Emergency visit, high (level 4) at Henry Ford St John Hospital. CPT 99284.
What Henry Ford St John Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$907cash price (self-pay)
$1,782list price
$133–$1,767range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Meridian Health Plan | 1945_medicaid Replacement Meridian Health Outpa | $172 |
| Ppom | 934_ppom 20191001 | $214 |
| Tricare | 2211_tricare Op 20250101 | $417 |
| Meridian Wellcare | 2210_medicare Advantage Meridian Wellcare Outpatie | $438 |
| Aetna PPO | 2136_aetna 20241001 | $1,283 |
| 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 |
Inpatient
—cash price (self-pay)
—list price
$396–$793range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare Pace | 2278_sjmc Sjma Pace Medicare Inpatient 20251001 | $396 |
| Amerihealth Vip Care | 2273_medicare Advantage Amerihealth Vip Care In | $413 |
| Aetna Better Health | 2272_medicare Advantage Aetna Better Health Inpa | $417 |
| Harbor Advantage HMO | 2274_medicare Advantage Harbor Advantage HMO In | $417 |
| Medicare Replacement | 2279_medicare Advantage Blue Cross Network Conn | $417 |
| Tricare | 480_tricare Ip 20170101 | $417 |
| Veterans Choice | 2283_veterans Choice Ip 20251001 | $417 |
| Humana Mcr | 2275_medicare Advantage Humana Inpatient 20251001 | $421 |
| Mclaren Medicare Advantage HMO | 2276_medicare Advantage Mclaren Inpat | $438 |
| Meridian Wellcare | 2280_medicare Advantage Meridian Wellcare Inpatien | $438 |
| Molina Advantage | 2281_medicare Advantage Molina Inpatient 20251001 | $438 |
| Molina Health Link | 2282_medicare Advantage Molina Health Link Inpati | $438 |
| Meridian Ambetter | 2286_medicare Advantage Meridian Ambetter Inpatien | $522 |
| Molina Market Place | 2287_molina Marketplace Inpatient 20251001 | $522 |
| Smarthealth | 2284_smarthealth Inpatient 20251001 | $584 |
| Aaa-Auto Insurance | 2285_aaa-Auto Insurance Inpatient 20251001 | $793 |
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