Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

VITAMIN E

Facility

$8.65

Service Code	HCPCS 84446
Hospital Charge Code	3001021
Hospital Revenue Code	301
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$14.89
Rate for Payer: BCBS BCN 65	$14.89
Rate for Payer: Blue Care Network Medicare Advantage	$14.89
Rate for Payer: Cash Price	$5.62
Rate for Payer: Cash Price	$5.62
Rate for Payer: Community Health Alliance Commercial	$7.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.89
Rate for Payer: Meridian Health Plan Medicare	$14.89
Rate for Payer: Priority Health Commercial	$6.05
Rate for Payer: Priority Health Medicaid	$14.89
Rate for Payer: Priority Health Medicare	$14.89
Rate for Payer: Priority Health PPO	$6.05
Rate for Payer: United Health Care Medicaid	$14.89
Rate for Payer: United Health Care Medicare Advantage	$6.55

VITAMIN K LEVEL

Facility

$42.00

Service Code	HCPCS 84597
Hospital Charge Code	3001030
Hospital Revenue Code	301
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$35.70
Rate for Payer: BCBS BCN 65	$14.41
Rate for Payer: Blue Care Network Medicare Advantage	$14.41
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	$14.41
Rate for Payer: Meridian Health Plan Medicare	$14.41
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health Medicaid	$14.41
Rate for Payer: Priority Health Medicare	$14.41
Rate for Payer: Priority Health PPO	$29.40
Rate for Payer: United Health Care Medicaid	$14.41
Rate for Payer: United Health Care Medicare Advantage	$6.34

VIT CABLE-2MM

Facility

$1,212.00

Hospital Charge Code	27017921
Hospital Revenue Code	270
Min. Negotiated Rate	$848.40
Max. Negotiated Rate	$1,030.20
Rate for Payer: Cash Price	$787.80
Rate for Payer: Community Health Alliance Commercial	$1,030.20
Rate for Payer: Priority Health Commercial	$848.40
Rate for Payer: Priority Health PPO	$848.40

VIT CABLE SLEEVE - 2MM

Facility

$1,212.00

Hospital Charge Code	27017939
Hospital Revenue Code	270
Min. Negotiated Rate	$848.40
Max. Negotiated Rate	$1,030.20
Rate for Payer: Cash Price	$787.80
Rate for Payer: Community Health Alliance Commercial	$1,030.20
Rate for Payer: Priority Health Commercial	$848.40
Rate for Payer: Priority Health PPO	$848.40

VIT D, 25-HYDROXY

Facility

$93.00

Service Code	HCPCS 82306
Hospital Charge Code	3008860
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$79.05
Rate for Payer: BCBS BCN 65	$31.08
Rate for Payer: Blue Care Network Medicare Advantage	$31.08
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Community Health Alliance Commercial	$79.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$31.08
Rate for Payer: Meridian Health Plan Medicare	$31.08
Rate for Payer: Priority Health Commercial	$65.10
Rate for Payer: Priority Health Medicaid	$31.08
Rate for Payer: Priority Health Medicare	$31.08
Rate for Payer: Priority Health PPO	$65.10
Rate for Payer: United Health Care Medicaid	$31.08
Rate for Payer: United Health Care Medicare Advantage	$13.68

VIT D-LC

Facility

$8.00

Hospital Charge Code	3101839
Hospital Revenue Code	300
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$6.80
Rate for Payer: Cash Price	$5.20
Rate for Payer: Community Health Alliance Commercial	$6.80
Rate for Payer: Priority Health Commercial	$5.60
Rate for Payer: Priority Health PPO	$5.60

VIVONEX T.E.N.

Facility

$131.00

Hospital Charge Code	27064751
Hospital Revenue Code	270
Min. Negotiated Rate	$91.70
Max. Negotiated Rate	$111.35
Rate for Payer: Cash Price	$85.15
Rate for Payer: Community Health Alliance Commercial	$111.35
Rate for Payer: Priority Health Commercial	$91.70
Rate for Payer: Priority Health PPO	$91.70

VLDL

Facility

$21.00

Service Code	HCPCS 84478
Hospital Charge Code	3008225
Hospital Revenue Code	301
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$17.85
Rate for Payer: BCBS BCN 65	$6.03
Rate for Payer: Blue Care Network Medicare Advantage	$6.03
Rate for Payer: Cash Price	$13.65
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.03
Rate for Payer: Meridian Health Plan Medicare	$6.03
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health Medicaid	$6.03
Rate for Payer: Priority Health Medicare	$6.03
Rate for Payer: Priority Health PPO	$14.70
Rate for Payer: United Health Care Medicaid	$6.03
Rate for Payer: United Health Care Medicare Advantage	$2.65

VMA

Facility

$5.70

Service Code	HCPCS 84585
Hospital Charge Code	3008780
Hospital Revenue Code	301
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$16.27
Rate for Payer: BCBS BCN 65	$16.27
Rate for Payer: Blue Care Network Medicare Advantage	$16.27
Rate for Payer: Cash Price	$3.71
Rate for Payer: Cash Price	$3.71
Rate for Payer: Community Health Alliance Commercial	$4.84
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.27
Rate for Payer: Meridian Health Plan Medicare	$16.27
Rate for Payer: Priority Health Commercial	$3.99
Rate for Payer: Priority Health Medicaid	$16.27
Rate for Payer: Priority Health Medicare	$16.27
Rate for Payer: Priority Health PPO	$3.99
Rate for Payer: United Health Care Medicaid	$16.27
Rate for Payer: United Health Care Medicare Advantage	$7.16

VOLATILES BLOOD

Facility

$6.00

Service Code	HCPCS G0480
Hospital Charge Code	3100874
Hospital Revenue Code	301
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$3.90
Rate for Payer: Cash Price	$3.90
Rate for Payer: Community Health Alliance Commercial	$5.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$4.20
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$4.20
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

VOLTAGE GATED CALCIUM CHANNEL

Facility

$90.00

Hospital Charge Code	3100766
Hospital Revenue Code	301
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$76.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Community Health Alliance Commercial	$76.50
Rate for Payer: Priority Health Commercial	$63.00
Rate for Payer: Priority Health PPO	$63.00

VOLTAGE GATED K CHANNEL AB

Facility

$375.00

Hospital Charge Code	3101407
Hospital Revenue Code	300
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$318.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Community Health Alliance Commercial	$318.75
Rate for Payer: Priority Health Commercial	$262.50
Rate for Payer: Priority Health PPO	$262.50

VOLUMNE MEASUREMENT 24 URINE

Facility

$21.00

Service Code	HCPCS 81050
Hospital Charge Code	3008340
Hospital Revenue Code	300
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$17.85
Rate for Payer: BCBS BCN 65	$3.82
Rate for Payer: Blue Care Network Medicare Advantage	$3.82
Rate for Payer: Cash Price	$13.65
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.82
Rate for Payer: Meridian Health Plan Medicare	$3.82
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health Medicaid	$3.82
Rate for Payer: Priority Health Medicare	$3.82
Rate for Payer: Priority Health PPO	$14.70
Rate for Payer: United Health Care Medicaid	$3.82
Rate for Payer: United Health Care Medicare Advantage	$1.68

VON WILLEBRAND ANTIGEN

Facility

$57.02

Service Code	HCPCS 85246
Hospital Charge Code	3008350
Hospital Revenue Code	305
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$48.47
Rate for Payer: BCBS BCN 65	$24.09
Rate for Payer: Blue Care Network Medicare Advantage	$24.09
Rate for Payer: Cash Price	$37.06
Rate for Payer: Cash Price	$37.06
Rate for Payer: Community Health Alliance Commercial	$48.47
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$24.09
Rate for Payer: Meridian Health Plan Medicare	$24.09
Rate for Payer: Priority Health Commercial	$39.91
Rate for Payer: Priority Health Medicaid	$24.09
Rate for Payer: Priority Health Medicare	$24.09
Rate for Payer: Priority Health PPO	$39.91
Rate for Payer: United Health Care Medicaid	$24.09
Rate for Payer: United Health Care Medicare Advantage	$10.60

VON WILLIBRAND ANALYSIS

Facility

$48.00

Service Code	HCPCS 82540
Hospital Charge Code	3008348
Hospital Revenue Code	301
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$40.80
Rate for Payer: BCBS BCN 65	$4.87
Rate for Payer: Blue Care Network Medicare Advantage	$4.87
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Community Health Alliance Commercial	$40.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.87
Rate for Payer: Meridian Health Plan Medicare	$4.87
Rate for Payer: Priority Health Commercial	$33.60
Rate for Payer: Priority Health Medicaid	$4.87
Rate for Payer: Priority Health Medicare	$4.87
Rate for Payer: Priority Health PPO	$33.60
Rate for Payer: United Health Care Medicaid	$4.87
Rate for Payer: United Health Care Medicare Advantage	$2.14

VON WILLIBRAND MULTIMERIC

Facility

$67.00

Service Code	HCPCS 85247
Hospital Charge Code	3008353
Hospital Revenue Code	305
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$56.95
Rate for Payer: BCBS BCN 65	$24.09
Rate for Payer: Blue Care Network Medicare Advantage	$24.09
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$24.09
Rate for Payer: Meridian Health Plan Medicare	$24.09
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health Medicaid	$24.09
Rate for Payer: Priority Health Medicare	$24.09
Rate for Payer: Priority Health PPO	$46.90
Rate for Payer: United Health Care Medicaid	$24.09
Rate for Payer: United Health Care Medicare Advantage	$10.60

VORICONAZOLE

Facility

$64.00

Hospital Charge Code	3008119
Hospital Revenue Code	301
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$54.40
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health PPO	$44.80

VPNS-1

Facility

$26.83

Hospital Charge Code	3102216
Hospital Revenue Code	300
Min. Negotiated Rate	$18.78
Max. Negotiated Rate	$22.81
Rate for Payer: Cash Price	$17.44
Rate for Payer: Community Health Alliance Commercial	$22.81
Rate for Payer: Priority Health Commercial	$18.78
Rate for Payer: Priority Health PPO	$18.78

VPNS-2

Facility

$26.83

Hospital Charge Code	3102217
Hospital Revenue Code	300
Min. Negotiated Rate	$18.78
Max. Negotiated Rate	$22.81
Rate for Payer: Cash Price	$17.44
Rate for Payer: Community Health Alliance Commercial	$22.81
Rate for Payer: Priority Health Commercial	$18.78
Rate for Payer: Priority Health PPO	$18.78

VPNS-3

Facility

$26.83

Hospital Charge Code	3102218
Hospital Revenue Code	300
Min. Negotiated Rate	$18.78
Max. Negotiated Rate	$22.81
Rate for Payer: Cash Price	$17.44
Rate for Payer: Community Health Alliance Commercial	$22.81
Rate for Payer: Priority Health Commercial	$18.78
Rate for Payer: Priority Health PPO	$18.78

VPNS-4

Facility

$26.83

Hospital Charge Code	3102219
Hospital Revenue Code	300
Min. Negotiated Rate	$18.78
Max. Negotiated Rate	$22.81
Rate for Payer: Cash Price	$17.44
Rate for Payer: Community Health Alliance Commercial	$22.81
Rate for Payer: Priority Health Commercial	$18.78
Rate for Payer: Priority Health PPO	$18.78

VPNS-5

Facility

$26.83

Hospital Charge Code	3102220
Hospital Revenue Code	300
Min. Negotiated Rate	$18.78
Max. Negotiated Rate	$22.81
Rate for Payer: Cash Price	$17.44
Rate for Payer: Community Health Alliance Commercial	$22.81
Rate for Payer: Priority Health Commercial	$18.78
Rate for Payer: Priority Health PPO	$18.78

VPNS-6

Facility

$26.85

Hospital Charge Code	3102221
Hospital Revenue Code	300
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$22.82
Rate for Payer: Cash Price	$17.45
Rate for Payer: Community Health Alliance Commercial	$22.82
Rate for Payer: Priority Health Commercial	$18.80
Rate for Payer: Priority Health PPO	$18.80

VSLSP-1

Facility

$225.00

Hospital Charge Code	3102359
Hospital Revenue Code	300
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$191.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Community Health Alliance Commercial	$191.25
Rate for Payer: Priority Health Commercial	$157.50
Rate for Payer: Priority Health PPO	$157.50

VSLSP-2

Facility

$225.00

Hospital Charge Code	3102360
Hospital Revenue Code	300
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$191.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Community Health Alliance Commercial	$191.25
Rate for Payer: Priority Health Commercial	$157.50
Rate for Payer: Priority Health PPO	$157.50

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges