Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

IFE-LC

Facility

$5.64

Hospital Charge Code	31027501
Hospital Revenue Code	300
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$4.79
Rate for Payer: Cash Price	$3.67
Rate for Payer: Community Health Alliance Commercial	$4.79
Rate for Payer: Priority Health Commercial	$3.95
Rate for Payer: Priority Health PPO	$3.95

IFE-LC

Facility

$5.64

Hospital Charge Code	31027503
Hospital Revenue Code	300
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$4.79
Rate for Payer: Cash Price	$3.67
Rate for Payer: Community Health Alliance Commercial	$4.79
Rate for Payer: Priority Health Commercial	$3.95
Rate for Payer: Priority Health PPO	$3.95

IFE-LC

Facility

$5.64

Hospital Charge Code	31027499
Hospital Revenue Code	300
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$4.79
Rate for Payer: Cash Price	$3.67
Rate for Payer: Community Health Alliance Commercial	$4.79
Rate for Payer: Priority Health Commercial	$3.95
Rate for Payer: Priority Health PPO	$3.95

IFE-LC

Facility

$5.64

Hospital Charge Code	31027502
Hospital Revenue Code	300
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$4.79
Rate for Payer: Cash Price	$3.67
Rate for Payer: Community Health Alliance Commercial	$4.79
Rate for Payer: Priority Health Commercial	$3.95
Rate for Payer: Priority Health PPO	$3.95

IFE-LC

Facility

$5.64

Hospital Charge Code	31027504
Hospital Revenue Code	300
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$4.79
Rate for Payer: Cash Price	$3.67
Rate for Payer: Community Health Alliance Commercial	$4.79
Rate for Payer: Priority Health Commercial	$3.95
Rate for Payer: Priority Health PPO	$3.95

IFE-LC

Facility

$5.64

Hospital Charge Code	31027500
Hospital Revenue Code	300
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$4.79
Rate for Payer: Cash Price	$3.67
Rate for Payer: Community Health Alliance Commercial	$4.79
Rate for Payer: Priority Health Commercial	$3.95
Rate for Payer: Priority Health PPO	$3.95

IFE-LC

Facility

$5.64

Hospital Charge Code	31027498
Hospital Revenue Code	300
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$4.79
Rate for Payer: Cash Price	$3.67
Rate for Payer: Community Health Alliance Commercial	$4.79
Rate for Payer: Priority Health Commercial	$3.95
Rate for Payer: Priority Health PPO	$3.95

IFE-LC

Facility

$5.71

Hospital Charge Code	31027505
Hospital Revenue Code	300
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.71
Rate for Payer: Community Health Alliance Commercial	$4.85
Rate for Payer: Priority Health Commercial	$4.00
Rate for Payer: Priority Health PPO	$4.00

IFE/PE/FLC

Facility

$45.19

Hospital Charge Code	31027497
Hospital Revenue Code	300
Min. Negotiated Rate	$31.63
Max. Negotiated Rate	$38.41
Rate for Payer: Cash Price	$29.37
Rate for Payer: Community Health Alliance Commercial	$38.41
Rate for Payer: Priority Health Commercial	$31.63
Rate for Payer: Priority Health PPO	$31.63

IFE REFLEX 1

Facility

$2.34

Hospital Charge Code	3101857
Hospital Revenue Code	300
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.99
Rate for Payer: Cash Price	$1.52
Rate for Payer: Community Health Alliance Commercial	$1.99
Rate for Payer: Priority Health Commercial	$1.64
Rate for Payer: Priority Health PPO	$1.64

IFE REF ONLY

Facility

$16.18

Hospital Charge Code	3102495
Hospital Revenue Code	300
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$13.75
Rate for Payer: Cash Price	$10.52
Rate for Payer: Community Health Alliance Commercial	$13.75
Rate for Payer: Priority Health Commercial	$11.33
Rate for Payer: Priority Health PPO	$11.33

IFS REFLEX R URINE

Facility

$28.19

Hospital Charge Code	3102106
Hospital Revenue Code	300
Min. Negotiated Rate	$19.73
Max. Negotiated Rate	$23.96
Rate for Payer: Cash Price	$18.32
Rate for Payer: Community Health Alliance Commercial	$23.96
Rate for Payer: Priority Health Commercial	$19.73
Rate for Payer: Priority Health PPO	$19.73

IgA CARDIOLIPIN

Facility

$2.82

Hospital Charge Code	3100864
Hospital Revenue Code	302
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.40
Rate for Payer: Cash Price	$1.83
Rate for Payer: Community Health Alliance Commercial	$2.40
Rate for Payer: Priority Health Commercial	$1.97
Rate for Payer: Priority Health PPO	$1.97

IGA-SERUM

Facility

$4.00

Service Code	HCPCS 82784
Hospital Charge Code	3005402
Hospital Revenue Code	301
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$9.77
Rate for Payer: BCBS BCN 65	$9.77
Rate for Payer: Blue Care Network Medicare Advantage	$9.77
Rate for Payer: Cash Price	$2.60
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.77
Rate for Payer: Meridian Health Plan Medicare	$9.77
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health Medicaid	$9.77
Rate for Payer: Priority Health Medicare	$9.77
Rate for Payer: Priority Health PPO	$2.80
Rate for Payer: United Health Care Medicaid	$9.77
Rate for Payer: United Health Care Medicare Advantage	$4.30

IGA SUBCLASS

Facility

$153.00

Service Code	HCPCS 82787
Hospital Charge Code	3005406
Hospital Revenue Code	301
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$130.05
Rate for Payer: BCBS BCN 65	$8.42
Rate for Payer: Blue Care Network Medicare Advantage	$8.42
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Community Health Alliance Commercial	$130.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.42
Rate for Payer: Meridian Health Plan Medicare	$8.42
Rate for Payer: Priority Health Commercial	$107.10
Rate for Payer: Priority Health Medicaid	$8.42
Rate for Payer: Priority Health Medicare	$8.42
Rate for Payer: Priority Health PPO	$107.10
Rate for Payer: United Health Care Medicaid	$8.42
Rate for Payer: United Health Care Medicare Advantage	$3.71

IGA SUBCLASS 2

Facility

$12.91

Hospital Charge Code	3101236
Hospital Revenue Code	301
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$10.97
Rate for Payer: Cash Price	$8.39
Rate for Payer: Community Health Alliance Commercial	$10.97
Rate for Payer: Priority Health Commercial	$9.04
Rate for Payer: Priority Health PPO	$9.04

IGA SUBCLASS I

Facility

$12.91

Hospital Charge Code	3101235
Hospital Revenue Code	301
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$10.97
Rate for Payer: Cash Price	$8.39
Rate for Payer: Community Health Alliance Commercial	$10.97
Rate for Payer: Priority Health Commercial	$9.04
Rate for Payer: Priority Health PPO	$9.04

IGD

Facility

$10.34

Service Code	HCPCS 82784
Hospital Charge Code	3005375
Hospital Revenue Code	301
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$9.77
Rate for Payer: BCBS BCN 65	$9.77
Rate for Payer: Blue Care Network Medicare Advantage	$9.77
Rate for Payer: Cash Price	$6.72
Rate for Payer: Cash Price	$6.72
Rate for Payer: Community Health Alliance Commercial	$8.79
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.77
Rate for Payer: Meridian Health Plan Medicare	$9.77
Rate for Payer: Priority Health Commercial	$7.24
Rate for Payer: Priority Health Medicaid	$9.77
Rate for Payer: Priority Health Medicare	$9.77
Rate for Payer: Priority Health PPO	$7.24
Rate for Payer: United Health Care Medicaid	$9.77
Rate for Payer: United Health Care Medicare Advantage	$4.30

IGFBP-1

Facility

$16.29

Hospital Charge Code	3101206
Hospital Revenue Code	300
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$13.85
Rate for Payer: Cash Price	$10.59
Rate for Payer: Community Health Alliance Commercial	$13.85
Rate for Payer: Priority Health Commercial	$11.40
Rate for Payer: Priority Health PPO	$11.40

IGF-BP3

Facility

$23.42

Service Code	HCPCS 83520
Hospital Charge Code	3005390
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$19.91
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$15.22
Rate for Payer: Cash Price	$15.22
Rate for Payer: Community Health Alliance Commercial	$19.91
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$16.39
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$16.39
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

IGF II-LC

Facility

$97.72

Hospital Charge Code	31027469
Hospital Revenue Code	300
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$83.06
Rate for Payer: Cash Price	$63.52
Rate for Payer: Community Health Alliance Commercial	$83.06
Rate for Payer: Priority Health Commercial	$68.40
Rate for Payer: Priority Health PPO	$68.40

IGG1

Facility

$83.00

Service Code	HCPCS 83520
Hospital Charge Code	3005386
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$70.55
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$53.95
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$58.10
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

IGG2

Facility

$83.00

Service Code	HCPCS 83520
Hospital Charge Code	3005387
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$70.55
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$53.95
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$58.10
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

IGG3

Facility

$83.00

Service Code	HCPCS 83520
Hospital Charge Code	3005388
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$70.55
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$53.95
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$58.10
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

IGG4

Facility

$83.00

Service Code	HCPCS 83520
Hospital Charge Code	3005389
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$70.55
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$53.95
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$58.10
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges