Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

METHYLMALONIC ACID URINE

Facility

$12.22

Service Code	HCPCS 83921
Hospital Charge Code	3006090
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$22.27
Rate for Payer: BCBS BCN 65	$22.27
Rate for Payer: Blue Care Network Medicare Advantage	$22.27
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	$22.27
Rate for Payer: Meridian Health Plan Medicare	$22.27
Rate for Payer: Priority Health Commercial	$8.55
Rate for Payer: Priority Health Medicaid	$22.27
Rate for Payer: Priority Health Medicare	$22.27
Rate for Payer: Priority Health PPO	$8.55
Rate for Payer: United Health Care Medicaid	$22.27
Rate for Payer: United Health Care Medicare Advantage	$9.80

METHYLMELONIC ACID

Facility

$10.00

Service Code	HCPCS 83921
Hospital Charge Code	3009140
Hospital Revenue Code	301
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$22.27
Rate for Payer: BCBS BCN 65	$22.27
Rate for Payer: Blue Care Network Medicare Advantage	$22.27
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$22.27
Rate for Payer: Meridian Health Plan Medicare	$22.27
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health Medicaid	$22.27
Rate for Payer: Priority Health Medicare	$22.27
Rate for Payer: Priority Health PPO	$7.00
Rate for Payer: United Health Care Medicaid	$22.27
Rate for Payer: United Health Care Medicare Advantage	$9.80

METHYLPHENIDATE URINE

Facility

$72.00

Service Code	HCPCS G0480
Hospital Charge Code	3100747
Hospital Revenue Code	301
Min. Negotiated Rate	$50.40
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	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Community Health Alliance Commercial	$61.20
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	$50.40
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$50.40
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

MEXITIL

Facility

$12.36

Service Code	HCPCS 80299
Hospital Charge Code	3009145
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$19.57
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$8.03
Rate for Payer: Cash Price	$8.03
Rate for Payer: Community Health Alliance Commercial	$10.51
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.57
Rate for Payer: Meridian Health Plan Medicare	$19.57
Rate for Payer: Priority Health Commercial	$8.65
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$8.65
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

MG-LC

Facility

$3.67

Hospital Charge Code	3102118
Hospital Revenue Code	300
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$3.12
Rate for Payer: Cash Price	$2.39
Rate for Payer: Community Health Alliance Commercial	$3.12
Rate for Payer: Priority Health Commercial	$2.57
Rate for Payer: Priority Health PPO	$2.57

MG - RBC

Facility

$5.00

Service Code	HCPCS 83735
Hospital Charge Code	3005965
Hospital Revenue Code	301
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$7.04
Rate for Payer: BCBS BCN 65	$7.04
Rate for Payer: Blue Care Network Medicare Advantage	$7.04
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	$7.04
Rate for Payer: Meridian Health Plan Medicare	$7.04
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$7.04
Rate for Payer: Priority Health Medicare	$7.04
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$7.04
Rate for Payer: United Health Care Medicare Advantage	$3.10

MGSD-1

Facility

$417.37

Hospital Charge Code	3102482
Hospital Revenue Code	300
Min. Negotiated Rate	$292.16
Max. Negotiated Rate	$354.76
Rate for Payer: Cash Price	$271.29
Rate for Payer: Community Health Alliance Commercial	$354.76
Rate for Payer: Priority Health Commercial	$292.16
Rate for Payer: Priority Health PPO	$292.16

MGSD-2

Facility

$417.38

Hospital Charge Code	3102483
Hospital Revenue Code	300
Min. Negotiated Rate	$292.17
Max. Negotiated Rate	$354.77
Rate for Payer: Cash Price	$271.30
Rate for Payer: Community Health Alliance Commercial	$354.77
Rate for Payer: Priority Health Commercial	$292.17
Rate for Payer: Priority Health PPO	$292.17

MICROALBUMIN 24 HR URINE

Facility

$64.00

Service Code	HCPCS 82043
Hospital Charge Code	3000741
Hospital Revenue Code	301
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$54.40
Rate for Payer: BCBS BCN 65	$6.07
Rate for Payer: Blue Care Network Medicare Advantage	$6.07
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.07
Rate for Payer: Meridian Health Plan Medicare	$6.07
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health Medicaid	$6.07
Rate for Payer: Priority Health Medicare	$6.07
Rate for Payer: Priority Health PPO	$44.80
Rate for Payer: United Health Care Medicaid	$6.07
Rate for Payer: United Health Care Medicare Advantage	$2.67

MICROALBUMIN 24HR UR LC

Facility

$4.48

Hospital Charge Code	3102391
Hospital Revenue Code	300
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.81
Rate for Payer: Cash Price	$2.91
Rate for Payer: Community Health Alliance Commercial	$3.81
Rate for Payer: Priority Health Commercial	$3.14
Rate for Payer: Priority Health PPO	$3.14

MICROALBUMIN QUANT

Facility

$73.00

Service Code	HCPCS 82044
Hospital Charge Code	3006100
Hospital Revenue Code	301
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$62.05
Rate for Payer: BCBS BCN 65	$6.54
Rate for Payer: Blue Care Network Medicare Advantage	$6.54
Rate for Payer: Cash Price	$47.45
Rate for Payer: Cash Price	$47.45
Rate for Payer: Community Health Alliance Commercial	$62.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.54
Rate for Payer: Meridian Health Plan Medicare	$6.54
Rate for Payer: Priority Health Commercial	$51.10
Rate for Payer: Priority Health Medicaid	$6.54
Rate for Payer: Priority Health Medicare	$6.54
Rate for Payer: Priority Health PPO	$51.10
Rate for Payer: United Health Care Medicaid	$6.54
Rate for Payer: United Health Care Medicare Advantage	$2.88

MICROALBUMIN T SBMF

Facility

$2.63

Hospital Charge Code	3101142
Hospital Revenue Code	301
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$2.24
Rate for Payer: Cash Price	$1.71
Rate for Payer: Community Health Alliance Commercial	$2.24
Rate for Payer: Priority Health Commercial	$1.84
Rate for Payer: Priority Health PPO	$1.84

MICROKNIFE XL #3281

Facility

$604.00

Hospital Charge Code	27265809
Hospital Revenue Code	272
Min. Negotiated Rate	$422.80
Max. Negotiated Rate	$513.40
Rate for Payer: Cash Price	$392.60
Rate for Payer: Community Health Alliance Commercial	$513.40
Rate for Payer: Priority Health Commercial	$422.80
Rate for Payer: Priority Health PPO	$422.80

MICROMARK II TISSUE MARKER 11G

Facility

$345.00

Hospital Charge Code	27264785
Hospital Revenue Code	272
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$293.25
Rate for Payer: Cash Price	$224.25
Rate for Payer: Community Health Alliance Commercial	$293.25
Rate for Payer: Priority Health Commercial	$241.50
Rate for Payer: Priority Health PPO	$241.50

MICROSPORIDIA STAIN

Facility

$40.00

Hospital Charge Code	3004752
Hospital Revenue Code	306
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

MICROSPORIDIUM

Facility

$141.00

Service Code	HCPCS 88313
Hospital Charge Code	3004620
Hospital Revenue Code	310
Min. Negotiated Rate	$62.80
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	$91.65
Rate for Payer: Cash Price	$91.65
Rate for Payer: Community Health Alliance Commercial	$119.85
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	$98.70
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$98.70
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

MID-PHALANX IMPLANT

Facility

$825.00

Service Code	HCPCS C1713
Hospital Charge Code	27872286
Hospital Revenue Code	278
Min. Negotiated Rate	$577.50
Max. Negotiated Rate	$701.25
Rate for Payer: Cash Price	$536.25
Rate for Payer: Community Health Alliance Commercial	$701.25
Rate for Payer: Priority Health Commercial	$577.50
Rate for Payer: Priority Health PPO	$577.50

MILK COW IGG4

Facility

$26.00

Hospital Charge Code	3100726
Hospital Revenue Code	302
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

MILLER LARYNGOSCOPE BLADE

Facility

$21.00

Hospital Charge Code	27060982
Hospital Revenue Code	272
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

MINI-ACUTRAK FIXATION SCREW

Facility

$1,259.00

Service Code	HCPCS C1713
Hospital Charge Code	27060925
Hospital Revenue Code	278
Min. Negotiated Rate	$881.30
Max. Negotiated Rate	$1,070.15
Rate for Payer: Cash Price	$818.35
Rate for Payer: Community Health Alliance Commercial	$1,070.15
Rate for Payer: Priority Health Commercial	$881.30
Rate for Payer: Priority Health PPO	$881.30

MINIBAND

Facility

$13.00

Hospital Charge Code	27021210
Hospital Revenue Code	270
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$11.05
Rate for Payer: Cash Price	$8.45
Rate for Payer: Community Health Alliance Commercial	$11.05
Rate for Payer: Priority Health Commercial	$9.10
Rate for Payer: Priority Health PPO	$9.10

MINI FRAGMENT SET

Facility

$458.00

Hospital Charge Code	27868514
Hospital Revenue Code	272
Min. Negotiated Rate	$320.60
Max. Negotiated Rate	$389.30
Rate for Payer: Cash Price	$297.70
Rate for Payer: Community Health Alliance Commercial	$389.30
Rate for Payer: Priority Health Commercial	$320.60
Rate for Payer: Priority Health PPO	$320.60

MINI IGNITE POWER MIX

Facility

$6,652.00

Hospital Charge Code	27868746
Hospital Revenue Code	272
Min. Negotiated Rate	$4,656.40
Max. Negotiated Rate	$5,654.20
Rate for Payer: Cash Price	$4,323.80
Rate for Payer: Community Health Alliance Commercial	$5,654.20
Rate for Payer: Priority Health Commercial	$4,656.40
Rate for Payer: Priority Health PPO	$4,656.40

MINI SCREW SET

Facility

$99.00

Hospital Charge Code	27017152
Hospital Revenue Code	270
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

MINITOME

Facility

$368.00

Hospital Charge Code	27262990
Hospital Revenue Code	272
Min. Negotiated Rate	$257.60
Max. Negotiated Rate	$312.80
Rate for Payer: Cash Price	$239.20
Rate for Payer: Community Health Alliance Commercial	$312.80
Rate for Payer: Priority Health Commercial	$257.60
Rate for Payer: Priority Health PPO	$257.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges