Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

LUTENIZING HORMONE SERUM (LH)-

Facility

$115.00

Hospital Charge Code	3101291
Hospital Revenue Code	301
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$97.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Community Health Alliance Commercial	$97.75
Rate for Payer: Priority Health Commercial	$80.50
Rate for Payer: Priority Health PPO	$80.50

LUTINIZING HORMONE - URINE

Facility

$167.00

Service Code	HCPCS 83002
Hospital Charge Code	3005925
Hospital Revenue Code	301
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$141.95
Rate for Payer: BCBS BCN 65	$19.45
Rate for Payer: Blue Care Network Medicare Advantage	$19.45
Rate for Payer: Cash Price	$108.55
Rate for Payer: Cash Price	$108.55
Rate for Payer: Community Health Alliance Commercial	$141.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.45
Rate for Payer: Meridian Health Plan Medicare	$19.45
Rate for Payer: Priority Health Commercial	$116.90
Rate for Payer: Priority Health Medicaid	$19.45
Rate for Payer: Priority Health Medicare	$19.45
Rate for Payer: Priority Health PPO	$116.90
Rate for Payer: United Health Care Medicaid	$19.45
Rate for Payer: United Health Care Medicare Advantage	$8.56

LUXOL FST BLU STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100340
Hospital Revenue Code	310
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

LYME DISEASE ANTIBODIES

Facility

$15.00

Service Code	HCPCS 86618
Hospital Charge Code	3005940
Hospital Revenue Code	302
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$17.88
Rate for Payer: BCBS BCN 65	$17.88
Rate for Payer: Blue Care Network Medicare Advantage	$17.88
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.88
Rate for Payer: Meridian Health Plan Medicare	$17.88
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$17.88
Rate for Payer: Priority Health Medicare	$17.88
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$17.88
Rate for Payer: United Health Care Medicare Advantage	$7.87

LYME DISEASE ANTIBODY TO STATE

Facility

$42.00

Service Code	HCPCS 86618
Hospital Charge Code	3005945
Hospital Revenue Code	302
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$35.70
Rate for Payer: BCBS BCN 65	$17.88
Rate for Payer: Blue Care Network Medicare Advantage	$17.88
Rate for Payer: Cash Price	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.88
Rate for Payer: Meridian Health Plan Medicare	$17.88
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health Medicaid	$17.88
Rate for Payer: Priority Health Medicare	$17.88
Rate for Payer: Priority Health PPO	$29.40
Rate for Payer: United Health Care Medicaid	$17.88
Rate for Payer: United Health Care Medicare Advantage	$7.87

LYME DISEASE BORRELIA BURGDORF

Facility

$59.00

Hospital Charge Code	3102532
Hospital Revenue Code	300
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$50.15
Rate for Payer: Cash Price	$38.35
Rate for Payer: Community Health Alliance Commercial	$50.15
Rate for Payer: Priority Health Commercial	$41.30
Rate for Payer: Priority Health PPO	$41.30

LYME DISEASE SER W/REF

Facility

$10.00

Hospital Charge Code	3102222
Hospital Revenue Code	300
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health PPO	$7.00

LYME DISEASE WESTERN BLOT Igm

Facility

$7.90

Service Code	HCPCS 86617
Hospital Charge Code	3005950
Hospital Revenue Code	302
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$16.26
Rate for Payer: BCBS BCN 65	$16.26
Rate for Payer: Blue Care Network Medicare Advantage	$16.26
Rate for Payer: Cash Price	$5.14
Rate for Payer: Cash Price	$5.14
Rate for Payer: Community Health Alliance Commercial	$6.71
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.26
Rate for Payer: Meridian Health Plan Medicare	$16.26
Rate for Payer: Priority Health Commercial	$5.53
Rate for Payer: Priority Health Medicaid	$16.26
Rate for Payer: Priority Health Medicare	$16.26
Rate for Payer: Priority Health PPO	$5.53
Rate for Payer: United Health Care Medicaid	$16.26
Rate for Payer: United Health Care Medicare Advantage	$7.16

LYME WESTERN BLOT IgG

Facility

$7.90

Hospital Charge Code	3005949
Hospital Revenue Code	302
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$6.71
Rate for Payer: Cash Price	$5.14
Rate for Payer: Community Health Alliance Commercial	$6.71
Rate for Payer: Priority Health Commercial	$5.53
Rate for Payer: Priority Health PPO	$5.53

LYMPHATIC MAPPING PROCEDURE

Facility

$684.00

Hospital Charge Code	27265577
Hospital Revenue Code	272
Min. Negotiated Rate	$478.80
Max. Negotiated Rate	$581.40
Rate for Payer: Cash Price	$444.60
Rate for Payer: Community Health Alliance Commercial	$581.40
Rate for Payer: Priority Health Commercial	$478.80
Rate for Payer: Priority Health PPO	$478.80

LYMPHOCYTE

Facility

$541.00

Hospital Charge Code	3000719
Hospital Revenue Code	311
Min. Negotiated Rate	$378.70
Max. Negotiated Rate	$459.85
Rate for Payer: Cash Price	$351.65
Rate for Payer: Community Health Alliance Commercial	$459.85
Rate for Payer: Priority Health Commercial	$378.70
Rate for Payer: Priority Health PPO	$378.70

LYNX SUPRAPUBIC SLING SYSTEM

Facility

$2,748.00

Service Code	HCPCS C1771
Hospital Charge Code	27274991
Hospital Revenue Code	278
Min. Negotiated Rate	$1,923.60
Max. Negotiated Rate	$2,335.80
Rate for Payer: Cash Price	$1,786.20
Rate for Payer: Community Health Alliance Commercial	$2,335.80
Rate for Payer: Priority Health Commercial	$1,923.60
Rate for Payer: Priority Health PPO	$1,923.60

LYSINE

Facility

$50.00

Service Code	HCPCS 82131
Hospital Charge Code	3005930
Hospital Revenue Code	301
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$24.13
Rate for Payer: Blue Care Network Medicare Advantage	$24.13
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$24.13
Rate for Payer: Meridian Health Plan Medicare	$24.13
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$24.13
Rate for Payer: Priority Health Medicare	$24.13
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$24.13
Rate for Payer: United Health Care Medicare Advantage	$10.62

LYSOZYME

Facility

$5.00

Service Code	HCPCS 85549
Hospital Charge Code	3005929
Hospital Revenue Code	300
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$19.69
Rate for Payer: BCBS BCN 65	$19.69
Rate for Payer: Blue Care Network Medicare Advantage	$19.69
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.69
Rate for Payer: Meridian Health Plan Medicare	$19.69
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$19.69
Rate for Payer: Priority Health Medicare	$19.69
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$19.69
Rate for Payer: United Health Care Medicare Advantage	$8.66

MAC BROTH

Facility

$21.00

Hospital Charge Code	3003349
Hospital Revenue Code	306
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health PPO	$14.70

MACROPROLACTIN

Facility

$72.49

Hospital Charge Code	3007113
Hospital Revenue Code	301
Min. Negotiated Rate	$50.74
Max. Negotiated Rate	$61.62
Rate for Payer: Cash Price	$47.12
Rate for Payer: Community Health Alliance Commercial	$61.62
Rate for Payer: Priority Health Commercial	$50.74
Rate for Payer: Priority Health PPO	$50.74

MAG ANTIBODIES

Facility

$46.00

Service Code	HCPCS 86255
Hospital Charge Code	3005955
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$39.10
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$29.90
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.65
Rate for Payer: Meridian Health Plan Medicare	$12.65
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$32.20
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

MAGNESIUM

Facility

$27.00

Service Code	HCPCS 83735
Hospital Charge Code	3005960
Hospital Revenue Code	301
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$22.95
Rate for Payer: BCBS BCN 65	$7.04
Rate for Payer: Blue Care Network Medicare Advantage	$7.04
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.04
Rate for Payer: Meridian Health Plan Medicare	$7.04
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health Medicaid	$7.04
Rate for Payer: Priority Health Medicare	$7.04
Rate for Payer: Priority Health PPO	$18.90
Rate for Payer: United Health Care Medicaid	$7.04
Rate for Payer: United Health Care Medicare Advantage	$3.10

MALARIAL THICK/THIN SMEAR

Facility

$9.87

Service Code	HCPCS 87207
Hospital Charge Code	3005980
Hospital Revenue Code	306
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$8.39
Rate for Payer: BCBS BCN 65	$6.29
Rate for Payer: Blue Care Network Medicare Advantage	$6.29
Rate for Payer: Cash Price	$6.42
Rate for Payer: Cash Price	$6.42
Rate for Payer: Community Health Alliance Commercial	$8.39
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.29
Rate for Payer: Meridian Health Plan Medicare	$6.29
Rate for Payer: Priority Health Commercial	$6.91
Rate for Payer: Priority Health Medicaid	$6.29
Rate for Payer: Priority Health Medicare	$6.29
Rate for Payer: Priority Health PPO	$6.91
Rate for Payer: United Health Care Medicaid	$6.29
Rate for Payer: United Health Care Medicare Advantage	$2.77

MALARIA TOTAL ANTIBODIES

Facility

$118.00

Hospital Charge Code	3100719
Hospital Revenue Code	300
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$100.30
Rate for Payer: Cash Price	$76.70
Rate for Payer: Community Health Alliance Commercial	$100.30
Rate for Payer: Priority Health Commercial	$82.60
Rate for Payer: Priority Health PPO	$82.60

MALECOT ABCESS DRAINAGE SET

Facility

$575.00

Hospital Charge Code	27264397
Hospital Revenue Code	272
Min. Negotiated Rate	$402.50
Max. Negotiated Rate	$488.75
Rate for Payer: Cash Price	$373.75
Rate for Payer: Community Health Alliance Commercial	$488.75
Rate for Payer: Priority Health Commercial	$402.50
Rate for Payer: Priority Health PPO	$402.50

MALECOT CATH DRAINAGE SET ASMS

Facility

$276.00

Hospital Charge Code	27014159
Hospital Revenue Code	272
Min. Negotiated Rate	$193.20
Max. Negotiated Rate	$234.60
Rate for Payer: Cash Price	$179.40
Rate for Payer: Community Health Alliance Commercial	$234.60
Rate for Payer: Priority Health Commercial	$193.20
Rate for Payer: Priority Health PPO	$193.20

MALLEO, EPI GENUTRAIN

Facility

$170.00

Hospital Charge Code	27013953
Hospital Revenue Code	270
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$144.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Community Health Alliance Commercial	$144.50
Rate for Payer: Priority Health Commercial	$119.00
Rate for Payer: Priority Health PPO	$119.00

MALYUGIN RING SYSTEM

Facility

$336.88

Hospital Charge Code	27274175
Hospital Revenue Code	272
Min. Negotiated Rate	$235.82
Max. Negotiated Rate	$286.35
Rate for Payer: Cash Price	$218.97
Rate for Payer: Community Health Alliance Commercial	$286.35
Rate for Payer: Priority Health Commercial	$235.82
Rate for Payer: Priority Health PPO	$235.82

MAMMOTOME HH PROBE 11G

Facility

$823.00

Hospital Charge Code	27264769
Hospital Revenue Code	272
Min. Negotiated Rate	$576.10
Max. Negotiated Rate	$699.55
Rate for Payer: Cash Price	$534.95
Rate for Payer: Community Health Alliance Commercial	$699.55
Rate for Payer: Priority Health Commercial	$576.10
Rate for Payer: Priority Health PPO	$576.10

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges