Henry Ford West Bloomfield Hospital
6777 W Maple Road, West Bloomfield, MI · Henry Ford Health · · NPI 1407867559
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $2,685.07 | $3,363.00 | $110.33 – $4,475.11 | 22 |
| Destruction ciliary body CPT 66700 | $3,173.34 | $1,230.00 | $213.85 – $5,288.90 | 20 |
| Destruction ciliary body CPT 66720 | $3,269.14 | $1,280.00 | $230.68 – $5,448.56 | 20 |
| Destruction ciliary body CPT 66740 | $3,269.14 | $1,230.00 | $213.85 – $5,448.56 | 20 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | $275.88 | $460.00 | $77.96 – $459.79 | 22 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | $3,816.64 | $420.00 | $77.11 – $6,361.06 | 20 |
| Destruction les conjunctiva CPT 68135 | $3,269.14 | $471.00 | $82.86 – $5,448.56 | 20 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | $558.97 | $460.00 | $73.06 – $931.62 | 22 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | $558.97 | $570.00 | $88.61 – $931.62 | 22 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | $558.97 | $440.00 | $69.65 – $931.62 | 22 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | $558.97 | $520.00 | $81.37 – $931.62 | 22 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | $558.97 | $357.00 | $61.77 – $931.62 | 22 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | $2,837.09 | $1,360.00 | $96.06 – $4,728.48 | 22 |
| Destruction premal lesions 15/> 17004 CPT 17004 | $558.97 | $321.00 | $52.82 – $931.62 | 22 |
| Destruction rectal tumor 45190 CPT 45190 | $3,816.64 | $2,300.00 | $428.77 – $6,361.06 | 20 |
| Destruction vag lesions complex 57065 CPT 57065 | $4,451.18 | $580.00 | $105.86 – $7,418.63 | 22 |
| Destruction vag lesions simple 57061 CPT 57061 | $4,451.18 | $327.00 | $67.31 – $7,418.63 | 22 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | $2,837.09 | $301.00 | $55.38 – $4,728.48 | 22 |
| Detect agent nos dna dir CPT 87797 | $41.44 | not published | $15.71 – $48.95 | 17 |
| Detect agnt mult dna direc CPT 87800 | $60.26 | not published | $22.73 – $71.18 | 17 |
| Determination venous press CPT 93770 | not published | $25.00 | $1.02 – $16.83 | 10 |
| Determine refractive state CPT 92015 | $35.00 | $35.00 | $10.01 – $28.29 | 15 |
| Developmental screen/score/document 96110 CPT 96110 | $43.95 | $88.00 | $8.91 – $58.96 | 17 |
| Devel tst phys/qhp 1st hr CPT 96112 | $176.93 | $388.00 | $68.16 – $299.15 | 21 |
| Device ablt adv novasure HCPCS C1886 | not published | $11,250.00 | $0.02 – $7,170.30 | 13 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | not published | $5,850.00 | $0.02 – $4,163.40 | 13 |
| Device intraute mirena HCPCS J7298 | $1,259.69 | $3,645.39 | $1,093.62 – $3,142.33 | 13 |
| Device tiss remov myosure reach HCPCS C1782 | not published | $2,836.00 | $0.02 – $1,336.10 | 13 |
| Dev interrog remote 1/2/mlt CPT 93295 | $50.87 | $186.00 | $23.00 – $51.60 | 18 |
| Devise bowel pouch CPT 44316 | $2,005.46 | $4,850.00 | $844.55 – $8,680.12 | 19 |
| Devlopment test interpt&rep HCPCS G0451 | $139.68 | $35.00 | $8.91 – $232.81 | 18 |
| Dev tst admin phys/qhp ea addl 30 min CPT 96113 | $62.91 | $191.00 | $28.76 – $147.26 | 21 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $119.66 | $232.00 | $5.96 – $129.31 | 22 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | $136.15 | not published | $51.60 – $226.91 | 19 |
| Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr HCPCS J1095 | not published | not published | $1.17 – $4.47 | 6 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $0.01 | $76.55 | $0.01 – $1.37 | 14 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $0.14 | $144.23 | $0.06 – $1.98 | 14 |
| Dexamethasone intra implant HCPCS J7312 | $282.26 | $4,124.00 | $106.97 – $3,550.58 | 21 |
| Dexamethasone panel CPT 80420 | $223.39 | not published | $132.08 – $263.86 | 15 |
| Dexmedetomidine film, 1 mcg HCPCS J1105 | not published | not published | $1.45 – $1.54 | 3 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $80.06 | $1,202.00 | $30.34 – $517.20 | 22 |
| Dextran 40 infusion HCPCS J7100 | not published | not published | $39.82 – $628.63 | 7 |
| Dextran 75 infusion HCPCS J7110 | not published | not published | $15.07 – $32.33 | 3 |
| Dextroamphetamine HCPCS S0160 | not published | not published | $1.12 – $1.84 | 3 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $1.81 | $23.00 | $0.74 – $11.57 | 12 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | not published | $23.00 | $6.90 – $17.73 | 11 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $2.41 | not published | $0.99 – $5.15 | 10 |
| Dextrose 5 % IV bolus HCPCS J7070 | $4.05 | not published | $1.66 – $10.32 | 10 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $30.68 | $149.00 | $11.63 – $99.83 | 21 |
| Diabetes (HbA1c) Test CPT 83036 | $38.00 | $67.00 | $1.82 – $44.89 | 21 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | $51.52 | $38.00 | $0.01 – $85.86 | 22 |
| Diabetic custom molded shoe HCPCS A5501 | $375.08 | not published | $184.80 – $366.93 | 15 |
| Diabetic shoe with wedge HCPCS A5504 | $63.19 | not published | $27.41 – $61.82 | 14 |
| Diabetic shoe w/off set heel HCPCS A5506 | $63.19 | not published | $27.41 – $61.82 | 14 |
| Diabetic shoe w/roller/rockr HCPCS A5503 | $63.19 | not published | $27.41 – $61.82 | 14 |
| Diab manage trn ind/group HCPCS G0109 | $22.08 | $34.00 | $8.37 – $34.56 | 22 |
| Diab shoe for density insert HCPCS A5500 | $125.07 | not published | $61.63 – $126.44 | 15 |
| Diab shoe w/metatarsal bar HCPCS A5505 | $63.19 | not published | $27.41 – $61.82 | 14 |
| Diag bronchoscope/catheter CPT 31643 | $2,447.43 | $1,376.00 | $97.13 – $4,079.05 | 22 |
| Diag laparo separate proc 49320 CPT 49320 | $8,312.83 | $1,090.00 | $201.71 – $13,854.72 | 20 |
| Diagnostic anoscopy CPT 46601 | $614.27 | $304.00 | $54.53 – $1,075.00 | 22 |
| Diagnostic anoscopy & biopsy CPT 46607 | $1,645.43 | $408.00 | $72.21 – $2,742.38 | 19 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $182.95 | $208.00 | $25.77 – $304.91 | 22 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | not published | $182.00 | $39.62 – $140.32 | 16 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | not published | $150.00 | $32.41 – $90.98 | 16 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $274.47 | $199.00 | $28.54 – $457.45 | 22 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $274.47 | $306.00 | $38.98 – $457.45 | 22 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $147.89 | $469.00 | $29.61 – $361.60 | 22 |
| Diagnostic Mammogram (one breast) CPT 77065 | $115.09 | $410.00 | $24.07 – $316.11 | 22 |
| Diagnostic radio unlisted proc CPT 76499 | $119.66 | $1,717.00 | $45.35 – $199.43 | 21 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $262.71 | $680.00 | $112.04 – $11,683.30 | 18 |
| Dialysis one evaluation CPT 90945 | $573.75 | $1,613.00 | $49.20 – $956.25 | 21 |
| Dialysis repeated eval CPT 90947 | $151.07 | $455.00 | $67.73 – $218.11 | 18 |
| Dialysis training complete CPT 90989 | not published | not published | $546.98 – $1,318.00 | 4 |
| Dialysis training incompl CPT 90993 | not published | not published | $95.53 – $182.50 | 3 |
| Diathermy eg microwave CPT 97024 | $10.21 | not published | $3.87 – $25.31 | 18 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $0.10 | $167.10 | $0.01 – $0.12 | 14 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $9.23 | $178.61 | $3.78 – $46.98 | 14 |
| Dicyclomine injection HCPCS J0500 | $15.63 | $122.00 | $6.40 – $66.99 | 14 |
| Difelikefalin, esrd on dialy HCPCS J0879 | not published | not published | $0.24 – $0.61 | 6 |
| Diffusing capacity CPT 94729 | $72.39 | $300.00 | $5.96 – $231.30 | 22 |
| Digital analysis of eeg CPT 95957 | $278.88 | $994.00 | $64.75 – $665.98 | 22 |
| Digit nerve surgery add-on CPT 64778 | $232.54 | $787.00 | $98.83 – $787.00 | 22 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $13.21 | $21.50 | $1.77 – $14.55 | 14 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $7,130.45 | $14,927.00 | $2,702.34 – $12,867.07 | 22 |
| Digoxin total therapeutic drug level CPT 80162 | $18.33 | $90.00 | $6.95 – $60.30 | 21 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $78.77 | $320.00 | $32.24 – $175.76 | 14 |
| Dilate biliary duct/ampulla CPT 47542 | $171.58 | $440.00 | $74.76 – $2,766.64 | 18 |
| Dilate esophagus CPT 43453 | $2,638.57 | $2,016.00 | $49.42 – $4,397.62 | 22 |
| Dilate esophagus 1/mult pass CPT 43450 | $1,247.13 | $2,016.00 | $46.65 – $2,078.56 | 22 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | not published | $3,380.00 | $271.00 – $1,352.00 | 8 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | not published | $1,690.00 | $135.49 – $676.00 | 8 |
| Dilate ic vasospasm init CPT 61640 | not published | $2,238.00 | $386.00 – $895.20 | 8 |
| Dilate tear duct opening CPT 68801 | $614.27 | $357.00 | $45.80 – $1,023.78 | 22 |
| Dilate urethra stricture CPT 53600 | $343.55 | $208.00 | $35.78 – $572.59 | 22 |
| Dilate urethra stricture CPT 53601 | $182.95 | $180.00 | $30.46 – $304.91 | 22 |
| Dilate urethra stricture CPT 53605 | $4,846.99 | $212.00 | $35.57 – $8,078.31 | 20 |
| Dilate urethra stricture CPT 53621 | $343.55 | $236.00 | $40.68 – $572.59 | 22 |
| Dilation/female urethra/initial 53660 CPT 53660 | $176.93 | $163.00 | $23.86 – $294.88 | 22 |
| Dilation of anal sphincter CPT 45905 | $1,645.43 | $560.00 | $107.78 – $2,742.38 | 20 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.