Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CRYSTALS

Facility

$8.15

Service Code	HCPCS 89060
Hospital Charge Code	3002950
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$7.70
Rate for Payer: BCBS BCN 65	$7.70
Rate for Payer: Blue Care Network Medicare Advantage	$7.70
Rate for Payer: Cash Price	$5.30
Rate for Payer: Cash Price	$5.30
Rate for Payer: Community Health Alliance Commercial	$6.93
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.70
Rate for Payer: Meridian Health Plan Medicare	$7.70
Rate for Payer: Priority Health Commercial	$5.71
Rate for Payer: Priority Health Medicaid	$7.70
Rate for Payer: Priority Health Medicare	$7.70
Rate for Payer: Priority Health PPO	$5.71
Rate for Payer: United Health Care Medicaid	$7.70
Rate for Payer: United Health Care Medicare Advantage	$3.39

CSDC ACYLCARNITINE PROF URINE

Facility

$9.89

Hospital Charge Code	3100017
Hospital Revenue Code	301
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$8.41
Rate for Payer: Cash Price	$6.43
Rate for Payer: Community Health Alliance Commercial	$8.41
Rate for Payer: Priority Health Commercial	$6.92
Rate for Payer: Priority Health PPO	$6.92

CSF IgG INDEX

Facility

$74.00

Service Code	HCPCS 82784
Hospital Charge Code	3003330
Hospital Revenue Code	301
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$62.90
Rate for Payer: BCBS BCN 65	$9.77
Rate for Payer: Blue Care Network Medicare Advantage	$9.77
Rate for Payer: Cash Price	$48.10
Rate for Payer: Cash Price	$48.10
Rate for Payer: Community Health Alliance Commercial	$62.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.77
Rate for Payer: Meridian Health Plan Medicare	$9.77
Rate for Payer: Priority Health Commercial	$51.80
Rate for Payer: Priority Health Medicaid	$9.77
Rate for Payer: Priority Health Medicare	$9.77
Rate for Payer: Priority Health PPO	$51.80
Rate for Payer: United Health Care Medicaid	$9.77
Rate for Payer: United Health Care Medicare Advantage	$4.30

CSFP-1

Facility

$7.66

Service Code	HCPCS 84166
Hospital Charge Code	3006920
Hospital Revenue Code	301
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$18.72
Rate for Payer: BCBS BCN 65	$18.72
Rate for Payer: Blue Care Network Medicare Advantage	$18.72
Rate for Payer: Cash Price	$4.98
Rate for Payer: Cash Price	$4.98
Rate for Payer: Community Health Alliance Commercial	$6.51
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.72
Rate for Payer: Meridian Health Plan Medicare	$18.72
Rate for Payer: Priority Health Commercial	$5.36
Rate for Payer: Priority Health Medicaid	$18.72
Rate for Payer: Priority Health Medicare	$18.72
Rate for Payer: Priority Health PPO	$5.36
Rate for Payer: United Health Care Medicaid	$18.72
Rate for Payer: United Health Care Medicare Advantage	$8.24

CSFPE-2

Facility

$7.66

Hospital Charge Code	3102187
Hospital Revenue Code	300
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$6.51
Rate for Payer: Cash Price	$4.98
Rate for Payer: Community Health Alliance Commercial	$6.51
Rate for Payer: Priority Health Commercial	$5.36
Rate for Payer: Priority Health PPO	$5.36

CT ABDOMEN AND PELVIS W CONTRA

Facility

$1,735.00

Hospital Charge Code	3500312
Hospital Revenue Code	350
Min. Negotiated Rate	$1,214.50
Max. Negotiated Rate	$1,474.75
Rate for Payer: Cash Price	$1,127.75
Rate for Payer: Community Health Alliance Commercial	$1,474.75
Rate for Payer: Priority Health Commercial	$1,214.50
Rate for Payer: Priority Health PPO	$1,214.50

CT ABDOMEN & PELVIS W/O CONTRA

Facility

$1,606.00

Hospital Charge Code	3500313
Hospital Revenue Code	350
Min. Negotiated Rate	$1,124.20
Max. Negotiated Rate	$1,365.10
Rate for Payer: Cash Price	$1,043.90
Rate for Payer: Community Health Alliance Commercial	$1,365.10
Rate for Payer: Priority Health Commercial	$1,124.20
Rate for Payer: Priority Health PPO	$1,124.20

CT ABDOMEN & PELVIS W/WO CONT

Facility

$2,065.00

Hospital Charge Code	3500314
Hospital Revenue Code	350
Min. Negotiated Rate	$1,445.50
Max. Negotiated Rate	$1,755.25
Rate for Payer: Cash Price	$1,342.25
Rate for Payer: Community Health Alliance Commercial	$1,755.25
Rate for Payer: Priority Health Commercial	$1,445.50
Rate for Payer: Priority Health PPO	$1,445.50

CT ABDOMEN W CONTRAST

Facility

$1,158.00

Service Code	HCPCS 74160
Hospital Charge Code	3500330
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$984.30
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$752.70
Rate for Payer: Cash Price	$752.70
Rate for Payer: Community Health Alliance Commercial	$984.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$188.16
Rate for Payer: Meridian Health Plan Medicare	$188.16
Rate for Payer: Priority Health Commercial	$810.60
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$810.60
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT ABDOMEN WO CONTRAST

Facility

$881.00

Service Code	HCPCS 74150
Hospital Charge Code	3500320
Hospital Revenue Code	350
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$748.85
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$572.65
Rate for Payer: Cash Price	$572.65
Rate for Payer: Community Health Alliance Commercial	$748.85
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	$616.70
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$616.70
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

CT ABDOMEN W/WO CONTRAST

Facility

$1,674.00

Service Code	HCPCS 74170
Hospital Charge Code	3500350
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,422.90
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$1,088.10
Rate for Payer: Cash Price	$1,088.10
Rate for Payer: Community Health Alliance Commercial	$1,422.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$188.16
Rate for Payer: Meridian Health Plan Medicare	$188.16
Rate for Payer: Priority Health Commercial	$1,171.80
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$1,171.80
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT ANGIO ABDOMEN-NOT RUN OFF

Facility

$1,132.00

Service Code	HCPCS 74175
Hospital Charge Code	3500405
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$962.20
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$735.80
Rate for Payer: Cash Price	$735.80
Rate for Payer: Community Health Alliance Commercial	$962.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$188.16
Rate for Payer: Meridian Health Plan Medicare	$188.16
Rate for Payer: Priority Health Commercial	$792.40
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$792.40
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT ANGIO ABD/PELVIS W & W/O CO

Facility

$1,320.00

Hospital Charge Code	3500412
Hospital Revenue Code	350
Min. Negotiated Rate	$924.00
Max. Negotiated Rate	$1,122.00
Rate for Payer: Cash Price	$858.00
Rate for Payer: Community Health Alliance Commercial	$1,122.00
Rate for Payer: Priority Health Commercial	$924.00
Rate for Payer: Priority Health PPO	$924.00

CT ANGIO AORTA-ILIO FEM.RUNOFF

Facility

$1,384.00

Service Code	HCPCS 75635
Hospital Charge Code	3500410
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,176.40
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$899.60
Rate for Payer: Cash Price	$899.60
Rate for Payer: Community Health Alliance Commercial	$1,176.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$188.16
Rate for Payer: Meridian Health Plan Medicare	$188.16
Rate for Payer: Priority Health Commercial	$968.80
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$968.80
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT ANGIO CHEST W/POST PROC.

Facility

$1,132.00

Service Code	HCPCS 71275
Hospital Charge Code	3500414
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$962.20
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$735.80
Rate for Payer: Cash Price	$735.80
Rate for Payer: Community Health Alliance Commercial	$962.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$188.16
Rate for Payer: Meridian Health Plan Medicare	$188.16
Rate for Payer: Priority Health Commercial	$792.40
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$792.40
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT ANGIO CHEST W/PULMON EMBOLU

Facility

$1,132.00

Hospital Charge Code	3500413
Hospital Revenue Code	350
Min. Negotiated Rate	$792.40
Max. Negotiated Rate	$962.20
Rate for Payer: Cash Price	$735.80
Rate for Payer: Community Health Alliance Commercial	$962.20
Rate for Payer: Priority Health Commercial	$792.40
Rate for Payer: Priority Health PPO	$792.40

CT ANGIO CORONARY

Facility

$1,063.00

Hospital Charge Code	3500417
Hospital Revenue Code	350
Min. Negotiated Rate	$744.10
Max. Negotiated Rate	$903.55
Rate for Payer: Cash Price	$690.95
Rate for Payer: Community Health Alliance Commercial	$903.55
Rate for Payer: Priority Health Commercial	$744.10
Rate for Payer: Priority Health PPO	$744.10

CT ANGIO EXTREMITY LOWER

Facility

$1,488.00

Service Code	HCPCS 73706
Hospital Charge Code	3500400
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,264.80
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$967.20
Rate for Payer: Cash Price	$967.20
Rate for Payer: Community Health Alliance Commercial	$1,264.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$188.16
Rate for Payer: Meridian Health Plan Medicare	$188.16
Rate for Payer: Priority Health Commercial	$1,041.60
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$1,041.60
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT ANGIO EXTREMITY UPPER

Facility

$1,353.00

Service Code	HCPCS 73206
Hospital Charge Code	3500402
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,150.05
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$879.45
Rate for Payer: Cash Price	$879.45
Rate for Payer: Community Health Alliance Commercial	$1,150.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$188.16
Rate for Payer: Meridian Health Plan Medicare	$188.16
Rate for Payer: Priority Health Commercial	$947.10
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$947.10
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT ANGIO HEAD W/POST PROC.

Facility

$1,132.00

Service Code	HCPCS 70496
Hospital Charge Code	3500416
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$962.20
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$735.80
Rate for Payer: Cash Price	$735.80
Rate for Payer: Community Health Alliance Commercial	$962.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$188.16
Rate for Payer: Meridian Health Plan Medicare	$188.16
Rate for Payer: Priority Health Commercial	$792.40
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$792.40
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT ANGIO HEAD W/WO CONTRAST

Facility

$1,132.00

Hospital Charge Code	3500442
Hospital Revenue Code	350
Min. Negotiated Rate	$792.40
Max. Negotiated Rate	$962.20
Rate for Payer: Cash Price	$735.80
Rate for Payer: Community Health Alliance Commercial	$962.20
Rate for Payer: Priority Health Commercial	$792.40
Rate for Payer: Priority Health PPO	$792.40

CT ANGIO NECK W/POST PROC.

Facility

$1,132.00

Service Code	HCPCS 70498
Hospital Charge Code	3500420
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$962.20
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$735.80
Rate for Payer: Cash Price	$735.80
Rate for Payer: Community Health Alliance Commercial	$962.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$188.16
Rate for Payer: Meridian Health Plan Medicare	$188.16
Rate for Payer: Priority Health Commercial	$792.40
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$792.40
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT BIOPSY

Facility

$136.00

Hospital Charge Code	4000223
Hospital Revenue Code	361
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$115.60
Rate for Payer: Cash Price	$88.40
Rate for Payer: Community Health Alliance Commercial	$115.60
Rate for Payer: Priority Health Commercial	$95.20
Rate for Payer: Priority Health PPO	$95.20

CT BONE DENSITY

Facility

$330.00

Service Code	HCPCS 77078
Hospital Charge Code	3500450
Hospital Revenue Code	352
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$280.50
Rate for Payer: BCBS BCN 65	$93.36
Rate for Payer: Blue Care Network Medicare Advantage	$93.36
Rate for Payer: Cash Price	$214.50
Rate for Payer: Cash Price	$214.50
Rate for Payer: Community Health Alliance Commercial	$280.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$93.36
Rate for Payer: Meridian Health Plan Medicare	$93.36
Rate for Payer: Priority Health Commercial	$231.00
Rate for Payer: Priority Health Medicaid	$93.36
Rate for Payer: Priority Health Medicare	$93.36
Rate for Payer: Priority Health PPO	$231.00
Rate for Payer: United Health Care Medicaid	$93.36
Rate for Payer: United Health Care Medicare Advantage	$41.08

CT CARDIAC SCORING

Facility

$217.00

Hospital Charge Code	3500460
Hospital Revenue Code	409
Min. Negotiated Rate	$151.90
Max. Negotiated Rate	$184.45
Rate for Payer: Cash Price	$141.05
Rate for Payer: Community Health Alliance Commercial	$184.45
Rate for Payer: Priority Health Commercial	$151.90
Rate for Payer: Priority Health PPO	$151.90

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges