Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

MAMMOTOME ST PROBE

Facility

$980.00

Hospital Charge Code	27264827
Hospital Revenue Code	272
Min. Negotiated Rate	$686.00
Max. Negotiated Rate	$833.00
Rate for Payer: Cash Price	$637.00
Rate for Payer: Community Health Alliance Commercial	$833.00
Rate for Payer: Priority Health Commercial	$686.00
Rate for Payer: Priority Health PPO	$686.00

MAMMOTOME VACUUM CANNISTER

Facility

$29.00

Hospital Charge Code	27264793
Hospital Revenue Code	272
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$24.65
Rate for Payer: Cash Price	$18.85
Rate for Payer: Community Health Alliance Commercial	$24.65
Rate for Payer: Priority Health Commercial	$20.30
Rate for Payer: Priority Health PPO	$20.30

MAMMOTOME VACUUM SET

Facility

$74.00

Hospital Charge Code	27264777
Hospital Revenue Code	272
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$62.90
Rate for Payer: Cash Price	$48.10
Rate for Payer: Community Health Alliance Commercial	$62.90
Rate for Payer: Priority Health Commercial	$51.80
Rate for Payer: Priority Health PPO	$51.80

MANGANESE

Facility

$62.00

Service Code	HCPCS 83785
Hospital Charge Code	3006000
Hospital Revenue Code	301
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$52.70
Rate for Payer: BCBS BCN 65	$27.98
Rate for Payer: Blue Care Network Medicare Advantage	$27.98
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cash Price	$40.30
Rate for Payer: Community Health Alliance Commercial	$52.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$27.98
Rate for Payer: Meridian Health Plan Medicare	$27.98
Rate for Payer: Priority Health Commercial	$43.40
Rate for Payer: Priority Health Medicaid	$27.98
Rate for Payer: Priority Health Medicare	$27.98
Rate for Payer: Priority Health PPO	$43.40
Rate for Payer: United Health Care Medicaid	$27.98
Rate for Payer: United Health Care Medicare Advantage	$12.31

MANIFOLD NEPTUNE ROVER

Facility

$38.00

Hospital Charge Code	27275313
Hospital Revenue Code	272
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$32.30
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health PPO	$26.60

MANOMETER - CENT VEIN PRESSURE

Facility

$44.00

Hospital Charge Code	27011098
Hospital Revenue Code	270
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

MANUAL THERAPY EACH 15 MINUTES

Facility

$71.00

Service Code	HCPCS 97140 GP
Hospital Charge Code	4200230
Hospital Revenue Code	420
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$60.35
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health PPO	$49.70

MARIJUANA LC-MS

Facility

$103.99

Service Code	HCPCS G0480
Hospital Charge Code	3100166
Hospital Revenue Code	309
Min. Negotiated Rate	$52.87
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$67.59
Rate for Payer: Cash Price	$67.59
Rate for Payer: Community Health Alliance Commercial	$88.39
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$72.79
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$72.79
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

MARKERS 17-26

Facility

$224.00

Hospital Charge Code	3006223
Hospital Revenue Code	971
Min. Negotiated Rate	$156.80
Max. Negotiated Rate	$190.40
Rate for Payer: Cash Price	$145.60
Rate for Payer: Community Health Alliance Commercial	$190.40
Rate for Payer: Priority Health Commercial	$156.80
Rate for Payer: Priority Health PPO	$156.80

MARLEX MESH

Facility

$217.00

Service Code	HCPCS C1781
Hospital Charge Code	27015396
Hospital Revenue Code	278
Min. Negotiated Rate	$151.90
Max. Negotiated Rate	$184.45
Rate for Payer: Cash Price	$141.05
Rate for Payer: Community Health Alliance Commercial	$184.45
Rate for Payer: Priority Health Commercial	$151.90
Rate for Payer: Priority Health PPO	$151.90

MASON ALLEN SPLINT

Facility

$77.00

Hospital Charge Code	27012955
Hospital Revenue Code	270
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$65.45
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health PPO	$53.90

MASSAGE EACH 15 MINUTES

Facility

$99.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	4200240
Hospital Revenue Code	420
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$84.15
Rate for Payer: Cash Price	$64.35
Rate for Payer: Community Health Alliance Commercial	$84.15
Rate for Payer: Priority Health Commercial	$69.30
Rate for Payer: Priority Health PPO	$69.30

MASTISOL

Facility

$47.00

Hospital Charge Code	27061915
Hospital Revenue Code	270
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$39.95
Rate for Payer: Cash Price	$30.55
Rate for Payer: Community Health Alliance Commercial	$39.95
Rate for Payer: Priority Health Commercial	$32.90
Rate for Payer: Priority Health PPO	$32.90

MaterniT21 Plus Core

Facility

$349.00

Hospital Charge Code	31027711
Hospital Revenue Code	300
Min. Negotiated Rate	$244.30
Max. Negotiated Rate	$296.65
Rate for Payer: Cash Price	$226.85
Rate for Payer: Community Health Alliance Commercial	$296.65
Rate for Payer: Priority Health Commercial	$244.30
Rate for Payer: Priority Health PPO	$244.30

MATERNITY 21 COLLECTION

Facility

$20.00

Hospital Charge Code	3100773
Hospital Revenue Code	300
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$17.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health PPO	$14.00

MATERNITY 21 LAB CORP

Facility

$795.00

Hospital Charge Code	3101677
Hospital Revenue Code	300
Min. Negotiated Rate	$556.50
Max. Negotiated Rate	$675.75
Rate for Payer: Cash Price	$516.75
Rate for Payer: Community Health Alliance Commercial	$675.75
Rate for Payer: Priority Health Commercial	$556.50
Rate for Payer: Priority Health PPO	$556.50

MATRAX AIR WALKER

Facility

$121.00

Hospital Charge Code	27072054
Hospital Revenue Code	270
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$102.85
Rate for Payer: Cash Price	$78.65
Rate for Payer: Community Health Alliance Commercial	$102.85
Rate for Payer: Priority Health Commercial	$84.70
Rate for Payer: Priority Health PPO	$84.70

MATRIX METAL09

Facility

$65.16

Hospital Charge Code	3101949
Hospital Revenue Code	300
Min. Negotiated Rate	$45.61
Max. Negotiated Rate	$55.39
Rate for Payer: Cash Price	$42.35
Rate for Payer: Community Health Alliance Commercial	$55.39
Rate for Payer: Priority Health Commercial	$45.61
Rate for Payer: Priority Health PPO	$45.61

MCG SITU HYBRID 305 CELLS-3

Facility

$46.00

Hospital Charge Code	3100242
Hospital Revenue Code	310
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

MCG SITU HYBRID 305 CELLS-5

Facility

$46.00

Hospital Charge Code	3100244
Hospital Revenue Code	310
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

MCG SITU HYBRID 3-5 CELLS-1

Facility

$46.00

Hospital Charge Code	3100239
Hospital Revenue Code	310
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

MCG SITU HYBRID 3-5 CELLS-2

Facility

$46.00

Hospital Charge Code	3100241
Hospital Revenue Code	310
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

MCG SITU HYBRID 3-5 CELLS-4

Facility

$46.00

Hospital Charge Code	3100243
Hospital Revenue Code	310
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

MCKENZIE NIGHT ROLL,LARGE

Facility

$78.00

Hospital Charge Code	27022871
Hospital Revenue Code	270
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health PPO	$54.60

MCT-1

Facility

$4.77

Hospital Charge Code	3101618
Hospital Revenue Code	300
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$4.05
Rate for Payer: Cash Price	$3.10
Rate for Payer: Community Health Alliance Commercial	$4.05
Rate for Payer: Priority Health Commercial	$3.34
Rate for Payer: Priority Health PPO	$3.34

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges