Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

HVAP-2

Facility

$5.96

Hospital Charge Code	3102560
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HVAP-3

Facility

$5.96

Hospital Charge Code	3102561
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HVAP-4

Facility

$5.96

Hospital Charge Code	3102562
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HVAP-5

Facility

$5.96

Hospital Charge Code	3102563
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HVAP-6

Facility

$5.96

Hospital Charge Code	3102564
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HVAP-7

Facility

$5.96

Hospital Charge Code	3102565
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HVAP-8

Facility

$5.96

Hospital Charge Code	3102566
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HVAP-9

Facility

$5.96

Hospital Charge Code	3102567
Hospital Revenue Code	300
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$5.07
Rate for Payer: Cash Price	$3.87
Rate for Payer: Community Health Alliance Commercial	$5.07
Rate for Payer: Priority Health Commercial	$4.17
Rate for Payer: Priority Health PPO	$4.17

HYCURE

Facility

$16.00

Hospital Charge Code	27022863
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
Rate for Payer: Priority Health Commercial	$11.20
Rate for Payer: Priority Health PPO	$11.20

HYDOXYPROLINE - 24 HOUR URINE

Facility

$125.00

Service Code	HCPCS 83505
Hospital Charge Code	3005330
Hospital Revenue Code	301
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$106.25
Rate for Payer: BCBS BCN 65	$25.52
Rate for Payer: Blue Care Network Medicare Advantage	$25.52
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Community Health Alliance Commercial	$106.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$25.52
Rate for Payer: Meridian Health Plan Medicare	$25.52
Rate for Payer: Priority Health Commercial	$87.50
Rate for Payer: Priority Health Medicaid	$25.52
Rate for Payer: Priority Health Medicare	$25.52
Rate for Payer: Priority Health PPO	$87.50
Rate for Payer: United Health Care Medicaid	$25.52
Rate for Payer: United Health Care Medicare Advantage	$11.23

HYDROCODONE 7.5MG/325MG 15ML

Facility

$17.19

Service Code	NDC 68094071462
Hospital Charge Code	2510831
Hospital Revenue Code	250
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$14.61
Rate for Payer: Cash Price	$11.17
Rate for Payer: Community Health Alliance Commercial	$14.61
Rate for Payer: Priority Health Commercial	$12.03
Rate for Payer: Priority Health PPO	$12.03

HYDRODISSECTION NEEDLE

Facility

$217.00

Hospital Charge Code	27016691
Hospital Revenue Code	270
Min. Negotiated Rate	$151.90
Max. Negotiated Rate	$184.45
Rate for Payer: Cash Price	$141.05
Rate for Payer: Community Health Alliance Commercial	$184.45
Rate for Payer: Priority Health Commercial	$151.90
Rate for Payer: Priority Health PPO	$151.90

HYDROFLEX LAPAROSCOPIC IRRI

Facility

$210.00

Hospital Charge Code	27263223
Hospital Revenue Code	272
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$178.50
Rate for Payer: Cash Price	$136.50
Rate for Payer: Community Health Alliance Commercial	$178.50
Rate for Payer: Priority Health Commercial	$147.00
Rate for Payer: Priority Health PPO	$147.00

HYDROMORPHONE HCL 1 MG/ML SYR

Facility

$81.62

Service Code	HCPCS J1170
Hospital Charge Code	2504192
Hospital Revenue Code	636
Min. Negotiated Rate	$57.13
Max. Negotiated Rate	$69.38
Rate for Payer: Cash Price	$53.05
Rate for Payer: Community Health Alliance Commercial	$69.38
Rate for Payer: Priority Health Commercial	$57.13
Rate for Payer: Priority Health PPO	$57.13

HYDROXCORTICOSTEROIDS-17

Facility

$92.05

Service Code	HCPCS 83491
Hospital Charge Code	3000140
Hospital Revenue Code	301
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$78.24
Rate for Payer: BCBS BCN 65	$18.80
Rate for Payer: Blue Care Network Medicare Advantage	$18.80
Rate for Payer: Cash Price	$59.83
Rate for Payer: Cash Price	$59.83
Rate for Payer: Community Health Alliance Commercial	$78.24
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.80
Rate for Payer: Meridian Health Plan Medicare	$18.80
Rate for Payer: Priority Health Commercial	$64.44
Rate for Payer: Priority Health Medicaid	$18.80
Rate for Payer: Priority Health Medicare	$18.80
Rate for Payer: Priority Health PPO	$64.44
Rate for Payer: United Health Care Medicaid	$18.80
Rate for Payer: United Health Care Medicare Advantage	$8.27

HYDROXYPROGESTERONE-17

Facility

$10.00

Service Code	HCPCS 83498
Hospital Charge Code	3000160
Hospital Revenue Code	301
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$28.53
Rate for Payer: BCBS BCN 65	$28.53
Rate for Payer: Blue Care Network Medicare Advantage	$28.53
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$28.53
Rate for Payer: Meridian Health Plan Medicare	$28.53
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health Medicaid	$28.53
Rate for Payer: Priority Health Medicare	$28.53
Rate for Payer: Priority Health PPO	$7.00
Rate for Payer: United Health Care Medicaid	$28.53
Rate for Payer: United Health Care Medicare Advantage	$12.55

HYDROXYPROLINE,TOTAL 24HR URIN

Facility

$82.00

Service Code	HCPCS 83505
Hospital Charge Code	3000541
Hospital Revenue Code	301
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$69.70
Rate for Payer: BCBS BCN 65	$25.52
Rate for Payer: Blue Care Network Medicare Advantage	$25.52
Rate for Payer: Cash Price	$53.30
Rate for Payer: Cash Price	$53.30
Rate for Payer: Community Health Alliance Commercial	$69.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$25.52
Rate for Payer: Meridian Health Plan Medicare	$25.52
Rate for Payer: Priority Health Commercial	$57.40
Rate for Payer: Priority Health Medicaid	$25.52
Rate for Payer: Priority Health Medicare	$25.52
Rate for Payer: Priority Health PPO	$57.40
Rate for Payer: United Health Care Medicaid	$25.52
Rate for Payer: United Health Care Medicare Advantage	$11.23

HYMENOPTERA VENOM PROFILE

Facility

$36.75

Hospital Charge Code	3102571
Hospital Revenue Code	300
Min. Negotiated Rate	$25.73
Max. Negotiated Rate	$31.24
Rate for Payer: Cash Price	$23.89
Rate for Payer: Community Health Alliance Commercial	$31.24
Rate for Payer: Priority Health Commercial	$25.73
Rate for Payer: Priority Health PPO	$25.73

HYPERSENSITIVITY PNEUMONITIS

Facility

$55.00

Service Code	HCPCS 86331
Hospital Charge Code	3005640
Hospital Revenue Code	302
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$46.75
Rate for Payer: BCBS BCN 65	$12.58
Rate for Payer: Blue Care Network Medicare Advantage	$12.58
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.58
Rate for Payer: Meridian Health Plan Medicare	$12.58
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health Medicaid	$12.58
Rate for Payer: Priority Health Medicare	$12.58
Rate for Payer: Priority Health PPO	$38.50
Rate for Payer: United Health Care Medicaid	$12.58
Rate for Payer: United Health Care Medicare Advantage	$5.53

HYPOXANTHINE

Facility

$50.00

Hospital Charge Code	3100840
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

HYSTOPLASMA CAPSULATUM DNA,RT-

Facility

$143.29

Hospital Charge Code	3101092
Hospital Revenue Code	300
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$121.80
Rate for Payer: Cash Price	$93.14
Rate for Payer: Community Health Alliance Commercial	$121.80
Rate for Payer: Priority Health Commercial	$100.30
Rate for Payer: Priority Health PPO	$100.30

IA-1

Facility

$21.28

Hospital Charge Code	3102642
Hospital Revenue Code	300
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$18.09
Rate for Payer: Cash Price	$13.83
Rate for Payer: Community Health Alliance Commercial	$18.09
Rate for Payer: Priority Health Commercial	$14.90
Rate for Payer: Priority Health PPO	$14.90

IA-2

Facility

$65.00

Hospital Charge Code	3101433
Hospital Revenue Code	300
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

IA-2

Facility

$21.28

Hospital Charge Code	3102643
Hospital Revenue Code	300
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$18.09
Rate for Payer: Cash Price	$13.83
Rate for Payer: Community Health Alliance Commercial	$18.09
Rate for Payer: Priority Health Commercial	$14.90
Rate for Payer: Priority Health PPO	$14.90

IA-2 ANTIBODY

Facility

$50.50

Hospital Charge Code	3004129
Hospital Revenue Code	302
Min. Negotiated Rate	$35.35
Max. Negotiated Rate	$42.92
Rate for Payer: Cash Price	$32.83
Rate for Payer: Community Health Alliance Commercial	$42.92
Rate for Payer: Priority Health Commercial	$35.35
Rate for Payer: Priority Health PPO	$35.35

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges