Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

MRI ARM LEFT W/O CONTRAST

Facility

$1,422.00

Service Code	HCPCS 73218 LT
Hospital Charge Code	6100269
Hospital Revenue Code	614
Min. Negotiated Rate	$995.40
Max. Negotiated Rate	$1,208.70
Rate for Payer: Cash Price	$924.30
Rate for Payer: Community Health Alliance Commercial	$1,208.70
Rate for Payer: Priority Health Commercial	$995.40
Rate for Payer: Priority Health PPO	$995.40

MRI ARM LEFT W & W/O CONTRAST

Facility

$2,256.00

Service Code	HCPCS 73220 LT
Hospital Charge Code	6100261
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 RIGHT WITH CONTRAST

Facility

$1,535.00

Service Code	HCPCS 73219 RT
Hospital Charge Code	6100262
Hospital Revenue Code	614
Min. Negotiated Rate	$1,074.50
Max. Negotiated Rate	$1,304.75
Rate for Payer: Cash Price	$997.75
Rate for Payer: Community Health Alliance Commercial	$1,304.75
Rate for Payer: Priority Health Commercial	$1,074.50
Rate for Payer: Priority Health PPO	$1,074.50

MRI ARM RIGHT W/O CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73218 RT
Hospital Charge Code	6100265
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 ARM RIGHT W & W/O CONTRAST

Facility

$2,031.00

Service Code	HCPCS 73220 RT
Hospital Charge Code	6100260
Hospital Revenue Code	614
Min. Negotiated Rate	$1,421.70
Max. Negotiated Rate	$1,726.35
Rate for Payer: Cash Price	$1,320.15
Rate for Payer: Community Health Alliance Commercial	$1,726.35
Rate for Payer: Priority Health Commercial	$1,421.70
Rate for Payer: Priority Health PPO	$1,421.70

MRI BONE MARROW

Facility

$1,269.00

Service Code	HCPCS 77084
Hospital Charge Code	6100240
Hospital Revenue Code	614
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$1,078.65
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$824.85
Rate for Payer: Cash Price	$824.85
Rate for Payer: Community Health Alliance Commercial	$1,078.65
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	$888.30
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$888.30
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

MRI BRACHIAL PLEXUS

Facility

$2,482.00

Service Code	HCPCS 73220
Hospital Charge Code	6100212
Hospital Revenue Code	614
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$2,109.70
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$1,613.30
Rate for Payer: Cash Price	$1,613.30
Rate for Payer: Community Health Alliance Commercial	$2,109.70
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	$1,737.40
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$1,737.40
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRI BRAIN W CONTRAST

Facility

$1,285.00

Service Code	HCPCS 70552
Hospital Charge Code	6100030
Hospital Revenue Code	611
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$1,092.25
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$835.25
Rate for Payer: Cash Price	$835.25
Rate for Payer: Community Health Alliance Commercial	$1,092.25
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	$899.50
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$899.50
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRI BRAIN W/O CONTRAST

Facility

$1,616.00

Service Code	HCPCS 70551
Hospital Charge Code	6100020
Hospital Revenue Code	611
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 BRAIN W/WO CONTRAST

Facility

$2,805.00

Service Code	HCPCS 70553
Hospital Charge Code	6100040
Hospital Revenue Code	611
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$2,384.25
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$1,823.25
Rate for Payer: Cash Price	$1,823.25
Rate for Payer: Community Health Alliance Commercial	$2,384.25
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	$1,963.50
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$1,963.50
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRI CALF LEFT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73719 LT
Hospital Charge Code	6100273
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 CALF LEFT WO CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73718 LT
Hospital Charge Code	6100275
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 CALF LEFT W & WO CONTRAST

Facility

$2,309.00

Service Code	HCPCS 73720 LT
Hospital Charge Code	6100271
Hospital Revenue Code	614
Min. Negotiated Rate	$1,616.30
Max. Negotiated Rate	$1,962.65
Rate for Payer: Cash Price	$1,500.85
Rate for Payer: Community Health Alliance Commercial	$1,962.65
Rate for Payer: Priority Health Commercial	$1,616.30
Rate for Payer: Priority Health PPO	$1,616.30

MRI CALF RIGHT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73719 RT
Hospital Charge Code	6100272
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 CALF RIGHT WO CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73718 RT
Hospital Charge Code	6100274
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 CALF RIGHT W & WO CONTRAST

Facility

$2,031.00

Service Code	HCPCS 73720 RT
Hospital Charge Code	6100270
Hospital Revenue Code	614
Min. Negotiated Rate	$1,421.70
Max. Negotiated Rate	$1,726.35
Rate for Payer: Cash Price	$1,320.15
Rate for Payer: Community Health Alliance Commercial	$1,726.35
Rate for Payer: Priority Health Commercial	$1,421.70
Rate for Payer: Priority Health PPO	$1,421.70

MRI CERVICAL SPINE W/CONTRAST

Facility

$1,741.00

Service Code	HCPCS 72142
Hospital Charge Code	6100050
Hospital Revenue Code	612
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$1,479.85
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$1,131.65
Rate for Payer: Cash Price	$1,131.65
Rate for Payer: Community Health Alliance Commercial	$1,479.85
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	$1,218.70
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$1,218.70
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRI CERVICAL SPINE WO CONTRAST

Facility

$1,616.00

Service Code	HCPCS 72141
Hospital Charge Code	6100010
Hospital Revenue Code	612
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 CERVICAL SPINE W/WO CONTRA

Facility

$2,805.00

Service Code	HCPCS 72156
Hospital Charge Code	6100060
Hospital Revenue Code	612
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$2,384.25
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$1,823.25
Rate for Payer: Cash Price	$1,823.25
Rate for Payer: Community Health Alliance Commercial	$2,384.25
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	$1,963.50
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$1,963.50
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRI CHEST W & W/O CONTRAST

Facility

$1,468.00

Hospital Charge Code	6100241
Hospital Revenue Code	610
Min. Negotiated Rate	$1,027.60
Max. Negotiated Rate	$1,247.80
Rate for Payer: Cash Price	$954.20
Rate for Payer: Community Health Alliance Commercial	$1,247.80
Rate for Payer: Priority Health Commercial	$1,027.60
Rate for Payer: Priority Health PPO	$1,027.60

MRI ELBOW LEFT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73222 LT
Hospital Charge Code	6100293
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 ELBOW LEFT WO CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73221 LT
Hospital Charge Code	6100291
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 ELBOW LEFT W & WO CONTRAST

Facility

$2,256.00

Service Code	HCPCS 73223 LT
Hospital Charge Code	6100295
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 ELBOW RIGHT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73222 RT
Hospital Charge Code	6100292
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 ELBOW RIGHT WO CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	6100290
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges