Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CT RIGHT UPPER EXT W CONTRAST

Facility

$1,024.00

Service Code	HCPCS 73201
Hospital Charge Code	3500270
Hospital Revenue Code	350
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$870.40
Rate for Payer: BCBS BCN 65	$374.25
Rate for Payer: Blue Care Network Medicare Advantage	$374.25
Rate for Payer: Cash Price	$665.60
Rate for Payer: Cash Price	$665.60
Rate for Payer: Community Health Alliance Commercial	$870.40
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	$716.80
Rate for Payer: Priority Health Medicaid	$374.25
Rate for Payer: Priority Health Medicare	$374.25
Rate for Payer: Priority Health PPO	$716.80
Rate for Payer: United Health Care Medicaid	$374.25
Rate for Payer: United Health Care Medicare Advantage	$164.67

CT RIGHT UPPER EXT WO CONTRAST

Facility

$876.00

Service Code	HCPCS 73200
Hospital Charge Code	3500300
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 RIGHT UPPER EXT W/WO CONTRA

Facility

$1,213.00

Service Code	HCPCS 73202
Hospital Charge Code	3500285
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 THORACIC SPINE W CONTRAST

Facility

$1,138.00

Service Code	HCPCS 72129
Hospital Charge Code	3500210
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 THORACIC SPINE WO CONTRAST

Facility

$1,069.00

Service Code	HCPCS 72128
Hospital Charge Code	3500110
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 THORACIC SPINE W/WO CONTRAS

Facility

$1,349.00

Service Code	HCPCS 72130
Hospital Charge Code	3500220
Hospital Revenue Code	350
Min. Negotiated Rate	$82.79
Max. Negotiated Rate	$1,146.65
Rate for Payer: BCBS BCN 65	$188.16
Rate for Payer: Blue Care Network Medicare Advantage	$188.16
Rate for Payer: Cash Price	$876.85
Rate for Payer: Cash Price	$876.85
Rate for Payer: Community Health Alliance Commercial	$1,146.65
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	$944.30
Rate for Payer: Priority Health Medicaid	$188.16
Rate for Payer: Priority Health Medicare	$188.16
Rate for Payer: Priority Health PPO	$944.30
Rate for Payer: United Health Care Medicaid	$188.16
Rate for Payer: United Health Care Medicare Advantage	$82.79

CT VENOGRAM ABD/PELVIS

Facility

$1,320.00

Hospital Charge Code	3500415
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 VENOGRAM HEAD

Facility

$1,132.00

Hospital Charge Code	3500441
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

CU-1

Facility

$11.24

Hospital Charge Code	3102183
Hospital Revenue Code	300
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$9.55
Rate for Payer: Cash Price	$7.31
Rate for Payer: Community Health Alliance Commercial	$9.55
Rate for Payer: Priority Health Commercial	$7.87
Rate for Payer: Priority Health PPO	$7.87

CU-1

Facility

$9.78

Hospital Charge Code	3102189
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

CU-2

Facility

$11.24

Hospital Charge Code	3102184
Hospital Revenue Code	300
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$9.55
Rate for Payer: Cash Price	$7.31
Rate for Payer: Community Health Alliance Commercial	$9.55
Rate for Payer: Priority Health Commercial	$7.87
Rate for Payer: Priority Health PPO	$7.87

CU-2

Facility

$9.77

Hospital Charge Code	3102190
Hospital Revenue Code	300
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$8.30
Rate for Payer: Cash Price	$6.35
Rate for Payer: Community Health Alliance Commercial	$8.30
Rate for Payer: Priority Health Commercial	$6.84
Rate for Payer: Priority Health PPO	$6.84

CULT RESP CYSTIC FIBROSIS/SMEA

Facility

$18.00

Hospital Charge Code	3101302
Hospital Revenue Code	306
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$15.30
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health PPO	$12.60

CULTURE,AFB

Facility

$7.00

Service Code	HCPCS 87015
Hospital Charge Code	3003140
Hospital Revenue Code	306
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$7.01
Rate for Payer: BCBS BCN 65	$7.01
Rate for Payer: Blue Care Network Medicare Advantage	$7.01
Rate for Payer: Cash Price	$4.55
Rate for Payer: Cash Price	$4.55
Rate for Payer: Community Health Alliance Commercial	$5.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.01
Rate for Payer: Meridian Health Plan Medicare	$7.01
Rate for Payer: Priority Health Commercial	$4.90
Rate for Payer: Priority Health Medicaid	$7.01
Rate for Payer: Priority Health Medicare	$7.01
Rate for Payer: Priority Health PPO	$4.90
Rate for Payer: United Health Care Medicaid	$7.01
Rate for Payer: United Health Care Medicare Advantage	$3.09

CULTURE BF LC

Facility

$9.60

Hospital Charge Code	3102430
Hospital Revenue Code	300
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$6.24
Rate for Payer: Community Health Alliance Commercial	$8.16
Rate for Payer: Priority Health Commercial	$6.72
Rate for Payer: Priority Health PPO	$6.72

CULTURE, BLOOD

Facility

$62.00

Service Code	HCPCS 87040
Hospital Charge Code	3003180
Hospital Revenue Code	306
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$52.70
Rate for Payer: BCBS BCN 65	$10.84
Rate for Payer: Blue Care Network Medicare Advantage	$10.84
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cash Price	$40.30
Rate for Payer: Community Health Alliance Commercial	$52.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.84
Rate for Payer: Meridian Health Plan Medicare	$10.84
Rate for Payer: Priority Health Commercial	$43.40
Rate for Payer: Priority Health Medicaid	$10.84
Rate for Payer: Priority Health Medicare	$10.84
Rate for Payer: Priority Health PPO	$43.40
Rate for Payer: United Health Care Medicaid	$10.84
Rate for Payer: United Health Care Medicare Advantage	$4.77

CULTURE BLOOD LC

Facility

$63.50

Hospital Charge Code	3102428
Hospital Revenue Code	300
Min. Negotiated Rate	$44.45
Max. Negotiated Rate	$53.98
Rate for Payer: Cash Price	$41.28
Rate for Payer: Community Health Alliance Commercial	$53.98
Rate for Payer: Priority Health Commercial	$44.45
Rate for Payer: Priority Health PPO	$44.45

CULTURE, FUNGAL, BLOOD

Facility

$65.00

Service Code	HCPCS 87103
Hospital Charge Code	3003441
Hospital Revenue Code	306
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$55.25
Rate for Payer: BCBS BCN 65	$21.48
Rate for Payer: Blue Care Network Medicare Advantage	$21.48
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.48
Rate for Payer: Meridian Health Plan Medicare	$21.48
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health Medicaid	$21.48
Rate for Payer: Priority Health Medicare	$21.48
Rate for Payer: Priority Health PPO	$45.50
Rate for Payer: United Health Care Medicaid	$21.48
Rate for Payer: United Health Care Medicare Advantage	$9.45

CULTURE, FUNGAL, OTHER

Facility

$9.39

Service Code	HCPCS 87102
Hospital Charge Code	3003320
Hospital Revenue Code	306
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$8.83
Rate for Payer: BCBS BCN 65	$8.83
Rate for Payer: Blue Care Network Medicare Advantage	$8.83
Rate for Payer: Cash Price	$6.10
Rate for Payer: Cash Price	$6.10
Rate for Payer: Community Health Alliance Commercial	$7.98
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.83
Rate for Payer: Meridian Health Plan Medicare	$8.83
Rate for Payer: Priority Health Commercial	$6.57
Rate for Payer: Priority Health Medicaid	$8.83
Rate for Payer: Priority Health Medicare	$8.83
Rate for Payer: Priority Health PPO	$6.57
Rate for Payer: United Health Care Medicaid	$8.83
Rate for Payer: United Health Care Medicare Advantage	$3.89

CULTURE, FUNGAL, SKIN

Facility

$33.00

Service Code	HCPCS 87101
Hospital Charge Code	3008580
Hospital Revenue Code	306
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$8.10
Rate for Payer: Blue Care Network Medicare Advantage	$8.10
Rate for Payer: Cash Price	$21.45
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.10
Rate for Payer: Meridian Health Plan Medicare	$8.10
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$8.10
Rate for Payer: Priority Health Medicare	$8.10
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$8.10
Rate for Payer: United Health Care Medicare Advantage	$3.56

CULTURE, GC SCREEN

Facility

$31.00

Service Code	HCPCS 87081
Hospital Charge Code	3003340
Hospital Revenue Code	306
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$26.35
Rate for Payer: BCBS BCN 65	$6.96
Rate for Payer: Blue Care Network Medicare Advantage	$6.96
Rate for Payer: Cash Price	$20.15
Rate for Payer: Cash Price	$20.15
Rate for Payer: Community Health Alliance Commercial	$26.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.96
Rate for Payer: Meridian Health Plan Medicare	$6.96
Rate for Payer: Priority Health Commercial	$21.70
Rate for Payer: Priority Health Medicaid	$6.96
Rate for Payer: Priority Health Medicare	$6.96
Rate for Payer: Priority Health PPO	$21.70
Rate for Payer: United Health Care Medicaid	$6.96
Rate for Payer: United Health Care Medicare Advantage	$3.06

CULTURE GENITAL LC

Facility

$9.93

Hospital Charge Code	3102420
Hospital Revenue Code	300
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$8.44
Rate for Payer: Cash Price	$6.45
Rate for Payer: Community Health Alliance Commercial	$8.44
Rate for Payer: Priority Health Commercial	$6.95
Rate for Payer: Priority Health PPO	$6.95

CULTURE, GROUP B STREP

Facility

$47.00

Service Code	HCPCS 87081
Hospital Charge Code	3000441
Hospital Revenue Code	306
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$39.95
Rate for Payer: BCBS BCN 65	$6.96
Rate for Payer: Blue Care Network Medicare Advantage	$6.96
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	$6.96
Rate for Payer: Meridian Health Plan Medicare	$6.96
Rate for Payer: Priority Health Commercial	$32.90
Rate for Payer: Priority Health Medicaid	$6.96
Rate for Payer: Priority Health Medicare	$6.96
Rate for Payer: Priority Health PPO	$32.90
Rate for Payer: United Health Care Medicaid	$6.96
Rate for Payer: United Health Care Medicare Advantage	$3.06

CULTURE, HERPES

Facility

$14.00

Service Code	HCPCS 87255
Hospital Charge Code	3003380
Hospital Revenue Code	306
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$35.55
Rate for Payer: BCBS BCN 65	$35.55
Rate for Payer: Blue Care Network Medicare Advantage	$35.55
Rate for Payer: Cash Price	$9.10
Rate for Payer: Cash Price	$9.10
Rate for Payer: Community Health Alliance Commercial	$11.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$35.55
Rate for Payer: Meridian Health Plan Medicare	$35.55
Rate for Payer: Priority Health Commercial	$9.80
Rate for Payer: Priority Health Medicaid	$35.55
Rate for Payer: Priority Health Medicare	$35.55
Rate for Payer: Priority Health PPO	$9.80
Rate for Payer: United Health Care Medicaid	$35.55
Rate for Payer: United Health Care Medicare Advantage	$15.64

CULTURE,LEGIONELLA

Facility

$81.00

Service Code	HCPCS 87081
Hospital Charge Code	3001040
Hospital Revenue Code	306
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$68.85
Rate for Payer: BCBS BCN 65	$6.96
Rate for Payer: Blue Care Network Medicare Advantage	$6.96
Rate for Payer: Cash Price	$52.65
Rate for Payer: Cash Price	$52.65
Rate for Payer: Community Health Alliance Commercial	$68.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.96
Rate for Payer: Meridian Health Plan Medicare	$6.96
Rate for Payer: Priority Health Commercial	$56.70
Rate for Payer: Priority Health Medicaid	$6.96
Rate for Payer: Priority Health Medicare	$6.96
Rate for Payer: Priority Health PPO	$56.70
Rate for Payer: United Health Care Medicaid	$6.96
Rate for Payer: United Health Care Medicare Advantage	$3.06

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges