Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

VHSV-2

Facility

$20.37

Hospital Charge Code	31027578
Hospital Revenue Code	300
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$17.31
Rate for Payer: Cash Price	$13.24
Rate for Payer: Community Health Alliance Commercial	$17.31
Rate for Payer: Priority Health Commercial	$14.26
Rate for Payer: Priority Health PPO	$14.26

VICADIN

Facility

$156.00

Service Code	HCPCS 80299
Hospital Charge Code	3008155
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$132.60
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$101.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Community Health Alliance Commercial	$132.60
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	$109.20
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$109.20
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

VICE,MULTI TORQUE

Facility

$34.00

Hospital Charge Code	27266617
Hospital Revenue Code	272
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$28.90
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health PPO	$23.80

VICODYN

Facility

$114.00

Hospital Charge Code	3006246
Hospital Revenue Code	301
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$96.90
Rate for Payer: Cash Price	$74.10
Rate for Payer: Community Health Alliance Commercial	$96.90
Rate for Payer: Priority Health Commercial	$79.80
Rate for Payer: Priority Health PPO	$79.80

VIRAL HEP

Facility

$16.00

Hospital Charge Code	31027513
Hospital Revenue Code	300
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
Rate for Payer: Priority Health Commercial	$11.20
Rate for Payer: Priority Health PPO	$11.20

VIRAL HSV CULTURE

Facility

$40.73

Hospital Charge Code	31027576
Hospital Revenue Code	300
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$34.62
Rate for Payer: Cash Price	$26.47
Rate for Payer: Community Health Alliance Commercial	$34.62
Rate for Payer: Priority Health Commercial	$28.51
Rate for Payer: Priority Health PPO	$28.51

VIRAL PANEL BY PCR 2013577

Facility

$265.00

Hospital Charge Code	3101124
Hospital Revenue Code	306
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$225.25
Rate for Payer: Cash Price	$172.25
Rate for Payer: Community Health Alliance Commercial	$225.25
Rate for Payer: Priority Health Commercial	$185.50
Rate for Payer: Priority Health PPO	$185.50

VIRUS CULTURE

Facility

$95.00

Hospital Charge Code	3001490
Hospital Revenue Code	306
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$80.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
Rate for Payer: Priority Health Commercial	$66.50
Rate for Payer: Priority Health PPO	$66.50

VIRUS ID

Facility

$35.00

Hospital Charge Code	3101012
Hospital Revenue Code	306
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

VISCOSITY

Facility

$47.00

Service Code	HCPCS 85810
Hospital Charge Code	3008160
Hospital Revenue Code	300
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$39.95
Rate for Payer: BCBS BCN 65	$12.25
Rate for Payer: Blue Care Network Medicare Advantage	$12.25
Rate for Payer: Cash Price	$30.55
Rate for Payer: Cash Price	$30.55
Rate for Payer: Community Health Alliance Commercial	$39.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.25
Rate for Payer: Meridian Health Plan Medicare	$12.25
Rate for Payer: Priority Health Commercial	$32.90
Rate for Payer: Priority Health Medicaid	$12.25
Rate for Payer: Priority Health Medicare	$12.25
Rate for Payer: Priority Health PPO	$32.90
Rate for Payer: United Health Care Medicaid	$12.25
Rate for Payer: United Health Care Medicare Advantage	$5.39

VISCOSITY,SERUM

Facility

$10.49

Service Code	HCPCS 85810
Hospital Charge Code	3008170
Hospital Revenue Code	300
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$12.25
Rate for Payer: BCBS BCN 65	$12.25
Rate for Payer: Blue Care Network Medicare Advantage	$12.25
Rate for Payer: Cash Price	$6.82
Rate for Payer: Cash Price	$6.82
Rate for Payer: Community Health Alliance Commercial	$8.92
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.25
Rate for Payer: Meridian Health Plan Medicare	$12.25
Rate for Payer: Priority Health Commercial	$7.34
Rate for Payer: Priority Health Medicaid	$12.25
Rate for Payer: Priority Health Medicare	$12.25
Rate for Payer: Priority Health PPO	$7.34
Rate for Payer: United Health Care Medicaid	$12.25
Rate for Payer: United Health Care Medicare Advantage	$5.39

VISTASEQ MSH6

Facility

$850.00

Hospital Charge Code	31027375
Hospital Revenue Code	300
Min. Negotiated Rate	$595.00
Max. Negotiated Rate	$722.50
Rate for Payer: Cash Price	$552.50
Rate for Payer: Community Health Alliance Commercial	$722.50
Rate for Payer: Priority Health Commercial	$595.00
Rate for Payer: Priority Health PPO	$595.00

VISTASEQ MSH6-1

Facility

$425.00

Hospital Charge Code	31027376
Hospital Revenue Code	300
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$361.25
Rate for Payer: Cash Price	$276.25
Rate for Payer: Community Health Alliance Commercial	$361.25
Rate for Payer: Priority Health Commercial	$297.50
Rate for Payer: Priority Health PPO	$297.50

VISTASEQ MSH6-2

Facility

$425.00

Hospital Charge Code	31027377
Hospital Revenue Code	300
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$361.25
Rate for Payer: Cash Price	$276.25
Rate for Payer: Community Health Alliance Commercial	$361.25
Rate for Payer: Priority Health Commercial	$297.50
Rate for Payer: Priority Health PPO	$297.50

VITAMIN A (RETINOL)

Facility

$9.50

Service Code	HCPCS 84590
Hospital Charge Code	3008180
Hospital Revenue Code	301
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$12.19
Rate for Payer: BCBS BCN 65	$12.19
Rate for Payer: Blue Care Network Medicare Advantage	$12.19
Rate for Payer: Cash Price	$6.18
Rate for Payer: Cash Price	$6.18
Rate for Payer: Community Health Alliance Commercial	$8.07
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.19
Rate for Payer: Meridian Health Plan Medicare	$12.19
Rate for Payer: Priority Health Commercial	$6.65
Rate for Payer: Priority Health Medicaid	$12.19
Rate for Payer: Priority Health Medicare	$12.19
Rate for Payer: Priority Health PPO	$6.65
Rate for Payer: United Health Care Medicaid	$12.19
Rate for Payer: United Health Care Medicare Advantage	$5.36

VITAMIN B12

Facility

$42.00

Service Code	HCPCS 82607
Hospital Charge Code	3008880
Hospital Revenue Code	301
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$35.70
Rate for Payer: BCBS BCN 65	$15.83
Rate for Payer: Blue Care Network Medicare Advantage	$15.83
Rate for Payer: Cash Price	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.83
Rate for Payer: Meridian Health Plan Medicare	$15.83
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health Medicaid	$15.83
Rate for Payer: Priority Health Medicare	$15.83
Rate for Payer: Priority Health PPO	$29.40
Rate for Payer: United Health Care Medicaid	$15.83
Rate for Payer: United Health Care Medicare Advantage	$6.97

VITAMIN B12-SBMF

Facility

$2.85

Hospital Charge Code	3101198
Hospital Revenue Code	301
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.42
Rate for Payer: Cash Price	$1.85
Rate for Payer: Community Health Alliance Commercial	$2.42
Rate for Payer: Priority Health Commercial	$2.00
Rate for Payer: Priority Health PPO	$2.00

VITAMIN B-1 (THIAMINE)

Facility

$10.00

Service Code	HCPCS 84425
Hospital Charge Code	3008200
Hospital Revenue Code	301
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$22.29
Rate for Payer: BCBS BCN 65	$22.29
Rate for Payer: Blue Care Network Medicare Advantage	$22.29
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$22.29
Rate for Payer: Meridian Health Plan Medicare	$22.29
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health Medicaid	$22.29
Rate for Payer: Priority Health Medicare	$22.29
Rate for Payer: Priority Health PPO	$7.00
Rate for Payer: United Health Care Medicaid	$22.29
Rate for Payer: United Health Care Medicare Advantage	$9.81

VITAMIN B1 THIAMINE PLASMA

Facility

$103.00

Hospital Charge Code	3002718
Hospital Revenue Code	301
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$87.55
Rate for Payer: Cash Price	$66.95
Rate for Payer: Community Health Alliance Commercial	$87.55
Rate for Payer: Priority Health Commercial	$72.10
Rate for Payer: Priority Health PPO	$72.10

Vitamin B 2

Facility

$7.75

Service Code	HCPCS 84252
Hospital Charge Code	3000195
Hospital Revenue Code	301
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$21.25
Rate for Payer: BCBS BCN 65	$21.25
Rate for Payer: Blue Care Network Medicare Advantage	$21.25
Rate for Payer: Cash Price	$5.04
Rate for Payer: Cash Price	$5.04
Rate for Payer: Community Health Alliance Commercial	$6.59
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.25
Rate for Payer: Meridian Health Plan Medicare	$21.25
Rate for Payer: Priority Health Commercial	$5.42
Rate for Payer: Priority Health Medicaid	$21.25
Rate for Payer: Priority Health Medicare	$21.25
Rate for Payer: Priority Health PPO	$5.42
Rate for Payer: United Health Care Medicaid	$21.25
Rate for Payer: United Health Care Medicare Advantage	$9.35

VITAMIN B-6 (PYRIDOXINE)

Facility

$7.25

Service Code	HCPCS 84207
Hospital Charge Code	3008220
Hospital Revenue Code	301
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$29.50
Rate for Payer: BCBS BCN 65	$29.50
Rate for Payer: Blue Care Network Medicare Advantage	$29.50
Rate for Payer: Cash Price	$4.71
Rate for Payer: Cash Price	$4.71
Rate for Payer: Community Health Alliance Commercial	$6.16
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$29.50
Rate for Payer: Meridian Health Plan Medicare	$29.50
Rate for Payer: Priority Health Commercial	$5.08
Rate for Payer: Priority Health Medicaid	$29.50
Rate for Payer: Priority Health Medicare	$29.50
Rate for Payer: Priority Health PPO	$5.08
Rate for Payer: United Health Care Medicaid	$29.50
Rate for Payer: United Health Care Medicare Advantage	$12.98

VITAMIN B7

Facility

$45.61

Hospital Charge Code	3102164
Hospital Revenue Code	300
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$38.77
Rate for Payer: Cash Price	$29.65
Rate for Payer: Community Health Alliance Commercial	$38.77
Rate for Payer: Priority Health Commercial	$31.93
Rate for Payer: Priority Health PPO	$31.93

VITAMIN C / ASCORBIC ACID

Facility

$11.24

Service Code	HCPCS 82180
Hospital Charge Code	3000190
Hospital Revenue Code	301
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$10.38
Rate for Payer: BCBS BCN 65	$10.38
Rate for Payer: Blue Care Network Medicare Advantage	$10.38
Rate for Payer: Cash Price	$7.31
Rate for Payer: Cash Price	$7.31
Rate for Payer: Community Health Alliance Commercial	$9.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.38
Rate for Payer: Meridian Health Plan Medicare	$10.38
Rate for Payer: Priority Health Commercial	$7.87
Rate for Payer: Priority Health Medicaid	$10.38
Rate for Payer: Priority Health Medicare	$10.38
Rate for Payer: Priority Health PPO	$7.87
Rate for Payer: United Health Care Medicaid	$10.38
Rate for Payer: United Health Care Medicare Advantage	$4.57

VITAMIN D1 DIHYROXY

Facility

$9.77

Service Code	HCPCS 82652
Hospital Charge Code	3008890
Hospital Revenue Code	301
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$40.42
Rate for Payer: BCBS BCN 65	$40.42
Rate for Payer: Blue Care Network Medicare Advantage	$40.42
Rate for Payer: Cash Price	$6.35
Rate for Payer: Cash Price	$6.35
Rate for Payer: Community Health Alliance Commercial	$8.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$40.42
Rate for Payer: Meridian Health Plan Medicare	$40.42
Rate for Payer: Priority Health Commercial	$6.84
Rate for Payer: Priority Health Medicaid	$40.42
Rate for Payer: Priority Health Medicare	$40.42
Rate for Payer: Priority Health PPO	$6.84
Rate for Payer: United Health Care Medicaid	$40.42
Rate for Payer: United Health Care Medicare Advantage	$17.79

VITAMIN D HYDROXY WITH FRACT

Facility

$28.00

Hospital Charge Code	3100255
Hospital Revenue Code	300
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges