Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

MRI ELBOW RIGHT W & WO CONTRAS

Facility

$2,256.00

Service Code	HCPCS 73223 RT
Hospital Charge Code	6100294
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 FOOT LEFT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73719 LT
Hospital Charge Code	6100313
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 FOOT LEFT WO CONTRAST

Facility

$1,783.00

Service Code	HCPCS 73718 LT
Hospital Charge Code	6100315
Hospital Revenue Code	614
Min. Negotiated Rate	$1,248.10
Max. Negotiated Rate	$1,515.55
Rate for Payer: Cash Price	$1,158.95
Rate for Payer: Community Health Alliance Commercial	$1,515.55
Rate for Payer: Priority Health Commercial	$1,248.10
Rate for Payer: Priority Health PPO	$1,248.10

MRI FOOT LEFT W & WO CONTRAST

Facility

$2,309.00

Service Code	HCPCS 73720 LT
Hospital Charge Code	6100311
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 FOOT RIGHT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73719 RT
Hospital Charge Code	6100312
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 FOOT RIGHT WO CONTRAST

Facility

$1,783.00

Service Code	HCPCS 73718 RT
Hospital Charge Code	6100314
Hospital Revenue Code	614
Min. Negotiated Rate	$1,248.10
Max. Negotiated Rate	$1,515.55
Rate for Payer: Cash Price	$1,158.95
Rate for Payer: Community Health Alliance Commercial	$1,515.55
Rate for Payer: Priority Health Commercial	$1,248.10
Rate for Payer: Priority Health PPO	$1,248.10

MRI FOOT RIGHT W & WO CONTRAST

Facility

$2,309.00

Service Code	HCPCS 73720 RT
Hospital Charge Code	6100310
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 FOREARM LEFT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73219 LT
Hospital Charge Code	6100303
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 FOREARM LEFT WO CONTRAST

Facility

$1,579.00

Service Code	HCPCS 73218 LT
Hospital Charge Code	6100305
Hospital Revenue Code	614
Min. Negotiated Rate	$1,105.30
Max. Negotiated Rate	$1,342.15
Rate for Payer: Cash Price	$1,026.35
Rate for Payer: Community Health Alliance Commercial	$1,342.15
Rate for Payer: Priority Health Commercial	$1,105.30
Rate for Payer: Priority Health PPO	$1,105.30

MRI FOREARM LEFT W & WO CONTRA

Facility

$2,482.00

Service Code	HCPCS 73220 LT
Hospital Charge Code	6100301
Hospital Revenue Code	614
Min. Negotiated Rate	$1,737.40
Max. Negotiated Rate	$2,109.70
Rate for Payer: Cash Price	$1,613.30
Rate for Payer: Community Health Alliance Commercial	$2,109.70
Rate for Payer: Priority Health Commercial	$1,737.40
Rate for Payer: Priority Health PPO	$1,737.40

MRI FOREARM RIGHT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73219 RT
Hospital Charge Code	6100302
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 FOREARM RIGHT WO CONTRAST

Facility

$1,579.00

Service Code	HCPCS 73218 RT
Hospital Charge Code	6100304
Hospital Revenue Code	614
Min. Negotiated Rate	$1,105.30
Max. Negotiated Rate	$1,342.15
Rate for Payer: Cash Price	$1,026.35
Rate for Payer: Community Health Alliance Commercial	$1,342.15
Rate for Payer: Priority Health Commercial	$1,105.30
Rate for Payer: Priority Health PPO	$1,105.30

MRI FOREARM RIGHT W & WO CONT

Facility

$2,482.00

Service Code	HCPCS 73220 RT
Hospital Charge Code	6100300
Hospital Revenue Code	614
Min. Negotiated Rate	$1,737.40
Max. Negotiated Rate	$2,109.70
Rate for Payer: Cash Price	$1,613.30
Rate for Payer: Community Health Alliance Commercial	$2,109.70
Rate for Payer: Priority Health Commercial	$1,737.40
Rate for Payer: Priority Health PPO	$1,737.40

MRI HAND LEFT WO CONTRAST

Facility

$1,783.00

Service Code	HCPCS 73218 LT
Hospital Charge Code	6100285
Hospital Revenue Code	614
Min. Negotiated Rate	$1,248.10
Max. Negotiated Rate	$1,515.55
Rate for Payer: Cash Price	$1,158.95
Rate for Payer: Community Health Alliance Commercial	$1,515.55
Rate for Payer: Priority Health Commercial	$1,248.10
Rate for Payer: Priority Health PPO	$1,248.10

MRI HAND LEFT W & WO CONTRAST

Facility

$2,600.00

Service Code	HCPCS 73220 LT
Hospital Charge Code	6100281
Hospital Revenue Code	614
Min. Negotiated Rate	$1,820.00
Max. Negotiated Rate	$2,210.00
Rate for Payer: Cash Price	$1,690.00
Rate for Payer: Community Health Alliance Commercial	$2,210.00
Rate for Payer: Priority Health Commercial	$1,820.00
Rate for Payer: Priority Health PPO	$1,820.00

MRI HAND RIGHT WO CONTRAST

Facility

$1,783.00

Service Code	HCPCS 73218 RT
Hospital Charge Code	6100284
Hospital Revenue Code	614
Min. Negotiated Rate	$1,248.10
Max. Negotiated Rate	$1,515.55
Rate for Payer: Cash Price	$1,158.95
Rate for Payer: Community Health Alliance Commercial	$1,515.55
Rate for Payer: Priority Health Commercial	$1,248.10
Rate for Payer: Priority Health PPO	$1,248.10

MRI HAND RIGHT W & WO CONTRAST

Facility

$2,600.00

Service Code	HCPCS 73220 RT
Hospital Charge Code	6100280
Hospital Revenue Code	614
Min. Negotiated Rate	$1,820.00
Max. Negotiated Rate	$2,210.00
Rate for Payer: Cash Price	$1,690.00
Rate for Payer: Community Health Alliance Commercial	$2,210.00
Rate for Payer: Priority Health Commercial	$1,820.00
Rate for Payer: Priority Health PPO	$1,820.00

MRI HIP LEFT WO CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73721 LT
Hospital Charge Code	6100321
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 HIP LEFT W & WO CONTRAST

Facility

$2,031.00

Service Code	HCPCS 73723 LT
Hospital Charge Code	6100325
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 HIP RIGHT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73722 RT
Hospital Charge Code	6100322
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 HIP RIGHT WO CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73721 RT
Hospital Charge Code	6100320
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 HIP RIGHT W & WO CONTRAST

Facility

$2,031.00

Service Code	HCPCS 73723 RT
Hospital Charge Code	6100324
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 IAC W/CONTRAST

Facility

$1,703.00

Service Code	HCPCS 70542
Hospital Charge Code	6100222
Hospital Revenue Code	614
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$1,447.55
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
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	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$1,192.10
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$1,192.10
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRI IAC W/O CONTRAST

Facility

$1,579.00

Service Code	HCPCS 70540
Hospital Charge Code	6100220
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 IAC W & W/O CONTRAST

Facility

$2,805.00

Service Code	HCPCS 70543
Hospital Charge Code	6100225
Hospital Revenue Code	614
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges