Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

MRI SHOULDER RIGHT WO CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	6100340
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 SHOULDER RIGHT W & WO CONT

Facility

$2,031.00

Service Code	HCPCS 73223 RT
Hospital Charge Code	6100344
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 SINUSES WO CONTRAST

Facility

$1,579.00

Service Code	HCPCS 70540
Hospital Charge Code	6100200
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 SOFT TISSUE NECK W CONTRAS

Facility

$1,703.00

Service Code	HCPCS 70542
Hospital Charge Code	6100051
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 SOFT TISSUE NECK WO CONTRA

Facility

$1,616.00

Service Code	HCPCS 70540
Hospital Charge Code	6100011
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 SOFT TISSUE NECK W/WO CON

Facility

$2,031.00

Service Code	HCPCS 70543
Hospital Charge Code	6100061
Hospital Revenue Code	614
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$1,726.35
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$1,320.15
Rate for Payer: Cash Price	$1,320.15
Rate for Payer: Community Health Alliance Commercial	$1,726.35
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	$1,421.70
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$1,421.70
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

MRI TEMPORAL-MANDIBULAR JOINTS

Facility

$1,269.00

Service Code	HCPCS 70336
Hospital Charge Code	6100190
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 THIGH LEFT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73719 LT
Hospital Charge Code	6100353
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 THIGH LEFT WO CONTRAST

Facility

$1,607.00

Service Code	HCPCS 73718 LT
Hospital Charge Code	6100355
Hospital Revenue Code	614
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

MRI THIGH LEFT W & WO CONTRAST

Facility

$2,309.00

Service Code	HCPCS 73720 LT
Hospital Charge Code	6100351
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 THIGH RIGHT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73719 RT
Hospital Charge Code	6100352
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 THIGH RIGHT WO CONTRAST

Facility

$1,607.00

Service Code	HCPCS 73718 RT
Hospital Charge Code	6100354
Hospital Revenue Code	614
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

MRI THIGH RIGHT W & WO CONTRAS

Facility

$2,309.00

Service Code	HCPCS 73720 RT
Hospital Charge Code	6100350
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 THORACIC LMTD WO CONTRAST

Facility

$840.00

Service Code	HCPCS 72146 52
Hospital Charge Code	6100071
Hospital Revenue Code	612
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$714.00
Rate for Payer: Cash Price	$546.00
Rate for Payer: Community Health Alliance Commercial	$714.00
Rate for Payer: Priority Health Commercial	$588.00
Rate for Payer: Priority Health PPO	$588.00

MRI THORACIC SPINE W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 72147
Hospital Charge Code	6100120
Hospital Revenue Code	612
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 THORACIC SPINE W/WO CONTRA

Facility

$2,805.00

Service Code	HCPCS 72157
Hospital Charge Code	6100130
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 THORACIC WO CONTRAST

Facility

$1,616.00

Service Code	HCPCS 72146
Hospital Charge Code	6100070
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 UROGRAM ABD/PELVIS/W/WO

Facility

$5,114.00

Hospital Charge Code	6100234
Hospital Revenue Code	610
Min. Negotiated Rate	$3,579.80
Max. Negotiated Rate	$4,346.90
Rate for Payer: Cash Price	$3,324.10
Rate for Payer: Community Health Alliance Commercial	$4,346.90
Rate for Payer: Priority Health Commercial	$3,579.80
Rate for Payer: Priority Health PPO	$3,579.80

MRI WRIST LEFT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73222 LT
Hospital Charge Code	6100363
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 WRIST LEFT WO CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73221 LT
Hospital Charge Code	6100361
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 WRIST LEFT W & WO CONTRAST

Facility

$2,256.00

Service Code	HCPCS 73223 LT
Hospital Charge Code	6100365
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 WRIST RIGHT W CONTRAST

Facility

$1,703.00

Service Code	HCPCS 73222 RT
Hospital Charge Code	6100362
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 WRIST RIGHT WO CONTRAST

Facility

$1,964.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	6100360
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 WRIST RIGHT W & WO CONTRAS

Facility

$2,256.00

Service Code	HCPCS 73223 RT
Hospital Charge Code	6100364
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

MRSA/COLONIZATION

Facility

$10.63

Hospital Charge Code	31027506
Hospital Revenue Code	300
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$9.04
Rate for Payer: Cash Price	$6.91
Rate for Payer: Community Health Alliance Commercial	$9.04
Rate for Payer: Priority Health Commercial	$7.44
Rate for Payer: Priority Health PPO	$7.44

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges