Does Henry Ford Health St John Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Henry Ford Health St John Hospital. In a medical emergency, call 911.

Where is Henry Ford Health St John Hospital?

22101 Moross Rd, Detroit, MI 48236, in Wayne County, Michigan.

What is the phone number of Henry Ford Health St John Hospital?

(313) 343-4000, as listed by Medicare (CMS).

What is the Medicare star rating of Henry Ford Health St John Hospital?

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

Henry Ford Health St John Hospital

Quick answers

Does Henry Ford Health St John Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Henry Ford Health St John Hospital. In a medical emergency, call 911.
Where is Henry Ford Health St John Hospital?: 22101 Moross Rd, Detroit, MI 48236, in Wayne County, Michigan.
What is the phone number of Henry Ford Health St John Hospital?: (313) 343-4000, as listed by Medicare (CMS).
What is the Medicare star rating of Henry Ford Health St John Hospital?: 1 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4]

Cardiology
Neurology
Neurosurgery
Orthopedics
Obstetrics
Pediatrics
Gynecology
Kidney Transplant
Palliative Medicine
Inpatient Rehabilitation
Reproductive Medicine
Behavioral Health
Emergency Care
Stroke Care
Cancer care
Women's health

Conditions treated^[4]

Brain tumors
Kidney disease
Concussions
Autism

Treatments^[4][6]

Chemotherapy
HIPEC
ECMO
Cardiac rehabilitation
Lab services

Procedures^[4][7]

Cardiac catheterization
Heart surgery
Joint replacement
Bariatric surgery
Colonoscopy
CT scan
Fluoroscopy
Interventional radiology
MRI
Nuclear medicine
PET scan
Ultrasound
Vascular testing
X-ray
Mammography

Programs and centers^[4][8]

Inpatient rehabilitation
St. John Children's Hospital
Pediatric intensive care unit
Neonatal intensive care unit (NICU)
Special care nursery
Birthing center
Stroke care

Emergency care (hospital website)^[4]

Emergency room	Yes
Open 24/7	Yes
Trauma designation	Level I

Visiting and practical information

Visiting	General visiting daily 8:00 a.m. to 7:00 p.m.; unit and after-hours info via operator (313) 343-4000^[5]
Parking	Parking in East and West parking decks and North Lot; valet in North Lot, hours vary^[5]

Recognition^[4]

Level II Pediatric Trauma Center

Doctors and clinicians (1,240)

1,240 doctors and other clinicians list Henry Ford Health St John Hospital 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

And 1,216 more: the button below opens the full list.

Other emergency rooms nearby

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

Beaumont Hospital - Grosse Pointe2.4 mi · Grosse Pointe, MI · Acute Care Hospital
Henry Ford Health Warren Hospital7.6 mi · Warren, MI · Acute Care Hospital
Detroit Receiving Hospital8.4 mi · Detroit, MI · Acute Care Hospital
Children's Hospital of Michigan8.5 mi · Detroit, MI · Children's Hospital
Detroit (John D. Dingell) VA Medical Center8.6 mi · Detroit, MI · Federal/VA Acute Care Hospital

Other hospitals nearby

Bca Stonecrest Center3.4 mi · Detroit, MI · Psychiatric Hospital
Samaritan Behavioral Center3.9 mi · Detroit, MI · Psychiatric 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

Riverview Health and Rehab Center North0.6 mi · Detroit, MI · 2 of 5 stars
The Rivers Health & Rehabilitation Center of Gross1.0 mi · Grosse Pointe Woods, MI · 4 of 5 stars
The Orchards at Harper Woods1.1 mi · Harper Woods, MI · 1 of 5 stars

All nursing homes in the state →

Hospice providers

Choice Hospice Inc8.5 mi · Warren, MI
Henry Ford Hospice8.9 mi · Detroit, MI · 3 of 5 stars
Compassus-Northern Detroit9.8 mi · Warren, MI · 2 of 5 stars

All hospice providers in the state →

Home health agencies

Allied Home Health Care & Nursing Services1.5 mi · Detroit, MI
Affinity Home Care, LLC3.3 mi · Saint Clair Shores, MI · 3 of 5 stars
Experts in Home Health Management3.6 mi · Eastpointe, MI

All home health agencies in the state →

Dialysis facilities

FMC Dialysis - East Detroit1.2 mi · Detroit, MI · 2 of 5 stars
DaVita English Village Dialysis1.5 mi · Detroit, MI · 1 of 5 stars
DaVita Grosse Pointe Dialysis1.5 mi · Detroit, MI · 1 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.

Lakeshore Surgery Center3.3 mi · St Clair Shores, MI
Eastside Endoscopy Center5.3 mi · Saint Clair Shores, MI
Surgery Centers of Michigan5.3 mi · Saint Clair Shores, 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

Covenant Community Care, Inc.0.7 mi · Grosse Pointe, MI · Community health center
Family Medical Center - Wayne Elementary2.1 mi · Detroit, MI · Community health center
Dr. Peter Slaughter Health Center2.5 mi · Harper Woods, MI · Community health center

Clinics and urgent care

HMC Urgent Care Gross Pointe PLLC1.5 mi · Detroit, MI · Urgent care center
Im Consultant1.5 mi · Detroit, MI · Urgent care center
Get Well Urgent Care Harper Woods PLC1.6 mi · Harper Woods, MI · Urgent care center

Pharmacies

Affiliated Health Services, Inc.1.2 mi · Detroit, MI · Community/retail pharmacy
Affiliated Health Services, Inc.1.2 mi · Detroit, MI · Community/retail pharmacy
Bormans Inc1.2 mi · Grosse Pointe Woods, MI · Community/retail pharmacy

Assisted living nearby

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

American House Grosse Pointe Cottage1.2 mi · Grosse Pointe Farms, MI
Family Tyes AFC Home1.2 mi · Detroit, MI
Sue Caring Hands1.2 mi · Grosse Pointe, MI
Sunrise of Grosse Pointe Woods1.2 mi · Grosse Pointe Woods, 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 Henry Ford Health St John Hospital 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	2 of 5 stars
Would recommend the hospital	2 of 5 stars
Nurses communicated well	2 of 5 stars
Doctors communicated well	2 of 5 stars
Staff explained medicines	1 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	58%National average: 72%
Would definitely recommend the hospital	56%National average: 71%
Nurses “always” communicated well	74%National average: 80%
Doctors “always” communicated well	71%National average: 80%
Staff “always” explained medicines before giving them	52%National average: 62%
Were given information about recovery at home	81%National average: 86%
Room and bathroom “always” clean	52%National average: 74%
Area around the room “always” quiet at night	45%National average: 60%
Completed surveys	688Response rate: 14%

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)	1.261No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.21Better than the national benchmark
Surgical site infections after colon surgery	0.785No different from the national benchmark
Surgical site infections after abdominal hysterectomy	1.976No different from the national benchmark
MRSA bloodstream infections	0.663No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.136Better 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	10.3%
Deaths within 30 days: heart failure patients	9.4%
Deaths within 30 days: pneumonia patients	18.1%
Deaths within 30 days: COPD patients	11.8%
Deaths within 30 days: stroke patients	10.4%
Deaths within 30 days: coronary bypass surgery (CABG)	2.6%
Serious complications (patient safety indicator PSI-90)	0.88No different from the national rate
Complications after hip or knee replacement	3.8%

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	14.5%
Readmitted within 30 days: heart failure	21.9%
Readmitted within 30 days: pneumonia	17.7%
Readmitted within 30 days: COPD	19.5%
Readmitted within 30 days: coronary bypass surgery	10.6%
Readmitted within 30 days: hip or knee replacement	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)	170 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)	27%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 Detroit Best hospitals in Detroit

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 Henry Ford Health St John Hospital 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 →

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient In the file: NEW PT DETAILED SVC	$161	$90.16	$107.15 – $130.13
New patient office visit (about 30–44 minutes): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $127.46 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $127.46 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $127.46 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $127.46
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient In the file: PROF-NP DETAIL/LOW COMP 99203	$161	$90.16	$107.15 – $130.13
New patient office visit (about 30–44 minutes): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $127.46 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $127.46 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $127.46 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $127.46
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: NEW PT DETAILED SVC	$161	$90.16	$107.15 – $130.13
New patient office visit (about 30–44 minutes): rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $107.15 PPOM — 934_PPOM 20191001: $130.13
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient In the file: NEW PT COMP/MOD SVC	$211	$118.16	$107.15 – $195.18
New patient office visit (about 45–59 minutes): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $195.18 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $195.18 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $195.18 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $195.18
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient In the file: PROF-NP COMPRE/MOD COMP 99204	$211	$118.16	$107.15 – $195.18
New patient office visit (about 45–59 minutes): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $195.18 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $195.18 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $195.18 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $195.18
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: NEW PT COMP/MOD SVC	$211	$118.16	$107.15 – $195.18
New patient office visit (about 45–59 minutes): rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $107.15 PPOM — 934_PPOM 20191001: $181.90
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient In the file: NEW PT COMP/HIGH SVC	$263	$147.28	$107.15 – $241.84
New patient office visit (about 60–74 minutes): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $241.84 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $241.84 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $241.84 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $241.84
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient In the file: PROF-NP COMPRE/HIGH COMP 99205	$263	$147.28	$107.15 – $241.84
New patient office visit (about 60–74 minutes): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $241.84 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $241.84 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $241.84 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $241.84
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: NEW PT COMP/HIGH SVC	$263	$147.28	$107.15 – $241.84
New patient office visit (about 60–74 minutes): rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $107.15 PPOM — 934_PPOM 20191001: $237.78
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: EST PT EXP PROB FOC SERVICE	$81	$45.36	$72.85 – $80.45
Established patient office visit (about 20–29 minutes): rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $72.85 PPOM — 934_PPOM 20191001: $80.45
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: PROF-EP EXP PROB FOCUS 99213	$81	$45.36	$72.85 – $80.45
Established patient office visit (about 20–29 minutes): rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $72.85 PPOM — 934_PPOM 20191001: $80.45
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: OFFICE O/P EST LOW 20 MIN	Not listed in the file	Not listed in the file	$72.85 – $84.65
Established patient office visit (about 20–29 minutes): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $84.65 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $84.65 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $84.65 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $84.65
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: EST PT DETAILED SERVICE	$132	$73.92	$72.85 – $125.02
Established patient office visit (about 30–39 minutes): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $125.02 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $125.02 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $125.02 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $125.02
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: PROF-EP DETAIL/MOD COMP 99214	$132	$73.92	$72.85 – $125.02
Established patient office visit (about 30–39 minutes): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $125.02 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $125.02 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $125.02 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $125.02
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: EST PT DETAILED SERVICE	$132	$73.92	$72.85 – $125.02
Established patient office visit (about 30–39 minutes): rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $72.85 PPOM — 934_PPOM 20191001: $118.90
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$137.07 – $160.70
Office consultation with a specialist (moderate): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $137.07 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $137.07 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $137.07 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $137.07
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 – $160.70
Office consultation with a specialist (moderate): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $160.70
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$201.15 – $227.60
Office consultation with a specialist (moderate to high): rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $201.15 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $201.15 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $201.15 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $201.15
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 – $227.60
Office consultation with a specialist (moderate to high): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $227.60
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$45 – $166.15
Preventive checkup, new patient, age 18–39: rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $144.99 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $144.99 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $144.99 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $144.99
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 – $166.15
Preventive checkup, new patient, age 18–39: rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $45 PPOM — 934_PPOM 20191001: $166.15
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient In the file: PREV VISIT NEW AGE 40-64	Not listed in the file	Not listed in the file	$107.15 – $207.11
Preventive checkup, new patient, age 40–64: rates for 4 insurance plans AHLIC — 2163_AHLIC 20241001: $168.03 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $168.03 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $168.03 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $168.03
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 – $207.11
Preventive checkup, new patient, age 40–64: rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $107.15 PPOM — 934_PPOM 20191001: $207.11
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: OB EMERGENCY - LEVEL III	$1,016	$568.96	$69.18 – $740
Emergency room visit (moderate): rates for 5 insurance plans AETNA PPO — 2136_AETNA 20241001: $731.52 AHLIC — 2163_AHLIC 20241001: $69.18 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $69.18 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $69.18 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $103.09
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: ED LEVEL 3, W/O PROCEDURE	$1,016	$568.96	$69.18 – $740
Emergency room visit (moderate): rates for 5 insurance plans AETNA PPO — 2136_AETNA 20241001: $731.52 AHLIC — 2163_AHLIC 20241001: $69.18 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $69.18 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $69.18 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $103.09
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: ED LEVEL 3, W/PROCEDURE	$1,016	$568.96	$69.18 – $740
Emergency room visit (moderate): rates for 5 insurance plans AETNA PPO — 2136_AETNA 20241001: $731.52 AHLIC — 2163_AHLIC 20241001: $69.18 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $69.18 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $69.18 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $103.09
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: OB EMERGENCY - LEVEL IV	$1,782	$997.92	$172 – $1,767
Emergency room visit (moderately high): rates for 6 insurance plans AETNA PPO — 2136_AETNA 20241001: $1,283.04 AHLIC — 2163_AHLIC 20241001: $1,767 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $1,767 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $1,767 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $1,767 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $172
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: ED LEVEL 4, W/O PROCEDURE	$1,782	$997.92	$172 – $1,767
Emergency room visit (moderately high): rates for 6 insurance plans AETNA PPO — 2136_AETNA 20241001: $1,283.04 AHLIC — 2163_AHLIC 20241001: $1,767 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $1,767 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $1,767 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $1,767 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $172
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: ED LEVEL 4, W/PROCEDURE	$1,782	$997.92	$172 – $1,767
Emergency room visit (moderately high): rates for 6 insurance plans AETNA PPO — 2136_AETNA 20241001: $1,283.04 AHLIC — 2163_AHLIC 20241001: $1,767 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $1,767 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $1,767 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $1,767 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $172
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: OB EMERGENCY - LEVEL V	$1,788	$1,001.28	$193.69 – $1,287.36
Emergency room visit (high): rates for 6 insurance plans AETNA PPO — 2136_AETNA 20241001: $1,287.36 AHLIC — 2163_AHLIC 20241001: $193.69 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $193.69 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $193.69 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $193.69 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $255.66
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: ED LEVEL 5, W/O PROCEDURE	$3,146	$1,761.76	$193.69 – $2,265.12
Emergency room visit (high): rates for 6 insurance plans AETNA PPO — 2136_AETNA 20241001: $2,265.12 AHLIC — 2163_AHLIC 20241001: $193.69 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $193.69 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $193.69 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $193.69 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $255.66
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: ED LEVEL 5, W/PROCEDURE	$3,146	$1,761.76	$193.69 – $2,265.12
Emergency room visit (high): rates for 6 insurance plans AETNA PPO — 2136_AETNA 20241001: $2,265.12 AHLIC — 2163_AHLIC 20241001: $193.69 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $193.69 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $193.69 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $193.69 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $255.66

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: BASIC METABOLIC PANEL	$32	$17.92	$8.68 – $14.01
Basic metabolic panel (blood test): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $12.75 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $8.68 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $8.68 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $12.75 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $12.75 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $12.75 PHCS POS — 1311_PHCS POS 20201001: $11.54 PHCS PPO — 1457_PHCS PPO 20201001: $11.54 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $13.57
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: BASIC METABOLIC PANEL	$32	$17.92	$8.68 – $14.01
Basic metabolic panel (blood test): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $14.01
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) In the file: METABOLIC PANEL TOTAL CA	Not listed in the file	Not listed in the file	$8.04 – $16.07
Basic metabolic panel (blood test): 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $16.07 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $8.46 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $8.38 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $8.46 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $8.54 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $8.88 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $8.04 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $8.46 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $10.58 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $8.88
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: COMPREHENSIVE METABOLIC PANEL	$44	$24.64	$14.20 – $25.56
Comprehensive metabolic panel (blood test): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $15.71 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $15.19 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $15.19 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $15.71 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $15.71 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $15.71 PHCS POS — 1311_PHCS POS 20201001: $14.20 PHCS PPO — 1457_PHCS PPO 20201001: $14.20 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $16.70
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: COMPREHENSIVE METABOLIC PANEL	$44	$24.64	$14.20 – $25.56
Comprehensive metabolic panel (blood test): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $25.56
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) In the file: COMPREHEN METABOLIC PANEL	Not listed in the file	Not listed in the file	$10.03 – $20.06
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $20.06 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $10.56 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $10.45 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $10.56 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $10.67 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $11.09 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $10.03 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $10.56 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $13.20 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $11.09
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$45.42 – $90.84
Obstetric blood test panel: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $90.84 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $47.81 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $47.33 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $47.81 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $48.29 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $50.20 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $45.42 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $47.81 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $59.76 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $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	$43.28 – $76.73
Obstetric blood test panel: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $62.65 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $43.28 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $43.28 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $62.65 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $62.65 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $62.65 PHCS POS — 1311_PHCS POS 20201001: $62.89 PHCS PPO — 1457_PHCS PPO 20201001: $62.89 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $76.73
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	$45.42 – $90.84
Obstetric blood test panel: rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $50.20 PPOM — 934_PPOM 20191001: $45.77 TRICARE — 2211_TRICARE OP 20250101: $47.81
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: LIPID CASCADE-LC	$28	$15.68	$11.58 – $25.74
Cholesterol panel (lipid panel): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $19.26 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $11.58 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $11.58 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $19.26 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $19.26 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $19.26 PHCS POS — 1311_PHCS POS 20201001: $17.44 PHCS PPO — 1457_PHCS PPO 20201001: $17.44 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $20.52
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: LP+NON-HDL CHOLESTEROL-LC	$28	$15.68	$11.58 – $25.74
Cholesterol panel (lipid panel): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $19.26 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $11.58 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $11.58 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $19.26 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $19.26 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $19.26 PHCS POS — 1311_PHCS POS 20201001: $17.44 PHCS PPO — 1457_PHCS PPO 20201001: $17.44 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $20.52
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: LP+CHD RISK-LC	$28	$15.68	$11.58 – $25.74
Cholesterol panel (lipid panel): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $19.26 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $11.58 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $11.58 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $19.26 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $19.26 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $19.26 PHCS POS — 1311_PHCS POS 20201001: $17.44 PHCS PPO — 1457_PHCS PPO 20201001: $17.44 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $20.52
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: RENAL FUNCTION PANEL	$36	$20.16	$10.84 – $22.84
Kidney function panel: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $13.09 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $10.84 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $10.84 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $13.09 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $13.09 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $13.09 PHCS POS — 1311_PHCS POS 20201001: $11.85 PHCS PPO — 1457_PHCS PPO 20201001: $11.85 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $13.93
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: RENAL FUNCT PANEL	$36	$20.16	$10.84 – $22.84
Kidney function panel: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $13.09 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $10.84 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $10.84 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $13.09 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $13.09 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $13.09 PHCS POS — 1311_PHCS POS 20201001: $11.85 PHCS PPO — 1457_PHCS PPO 20201001: $11.85 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $13.93
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL FUNCTION PANEL	$36	$20.16	$10.84 – $22.84
Kidney function panel: rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $9.11 PPOM — 934_PPOM 20191001: $22.84 TRICARE — 2211_TRICARE OP 20250101: $8.68
Liver function panel CPT 80076 · Inpatient or outpatient In the file: HEPATIC FUNCTION PANEL	$29	$16.24	$6.26 – $21.36
Liver function panel: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $6.92 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $7.59 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $7.59 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $6.92 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $6.92 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $6.92 PHCS POS — 1311_PHCS POS 20201001: $6.26 PHCS PPO — 1457_PHCS PPO 20201001: $6.26 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $7.36
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HEPATIC FUNCTION PANEL	$29	$16.24	$6.26 – $21.36
Liver function panel: rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $8.58 PPOM — 934_PPOM 20191001: $21.36 TRICARE — 2211_TRICARE OP 20250101: $8.17
Liver function panel CPT 80076 · Inpatient (hospital stay) In the file: HEPATIC FUNCTION PANEL	Not listed in the file	Not listed in the file	$7.76 – $15.52
Liver function panel: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $15.52 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $8.17 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $8.09 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $8.17 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $8.25 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $8.58 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $7.76 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $8.17 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $10.21 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $8.58
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: URINALYSIS AUTOMATED W MICRO	$46	$25.76	$2.59 – $6.02
Urine test (automated, with microscope): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $4.77 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $2.59 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2.59 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $4.77 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $4.77 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $4.77 PHCS POS — 1311_PHCS POS 20201001: $4.33 PHCS PPO — 1457_PHCS PPO 20201001: $4.33 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $5.09
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: URINALYSIS AUTO W/MICRO	$16	$8.96	$2.59 – $6.02
Urine test (automated, with microscope): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $4.77 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $2.59 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2.59 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $4.77 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $4.77 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $4.77 PHCS POS — 1311_PHCS POS 20201001: $4.33 PHCS PPO — 1457_PHCS PPO 20201001: $4.33 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $5.09
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: URINALYSIS AUTOMATED W MICRO	$46	$25.76	$2.59 – $6.02
Urine test (automated, with microscope): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $6.02
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: URINALYSIS-POC	$11	$6.16	$2.30 – $4.10
Urine test (manual, without microscope): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $3.85 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $2.30 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2.30 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $3.85 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $3.85 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $3.85 PHCS POS — 1311_PHCS POS 20201001: $3.49 PHCS PPO — 1457_PHCS PPO 20201001: $3.49 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $4.10
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: URINALYSIS-SPECIFIC GRAVITY	$19	$10.64	$2.30 – $4.10
Urine test (manual, without microscope): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $3.85 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $2.30 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2.30 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $3.85 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $3.85 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $3.85 PHCS POS — 1311_PHCS POS 20201001: $3.49 PHCS PPO — 1457_PHCS PPO 20201001: $3.49 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $4.10
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: URINALYSIS-POC	$11	$6.16	$2.30 – $4.10
Urine test (manual, without microscope): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $4.06
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: K STONE, PH, 24 HR URINE-LC	$5	$2.80	$1.83 – $4.04
Urine test (automated, without microscope): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $3.39 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $1.83 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1.83 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $3.39 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $3.39 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $3.39 PHCS POS — 1311_PHCS POS 20201001: $3.06 PHCS PPO — 1457_PHCS PPO 20201001: $3.06 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $3.60
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: URINALYSIS WO MICRO AUTOMATED	$21	$11.76	$1.83 – $4.04
Urine test (automated, without microscope): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $3.39 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $1.83 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1.83 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $3.39 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $3.39 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $3.39 PHCS POS — 1311_PHCS POS 20201001: $3.06 PHCS PPO — 1457_PHCS PPO 20201001: $3.06 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $3.60
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: SPECIFIC GRAVITY, URINE	$5	$2.80	$1.83 – $4.04
Urine test (automated, without microscope): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $3.39 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $1.83 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1.83 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $3.39 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $3.39 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $3.39 PHCS POS — 1311_PHCS POS 20201001: $3.06 PHCS PPO — 1457_PHCS PPO 20201001: $3.06 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $3.60
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: PSA - DIAGNOSTIC	$85	$47.60	$14.99 – $29.52
PSA (prostate specific antigen) blood test: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $27.75 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $14.99 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $14.99 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $27.75 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $27.75 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $27.75 PHCS POS — 1311_PHCS POS 20201001: $25.09 PHCS PPO — 1457_PHCS PPO 20201001: $25.09 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $29.52
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: PSA-DIAGNOSTIC	$85	$47.60	$14.99 – $29.52
PSA (prostate specific antigen) blood test: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $27.75 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $14.99 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $14.99 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $27.75 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $27.75 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $27.75 PHCS POS — 1311_PHCS POS 20201001: $25.09 PHCS PPO — 1457_PHCS PPO 20201001: $25.09 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $29.52
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA - DIAGNOSTIC	$85	$47.60	$14.99 – $29.52
PSA (prostate specific antigen) blood test: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $23.50
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: THYROID STIMULATING HORMONE	$56	$31.36	$13.70 – $26.97
Thyroid stimulating hormone (TSH) test: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $25.33 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $13.70 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $13.70 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $25.33 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $25.33 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $25.33 PHCS POS — 1311_PHCS POS 20201001: $22.93 PHCS PPO — 1457_PHCS PPO 20201001: $22.93 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $26.97
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: THYROID STIMULATING HORMONE	$56	$31.36	$13.70 – $26.97
Thyroid stimulating hormone (TSH) test: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $14.04
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) In the file: ASSAY THYROID STIM HORMONE	Not listed in the file	Not listed in the file	$15.96 – $31.92
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $31.92 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $16.80 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $16.63 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $16.80 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $16.97 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $17.64 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $15.96 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $16.80 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $21 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $17.64
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: CBC PLT AUTO DIFF	$51	$28.56	$6.33 – $18.10
Complete blood count (CBC) with differential: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $11.71 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $6.33 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $6.33 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $11.71 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $11.71 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $11.71 PHCS POS — 1311_PHCS POS 20201001: $10.60 PHCS PPO — 1457_PHCS PPO 20201001: $10.60 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $12.46
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: CBC,PLT AUTO DIFF	$24	$13.44	$6.33 – $18.10
Complete blood count (CBC) with differential: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $11.71 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $6.33 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $6.33 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $11.71 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $11.71 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $11.71 PHCS POS — 1311_PHCS POS 20201001: $10.60 PHCS PPO — 1457_PHCS PPO 20201001: $10.60 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $12.46
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: CBC PLT AUTO DIFF	$51	$28.56	$6.33 – $18.10
Complete blood count (CBC) with differential: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $18.10
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: CBC PLT AUTO	$30	$16.80	$5.27 – $8.02
Complete blood count (CBC), automated: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $7.01 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $5.27 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $5.27 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $7.01 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $7.01 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $7.01 PHCS POS — 1311_PHCS POS 20201001: $6.34 PHCS PPO — 1457_PHCS PPO 20201001: $6.34 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $7.45
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: CBC,PLT AUTO	$30	$16.80	$5.27 – $8.02
Complete blood count (CBC), automated: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $7.01 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $5.27 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $5.27 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $7.01 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $7.01 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $7.01 PHCS POS — 1311_PHCS POS 20201001: $6.34 PHCS PPO — 1457_PHCS PPO 20201001: $6.34 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $7.45
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: CBC PLT AUTO	$30	$16.80	$5.27 – $8.02
Complete blood count (CBC), automated: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $8.02
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: PROTHROMBIN TIME	$33	$18.48	$3.20 – $11.93
Blood clotting time test (prothrombin time, PT): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $5.92 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $3.20 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $3.20 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $5.92 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $5.92 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $5.92 PHCS POS — 1311_PHCS POS 20201001: $5.38 PHCS PPO — 1457_PHCS PPO 20201001: $5.38 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $6.31
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: PROTIME LUPUS PANEL	$5.82	$3.26	$3.20 – $5.38
Blood clotting time test (prothrombin time, PT): rates for 4 insurance plans BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $3.20 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $3.20 PHCS POS — 1311_PHCS POS 20201001: $5.38 PHCS PPO — 1457_PHCS PPO 20201001: $5.38
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PROTHROMBIN TIME	$33	$18.48	$3.20 – $11.93
Blood clotting time test (prothrombin time, PT): rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $4.50 PPOM — 934_PPOM 20191001: $11.93 TRICARE — 2211_TRICARE OP 20250101: $4.29
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: THROMBOPLSTN TIME, PAR(PTT)-LC	$13	$7.28	$4.90 – $9.64
Blood clotting test (partial thromboplastin time, PTT): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $9.05 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $4.90 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $4.90 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $9.05 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $9.05 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $9.05 PHCS POS — 1311_PHCS POS 20201001: $8.19 PHCS PPO — 1457_PHCS PPO 20201001: $8.19 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $9.64
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: THROMBOPLASTIN TIME PARTIAL	$43	$24.08	$4.90 – $17.46
Blood clotting test (partial thromboplastin time, PTT): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $9.05 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $4.90 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $4.90 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $9.05 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $9.05 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $9.05 PHCS POS — 1311_PHCS POS 20201001: $8.19 PHCS PPO — 1457_PHCS PPO 20201001: $8.19 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $9.64
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: THROMBOPLASTIN, PARTIAL(PTT)	$22	$12.32	$4.90 – $17.46
Blood clotting test (partial thromboplastin time, PTT): rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $9.05 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $4.90 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $4.90 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $9.05 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $9.05 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $9.05 PHCS POS — 1311_PHCS POS 20201001: $8.19 PHCS PPO — 1457_PHCS PPO 20201001: $8.19 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $9.64

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 · Inpatient or outpatient In the file: CT HEAD/BRAIN W/O CONTRAST	$1,153	$645.68	$59.17 – $347.74
CT scan of the head or brain, without contrast: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $127.79 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $110.36 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $110.36 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $127.79 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $127.79 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $127.79 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $59.17 PHCS POS — 1311_PHCS POS 20201001: $290.40 PHCS PPO — 1457_PHCS PPO 20201001: $290.40 PRIORITY HMO — 2010_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 CONTRAST	$1,153	$645.68	$59.17 – $347.74
CT scan of the head or brain, without contrast: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $347.74
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) In the file: CT HEAD/BRAIN W/O DYE	Not listed in the file	Not listed in the file	$98.98 – $197.96
CT scan of the head or brain, without contrast: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $197.96 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $104.19 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $103.15 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $104.19 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $105.23 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $109.40 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $98.98 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $104.19 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $130.24 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $109.40
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: MRI BRAIN W & W/O CONTRAST	$2,343	$1,312.08	$238.97 – $1,317.29
MRI of the brain, before and after contrast: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $483.83 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $397.73 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $397.73 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $483.83 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $483.83 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $483.83 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $238.97 PHCS POS — 1311_PHCS POS 20201001: $1,203.67 PHCS PPO — 1457_PHCS PPO 20201001: $1,203.67 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $308.26
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN W & W/O CONTRAST	$2,343	$1,312.08	$238.97 – $1,317.29
MRI of the brain, before and after contrast: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $1,317.29
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$332.41 – $664.83
MRI of the brain, before and after contrast: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $664.83 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $349.91 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $346.41 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $349.91 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $353.41 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $367.41 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $332.41 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $349.91 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $437.39 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $367.41
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: CHEST- 2 VIEW	$227	$127.12	$16.91 – $227
Chest X-ray, 2 views: rates for 6 insurance plans AHLIC — 2163_AHLIC 20241001: $16.91 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $29.32 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $29.32 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $16.91 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $16.91 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $16.91
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: CHEST-2 VIEW	$227	$127.12	$16.91 – $227
Chest X-ray, 2 views: rates for 6 insurance plans AHLIC — 2163_AHLIC 20241001: $16.91 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $29.32 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $29.32 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $16.91 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $16.91 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $16.91
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: CHEST - 2 VIEW	$227	$127.12	$16.91 – $227
Chest X-ray, 2 views: rates for 6 insurance plans AHLIC — 2163_AHLIC 20241001: $16.91 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $29.32 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $29.32 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $16.91 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $16.91 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $16.91
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: SPINE,LUMBOSACRAL,MIN 4 VIEWS	$376	$210.56	$32.05 – $85.01
X-ray of the lower spine, at least 4 views: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $32.05 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $49.59 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $49.59 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $32.05 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $32.05 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $32.05 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $52.96 PHCS POS — 1311_PHCS POS 20201001: $59.58 PHCS PPO — 1457_PHCS PPO 20201001: $59.58 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $38.96
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: SPINE LUMBOSACRAL MIN 4 VIEWS	$376	$210.56	$32.05 – $85.01
X-ray of the lower spine, at least 4 views: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $32.05 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $49.59 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $49.59 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $32.05 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $32.05 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $32.05 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $52.96 PHCS POS — 1311_PHCS POS 20201001: $59.58 PHCS PPO — 1457_PHCS PPO 20201001: $59.58 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $38.96
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: SPINE,LUMBOSACRAL,MIN 4 VIEWS	$376	$210.56	$32.05 – $85.01
X-ray of the lower spine, at least 4 views: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $85.01
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: MRI SPINE LUMBAR W/O CONTRAST	$1,757	$983.92	$143.88 – $779.32
MRI of the lower back (lumbar spine), without contrast: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $319.91 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $226.59 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $226.59 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $319.91 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $319.91 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $319.91 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $143.88 PHCS POS — 1311_PHCS POS 20201001: $729 PHCS PPO — 1457_PHCS PPO 20201001: $729 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $174.75
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI SPINE LUMBAR W/O CONTRAST	$1,757	$983.92	$143.88 – $779.32
MRI of the lower back (lumbar spine), without contrast: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $779.32
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) In the file: MRI LUMBAR SPINE W/O DYE	Not listed in the file	Not listed in the file	$224.99 – $449.98
MRI of the lower back (lumbar spine), without contrast: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $449.98 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $236.83 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $234.46 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $236.83 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $239.20 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $248.67 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $224.99 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $236.83 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $296.04 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $248.67
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: CT PELVIS W/CONTRAST	$1,525	$854	$124.59 – $630.73
CT scan of the pelvis, with contrast: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $196.29 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $252.19 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $252.19 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $196.29 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $196.29 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $196.29 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $124.59 PHCS POS — 1311_PHCS POS 20201001: $630.73 PHCS PPO — 1457_PHCS PPO 20201001: $630.73 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $196.83
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: CT PELVIS W/ CONTRAST	$1,525	$854	$124.59 – $630.73
CT scan of the pelvis, with contrast: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $196.29 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $252.19 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $252.19 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $196.29 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $196.29 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $196.29 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $124.59 PHCS POS — 1311_PHCS POS 20201001: $630.73 PHCS PPO — 1457_PHCS PPO 20201001: $630.73 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $196.83
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W/CONTRAST	$1,525	$854	$124.59 – $630.73
CT scan of the pelvis, with contrast: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $510.03
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: MRI JOINT LOWER EXT W/O CONT	$1,757	$983.92	$143.88 – $804.27
MRI of a leg joint (such as the knee), without contrast: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $355.06 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $255.38 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $255.38 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $355.06 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $355.06 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $355.06 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $143.88 PHCS POS — 1311_PHCS POS 20201001: $804.27 PHCS PPO — 1457_PHCS PPO 20201001: $804.27 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $198.29
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: MRI JNT LOW EXT WO CONTRST-BIL	$3,855	$2,158.80	$143.88 – $804.27
MRI of a leg joint (such as the knee), without contrast: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $355.06 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $255.38 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $255.38 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $355.06 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $355.06 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $355.06 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $143.88 PHCS POS — 1311_PHCS POS 20201001: $804.27 PHCS PPO — 1457_PHCS PPO 20201001: $804.27 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $198.29
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI JOINT LOWER EXT W/O CONT	$1,757	$983.92	$143.88 – $804.27
MRI of a leg joint (such as the knee), without contrast: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $658.53
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: CT ABD/PELVIS W/ CONTRAST	$3,005	$1,682.80	$182.90 – $3,005
CT scan of the abdomen and pelvis, with contrast: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $241.13 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $331.62 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $331.62 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $241.13 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $241.13 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $241.13 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $182.90 PHCS POS — 1311_PHCS POS 20201001: $829.33 PHCS PPO — 1457_PHCS PPO 20201001: $829.33 PRIORITY HMO — 2010_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	$3,005	$1,682.80	$182.90 – $3,005
CT scan of the abdomen and pelvis, with contrast: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $3,005
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$332.41 – $664.83
CT scan of the abdomen and pelvis, with contrast: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $664.83 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $349.91 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $346.41 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $349.91 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $353.41 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $367.41 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $332.41 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $349.91 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $437.39 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $367.41
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: US-ABDOMEN COMPLETE	$909	$509.04	$80.78 – $186.65
Ultrasound of the abdomen, complete: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $92.95 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $124.76 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $124.76 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $92.95 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $92.95 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $92.95 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $80.78 PHCS POS — 1311_PHCS POS 20201001: $177.42 PHCS PPO — 1457_PHCS PPO 20201001: $177.42 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $97.27
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: US-ABDOMEN,COMPLETE	$909	$509.04	$80.78 – $186.65
Ultrasound of the abdomen, complete: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $92.95 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $124.76 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $124.76 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $92.95 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $92.95 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $92.95 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $80.78 PHCS POS — 1311_PHCS POS 20201001: $177.42 PHCS PPO — 1457_PHCS PPO 20201001: $177.42 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $97.27
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US-ABDOMEN COMPLETE	$909	$509.04	$80.78 – $186.65
Ultrasound of the abdomen, complete: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $186.65
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: US PREG UTERUS,COMP SINGL GEST	$210	$117.60	$80.78 – $186.52
Pregnancy ultrasound (after the first trimester): rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $92.95 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $139.68 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $139.68 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $92.95 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $92.95 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $92.95 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $80.78 PHCS POS — 1311_PHCS POS 20201001: $170.56 PHCS PPO — 1457_PHCS PPO 20201001: $170.56 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $109.35
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: US-OB >14 WEEKS, SINGLE GEST	$210	$117.60	$80.78 – $186.52
Pregnancy ultrasound (after the first trimester): rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $92.95 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $139.68 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $139.68 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $92.95 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $92.95 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $92.95 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $80.78 PHCS POS — 1311_PHCS POS 20201001: $170.56 PHCS PPO — 1457_PHCS PPO 20201001: $170.56 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $109.35
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: US PREG UTERUS,COMP SINGL GEST	$210	$117.60	$80.78 – $186.52
Pregnancy ultrasound (after the first trimester): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $186.52
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: ECHOGRAPHY TRANSVAGINAL	$212	$118.72	$80.78 – $161.84
Transvaginal ultrasound: rates for 10 insurance plans AHLIC — 2163_AHLIC 20241001: $85.08 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $132.75 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $132.75 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $85.08 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $85.08 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $85.08 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $80.78 PHCS POS — 1311_PHCS POS 20201001: $161.84 PHCS PPO — 1457_PHCS PPO 20201001: $161.84 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $103.93
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: ECHOGRAPHY TRANSVAGINAL	$212	$118.72	$80.78 – $161.84
Transvaginal ultrasound: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $161.46
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) In the file: TRANSVAGINAL US NON-OB	Not listed in the file	Not listed in the file	$98.98 – $197.96
Transvaginal ultrasound: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $197.96 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $104.19 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $103.15 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $104.19 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $105.23 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $109.40 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $98.98 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $104.19 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $130.24 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $109.40
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient In the file: MAMMO DIAG UNIL W/WO CAD	$588	$329.28	$80.62 – $588
Diagnostic mammogram, one breast: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $80.62 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $142.35 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $142.35 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $80.62 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $80.62 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $80.62 PHCS POS — 1311_PHCS POS 20201001: $163.06 PHCS PPO — 1457_PHCS PPO 20201001: $163.06 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $110.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: MAMMO DIAG UNIL W/WO CAD	$588	$329.28	$80.62 – $588
Diagnostic mammogram, one breast: rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $91.36 PPOM — 934_PPOM 20191001: $588
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) In the file: DX MAMMO INCL CAD UNI	Not listed in the file	Not listed in the file	$73.79 – $147.57
Diagnostic mammogram, one breast: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $147.57 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $77.67 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $76.89 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $77.67 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $78.45 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $81.55 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $73.79 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $77.67 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $97.09 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $81.55
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient In the file: MAMMO DIAG BILAT W/WO CAD	$791	$442.96	$103.08 – $791
Diagnostic mammogram, both breasts: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $103.08 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $181.81 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $181.81 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $103.08 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $103.08 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $103.08 PHCS POS — 1311_PHCS POS 20201001: $208.51 PHCS PPO — 1457_PHCS PPO 20201001: $208.51 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $141.43
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: MAMMO DIAG BILAT W/WO CAD	$791	$442.96	$103.08 – $791
Diagnostic mammogram, both breasts: rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $116.76 PPOM — 934_PPOM 20191001: $791
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) In the file: DX MAMMO INCL CAD BI	Not listed in the file	Not listed in the file	$93.95 – $187.89
Diagnostic mammogram, both breasts: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $187.89 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $98.89 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $97.90 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $98.89 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $99.88 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $103.83 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $93.95 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $98.89 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $123.61 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $103.83
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: MAMMO SCRN BILAT W/WO CAD	$371	$207.76	$85.17 – $371
Screening mammogram, both breasts: rates for 9 insurance plans AHLIC — 2163_AHLIC 20241001: $85.17 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $150.34 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $150.34 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $85.17 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $85.17 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $85.17 PHCS POS — 1311_PHCS POS 20201001: $172.28 PHCS PPO — 1457_PHCS PPO 20201001: $172.28 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $116.85
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: MAMMO SCRN BILAT W/WO CAD	$371	$207.76	$85.17 – $371
Screening mammogram, both breasts: rates for 2 insurance plans BCCCP — 1782_BCCCP 20210201: $96.58 PPOM — 934_PPOM 20191001: $371
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) In the file: SCR MAMMO BI INCL CAD	Not listed in the file	Not listed in the file	$77.62 – $155.25
Screening mammogram, both breasts: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $155.25 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $81.71 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $80.89 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $81.71 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $82.53 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $85.80 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $77.62 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $81.71 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $102.14 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $85.80

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient In the file: ELECTROCARDIOGRAM COMPLETE	Not listed in the file	Not listed in the file	$21.56 – $37.28
Electrocardiogram (ECG/EKG) with reading: rates for 6 insurance plans AHLIC — 2163_AHLIC 20241001: $21.56 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $21.56 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $21.56 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $21.56 PHCS POS — 1311_PHCS POS 20201001: $32.63 PHCS PPO — 1457_PHCS PPO 20201001: $32.63
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 – $37.28
Electrocardiogram (ECG/EKG) with reading: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $37.28
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient In the file: LH W/WO LV	$13,437	$7,524.72	$689.70 – $13,437
Left heart catheterization (diagnostic): rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $689.70 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $689.70 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $689.70 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $689.70 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $1,340.84
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: LH W/WO LV	$13,437	$7,524.72	$689.70 – $13,437
Left heart catheterization (diagnostic): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $13,437
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$689.70 – $8,707.18
Left heart catheterization (diagnostic): rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $689.70 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $689.70 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $689.70 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $689.70 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $1,340.84
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient In the file: UNLIST PROC-CARDIOVASC	$15,505	$8,682.80	$354.74 – $2,471.13
Heart rhythm study (electrophysiology evaluation): rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $354.74 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $354.74 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $354.74 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $354.74 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $2,471.13
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient In the file: EPS W/O IND ARRHYTHMIA	$15,505	$8,682.80	$354.74 – $2,471.13
Heart rhythm study (electrophysiology evaluation): rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $354.74 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $354.74 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $354.74 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $354.74 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $2,471.13
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: UNLIST PROC-CARDIOVASC	$15,505	$8,682.80	$354.74 – $2,471.13
Heart rhythm study (electrophysiology evaluation): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $1,140.03
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient In the file: EVAL & ABLATE ATRIAL FIB	$38,553	$21,589.68	$1,334.81 – $38,553
Heart rhythm study with ablation for atrial fibrillation: rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $1,334.81 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $1,334.81 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $1,334.81 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $1,334.81 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $8,185.14
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: EVAL & ABLATE ATRIAL FIB	$38,553	$21,589.68	$1,334.81 – $38,553
Heart rhythm study with ablation for atrial fibrillation: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $38,553
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$1,334.81 – $24,982.34
Heart rhythm study with ablation for atrial fibrillation: rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $1,334.81 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $1,334.81 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $1,334.81 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $1,334.81 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $8,185.14
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	$946.98 – $1,893.96
Sleep study (overnight, in a sleep lab): 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $1,893.96 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $996.82 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $986.85 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $996.82 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $1,006.79 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $1,046.66 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $946.98 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $996.82 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $1,246.03 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $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	$450.49 – $1,098.34
Sleep study (overnight, in a sleep lab): rates for 7 insurance plans AHLIC — 2163_AHLIC 20241001: $599.08 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $599.08 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $599.08 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $599.08 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $450.49 PHCS POS — 1311_PHCS POS 20201001: $719.59 PHCS PPO — 1457_PHCS PPO 20201001: $719.59
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	$946.98 – $1,893.96
Sleep study (overnight, in a sleep lab): rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $1,046.66 PPOM — 934_PPOM 20191001: $1,098.34 TRICARE — 2211_TRICARE OP 20250101: $996.82

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: THERAPEUTIC EXER,15 MIN(97110)	$94	$52.64	$30.94 – $37.62
Physical therapy: therapeutic exercise (each 15 minutes): rates for 6 insurance plans AHLIC — 2163_AHLIC 20241001: $35.48 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $35.48 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $35.48 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $35.48 PHCS POS — 1311_PHCS POS 20201001: $30.94 PHCS PPO — 1457_PHCS PPO 20201001: $30.94
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: PT THERAPEUTIC EXER15MIN97110	$94	$52.64	$30.94 – $37.62
Physical therapy: therapeutic exercise (each 15 minutes): rates for 6 insurance plans AHLIC — 2163_AHLIC 20241001: $35.48 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $35.48 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $35.48 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $35.48 PHCS POS — 1311_PHCS POS 20201001: $30.94 PHCS PPO — 1457_PHCS PPO 20201001: $30.94
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: OT THERAP EXER 15 MIN (97110)	$94	$52.64	$30.94 – $37.62
Physical therapy: therapeutic exercise (each 15 minutes): rates for 6 insurance plans AHLIC — 2163_AHLIC 20241001: $35.48 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $35.48 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $35.48 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $35.48 PHCS POS — 1311_PHCS POS 20201001: $30.94 PHCS PPO — 1457_PHCS PPO 20201001: $30.94
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: PT 1-2 ELEMENTS	$309	$173.04	$309
Physical therapy evaluation (low complexity): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $309
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) In the file: PT EVAL LOW COMPLEX 20 MIN	Not listed in the file	Not listed in the file	$89.36 – $178.71
Physical therapy evaluation (low complexity): 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $178.71 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $94.06 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $93.12 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $94.06 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $95 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $98.76 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $89.36 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $94.06 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $117.58 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $98.76
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	$89.36 – $178.71
Physical therapy evaluation (low complexity): rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $98.76 PPOM — 934_PPOM 20191001: $200.23 TRICARE — 2211_TRICARE OP 20250101: $94.06
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: PT 1-2PF 3/>ELEMENTS	$309	$173.04	$309
Physical therapy evaluation (moderate complexity): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $309
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) In the file: PT EVAL MOD COMPLEX 30 MIN	Not listed in the file	Not listed in the file	$89.36 – $178.71
Physical therapy evaluation (moderate complexity): 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $178.71 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $94.06 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $93.12 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $94.06 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $95 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $98.76 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $89.36 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $94.06 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $117.58 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $98.76
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	$89.36 – $178.71
Physical therapy evaluation (moderate complexity): rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $98.76 PPOM — 934_PPOM 20191001: $200.23 TRICARE — 2211_TRICARE OP 20250101: $94.06
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: PT 3/>PF 4/>ELEMENTS	$309	$173.04	$309
Physical therapy evaluation (high complexity): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $309
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) In the file: PT EVAL HIGH COMPLEX 45 MIN	Not listed in the file	Not listed in the file	$89.36 – $178.71
Physical therapy evaluation (high complexity): 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $178.71 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $94.06 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $93.12 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $94.06 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $95 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $98.76 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $89.36 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $94.06 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $117.58 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $98.76
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	$89.36 – $178.71
Physical therapy evaluation (high complexity): rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $98.76 PPOM — 934_PPOM 20191001: $200.23 TRICARE — 2211_TRICARE OP 20250101: $94.06
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	$149.55 – $299.10
Psychotherapy, 30 minutes: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $299.10 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $157.42 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $155.85 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $157.42 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $158.99 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $165.29 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $149.55 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $157.42 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $196.77 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $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 – $62.18
Psychotherapy, 30 minutes: rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $62.18 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $62.18 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $62.18 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $62.18 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $36.64
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	$149.55 – $299.10
Psychotherapy, 30 minutes: rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $165.29 TRICARE — 2211_TRICARE OP 20250101: $157.42 PPOM — 934_PPOM 20191001: 64.8% (a percentage in the contract, not a dollar amount)
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	$149.55 – $299.10
Psychotherapy, 45 minutes: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $299.10 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $157.42 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $155.85 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $157.42 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $158.99 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $165.29 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $149.55 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $157.42 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $196.77 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $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 – $92.18
Psychotherapy, 45 minutes: rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $92.18 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $92.18 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $92.18 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $92.18 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $65.77
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	$149.55 – $299.10
Psychotherapy, 45 minutes: rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $165.29 TRICARE — 2211_TRICARE OP 20250101: $157.42 PPOM — 934_PPOM 20191001: 64.8% (a percentage in the contract, not a dollar amount)
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	$149.55 – $299.10
Psychotherapy, 60 minutes: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $299.10 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $157.42 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $155.85 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $157.42 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $158.99 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $165.29 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $149.55 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $157.42 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $196.77 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $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 – $108.78
Psychotherapy, 60 minutes: rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $108.78 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $108.78 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $108.78 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $108.78 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $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	$149.55 – $299.10
Psychotherapy, 60 minutes: rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $165.29 TRICARE — 2211_TRICARE OP 20250101: $157.42 PPOM — 934_PPOM 20191001: 64.8% (a percentage in the contract, not a dollar amount)
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	$149.55 – $299.10
Family psychotherapy, without the patient: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $299.10 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $157.42 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $155.85 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $157.42 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $158.99 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $165.29 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $149.55 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $157.42 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $196.77 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $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 – $115.25
Family psychotherapy, without the patient: rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $92.29 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $92.29 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $92.29 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $92.29 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $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	$149.55 – $299.10
Family psychotherapy, without the patient: rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $165.29 PPOM — 934_PPOM 20191001: $115.25 TRICARE — 2211_TRICARE OP 20250101: $157.42
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	$149.55 – $299.10
Family psychotherapy, with the patient: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $299.10 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $157.42 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $155.85 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $157.42 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $158.99 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $165.29 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $149.55 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $157.42 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $196.77 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $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 – $129.59
Family psychotherapy, with the patient: rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $114.67 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $114.67 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $114.67 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $114.67 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $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	$149.55 – $299.10
Family psychotherapy, with the patient: rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $165.29 PPOM — 934_PPOM 20191001: $129.59 TRICARE — 2211_TRICARE OP 20250101: $157.42
Group psychotherapy CPT 90853 · Inpatient (hospital stay) In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$86.10 – $172.20
Group psychotherapy: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $172.20 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $90.63 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $89.72 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $90.63 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $91.54 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $95.16 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $86.10 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $90.63 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $113.29 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $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 – $45.42
Group psychotherapy: rates for 5 insurance plans AHLIC — 2163_AHLIC 20241001: $43.17 HAP HMO — 2166_HEALTH ALLIANCE HMO 20241001: $43.17 HAP HMO — 2174_SJMA HEALTH ALLIANCE HMO 20241001: $43.17 HAP PREFERRED — 2171_HAP PREFERRED (PHP) 20241001: $43.17 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $36.64
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$86.10 – $172.20
Group psychotherapy: rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $95.16 PPOM — 934_PPOM 20191001: $45.42 TRICARE — 2211_TRICARE OP 20250101: $90.63

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 – $1,749
Removal of breast growth (open surgery): rates for 5 insurance plans BCCCP — 1782_BCCCP 20210201: $459.27 PHCS POS — 1311_PHCS POS 20201001: $1,564 PHCS PPO — 1457_PHCS PPO 20201001: $1,738 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $1,492 PPOM — 934_PPOM 20191001: $519.93
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 – $1,749
Removal of breast growth (open surgery): rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $1,749 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $1,749 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,749 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $1,150.86
Total hip replacement CPT 27130 · Inpatient or outpatient In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$2,936.67 – $16,101.61
Total hip replacement: rates for 5 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $16,101.61 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $16,101.61 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $16,101.61 PHCS POS — 1311_PHCS POS 20201001: 72% (a percentage in the contract, not a dollar amount) PHCS PPO — 1457_PHCS PPO 20201001: 72% (a percentage in the contract, not a dollar amount)
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	$2,936.67 – $16,101.61
Total hip replacement: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $2,936.67
Total knee replacement CPT 27447 · Inpatient or outpatient In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$3,189.55 – $15,701.57
Total knee replacement: rates for 5 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $15,701.57 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $15,701.57 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $15,701.57 PHCS POS — 1311_PHCS POS 20201001: 72% (a percentage in the contract, not a dollar amount) PHCS PPO — 1457_PHCS PPO 20201001: 72% (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	$3,189.55 – $15,701.57
Total knee replacement: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $3,189.55
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	$1,358.55 – $2,271.88
Shoulder arthroscopy: shaving of shoulder bone: rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $1,564 PHCS PPO — 1457_PHCS PPO 20201001: $1,738 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $1,492 PPOM — 934_PPOM 20191001: $1,358.55
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$1,358.55 – $2,271.88
Shoulder arthroscopy: shaving of shoulder bone: rates for 3 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $2,271.88 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $2,271.88 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2,271.88
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	$1,188.84 – $2,380
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $1,910.21 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $1,910.21 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,910.21 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $1,260.08
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	$1,188.84 – $2,380
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $2,141 PHCS PPO — 1457_PHCS PPO 20201001: $2,380 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $2,043 PPOM — 934_PPOM 20191001: $1,188.84
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	$477.73 – $1,577.95
Removal of tonsils and adenoids (under age 12): rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $1,577.95 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $1,577.95 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,577.95 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $850.49
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	$477.73 – $1,577.95
Removal of tonsils and adenoids (under age 12): rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $1,243 PHCS PPO — 1457_PHCS PPO 20201001: $1,381 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $1,186 PPOM — 934_PPOM 20191001: $477.73
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	$872.67 – $1,745.34
Upper GI endoscopy (diagnostic): 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $1,745.34 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $918.60 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $909.41 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $918.60 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $927.79 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $964.53 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $872.67 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $918.60 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $1,148.25 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $964.53
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	$872.67 – $1,745.34
Upper GI endoscopy (diagnostic): rates for 6 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $964.53 PHCS POS — 1311_PHCS POS 20201001: $732 PHCS PPO — 1457_PHCS PPO 20201001: $813 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $698 PPOM — 934_PPOM 20191001: $378.05 TRICARE — 2211_TRICARE OP 20250101: $918.60
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	$378.05 – $813
Upper GI endoscopy (diagnostic): rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $540.89 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $540.89 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $540.89 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $392.06
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	$872.67 – $1,745.34
Upper GI endoscopy with biopsy: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $1,745.34 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $918.60 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $909.41 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $918.60 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $927.79 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $964.53 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $872.67 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $918.60 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $1,148.25 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $964.53
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	$872.67 – $1,745.34
Upper GI endoscopy with biopsy: rates for 6 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $964.53 PHCS POS — 1311_PHCS POS 20201001: $1,243 PHCS PPO — 1457_PHCS PPO 20201001: $1,381 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $1,186 PPOM — 934_PPOM 20191001: $408.99 TRICARE — 2211_TRICARE OP 20250101: $918.60
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 – $1,381
Upper GI endoscopy with biopsy: rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $545.74 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $545.74 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $545.74 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $392.06
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$848.62 – $1,697.23
Colonoscopy (diagnostic): 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $1,697.23 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $893.28 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $884.35 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $893.28 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $902.21 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $937.94 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $848.62 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $893.28 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $1,116.60 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $937.94
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$848.62 – $1,697.23
Colonoscopy (diagnostic): rates for 6 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $937.94 PHCS POS — 1311_PHCS POS 20201001: $1,243 PHCS PPO — 1457_PHCS PPO 20201001: $1,381 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $1,186 PPOM — 934_PPOM 20191001: $485.45 TRICARE — 2211_TRICARE OP 20250101: $893.28
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$395.95 – $1,381
Colonoscopy (diagnostic): rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $552.95 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $552.95 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $552.95 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $395.95
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 – $1,381
Colonoscopy with biopsy: rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $635.22 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $635.22 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $635.22 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $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 – $1,381
Colonoscopy with biopsy: rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $1,243 PHCS PPO — 1457_PHCS PPO 20201001: $1,381 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $1,186 PPOM — 934_PPOM 20191001: $586.83
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 – $1,381
Colonoscopy with removal of polyps (snare): rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $634.10 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $634.10 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $634.10 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $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 – $1,381
Colonoscopy with removal of polyps (snare): rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $1,243 PHCS PPO — 1457_PHCS PPO 20201001: $1,381 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $1,186 PPOM — 934_PPOM 20191001: $691.42
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	$357.65 – $678.33
Ultrasound of the lower bowel by endoscope: rates for 6 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $678.33 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $678.33 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $678.33 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $395.95 PHCS POS — 1311_PHCS POS 20201001: 72% (a percentage in the contract, not a dollar amount) PHCS PPO — 1457_PHCS PPO 20201001: 72% (a percentage in the contract, not a dollar amount)
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	$357.65 – $678.33
Ultrasound of the lower bowel by endoscope: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $357.65
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient In the file: LAPAROSCOPIC CHOLECYSTECTOMY	$10,351	$5,796.56	$1,252.78 – $7,452.72
Gallbladder removal by laparoscope: rates for 6 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $3,181.74 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $3,181.74 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $3,181.74 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $2,104.60 PHCS POS — 1311_PHCS POS 20201001: $7,452.72 PHCS PPO — 1457_PHCS PPO 20201001: $7,452.72
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: LAPAROSCOPIC CHOLECYSTECTOMY	$10,351	$5,796.56	$1,252.78 – $7,452.72
Gallbladder removal by laparoscope: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $1,252.78
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	$832.26 – $2,380
Groin (inguinal) hernia repair, age 5 or older: rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $2,079.74 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $2,079.74 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $2,079.74 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $1,374.21
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	$832.26 – $2,380
Groin (inguinal) hernia repair, age 5 or older: rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $2,141 PHCS PPO — 1457_PHCS PPO 20201001: $2,380 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $2,043 PPOM — 934_PPOM 20191001: $832.26
Prostate biopsy CPT 55700 · Inpatient or outpatient In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$185.46 – $1,381
Prostate biopsy: rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $1,133.33 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $1,133.33 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,133.33 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $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	$185.46 – $1,381
Prostate biopsy: rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $1,243 PHCS PPO — 1457_PHCS PPO 20201001: $1,381 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $1,186 PPOM — 934_PPOM 20191001: $185.46
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$2,518.32 – $4,961.73
Prostate removal by laparoscope (radical prostatectomy): rates for 5 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $4,961.73 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $4,961.73 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $4,961.73 PHCS POS — 1311_PHCS POS 20201001: 72% (a percentage in the contract, not a dollar amount) PHCS PPO — 1457_PHCS PPO 20201001: 72% (a percentage in the contract, not a dollar amount)
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	$2,518.32 – $4,961.73
Prostate removal by laparoscope (radical prostatectomy): rates for 1 insurance plan PPOM — 934_PPOM 20191001: $2,518.32
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	$430.66 – $1,517.86
Hysteroscopy with biopsy of the uterus lining: rates for 6 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $1,517.86 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $1,517.86 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,517.86 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $978.98 PHCS POS — 1311_PHCS POS 20201001: 72% (a percentage in the contract, not a dollar amount) PHCS PPO — 1457_PHCS PPO 20201001: 72% (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	$430.66 – $1,517.86
Hysteroscopy with biopsy of the uterus lining: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $430.66
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: INJ INTERLAMINAR LMBR/SAC W/IG	$2,352	$1,317.12	$392.02 – $2,352
Spinal injection, lower back (epidural), with imaging guidance: rates for 3 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $392.02 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $392.02 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $392.02
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: INJ INTERLAMINAR LMBR/SAC W/IG	$2,352	$1,317.12	$392.02 – $2,352
Spinal injection, lower back (epidural), with imaging guidance: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $2,352
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	$644.59 – $1,289.19
Spinal injection, lower back (epidural), with imaging guidance: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $1,289.19 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $678.52 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $671.73 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $678.52 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $685.31 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $712.45 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $644.59 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $678.52 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $848.15 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $712.45
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	$828.68 – $1,657.35
Nerve root injection, lower back, with imaging guidance: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $1,657.35 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $872.29 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $863.57 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $872.29 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $881.01 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $915.90 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $828.68 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $872.29 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $1,090.36 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $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	$292.73 – $546.75
Nerve root injection, lower back, with imaging guidance: rates for 6 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $546.75 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $546.75 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $546.75 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $307.80 PHCS POS — 1311_PHCS POS 20201001: 72% (a percentage in the contract, not a dollar amount) PHCS PPO — 1457_PHCS PPO 20201001: 72% (a percentage in the contract, not a dollar amount)
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	$828.68 – $1,657.35
Nerve root injection, lower back, with imaging guidance: rates for 3 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $915.90 PPOM — 934_PPOM 20191001: $292.73 TRICARE — 2211_TRICARE OP 20250101: $872.29
Carpal tunnel release CPT 64721 · Inpatient or outpatient In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$694.71 – $1,381
Carpal tunnel release: rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $1,105.86 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $1,105.86 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,105.86 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $732.49
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	$694.71 – $1,381
Carpal tunnel release: rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $1,243 PHCS PPO — 1457_PHCS PPO 20201001: $1,381 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $1,186 PPOM — 934_PPOM 20191001: $694.71
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	$510.63 – $1,021.27
Laser treatment of clouding after cataract surgery: 10 of 16 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $1,021.27 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $537.51 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $532.13 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $537.51 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $542.89 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $564.39 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $510.63 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $537.51 MERIDIAN AMBETTER — 2286_MEDICARE ADVANTAGE MERIDIAN AMBETTER INPATIENT 20251001: $671.89 MERIDIAN WELLCARE — 2280_MEDICARE ADVANTAGE MERIDIAN WELLCARE INPATIENT 20251001: $564.39
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	$510.63 – $1,021.27
Laser treatment of clouding after cataract surgery: rates for 6 insurance plans MERIDIAN WELLCARE — 2210_MEDICARE ADVANTAGE MERIDIAN WELLCARE OUTPATIENT 2025010: $564.39 PHCS POS — 1311_PHCS POS 20201001: $1,243 PHCS PPO — 1457_PHCS PPO 20201001: $1,381 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: $1,186 PPOM — 934_PPOM 20191001: $514.84 TRICARE — 2211_TRICARE OP 20250101: $537.51
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 – $1,381
Laser treatment of clouding after cataract surgery: rates for 4 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $402.09 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $402.09 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $402.09 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $231.64
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	$918.24 – $1,815.93
Cataract removal with lens implant: rates for 6 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $1,815.93 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $1,815.93 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $1,815.93 MERIDIAN HEALTH PLAN — 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 2022010: $918.24 PHCS POS — 1311_PHCS POS 20201001: 72% (a percentage in the contract, not a dollar amount) PHCS PPO — 1457_PHCS PPO 20201001: 72% (a percentage in the contract, not a dollar amount)
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	$918.24 – $1,815.93
Cataract removal with lens implant: rates for 2 insurance plans PPOM — 934_PPOM 20191001: $978.42 PHCS PPO GREAT WEST & MAILHANDLERS — 1458_PHCS PPO GR WEST & MAILHANDLERS 20201001: 75% (a percentage in the contract, not a dollar amount)

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$2,730.39 – $5,995.17
Vaginal delivery, with care before and after: rates for 5 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $5,995.17 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $5,995.17 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $5,995.17 PHCS POS — 1311_PHCS POS 20201001: 72% (a percentage in the contract, not a dollar amount) PHCS PPO — 1457_PHCS PPO 20201001: 72% (a percentage in the contract, not a dollar amount)
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	$2,730.39 – $5,995.17
Vaginal delivery, with care before and after: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $2,730.39
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$2,810.70 – $6,654.56
Cesarean delivery (C-section), with care before and after: rates for 5 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $6,654.56 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $6,654.56 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $6,654.56 PHCS POS — 1311_PHCS POS 20201001: 72% (a percentage in the contract, not a dollar amount) PHCS PPO — 1457_PHCS PPO 20201001: 72% (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	$2,810.70 – $6,654.56
Cesarean delivery (C-section), with care before and after: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $2,810.70
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$2,743.76 – $6,310.44
Vaginal delivery after a previous C-section, with care before and after: rates for 5 insurance plans BLUE CARE NETWORK — 2054_SJMC BLUE CROSS BLUE SHIELD BCN 20220401: $6,310.44 BLUE CROSS PPO — 2059_SJMC BLUE CROSS BLUE SHIELD PPO 20220401: $6,310.44 BLUE CROSS TRADITIONAL — 2058_SJMC BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL 202: $6,310.44 PHCS POS — 1311_PHCS POS 20201001: 72% (a percentage in the contract, not a dollar amount) PHCS PPO — 1457_PHCS PPO 20201001: 72% (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	$2,743.76 – $6,310.44
Vaginal delivery after a previous C-section, with care before and after: rates for 1 insurance plan PPOM — 934_PPOM 20191001: $2,743.76

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	$71,932.56 – $143,865.11
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 26 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $143,865.11 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $75,718.48 AETNA PPO — 2136_AETNA 20241001: $9,410 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $74,961.30 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $75,718.48 HUMANA HMOX — 2178_HUMANA HMOX INPATIENT 20241001: $8,400 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $76,475.66 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $79,504.40 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $71,932.56 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $75,718.48
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	$8,400 – $125,953.04
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 2 insurance plans PRIORITY HMO — 2010_PRIORITY HMO 20210701: $125,953.04 PRIORITY PPO — 2009_PRIORITY PPO 20210801: $125,953.04
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	$14,183.13 – $28,366.26
Hip or knee replacement (major joint of the leg), without major complications: 10 of 23 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $28,366.26 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $14,929.61 AETNA PPO — 2136_AETNA 20241001: $9,410 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $14,780.31 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $14,929.61 HUMANA HMOX — 2178_HUMANA HMOX INPATIENT 20241001: $8,400 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $15,078.91 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $15,676.09 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $14,183.13 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $14,929.61
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	$8,400 – $25,519.19
Hip or knee replacement (major joint of the leg), without major complications: rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $9,410 PHCS PPO — 1457_PHCS PPO 20201001: $9,410 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $25,519.19 PRIORITY PPO — 2009_PRIORITY PPO 20210801: $25,519.19
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	$17,950.78 – $35,901.56
Neck (cervical) spinal fusion, without complications: 10 of 23 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $35,901.56 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $18,895.56 AETNA PPO — 2136_AETNA 20241001: $9,410 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $18,706.60 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $18,895.56 HUMANA HMOX — 2178_HUMANA HMOX INPATIENT 20241001: $8,400 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $19,084.52 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $19,840.34 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $17,950.78 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $18,895.56
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	$8,400 – $30,432.44
Neck (cervical) spinal fusion, without complications: rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $9,410 PHCS PPO — 1457_PHCS PPO 20201001: $9,410 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $30,432.44 PRIORITY PPO — 2009_PRIORITY PPO 20210801: $30,432.44
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	$9,122.82 – $18,245.64
Uterus and ovary surgery (not for cancer), without complications: 10 of 23 insurance plan rates AAA-AUTO INSURANCE — 2285_AAA-AUTO INSURANCE INPATIENT 20251001: $18,245.64 AETNA BETTER HEALTH — 2272_MEDICARE ADVANTAGE AETNA BETTER HEALTH INPATIENT 202510: $9,602.97 AETNA PPO — 2136_AETNA 20241001: $9,410 AMERIHEALTH VIP CARE — 2273_MEDICARE ADVANTAGE AMERIHEALTH VIP CARE INPATIENT 20251: $9,506.94 HARBOR ADVANTAGE HMO — 2274_MEDICARE ADVANTAGE HARBOR ADVANTAGE HMO INPATIENT 20251: $9,602.97 HUMANA HMOX — 2178_HUMANA HMOX INPATIENT 20241001: $8,400 HUMANA MCR — 2275_MEDICARE ADVANTAGE HUMANA INPATIENT 20251001: $9,699 MCLAREN MEDICARE ADVANTAGE HMO — 2276_MEDICARE ADVANTAGE MCLAREN INPATIENT 20251001: $10,083.12 MEDICARE PACE — 2278_SJMC SJMA PACE MEDICARE INPATIENT 20251001: $9,122.82 MEDICARE REPLACEMENT — 2279_MEDICARE ADVANTAGE BLUE CROSS NETWORK CONNECTED CARE HM: $9,602.97
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	$8,400 – $14,307.57
Uterus and ovary surgery (not for cancer), without complications: rates for 4 insurance plans PHCS POS — 1311_PHCS POS 20201001: $9,410 PHCS PPO — 1457_PHCS PPO 20201001: $9,410 PRIORITY HMO — 2010_PRIORITY HMO 20210701: $14,307.57 PRIORITY PPO — 2009_PRIORITY PPO 20210801: $14,307.57

Source: Henry Ford Health St John Hospital’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	22101 Moross Rd, Detroit, MI 48236
County	Wayne County
State	Michigan
Phone	(313) 343‑4000
Emergency services	Yes
Ownership	Voluntary non-profit - Church
Medicare overall rating	1 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	230165
Name in Medicare records	HENRY FORD HEALTH ST JOHN HOSPITAL
Profile level	Medicare data + hospital website
Name on the hospital’s website	Henry Ford St. John 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 St. John Hospital — henryford.com
Patient & Visitor Information | St. John Hospital | Henry Ford Health — henryford.com
Henry Ford Lab Services - St. John Hospital | Henry Ford Health — henryford.com
Henry Ford Radiology and Imaging - St. John Hospital | Henry Ford Health — henryford.com
Henry Ford Inpatient Rehabilitation – St. John Hopsital | Henry Ford Health — henryford.com