Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

I&D ABSCESS SIMPLE P/C

Facility

$310.00

Hospital Charge Code	5150685
Hospital Revenue Code	960
Min. Negotiated Rate	$217.00
Max. Negotiated Rate	$263.50
Rate for Payer: Cash Price	$201.50
Rate for Payer: Community Health Alliance Commercial	$263.50
Rate for Payer: Priority Health Commercial	$217.00
Rate for Payer: Priority Health PPO	$217.00

IDE-1

Facility

$625.00

Hospital Charge Code	3102368
Hospital Revenue Code	300
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$531.25
Rate for Payer: Cash Price	$406.25
Rate for Payer: Community Health Alliance Commercial	$531.25
Rate for Payer: Priority Health Commercial	$437.50
Rate for Payer: Priority Health PPO	$437.50

IDE-2

Facility

$625.00

Hospital Charge Code	3102369
Hospital Revenue Code	300
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$531.25
Rate for Payer: Cash Price	$406.25
Rate for Payer: Community Health Alliance Commercial	$531.25
Rate for Payer: Priority Health Commercial	$437.50
Rate for Payer: Priority Health PPO	$437.50

IDENTIFICATION ANAEROBE RML

Facility

$41.00

Service Code	HCPCS 87076
Hospital Charge Code	3006835
Hospital Revenue Code	306
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$34.85
Rate for Payer: BCBS BCN 65	$8.48
Rate for Payer: Blue Care Network Medicare Advantage	$8.48
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Community Health Alliance Commercial	$34.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.48
Rate for Payer: Meridian Health Plan Medicare	$8.48
Rate for Payer: Priority Health Commercial	$28.70
Rate for Payer: Priority Health Medicaid	$8.48
Rate for Payer: Priority Health Medicare	$8.48
Rate for Payer: Priority Health PPO	$28.70
Rate for Payer: United Health Care Medicaid	$8.48
Rate for Payer: United Health Care Medicare Advantage	$3.73

IDENTIFICATION FUNGAL

Facility

$33.00

Service Code	HCPCS 87106
Hospital Charge Code	3008380
Hospital Revenue Code	306
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$10.84
Rate for Payer: Blue Care Network Medicare Advantage	$10.84
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	$10.84
Rate for Payer: Meridian Health Plan Medicare	$10.84
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$10.84
Rate for Payer: Priority Health Medicare	$10.84
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$10.84
Rate for Payer: United Health Care Medicare Advantage	$4.77

IDENTIFICATION OTHER THAN URIN

Facility

$6.11

Service Code	HCPCS 87077
Hospital Charge Code	3005660
Hospital Revenue Code	306
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$8.48
Rate for Payer: BCBS BCN 65	$8.48
Rate for Payer: Blue Care Network Medicare Advantage	$8.48
Rate for Payer: Cash Price	$3.97
Rate for Payer: Cash Price	$3.97
Rate for Payer: Community Health Alliance Commercial	$5.19
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.48
Rate for Payer: Meridian Health Plan Medicare	$8.48
Rate for Payer: Priority Health Commercial	$4.28
Rate for Payer: Priority Health Medicaid	$8.48
Rate for Payer: Priority Health Medicare	$8.48
Rate for Payer: Priority Health PPO	$4.28
Rate for Payer: United Health Care Medicaid	$8.48
Rate for Payer: United Health Care Medicare Advantage	$3.73

IDENTIFICATION URINE

Facility

$27.00

Service Code	HCPCS 87088
Hospital Charge Code	3005740
Hospital Revenue Code	306
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$22.95
Rate for Payer: BCBS BCN 65	$8.49
Rate for Payer: Blue Care Network Medicare Advantage	$8.49
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.49
Rate for Payer: Meridian Health Plan Medicare	$8.49
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health Medicaid	$8.49
Rate for Payer: Priority Health Medicare	$8.49
Rate for Payer: Priority Health PPO	$18.90
Rate for Payer: United Health Care Medicaid	$8.49
Rate for Payer: United Health Care Medicare Advantage	$3.74

ID SHELL VIAL CULTURE

Facility

$13.00

Hospital Charge Code	3000815
Hospital Revenue Code	306
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$11.05
Rate for Payer: Cash Price	$8.45
Rate for Payer: Community Health Alliance Commercial	$11.05
Rate for Payer: Priority Health Commercial	$9.10
Rate for Payer: Priority Health PPO	$9.10

ID&SUSCUR-1

Facility

$32.58

Hospital Charge Code	3101954
Hospital Revenue Code	300
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$27.69
Rate for Payer: Cash Price	$21.18
Rate for Payer: Community Health Alliance Commercial	$27.69
Rate for Payer: Priority Health Commercial	$22.81
Rate for Payer: Priority Health PPO	$22.81

ID&SUSCUR-2

Facility

$5.00

Hospital Charge Code	3101955
Hospital Revenue Code	300
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$4.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health PPO	$3.50

IEP-1

Facility

$32.07

Hospital Charge Code	3101773
Hospital Revenue Code	300
Min. Negotiated Rate	$22.45
Max. Negotiated Rate	$27.26
Rate for Payer: Cash Price	$20.85
Rate for Payer: Community Health Alliance Commercial	$27.26
Rate for Payer: Priority Health Commercial	$22.45
Rate for Payer: Priority Health PPO	$22.45

IEP-2

Facility

$32.08

Hospital Charge Code	3101774
Hospital Revenue Code	300
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$27.27
Rate for Payer: Cash Price	$20.85
Rate for Payer: Community Health Alliance Commercial	$27.27
Rate for Payer: Priority Health Commercial	$22.46
Rate for Payer: Priority Health PPO	$22.46

IFA DNASE

Facility

$103.00

Hospital Charge Code	3000831
Hospital Revenue Code	310
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$87.55
Rate for Payer: Cash Price	$66.95
Rate for Payer: Community Health Alliance Commercial	$87.55
Rate for Payer: Priority Health Commercial	$72.10
Rate for Payer: Priority Health PPO	$72.10

IFA PERINUCLEAR

Facility

$103.00

Hospital Charge Code	3000830
Hospital Revenue Code	310
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$87.55
Rate for Payer: Cash Price	$66.95
Rate for Payer: Community Health Alliance Commercial	$87.55
Rate for Payer: Priority Health Commercial	$72.10
Rate for Payer: Priority Health PPO	$72.10

IFE-1

Facility

$3.00

Hospital Charge Code	3101808
Hospital Revenue Code	300
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.55
Rate for Payer: Cash Price	$1.95
Rate for Payer: Community Health Alliance Commercial	$2.55
Rate for Payer: Priority Health Commercial	$2.10
Rate for Payer: Priority Health PPO	$2.10

IFE1

Facility

$8.06

Hospital Charge Code	31027520
Hospital Revenue Code	300
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$6.85
Rate for Payer: Cash Price	$5.24
Rate for Payer: Community Health Alliance Commercial	$6.85
Rate for Payer: Priority Health Commercial	$5.64
Rate for Payer: Priority Health PPO	$5.64

IFE-2

Facility

$3.00

Hospital Charge Code	3101809
Hospital Revenue Code	300
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.55
Rate for Payer: Cash Price	$1.95
Rate for Payer: Community Health Alliance Commercial	$2.55
Rate for Payer: Priority Health Commercial	$2.10
Rate for Payer: Priority Health PPO	$2.10

IFE2

Facility

$8.06

Hospital Charge Code	31027521
Hospital Revenue Code	300
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$6.85
Rate for Payer: Cash Price	$5.24
Rate for Payer: Community Health Alliance Commercial	$6.85
Rate for Payer: Priority Health Commercial	$5.64
Rate for Payer: Priority Health PPO	$5.64

IFE 24HR

Facility

$24.18

Hospital Charge Code	31027519
Hospital Revenue Code	300
Min. Negotiated Rate	$16.93
Max. Negotiated Rate	$20.55
Rate for Payer: Cash Price	$15.72
Rate for Payer: Community Health Alliance Commercial	$20.55
Rate for Payer: Priority Health Commercial	$16.93
Rate for Payer: Priority Health PPO	$16.93

IFE-3

Facility

$3.00

Hospital Charge Code	3101810
Hospital Revenue Code	300
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.55
Rate for Payer: Cash Price	$1.95
Rate for Payer: Community Health Alliance Commercial	$2.55
Rate for Payer: Priority Health Commercial	$2.10
Rate for Payer: Priority Health PPO	$2.10

IFE3

Facility

$8.06

Hospital Charge Code	31027522
Hospital Revenue Code	300
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$6.85
Rate for Payer: Cash Price	$5.24
Rate for Payer: Community Health Alliance Commercial	$6.85
Rate for Payer: Priority Health Commercial	$5.64
Rate for Payer: Priority Health PPO	$5.64

IFE/DARA1

Facility

$89.18

Hospital Charge Code	31027524
Hospital Revenue Code	300
Min. Negotiated Rate	$62.43
Max. Negotiated Rate	$75.80
Rate for Payer: Cash Price	$57.97
Rate for Payer: Community Health Alliance Commercial	$75.80
Rate for Payer: Priority Health Commercial	$62.43
Rate for Payer: Priority Health PPO	$62.43

IFE/DARA 2

Facility

$89.18

Hospital Charge Code	31027525
Hospital Revenue Code	300
Min. Negotiated Rate	$62.43
Max. Negotiated Rate	$75.80
Rate for Payer: Cash Price	$57.97
Rate for Payer: Community Health Alliance Commercial	$75.80
Rate for Payer: Priority Health Commercial	$62.43
Rate for Payer: Priority Health PPO	$62.43

IFE/DARA 3

Facility

$89.18

Hospital Charge Code	31027526
Hospital Revenue Code	300
Min. Negotiated Rate	$62.43
Max. Negotiated Rate	$75.80
Rate for Payer: Cash Price	$57.97
Rate for Payer: Community Health Alliance Commercial	$75.80
Rate for Payer: Priority Health Commercial	$62.43
Rate for Payer: Priority Health PPO	$62.43

IFE/DARA 4

Facility

$89.21

Hospital Charge Code	31027527
Hospital Revenue Code	300
Min. Negotiated Rate	$62.45
Max. Negotiated Rate	$75.83
Rate for Payer: Cash Price	$57.99
Rate for Payer: Community Health Alliance Commercial	$75.83
Rate for Payer: Priority Health Commercial	$62.45
Rate for Payer: Priority Health PPO	$62.45

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges