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Emergency visit, moderate (level 3) at Henry Ford Jackson Hospital. CPT 99283.

What Henry Ford Jackson Hospital publishes for this service, straight from its standard-charges file, last updated June 28, 2026.

Outpatient / ER

$105cash price (self-pay)
$211list price
$44.30–$973range insurers pay
Insurance planNegotiated rate
HAP | HAP Caresource Medicaid-FAC$44.30
Aetna Better Health | Medicaid HMO-FAC$46.52
Blue Cross | Blue Cross Complete-Child-FAC$46.52
Blue Cross | Blue Cross Complete-Adult-FAC$46.52
Humana Military | Tricare-NonPhysician-NONFAC$52.27
Humana Military | Tricare-NonPhysician-FAC$56.12
HAP | Medicare Advantage HMO/PPO-NonPhysician-FAC$59.09
HAP | Medicare Advantage HMO/PPO-NonPhysician-NONFAC$59.09
Humana Military | Tricare-Physician-NONFAC$64.73
Humana Military | Tricare-Physician-FAC$64.73
Aetna | Medicare Advantage/Dual Products-FAC$69.52
Aetna | Medicare Advantage/Dual Products-NONFAC$69.52
Blue Cross | Medicare Plus Blue-NONFAC$69.52
Blue Cross | BCN Medicare Advantage -FAC$69.52
Blue Cross | Medicare Plus Blue-FAC$69.52
Blue Cross | BCN Medicare Advantage -NONFAC$69.52
Cascade Thome Pace | All Products-FAC$69.52
Cascade Thome Pace | All Products-NONFAC$69.52
HAP | Medicare Advantage HMO/PPO-Physician-NONFAC$69.52
HAP | HAP Dual Products-FAC$69.52
HAP | Medicare Advantage-FAC$69.52
HAP | HAP Dual Products-NONFAC$69.52
HAP | Medicare Advantage HMO/PPO-Physician-FAC$69.52
HAP | Medicare Advantage-NONFAC$69.52
Humana | Medicare Advantage-FAC$69.52
Humana | Medicare Advantage-NONFAC$70.91
Blue Cross | Blue Cross Complete-Child-NONFAC$84.40
Blue Cross | Blue Cross Complete-Adult-NONFAC$84.40
Hap | HMO/Ahl-Fac$90.25
Hap | HMO/Ahl-Nonfac$90.25

Inpatient

—cash price (self-pay)
$1,068list price
$536–$961range insurers pay
Insurance planNegotiated rate
United Healthcare | UHC Commercial$787
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All common services at Henry Ford Jackson Hospital