Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

MRA ANGIO HEAD WITH CONTRAST

Facility

$1,607.00

Hospital Charge Code	6100169
Hospital Revenue Code	615
Min. Negotiated Rate	$1,124.90
Max. Negotiated Rate	$1,365.95
Rate for Payer: Cash Price	$1,044.55
Rate for Payer: Community Health Alliance Commercial	$1,365.95
Rate for Payer: Priority Health Commercial	$1,124.90
Rate for Payer: Priority Health PPO	$1,124.90

MRA ANGIO HEAD W/O CONTRAST

Facility

$1,607.00

Service Code	HCPCS 70544
Hospital Charge Code	6100170
Hospital Revenue Code	615
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$1,365.95
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$1,044.55
Rate for Payer: Cash Price	$1,044.55
Rate for Payer: Community Health Alliance Commercial	$1,365.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$255.96
Rate for Payer: Meridian Health Plan Medicare	$255.96
Rate for Payer: Priority Health Commercial	$1,124.90
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$1,124.90
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

MRA ANGIO HEAD W/& W/O CONTRA

Facility

$1,607.00

Hospital Charge Code	6100168
Hospital Revenue Code	615
Min. Negotiated Rate	$1,124.90
Max. Negotiated Rate	$1,365.95
Rate for Payer: Cash Price	$1,044.55
Rate for Payer: Community Health Alliance Commercial	$1,365.95
Rate for Payer: Priority Health Commercial	$1,124.90
Rate for Payer: Priority Health PPO	$1,124.90

MRA ANGIO NECK W/O CONTRAST

Facility

$1,448.00

Service Code	HCPCS 70547
Hospital Charge Code	6100160
Hospital Revenue Code	615
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$1,230.80
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$941.20
Rate for Payer: Cash Price	$941.20
Rate for Payer: Community Health Alliance Commercial	$1,230.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$255.96
Rate for Payer: Meridian Health Plan Medicare	$255.96
Rate for Payer: Priority Health Commercial	$1,013.60
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$1,013.60
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

MRA ANGIO NECK W/WO CONTRAST

Facility

$2,549.00

Hospital Charge Code	6100161
Hospital Revenue Code	615
Min. Negotiated Rate	$1,784.30
Max. Negotiated Rate	$2,166.65
Rate for Payer: Cash Price	$1,656.85
Rate for Payer: Community Health Alliance Commercial	$2,166.65
Rate for Payer: Priority Health Commercial	$1,784.30
Rate for Payer: Priority Health PPO	$1,784.30

MRA ANGIO PELVIS W/OR W/O CONT

Facility

$1,241.00

Service Code	HCPCS C8920
Hospital Charge Code	6100380
Hospital Revenue Code	618
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$1,054.85
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$806.65
Rate for Payer: Cash Price	$806.65
Rate for Payer: Community Health Alliance Commercial	$1,054.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$868.70
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$868.70
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRA ANGIO UPPER EXTREMITY LT

Facility

$915.00

Service Code	HCPCS 73225
Hospital Charge Code	6100391
Hospital Revenue Code	618
Min. Negotiated Rate	$640.50
Max. Negotiated Rate	$777.75
Rate for Payer: Cash Price	$594.75
Rate for Payer: Community Health Alliance Commercial	$777.75
Rate for Payer: Priority Health Commercial	$640.50
Rate for Payer: Priority Health PPO	$640.50

MRA ANGIO UPPER EXTREMITY RT

Facility

$915.00

Service Code	HCPCS 73225
Hospital Charge Code	6100390
Hospital Revenue Code	618
Min. Negotiated Rate	$640.50
Max. Negotiated Rate	$777.75
Rate for Payer: Cash Price	$594.75
Rate for Payer: Community Health Alliance Commercial	$777.75
Rate for Payer: Priority Health Commercial	$640.50
Rate for Payer: Priority Health PPO	$640.50

MRA CHEST

Facility

$1,106.00

Service Code	HCPCS C8909
Hospital Charge Code	6100379
Hospital Revenue Code	618
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$940.10
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$718.90
Rate for Payer: Cash Price	$718.90
Rate for Payer: Community Health Alliance Commercial	$940.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$774.20
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$774.20
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRA LOWER EXTREMITY,W/CONTRAST

Facility

$953.00

Service Code	HCPCS C8912
Hospital Charge Code	6100400
Hospital Revenue Code	616
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$810.05
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$619.45
Rate for Payer: Cash Price	$619.45
Rate for Payer: Community Health Alliance Commercial	$810.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$667.10
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$667.10
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRA LOWER EXTREMITY,W/O CONTRA

Facility

$953.00

Service Code	HCPCS C8913
Hospital Charge Code	6100401
Hospital Revenue Code	616
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$810.05
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$619.45
Rate for Payer: Cash Price	$619.45
Rate for Payer: Community Health Alliance Commercial	$810.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$255.96
Rate for Payer: Meridian Health Plan Medicare	$255.96
Rate for Payer: Priority Health Commercial	$667.10
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$667.10
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

MRA LOWER EXTREMITY,W/WO CONTR

Facility

$859.00

Service Code	HCPCS 73725
Hospital Charge Code	6100405
Hospital Revenue Code	616
Min. Negotiated Rate	$601.30
Max. Negotiated Rate	$730.15
Rate for Payer: Cash Price	$558.35
Rate for Payer: Community Health Alliance Commercial	$730.15
Rate for Payer: Priority Health Commercial	$601.30
Rate for Payer: Priority Health PPO	$601.30

MRI ABDOMEN WITH CONTRAST

Facility

$1,427.00

Service Code	HCPCS 74182
Hospital Charge Code	6100205
Hospital Revenue Code	614
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$1,212.95
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$927.55
Rate for Payer: Cash Price	$927.55
Rate for Payer: Community Health Alliance Commercial	$1,212.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$998.90
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$998.90
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRI ABDOMEN W/O CONTRAST

Facility

$1,616.00

Service Code	HCPCS 74181
Hospital Charge Code	6100210
Hospital Revenue Code	614
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$1,373.60
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$1,050.40
Rate for Payer: Cash Price	$1,050.40
Rate for Payer: Community Health Alliance Commercial	$1,373.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$255.96
Rate for Payer: Meridian Health Plan Medicare	$255.96
Rate for Payer: Priority Health Commercial	$1,131.20
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$1,131.20
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

MRI ABDOMEN W & W/O CONTRAST

Facility

$2,309.00

Service Code	HCPCS 74183
Hospital Charge Code	6100207
Hospital Revenue Code	614
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$1,962.65
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$1,500.85
Rate for Payer: Cash Price	$1,500.85
Rate for Payer: Community Health Alliance Commercial	$1,962.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$1,616.30
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$1,616.30
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRI ACROMIOCLAVICULAR JTS W

Facility

$1,703.00

Service Code	HCPCS 73222
Hospital Charge Code	6100217
Hospital Revenue Code	614
Min. Negotiated Rate	$370.02
Max. Negotiated Rate	$1,447.55
Rate for Payer: BCBS BCN 65	$840.95
Rate for Payer: Blue Care Network Medicare Advantage	$840.95
Rate for Payer: Cash Price	$1,106.95
Rate for Payer: Cash Price	$1,106.95
Rate for Payer: Community Health Alliance Commercial	$1,447.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$840.95
Rate for Payer: Meridian Health Plan Medicare	$840.95
Rate for Payer: Priority Health Commercial	$1,192.10
Rate for Payer: Priority Health Medicaid	$840.95
Rate for Payer: Priority Health Medicare	$840.95
Rate for Payer: Priority Health PPO	$1,192.10
Rate for Payer: United Health Care Medicaid	$840.95
Rate for Payer: United Health Care Medicare Advantage	$370.02

MRI ACROMIOCLAVICULAR JTS W/O

Facility

$1,579.00

Service Code	HCPCS 73221
Hospital Charge Code	6100215
Hospital Revenue Code	614
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$1,342.15
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$1,026.35
Rate for Payer: Cash Price	$1,026.35
Rate for Payer: Community Health Alliance Commercial	$1,342.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$255.96
Rate for Payer: Meridian Health Plan Medicare	$255.96
Rate for Payer: Priority Health Commercial	$1,105.30
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$1,105.30
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

MRI ACROMIOCLAVICULAR JTS W/WO

Facility

$2,256.00

Service Code	HCPCS 73223
Hospital Charge Code	6100219
Hospital Revenue Code	614
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$1,917.60
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$1,466.40
Rate for Payer: Cash Price	$1,466.40
Rate for Payer: Community Health Alliance Commercial	$1,917.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$1,579.20
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$1,579.20
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRI ANKLE LEFT WITH CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73722 LT
Hospital Charge Code	6100257
Hospital Revenue Code	614
Min. Negotiated Rate	$1,192.10
Max. Negotiated Rate	$1,447.55
Rate for Payer: Cash Price	$1,106.95
Rate for Payer: Community Health Alliance Commercial	$1,447.55
Rate for Payer: Priority Health Commercial	$1,192.10
Rate for Payer: Priority Health PPO	$1,192.10

MRI ANKLE LEFT W/O CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73721 LT
Hospital Charge Code	6100251
Hospital Revenue Code	614
Min. Negotiated Rate	$1,374.80
Max. Negotiated Rate	$1,669.40
Rate for Payer: Cash Price	$1,276.60
Rate for Payer: Community Health Alliance Commercial	$1,669.40
Rate for Payer: Priority Health Commercial	$1,374.80
Rate for Payer: Priority Health PPO	$1,374.80

MRI ANKLE LEFT W & W/O CONTRAS

Facility

$2,256.00

Service Code	HCPCS 73723 LT
Hospital Charge Code	6100259
Hospital Revenue Code	614
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$1,917.60
Rate for Payer: Cash Price	$1,466.40
Rate for Payer: Community Health Alliance Commercial	$1,917.60
Rate for Payer: Priority Health Commercial	$1,579.20
Rate for Payer: Priority Health PPO	$1,579.20

MRI ANKLE RIGHT WITH CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73722 RT
Hospital Charge Code	6100252
Hospital Revenue Code	614
Min. Negotiated Rate	$1,192.10
Max. Negotiated Rate	$1,447.55
Rate for Payer: Cash Price	$1,106.95
Rate for Payer: Community Health Alliance Commercial	$1,447.55
Rate for Payer: Priority Health Commercial	$1,192.10
Rate for Payer: Priority Health PPO	$1,192.10

MRI ANKLE RIGHT W/O CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73721 RT
Hospital Charge Code	6100250
Hospital Revenue Code	614
Min. Negotiated Rate	$1,374.80
Max. Negotiated Rate	$1,669.40
Rate for Payer: Cash Price	$1,276.60
Rate for Payer: Community Health Alliance Commercial	$1,669.40
Rate for Payer: Priority Health Commercial	$1,374.80
Rate for Payer: Priority Health PPO	$1,374.80

MRI ANKLE RIGHT W & W/O CONTRA

Facility

$2,256.00

Service Code	HCPCS 73723 RT
Hospital Charge Code	6100255
Hospital Revenue Code	614
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$1,917.60
Rate for Payer: Cash Price	$1,466.40
Rate for Payer: Community Health Alliance Commercial	$1,917.60
Rate for Payer: Priority Health Commercial	$1,579.20
Rate for Payer: Priority Health PPO	$1,579.20

MRI ARM LEFT WITH CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73219 LT
Hospital Charge Code	6100267
Hospital Revenue Code	614
Min. Negotiated Rate	$1,192.10
Max. Negotiated Rate	$1,447.55
Rate for Payer: Cash Price	$1,106.95
Rate for Payer: Community Health Alliance Commercial	$1,447.55
Rate for Payer: Priority Health Commercial	$1,192.10
Rate for Payer: Priority Health PPO	$1,192.10

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges