Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

IHC-2

Facility

$56.88

Hospital Charge Code	31027484
Hospital Revenue Code	300
Min. Negotiated Rate	$39.82
Max. Negotiated Rate	$48.35
Rate for Payer: Cash Price	$36.97
Rate for Payer: Community Health Alliance Commercial	$48.35
Rate for Payer: Priority Health Commercial	$39.82
Rate for Payer: Priority Health PPO	$39.82

IHC-3

Facility

$56.88

Hospital Charge Code	31027485
Hospital Revenue Code	300
Min. Negotiated Rate	$39.82
Max. Negotiated Rate	$48.35
Rate for Payer: Cash Price	$36.97
Rate for Payer: Community Health Alliance Commercial	$48.35
Rate for Payer: Priority Health Commercial	$39.82
Rate for Payer: Priority Health PPO	$39.82

IHC-4

Facility

$56.88

Hospital Charge Code	31027486
Hospital Revenue Code	300
Min. Negotiated Rate	$39.82
Max. Negotiated Rate	$48.35
Rate for Payer: Cash Price	$36.97
Rate for Payer: Community Health Alliance Commercial	$48.35
Rate for Payer: Priority Health Commercial	$39.82
Rate for Payer: Priority Health PPO	$39.82

IHC-5

Facility

$56.88

Hospital Charge Code	31027487
Hospital Revenue Code	300
Min. Negotiated Rate	$39.82
Max. Negotiated Rate	$48.35
Rate for Payer: Cash Price	$36.97
Rate for Payer: Community Health Alliance Commercial	$48.35
Rate for Payer: Priority Health Commercial	$39.82
Rate for Payer: Priority Health PPO	$39.82

IHC-6

Facility

$56.88

Hospital Charge Code	31027488
Hospital Revenue Code	300
Min. Negotiated Rate	$39.82
Max. Negotiated Rate	$48.35
Rate for Payer: Cash Price	$36.97
Rate for Payer: Community Health Alliance Commercial	$48.35
Rate for Payer: Priority Health Commercial	$39.82
Rate for Payer: Priority Health PPO	$39.82

IHC-7

Facility

$56.88

Hospital Charge Code	31024789
Hospital Revenue Code	300
Min. Negotiated Rate	$39.82
Max. Negotiated Rate	$48.35
Rate for Payer: Cash Price	$36.97
Rate for Payer: Community Health Alliance Commercial	$48.35
Rate for Payer: Priority Health Commercial	$39.82
Rate for Payer: Priority Health PPO	$39.82

IHC-8

Facility

$56.88

Hospital Charge Code	31024790
Hospital Revenue Code	300
Min. Negotiated Rate	$39.82
Max. Negotiated Rate	$48.35
Rate for Payer: Cash Price	$36.97
Rate for Payer: Community Health Alliance Commercial	$48.35
Rate for Payer: Priority Health Commercial	$39.82
Rate for Payer: Priority Health PPO	$39.82

IHC-9

Facility

$56.88

Hospital Charge Code	31024791
Hospital Revenue Code	300
Min. Negotiated Rate	$39.82
Max. Negotiated Rate	$48.35
Rate for Payer: Cash Price	$36.97
Rate for Payer: Community Health Alliance Commercial	$48.35
Rate for Payer: Priority Health Commercial	$39.82
Rate for Payer: Priority Health PPO	$39.82

IHC EA addl AB Stain X9 GLBL

Facility

$511.92

Hospital Charge Code	31027482
Hospital Revenue Code	300
Min. Negotiated Rate	$358.34
Max. Negotiated Rate	$435.13
Rate for Payer: Cash Price	$332.75
Rate for Payer: Community Health Alliance Commercial	$435.13
Rate for Payer: Priority Health Commercial	$358.34
Rate for Payer: Priority Health PPO	$358.34

I.M. ANTIBIOTIC INJECTION M/S

Facility

$77.00

Service Code	HCPCS 96372
Hospital Charge Code	9400510
Hospital Revenue Code	940
Min. Negotiated Rate	$33.98
Max. Negotiated Rate	$77.24
Rate for Payer: BCBS BCN 65	$77.24
Rate for Payer: Blue Care Network Medicare Advantage	$77.24
Rate for Payer: Cash Price	$50.05
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$77.24
Rate for Payer: Meridian Health Plan Medicare	$77.24
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health Medicaid	$77.24
Rate for Payer: Priority Health Medicare	$77.24
Rate for Payer: Priority Health PPO	$53.90
Rate for Payer: United Health Care Medicaid	$77.24
Rate for Payer: United Health Care Medicare Advantage	$33.98

I.M. ANTIBIOTIC INJ FOR CLINIC

Facility

$50.00

Service Code	HCPCS 96372
Hospital Charge Code	4501025
Hospital Revenue Code	940
Min. Negotiated Rate	$33.98
Max. Negotiated Rate	$77.24
Rate for Payer: BCBS BCN 65	$77.24
Rate for Payer: Blue Care Network Medicare Advantage	$77.24
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$77.24
Rate for Payer: Meridian Health Plan Medicare	$77.24
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$77.24
Rate for Payer: Priority Health Medicare	$77.24
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$77.24
Rate for Payer: United Health Care Medicare Advantage	$33.98

IMC-1

Facility

$1,134.00

Hospital Charge Code	3102486
Hospital Revenue Code	300
Min. Negotiated Rate	$793.80
Max. Negotiated Rate	$963.90
Rate for Payer: Cash Price	$737.10
Rate for Payer: Community Health Alliance Commercial	$963.90
Rate for Payer: Priority Health Commercial	$793.80
Rate for Payer: Priority Health PPO	$793.80

IMC-2

Facility

$1,134.00

Hospital Charge Code	3102487
Hospital Revenue Code	300
Min. Negotiated Rate	$793.80
Max. Negotiated Rate	$963.90
Rate for Payer: Cash Price	$737.10
Rate for Payer: Community Health Alliance Commercial	$963.90
Rate for Payer: Priority Health Commercial	$793.80
Rate for Payer: Priority Health PPO	$793.80

IMMEDIATE ADQ EVAL

Facility

$71.00

Hospital Charge Code	3100326
Hospital Revenue Code	311
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$60.35
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health PPO	$49.70

IMMUNE DEFICIENCY PANEL COMP

Facility

$353.00

Hospital Charge Code	3002063
Hospital Revenue Code	302
Min. Negotiated Rate	$247.10
Max. Negotiated Rate	$300.05
Rate for Payer: Cash Price	$229.45
Rate for Payer: Community Health Alliance Commercial	$300.05
Rate for Payer: Priority Health Commercial	$247.10
Rate for Payer: Priority Health PPO	$247.10

IMMUNOASSAY MULTISTEP

Facility

$116.69

Hospital Charge Code	3000905
Hospital Revenue Code	300
Min. Negotiated Rate	$81.68
Max. Negotiated Rate	$99.19
Rate for Payer: Cash Price	$75.85
Rate for Payer: Community Health Alliance Commercial	$99.19
Rate for Payer: Priority Health Commercial	$81.68
Rate for Payer: Priority Health PPO	$81.68

IMMUNOASSAY MULTISTEP

Facility

$116.69

Hospital Charge Code	3000904
Hospital Revenue Code	300
Min. Negotiated Rate	$81.68
Max. Negotiated Rate	$99.19
Rate for Payer: Cash Price	$75.85
Rate for Payer: Community Health Alliance Commercial	$99.19
Rate for Payer: Priority Health Commercial	$81.68
Rate for Payer: Priority Health PPO	$81.68

IMMUNOASSAY NONANTIBODY -DGP

Facility

$61.00

Hospital Charge Code	3100695
Hospital Revenue Code	300
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$51.85
Rate for Payer: Cash Price	$39.65
Rate for Payer: Community Health Alliance Commercial	$51.85
Rate for Payer: Priority Health Commercial	$42.70
Rate for Payer: Priority Health PPO	$42.70

IMMUNOASSAY NONANTIBODY-DGP

Facility

$61.00

Hospital Charge Code	3100696
Hospital Revenue Code	300
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$51.85
Rate for Payer: Cash Price	$39.65
Rate for Payer: Community Health Alliance Commercial	$51.85
Rate for Payer: Priority Health Commercial	$42.70
Rate for Payer: Priority Health PPO	$42.70

IMMUNOASSAY NONANTIBODY-EJ

Facility

$63.00

Hospital Charge Code	3100362
Hospital Revenue Code	300
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$53.55
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health PPO	$44.10

IMMUNOASSAY NONANTIBODY-KU

Facility

$63.00

Hospital Charge Code	3100359
Hospital Revenue Code	300
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$53.55
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health PPO	$44.10

IMMUNOASSAY NONANTIBODY-OJ

Facility

$63.00

Hospital Charge Code	3100361
Hospital Revenue Code	300
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$53.55
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health PPO	$44.10

IMMUNOASSAY NONANTIBODY PI12

Facility

$63.00

Hospital Charge Code	3100358
Hospital Revenue Code	300
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$53.55
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health PPO	$44.10

IMMUNOASSAY NONANTIBODY PI7

Facility

$63.00

Hospital Charge Code	3100357
Hospital Revenue Code	300
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$53.55
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health PPO	$44.10

IMMUNOASSAY, QUANT NOS

Facility

$42.00

Service Code	HCPCS 82397
Hospital Charge Code	3005350
Hospital Revenue Code	301
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$35.70
Rate for Payer: BCBS BCN 65	$14.83
Rate for Payer: Blue Care Network Medicare Advantage	$14.83
Rate for Payer: Cash Price	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.83
Rate for Payer: Meridian Health Plan Medicare	$14.83
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health Medicaid	$14.83
Rate for Payer: Priority Health Medicare	$14.83
Rate for Payer: Priority Health PPO	$29.40
Rate for Payer: United Health Care Medicaid	$14.83
Rate for Payer: United Health Care Medicare Advantage	$6.52

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges