Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

EXC BACK TUM DEEP <5CM

Facility

$1,029.00

Hospital Charge Code	5150747
Hospital Revenue Code	960
Min. Negotiated Rate	$720.30
Max. Negotiated Rate	$874.65
Rate for Payer: Cash Price	$668.85
Rate for Payer: Community Health Alliance Commercial	$874.65
Rate for Payer: Priority Health Commercial	$720.30
Rate for Payer: Priority Health PPO	$720.30

EXC FACE

Facility

$671.00

Hospital Charge Code	5150766
Hospital Revenue Code	960
Min. Negotiated Rate	$469.70
Max. Negotiated Rate	$570.35
Rate for Payer: Cash Price	$436.15
Rate for Payer: Community Health Alliance Commercial	$570.35
Rate for Payer: Priority Health Commercial	$469.70
Rate for Payer: Priority Health PPO	$469.70

EXC FACE LES SBQ 2 CM>

Facility

$817.00

Hospital Charge Code	5150735
Hospital Revenue Code	960
Min. Negotiated Rate	$571.90
Max. Negotiated Rate	$694.45
Rate for Payer: Cash Price	$531.05
Rate for Payer: Community Health Alliance Commercial	$694.45
Rate for Payer: Priority Health Commercial	$571.90
Rate for Payer: Priority Health PPO	$571.90

EXC FACE MM 89+MARG 0.6-1 CM

Facility

$438.00

Hospital Charge Code	5150745
Hospital Revenue Code	960
Min. Negotiated Rate	$306.60
Max. Negotiated Rate	$372.30
Rate for Payer: Cash Price	$284.70
Rate for Payer: Community Health Alliance Commercial	$372.30
Rate for Payer: Priority Health Commercial	$306.60
Rate for Payer: Priority Health PPO	$306.60

EXC FACE-MM B9

Facility

$278.00

Hospital Charge Code	5150733
Hospital Revenue Code	960
Min. Negotiated Rate	$194.60
Max. Negotiated Rate	$236.30
Rate for Payer: Cash Price	$180.70
Rate for Payer: Community Health Alliance Commercial	$236.30
Rate for Payer: Priority Health Commercial	$194.60
Rate for Payer: Priority Health PPO	$194.60

EXC FOREARM LES SC < 3 CM

Facility

$1,217.00

Hospital Charge Code	5150707
Hospital Revenue Code	960
Min. Negotiated Rate	$851.90
Max. Negotiated Rate	$1,034.45
Rate for Payer: Cash Price	$791.05
Rate for Payer: Community Health Alliance Commercial	$1,034.45
Rate for Payer: Priority Health Commercial	$851.90
Rate for Payer: Priority Health PPO	$851.90

EXC HAND LES SC 1.5 CM

Facility

$1,007.00

Hospital Charge Code	5150780
Hospital Revenue Code	960
Min. Negotiated Rate	$704.90
Max. Negotiated Rate	$855.95
Rate for Payer: Cash Price	$654.55
Rate for Payer: Community Health Alliance Commercial	$855.95
Rate for Payer: Priority Health Commercial	$704.90
Rate for Payer: Priority Health PPO	$704.90

EXCHANGE OF INTRAOCULAR LENS

Facility

$2,475.70

Service Code	CPT 66986
Hospital Revenue Code	360
Min. Negotiated Rate	$1,089.31
Max. Negotiated Rate	$2,475.70
Rate for Payer: BCBS BCN 65	$2,475.70
Rate for Payer: Blue Care Network Medicare Advantage	$2,475.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,475.70
Rate for Payer: Meridian Health Plan Medicare	$2,475.70
Rate for Payer: Priority Health Medicaid	$2,475.70
Rate for Payer: Priority Health Medicare	$2,475.70
Rate for Payer: United Health Care Medicaid	$2,475.70
Rate for Payer: United Health Care Medicare Advantage	$1,089.31

EXC H-F-NK-SP B9+MARG 0.6-1

Facility

$258.00

Hospital Charge Code	5150790
Hospital Revenue Code	960
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$219.30
Rate for Payer: Cash Price	$167.70
Rate for Payer: Community Health Alliance Commercial	$219.30
Rate for Payer: Priority Health Commercial	$180.60
Rate for Payer: Priority Health PPO	$180.60

EXC H-F-NK-SP B9 MARG2 1-3 PC

Facility

$643.00

Hospital Charge Code	5150703
Hospital Revenue Code	960
Min. Negotiated Rate	$450.10
Max. Negotiated Rate	$546.55
Rate for Payer: Cash Price	$417.95
Rate for Payer: Community Health Alliance Commercial	$546.55
Rate for Payer: Priority Health Commercial	$450.10
Rate for Payer: Priority Health PPO	$450.10

EXC H-F-NK-SP B9+MARG 3.1-4

Facility

$433.50

Hospital Charge Code	5150781
Hospital Revenue Code	960
Min. Negotiated Rate	$303.45
Max. Negotiated Rate	$368.48
Rate for Payer: Cash Price	$281.78
Rate for Payer: Community Health Alliance Commercial	$368.48
Rate for Payer: Priority Health Commercial	$303.45
Rate for Payer: Priority Health PPO	$303.45

EXC H-F-NK-SP B9+MARG>4CM

Facility

$645.00

Hospital Charge Code	5150786
Hospital Revenue Code	960
Min. Negotiated Rate	$451.50
Max. Negotiated Rate	$548.25
Rate for Payer: Cash Price	$419.25
Rate for Payer: Community Health Alliance Commercial	$548.25
Rate for Payer: Priority Health Commercial	$451.50
Rate for Payer: Priority Health PPO	$451.50

EXC H-F-NK-SP B9+MARG PC

Facility

$447.00

Hospital Charge Code	5150727
Hospital Revenue Code	960
Min. Negotiated Rate	$312.90
Max. Negotiated Rate	$379.95
Rate for Payer: Cash Price	$290.55
Rate for Payer: Community Health Alliance Commercial	$379.95
Rate for Payer: Priority Health Commercial	$312.90
Rate for Payer: Priority Health PPO	$312.90

EXC HIP PELVIS LES SC 3 CM

Facility

$1,136.00

Hospital Charge Code	5150753
Hospital Revenue Code	960
Min. Negotiated Rate	$795.20
Max. Negotiated Rate	$965.60
Rate for Payer: Cash Price	$738.40
Rate for Payer: Community Health Alliance Commercial	$965.60
Rate for Payer: Priority Health Commercial	$795.20
Rate for Payer: Priority Health PPO	$795.20

EXCISE EXTERNAL HEMORRHOID

Facility

$619.00

Hospital Charge Code	5150739
Hospital Revenue Code	960
Min. Negotiated Rate	$433.30
Max. Negotiated Rate	$526.15
Rate for Payer: Cash Price	$402.35
Rate for Payer: Community Health Alliance Commercial	$526.15
Rate for Payer: Priority Health Commercial	$433.30
Rate for Payer: Priority Health PPO	$433.30

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM

Facility

$759.64

Service Code	CPT 11421
Hospital Revenue Code	360
Min. Negotiated Rate	$334.24
Max. Negotiated Rate	$759.64
Rate for Payer: BCBS BCN 65	$759.64
Rate for Payer: Blue Care Network Medicare Advantage	$759.64
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$759.64
Rate for Payer: Meridian Health Plan Medicare	$759.64
Rate for Payer: Priority Health Medicaid	$759.64
Rate for Payer: Priority Health Medicare	$759.64
Rate for Payer: United Health Care Medicaid	$759.64
Rate for Payer: United Health Care Medicare Advantage	$334.24

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM

Facility

$1,771.74

Service Code	CPT 11424
Hospital Revenue Code	360
Min. Negotiated Rate	$779.56
Max. Negotiated Rate	$1,771.74
Rate for Payer: BCBS BCN 65	$1,771.74
Rate for Payer: Blue Care Network Medicare Advantage	$1,771.74
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,771.74
Rate for Payer: Meridian Health Plan Medicare	$1,771.74
Rate for Payer: Priority Health Medicaid	$1,771.74
Rate for Payer: Priority Health Medicare	$1,771.74
Rate for Payer: United Health Care Medicaid	$1,771.74
Rate for Payer: United Health Care Medicare Advantage	$779.56

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM

Facility

$3,116.01

Service Code	CPT 11426
Hospital Revenue Code	360
Min. Negotiated Rate	$1,371.05
Max. Negotiated Rate	$3,116.01
Rate for Payer: BCBS BCN 65	$3,116.01
Rate for Payer: Blue Care Network Medicare Advantage	$3,116.01
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,116.01
Rate for Payer: Meridian Health Plan Medicare	$3,116.01
Rate for Payer: Priority Health Medicaid	$3,116.01
Rate for Payer: Priority Health Medicare	$3,116.01
Rate for Payer: United Health Care Medicaid	$3,116.01
Rate for Payer: United Health Care Medicare Advantage	$1,371.05

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM

Facility

$436.09

Service Code	CPT 11401
Hospital Revenue Code	360
Min. Negotiated Rate	$191.88
Max. Negotiated Rate	$436.09
Rate for Payer: BCBS BCN 65	$436.09
Rate for Payer: Blue Care Network Medicare Advantage	$436.09
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$436.09
Rate for Payer: Meridian Health Plan Medicare	$436.09
Rate for Payer: Priority Health Medicaid	$436.09
Rate for Payer: Priority Health Medicare	$436.09
Rate for Payer: United Health Care Medicaid	$436.09
Rate for Payer: United Health Care Medicare Advantage	$191.88

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM

Facility

$759.64

Service Code	CPT 11403
Hospital Revenue Code	360
Min. Negotiated Rate	$334.24
Max. Negotiated Rate	$759.64
Rate for Payer: BCBS BCN 65	$759.64
Rate for Payer: Blue Care Network Medicare Advantage	$759.64
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$759.64
Rate for Payer: Meridian Health Plan Medicare	$759.64
Rate for Payer: Priority Health Medicaid	$759.64
Rate for Payer: Priority Health Medicare	$759.64
Rate for Payer: United Health Care Medicaid	$759.64
Rate for Payer: United Health Care Medicare Advantage	$334.24

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM

Facility

$1,771.74

Service Code	CPT 11406
Hospital Revenue Code	360
Min. Negotiated Rate	$779.56
Max. Negotiated Rate	$1,771.74
Rate for Payer: BCBS BCN 65	$1,771.74
Rate for Payer: Blue Care Network Medicare Advantage	$1,771.74
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,771.74
Rate for Payer: Meridian Health Plan Medicare	$1,771.74
Rate for Payer: Priority Health Medicaid	$1,771.74
Rate for Payer: Priority Health Medicare	$1,771.74
Rate for Payer: United Health Care Medicaid	$1,771.74
Rate for Payer: United Health Care Medicare Advantage	$779.56

EXCISION LES ANUS/SIMPLE

Facility

$669.00

Hospital Charge Code	5150712
Hospital Revenue Code	960
Min. Negotiated Rate	$468.30
Max. Negotiated Rate	$568.65
Rate for Payer: Cash Price	$434.85
Rate for Payer: Community Health Alliance Commercial	$568.65
Rate for Payer: Priority Health Commercial	$468.30
Rate for Payer: Priority Health PPO	$468.30

EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER OVER 4.0 CM

Facility

$1,771.74

Service Code	CPT 11606
Hospital Revenue Code	490
Min. Negotiated Rate	$779.56
Max. Negotiated Rate	$1,771.74
Rate for Payer: BCBS BCN 65	$1,771.74
Rate for Payer: Blue Care Network Medicare Advantage	$1,771.74
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,771.74
Rate for Payer: Meridian Health Plan Medicare	$1,771.74
Rate for Payer: Priority Health Medicaid	$1,771.74
Rate for Payer: Priority Health Medicare	$1,771.74
Rate for Payer: United Health Care Medicaid	$1,771.74
Rate for Payer: United Health Care Medicare Advantage	$779.56

EXCISION OF CHALAZION; SINGLE

Facility

$340.49

Service Code	CPT 67800
Hospital Revenue Code	360
Min. Negotiated Rate	$149.82
Max. Negotiated Rate	$340.49
Rate for Payer: BCBS BCN 65	$340.49
Rate for Payer: Blue Care Network Medicare Advantage	$340.49
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$340.49
Rate for Payer: Meridian Health Plan Medicare	$340.49
Rate for Payer: Priority Health Medicaid	$340.49
Rate for Payer: Priority Health Medicare	$340.49
Rate for Payer: United Health Care Medicaid	$340.49
Rate for Payer: United Health Care Medicare Advantage	$149.82

EXCISION OF HYDROCELE; UNILATERAL

Facility

$3,840.85

Service Code	CPT 55040
Hospital Revenue Code	360
Min. Negotiated Rate	$1,689.97
Max. Negotiated Rate	$3,840.85
Rate for Payer: BCBS BCN 65	$3,840.85
Rate for Payer: Blue Care Network Medicare Advantage	$3,840.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,840.85
Rate for Payer: Meridian Health Plan Medicare	$3,840.85
Rate for Payer: Priority Health Medicaid	$3,840.85
Rate for Payer: Priority Health Medicare	$3,840.85
Rate for Payer: United Health Care Medicaid	$3,840.85
Rate for Payer: United Health Care Medicare Advantage	$1,689.97

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges