Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

MYELOPEROXIDASE/PROTEINASE

Facility

$111.00

Hospital Charge Code	3100028
Hospital Revenue Code	301
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$94.35
Rate for Payer: Cash Price	$72.15
Rate for Payer: Community Health Alliance Commercial	$94.35
Rate for Payer: Priority Health Commercial	$77.70
Rate for Payer: Priority Health PPO	$77.70

MYERS MESH

Facility

$921.00

Service Code	HCPCS C1781
Hospital Charge Code	27017681
Hospital Revenue Code	278
Min. Negotiated Rate	$644.70
Max. Negotiated Rate	$782.85
Rate for Payer: Cash Price	$598.65
Rate for Payer: Community Health Alliance Commercial	$782.85
Rate for Payer: Priority Health Commercial	$644.70
Rate for Payer: Priority Health PPO	$644.70

MYOGLOBIN-SERUM

Facility

$5.00

Service Code	HCPCS 83874
Hospital Charge Code	3000762
Hospital Revenue Code	301
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$13.57
Rate for Payer: BCBS BCN 65	$13.57
Rate for Payer: Blue Care Network Medicare Advantage	$13.57
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.57
Rate for Payer: Meridian Health Plan Medicare	$13.57
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$13.57
Rate for Payer: Priority Health Medicare	$13.57
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$13.57
Rate for Payer: United Health Care Medicare Advantage	$5.97

MYOGLOBIN-URINE

Facility

$5.00

Service Code	HCPCS 83874
Hospital Charge Code	3000761
Hospital Revenue Code	301
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$13.57
Rate for Payer: BCBS BCN 65	$13.57
Rate for Payer: Blue Care Network Medicare Advantage	$13.57
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.57
Rate for Payer: Meridian Health Plan Medicare	$13.57
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$13.57
Rate for Payer: Priority Health Medicare	$13.57
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$13.57
Rate for Payer: United Health Care Medicare Advantage	$5.97

MYOMARKER 3 PROFILE LC

Facility

$595.00

Hospital Charge Code	31027390
Hospital Revenue Code	300
Min. Negotiated Rate	$416.50
Max. Negotiated Rate	$505.75
Rate for Payer: Cash Price	$386.75
Rate for Payer: Community Health Alliance Commercial	$505.75
Rate for Payer: Priority Health Commercial	$416.50
Rate for Payer: Priority Health PPO	$416.50

MYSOLINE-1

Facility

$5.44

Hospital Charge Code	3101821
Hospital Revenue Code	300
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$4.62
Rate for Payer: Cash Price	$3.54
Rate for Payer: Community Health Alliance Commercial	$4.62
Rate for Payer: Priority Health Commercial	$3.81
Rate for Payer: Priority Health PPO	$3.81

MYSOLINE-PRIMIDONE INC PHENOB

Facility

$5.44

Service Code	HCPCS 80188
Hospital Charge Code	3006760
Hospital Revenue Code	301
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$17.42
Rate for Payer: BCBS BCN 65	$17.42
Rate for Payer: Blue Care Network Medicare Advantage	$17.42
Rate for Payer: Cash Price	$3.54
Rate for Payer: Cash Price	$3.54
Rate for Payer: Community Health Alliance Commercial	$4.62
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.42
Rate for Payer: Meridian Health Plan Medicare	$17.42
Rate for Payer: Priority Health Commercial	$3.81
Rate for Payer: Priority Health Medicaid	$17.42
Rate for Payer: Priority Health Medicare	$17.42
Rate for Payer: Priority Health PPO	$3.81
Rate for Payer: United Health Care Medicaid	$17.42
Rate for Payer: United Health Care Medicare Advantage	$7.66

NABFERON 1

Facility

$346.00

Service Code	HCPCS 86382
Hospital Charge Code	3006251
Hospital Revenue Code	302
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$294.10
Rate for Payer: BCBS BCN 65	$17.76
Rate for Payer: Blue Care Network Medicare Advantage	$17.76
Rate for Payer: Cash Price	$224.90
Rate for Payer: Cash Price	$224.90
Rate for Payer: Community Health Alliance Commercial	$294.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.76
Rate for Payer: Meridian Health Plan Medicare	$17.76
Rate for Payer: Priority Health Commercial	$242.20
Rate for Payer: Priority Health Medicaid	$17.76
Rate for Payer: Priority Health Medicare	$17.76
Rate for Payer: Priority Health PPO	$242.20
Rate for Payer: United Health Care Medicaid	$17.76
Rate for Payer: United Health Care Medicare Advantage	$7.81

NABFERON 2

Facility

$346.00

Service Code	HCPCS 86384
Hospital Charge Code	3006252
Hospital Revenue Code	302
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$294.10
Rate for Payer: BCBS BCN 65	$14.29
Rate for Payer: Blue Care Network Medicare Advantage	$14.29
Rate for Payer: Cash Price	$224.90
Rate for Payer: Cash Price	$224.90
Rate for Payer: Community Health Alliance Commercial	$294.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.29
Rate for Payer: Meridian Health Plan Medicare	$14.29
Rate for Payer: Priority Health Commercial	$242.20
Rate for Payer: Priority Health Medicaid	$14.29
Rate for Payer: Priority Health Medicare	$14.29
Rate for Payer: Priority Health PPO	$242.20
Rate for Payer: United Health Care Medicaid	$14.29
Rate for Payer: United Health Care Medicare Advantage	$6.29

NABFERON 3

Facility

$346.00

Service Code	HCPCS 87253
Hospital Charge Code	3006253
Hospital Revenue Code	306
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$294.10
Rate for Payer: BCBS BCN 65	$21.21
Rate for Payer: Blue Care Network Medicare Advantage	$21.21
Rate for Payer: Cash Price	$224.90
Rate for Payer: Cash Price	$224.90
Rate for Payer: Community Health Alliance Commercial	$294.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.21
Rate for Payer: Meridian Health Plan Medicare	$21.21
Rate for Payer: Priority Health Commercial	$242.20
Rate for Payer: Priority Health Medicaid	$21.21
Rate for Payer: Priority Health Medicare	$21.21
Rate for Payer: Priority Health PPO	$242.20
Rate for Payer: United Health Care Medicaid	$21.21
Rate for Payer: United Health Care Medicare Advantage	$9.33

NAIL END CAP OMM

Facility

$291.00

Hospital Charge Code	27268431
Hospital Revenue Code	272
Min. Negotiated Rate	$203.70
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$189.15
Rate for Payer: Community Health Alliance Commercial	$247.35
Rate for Payer: Priority Health Commercial	$203.70
Rate for Payer: Priority Health PPO	$203.70

NAIL,FEMORAL/RECON 12MM X 60CM

Facility

$2,681.00

Service Code	HCPCS C1713
Hospital Charge Code	27866518
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.70
Max. Negotiated Rate	$2,278.85
Rate for Payer: Cash Price	$1,742.65
Rate for Payer: Community Health Alliance Commercial	$2,278.85
Rate for Payer: Priority Health Commercial	$1,876.70
Rate for Payer: Priority Health PPO	$1,876.70

NAIL,FEMORAL/RECON 14 X42

Facility

$2,681.00

Service Code	HCPCS C1713
Hospital Charge Code	27266013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.70
Max. Negotiated Rate	$2,278.85
Rate for Payer: Cash Price	$1,742.65
Rate for Payer: Community Health Alliance Commercial	$2,278.85
Rate for Payer: Priority Health Commercial	$1,876.70
Rate for Payer: Priority Health PPO	$1,876.70

NAIL, TIBIAL 12MM X 34CM

Facility

$1,981.00

Service Code	HCPCS C1713
Hospital Charge Code	27868399
Hospital Revenue Code	278
Min. Negotiated Rate	$1,386.70
Max. Negotiated Rate	$1,683.85
Rate for Payer: Cash Price	$1,287.65
Rate for Payer: Community Health Alliance Commercial	$1,683.85
Rate for Payer: Priority Health Commercial	$1,386.70
Rate for Payer: Priority Health PPO	$1,386.70

NAPROSYN

Facility

$22.48

Service Code	HCPCS 80329
Hospital Charge Code	3006210
Hospital Revenue Code	301
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$19.11
Rate for Payer: Cash Price	$14.61
Rate for Payer: Community Health Alliance Commercial	$19.11
Rate for Payer: Priority Health Commercial	$15.74
Rate for Payer: Priority Health PPO	$15.74

NA QUAN NOS AGENT

Facility

$65.00

Hospital Charge Code	3100039
Hospital Revenue Code	306
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

NASAL BILIARY DRAINAGE SET

Facility

$441.00

Hospital Charge Code	27262888
Hospital Revenue Code	272
Min. Negotiated Rate	$308.70
Max. Negotiated Rate	$374.85
Rate for Payer: Cash Price	$286.65
Rate for Payer: Community Health Alliance Commercial	$374.85
Rate for Payer: Priority Health Commercial	$308.70
Rate for Payer: Priority Health PPO	$308.70

NASAL PACKING

Facility

$59.00

Hospital Charge Code	27261618
Hospital Revenue Code	272
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$50.15
Rate for Payer: Cash Price	$38.35
Rate for Payer: Community Health Alliance Commercial	$50.15
Rate for Payer: Priority Health Commercial	$41.30
Rate for Payer: Priority Health PPO	$41.30

NATURAL KILLER CELL

Facility

$17.97

Hospital Charge Code	3002062
Hospital Revenue Code	302
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$15.27
Rate for Payer: Cash Price	$11.68
Rate for Payer: Community Health Alliance Commercial	$15.27
Rate for Payer: Priority Health Commercial	$12.58
Rate for Payer: Priority Health PPO	$12.58

NATURAL KILLER CELL-QUANT

Facility

$66.00

Hospital Charge Code	3006642
Hospital Revenue Code	302
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$56.10
Rate for Payer: Cash Price	$42.90
Rate for Payer: Community Health Alliance Commercial	$56.10
Rate for Payer: Priority Health Commercial	$46.20
Rate for Payer: Priority Health PPO	$46.20

NAVANE

Facility

$120.00

Service Code	HCPCS 80299
Hospital Charge Code	3006265
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$102.00
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.57
Rate for Payer: Meridian Health Plan Medicare	$19.57
Rate for Payer: Priority Health Commercial	$84.00
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$84.00
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

NEEDLE BIOPSY BREAST

Facility

$179.00

Service Code	HCPCS 19100
Hospital Charge Code	3201376
Hospital Revenue Code	361
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$1,771.74
Rate for Payer: BCBS BCN 65	$1,771.74
Rate for Payer: Blue Care Network Medicare Advantage	$1,771.74
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Community Health Alliance Commercial	$152.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,771.74
Rate for Payer: Meridian Health Plan Medicare	$1,771.74
Rate for Payer: Priority Health Commercial	$125.30
Rate for Payer: Priority Health Medicaid	$1,771.74
Rate for Payer: Priority Health Medicare	$1,771.74
Rate for Payer: Priority Health PPO	$125.30
Rate for Payer: United Health Care Medicaid	$1,771.74
Rate for Payer: United Health Care Medicare Advantage	$779.56

NEEDLE,CALDWELL PARACENTESIS

Facility

$78.00

Hospital Charge Code	27262705
Hospital Revenue Code	272
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health PPO	$54.60

NEEDLE, CHIBA TYPE 20 CM

Facility

$44.00

Hospital Charge Code	27019547
Hospital Revenue Code	272
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

NEEDLE,CORSON FOR DISSECTION

Facility

$422.00

Hospital Charge Code	27021626
Hospital Revenue Code	272
Min. Negotiated Rate	$295.40
Max. Negotiated Rate	$358.70
Rate for Payer: Cash Price	$274.30
Rate for Payer: Community Health Alliance Commercial	$358.70
Rate for Payer: Priority Health Commercial	$295.40
Rate for Payer: Priority Health PPO	$295.40

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges