Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

US LIMITED STUDY/BUBBLE

Facility

$273.00

Service Code	HCPCS 93308
Hospital Charge Code	4000113
Hospital Revenue Code	480
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$255.96
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$177.45
Rate for Payer: Cash Price	$177.45
Rate for Payer: Community Health Alliance Commercial	$232.05
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	$191.10
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$191.10
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

US LIVER

Facility

$247.00

Hospital Charge Code	4000041
Hospital Revenue Code	402
Min. Negotiated Rate	$172.90
Max. Negotiated Rate	$209.95
Rate for Payer: Cash Price	$160.55
Rate for Payer: Community Health Alliance Commercial	$209.95
Rate for Payer: Priority Health Commercial	$172.90
Rate for Payer: Priority Health PPO	$172.90

US LIVER

Facility

$247.00

Service Code	HCPCS 76705
Hospital Charge Code	4000040
Hospital Revenue Code	402
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$209.95
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$160.55
Rate for Payer: Cash Price	$160.55
Rate for Payer: Community Health Alliance Commercial	$209.95
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	$172.90
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$172.90
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

US LIVER CYST ASPIRATION

Facility

$1,904.00

Service Code	HCPCS 49405
Hospital Charge Code	3500435
Hospital Revenue Code	361
Min. Negotiated Rate	$779.56
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	$1,237.60
Rate for Payer: Cash Price	$1,237.60
Rate for Payer: Community Health Alliance Commercial	$1,618.40
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	$1,332.80
Rate for Payer: Priority Health Medicaid	$1,771.74
Rate for Payer: Priority Health Medicare	$1,771.74
Rate for Payer: Priority Health PPO	$1,332.80
Rate for Payer: United Health Care Medicaid	$1,771.74
Rate for Payer: United Health Care Medicare Advantage	$779.56

US LOWER EXT ARTERIAL BILAT

Facility

$837.00

Hospital Charge Code	4000372
Hospital Revenue Code	921
Min. Negotiated Rate	$585.90
Max. Negotiated Rate	$711.45
Rate for Payer: Cash Price	$544.05
Rate for Payer: Community Health Alliance Commercial	$711.45
Rate for Payer: Priority Health Commercial	$585.90
Rate for Payer: Priority Health PPO	$585.90

US LOWER EXT.ARTERIAL BILAT.

Facility

$627.00

Service Code	HCPCS 93923
Hospital Charge Code	4000340
Hospital Revenue Code	921
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$532.95
Rate for Payer: BCBS BCN 65	$231.63
Rate for Payer: Blue Care Network Medicare Advantage	$231.63
Rate for Payer: Cash Price	$407.55
Rate for Payer: Cash Price	$407.55
Rate for Payer: Community Health Alliance Commercial	$532.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$231.63
Rate for Payer: Meridian Health Plan Medicare	$231.63
Rate for Payer: Priority Health Commercial	$438.90
Rate for Payer: Priority Health Medicaid	$231.63
Rate for Payer: Priority Health Medicare	$231.63
Rate for Payer: Priority Health PPO	$438.90
Rate for Payer: United Health Care Medicaid	$231.63
Rate for Payer: United Health Care Medicare Advantage	$101.92

US LOWER EXT. ARTERIAL DUPLEX

Facility

$510.00

Service Code	HCPCS 93925
Hospital Charge Code	4000370
Hospital Revenue Code	921
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 LOWER EXTREMITY ARTERY UNI

Facility

$268.00

Service Code	HCPCS 93926
Hospital Charge Code	4000365
Hospital Revenue Code	921
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$227.80
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Community Health Alliance Commercial	$227.80
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	$187.60
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$187.60
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

US LOWER EXTREMITY BI W/STRESS

Facility

$352.00

Service Code	HCPCS 93924
Hospital Charge Code	4000360
Hospital Revenue Code	921
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$299.20
Rate for Payer: BCBS BCN 65	$231.63
Rate for Payer: Blue Care Network Medicare Advantage	$231.63
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Community Health Alliance Commercial	$299.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$231.63
Rate for Payer: Meridian Health Plan Medicare	$231.63
Rate for Payer: Priority Health Commercial	$246.40
Rate for Payer: Priority Health Medicaid	$231.63
Rate for Payer: Priority Health Medicare	$231.63
Rate for Payer: Priority Health PPO	$246.40
Rate for Payer: United Health Care Medicaid	$231.63
Rate for Payer: United Health Care Medicare Advantage	$101.92

US LOW EXT.VENOUS THROMBOSIS L

Facility

$268.00

Service Code	HCPCS 93971
Hospital Charge Code	4000351
Hospital Revenue Code	921
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$227.80
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Community Health Alliance Commercial	$227.80
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	$187.60
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$187.60
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

US LOW.EXT.VENOUS-THROMBOSIS R

Facility

$268.00

Service Code	HCPCS 93971
Hospital Charge Code	4000350
Hospital Revenue Code	921
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$227.80
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Community Health Alliance Commercial	$227.80
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	$187.60
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$187.60
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

US L SOFT TISSUE LEGS

Facility

$325.00

Service Code	HCPCS 76882
Hospital Charge Code	4000161
Hospital Revenue Code	402
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$276.25
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$211.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Community Health Alliance Commercial	$276.25
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	$227.50
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$227.50
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

US LT BREAST BIOPSY

Facility

$238.00

Service Code	HCPCS 76942
Hospital Charge Code	4000231
Hospital Revenue Code	402
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$202.30
Rate for Payer: Cash Price	$154.70
Rate for Payer: Community Health Alliance Commercial	$202.30
Rate for Payer: Priority Health Commercial	$166.60
Rate for Payer: Priority Health PPO	$166.60

US LT BREAST CORE BX W/CLIP

Facility

$1,866.00

Hospital Charge Code	4000266
Hospital Revenue Code	360
Min. Negotiated Rate	$1,306.20
Max. Negotiated Rate	$1,586.10
Rate for Payer: Cash Price	$1,212.90
Rate for Payer: Community Health Alliance Commercial	$1,586.10
Rate for Payer: Priority Health Commercial	$1,306.20
Rate for Payer: Priority Health PPO	$1,306.20

US L UPPER EXTREMITY VENOUS

Facility

$268.00

Service Code	HCPCS 93971
Hospital Charge Code	4000401
Hospital Revenue Code	921
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$227.80
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Community Health Alliance Commercial	$227.80
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	$187.60
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$187.60
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

US NEONATAL CRANIAL

Facility

$221.00

Service Code	HCPCS 76506
Hospital Charge Code	4000050
Hospital Revenue Code	402
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$187.85
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$143.65
Rate for Payer: Cash Price	$143.65
Rate for Payer: Community Health Alliance Commercial	$187.85
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	$154.70
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$154.70
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

USN TREATMENT, INITIAL

Facility

$387.00

Service Code	HCPCS 94664
Hospital Charge Code	4100100
Hospital Revenue Code	410
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$328.95
Rate for Payer: BCBS BCN 65	$234.91
Rate for Payer: Blue Care Network Medicare Advantage	$234.91
Rate for Payer: Cash Price	$251.55
Rate for Payer: Cash Price	$251.55
Rate for Payer: Community Health Alliance Commercial	$328.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$234.91
Rate for Payer: Meridian Health Plan Medicare	$234.91
Rate for Payer: Priority Health Commercial	$270.90
Rate for Payer: Priority Health Medicaid	$234.91
Rate for Payer: Priority Health Medicare	$234.91
Rate for Payer: Priority Health PPO	$270.90
Rate for Payer: United Health Care Medicaid	$234.91
Rate for Payer: United Health Care Medicare Advantage	$103.36

USN TREATMENT, SUBSEQUENT

Facility

$168.00

Service Code	HCPCS 94664
Hospital Charge Code	4100102
Hospital Revenue Code	410
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$234.91
Rate for Payer: BCBS BCN 65	$234.91
Rate for Payer: Blue Care Network Medicare Advantage	$234.91
Rate for Payer: Cash Price	$109.20
Rate for Payer: Cash Price	$109.20
Rate for Payer: Community Health Alliance Commercial	$142.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$234.91
Rate for Payer: Meridian Health Plan Medicare	$234.91
Rate for Payer: Priority Health Commercial	$117.60
Rate for Payer: Priority Health Medicaid	$234.91
Rate for Payer: Priority Health Medicare	$234.91
Rate for Payer: Priority Health PPO	$117.60
Rate for Payer: United Health Care Medicaid	$234.91
Rate for Payer: United Health Care Medicare Advantage	$103.36

US OB TRANSVAGINAL

Facility

$360.00

Service Code	HCPCS 76817
Hospital Charge Code	4000098
Hospital Revenue Code	402
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$306.00
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Community Health Alliance Commercial	$306.00
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	$252.00
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$252.00
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

US PANCREAS

Facility

$287.00

Service Code	HCPCS 76705
Hospital Charge Code	4000060
Hospital Revenue Code	402
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$243.95
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$186.55
Rate for Payer: Cash Price	$186.55
Rate for Payer: Community Health Alliance Commercial	$243.95
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	$200.90
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$200.90
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

USPE-1

Facility

$4.41

Hospital Charge Code	3101645
Hospital Revenue Code	300
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$3.75
Rate for Payer: Cash Price	$2.87
Rate for Payer: Community Health Alliance Commercial	$3.75
Rate for Payer: Priority Health Commercial	$3.09
Rate for Payer: Priority Health PPO	$3.09

USPE-2

Facility

$4.41

Hospital Charge Code	3101646
Hospital Revenue Code	300
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$3.75
Rate for Payer: Cash Price	$2.87
Rate for Payer: Community Health Alliance Commercial	$3.75
Rate for Payer: Priority Health Commercial	$3.09
Rate for Payer: Priority Health PPO	$3.09

US PELVIS

Facility

$395.00

Service Code	HCPCS 76856
Hospital Charge Code	4000070
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

USPE RFX IFE-1

Facility

$5.28

Hospital Charge Code	3102493
Hospital Revenue Code	300
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$4.49
Rate for Payer: Cash Price	$3.43
Rate for Payer: Community Health Alliance Commercial	$4.49
Rate for Payer: Priority Health Commercial	$3.70
Rate for Payer: Priority Health PPO	$3.70

USPE RFX IFE-2

Facility

$5.27

Hospital Charge Code	3102494
Hospital Revenue Code	300
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$4.48
Rate for Payer: Cash Price	$3.43
Rate for Payer: Community Health Alliance Commercial	$4.48
Rate for Payer: Priority Health Commercial	$3.69
Rate for Payer: Priority Health PPO	$3.69

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges