Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

XR ANGIO VISCERAL CELIAC

Facility

$2,212.00

Service Code	HCPCS 75726
Hospital Charge Code	3201220
Hospital Revenue Code	323
Min. Negotiated Rate	$1,548.40
Max. Negotiated Rate	$5,969.26
Rate for Payer: BCBS BCN 65	$5,969.26
Rate for Payer: Blue Care Network Medicare Advantage	$5,969.26
Rate for Payer: Cash Price	$1,437.80
Rate for Payer: Cash Price	$1,437.80
Rate for Payer: Community Health Alliance Commercial	$1,880.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5,969.26
Rate for Payer: Meridian Health Plan Medicare	$5,969.26
Rate for Payer: Priority Health Commercial	$1,548.40
Rate for Payer: Priority Health Medicaid	$5,969.26
Rate for Payer: Priority Health Medicare	$5,969.26
Rate for Payer: Priority Health PPO	$1,548.40
Rate for Payer: United Health Care Medicaid	$5,969.26
Rate for Payer: United Health Care Medicare Advantage	$2,626.47

XR ANKLE LT, 2 VIEWS

Facility

$154.00

Service Code	HCPCS 73600 LT
Hospital Charge Code	3200031
Hospital Revenue Code	320
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$130.90
Rate for Payer: Cash Price	$100.10
Rate for Payer: Community Health Alliance Commercial	$130.90
Rate for Payer: Priority Health Commercial	$107.80
Rate for Payer: Priority Health PPO	$107.80

XR ANKLE LT, MIN 3 VIEWS

Facility

$186.00

Service Code	HCPCS 73610 LT
Hospital Charge Code	3200051
Hospital Revenue Code	320
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$158.10
Rate for Payer: Cash Price	$120.90
Rate for Payer: Community Health Alliance Commercial	$158.10
Rate for Payer: Priority Health Commercial	$130.20
Rate for Payer: Priority Health PPO	$130.20

XR ANKLE RT, 2 VIEWS

Facility

$154.00

Service Code	HCPCS 73600 RT
Hospital Charge Code	3200030
Hospital Revenue Code	320
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$130.90
Rate for Payer: Cash Price	$100.10
Rate for Payer: Community Health Alliance Commercial	$130.90
Rate for Payer: Priority Health Commercial	$107.80
Rate for Payer: Priority Health PPO	$107.80

XR ANKLE RT, MIN 3 VIEWS

Facility

$186.00

Service Code	HCPCS 73610 RT
Hospital Charge Code	3200050
Hospital Revenue Code	320
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$158.10
Rate for Payer: Cash Price	$120.90
Rate for Payer: Community Health Alliance Commercial	$158.10
Rate for Payer: Priority Health Commercial	$130.20
Rate for Payer: Priority Health PPO	$130.20

XR ARTHOGRAM SHOULDER

Facility

$708.00

Service Code	HCPCS 73040
Hospital Charge Code	3201003
Hospital Revenue Code	322
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$601.80
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Community Health Alliance Commercial	$601.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$495.60
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$495.60
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

XR ARTHROGRAM ANKLE

Facility

$697.00

Service Code	HCPCS 73615
Hospital Charge Code	3200953
Hospital Revenue Code	322
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$592.45
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$453.05
Rate for Payer: Cash Price	$453.05
Rate for Payer: Community Health Alliance Commercial	$592.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$487.90
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$487.90
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

XR ARTHROGRAM HIP

Facility

$647.00

Service Code	HCPCS 73525
Hospital Charge Code	3201013
Hospital Revenue Code	322
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$549.95
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$420.55
Rate for Payer: Cash Price	$420.55
Rate for Payer: Community Health Alliance Commercial	$549.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$452.90
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$452.90
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

XR ARTHROGRAM KNEE

Facility

$869.00

Service Code	HCPCS 73580
Hospital Charge Code	3200993
Hospital Revenue Code	322
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$738.65
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$564.85
Rate for Payer: Cash Price	$564.85
Rate for Payer: Community Health Alliance Commercial	$738.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$608.30
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$608.30
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

XR ARTHROGRAM WRIST

Facility

$697.00

Service Code	HCPCS 73115
Hospital Charge Code	3200983
Hospital Revenue Code	322
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$592.45
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$453.05
Rate for Payer: Cash Price	$453.05
Rate for Payer: Community Health Alliance Commercial	$592.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$374.25
Rate for Payer: Meridian Health Plan Medicare	$374.25
Rate for Payer: Priority Health Commercial	$487.90
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$487.90
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

X RAST ADULT FOOD W/O IGG

Facility

$39.12

Hospital Charge Code	3100953
Hospital Revenue Code	302
Min. Negotiated Rate	$27.38
Max. Negotiated Rate	$33.25
Rate for Payer: Cash Price	$25.43
Rate for Payer: Community Health Alliance Commercial	$33.25
Rate for Payer: Priority Health Commercial	$27.38
Rate for Payer: Priority Health PPO	$27.38

X RAST CHILDHOOD PANEL NO IGE

Facility

$48.90

Hospital Charge Code	3100677
Hospital Revenue Code	302
Min. Negotiated Rate	$34.23
Max. Negotiated Rate	$41.56
Rate for Payer: Cash Price	$31.79
Rate for Payer: Community Health Alliance Commercial	$41.56
Rate for Payer: Priority Health Commercial	$34.23
Rate for Payer: Priority Health PPO	$34.23

X RAST EGG COMPONENTS IGE

Facility

$7.52

Hospital Charge Code	3101069
Hospital Revenue Code	302
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$6.39
Rate for Payer: Cash Price	$4.89
Rate for Payer: Community Health Alliance Commercial	$6.39
Rate for Payer: Priority Health Commercial	$5.26
Rate for Payer: Priority Health PPO	$5.26

X RAST-FOOD W/REFLEX

Facility

$58.68

Hospital Charge Code	3102616
Hospital Revenue Code	300
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$49.88
Rate for Payer: Cash Price	$38.14
Rate for Payer: Community Health Alliance Commercial	$49.88
Rate for Payer: Priority Health Commercial	$41.08
Rate for Payer: Priority Health PPO	$41.08

X RAST FRUIT PANEL #2 IgE

Facility

$40.40

Hospital Charge Code	3101624
Hospital Revenue Code	300
Min. Negotiated Rate	$28.28
Max. Negotiated Rate	$34.34
Rate for Payer: Cash Price	$26.26
Rate for Payer: Community Health Alliance Commercial	$34.34
Rate for Payer: Priority Health Commercial	$28.28
Rate for Payer: Priority Health PPO	$28.28

X RAST GRASS POLLENS PANEL

Facility

$50.50

Hospital Charge Code	3101258
Hospital Revenue Code	302
Min. Negotiated Rate	$35.35
Max. Negotiated Rate	$42.92
Rate for Payer: Cash Price	$32.83
Rate for Payer: Community Health Alliance Commercial	$42.92
Rate for Payer: Priority Health Commercial	$35.35
Rate for Payer: Priority Health PPO	$35.35

X RAST INHALENT WITH IGE

Facility

$82.49

Hospital Charge Code	3100678
Hospital Revenue Code	302
Min. Negotiated Rate	$57.74
Max. Negotiated Rate	$70.12
Rate for Payer: Cash Price	$53.62
Rate for Payer: Community Health Alliance Commercial	$70.12
Rate for Payer: Priority Health Commercial	$57.74
Rate for Payer: Priority Health PPO	$57.74

X RAST MILK COMPONENT IGE

Facility

$9.78

Hospital Charge Code	3101601
Hospital Revenue Code	300
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$8.31
Rate for Payer: Cash Price	$6.36
Rate for Payer: Community Health Alliance Commercial	$8.31
Rate for Payer: Priority Health Commercial	$6.85
Rate for Payer: Priority Health PPO	$6.85

X RAST MOLD PANEL IGE

Facility

$16.30

Hospital Charge Code	3101542
Hospital Revenue Code	300
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$13.86
Rate for Payer: Cash Price	$10.60
Rate for Payer: Community Health Alliance Commercial	$13.86
Rate for Payer: Priority Health Commercial	$11.41
Rate for Payer: Priority Health PPO	$11.41

X RAST NUTS PANEL 2

Facility

$242.50

Hospital Charge Code	3101026
Hospital Revenue Code	302
Min. Negotiated Rate	$169.75
Max. Negotiated Rate	$206.12
Rate for Payer: Cash Price	$157.63
Rate for Payer: Community Health Alliance Commercial	$206.12
Rate for Payer: Priority Health Commercial	$169.75
Rate for Payer: Priority Health PPO	$169.75

X RAST PEANUT COMP ALLERGY PRO

Facility

$66.00

Hospital Charge Code	3101786
Hospital Revenue Code	300
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$56.10
Rate for Payer: Cash Price	$42.90
Rate for Payer: Community Health Alliance Commercial	$56.10
Rate for Payer: Priority Health Commercial	$46.20
Rate for Payer: Priority Health PPO	$46.20

XR BIOPSY X-RAY

Facility

$179.00

Hospital Charge Code	4000222
Hospital Revenue Code	361
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$152.15
Rate for Payer: Cash Price	$116.35
Rate for Payer: Community Health Alliance Commercial	$152.15
Rate for Payer: Priority Health Commercial	$125.30
Rate for Payer: Priority Health PPO	$125.30

XR BONE AGE STUDIES

Facility

$154.00

Service Code	HCPCS 77072
Hospital Charge Code	3200090
Hospital Revenue Code	320
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$130.90
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$100.10
Rate for Payer: Cash Price	$100.10
Rate for Payer: Community Health Alliance Commercial	$130.90
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	$107.80
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$107.80
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

XR BONE DENSITOMETRY

Facility

$311.00

Hospital Charge Code	3200815
Hospital Revenue Code	320
Min. Negotiated Rate	$217.70
Max. Negotiated Rate	$264.35
Rate for Payer: Cash Price	$202.15
Rate for Payer: Community Health Alliance Commercial	$264.35
Rate for Payer: Priority Health Commercial	$217.70
Rate for Payer: Priority Health PPO	$217.70

XR BONE DENSITOMETRY FX ASSESS

Facility

$165.00

Hospital Charge Code	3200816
Hospital Revenue Code	320
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$140.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Community Health Alliance Commercial	$140.25
Rate for Payer: Priority Health Commercial	$115.50
Rate for Payer: Priority Health PPO	$115.50

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges