Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

MDMA CONFIRMATION

Facility

$28.51

Hospital Charge Code	3101604
Hospital Revenue Code	300
Min. Negotiated Rate	$19.96
Max. Negotiated Rate	$24.23
Rate for Payer: Cash Price	$18.53
Rate for Payer: Community Health Alliance Commercial	$24.23
Rate for Payer: Priority Health Commercial	$19.96
Rate for Payer: Priority Health PPO	$19.96

MDMA/MDA GCMS

Facility

$119.00

Hospital Charge Code	3005581
Hospital Revenue Code	301
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$101.15
Rate for Payer: Cash Price	$77.35
Rate for Payer: Community Health Alliance Commercial	$101.15
Rate for Payer: Priority Health Commercial	$83.30
Rate for Payer: Priority Health PPO	$83.30

MEASLES AB IGM-LC

Facility

$32.39

Hospital Charge Code	31027470
Hospital Revenue Code	300
Min. Negotiated Rate	$22.67
Max. Negotiated Rate	$27.53
Rate for Payer: Cash Price	$21.05
Rate for Payer: Community Health Alliance Commercial	$27.53
Rate for Payer: Priority Health Commercial	$22.67
Rate for Payer: Priority Health PPO	$22.67

MECONIUM DRUG SCREEN

Facility

$70.00

Service Code	HCPCS 80307
Hospital Charge Code	3002910
Hospital Revenue Code	301
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$65.25
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$45.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$65.25
Rate for Payer: Meridian Health Plan Medicare	$65.25
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$49.00
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

MEDACTA KNEE COMPONENTS

Facility

$16,130.00

Hospital Charge Code	27882962
Hospital Revenue Code	278
Min. Negotiated Rate	$11,291.00
Max. Negotiated Rate	$13,710.50
Rate for Payer: Cash Price	$10,484.50
Rate for Payer: Community Health Alliance Commercial	$13,710.50
Rate for Payer: Priority Health Commercial	$11,291.00
Rate for Payer: Priority Health PPO	$11,291.00

MELANIN STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100360
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

MELANOCYTE STIMULATING HORMONE

Facility

$56.20

Hospital Charge Code	3101471
Hospital Revenue Code	300
Min. Negotiated Rate	$39.34
Max. Negotiated Rate	$47.77
Rate for Payer: Cash Price	$36.53
Rate for Payer: Community Health Alliance Commercial	$47.77
Rate for Payer: Priority Health Commercial	$39.34
Rate for Payer: Priority Health PPO	$39.34

MELATONIN

Facility

$96.00

Hospital Charge Code	3100018
Hospital Revenue Code	301
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$81.60
Rate for Payer: Cash Price	$62.40
Rate for Payer: Community Health Alliance Commercial	$81.60
Rate for Payer: Priority Health Commercial	$67.20
Rate for Payer: Priority Health PPO	$67.20

MEMORY II DBL LUMEN BASKET

Facility

$539.00

Hospital Charge Code	27264595
Hospital Revenue Code	272
Min. Negotiated Rate	$377.30
Max. Negotiated Rate	$458.15
Rate for Payer: Cash Price	$350.35
Rate for Payer: Community Health Alliance Commercial	$458.15
Rate for Payer: Priority Health Commercial	$377.30
Rate for Payer: Priority Health PPO	$377.30

MENINGITIS/ENCEPHALITIS PAN

Facility

$550.00

Hospital Charge Code	3101233
Hospital Revenue Code	306
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$467.50
Rate for Payer: Cash Price	$357.50
Rate for Payer: Community Health Alliance Commercial	$467.50
Rate for Payer: Priority Health Commercial	$385.00
Rate for Payer: Priority Health PPO	$385.00

MENISCUS CUTTER

Facility

$287.00

Hospital Charge Code	27016899
Hospital Revenue Code	272
Min. Negotiated Rate	$200.90
Max. Negotiated Rate	$243.95
Rate for Payer: Cash Price	$186.55
Rate for Payer: Community Health Alliance Commercial	$243.95
Rate for Payer: Priority Health Commercial	$200.90
Rate for Payer: Priority Health PPO	$200.90

MENISCUS CUTTER BLADE 4.0MM

Facility

$238.00

Hospital Charge Code	27016626
Hospital Revenue Code	272
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$202.30
Rate for Payer: Cash Price	$154.70
Rate for Payer: Community Health Alliance Commercial	$202.30
Rate for Payer: Priority Health Commercial	$166.60
Rate for Payer: Priority Health PPO	$166.60

MEPERIDINE SERUM PLASMA

Facility

$96.00

Service Code	HCPCS G0480
Hospital Charge Code	3003570
Hospital Revenue Code	301
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	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Community Health Alliance Commercial	$81.60
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	$67.20
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$67.20
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

MERCURY, HAIR ANALYSIS

Facility

$100.00

Service Code	HCPCS 83825
Hospital Charge Code	3006025
Hospital Revenue Code	301
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$85.00
Rate for Payer: BCBS BCN 65	$17.07
Rate for Payer: Blue Care Network Medicare Advantage	$17.07
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.07
Rate for Payer: Meridian Health Plan Medicare	$17.07
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health Medicaid	$17.07
Rate for Payer: Priority Health Medicare	$17.07
Rate for Payer: Priority Health PPO	$70.00
Rate for Payer: United Health Care Medicaid	$17.07
Rate for Payer: United Health Care Medicare Advantage	$7.51

MERCURY, SERUM

Facility

$15.48

Service Code	HCPCS 83825
Hospital Charge Code	3006050
Hospital Revenue Code	301
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$17.07
Rate for Payer: BCBS BCN 65	$17.07
Rate for Payer: Blue Care Network Medicare Advantage	$17.07
Rate for Payer: Cash Price	$10.06
Rate for Payer: Cash Price	$10.06
Rate for Payer: Community Health Alliance Commercial	$13.16
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.07
Rate for Payer: Meridian Health Plan Medicare	$17.07
Rate for Payer: Priority Health Commercial	$10.84
Rate for Payer: Priority Health Medicaid	$17.07
Rate for Payer: Priority Health Medicare	$17.07
Rate for Payer: Priority Health PPO	$10.84
Rate for Payer: United Health Care Medicaid	$17.07
Rate for Payer: United Health Care Medicare Advantage	$7.51

MERCURY URINE

Facility

$8.00

Hospital Charge Code	3102389
Hospital Revenue Code	300
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$6.80
Rate for Payer: Cash Price	$5.20
Rate for Payer: Community Health Alliance Commercial	$6.80
Rate for Payer: Priority Health Commercial	$5.60
Rate for Payer: Priority Health PPO	$5.60

MESH

Facility

$105.00

Service Code	HCPCS C1781
Hospital Charge Code	27265379
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

MESH 6.6 CM

Facility

$742.72

Service Code	HCPCS C1781
Hospital Charge Code	27885695
Hospital Revenue Code	278
Min. Negotiated Rate	$519.90
Max. Negotiated Rate	$631.31
Rate for Payer: Cash Price	$482.77
Rate for Payer: Community Health Alliance Commercial	$631.31
Rate for Payer: Priority Health Commercial	$519.90
Rate for Payer: Priority Health PPO	$519.90

MESH 8.6 CM

Facility

$1,157.04

Service Code	HCPCS C1781
Hospital Charge Code	27885759
Hospital Revenue Code	278
Min. Negotiated Rate	$809.93
Max. Negotiated Rate	$983.48
Rate for Payer: Cash Price	$752.08
Rate for Payer: Community Health Alliance Commercial	$983.48
Rate for Payer: Priority Health Commercial	$809.93
Rate for Payer: Priority Health PPO	$809.93

MESH, COMPOSITE

Facility

$1,025.00

Service Code	HCPCS C1781
Hospital Charge Code	27262740
Hospital Revenue Code	278
Min. Negotiated Rate	$717.50
Max. Negotiated Rate	$871.25
Rate for Payer: Cash Price	$666.25
Rate for Payer: Community Health Alliance Commercial	$871.25
Rate for Payer: Priority Health Commercial	$717.50
Rate for Payer: Priority Health PPO	$717.50

MESH, COMPOSIX 2 X 4

Facility

$823.00

Service Code	HCPCS C1781
Hospital Charge Code	27263540
Hospital Revenue Code	278
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

MESH, COMPOSIX 4 X 8

Facility

$1,547.00

Service Code	HCPCS C1781
Hospital Charge Code	27262301
Hospital Revenue Code	278
Min. Negotiated Rate	$1,082.90
Max. Negotiated Rate	$1,314.95
Rate for Payer: Cash Price	$1,005.55
Rate for Payer: Community Health Alliance Commercial	$1,314.95
Rate for Payer: Priority Health Commercial	$1,082.90
Rate for Payer: Priority Health PPO	$1,082.90

MESH, LURH MICRO 60MM X 100MM

Facility

$2,147.00

Service Code	HCPCS C1781
Hospital Charge Code	27017343
Hospital Revenue Code	278
Min. Negotiated Rate	$1,502.90
Max. Negotiated Rate	$1,824.95
Rate for Payer: Cash Price	$1,395.55
Rate for Payer: Community Health Alliance Commercial	$1,824.95
Rate for Payer: Priority Health Commercial	$1,502.90
Rate for Payer: Priority Health PPO	$1,502.90

MESH, MARLEX

Facility

$217.00

Service Code	HCPCS C1781
Hospital Charge Code	27815396
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

MESH, OVAL-LG

Facility

$4,278.00

Service Code	HCPCS C1781
Hospital Charge Code	27866716
Hospital Revenue Code	278
Min. Negotiated Rate	$2,994.60
Max. Negotiated Rate	$3,636.30
Rate for Payer: Cash Price	$2,780.70
Rate for Payer: Community Health Alliance Commercial	$3,636.30
Rate for Payer: Priority Health Commercial	$2,994.60
Rate for Payer: Priority Health PPO	$2,994.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges