Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CTCC-2

Facility

$297.50

Hospital Charge Code	3101241
Hospital Revenue Code	309
Min. Negotiated Rate	$208.25
Max. Negotiated Rate	$252.88
Rate for Payer: Cash Price	$193.38
Rate for Payer: Community Health Alliance Commercial	$252.88
Rate for Payer: Priority Health Commercial	$208.25
Rate for Payer: Priority Health PPO	$208.25

CT CERVICAL SPINE MYELOGRAM

Facility

$2,957.00

Hospital Charge Code	3500165
Hospital Revenue Code	361
Min. Negotiated Rate	$2,069.90
Max. Negotiated Rate	$2,513.45
Rate for Payer: Cash Price	$1,922.05
Rate for Payer: Community Health Alliance Commercial	$2,513.45
Rate for Payer: Priority Health Commercial	$2,069.90
Rate for Payer: Priority Health PPO	$2,069.90

CT CERVICAL SPINE W CONTRAST

Facility

$853.00

Service Code	HCPCS 72126
Hospital Charge Code	3500150
Hospital Revenue Code	350
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$725.05
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$554.45
Rate for Payer: Cash Price	$554.45
Rate for Payer: Community Health Alliance Commercial	$725.05
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	$597.10
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$597.10
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

CT CERVICAL SPINE WO CONTRAST

Facility

$1,069.00

Service Code	HCPCS 72125
Hospital Charge Code	3500130
Hospital Revenue Code	350
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$908.65
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$694.85
Rate for Payer: Cash Price	$694.85
Rate for Payer: Community Health Alliance Commercial	$908.65
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	$748.30
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$748.30
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

CT CERVICAL SPINE W/WO CONTRAS

Facility

$1,213.00

Service Code	HCPCS 72127
Hospital Charge Code	3500160
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,031.05
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$788.45
Rate for Payer: Cash Price	$788.45
Rate for Payer: Community Health Alliance Commercial	$1,031.05
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	$849.10
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$849.10
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT CHEST W CONTRAST

Facility

$953.00

Service Code	HCPCS 71260
Hospital Charge Code	3500120
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$810.05
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$619.45
Rate for Payer: Cash Price	$619.45
Rate for Payer: Community Health Alliance Commercial	$810.05
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	$667.10
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$667.10
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT CHEST WO CONTRAST

Facility

$721.00

Service Code	HCPCS 71250
Hospital Charge Code	3500190
Hospital Revenue Code	350
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$612.85
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$468.65
Rate for Payer: Cash Price	$468.65
Rate for Payer: Community Health Alliance Commercial	$612.85
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	$504.70
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$504.70
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

CT CHEST W/WO CONTRAST

Facility

$1,370.00

Service Code	HCPCS 71270
Hospital Charge Code	3500140
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,164.50
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$890.50
Rate for Payer: Cash Price	$890.50
Rate for Payer: Community Health Alliance Commercial	$1,164.50
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	$959.00
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$959.00
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT CORONARY WITH SCORING

Facility

$1,063.00

Hospital Charge Code	3500418
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 CYST ASPIRATION COMPLETE

Facility

$1,138.00

Service Code	HCPCS 77012
Hospital Charge Code	3500430
Hospital Revenue Code	350
Min. Negotiated Rate	$796.60
Max. Negotiated Rate	$967.30
Rate for Payer: Cash Price	$739.70
Rate for Payer: Community Health Alliance Commercial	$967.30
Rate for Payer: Priority Health Commercial	$796.60
Rate for Payer: Priority Health PPO	$796.60

CT CYST OR ABCESS DRAINAGE

Facility

$788.00

Service Code	HCPCS 75989
Hospital Charge Code	3500438
Hospital Revenue Code	350
Min. Negotiated Rate	$551.60
Max. Negotiated Rate	$669.80
Rate for Payer: Cash Price	$512.20
Rate for Payer: Community Health Alliance Commercial	$669.80
Rate for Payer: Priority Health Commercial	$551.60
Rate for Payer: Priority Health PPO	$551.60

C-TELOPEPTIDE

Facility

$56.61

Hospital Charge Code	3007748
Hospital Revenue Code	301
Min. Negotiated Rate	$39.63
Max. Negotiated Rate	$48.12
Rate for Payer: Cash Price	$36.80
Rate for Payer: Community Health Alliance Commercial	$48.12
Rate for Payer: Priority Health Commercial	$39.63
Rate for Payer: Priority Health PPO	$39.63

CT ENTEROGRAPHY

Facility

$1,735.00

Hospital Charge Code	3500328
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 HEAD W CONTRAST

Facility

$1,414.00

Service Code	HCPCS 70460
Hospital Charge Code	3500030
Hospital Revenue Code	351
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,201.90
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$919.10
Rate for Payer: Cash Price	$919.10
Rate for Payer: Community Health Alliance Commercial	$1,201.90
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	$989.80
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$989.80
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT HEAD WO CONTRAST

Facility

$721.00

Service Code	HCPCS 70450
Hospital Charge Code	3500010
Hospital Revenue Code	351
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$612.85
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$468.65
Rate for Payer: Cash Price	$468.65
Rate for Payer: Community Health Alliance Commercial	$612.85
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	$504.70
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$504.70
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

CT HEAD W/WO CONTRAST

Facility

$1,370.00

Service Code	HCPCS 70470
Hospital Charge Code	3500020
Hospital Revenue Code	351
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,164.50
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$890.50
Rate for Payer: Cash Price	$890.50
Rate for Payer: Community Health Alliance Commercial	$1,164.50
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	$959.00
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$959.00
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT LEFT LOWER EXT W CONTRAST

Facility

$1,138.00

Service Code	HCPCS 73701
Hospital Charge Code	3500311
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$967.30
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$739.70
Rate for Payer: Cash Price	$739.70
Rate for Payer: Community Health Alliance Commercial	$967.30
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	$796.60
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$796.60
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT LEFT LOWER EXT WO CONTRAST

Facility

$721.00

Service Code	HCPCS 73700
Hospital Charge Code	3500291
Hospital Revenue Code	350
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$612.85
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$468.65
Rate for Payer: Cash Price	$468.65
Rate for Payer: Community Health Alliance Commercial	$612.85
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	$504.70
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$504.70
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

CT LEFT LOWER EXT W/WO CONTRAS

Facility

$1,481.00

Service Code	HCPCS 73702
Hospital Charge Code	3500341
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,258.85
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$962.65
Rate for Payer: Cash Price	$962.65
Rate for Payer: Community Health Alliance Commercial	$1,258.85
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	$1,036.70
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$1,036.70
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT LEFT UPPER EXT W CONTRAST

Facility

$1,286.00

Service Code	HCPCS 73201
Hospital Charge Code	3500271
Hospital Revenue Code	350
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$1,093.10
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$835.90
Rate for Payer: Cash Price	$835.90
Rate for Payer: Community Health Alliance Commercial	$1,093.10
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	$900.20
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$900.20
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

CT LEFT UPPER EXT WO CONTRAST

Facility

$876.00

Service Code	HCPCS 73200
Hospital Charge Code	3500301
Hospital Revenue Code	350
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$744.60
Rate for Payer: BCBS BCN 65	$112.15
Rate for Payer: Blue Care Network Medicare Advantage	$112.15
Rate for Payer: Cash Price	$569.40
Rate for Payer: Cash Price	$569.40
Rate for Payer: Community Health Alliance Commercial	$744.60
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	$613.20
Rate for Payer: Priority Health Medicaid	$112.15
Rate for Payer: Priority Health Medicare	$112.15
Rate for Payer: Priority Health PPO	$613.20
Rate for Payer: United Health Care Medicaid	$112.15
Rate for Payer: United Health Care Medicare Advantage	$49.35

CT LEFT UPPER EXT W/WO CONTRAS

Facility

$1,213.00

Service Code	HCPCS 73202
Hospital Charge Code	3500286
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,031.05
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$788.45
Rate for Payer: Cash Price	$788.45
Rate for Payer: Community Health Alliance Commercial	$1,031.05
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	$849.10
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$849.10
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT LIMITED AREA

Facility

$431.00

Service Code	HCPCS 76380
Hospital Charge Code	3500470
Hospital Revenue Code	350
Min. Negotiated Rate	$41.08
Max. Negotiated Rate	$366.35
Rate for Payer: BCBS BCN 65	$93.36
Rate for Payer: Blue Care Network Medicare Advantage	$93.36
Rate for Payer: Cash Price	$280.15
Rate for Payer: Cash Price	$280.15
Rate for Payer: Community Health Alliance Commercial	$366.35
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	$301.70
Rate for Payer: Priority Health Medicaid	$93.36
Rate for Payer: Priority Health Medicare	$93.36
Rate for Payer: Priority Health PPO	$301.70
Rate for Payer: United Health Care Medicaid	$93.36
Rate for Payer: United Health Care Medicare Advantage	$41.08

CT LIVER BIOPSY

Facility

$1,979.00

Hospital Charge Code	3500363
Hospital Revenue Code	350
Min. Negotiated Rate	$1,385.30
Max. Negotiated Rate	$1,682.15
Rate for Payer: Cash Price	$1,286.35
Rate for Payer: Community Health Alliance Commercial	$1,682.15
Rate for Payer: Priority Health Commercial	$1,385.30
Rate for Payer: Priority Health PPO	$1,385.30

CT LIVER BIOPSY

Facility

$2,931.00

Hospital Charge Code	3500362
Hospital Revenue Code	361
Min. Negotiated Rate	$2,051.70
Max. Negotiated Rate	$2,491.35
Rate for Payer: Cash Price	$1,905.15
Rate for Payer: Community Health Alliance Commercial	$2,491.35
Rate for Payer: Priority Health Commercial	$2,051.70
Rate for Payer: Priority Health PPO	$2,051.70

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges