▸ Hospital · MI · CCN 231328

Ascension Borgess Allegan Hospital

555 LINN STREET, ALLEGAN, MI, 49010

25 bedsCritical Access Hospitals1

Compliance grade

100/100

Procedures tracked

169

of 209 target codes

Payers

with negotiated rates

Rates published

18,469

last crawl 2026-05-24

▸ Compare with other hospitals All MI hospitals JSON Full cost report on HCRIS.io →

Source MRF: https://healthcare.ascension.org/-/media/project/ascension/healthcare/price-transparency-files/fl-csv/590634434_sacred-heart-health-system-inc_standardcharges.csv · CSV

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
behavioral
Psychoses	MS-DRG	885	17	—	—	$3,046.63	$10,470	$19,711
Psychiatric diagnostic evaluation	CPT	90791	13	—	—	$65	$164.51	$362.88
Psychiatric eval with medical services	CPT	90792	13	—	—	$65	$164.51	$362.88
Psychotherapy 30 minutes	CPT	90832	13	—	—	$35	$164.51	$362.88
Psychotherapy 45 minutes	CPT	90834	13	—	—	$63	$164.51	$362.88
Psychotherapy 60 minutes	CPT	90837	13	—	—	$68	$164.51	$362.88
Crisis psychotherapy 60 minutes	CPT	90839	13	—	—	$161.28	$166.12	$362.88
emergency
ED visit level 1	CPT	99281	14	$612	$244.8	$88.38	$123.73	$968
ED visit level 2	CPT	99282	14	$802	$320.8	$158.96	$222.54	$1,520
ED visit level 3	CPT	99283	14	$2,032	$812.8	$277.94	$389.12	$2,345
ED visit level 4	CPT	99284	14	$3,406	$1,362.4	$427.43	$598.4	$4,146
ED visit level 5	CPT	99285	14	$11,795	$4,718	$615.42	$861.59	$5,318
Critical care, first hour	CPT	99291	14	$11,833	$4,733.2	$845.8	$1,184.12	$7,186
imaging
CT head without contrast	CPT	70450	13	$2,139	$855.6	$106.74	$109.94	$1,359
CT head with contrast	CPT	70460	13	$2,758	$1,103.2	$178.69	$184.05	$1,406.58
CT head with and without contrast	CPT	70470	13	$2,982	$1,192.8	$178.69	$184.05	$1,520.82
CT neck with contrast	CPT	70491	13	$3,241	$1,296.4	$178.69	$184.05	$1,652.91
MRI brain without contrast	CPT	70551	13	$2,700	$1,080	$242.63	$249.91	$1,645
MRI brain with contrast	CPT	70552	13	$3,486	$1,394.4	$358.48	$369.23	$1,777.86
MRI brain with and without contrast	CPT	70553	13	$4,079	$1,631.6	$358.48	$369.23	$2,080.29
Chest X-ray single view	CPT	71045	13	$563	$225.2	$51.26	$91.03	$287.13
Chest X-ray 2 views	CPT	71046	13	$649	$259.6	$67.8	$91.03	$330.99
Chest X-ray 3 views	CPT	71047	13	$1,108	$443.2	$85.43	$91.03	$565.08
CT chest without contrast	CPT	71250	13	$3,104	$1,241.6	$106.74	$109.94	$1,583.04
CT chest with contrast	CPT	71260	13	$3,500	$1,400	$178.69	$184.05	$1,785
CT chest with and without contrast	CPT	71270	13	$4,386	$1,754.4	$178.69	$184.05	$2,236.86
MRI chest without contrast	CPT	71550	13	$4,032	$1,612.8	$242.63	$249.91	$2,056.32
MRI chest with contrast	CPT	71551	13	$4,032	$1,612.8	$793.05	$816.84	$2,056.32
MRI chest with and without contrast	CPT	71552	13	$4,032	$1,612.8	$358.48	$369.23	$2,056.32
Lumbosacral spine X-ray	CPT	72100	13	$958	$383.2	$83.24	$109.94	$488.58
CT cervical spine without contrast	CPT	72125	13	$2,193	$877.2	$106.74	$109.94	$1,359
CT thoracic spine without contrast	CPT	72128	13	$2,210	$884	$106.74	$109.94	$1,359
CT lumbar spine without contrast	CPT	72131	13	$2,207	$882.8	$106.74	$109.94	$1,359
MRI cervical spine without contrast	CPT	72141	13	$3,721	$1,488.4	$242.63	$249.91	$1,897.71
MRI thoracic spine without contrast	CPT	72146	13	$3,882	$1,552.8	$242.63	$249.91	$1,979.82
MRI lumbar spine without contrast	CPT	72148	13	$3,748	$1,499.2	$242.63	$249.91	$1,911.48
MRI lumbar spine with and without contrast	CPT	72149	13	$3,730	$1,492	$358.48	$369.23	$1,902.3
MRI cervical spine with and without contrast	CPT	72156	13	$4,079	$1,631.6	$358.48	$369.23	$2,080.29
MRI lumbar spine with contrast	CPT	72158	13	$4,079	$1,631.6	$358.48	$369.23	$2,080.29
CT pelvis without contrast	CPT	72192	13	$2,435	$974	$106.74	$109.94	$1,359
CT pelvis with contrast	CPT	72193	13	$3,338	$1,335.2	$178.69	$184.05	$1,702.38
Shoulder X-ray	CPT	73030	13	$1,076	$430.4	$73.32	$91.03	$548.76
Humerus X-ray	CPT	73060	13	$629	$251.6	$71.09	$91.03	$320.79
Hand X-ray 3 views	CPT	73130	13	$2,015	$806	$81.04	$91.03	$1,027.65
MRI upper extremity joint without contrast	CPT	73221	13	$3,669	$1,467.6	$242.63	$249.91	$1,871.19
MRI upper extremity joint with and without contrast	CPT	73223	13	$4,079	$1,631.6	$358.48	$369.23	$2,080.29
Knee X-ray 1-2 views	CPT	73560	13	$978	$391.2	$77.72	$91.03	$498.78
Ankle X-ray 3 views	CPT	73610	13	$2,110	$844	$81.04	$91.03	$1,076.1
MRI lower extremity joint without contrast	CPT	73721	13	$3,513	$1,405.2	$242.63	$249.91	$1,791.63
MRI lower extremity joint with and without contrast	CPT	73723	13	$4,079	$1,631.6	$358.48	$369.23	$2,080.29
CT abdomen without contrast	CPT	74150	13	$2,954	$1,181.6	$106.74	$109.94	$1,506.54
CT abdomen with contrast	CPT	74160	13	$4,195	$1,678	$178.69	$184.05	$2,139.45
CT abdomen with and without contrast	CPT	74170	13	$4,199	$1,679.6	$178.69	$184.05	$2,141.49
CT abdomen and pelvis without contrast	CPT	74176	13	$4,451	$1,780.4	$242.63	$249.91	$2,270.01
CT abdomen and pelvis with contrast	CPT	74177	13	$4,451	$1,780.4	$358.48	$369.23	$2,270.01
CT abdomen and pelvis with and without contrast	CPT	74178	13	$4,451	$1,780.4	$358.48	$369.23	$2,270.01
MRI abdomen without contrast	CPT	74181	13	$3,721	$1,488.4	$242.63	$249.91	$1,897.71
MRI abdomen with and without contrast	CPT	74183	13	$3,711	$1,484.4	$358.48	$369.23	$1,892.61
Abdominal ultrasound complete	CPT	76700	13	$4,345	$1,738	$106.74	$109.94	$2,215.95
Abdominal ultrasound limited	CPT	76705	13	$2,324	$929.6	$106.74	$109.94	$1,185.24
Retroperitoneal ultrasound complete	CPT	76770	13	$2,316	$926.4	$106.74	$109.94	$1,181.16
Obstetric ultrasound first trimester	CPT	76801	13	$1,242	$496.8	$106.74	$109.94	$633.42
Obstetric ultrasound after first trimester	CPT	76805	13	$847	$338.8	$106.74	$109.94	$431.97
Obstetric ultrasound with fetal anatomy	CPT	76811	13	$3,248	$1,299.2	$242.63	$249.91	$1,656.48
Transvaginal ultrasound	CPT	76830	13	$2,670	$1,068	$106.74	$109.94	$1,361.7
Pelvic ultrasound complete	CPT	76856	13	$3,348	$1,339.2	$106.74	$109.94	$1,707.48
Scrotal ultrasound	CPT	76870	13	$2,316	$926.4	$106.74	$109.94	$1,181.16
Diagnostic mammography unilateral	CPT	77065	13	$1,004	$401.6	$80.31	$82.72	$512.04
Diagnostic mammography bilateral	CPT	77066	13	$1,517	$606.8	$102.2	$105.27	$773.67
Screening mammography bilateral	CPT	77067	13	$1,236	$494.4	$84.39	$86.92	$630.36
EKG complete	CPT	93000	1	—	—	$1,617	$1,617	$1,617
EKG tracing only	CPT	93005	12	—	—	$59.62	$61.41	$1,617
EKG interpretation only	CPT	93010	1	—	—	$1,617	$1,617	$1,617
Transthoracic echocardiogram complete	CPT	93306	12	$4,463	$1,785.2	$550.37	$566.88	$1,617
Transthoracic echocardiogram	CPT	93307	12	$1,827	$730.8	$242.63	$249.91	$1,617
Stress echocardiogram	CPT	93350	12	—	—	$550.37	$566.88	$1,617
inpatient
Respiratory infections & inflammations w MCC	MS-DRG	177	17	—	—	$7,300	$11,701	$22,052
COPD w MCC	MS-DRG	190	17	—	—	$6,947.15	$10,172	$19,155
COPD w CC	MS-DRG	191	17	—	—	$5,206.87	$8,723.6	$19,155
COPD w/o CC/MCC	MS-DRG	192	17	—	—	$4,026.42	$7,300	$19,155
Simple pneumonia & pleurisy w CC	MS-DRG	194	17	—	—	$5,054.35	$8,339.68	$19,155
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	17	—	—	$3,761.78	$7,300	$19,155
AMI discharged alive w MCC	MS-DRG	280	17	—	—	$7,300	$10,747	$22,636
AMI discharged alive w CC	MS-DRG	281	17	—	—	$5,764.31	$9,511.11	$19,155
AMI discharged alive w/o CC/MCC	MS-DRG	282	17	—	—	$4,535.06	$7,482.85	$19,155
Heart failure & shock w MCC	MS-DRG	291	17	—	—	$7,300	$10,470	$19,155
Heart failure & shock w CC	MS-DRG	292	17	—	—	$5,324.66	$8,785.69	$19,155
Heart failure & shock w/o CC/MCC	MS-DRG	293	17	—	—	$3,549.78	$7,300	$19,155
Cardiac arrhythmia w MCC	MS-DRG	308	17	—	—	$5,976.23	$10,470	$19,155
Cardiac arrhythmia w CC	MS-DRG	309	17	—	—	$4,029.12	$7,613.23	$19,155
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	17	—	—	$2,915.43	$7,300	$19,155
GI hemorrhage w CC	MS-DRG	378	17	—	—	$5,359.02	$10,149	$19,155
GI hemorrhage w/o CC/MCC	MS-DRG	379	17	—	—	$3,673.08	$7,300	$19,155
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	17	—	—	$4,366.06	$8,067.53	$19,155
Fractures of femur w/o MCC	MS-DRG	533	17	—	—	$7,300	$10,470	$22,122
Kidney/UTI w MCC	MS-DRG	689	17	—	—	$6,164.72	$10,188	$19,155
Kidney/UTI w/o MCC	MS-DRG	690	17	—	—	$4,263.81	$8,376.93	$19,155
Septicemia or severe sepsis w MV 96+ hrs	MS-DRG	871	17	—	—	$7,300	$12,305	$27,411
Septicemia or severe sepsis w/o MV 96+ hrs	MS-DRG	872	17	—	—	$5,205.02	$10,172	$19,155
Initial hospital care, low complexity	CPT	99221	1	—	—	$67.81	$67.81	$67.81
Initial hospital care, moderate complexity	CPT	99222	1	—	—	$112.11	$112.11	$112.11
Initial hospital care, high complexity	CPT	99223	1	—	—	$156.04	$156.04	$156.04
Hospital discharge, <30 min	CPT	99238	1	—	—	$70.03	$70.03	$70.03
Hospital discharge, >30 min	CPT	99239	1	—	—	$100	$100	$100
lab
Basic metabolic panel (BMP)	CPT	80048	13	$105.4	$42.16	$8.46	$8.67	$31.88
General health panel	CPT	80050	2	$349.9	$139.96	$47.28	$47.28	$152.92
Electrolyte panel	CPT	80051	13	$51.5	$20.6	$7.01	$7.19	$26.76
Comprehensive metabolic panel	CPT	80053	13	$138	$55.2	$10.56	$10.83	$39.52
Lipid panel	CPT	80061	13	$93	$37.2	$13.39	$13.73	$50.96
Renal function panel	CPT	80069	13	$78.7	$31.48	$8.68	$8.9	$33.16
Hepatic function panel	CPT	80076	13	$61.9	$24.76	$8.17	$8.38	$30.6
Urinalysis non-automated	CPT	81002	13	$20.5	$8.2	$3.48	$3.57	$12.76
Urinalysis automated	CPT	81003	13	$36.4	$14.56	$2.25	$2.31	$8.92
Glucose quantitative	CPT	82947	13	$42.4	$16.96	$3.93	$4.03	$15.32
Hemoglobin A1c	CPT	83036	13	$64.2	$25.68	$9.71	$9.95	$36.96
Thyroid stimulating hormone (TSH)	CPT	84443	13	$147.6	$59.04	$16.8	$17.22	$63.72
Complete blood count with automated differential	CPT	85025	13	$193	$77.2	$7.77	$7.97	$29.32
Complete blood count without differential	CPT	85027	13	$51	$20.4	$6.47	$6.63	$24.24
Urine culture bacterial	CPT	87086	13	$45.4	$18.16	$8.07	$8.27	$30.6
Urine culture identification	CPT	87088	13	$70.9	$28.36	$8.09	$8.29	$30.6
Tissue exam by pathologist level IV	CPT	88305	13	$387	$154.8	$49.47	$54.97	$133.2
maternity
Fetal non-stress test	CPT	59025	12	—	—	$201.93	$206.98	$454.34
office
Office visit, new patient, 15-29 min	CPT	99202	1	$432	$172.8	$63.72	$63.72	$63.72
Office visit, new patient, 30-44 minutes	CPT	99203	1	$732	$292.8	$95.12	$95.12	$95.12
Office visit, new patient, 45-59 min	CPT	99204	1	$707	$282.8	$134.67	$134.67	$134.67
Office visit, new patient, 60-74 min	CPT	99205	1	$1,083	$433.2	$171.42	$171.42	$171.42
Office visit, established patient, 5 min	CPT	99211	1	$432	$172.8	$20.73	$20.73	$20.73
Office visit, established patient, 10-19 min	CPT	99212	1	$395	$158	$37.61	$37.61	$37.61
Office visit, established patient, 20-29 minutes	CPT	99213	1	$593	$237.2	$51.26	$51.26	$51.26
Office visit, established patient, 30-39 minutes	CPT	99214	1	$729	$291.6	$80.56	$80.56	$80.56
Office visit, established patient, 40-54 min	CPT	99215	1	$1,067	$426.8	$117.66	$117.66	$117.66
preventive
Upper GI endoscopy diagnostic	CPT	43235	12	—	—	$941.1	$969.33	$11,584
Upper GI endoscopy with biopsy	CPT	43239	12	—	—	$941.1	$969.33	$11,584
Sigmoidoscopy diagnostic	CPT	45330	12	—	—	$915.16	$942.61	$11,584
Sigmoidoscopy with biopsy	CPT	45331	12	—	—	$915.16	$942.61	$11,584
Colonoscopy diagnostic	CPT	45378	12	—	—	$915.16	$942.61	$11,584
Colonoscopy with biopsy	CPT	45380	1	—	—	$5,792	$8,688	$11,584
Colonoscopy with polyp removal	CPT	45385	1	—	—	$5,792	$8,688	$11,584
surgery
Total hip replacement	CPT	27130	2	—	—	$8,720	$20,977	$33,233
Total knee replacement	CPT	27447	2	—	—	$8,720	$20,714	$32,708
Shoulder arthroscopy with decompression	CPT	29826	1	—	—	$19,776	$19,776	$19,776
Shoulder arthroscopy with rotator cuff repair	CPT	29827	1	—	—	$19,776	$19,776	$19,776
Knee arthroscopy with meniscectomy	CPT	29881	1	—	—	$19,776	$19,776	$19,776
ACL reconstruction	CPT	29888	1	—	—	$19,776	$19,776	$19,776
Major small/large bowel procedures w MCC	MS-DRG	329	17	—	—	$7,300	$28,828	$64,863
Major small/large bowel procedures w CC	MS-DRG	330	17	—	—	$7,300	$15,035	$33,828
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	17	—	—	$7,300	$11,153	$23,748
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	17	—	—	$7,300	$10,927	$23,871
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	17	—	—	$7,300	$10,470	$19,273
Laparoscopic cholecystectomy w/o CDE w/o CC/MCC	MS-DRG	420	17	—	—	$7,300	$21,368	$48,079
Open appendectomy	CPT	44950	1	—	—	$5,792	$8,688	$11,584
Major joint replacement w MCC	MS-DRG	469	17	—	—	$7,300	$19,023	$44,380
Major joint replacement w/o MCC	MS-DRG	470	17	—	—	$7,300	$12,429	$44,380
Hip & femur procedures except major joint w MCC	MS-DRG	480	17	—	—	$7,300	$18,265	$41,096
Hip & femur procedures except major joint w CC	MS-DRG	481	17	—	—	$7,300	$13,530	$39,104
Hip & femur procedures except major joint w/o CC/MCC	MS-DRG	482	17	—	—	$7,300	$10,536	$39,104
Lap inguinal hernia repair	CPT	49650	1	—	—	$9,500	$9,500	$9,500
OR procedure for obesity w MCC	MS-DRG	619	17	—	—	$7,300	$18,180	$40,745
OR procedure for obesity w CC	MS-DRG	620	17	—	—	$7,300	$12,024	$30,965
OR procedure for obesity w/o CC/MCC	MS-DRG	621	17	—	—	$7,300	$11,133	$30,965
Intravitreal injection	CPT	67028	12	—	—	$332.94	$341.27	$749.12
Uterine & adnexa procedures w CC/MCC	MS-DRG	743	17	—	—	$6,978.43	$10,470	$19,155
Uterine & adnexa procedures w/o CC/MCC	MS-DRG	744	17	—	—	$7,300	$12,980	$28,915
PCI single major coronary artery	CPT	92920	3	$30,446	$12,178	$10,790	$19,483	$34,355
PCI with drug-eluting stent	CPT	92928	3	—	—	$18,946	$22,049	$34,355
PCI bypass graft	CPT	92937	3	—	—	$18,946	$22,049	$34,355
Left heart catheterization	CPT	93452	1	—	—	$16,775	$16,775	$16,775
Coronary angiography with cath	CPT	93455	1	—	—	$16,775	$16,775	$16,775
Coronary angiography with bypass cath	CPT	93458	1	—	—	$16,775	$16,775	$16,775

Payer mix (top 18)

Payer	Codes covered	Median rate
Aetna	146	$369.23
UnitedHealthcare	140	$362.06
blue mcr replacement	136	$178.69
WellCare	136	$178.69
Ambetter	136	$294.84
healthspring mcr replacement	136	$182.26
Humana	136	$184.05
Medicare Advantage	136	$178.69
occunet	136	$402.05
Oscar Health	136	$285.9
smarthealth	136	$250.17
facility billing - op	136	$178.69
Cigna	130	$2,018.07
Blue Cross Blue Shield	49	$12,024
TRICARE	40	$7,477.06
First Health	40	$7,300
pcc employee	40	$10,815
evernorth behavioral health	20	$69.02