Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

US CAROTID ARTERY LMT

Facility

$510.00

Service Code	HCPCS 93882
Hospital Charge Code	4000325
Hospital Revenue Code	921
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$433.50
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$331.50
Rate for Payer: Cash Price	$331.50
Rate for Payer: Community Health Alliance Commercial	$433.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$112.15
Rate for Payer: Meridian Health Plan Medicare	$112.15
Rate for Payer: Priority Health Commercial	$357.00
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$357.00
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

US CATH &INTRO HYSTERSONOGRAPH

Facility

$387.00

Service Code	HCPCS 58340
Hospital Charge Code	4000072
Hospital Revenue Code	402
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$328.95
Rate for Payer: Cash Price	$251.55
Rate for Payer: Community Health Alliance Commercial	$328.95
Rate for Payer: Priority Health Commercial	$270.90
Rate for Payer: Priority Health PPO	$270.90

US CHEST

Facility

$280.20

Hospital Charge Code	4000490
Hospital Revenue Code	402
Min. Negotiated Rate	$196.14
Max. Negotiated Rate	$238.17
Rate for Payer: Cash Price	$182.13
Rate for Payer: Community Health Alliance Commercial	$238.17
Rate for Payer: Priority Health Commercial	$196.14
Rate for Payer: Priority Health PPO	$196.14

US COLOR FLOW (ECHO)

Facility

$273.00

Service Code	HCPCS 93325
Hospital Charge Code	4000112
Hospital Revenue Code	483
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$232.05
Rate for Payer: Cash Price	$177.45
Rate for Payer: Community Health Alliance Commercial	$232.05
Rate for Payer: Priority Health Commercial	$191.10
Rate for Payer: Priority Health PPO	$191.10

US DEFINITY CONTRAST

Facility

$597.00

Service Code	HCPCS Q9957
Hospital Charge Code	4000055
Hospital Revenue Code	636
Min. Negotiated Rate	$417.90
Max. Negotiated Rate	$507.45
Rate for Payer: Cash Price	$388.05
Rate for Payer: Community Health Alliance Commercial	$507.45
Rate for Payer: Priority Health Commercial	$417.90
Rate for Payer: Priority Health PPO	$417.90

US DOPPLER ART/VEN ANY ORGAN

Facility

$518.00

Service Code	HCPCS 93975
Hospital Charge Code	4000420
Hospital Revenue Code	921
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$440.30
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$336.70
Rate for Payer: Cash Price	$336.70
Rate for Payer: Community Health Alliance Commercial	$440.30
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	$362.60
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$362.60
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

US DOPPLER (ECHO ONLY)

Facility

$303.00

Service Code	HCPCS 93320
Hospital Charge Code	4000111
Hospital Revenue Code	483
Min. Negotiated Rate	$212.10
Max. Negotiated Rate	$257.55
Rate for Payer: Cash Price	$196.95
Rate for Payer: Community Health Alliance Commercial	$257.55
Rate for Payer: Priority Health Commercial	$212.10
Rate for Payer: Priority Health PPO	$212.10

US DUPLEX CAROTID EXRACRNL ART

Facility

$427.00

Service Code	HCPCS 93880
Hospital Charge Code	4000320
Hospital Revenue Code	921
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$362.95
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$277.55
Rate for Payer: Cash Price	$277.55
Rate for Payer: Community Health Alliance Commercial	$362.95
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	$298.90
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$298.90
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

US DUPLEX EXT VEINS UNIL/LIMIT

Facility

$263.00

Hospital Charge Code	4000333
Hospital Revenue Code	921
Min. Negotiated Rate	$184.10
Max. Negotiated Rate	$223.55
Rate for Payer: Cash Price	$170.95
Rate for Payer: Community Health Alliance Commercial	$223.55
Rate for Payer: Priority Health Commercial	$184.10
Rate for Payer: Priority Health PPO	$184.10

US DUPLEX VEINS BILAT

Facility

$413.00

Hospital Charge Code	4000334
Hospital Revenue Code	921
Min. Negotiated Rate	$289.10
Max. Negotiated Rate	$351.05
Rate for Payer: Cash Price	$268.45
Rate for Payer: Community Health Alliance Commercial	$351.05
Rate for Payer: Priority Health Commercial	$289.10
Rate for Payer: Priority Health PPO	$289.10

US ECHO COMPLETE

Facility

$1,178.00

Hospital Charge Code	4000109
Hospital Revenue Code	483
Min. Negotiated Rate	$824.60
Max. Negotiated Rate	$1,001.30
Rate for Payer: Cash Price	$765.70
Rate for Payer: Community Health Alliance Commercial	$1,001.30
Rate for Payer: Priority Health Commercial	$824.60
Rate for Payer: Priority Health PPO	$824.60

US ECHO TRANSTHORACIC

Facility

$1,460.00

Service Code	HCPCS C8929
Hospital Charge Code	4000212
Hospital Revenue Code	480
Min. Negotiated Rate	$370.02
Max. Negotiated Rate	$1,241.00
Rate for Payer: BCBS BCN 65	$840.95
Rate for Payer: Blue Care Network Medicare Advantage	$840.95
Rate for Payer: Cash Price	$949.00
Rate for Payer: Cash Price	$949.00
Rate for Payer: Community Health Alliance Commercial	$1,241.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$840.95
Rate for Payer: Meridian Health Plan Medicare	$840.95
Rate for Payer: Priority Health Commercial	$1,022.00
Rate for Payer: Priority Health Medicaid	$840.95
Rate for Payer: Priority Health Medicare	$840.95
Rate for Payer: Priority Health PPO	$1,022.00
Rate for Payer: United Health Care Medicaid	$840.95
Rate for Payer: United Health Care Medicare Advantage	$370.02

US ECHO TRANSTHORACIC WITH CON

Facility

$1,291.00

Hospital Charge Code	4000211
Hospital Revenue Code	480
Min. Negotiated Rate	$903.70
Max. Negotiated Rate	$1,097.35
Rate for Payer: Cash Price	$839.15
Rate for Payer: Community Health Alliance Commercial	$1,097.35
Rate for Payer: Priority Health Commercial	$903.70
Rate for Payer: Priority Health PPO	$903.70

US FETAL BIOPHYSICAL PROFILE

Facility

$324.00

Service Code	HCPCS 76818
Hospital Charge Code	4000030
Hospital Revenue Code	402
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$275.40
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Community Health Alliance Commercial	$275.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$112.15
Rate for Payer: Meridian Health Plan Medicare	$112.15
Rate for Payer: Priority Health Commercial	$226.80
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$226.80
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

US FETAL FACE 4D (CUTSIE)

Facility

$105.00

Hospital Charge Code	4000005
Hospital Revenue Code	402
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

US FNA THYROID

Facility

$1,395.00

Hospital Charge Code	4000463
Hospital Revenue Code	402
Min. Negotiated Rate	$976.50
Max. Negotiated Rate	$1,185.75
Rate for Payer: Cash Price	$906.75
Rate for Payer: Community Health Alliance Commercial	$1,185.75
Rate for Payer: Priority Health Commercial	$976.50
Rate for Payer: Priority Health PPO	$976.50

US GALLBLADDER

Facility

$395.00

Service Code	HCPCS 76705
Hospital Charge Code	4000010
Hospital Revenue Code	402
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$335.75
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$256.75
Rate for Payer: Cash Price	$256.75
Rate for Payer: Community Health Alliance Commercial	$335.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$112.15
Rate for Payer: Meridian Health Plan Medicare	$112.15
Rate for Payer: Priority Health Commercial	$276.50
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$276.50
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

US GUIDANCE/ABCESS DRAINAGE

Facility

$172.00

Service Code	HCPCS 75989
Hospital Charge Code	4000190
Hospital Revenue Code	402
Min. Negotiated Rate	$120.40
Max. Negotiated Rate	$146.20
Rate for Payer: Cash Price	$111.80
Rate for Payer: Community Health Alliance Commercial	$146.20
Rate for Payer: Priority Health Commercial	$120.40
Rate for Payer: Priority Health PPO	$120.40

US GUIDANCE NEEDLE PLACEMENT

Facility

$264.00

Service Code	HCPCS 76942
Hospital Charge Code	4000210
Hospital Revenue Code	402
Min. Negotiated Rate	$184.80
Max. Negotiated Rate	$224.40
Rate for Payer: Cash Price	$171.60
Rate for Payer: Community Health Alliance Commercial	$224.40
Rate for Payer: Priority Health Commercial	$184.80
Rate for Payer: Priority Health PPO	$184.80

US GUIDANCE/THORACENTESIS

Facility

$176.00

Service Code	HCPCS 76942
Hospital Charge Code	4000250
Hospital Revenue Code	402
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$149.60
Rate for Payer: Cash Price	$114.40
Rate for Payer: Community Health Alliance Commercial	$149.60
Rate for Payer: Priority Health Commercial	$123.20
Rate for Payer: Priority Health PPO	$123.20

US HYSTEROSONOGRAPHY

Facility

$510.00

Service Code	HCPCS 76831
Hospital Charge Code	4000071
Hospital Revenue Code	402
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$433.50
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$331.50
Rate for Payer: Cash Price	$331.50
Rate for Payer: Community Health Alliance Commercial	$433.50
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	$357.00
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$357.00
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

US INFANT HIPS, REAL TIME

Facility

$201.00

Service Code	HCPCS 76885
Hospital Charge Code	4000075
Hospital Revenue Code	402
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$170.85
Rate for Payer: BCBS BCN 65	$93.36
Rate for Payer: Blue Care Network Medicare Advantage	$93.36
Rate for Payer: Cash Price	$130.65
Rate for Payer: Cash Price	$130.65
Rate for Payer: Community Health Alliance Commercial	$170.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$93.36
Rate for Payer: Meridian Health Plan Medicare	$93.36
Rate for Payer: Priority Health Commercial	$140.70
Rate for Payer: Priority Health Medicaid	$93.36
Rate for Payer: Priority Health Medicare	$93.36
Rate for Payer: Priority Health PPO	$140.70
Rate for Payer: United Health Care Medicaid	$93.36
Rate for Payer: United Health Care Medicare Advantage	$41.08

US INTEROPERATIVE

Facility

$333.00

Service Code	HCPCS 76998
Hospital Charge Code	4000260
Hospital Revenue Code	402
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$283.05
Rate for Payer: Cash Price	$216.45
Rate for Payer: Community Health Alliance Commercial	$283.05
Rate for Payer: Priority Health Commercial	$233.10
Rate for Payer: Priority Health PPO	$233.10

US L BREAST CYST ASPIRATION

Facility

$234.00

Service Code	HCPCS 76942
Hospital Charge Code	4000021
Hospital Revenue Code	402
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$198.90
Rate for Payer: Cash Price	$152.10
Rate for Payer: Community Health Alliance Commercial	$198.90
Rate for Payer: Priority Health Commercial	$163.80
Rate for Payer: Priority Health PPO	$163.80

US LIMITED PREG

Facility

$204.00

Service Code	HCPCS 76815
Hospital Charge Code	4000091
Hospital Revenue Code	402
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$173.40
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$132.60
Rate for Payer: Cash Price	$132.60
Rate for Payer: Community Health Alliance Commercial	$173.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$112.15
Rate for Payer: Meridian Health Plan Medicare	$112.15
Rate for Payer: Priority Health Commercial	$142.80
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$142.80
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges