Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

MMP-2

Facility

$68.00

Hospital Charge Code	3101184
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

MMP-3

Facility

$68.00

Hospital Charge Code	3101185
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

MMP-4

Facility

$68.00

Hospital Charge Code	3101186
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

MMP-5

Facility

$68.00

Hospital Charge Code	3101187
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

MMP-6

Facility

$68.00

Hospital Charge Code	3101188
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

MMP-7

Facility

$68.00

Hospital Charge Code	3101189
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

MMP-8

Facility

$68.00

Hospital Charge Code	3101190
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

MMP-9

Facility

$68.00

Hospital Charge Code	3101191
Hospital Revenue Code	310
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

M-M-R 0.5ML LIVE VIRUS VACCINE

Facility

$323.31

Service Code	NDC 6468100
Hospital Charge Code	2500708
Hospital Revenue Code	636
Min. Negotiated Rate	$226.32
Max. Negotiated Rate	$274.81
Rate for Payer: Cash Price	$210.15
Rate for Payer: Community Health Alliance Commercial	$274.81
Rate for Payer: Priority Health Commercial	$226.32
Rate for Payer: Priority Health PPO	$226.32

MMR1

Facility

$2.57

Hospital Charge Code	31027537
Hospital Revenue Code	300
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.18
Rate for Payer: Cash Price	$1.67
Rate for Payer: Community Health Alliance Commercial	$2.18
Rate for Payer: Priority Health Commercial	$1.80
Rate for Payer: Priority Health PPO	$1.80

MMR2

Facility

$2.57

Hospital Charge Code	31027538
Hospital Revenue Code	300
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.18
Rate for Payer: Cash Price	$1.67
Rate for Payer: Community Health Alliance Commercial	$2.18
Rate for Payer: Priority Health Commercial	$1.80
Rate for Payer: Priority Health PPO	$1.80

MMR3

Facility

$2.59

Hospital Charge Code	31027539
Hospital Revenue Code	300
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.20
Rate for Payer: Cash Price	$1.68
Rate for Payer: Community Health Alliance Commercial	$2.20
Rate for Payer: Priority Health Commercial	$1.81
Rate for Payer: Priority Health PPO	$1.81

MMR IMMUNITY TOTAL

Facility

$7.73

Hospital Charge Code	31027536
Hospital Revenue Code	300
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$6.57
Rate for Payer: Cash Price	$5.02
Rate for Payer: Community Health Alliance Commercial	$6.57
Rate for Payer: Priority Health Commercial	$5.41
Rate for Payer: Priority Health PPO	$5.41

MODERATE SEDATION ADD'L 15 MIN

Facility

$229.00

Hospital Charge Code	5150732
Hospital Revenue Code	960
Min. Negotiated Rate	$160.30
Max. Negotiated Rate	$194.65
Rate for Payer: Cash Price	$148.85
Rate for Payer: Community Health Alliance Commercial	$194.65
Rate for Payer: Priority Health Commercial	$160.30
Rate for Payer: Priority Health PPO	$160.30

MODERATE SEDATION INIT 15 MIN

Facility

$229.00

Hospital Charge Code	5150729
Hospital Revenue Code	960
Min. Negotiated Rate	$160.30
Max. Negotiated Rate	$194.65
Rate for Payer: Cash Price	$148.85
Rate for Payer: Community Health Alliance Commercial	$194.65
Rate for Payer: Priority Health Commercial	$160.30
Rate for Payer: Priority Health PPO	$160.30

MODIFIED FITE STAIN TECH

Facility

$78.00

Service Code	HCPCS 88312
Hospital Charge Code	3100380
Hospital Revenue Code	310
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$66.30
Rate for Payer: BCBS BCN 65	$55.90
Rate for Payer: Blue Care Network Medicare Advantage	$55.90
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$55.90
Rate for Payer: Meridian Health Plan Medicare	$55.90
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health Medicaid	$55.90
Rate for Payer: Priority Health Medicare	$55.90
Rate for Payer: Priority Health PPO	$54.60
Rate for Payer: United Health Care Medicaid	$55.90
Rate for Payer: United Health Care Medicare Advantage	$24.60

MOD/TRA VOICE PROSTHETIC 92507

Facility

$171.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	4400060
Hospital Revenue Code	440
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$145.35
Rate for Payer: Cash Price	$111.15
Rate for Payer: Community Health Alliance Commercial	$145.35
Rate for Payer: Priority Health Commercial	$119.70
Rate for Payer: Priority Health PPO	$119.70

MOG ANTIBODY

Facility

$550.00

Hospital Charge Code	3102506
Hospital Revenue Code	300
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

MOG ANTIBODY TITER

Facility

$100.00

Hospital Charge Code	3102507
Hospital Revenue Code	300
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$85.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health PPO	$70.00

MOLD ID BY SEQUENCING

Facility

$65.00

Hospital Charge Code	3102068
Hospital Revenue Code	300
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

MOLD ID BY SEQUENCING

Facility

$65.00

Hospital Charge Code	3102066
Hospital Revenue Code	300
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

MOLECULAR TYPING FOR HLA-B27

Facility

$189.00

Hospital Charge Code	3005291
Hospital Revenue Code	302
Min. Negotiated Rate	$132.30
Max. Negotiated Rate	$160.65
Rate for Payer: Cash Price	$122.85
Rate for Payer: Community Health Alliance Commercial	$160.65
Rate for Payer: Priority Health Commercial	$132.30
Rate for Payer: Priority Health PPO	$132.30

MOMA IGG

Facility

$299.00

Hospital Charge Code	3102228
Hospital Revenue Code	300
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$254.15
Rate for Payer: Cash Price	$194.35
Rate for Payer: Community Health Alliance Commercial	$254.15
Rate for Payer: Priority Health Commercial	$209.30
Rate for Payer: Priority Health PPO	$209.30

MOMA IGG (REFLEX)

Facility

$250.00

Hospital Charge Code	3102229
Hospital Revenue Code	300
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$212.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Community Health Alliance Commercial	$212.50
Rate for Payer: Priority Health Commercial	$175.00
Rate for Payer: Priority Health PPO	$175.00

MONARC SUBFASCIAL HAMMOCK

Facility

$2,948.00

Service Code	HCPCS C1771
Hospital Charge Code	27868340
Hospital Revenue Code	278
Min. Negotiated Rate	$2,063.60
Max. Negotiated Rate	$2,505.80
Rate for Payer: Cash Price	$1,916.20
Rate for Payer: Community Health Alliance Commercial	$2,505.80
Rate for Payer: Priority Health Commercial	$2,063.60
Rate for Payer: Priority Health PPO	$2,063.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges