Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

URACIL

Facility

$50.00

Hospital Charge Code	3100838
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

UREA NITROGEN, RANDOM

Facility

$2.00

Service Code	HCPCS 84540
Hospital Charge Code	3008700
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.84
Rate for Payer: BCBS BCN 65	$5.84
Rate for Payer: Blue Care Network Medicare Advantage	$5.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.84
Rate for Payer: Meridian Health Plan Medicare	$5.84
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health Medicaid	$5.84
Rate for Payer: Priority Health Medicare	$5.84
Rate for Payer: Priority Health PPO	$1.40
Rate for Payer: United Health Care Medicaid	$5.84
Rate for Payer: United Health Care Medicare Advantage	$2.57

UREAPLASMA

Facility

$16.29

Service Code	HCPCS 87109
Hospital Charge Code	3008230
Hospital Revenue Code	306
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$16.16
Rate for Payer: BCBS BCN 65	$16.16
Rate for Payer: Blue Care Network Medicare Advantage	$16.16
Rate for Payer: Cash Price	$10.59
Rate for Payer: Cash Price	$10.59
Rate for Payer: Community Health Alliance Commercial	$13.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.16
Rate for Payer: Meridian Health Plan Medicare	$16.16
Rate for Payer: Priority Health Commercial	$11.40
Rate for Payer: Priority Health Medicaid	$16.16
Rate for Payer: Priority Health Medicare	$16.16
Rate for Payer: Priority Health PPO	$11.40
Rate for Payer: United Health Care Medicaid	$16.16
Rate for Payer: United Health Care Medicare Advantage	$7.11

URETERAL CATHETER CONNECTOR

Facility

$51.00

Hospital Charge Code	27060602
Hospital Revenue Code	272
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

URIC ACID

Facility

$50.00

Hospital Charge Code	3100839
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

URIC ACID

Facility

$33.00

Service Code	HCPCS 84560
Hospital Charge Code	3008500
Hospital Revenue Code	301
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$5.33
Rate for Payer: Blue Care Network Medicare Advantage	$5.33
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	$5.33
Rate for Payer: Meridian Health Plan Medicare	$5.33
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$5.33
Rate for Payer: Priority Health Medicare	$5.33
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$5.33
Rate for Payer: United Health Care Medicare Advantage	$2.35

URIC ACID, 24 HR URINE

Facility

$2.00

Service Code	HCPCS 84560
Hospital Charge Code	3008640
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.33
Rate for Payer: BCBS BCN 65	$5.33
Rate for Payer: Blue Care Network Medicare Advantage	$5.33
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.33
Rate for Payer: Meridian Health Plan Medicare	$5.33
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health Medicaid	$5.33
Rate for Payer: Priority Health Medicare	$5.33
Rate for Payer: Priority Health PPO	$1.40
Rate for Payer: United Health Care Medicaid	$5.33
Rate for Payer: United Health Care Medicare Advantage	$2.35

URINALYSIS AUTOMATED W MICRO

Facility

$27.00

Service Code	HCPCS 81001
Hospital Charge Code	3008660
Hospital Revenue Code	307
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$22.95
Rate for Payer: BCBS BCN 65	$3.33
Rate for Payer: Blue Care Network Medicare Advantage	$3.33
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.33
Rate for Payer: Meridian Health Plan Medicare	$3.33
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health Medicaid	$3.33
Rate for Payer: Priority Health Medicare	$3.33
Rate for Payer: Priority Health PPO	$18.90
Rate for Payer: United Health Care Medicaid	$3.33
Rate for Payer: United Health Care Medicare Advantage	$1.46

URINALYSIS NO MICRO

Facility

$33.00

Service Code	HCPCS 81003
Hospital Charge Code	3007920
Hospital Revenue Code	307
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$2.36
Rate for Payer: Blue Care Network Medicare Advantage	$2.36
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	$2.36
Rate for Payer: Meridian Health Plan Medicare	$2.36
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$2.36
Rate for Payer: Priority Health Medicare	$2.36
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$2.36
Rate for Payer: United Health Care Medicare Advantage	$1.04

URINARY CONTROL SYSTEM

Facility

$14,225.00

Service Code	HCPCS C1815
Hospital Charge Code	27878499
Hospital Revenue Code	278
Min. Negotiated Rate	$9,957.50
Max. Negotiated Rate	$12,091.25
Rate for Payer: Cash Price	$9,246.25
Rate for Payer: Community Health Alliance Commercial	$12,091.25
Rate for Payer: Priority Health Commercial	$9,957.50
Rate for Payer: Priority Health PPO	$9,957.50

URINARY CYCLIC AMP

Facility

$12.15

Hospital Charge Code	3008154
Hospital Revenue Code	301
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$10.33
Rate for Payer: Cash Price	$7.90
Rate for Payer: Community Health Alliance Commercial	$10.33
Rate for Payer: Priority Health Commercial	$8.51
Rate for Payer: Priority Health PPO	$8.51

URINE CALCIUM

Facility

$2.00

Hospital Charge Code	3101942
Hospital Revenue Code	300
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health PPO	$1.40

URINE CREAT 24 LC

Facility

$2.00

Hospital Charge Code	3102582
Hospital Revenue Code	300
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health PPO	$1.40

URINE DRUG SCREEN 8 WITH CONF

Facility

$358.00

Hospital Charge Code	3100163
Hospital Revenue Code	300
Min. Negotiated Rate	$250.60
Max. Negotiated Rate	$304.30
Rate for Payer: Cash Price	$232.70
Rate for Payer: Community Health Alliance Commercial	$304.30
Rate for Payer: Priority Health Commercial	$250.60
Rate for Payer: Priority Health PPO	$250.60

URINE KAPPA LAMBDA FREE LIGHT

Facility

$129.00

Hospital Charge Code	3009891
Hospital Revenue Code	301
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$109.65
Rate for Payer: Cash Price	$83.85
Rate for Payer: Community Health Alliance Commercial	$109.65
Rate for Payer: Priority Health Commercial	$90.30
Rate for Payer: Priority Health PPO	$90.30

URINE MAGNESIUM

Facility

$3.26

Service Code	HCPCS 83735
Hospital Charge Code	3008135
Hospital Revenue Code	301
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$7.04
Rate for Payer: BCBS BCN 65	$7.04
Rate for Payer: Blue Care Network Medicare Advantage	$7.04
Rate for Payer: Cash Price	$2.12
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.04
Rate for Payer: Meridian Health Plan Medicare	$7.04
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health Medicaid	$7.04
Rate for Payer: Priority Health Medicare	$7.04
Rate for Payer: Priority Health PPO	$2.28
Rate for Payer: United Health Care Medicaid	$7.04
Rate for Payer: United Health Care Medicare Advantage	$3.10

URINE MG 24 HOUR

Facility

$3.26

Hospital Charge Code	3102110
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

URINE MUCOPOLYSACCARIDES

Facility

$109.00

Hospital Charge Code	3000817
Hospital Revenue Code	301
Min. Negotiated Rate	$76.30
Max. Negotiated Rate	$92.65
Rate for Payer: Cash Price	$70.85
Rate for Payer: Community Health Alliance Commercial	$92.65
Rate for Payer: Priority Health Commercial	$76.30
Rate for Payer: Priority Health PPO	$76.30

URINE/PLASMA AMINO ACID SCREEN

Facility

$93.67

Hospital Charge Code	3006489
Hospital Revenue Code	301
Min. Negotiated Rate	$65.57
Max. Negotiated Rate	$79.62
Rate for Payer: Cash Price	$60.89
Rate for Payer: Community Health Alliance Commercial	$79.62
Rate for Payer: Priority Health Commercial	$65.57
Rate for Payer: Priority Health PPO	$65.57

URINE PREGNANCY

Facility

$33.00

Hospital Charge Code	3005042
Hospital Revenue Code	307
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

URINE URANIUM

Facility

$102.00

Service Code	HCPCS 83018
Hospital Charge Code	3008138
Hospital Revenue Code	301
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$86.70
Rate for Payer: BCBS BCN 65	$23.06
Rate for Payer: Blue Care Network Medicare Advantage	$23.06
Rate for Payer: Cash Price	$66.30
Rate for Payer: Cash Price	$66.30
Rate for Payer: Community Health Alliance Commercial	$86.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$23.06
Rate for Payer: Meridian Health Plan Medicare	$23.06
Rate for Payer: Priority Health Commercial	$71.40
Rate for Payer: Priority Health Medicaid	$23.06
Rate for Payer: Priority Health Medicare	$23.06
Rate for Payer: Priority Health PPO	$71.40
Rate for Payer: United Health Care Medicaid	$23.06
Rate for Payer: United Health Care Medicare Advantage	$10.15

URINE URIC ACID 24HR

Facility

$2.00

Hospital Charge Code	3101863
Hospital Revenue Code	300
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health PPO	$1.40

URINE URIC ACID RANDOM

Facility

$2.00

Hospital Charge Code	3101862
Hospital Revenue Code	300
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health PPO	$1.40

UROPORPHYRINS,24 HOUR

Facility

$73.00

Service Code	HCPCS 84120
Hospital Charge Code	3008250
Hospital Revenue Code	301
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$62.05
Rate for Payer: BCBS BCN 65	$15.45
Rate for Payer: Blue Care Network Medicare Advantage	$15.45
Rate for Payer: Cash Price	$47.45
Rate for Payer: Cash Price	$47.45
Rate for Payer: Community Health Alliance Commercial	$62.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.45
Rate for Payer: Meridian Health Plan Medicare	$15.45
Rate for Payer: Priority Health Commercial	$51.10
Rate for Payer: Priority Health Medicaid	$15.45
Rate for Payer: Priority Health Medicare	$15.45
Rate for Payer: Priority Health PPO	$51.10
Rate for Payer: United Health Care Medicaid	$15.45
Rate for Payer: United Health Care Medicare Advantage	$6.80

UROSTOMY DRAIN TUBE

Facility

$24.00

Hospital Charge Code	27011585
Hospital Revenue Code	272
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$20.40
Rate for Payer: Cash Price	$15.60
Rate for Payer: Community Health Alliance Commercial	$20.40
Rate for Payer: Priority Health Commercial	$16.80
Rate for Payer: Priority Health PPO	$16.80

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges