Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

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, REDUCIBLE

Facility

$6,944.74

Service Code	CPT 49593
Hospital Revenue Code	360
Min. Negotiated Rate	$3,055.69
Max. Negotiated Rate	$6,944.74
Rate for Payer: BCBS BCN 65	$6,944.74
Rate for Payer: Blue Care Network Medicare Advantage	$6,944.74
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6,944.74
Rate for Payer: Meridian Health Plan Medicare	$6,944.74
Rate for Payer: Priority Health Medicaid	$6,944.74
Rate for Payer: Priority Health Medicare	$6,944.74
Rate for Payer: United Health Care Medicaid	$6,944.74
Rate for Payer: United Health Care Medicare Advantage	$3,055.69

Facility

$6,485.29

Service Code	CPT 49592
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

Facility

$3,840.85

Service Code	CPT 49591
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 OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED

Facility

$6,485.29

Service Code	CPT 49614
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

Facility

$3,840.85

Service Code	CPT 49613
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 OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROACH

Facility

$2,550.43

Service Code	CPT 67904
Hospital Revenue Code	360
Min. Negotiated Rate	$1,122.19
Max. Negotiated Rate	$2,550.43
Rate for Payer: BCBS BCN 65	$2,550.43
Rate for Payer: Blue Care Network Medicare Advantage	$2,550.43
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,550.43
Rate for Payer: Meridian Health Plan Medicare	$2,550.43
Rate for Payer: Priority Health Medicaid	$2,550.43
Rate for Payer: Priority Health Medicare	$2,550.43
Rate for Payer: United Health Care Medicaid	$2,550.43
Rate for Payer: United Health Care Medicare Advantage	$1,122.19

REPAIR OF ECTROPION; EXTENSIVE (EG, TARSAL STRIP OPERATIONS)

Facility

$2,550.43

Service Code	CPT 67917
Hospital Revenue Code	360
Min. Negotiated Rate	$1,122.19
Max. Negotiated Rate	$2,550.43
Rate for Payer: BCBS BCN 65	$2,550.43
Rate for Payer: Blue Care Network Medicare Advantage	$2,550.43
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,550.43
Rate for Payer: Meridian Health Plan Medicare	$2,550.43
Rate for Payer: Priority Health Medicaid	$2,550.43
Rate for Payer: Priority Health Medicare	$2,550.43
Rate for Payer: United Health Care Medicaid	$2,550.43
Rate for Payer: United Health Care Medicare Advantage	$1,122.19

REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE

Facility

$3,840.85

Service Code	CPT 49520
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 UMBIL HERNIA BLOCK >5

Facility

$2,039.00

Hospital Charge Code	5150701
Hospital Revenue Code	960
Min. Negotiated Rate	$1,427.30
Max. Negotiated Rate	$1,733.15
Rate for Payer: Cash Price	$1,325.35
Rate for Payer: Community Health Alliance Commercial	$1,733.15
Rate for Payer: Priority Health Commercial	$1,427.30
Rate for Payer: Priority Health PPO	$1,427.30

REPEAT ANTISCL-7

Facility

$92.93

Hospital Charge Code	3102640
Hospital Revenue Code	300
Min. Negotiated Rate	$65.05
Max. Negotiated Rate	$78.99
Rate for Payer: Cash Price	$60.40
Rate for Payer: Community Health Alliance Commercial	$78.99
Rate for Payer: Priority Health Commercial	$65.05
Rate for Payer: Priority Health PPO	$65.05

REPLIFORM 2 CM x 4 CM

Facility

$1,518.00

Hospital Charge Code	27266641
Hospital Revenue Code	272
Min. Negotiated Rate	$1,062.60
Max. Negotiated Rate	$1,290.30
Rate for Payer: Cash Price	$986.70
Rate for Payer: Community Health Alliance Commercial	$1,290.30
Rate for Payer: Priority Health Commercial	$1,062.60
Rate for Payer: Priority Health PPO	$1,062.60

REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS, REQUIRING AN INCISION (SEPARATE PROCEDURE)

Facility

$2,475.70

Service Code	CPT 66825
Hospital Revenue Code	360
Min. Negotiated Rate	$1,089.31
Max. Negotiated Rate	$2,475.70
Rate for Payer: BCBS BCN 65	$2,475.70
Rate for Payer: Blue Care Network Medicare Advantage	$2,475.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,475.70
Rate for Payer: Meridian Health Plan Medicare	$2,475.70
Rate for Payer: Priority Health Medicaid	$2,475.70
Rate for Payer: Priority Health Medicare	$2,475.70
Rate for Payer: United Health Care Medicaid	$2,475.70
Rate for Payer: United Health Care Medicare Advantage	$1,089.31

REPTILASE TIME

Facility

$58.24

Service Code	HCPCS 85635
Hospital Charge Code	3007165
Hospital Revenue Code	305
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$49.50
Rate for Payer: BCBS BCN 65	$10.34
Rate for Payer: Blue Care Network Medicare Advantage	$10.34
Rate for Payer: Cash Price	$37.86
Rate for Payer: Cash Price	$37.86
Rate for Payer: Community Health Alliance Commercial	$49.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.34
Rate for Payer: Meridian Health Plan Medicare	$10.34
Rate for Payer: Priority Health Commercial	$40.77
Rate for Payer: Priority Health Medicaid	$10.34
Rate for Payer: Priority Health Medicare	$10.34
Rate for Payer: Priority Health PPO	$40.77
Rate for Payer: United Health Care Medicaid	$10.34
Rate for Payer: United Health Care Medicare Advantage	$4.55

RESPERIDONE I

Facility

$18.73

Service Code	HCPCS G0480
Hospital Charge Code	3007171
Hospital Revenue Code	301
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$12.17
Rate for Payer: Cash Price	$12.17
Rate for Payer: Community Health Alliance Commercial	$15.92
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$13.11
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$13.11
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

RESPERIDONE II

Facility

$100.00

Service Code	HCPCS 80299
Hospital Charge Code	3007172
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$85.00
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
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	$70.00
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$70.00
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

RESPIRATORY PATHOGEN PROF MAYO

Facility

$552.50

Hospital Charge Code	3101924
Hospital Revenue Code	300
Min. Negotiated Rate	$386.75
Max. Negotiated Rate	$469.62
Rate for Payer: Cash Price	$359.13
Rate for Payer: Community Health Alliance Commercial	$469.62
Rate for Payer: Priority Health Commercial	$386.75
Rate for Payer: Priority Health PPO	$386.75

RESP PATHOGEN PANEL-LC

Facility

$296.31

Hospital Charge Code	3102677
Hospital Revenue Code	300
Min. Negotiated Rate	$207.42
Max. Negotiated Rate	$251.86
Rate for Payer: Cash Price	$192.60
Rate for Payer: Community Health Alliance Commercial	$251.86
Rate for Payer: Priority Health Commercial	$207.42
Rate for Payer: Priority Health PPO	$207.42

RESP VIRUS 12-25 TARGETS PCR

Facility

$73.75

Hospital Charge Code	3101009
Hospital Revenue Code	306
Min. Negotiated Rate	$51.62
Max. Negotiated Rate	$62.69
Rate for Payer: Cash Price	$47.94
Rate for Payer: Community Health Alliance Commercial	$62.69
Rate for Payer: Priority Health Commercial	$51.62
Rate for Payer: Priority Health PPO	$51.62

RETIC COUNT

Facility

$33.00

Service Code	HCPCS 85044
Hospital Charge Code	3007180
Hospital Revenue Code	305
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$4.53
Rate for Payer: Blue Care Network Medicare Advantage	$4.53
Rate for Payer: Cash Price	$21.45
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.53
Rate for Payer: Meridian Health Plan Medicare	$4.53
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$4.53
Rate for Payer: Priority Health Medicare	$4.53
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$4.53
Rate for Payer: United Health Care Medicare Advantage	$1.99

RETICULUM STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100500
Hospital Revenue Code	310
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

RETICYTE HGB CONCENTRATE

Facility

$33.00

Hospital Charge Code	3100248
Hospital Revenue Code	305
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$28.05
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health PPO	$23.10

RETRACTOR PIN 85MM

Facility

$458.00

Hospital Charge Code	27867367
Hospital Revenue Code	272
Min. Negotiated Rate	$320.60
Max. Negotiated Rate	$389.30
Rate for Payer: Cash Price	$297.70
Rate for Payer: Community Health Alliance Commercial	$389.30
Rate for Payer: Priority Health Commercial	$320.60
Rate for Payer: Priority Health PPO	$320.60

RETRACTORS

Facility

$193.00

Hospital Charge Code	27061022
Hospital Revenue Code	272
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$164.05
Rate for Payer: Cash Price	$125.45
Rate for Payer: Community Health Alliance Commercial	$164.05
Rate for Payer: Priority Health Commercial	$135.10
Rate for Payer: Priority Health PPO	$135.10

RFCP-1

Facility

$3.09

Hospital Charge Code	3102617
Hospital Revenue Code	300
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.63
Rate for Payer: Cash Price	$2.01
Rate for Payer: Community Health Alliance Commercial	$2.63
Rate for Payer: Priority Health Commercial	$2.16
Rate for Payer: Priority Health PPO	$2.16

RFCP-10

Facility

$3.09

Hospital Charge Code	3102626
Hospital Revenue Code	300
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.63
Rate for Payer: Cash Price	$2.01
Rate for Payer: Community Health Alliance Commercial	$2.63
Rate for Payer: Priority Health Commercial	$2.16
Rate for Payer: Priority Health PPO	$2.16

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges