Emergency visit, high (level 4) at Henry Ford Rochester Hospital. CPT 99284.
What Henry Ford Rochester Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$372cash price (self-pay)
$1,521list price
$225–$793range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Bluecaid | 1131_michigan Medicaid Replacement Bluecaid Outpatient 2025 | $225 |
| Medicaid | 1130_mi Medicaid Outpatient 20250701 | $225 |
| Medicaid Replacement | 1132_michigan Medicaid Replacement Outpatient 2 | $225 |
| Molina Medicaid | 1128_medicaid Replacement Molina Outpatient 20250701 | $225 |
| Total Health Care HMO | 1129_medicaid Replacement Total Health Care Hm | $225 |
| Smarthealth | 1090_smart Health Outpatient 20250101 | $371 |
| Blue Cross Adv | 1082_medicare Advantage Blue Cross Network Outpatient | $417 |
| Hap Senior Plus | 1083_medicare Advantage Hap Senior Plus Outpatient 2 | $417 |
| Humana | 469_humana Outpatient 20200101 | $417 |
| Humana Medicare Advantage | 1084_medicare Advantage Humana Choicecare | $417 |
| Medicare Advantage | 1086_medicare Advantage Outpatient 20250101 | $417 |
| Medicare Plus Blue | 1087_medicare Advantage Plus Blue Outpatient 2025 | $417 |
| Priority Health Advantage (Mcr) | 1088_medicare Advantage Priority Hea | $417 |
| - None - | 985_zing Health Medicare Advantage Outpatient 20231013 | $438 |
| Molina Medicare | 1085_medicare Advantage Molina Outpatient 20250101 | $438 |
| Meridian Health Plan | 1089_meridian Ambetter Outpatient 20250101 | $522 |
| Blue Cross Blue Shield Hpn 20250701 | 1111_blue Cross Blue Shield Hpn | $606 |
| Blue Cross PPO | 1113_blue Cross Blue Shield PPO 20250701 | $650 |
| Blue Care Network | 1112_blue Cross Blue Shield Bcn 20250701 | $650 |
| Blue Cross Trad | 1114_blue Cross Blue Shield Trad 20250701 | $650 |
| Mva | 1075_medicare Advantage Mva Auto Outpatient 20250101 | $793 |
Inpatient
—cash price (self-pay)
—list price
$225–$793range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Smarthealth | 1134_smart Health Inpatient 20251001 | $371 |
| Blue Cross Adv | 1135_medicare Advantage Blue Cross Network Inpatient | $417 |
| Humana Medicare Advantage | 1137_medicare Advantage Humana Choicecare | $417 |
| Medicare Advantage | 1139_medicare Advantage Inpatient 20251001 | $417 |
| Medicare Plus Blue | 1142_medicare Advantage Plus Blue Inpatient 20251 | $417 |
| Priority Health Advantage (Mcr) | 1140_medicare Advantage Priority Hea | $417 |
| Molina Medicare | 1141_medicare Advantage Molina Inpatient 20251001 | $438 |
| Meridian Health Plan | 1143_meridian Ambetter Inpatient 20251001 | $522 |
| Mva | 1133_medicare Advantage Mva Auto Inpatient 20251001 | $793 |
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