Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

1000CC 0.45%NaCR + 20mEq KCL

Facility

$45.22

Service Code	NDC 338070434
Hospital Charge Code	2506666
Hospital Revenue Code	258
Min. Negotiated Rate	$31.65
Max. Negotiated Rate	$38.44
Rate for Payer: Cash Price	$29.39
Rate for Payer: Community Health Alliance Commercial	$38.44
Rate for Payer: Priority Health Commercial	$31.65
Rate for Payer: Priority Health PPO	$31.65

10-HYDROXYCARBAZEPINE

Facility

$93.00

Service Code	HCPCS 80299
Hospital Charge Code	3000672
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$79.05
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Community Health Alliance Commercial	$79.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.57
Rate for Payer: Meridian Health Plan Medicare	$19.57
Rate for Payer: Priority Health Commercial	$65.10
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$65.10
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

10 PK/4X4/STERILE

Facility

$23.00

Hospital Charge Code	27020479
Hospital Revenue Code	270
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

1 3/4 COLOSTOMY KIT

Facility

$122.00

Hospital Charge Code	27016683
Hospital Revenue Code	270
Min. Negotiated Rate	$85.40
Max. Negotiated Rate	$103.70
Rate for Payer: Cash Price	$79.30
Rate for Payer: Community Health Alliance Commercial	$103.70
Rate for Payer: Priority Health Commercial	$85.40
Rate for Payer: Priority Health PPO	$85.40

(1,3)BETA-D-GLUCAN FUNGITELL

Facility

$110.00

Hospital Charge Code	3100846
Hospital Revenue Code	306
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$93.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Community Health Alliance Commercial	$93.50
Rate for Payer: Priority Health Commercial	$77.00
Rate for Payer: Priority Health PPO	$77.00

15-20 CELLS, 2 KARYOTPES W/BAN

Facility

$488.00

Hospital Charge Code	3007711
Hospital Revenue Code	311
Min. Negotiated Rate	$341.60
Max. Negotiated Rate	$414.80
Rate for Payer: Cash Price	$317.20
Rate for Payer: Community Health Alliance Commercial	$414.80
Rate for Payer: Priority Health Commercial	$341.60
Rate for Payer: Priority Health PPO	$341.60

16 OR MORE MARKERS

Facility

$428.00

Hospital Charge Code	3000268
Hospital Revenue Code	971
Min. Negotiated Rate	$299.60
Max. Negotiated Rate	$363.80
Rate for Payer: Cash Price	$278.20
Rate for Payer: Community Health Alliance Commercial	$363.80
Rate for Payer: Priority Health Commercial	$299.60
Rate for Payer: Priority Health PPO	$299.60

17 HYDROXY PREGNENELONE

Facility

$33.39

Hospital Charge Code	3000675
Hospital Revenue Code	301
Min. Negotiated Rate	$23.37
Max. Negotiated Rate	$28.38
Rate for Payer: Cash Price	$21.70
Rate for Payer: Community Health Alliance Commercial	$28.38
Rate for Payer: Priority Health Commercial	$23.37
Rate for Payer: Priority Health PPO	$23.37

21 HYDROXYLASE ANTIBODY

Facility

$29.75

Service Code	HCPCS 83516
Hospital Charge Code	3000676
Hospital Revenue Code	301
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$25.29
Rate for Payer: BCBS BCN 65	$12.11
Rate for Payer: Blue Care Network Medicare Advantage	$12.11
Rate for Payer: Cash Price	$19.34
Rate for Payer: Cash Price	$19.34
Rate for Payer: Community Health Alliance Commercial	$25.29
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.11
Rate for Payer: Meridian Health Plan Medicare	$12.11
Rate for Payer: Priority Health Commercial	$20.82
Rate for Payer: Priority Health Medicaid	$12.11
Rate for Payer: Priority Health Medicare	$12.11
Rate for Payer: Priority Health PPO	$20.82
Rate for Payer: United Health Care Medicaid	$12.11
Rate for Payer: United Health Care Medicare Advantage	$5.33

21 HYDROXYLASE ANTIBODY 1

Facility

$73.00

Service Code	HCPCS 83519
Hospital Charge Code	3000677
Hospital Revenue Code	301
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$62.05
Rate for Payer: BCBS BCN 65	$19.32
Rate for Payer: Blue Care Network Medicare Advantage	$19.32
Rate for Payer: Cash Price	$47.45
Rate for Payer: Cash Price	$47.45
Rate for Payer: Community Health Alliance Commercial	$62.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.32
Rate for Payer: Meridian Health Plan Medicare	$19.32
Rate for Payer: Priority Health Commercial	$51.10
Rate for Payer: Priority Health Medicaid	$19.32
Rate for Payer: Priority Health Medicare	$19.32
Rate for Payer: Priority Health PPO	$51.10
Rate for Payer: United Health Care Medicaid	$19.32
Rate for Payer: United Health Care Medicare Advantage	$8.50

21 HYDROXYLASE ANTIBODY 2

Facility

$73.00

Service Code	HCPCS 83519
Hospital Charge Code	3000678
Hospital Revenue Code	301
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$62.05
Rate for Payer: BCBS BCN 65	$19.32
Rate for Payer: Blue Care Network Medicare Advantage	$19.32
Rate for Payer: Cash Price	$47.45
Rate for Payer: Cash Price	$47.45
Rate for Payer: Community Health Alliance Commercial	$62.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.32
Rate for Payer: Meridian Health Plan Medicare	$19.32
Rate for Payer: Priority Health Commercial	$51.10
Rate for Payer: Priority Health Medicaid	$19.32
Rate for Payer: Priority Health Medicare	$19.32
Rate for Payer: Priority Health PPO	$51.10
Rate for Payer: United Health Care Medicaid	$19.32
Rate for Payer: United Health Care Medicare Advantage	$8.50

2,3 DINOR BETA PROSTAGLANDIN

Facility

$267.00

Hospital Charge Code	3102159
Hospital Revenue Code	300
Min. Negotiated Rate	$186.90
Max. Negotiated Rate	$226.95
Rate for Payer: Cash Price	$173.55
Rate for Payer: Community Health Alliance Commercial	$226.95
Rate for Payer: Priority Health Commercial	$186.90
Rate for Payer: Priority Health PPO	$186.90

23 HR OBSERVATION 1+ HOURS

Facility

$124.00

Service Code	HCPCS G0378
Hospital Charge Code	7610010
Hospital Revenue Code	762
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$1,608.00
Rate for Payer: Cash Price	$80.60
Rate for Payer: Cash Price	$80.60
Rate for Payer: Community Health Alliance Commercial	$105.40
Rate for Payer: Priority Health Commercial	$86.80
Rate for Payer: Priority Health PPO	$86.80
Rate for Payer: United Health Care Medicaid	$1,608.00

23 OBSERVATION 1ST HOUR

Facility

$124.00

Service Code	HCPCS G0378
Hospital Charge Code	7610020
Hospital Revenue Code	762
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$1,608.00
Rate for Payer: Cash Price	$80.60
Rate for Payer: Cash Price	$80.60
Rate for Payer: Community Health Alliance Commercial	$105.40
Rate for Payer: Priority Health Commercial	$86.80
Rate for Payer: Priority Health PPO	$86.80
Rate for Payer: United Health Care Medicaid	$1,608.00

24 HOUR URINE GOLD

Facility

$60.00

Service Code	HCPCS G0480
Hospital Charge Code	3007847
Hospital Revenue Code	301
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$42.00
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

2 AG SCRN PERN CHARGE ONLY

Facility

$156.00

Hospital Charge Code	3102011
Hospital Revenue Code	300
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$132.60
Rate for Payer: Cash Price	$101.40
Rate for Payer: Community Health Alliance Commercial	$132.60
Rate for Payer: Priority Health Commercial	$109.20
Rate for Payer: Priority Health PPO	$109.20

2 PIN PASSER

Facility

$776.00

Hospital Charge Code	27265353
Hospital Revenue Code	272
Min. Negotiated Rate	$543.20
Max. Negotiated Rate	$659.60
Rate for Payer: Cash Price	$504.40
Rate for Payer: Community Health Alliance Commercial	$659.60
Rate for Payer: Priority Health Commercial	$543.20
Rate for Payer: Priority Health PPO	$543.20

3MM BLOCK

Facility

$2,405.00

Hospital Charge Code	27060537
Hospital Revenue Code	270
Min. Negotiated Rate	$1,683.50
Max. Negotiated Rate	$2,044.25
Rate for Payer: Cash Price	$1,563.25
Rate for Payer: Community Health Alliance Commercial	$2,044.25
Rate for Payer: Priority Health Commercial	$1,683.50
Rate for Payer: Priority Health PPO	$1,683.50

5FR PIGTAIL #451-503-H5

Facility

$47.00

Hospital Charge Code	27265973
Hospital Revenue Code	272
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$39.95
Rate for Payer: Cash Price	$30.55
Rate for Payer: Community Health Alliance Commercial	$39.95
Rate for Payer: Priority Health Commercial	$32.90
Rate for Payer: Priority Health PPO	$32.90

603851-LC1

Facility

$3.76

Hospital Charge Code	31027702
Hospital Revenue Code	300
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$3.20
Rate for Payer: Cash Price	$2.44
Rate for Payer: Community Health Alliance Commercial	$3.20
Rate for Payer: Priority Health Commercial	$2.63
Rate for Payer: Priority Health PPO	$2.63

603851-LC2

Facility

$3.76

Hospital Charge Code	31027703
Hospital Revenue Code	300
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$3.20
Rate for Payer: Cash Price	$2.44
Rate for Payer: Community Health Alliance Commercial	$3.20
Rate for Payer: Priority Health Commercial	$2.63
Rate for Payer: Priority Health PPO	$2.63

604721-1

Facility

$5.67

Hospital Charge Code	31027684
Hospital Revenue Code	300
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$4.82
Rate for Payer: Cash Price	$3.69
Rate for Payer: Community Health Alliance Commercial	$4.82
Rate for Payer: Priority Health Commercial	$3.97
Rate for Payer: Priority Health PPO	$3.97

604721-2

Facility

$5.67

Hospital Charge Code	31027685
Hospital Revenue Code	300
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$4.82
Rate for Payer: Cash Price	$3.69
Rate for Payer: Community Health Alliance Commercial	$4.82
Rate for Payer: Priority Health Commercial	$3.97
Rate for Payer: Priority Health PPO	$3.97

604726-1

Facility

$9.00

Hospital Charge Code	31027687
Hospital Revenue Code	300
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$7.65
Rate for Payer: Cash Price	$5.85
Rate for Payer: Community Health Alliance Commercial	$7.65
Rate for Payer: Priority Health Commercial	$6.30
Rate for Payer: Priority Health PPO	$6.30

604726-2

Facility

$9.00

Hospital Charge Code	31027688
Hospital Revenue Code	300
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$7.65
Rate for Payer: Cash Price	$5.85
Rate for Payer: Community Health Alliance Commercial	$7.65
Rate for Payer: Priority Health Commercial	$6.30
Rate for Payer: Priority Health PPO	$6.30

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges