without major complications: 10 of 24 insurance plan rates BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $35,759.15 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $35,759.15 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $35,759.15 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $35,759.15 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $35,759.15 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $35,759.15 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $19,088.33 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $19,088.33 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $22,552.94 UHC (ASO) — 1207_SJPR,SJPK UNITED HEALTH CARE ASO 20241001: $10,828
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient or outpatient In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$10,828 – $35,759.15
Hip or knee replacement (major joint of the leg), without major complications: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $18,903.10
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$10,828 – $31,990.07
Neck (cervical) spinal fusion, without complications: 10 of 24 insurance plan rates BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $31,990.07 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $31,990.07 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $31,990.07 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $31,990.07 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $31,990.07 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $31,990.07 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $23,964.94 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $23,964.94 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $28,314.67 UHC (ASO) — 1207_SJPR,SJPK UNITED HEALTH CARE ASO 20241001: $10,828
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient or outpatient In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$10,828 – $31,990.07
Neck (cervical) spinal fusion, without complications: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $22,542.55
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$10,598.20 – $20,626.74
Uterus and ovary surgery (not for cancer), without complications: 10 of 24 insurance plan rates BC METRO DETROIT EPO — 1127_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT EPO 20220401: $20,626.74 BC METRO DETROIT HMO — 1133_SJPR BLUE CROSS BLUE SHIELD METRO DETROIT HMO 20220401: $20,626.74 BCN LOCAL NETWORK SOUTHEAST — 1131_SJPR BLUE CROSS BLUE SHIELD BCN LOCAL NETWORK SE 202204: $20,626.74 BLUE CARE NETWORK — 1129_SJPR BLUE CROSS BLUE SHIELD BCN 20220401: $20,626.74 BLUE CROSS PPO — 1137_SJPR BLUE CROSS BLUE SHIELD PPO 20220401: $20,626.74 BLUE CROSS TRADITIONAL — 1135_SJPR BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $20,626.74 HAP ALLIANCE HEALTH — 1212_SJPK,SJPR AHLIC 20241001: $12,134.33 HAP HMO POS — 1217_SJPK,SJPR HAP HMO 20241001: $12,134.33 HAP PREFERRED — 1210_SJPK,SJPR HAP PREFERRED 20241001: $14,336.75 UHC (ASO) — 1207_SJPR,SJPK UNITED HEALTH CARE ASO 20241001: $10,828
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient or outpatient In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$10,598.20 – $20,626.74
Uterus and ovary surgery (not for cancer), without complications: rates for 1 insurance plan PRIORITY HEALTH HMO — 1104_SJPK,SJPR PRIORITY HMO 20210701: $10,598.20

Source: Ascension Providence Hospital, Southfield and Novi…’s standard charges file (henryford.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on January 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Acute Care Hospital
Address	16001 W Nine Mile Rd, Southfield, MI 48075
County	Oakland County
State	Michigan
Phone	(248) 849‑3000
Emergency services	Yes
Ownership	Voluntary non-profit - Church
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	230019
Name in Medicare records	ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD AND NOVI Medicare’s file shortens long names to 50 characters, so the end of this name is missing.
Profile level	Medicare data + hospital website
Name on the hospital’s website	Henry Ford Providence Southfield Hospital
Official website	henryford.com
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

Henry Ford Providence Southfield Hospital | Henry Ford Health — henryford.com
Henry Ford Providence Heart Institute - Southfield | Henry Ford Health — henryford.com