ProMedica Memorial Hospital — price list

← Hospital overviewVerified from ProMedica Memorial 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.

355 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
276 suphcpcs v2632 Inpatient	V2632 HCPCS	$448	$291	$193 – $403	—
276 suphcpcs v2632 Outpatient	V2632 HCPCS	$448	$291	$246 – $403	—
Abdominal binder Inpatient	L0625 HCPCS	$211	$137	$90.73 – $190	—
Abdominal binder Outpatient	L0625 HCPCS	$211	$137	$53.87 – $190	—
Access rn brings in supply for midline Inpatient	C1751 HCPCS	$431	$280	$185 – $388	—
Access rn brings in supply for midline Outpatient	C1751 HCPCS	$431	$280	$237 – $388	—
Access rn brings in supply for PICC Inpatient	C1751 HCPCS	$1,063	$691	$457 – $957	—
Access rn brings in supply for PICC Outpatient	C1751 HCPCS	$1,063	$691	$585 – $957	—
Aircast ankle including fitting Inpatient	L4350 HCPCS	$431	$280	$185 – $388	—
Aircast ankle including fitting Outpatient	L4350 HCPCS	$431	$280	$63.73 – $388	—
Bakri tamponade Inpatient	27200047 CDM	$812	$528	$349 – $731	—
Bakri tamponade Outpatient	27200047 CDM	$812	$528	$447 – $731	—
Bard power midline p4154108d Inpatient	C1751 HCPCS	$588	$382	$253 – $529	—
Bard power midline p4154108d Outpatient	C1751 HCPCS	$588	$382	$323 – $529	—
Cast supplies fiberglass Inpatient	Q4038 HCPCS	$333	$216	$143 – $300	—
Cast supplies fiberglass Outpatient	Q4038 HCPCS	$333	$216	$75.26 – $300	—
Chemo initiate infusion 8 hrs wpump Inpatient	96416 CPT	$1,245	$809	$535 – $1,121	—
Chemo initiate infusion 8 hrs wpump Outpatient	96416 CPT	$1,245	$809	$685 – $1,121	—
Cooling collar Inpatient	27200094 CDM	$302	$196	$130 – $272	—
Cooling collar Outpatient	27200094 CDM	$302	$196	$166 – $272	—
Dressing nasal 8 cm length foam bioresorbable Inpatient	C1763 HCPCS	$424	$276	$182 – $382	—
Dressing nasal 8 cm length foam bioresorbable Outpatient	C1763 HCPCS	$424	$276	$233 – $382	—
Drsg plurogel 50gm jar Inpatient	27000039 CDM	$335	$218	$144 – $302	—
Drsg plurogel 50gm jar Outpatient	27000039 CDM	$335	$218	$184 – $302	—
Epicord per sq cm Inpatient	Q4187 HCPCS	$663	$431	$285 – $597	—
Epicord per sq cm Outpatient	Q4187 HCPCS	$663	$431	$365 – $597	—
Epicord per sq cm wasted Inpatient	Q4187 HCPCS	$663	$431	$285 – $597	—
Epicord per sq cm wasted Outpatient	Q4187 HCPCS	$663	$431	$365 – $597	—
Epifix per square cm Inpatient	Q4186 HCPCS	$630	$410	$271 – $567	—
Epifix per square cm Outpatient	Q4186 HCPCS	$630	$410	$347 – $567	—