Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

MESH,OVAL-MEDIUM

Facility

$3,365.00

Service Code	HCPCS C1781
Hospital Charge Code	27866708
Hospital Revenue Code	278
Min. Negotiated Rate	$2,355.50
Max. Negotiated Rate	$2,860.25
Rate for Payer: Cash Price	$2,187.25
Rate for Payer: Community Health Alliance Commercial	$2,860.25
Rate for Payer: Priority Health Commercial	$2,355.50
Rate for Payer: Priority Health PPO	$2,355.50

MESH, PATCH VENTRALEX -MED

Facility

$1,794.00

Service Code	HCPCS C1781
Hospital Charge Code	27866906
Hospital Revenue Code	278
Min. Negotiated Rate	$1,255.80
Max. Negotiated Rate	$1,524.90
Rate for Payer: Cash Price	$1,166.10
Rate for Payer: Community Health Alliance Commercial	$1,524.90
Rate for Payer: Priority Health Commercial	$1,255.80
Rate for Payer: Priority Health PPO	$1,255.80

MESH, PATCH VENTRALEX-MED

Facility

$1,847.00

Service Code	HCPCS C1781
Hospital Charge Code	278666906
Hospital Revenue Code	278
Min. Negotiated Rate	$1,292.90
Max. Negotiated Rate	$1,569.95
Rate for Payer: Cash Price	$1,200.55
Rate for Payer: Community Health Alliance Commercial	$1,569.95
Rate for Payer: Priority Health Commercial	$1,292.90
Rate for Payer: Priority Health PPO	$1,292.90

MESH,PATCH VENTRALEX-SMALL

Facility

$1,688.00

Service Code	HCPCS C1781
Hospital Charge Code	27866914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.60
Max. Negotiated Rate	$1,434.80
Rate for Payer: Cash Price	$1,097.20
Rate for Payer: Community Health Alliance Commercial	$1,434.80
Rate for Payer: Priority Health Commercial	$1,181.60
Rate for Payer: Priority Health PPO	$1,181.60

MESH PROCEED 4 x 6

Facility

$836.19

Service Code	HCPCS C1781
Hospital Charge Code	27876089
Hospital Revenue Code	278
Min. Negotiated Rate	$585.33
Max. Negotiated Rate	$710.76
Rate for Payer: Cash Price	$543.52
Rate for Payer: Community Health Alliance Commercial	$710.76
Rate for Payer: Priority Health Commercial	$585.33
Rate for Payer: Priority Health PPO	$585.33

MESH, PROCEED 6 X 8

Facility

$2,750.00

Service Code	HCPCS C1781
Hospital Charge Code	27262318
Hospital Revenue Code	278
Min. Negotiated Rate	$1,925.00
Max. Negotiated Rate	$2,337.50
Rate for Payer: Cash Price	$1,787.50
Rate for Payer: Community Health Alliance Commercial	$2,337.50
Rate for Payer: Priority Health Commercial	$1,925.00
Rate for Payer: Priority Health PPO	$1,925.00

MESH, PROGRIP 12X16 FLAT SHT

Facility

$978.75

Service Code	HCPCS C1781
Hospital Charge Code	27885887
Hospital Revenue Code	278
Min. Negotiated Rate	$685.12
Max. Negotiated Rate	$831.94
Rate for Payer: Cash Price	$636.19
Rate for Payer: Community Health Alliance Commercial	$831.94
Rate for Payer: Priority Health Commercial	$685.12
Rate for Payer: Priority Health PPO	$685.12

MESH, PROGRIP 12x8

Facility

$598.34

Hospital Charge Code	27886015
Hospital Revenue Code	278
Min. Negotiated Rate	$418.84
Max. Negotiated Rate	$508.59
Rate for Payer: Cash Price	$388.92
Rate for Payer: Community Health Alliance Commercial	$508.59
Rate for Payer: Priority Health Commercial	$418.84
Rate for Payer: Priority Health PPO	$418.84

MESH PROGRIP 12 X 8

Facility

$598.34

Hospital Charge Code	27885951
Hospital Revenue Code	278
Min. Negotiated Rate	$418.84
Max. Negotiated Rate	$508.59
Rate for Payer: Cash Price	$388.92
Rate for Payer: Community Health Alliance Commercial	$508.59
Rate for Payer: Priority Health Commercial	$418.84
Rate for Payer: Priority Health PPO	$418.84

MESH PROGRIP 15 X 10 FLAT

Facility

$1,218.09

Hospital Charge Code	27885823
Hospital Revenue Code	278
Min. Negotiated Rate	$852.66
Max. Negotiated Rate	$1,035.38
Rate for Payer: Cash Price	$791.76
Rate for Payer: Community Health Alliance Commercial	$1,035.38
Rate for Payer: Priority Health Commercial	$852.66
Rate for Payer: Priority Health PPO	$852.66

MESH, PROLENE

Facility

$260.00

Service Code	HCPCS C1781
Hospital Charge Code	27022459
Hospital Revenue Code	278
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$221.00
Rate for Payer: Cash Price	$169.00
Rate for Payer: Community Health Alliance Commercial	$221.00
Rate for Payer: Priority Health Commercial	$182.00
Rate for Payer: Priority Health PPO	$182.00

MESH, PROLENE 6 X 6

Facility

$372.00

Service Code	HCPCS C1781
Hospital Charge Code	27018465
Hospital Revenue Code	278
Min. Negotiated Rate	$260.40
Max. Negotiated Rate	$316.20
Rate for Payer: Cash Price	$241.80
Rate for Payer: Community Health Alliance Commercial	$316.20
Rate for Payer: Priority Health Commercial	$260.40
Rate for Payer: Priority Health PPO	$260.40

MESH, VICRYL

Facility

$422.00

Service Code	HCPCS C1781
Hospital Charge Code	27019034
Hospital Revenue Code	278
Min. Negotiated Rate	$295.40
Max. Negotiated Rate	$358.70
Rate for Payer: Cash Price	$274.30
Rate for Payer: Community Health Alliance Commercial	$358.70
Rate for Payer: Priority Health Commercial	$295.40
Rate for Payer: Priority Health PPO	$295.40

METANEPHRINE PLASMA

Facility

$25.00

Service Code	HCPCS 83835
Hospital Charge Code	3006055
Hospital Revenue Code	301
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$21.25
Rate for Payer: BCBS BCN 65	$17.79
Rate for Payer: Blue Care Network Medicare Advantage	$17.79
Rate for Payer: Cash Price	$16.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.79
Rate for Payer: Meridian Health Plan Medicare	$17.79
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health Medicaid	$17.79
Rate for Payer: Priority Health Medicare	$17.79
Rate for Payer: Priority Health PPO	$17.50
Rate for Payer: United Health Care Medicaid	$17.79
Rate for Payer: United Health Care Medicare Advantage	$7.83

METANEPHRINES 24 HR UA

Facility

$12.22

Service Code	HCPCS 83835
Hospital Charge Code	3006060
Hospital Revenue Code	301
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$17.79
Rate for Payer: BCBS BCN 65	$17.79
Rate for Payer: Blue Care Network Medicare Advantage	$17.79
Rate for Payer: Cash Price	$7.94
Rate for Payer: Cash Price	$7.94
Rate for Payer: Community Health Alliance Commercial	$10.39
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.79
Rate for Payer: Meridian Health Plan Medicare	$17.79
Rate for Payer: Priority Health Commercial	$8.55
Rate for Payer: Priority Health Medicaid	$17.79
Rate for Payer: Priority Health Medicare	$17.79
Rate for Payer: Priority Health PPO	$8.55
Rate for Payer: United Health Care Medicaid	$17.79
Rate for Payer: United Health Care Medicare Advantage	$7.83

METATARSAL COMPONENT

Facility

$1,892.00

Service Code	HCPCS C1713
Hospital Charge Code	27017632
Hospital Revenue Code	278
Min. Negotiated Rate	$1,324.40
Max. Negotiated Rate	$1,608.20
Rate for Payer: Cash Price	$1,229.80
Rate for Payer: Community Health Alliance Commercial	$1,608.20
Rate for Payer: Priority Health Commercial	$1,324.40
Rate for Payer: Priority Health PPO	$1,324.40

METATARSAL, LG NEUTRAL

Facility

$2,693.00

Service Code	HCPCS C1713
Hospital Charge Code	27867094
Hospital Revenue Code	278
Min. Negotiated Rate	$1,885.10
Max. Negotiated Rate	$2,289.05
Rate for Payer: Cash Price	$1,750.45
Rate for Payer: Community Health Alliance Commercial	$2,289.05
Rate for Payer: Priority Health Commercial	$1,885.10
Rate for Payer: Priority Health PPO	$1,885.10

METHADONE

Facility

$14.70

Service Code	HCPCS G0480
Hospital Charge Code	3000253
Hospital Revenue Code	301
Min. Negotiated Rate	$10.29
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	$9.56
Rate for Payer: Cash Price	$9.56
Rate for Payer: Community Health Alliance Commercial	$12.49
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	$10.29
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$10.29
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

METHADONE AND MET QUANT BLD

Facility

$73.00

Service Code	HCPCS G6053
Hospital Charge Code	3100916
Hospital Revenue Code	309
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$62.05
Rate for Payer: Cash Price	$47.45
Rate for Payer: Community Health Alliance Commercial	$62.05
Rate for Payer: Priority Health Commercial	$51.10
Rate for Payer: Priority Health PPO	$51.10

METHADONE AND MET QUANT SERUM

Facility

$63.00

Service Code	HCPCS G0480
Hospital Charge Code	3100992
Hospital Revenue Code	301
Min. Negotiated Rate	$44.10
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	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
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	$44.10
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$44.10
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

METHADONE SERUM

Facility

$45.00

Hospital Charge Code	3102076
Hospital Revenue Code	300
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

METHANOL

Facility

$73.00

Service Code	HCPCS 80320
Hospital Charge Code	3006065
Hospital Revenue Code	301
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$62.05
Rate for Payer: Cash Price	$47.45
Rate for Payer: Community Health Alliance Commercial	$62.05
Rate for Payer: Priority Health Commercial	$51.10
Rate for Payer: Priority Health PPO	$51.10

METHEMOGLOBIN

Facility

$14.85

Service Code	HCPCS 83050
Hospital Charge Code	3006080
Hospital Revenue Code	301
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$12.62
Rate for Payer: BCBS BCN 65	$8.61
Rate for Payer: Blue Care Network Medicare Advantage	$8.61
Rate for Payer: Cash Price	$9.65
Rate for Payer: Cash Price	$9.65
Rate for Payer: Community Health Alliance Commercial	$12.62
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.61
Rate for Payer: Meridian Health Plan Medicare	$8.61
Rate for Payer: Priority Health Commercial	$10.39
Rate for Payer: Priority Health Medicaid	$8.61
Rate for Payer: Priority Health Medicare	$8.61
Rate for Payer: Priority Health PPO	$10.39
Rate for Payer: United Health Care Medicaid	$8.61
Rate for Payer: United Health Care Medicare Advantage	$3.79

METHOTREXATE

Facility

$17.71

Service Code	HCPCS 80204
Hospital Charge Code	3006070
Hospital Revenue Code	301
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$40.50
Rate for Payer: BCBS BCN 65	$40.50
Rate for Payer: Blue Care Network Medicare Advantage	$40.50
Rate for Payer: Cash Price	$11.51
Rate for Payer: Cash Price	$11.51
Rate for Payer: Community Health Alliance Commercial	$15.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$40.50
Rate for Payer: Meridian Health Plan Medicare	$40.50
Rate for Payer: Priority Health Commercial	$12.40
Rate for Payer: Priority Health Medicaid	$40.50
Rate for Payer: Priority Health Medicare	$40.50
Rate for Payer: Priority Health PPO	$12.40
Rate for Payer: United Health Care Medicaid	$40.50
Rate for Payer: United Health Care Medicare Advantage	$17.82

METHYL GRN PYRO STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100370
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges