Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

EXCISION OF LESION OF EYELID (EXCEPT CHALAZION) WITHOUT CLOSURE OR WITH SIMPLE DIRECT CLOSURE

Facility

$1,069.39

Service Code	CPT 67840
Hospital Revenue Code	490
Min. Negotiated Rate	$470.53
Max. Negotiated Rate	$1,069.39
Rate for Payer: BCBS BCN 65	$1,069.39
Rate for Payer: Blue Care Network Medicare Advantage	$1,069.39
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,069.39
Rate for Payer: Meridian Health Plan Medicare	$1,069.39
Rate for Payer: Priority Health Medicaid	$1,069.39
Rate for Payer: Priority Health Medicare	$1,069.39
Rate for Payer: United Health Care Medicaid	$1,069.39
Rate for Payer: United Health Care Medicare Advantage	$470.53

EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE (EG, INGROWN OR DEFORMED NAIL), FOR PERMANENT REMOVAL

Facility

$436.09

Service Code	CPT 11750
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 OF PILONIDAL CYST OR SINUS; EXTENSIVE

Facility

$3,116.01

Service Code	CPT 11771
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 OF PILONIDAL CYST OR SINUS; SIMPLE

Facility

$3,116.01

Service Code	CPT 11770
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 OR TRANSPOSITION OF PTERYGIUM; WITHOUT GRAFT

Facility

$2,550.43

Service Code	CPT 65420
Hospital Revenue Code	360
Min. Negotiated Rate	$1,122.19
Max. Negotiated Rate	$2,550.43
Rate for Payer: BCBS BCN 65	$2,550.43
Rate for Payer: Blue Care Network Medicare Advantage	$2,550.43
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,550.43
Rate for Payer: Meridian Health Plan Medicare	$2,550.43
Rate for Payer: Priority Health Medicaid	$2,550.43
Rate for Payer: Priority Health Medicare	$2,550.43
Rate for Payer: United Health Care Medicaid	$2,550.43
Rate for Payer: United Health Care Medicare Advantage	$1,122.19

EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; 1.5 CM OR GREATER

Facility

$1,771.74

Service Code	CPT 26111
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, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$3,116.01

Service Code	CPT 22903
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, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,771.74

Service Code	CPT 21931
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, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM

Facility

$1,771.74

Service Code	CPT 21011
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, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,771.74

Service Code	CPT 25071
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, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$3,116.01

Service Code	CPT 27043
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, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,771.74

Service Code	CPT 23071
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, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$3,116.01

Service Code	CPT 23073
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, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$3,116.01

Service Code	CPT 24071
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

EXC MALIG LESION

Facility

$1,220.00

Hospital Charge Code	5150760
Hospital Revenue Code	960
Min. Negotiated Rate	$854.00
Max. Negotiated Rate	$1,037.00
Rate for Payer: Cash Price	$793.00
Rate for Payer: Community Health Alliance Commercial	$1,037.00
Rate for Payer: Priority Health Commercial	$854.00
Rate for Payer: Priority Health PPO	$854.00

EXC MALIG LESION

Facility

$642.00

Hospital Charge Code	5150763
Hospital Revenue Code	960
Min. Negotiated Rate	$449.40
Max. Negotiated Rate	$545.70
Rate for Payer: Cash Price	$417.30
Rate for Payer: Community Health Alliance Commercial	$545.70
Rate for Payer: Priority Health Commercial	$449.40
Rate for Payer: Priority Health PPO	$449.40

EXC MALIG LESION 1-2 CM

Facility

$888.00

Hospital Charge Code	5150714
Hospital Revenue Code	960
Min. Negotiated Rate	$621.60
Max. Negotiated Rate	$754.80
Rate for Payer: Cash Price	$577.20
Rate for Payer: Community Health Alliance Commercial	$754.80
Rate for Payer: Priority Health Commercial	$621.60
Rate for Payer: Priority Health PPO	$621.60

EXC NECK LES SC 3 CM> PC

Facility

$1,434.00

Hospital Charge Code	5150743
Hospital Revenue Code	960
Min. Negotiated Rate	$1,003.80
Max. Negotiated Rate	$1,218.90
Rate for Payer: Cash Price	$932.10
Rate for Payer: Community Health Alliance Commercial	$1,218.90
Rate for Payer: Priority Health Commercial	$1,003.80
Rate for Payer: Priority Health PPO	$1,003.80

EXC NECK TUM DEEP < 5 CM

Facility

$554.00

Hospital Charge Code	5150777
Hospital Revenue Code	960
Min. Negotiated Rate	$387.80
Max. Negotiated Rate	$470.90
Rate for Payer: Cash Price	$360.10
Rate for Payer: Community Health Alliance Commercial	$470.90
Rate for Payer: Priority Health Commercial	$387.80
Rate for Payer: Priority Health PPO	$387.80

EXC PILONIDAL CYST

Facility

$1,904.00

Hospital Charge Code	5150759
Hospital Revenue Code	960
Min. Negotiated Rate	$1,332.80
Max. Negotiated Rate	$1,618.40
Rate for Payer: Cash Price	$1,237.60
Rate for Payer: Community Health Alliance Commercial	$1,618.40
Rate for Payer: Priority Health Commercial	$1,332.80
Rate for Payer: Priority Health PPO	$1,332.80

EXC PILONIDAL CYST PC

Facility

$1,591.00

Hospital Charge Code	5150749
Hospital Revenue Code	960
Min. Negotiated Rate	$1,113.70
Max. Negotiated Rate	$1,352.35
Rate for Payer: Cash Price	$1,034.15
Rate for Payer: Community Health Alliance Commercial	$1,352.35
Rate for Payer: Priority Health Commercial	$1,113.70
Rate for Payer: Priority Health PPO	$1,113.70

EXC RECT TUM TRANSANAL PART

Facility

$2,433.00

Hospital Charge Code	5150709
Hospital Revenue Code	960
Min. Negotiated Rate	$1,703.10
Max. Negotiated Rate	$2,068.05
Rate for Payer: Cash Price	$1,581.45
Rate for Payer: Community Health Alliance Commercial	$2,068.05
Rate for Payer: Priority Health Commercial	$1,703.10
Rate for Payer: Priority Health PPO	$1,703.10

EXC SHOULDER LES SC 3 CM PC

Facility

$978.00

Hospital Charge Code	5150742
Hospital Revenue Code	960
Min. Negotiated Rate	$684.60
Max. Negotiated Rate	$831.30
Rate for Payer: Cash Price	$635.70
Rate for Payer: Community Health Alliance Commercial	$831.30
Rate for Payer: Priority Health Commercial	$684.60
Rate for Payer: Priority Health PPO	$684.60

EXC SHOULDER TUM DEEP< 5CM

Facility

$1,319.00

Hospital Charge Code	5150782
Hospital Revenue Code	960
Min. Negotiated Rate	$923.30
Max. Negotiated Rate	$1,121.15
Rate for Payer: Cash Price	$857.35
Rate for Payer: Community Health Alliance Commercial	$1,121.15
Rate for Payer: Priority Health Commercial	$923.30
Rate for Payer: Priority Health PPO	$923.30

EXC SKN H/P/P/U SMPL/NTRM

Facility

$1,002.00

Hospital Charge Code	4510753
Hospital Revenue Code	960
Min. Negotiated Rate	$701.40
Max. Negotiated Rate	$851.70
Rate for Payer: Cash Price	$651.30
Rate for Payer: Community Health Alliance Commercial	$851.70
Rate for Payer: Priority Health Commercial	$701.40
Rate for Payer: Priority Health PPO	$701.40

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges