Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

USTEKINUMAB 2

Facility

$62.50

Hospital Charge Code	3102137
Hospital Revenue Code	300
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$53.12
Rate for Payer: Cash Price	$40.63
Rate for Payer: Community Health Alliance Commercial	$53.12
Rate for Payer: Priority Health Commercial	$43.75
Rate for Payer: Priority Health PPO	$43.75

US TESTICULAR ARTERY

Facility

$459.00

Service Code	HCPCS 93975
Hospital Charge Code	4000440
Hospital Revenue Code	921
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$390.15
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$298.35
Rate for Payer: Cash Price	$298.35
Rate for Payer: Community Health Alliance Commercial	$390.15
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	$321.30
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$321.30
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

US TESTICULAR ARTERY DOPPLER

Facility

$560.00

Service Code	HCPCS 93975
Hospital Charge Code	4000200
Hospital Revenue Code	921
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$476.00
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Cash Price	$364.00
Rate for Payer: Cash Price	$364.00
Rate for Payer: Community Health Alliance Commercial	$476.00
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	$392.00
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: Priority Health PPO	$392.00
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

US THORACENTESIS W/ IMAGING

Facility

$1,258.00

Hospital Charge Code	4000194
Hospital Revenue Code	490
Min. Negotiated Rate	$880.60
Max. Negotiated Rate	$1,069.30
Rate for Payer: Cash Price	$817.70
Rate for Payer: Community Health Alliance Commercial	$1,069.30
Rate for Payer: Priority Health Commercial	$880.60
Rate for Payer: Priority Health PPO	$880.60

US THYROID

Facility

$395.00

Service Code	HCPCS 76536
Hospital Charge Code	4000180
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 THYROID CORE BIOPSY

Facility

$1,374.00

Hospital Charge Code	4000364
Hospital Revenue Code	361
Min. Negotiated Rate	$961.80
Max. Negotiated Rate	$1,167.90
Rate for Payer: Cash Price	$893.10
Rate for Payer: Community Health Alliance Commercial	$1,167.90
Rate for Payer: Priority Health Commercial	$961.80
Rate for Payer: Priority Health PPO	$961.80

US THYROID CORE BIOPSY

Facility

$1,637.00

Hospital Charge Code	4000363
Hospital Revenue Code	402
Min. Negotiated Rate	$1,145.90
Max. Negotiated Rate	$1,391.45
Rate for Payer: Cash Price	$1,064.05
Rate for Payer: Community Health Alliance Commercial	$1,391.45
Rate for Payer: Priority Health Commercial	$1,145.90
Rate for Payer: Priority Health PPO	$1,145.90

US THYROID CYST ASPIRATION

Facility

$1,243.00

Service Code	HCPCS 60300
Hospital Charge Code	3500431
Hospital Revenue Code	361
Min. Negotiated Rate	$334.24
Max. Negotiated Rate	$1,056.55
Rate for Payer: BCBS BCN 65	$759.64
Rate for Payer: Blue Care Network Medicare Advantage	$759.64
Rate for Payer: Cash Price	$807.95
Rate for Payer: Cash Price	$807.95
Rate for Payer: Community Health Alliance Commercial	$1,056.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$759.64
Rate for Payer: Meridian Health Plan Medicare	$759.64
Rate for Payer: Priority Health Commercial	$870.10
Rate for Payer: Priority Health Medicaid	$759.64
Rate for Payer: Priority Health Medicare	$759.64
Rate for Payer: Priority Health PPO	$870.10
Rate for Payer: United Health Care Medicaid	$759.64
Rate for Payer: United Health Care Medicare Advantage	$334.24

US TRANSVAGINAL

Facility

$395.00

Service Code	HCPCS 76830
Hospital Charge Code	4000080
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 UPPER EXTREMITY ARTERIAL

Facility

$627.00

Service Code	HCPCS 93923
Hospital Charge Code	4000390
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 UPPER EXTREMITY ARTERIAL BL

Facility

$510.00

Service Code	HCPCS 93930
Hospital Charge Code	4000395
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 UPPER EXTREMITY ARTER LEFT

Facility

$360.00

Service Code	HCPCS 93931
Hospital Charge Code	4000396
Hospital Revenue Code	921
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 UPPER EXTREMITY ARTER RIGHT

Facility

$360.00

Hospital Charge Code	4000394
Hospital Revenue Code	921
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$306.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Community Health Alliance Commercial	$306.00
Rate for Payer: Priority Health Commercial	$252.00
Rate for Payer: Priority Health PPO	$252.00

V.A.C. ATS CANISTER ASSY

Facility

$303.00

Hospital Charge Code	27015227
Hospital Revenue Code	270
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

V.A.C. ATS SMALL DRESSING

Facility

$224.00

Hospital Charge Code	27015226
Hospital Revenue Code	270
Min. Negotiated Rate	$156.80
Max. Negotiated Rate	$190.40
Rate for Payer: Cash Price	$145.60
Rate for Payer: Community Health Alliance Commercial	$190.40
Rate for Payer: Priority Health Commercial	$156.80
Rate for Payer: Priority Health PPO	$156.80

V.A.C. ATS THERAPY UNIT

Facility

$102.00

Hospital Charge Code	27015225
Hospital Revenue Code	270
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$86.70
Rate for Payer: Cash Price	$66.30
Rate for Payer: Community Health Alliance Commercial	$86.70
Rate for Payer: Priority Health Commercial	$71.40
Rate for Payer: Priority Health PPO	$71.40

VAGINOSIS PANEL

Facility

$30.00

Hospital Charge Code	3002833
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$25.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health PPO	$21.00

VALIUM (DIAZEPAM)

Facility

$13.32

Service Code	HCPCS 80299
Hospital Charge Code	3008730
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$19.57
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$8.66
Rate for Payer: Cash Price	$8.66
Rate for Payer: Community Health Alliance Commercial	$11.32
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	$9.32
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$9.32
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

VANCOMYCIN PEAK

Facility

$56.00

Service Code	HCPCS 80202
Hospital Charge Code	3008740
Hospital Revenue Code	301
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$47.60
Rate for Payer: BCBS BCN 65	$14.22
Rate for Payer: Blue Care Network Medicare Advantage	$14.22
Rate for Payer: Cash Price	$36.40
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.22
Rate for Payer: Meridian Health Plan Medicare	$14.22
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health Medicaid	$14.22
Rate for Payer: Priority Health Medicare	$14.22
Rate for Payer: Priority Health PPO	$39.20
Rate for Payer: United Health Care Medicaid	$14.22
Rate for Payer: United Health Care Medicare Advantage	$6.26

VANCOMYCIN TROUGH

Facility

$56.00

Service Code	HCPCS 80202
Hospital Charge Code	3008760
Hospital Revenue Code	301
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$47.60
Rate for Payer: BCBS BCN 65	$14.22
Rate for Payer: Blue Care Network Medicare Advantage	$14.22
Rate for Payer: Cash Price	$36.40
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.22
Rate for Payer: Meridian Health Plan Medicare	$14.22
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health Medicaid	$14.22
Rate for Payer: Priority Health Medicare	$14.22
Rate for Payer: Priority Health PPO	$39.20
Rate for Payer: United Health Care Medicaid	$14.22
Rate for Payer: United Health Care Medicare Advantage	$6.26

VAPOTHERM

Facility

$25.00

Hospital Charge Code	27094988
Hospital Revenue Code	270
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

VAP PROFILE

Facility

$119.00

Hospital Charge Code	3008462
Hospital Revenue Code	301
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$101.15
Rate for Payer: Cash Price	$77.35
Rate for Payer: Community Health Alliance Commercial	$101.15
Rate for Payer: Priority Health Commercial	$83.30
Rate for Payer: Priority Health PPO	$83.30

VARICELLA TITRE IGG

Facility

$3.46

Service Code	HCPCS 86787
Hospital Charge Code	3008150
Hospital Revenue Code	302
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$13.52
Rate for Payer: BCBS BCN 65	$13.52
Rate for Payer: Blue Care Network Medicare Advantage	$13.52
Rate for Payer: Cash Price	$2.25
Rate for Payer: Cash Price	$2.25
Rate for Payer: Community Health Alliance Commercial	$2.94
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.52
Rate for Payer: Meridian Health Plan Medicare	$13.52
Rate for Payer: Priority Health Commercial	$2.42
Rate for Payer: Priority Health Medicaid	$13.52
Rate for Payer: Priority Health Medicare	$13.52
Rate for Payer: Priority Health PPO	$2.42
Rate for Payer: United Health Care Medicaid	$13.52
Rate for Payer: United Health Care Medicare Advantage	$5.95

VARICELLA TITRE IGM

Facility

$13.49

Hospital Charge Code	3008151
Hospital Revenue Code	302
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$11.47
Rate for Payer: Cash Price	$8.77
Rate for Payer: Community Health Alliance Commercial	$11.47
Rate for Payer: Priority Health Commercial	$9.44
Rate for Payer: Priority Health PPO	$9.44

VARICELLA-ZOSTER

Facility

$61.00

Service Code	HCPCS 86787
Hospital Charge Code	3008800
Hospital Revenue Code	302
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$51.85
Rate for Payer: BCBS BCN 65	$13.52
Rate for Payer: Blue Care Network Medicare Advantage	$13.52
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Community Health Alliance Commercial	$51.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.52
Rate for Payer: Meridian Health Plan Medicare	$13.52
Rate for Payer: Priority Health Commercial	$42.70
Rate for Payer: Priority Health Medicaid	$13.52
Rate for Payer: Priority Health Medicare	$13.52
Rate for Payer: Priority Health PPO	$42.70
Rate for Payer: United Health Care Medicaid	$13.52
Rate for Payer: United Health Care Medicare Advantage	$5.95

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges