Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

REMOVAL OF THYROID LESION P/C

Facility

$2,190.00

Hospital Charge Code	5150696
Hospital Revenue Code	960
Min. Negotiated Rate	$1,533.00
Max. Negotiated Rate	$1,861.50
Rate for Payer: Cash Price	$1,423.50
Rate for Payer: Community Health Alliance Commercial	$1,861.50
Rate for Payer: Priority Health Commercial	$1,533.00
Rate for Payer: Priority Health PPO	$1,533.00

REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP

Facility

$672.93

Service Code	CPT 36589
Hospital Revenue Code	360
Min. Negotiated Rate	$296.09
Max. Negotiated Rate	$672.93
Rate for Payer: BCBS BCN 65	$672.93
Rate for Payer: Blue Care Network Medicare Advantage	$672.93
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$672.93
Rate for Payer: Meridian Health Plan Medicare	$672.93
Rate for Payer: Priority Health Medicaid	$672.93
Rate for Payer: Priority Health Medicare	$672.93
Rate for Payer: United Health Care Medicaid	$672.93
Rate for Payer: United Health Care Medicare Advantage	$296.09

REMOVAL SWEAT GLAND LESION PC

Facility

$897.00

Hospital Charge Code	5150724
Hospital Revenue Code	960
Min. Negotiated Rate	$627.90
Max. Negotiated Rate	$762.45
Rate for Payer: Cash Price	$583.05
Rate for Payer: Community Health Alliance Commercial	$762.45
Rate for Payer: Priority Health Commercial	$627.90
Rate for Payer: Priority Health PPO	$627.90

REMOVAL SWEAT GLAND LESION PC

Facility

$969.00

Hospital Charge Code	5150723
Hospital Revenue Code	960
Min. Negotiated Rate	$678.30
Max. Negotiated Rate	$823.65
Rate for Payer: Cash Price	$629.85
Rate for Payer: Community Health Alliance Commercial	$823.65
Rate for Payer: Priority Health Commercial	$678.30
Rate for Payer: Priority Health PPO	$678.30

REMOVAL TUNNELED CV CATH

Facility

$727.00

Hospital Charge Code	5150771
Hospital Revenue Code	960
Min. Negotiated Rate	$508.90
Max. Negotiated Rate	$617.95
Rate for Payer: Cash Price	$472.55
Rate for Payer: Community Health Alliance Commercial	$617.95
Rate for Payer: Priority Health Commercial	$508.90
Rate for Payer: Priority Health PPO	$508.90

REMOVE ANAL FIST COMPLEX

Facility

$1,167.00

Hospital Charge Code	5150794
Hospital Revenue Code	960
Min. Negotiated Rate	$816.90
Max. Negotiated Rate	$991.95
Rate for Payer: Cash Price	$758.55
Rate for Payer: Community Health Alliance Commercial	$991.95
Rate for Payer: Priority Health Commercial	$816.90
Rate for Payer: Priority Health PPO	$816.90

REMOVE IN/EX HEM GROUPS 2+

Facility

$1,157.00

Hospital Charge Code	5150788
Hospital Revenue Code	960
Min. Negotiated Rate	$809.90
Max. Negotiated Rate	$983.45
Rate for Payer: Cash Price	$752.05
Rate for Payer: Community Health Alliance Commercial	$983.45
Rate for Payer: Priority Health Commercial	$809.90
Rate for Payer: Priority Health PPO	$809.90

REMOVER - SKIN STAPLES

Facility

$25.00

Hospital Charge Code	27011031
Hospital Revenue Code	272
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

RENAL FUNCTION PANEL

Facility

$71.00

Service Code	HCPCS 80069
Hospital Charge Code	3007150
Hospital Revenue Code	301
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$60.35
Rate for Payer: BCBS BCN 65	$9.11
Rate for Payer: Blue Care Network Medicare Advantage	$9.11
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.11
Rate for Payer: Meridian Health Plan Medicare	$9.11
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health Medicaid	$9.11
Rate for Payer: Priority Health Medicare	$9.11
Rate for Payer: Priority Health PPO	$49.70
Rate for Payer: United Health Care Medicaid	$9.11
Rate for Payer: United Health Care Medicare Advantage	$4.01

RENAL FUNTION PANEL LC

Facility

$2.70

Hospital Charge Code	3102484
Hospital Revenue Code	300
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$2.29
Rate for Payer: Cash Price	$1.76
Rate for Payer: Community Health Alliance Commercial	$2.29
Rate for Payer: Priority Health Commercial	$1.89
Rate for Payer: Priority Health PPO	$1.89

RENAL SCAN W PHARM INTERVENT

Facility

$767.00

Service Code	HCPCS 78708
Hospital Charge Code	3400121
Hospital Revenue Code	340
Min. Negotiated Rate	$256.29
Max. Negotiated Rate	$651.95
Rate for Payer: BCBS BCN 65	$582.47
Rate for Payer: Blue Care Network Medicare Advantage	$582.47
Rate for Payer: Cash Price	$498.55
Rate for Payer: Cash Price	$498.55
Rate for Payer: Community Health Alliance Commercial	$651.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$582.47
Rate for Payer: Meridian Health Plan Medicare	$582.47
Rate for Payer: Priority Health Commercial	$536.90
Rate for Payer: Priority Health Medicaid	$582.47
Rate for Payer: Priority Health Medicare	$582.47
Rate for Payer: Priority Health PPO	$536.90
Rate for Payer: United Health Care Medicaid	$582.47
Rate for Payer: United Health Care Medicare Advantage	$256.29

RENIN, PLASMA

Facility

$5.00

Service Code	HCPCS 84244
Hospital Charge Code	3007160
Hospital Revenue Code	301
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$23.09
Rate for Payer: BCBS BCN 65	$23.09
Rate for Payer: Blue Care Network Medicare Advantage	$23.09
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	$23.09
Rate for Payer: Meridian Health Plan Medicare	$23.09
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$23.09
Rate for Payer: Priority Health Medicare	$23.09
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$23.09
Rate for Payer: United Health Care Medicare Advantage	$10.16

REPAIR AA HERNIA 1ST 3-10 RDC

Facility

$1,200.00

Hospital Charge Code	5150730
Hospital Revenue Code	960
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Cash Price	$780.00
Rate for Payer: Community Health Alliance Commercial	$1,020.00
Rate for Payer: Priority Health Commercial	$840.00
Rate for Payer: Priority Health PPO	$840.00

REPAIR AA HRN 1ST <3 CM

Facility

$972.00

Hospital Charge Code	5150737
Hospital Revenue Code	960
Min. Negotiated Rate	$680.40
Max. Negotiated Rate	$826.20
Rate for Payer: Cash Price	$631.80
Rate for Payer: Community Health Alliance Commercial	$826.20
Rate for Payer: Priority Health Commercial	$680.40
Rate for Payer: Priority Health PPO	$680.40

REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM

Facility

$436.09

Service Code	CPT 13121
Hospital Revenue Code	360
Min. Negotiated Rate	$191.88
Max. Negotiated Rate	$436.09
Rate for Payer: BCBS BCN 65	$436.09
Rate for Payer: Blue Care Network Medicare Advantage	$436.09
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$436.09
Rate for Payer: Meridian Health Plan Medicare	$436.09
Rate for Payer: Priority Health Medicaid	$436.09
Rate for Payer: Priority Health Medicare	$436.09
Rate for Payer: United Health Care Medicaid	$436.09
Rate for Payer: United Health Care Medicare Advantage	$191.88

REPAIR EPIGASTRIC HERN RED PC

Facility

$1,356.00

Hospital Charge Code	5150702
Hospital Revenue Code	960
Min. Negotiated Rate	$949.20
Max. Negotiated Rate	$1,152.60
Rate for Payer: Cash Price	$881.40
Rate for Payer: Community Health Alliance Commercial	$1,152.60
Rate for Payer: Priority Health Commercial	$949.20
Rate for Payer: Priority Health PPO	$949.20

REPAIR HERNIA REDUCIBLE PC

Facility

$2,036.00

Hospital Charge Code	5150695
Hospital Revenue Code	960
Min. Negotiated Rate	$1,425.20
Max. Negotiated Rate	$1,730.60
Rate for Payer: Cash Price	$1,323.40
Rate for Payer: Community Health Alliance Commercial	$1,730.60
Rate for Payer: Priority Health Commercial	$1,425.20
Rate for Payer: Priority Health PPO	$1,425.20

REPAIR ING HERNIA P/C

Facility

$2,258.00

Hospital Charge Code	5150676
Hospital Revenue Code	960
Min. Negotiated Rate	$1,580.60
Max. Negotiated Rate	$1,919.30
Rate for Payer: Cash Price	$1,467.70
Rate for Payer: Community Health Alliance Commercial	$1,919.30
Rate for Payer: Priority Health Commercial	$1,580.60
Rate for Payer: Priority Health PPO	$1,580.60

REPAIR ING HERNIA SLIDING PC

Facility

$1,932.00

Hospital Charge Code	5150693
Hospital Revenue Code	960
Min. Negotiated Rate	$1,352.40
Max. Negotiated Rate	$1,642.20
Rate for Payer: Cash Price	$1,255.80
Rate for Payer: Community Health Alliance Commercial	$1,642.20
Rate for Payer: Priority Health Commercial	$1,352.40
Rate for Payer: Priority Health PPO	$1,352.40

REPAIR INGUINAL HERNIA, SLIDING, ANY AGE

Facility

$3,840.85

Service Code	CPT 49525
Hospital Revenue Code	360
Min. Negotiated Rate	$1,689.97
Max. Negotiated Rate	$3,840.85
Rate for Payer: BCBS BCN 65	$3,840.85
Rate for Payer: Blue Care Network Medicare Advantage	$3,840.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,840.85
Rate for Payer: Meridian Health Plan Medicare	$3,840.85
Rate for Payer: Priority Health Medicaid	$3,840.85
Rate for Payer: Priority Health Medicare	$3,840.85
Rate for Payer: United Health Care Medicaid	$3,840.85
Rate for Payer: United Health Care Medicare Advantage	$1,689.97

REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED

Facility

$3,840.85

Service Code	CPT 49507
Hospital Revenue Code	360
Min. Negotiated Rate	$1,689.97
Max. Negotiated Rate	$3,840.85
Rate for Payer: BCBS BCN 65	$3,840.85
Rate for Payer: Blue Care Network Medicare Advantage	$3,840.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,840.85
Rate for Payer: Meridian Health Plan Medicare	$3,840.85
Rate for Payer: Priority Health Medicaid	$3,840.85
Rate for Payer: Priority Health Medicare	$3,840.85
Rate for Payer: United Health Care Medicaid	$3,840.85
Rate for Payer: United Health Care Medicare Advantage	$1,689.97

REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE

Facility

$3,840.85

Service Code	CPT 49505
Hospital Revenue Code	360
Min. Negotiated Rate	$1,689.97
Max. Negotiated Rate	$3,840.85
Rate for Payer: BCBS BCN 65	$3,840.85
Rate for Payer: Blue Care Network Medicare Advantage	$3,840.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,840.85
Rate for Payer: Meridian Health Plan Medicare	$3,840.85
Rate for Payer: Priority Health Medicaid	$3,840.85
Rate for Payer: Priority Health Medicare	$3,840.85
Rate for Payer: United Health Care Medicaid	$3,840.85
Rate for Payer: United Health Care Medicare Advantage	$1,689.97

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.5 CM OR LESS

Facility

$436.09

Service Code	CPT 12031
Hospital Revenue Code	360
Min. Negotiated Rate	$191.88
Max. Negotiated Rate	$436.09
Rate for Payer: BCBS BCN 65	$436.09
Rate for Payer: Blue Care Network Medicare Advantage	$436.09
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$436.09
Rate for Payer: Meridian Health Plan Medicare	$436.09
Rate for Payer: Priority Health Medicaid	$436.09
Rate for Payer: Priority Health Medicare	$436.09
Rate for Payer: United Health Care Medicaid	$436.09
Rate for Payer: United Health Care Medicare Advantage	$191.88

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM

Facility

$436.09

Service Code	CPT 12032
Hospital Revenue Code	360
Min. Negotiated Rate	$191.88
Max. Negotiated Rate	$436.09
Rate for Payer: BCBS BCN 65	$436.09
Rate for Payer: Blue Care Network Medicare Advantage	$436.09
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$436.09
Rate for Payer: Meridian Health Plan Medicare	$436.09
Rate for Payer: Priority Health Medicaid	$436.09
Rate for Payer: Priority Health Medicare	$436.09
Rate for Payer: United Health Care Medicaid	$436.09
Rate for Payer: United Health Care Medicare Advantage	$191.88

REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, INCARCERATED OR STRANGULATED

Facility

$6,485.29

Service Code	CPT 49594
Hospital Revenue Code	360
Min. Negotiated Rate	$2,853.53
Max. Negotiated Rate	$6,485.29
Rate for Payer: BCBS BCN 65	$6,485.29
Rate for Payer: Blue Care Network Medicare Advantage	$6,485.29
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6,485.29
Rate for Payer: Meridian Health Plan Medicare	$6,485.29
Rate for Payer: Priority Health Medicaid	$6,485.29
Rate for Payer: Priority Health Medicare	$6,485.29
Rate for Payer: United Health Care Medicaid	$6,485.29
Rate for Payer: United Health Care Medicare Advantage	$2,853.53

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges