ProMedica Charles and Virginia Hickman Hospital — price list
← Hospital overviewVerified from ProMedica Charles and Virginia Hickman Hospital’s published price file
Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.
How to read these columns
- List
- The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
- Cash
- The discounted self-pay price for paying directly, without insurance.
- Negotiated
- Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.
These are the hospital’s published reference prices, not a personalized estimate of your bill.
322 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| 276 suphcpcs v2632 Inpatient | V2632 HCPCS | $570 | $371 | $228 – $1,417 | — | |
| 276 suphcpcs v2632 Outpatient | V2632 HCPCS | $570 | $371 | $209 – $570 | — | |
| Abdominal binder Inpatient | L0625 HCPCS | $205 | $133 | $82.00 – $1,417 | — | |
| Abdominal binder Outpatient | L0625 HCPCS | $205 | $133 | $53.01 – $205 | — | |
| Access rn brings in supply for midline Inpatient | C1751 HCPCS | $418 | $272 | $167 – $334 | — | |
| Access rn brings in supply for midline Outpatient | C1751 HCPCS | $418 | $272 | $153 – $418 | — | |
| Access rn brings in supply for PICC Inpatient | C1751 HCPCS | $1,027 | $668 | $411 – $822 | — | |
| Access rn brings in supply for PICC Outpatient | C1751 HCPCS | $1,027 | $668 | $377 – $1,027 | — | |
| Aircast ankle including fitting Inpatient | L4350 HCPCS | $418 | $272 | $167 – $1,417 | — | |
| Aircast ankle including fitting Outpatient | L4350 HCPCS | $418 | $272 | $63.73 – $418 | — | |
| Amphetamine quant 5 or more Inpatient | 80326 CPT | $225 | $146 | $90.00 – $180 | — | |
| Amphetamine quant 5 or more Outpatient | 80326 CPT | $225 | $146 | $90.00 – $225 | — | |
| Antidepressants nos Inpatient | 80338 CPT | $625 | $406 | $250 – $500 | — | |
| Antidepressants nos Outpatient | 80338 CPT | $625 | $406 | $250 – $625 | — | |
| Antidepressants tricyclic and other cyclicals Inpatient | 80337 CPT | $625 | $406 | $250 – $500 | — | |
| Antidepressants tricyclic and other cyclicals Outpatient | 80337 CPT | $625 | $406 | $250 – $625 | — | |
| Antipsychotics not otherwise specified 13 Inpatient | 80342 CPT | $181 | $118 | $72.40 – $145 | — | |
| Antipsychotics not otherwise specified 13 Outpatient | 80342 CPT | $181 | $118 | $72.40 – $181 | — | |
| Antipsychotics not otherwise specified 7 more Inpatient | 80344 CPT | $221 | $144 | $88.40 – $177 | — | |
| Antipsychotics not otherwise specified 7 more Outpatient | 80344 CPT | $221 | $144 | $88.40 – $221 | — | |
| Apc gene analysis full gene sequence Inpatient | 81201 CPT | $4,263 | $2,771 | $1,705 – $3,410 | — | |
| Apc gene analysis full gene sequence Outpatient | 81201 CPT | $4,263 | $2,771 | $418 – $4,263 | — | |
| Bakri tamponade Inpatient | 27200047 CDM | $1,055 | $686 | $422 – $844 | — | |
| Bakri tamponade Outpatient | 27200047 CDM | $1,055 | $686 | $387 – $1,055 | — | |
| Bard power midline p4154108d Inpatient | C1751 HCPCS | $533 | $346 | $213 – $426 | — | |
| Bard power midline p4154108d Outpatient | C1751 HCPCS | $533 | $346 | $196 – $533 | — | |
| Basic metabolic panel Inpatient | 80048 CPT | $248 | $161 | $99.20 – $198 | — | |
| Basic metabolic panel Outpatient | 80048 CPT | $248 | $161 | $4.53 – $248 | — | |
| Bcrabl kinase gene Inpatient | 81170 CPT | $692 | $450 | $277 – $554 | — | |
| Bcrabl kinase gene Outpatient | 81170 CPT | $692 | $450 | $161 – $692 | — |