Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

IMMUNOASSAY QUANT NOS NONAB

Facility

$48.00

Hospital Charge Code	3100168
Hospital Revenue Code	300
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$40.80
Rate for Payer: Cash Price	$31.20
Rate for Payer: Community Health Alliance Commercial	$40.80
Rate for Payer: Priority Health Commercial	$33.60
Rate for Payer: Priority Health PPO	$33.60

IMMUNOASSAY QUANT NOS NONAB

Facility

$98.00

Hospital Charge Code	3100042
Hospital Revenue Code	301
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$83.30
Rate for Payer: Cash Price	$63.70
Rate for Payer: Community Health Alliance Commercial	$83.30
Rate for Payer: Priority Health Commercial	$68.60
Rate for Payer: Priority Health PPO	$68.60

IMMUNOASSAY RIA

Facility

$185.00

Hospital Charge Code	3005352
Hospital Revenue Code	301
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$157.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Community Health Alliance Commercial	$157.25
Rate for Payer: Priority Health Commercial	$129.50
Rate for Payer: Priority Health PPO	$129.50

IMMUNOELECTROPHORESIS, URINE

Facility

$16.18

Service Code	HCPCS 86335
Hospital Charge Code	3005360
Hospital Revenue Code	302
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$30.82
Rate for Payer: BCBS BCN 65	$30.82
Rate for Payer: Blue Care Network Medicare Advantage	$30.82
Rate for Payer: Cash Price	$10.52
Rate for Payer: Cash Price	$10.52
Rate for Payer: Community Health Alliance Commercial	$13.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$30.82
Rate for Payer: Meridian Health Plan Medicare	$30.82
Rate for Payer: Priority Health Commercial	$11.33
Rate for Payer: Priority Health Medicaid	$30.82
Rate for Payer: Priority Health Medicare	$30.82
Rate for Payer: Priority Health PPO	$11.33
Rate for Payer: United Health Care Medicaid	$30.82
Rate for Payer: United Health Care Medicare Advantage	$13.56

IMMUNOELECTRO SERUM

Facility

$3.00

Service Code	HCPCS 86334
Hospital Charge Code	3005780
Hospital Revenue Code	302
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$23.46
Rate for Payer: BCBS BCN 65	$23.46
Rate for Payer: Blue Care Network Medicare Advantage	$23.46
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.95
Rate for Payer: Community Health Alliance Commercial	$2.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$23.46
Rate for Payer: Meridian Health Plan Medicare	$23.46
Rate for Payer: Priority Health Commercial	$2.10
Rate for Payer: Priority Health Medicaid	$23.46
Rate for Payer: Priority Health Medicare	$23.46
Rate for Payer: Priority Health PPO	$2.10
Rate for Payer: United Health Care Medicaid	$23.46
Rate for Payer: United Health Care Medicare Advantage	$10.32

IMMUNOFICATION DARATUB

Facility

$356.75

Hospital Charge Code	31027523
Hospital Revenue Code	300
Min. Negotiated Rate	$249.72
Max. Negotiated Rate	$303.24
Rate for Payer: Cash Price	$231.89
Rate for Payer: Community Health Alliance Commercial	$303.24
Rate for Payer: Priority Health Commercial	$249.72
Rate for Payer: Priority Health PPO	$249.72

IMMUNOFIXATION

Facility

$50.00

Service Code	HCPCS 86334
Hospital Charge Code	3005790
Hospital Revenue Code	302
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$23.46
Rate for Payer: Blue Care Network Medicare Advantage	$23.46
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	$23.46
Rate for Payer: Meridian Health Plan Medicare	$23.46
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$23.46
Rate for Payer: Priority Health Medicare	$23.46
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$23.46
Rate for Payer: United Health Care Medicare Advantage	$10.32

IMMUNOFIXATION ELECTRO-URINE

Facility

$66.00

Hospital Charge Code	3005792
Hospital Revenue Code	302
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$56.10
Rate for Payer: Cash Price	$42.90
Rate for Payer: Community Health Alliance Commercial	$56.10
Rate for Payer: Priority Health Commercial	$46.20
Rate for Payer: Priority Health PPO	$46.20

IMMUNOFLORESCENT STUDY

Facility

$185.00

Hospital Charge Code	3005351
Hospital Revenue Code	312
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$157.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Community Health Alliance Commercial	$157.25
Rate for Payer: Priority Health Commercial	$129.50
Rate for Payer: Priority Health PPO	$129.50

IMMUNOFLUORSCENT INDIRECT

Facility

$116.69

Hospital Charge Code	3000903
Hospital Revenue Code	310
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

IMMUNOFLUORSCENT INDIRECT

Facility

$116.69

Hospital Charge Code	3000902
Hospital Revenue Code	310
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

IMMUNOFLUORSCENT INDIRECT

Facility

$116.69

Hospital Charge Code	3000901
Hospital Revenue Code	310
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

IMMUNOFLUORSCENT INDIRECT ADD

Facility

$99.30

Hospital Charge Code	3100993
Hospital Revenue Code	310
Min. Negotiated Rate	$69.51
Max. Negotiated Rate	$84.41
Rate for Payer: Cash Price	$64.55
Rate for Payer: Community Health Alliance Commercial	$84.41
Rate for Payer: Priority Health Commercial	$69.51
Rate for Payer: Priority Health PPO	$69.51

IMMUNOLOGY PROC. TISSUE TYPING

Facility

$58.00

Hospital Charge Code	3000148
Hospital Revenue Code	302
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$49.30
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health PPO	$40.60

IMMUNOPEROXIDASE STAIN TECH

Facility

$140.00

Service Code	HCPCS 88342
Hospital Charge Code	3100300
Hospital Revenue Code	310
Min. Negotiated Rate	$80.42
Max. Negotiated Rate	$182.76
Rate for Payer: BCBS BCN 65	$182.76
Rate for Payer: Blue Care Network Medicare Advantage	$182.76
Rate for Payer: Cash Price	$91.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Community Health Alliance Commercial	$119.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$182.76
Rate for Payer: Meridian Health Plan Medicare	$182.76
Rate for Payer: Priority Health Commercial	$98.00
Rate for Payer: Priority Health Medicaid	$182.76
Rate for Payer: Priority Health Medicare	$182.76
Rate for Payer: Priority Health PPO	$98.00
Rate for Payer: United Health Care Medicaid	$182.76
Rate for Payer: United Health Care Medicare Advantage	$80.42

IMMUNOPEROXIDASE STAIN TECH AD

Facility

$135.00

Hospital Charge Code	3100895
Hospital Revenue Code	310
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$114.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Community Health Alliance Commercial	$114.75
Rate for Payer: Priority Health Commercial	$94.50
Rate for Payer: Priority Health PPO	$94.50

IMMUNOPEROXIDASE STAIN TECH AD

Facility

$135.00

Hospital Charge Code	3000896
Hospital Revenue Code	310
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$114.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Community Health Alliance Commercial	$114.75
Rate for Payer: Priority Health Commercial	$94.50
Rate for Payer: Priority Health PPO	$94.50

IMPLANT,MEDPOR 1.5MM X 38 X 50

Facility

$913.00

Hospital Charge Code	27060578
Hospital Revenue Code	278
Min. Negotiated Rate	$639.10
Max. Negotiated Rate	$776.05
Rate for Payer: Cash Price	$593.45
Rate for Payer: Community Health Alliance Commercial	$776.05
Rate for Payer: Priority Health Commercial	$639.10
Rate for Payer: Priority Health PPO	$639.10

IMPLANT,MEDPOR 3 MM X 13

Facility

$684.00

Hospital Charge Code	27022442
Hospital Revenue Code	278
Min. Negotiated Rate	$478.80
Max. Negotiated Rate	$581.40
Rate for Payer: Cash Price	$444.60
Rate for Payer: Community Health Alliance Commercial	$581.40
Rate for Payer: Priority Health Commercial	$478.80
Rate for Payer: Priority Health PPO	$478.80

IMPLANT TRAY

Facility

$203.00

Hospital Charge Code	27060579
Hospital Revenue Code	270
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$172.55
Rate for Payer: Cash Price	$131.95
Rate for Payer: Community Health Alliance Commercial	$172.55
Rate for Payer: Priority Health Commercial	$142.10
Rate for Payer: Priority Health PPO	$142.10

I.M. THERAPEUTIC INJECTION AMB

Facility

$46.00

Service Code	HCPCS 96372
Hospital Charge Code	9400100
Hospital Revenue Code	940
Min. Negotiated Rate	$32.20
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	$29.90
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
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	$32.20
Rate for Payer: Priority Health Medicaid	$77.24
Rate for Payer: Priority Health Medicare	$77.24
Rate for Payer: Priority Health PPO	$32.20
Rate for Payer: United Health Care Medicaid	$77.24
Rate for Payer: United Health Care Medicare Advantage	$33.98

I.M. THERAPEUTIC INJECTION M/S

Facility

$77.00

Service Code	HCPCS 96372
Hospital Charge Code	9400500
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. THERAPUTIC INJ FOR CLINIC

Facility

$46.00

Service Code	HCPCS 96372
Hospital Charge Code	4501000
Hospital Revenue Code	940
Min. Negotiated Rate	$32.20
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	$29.90
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
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	$32.20
Rate for Payer: Priority Health Medicaid	$77.24
Rate for Payer: Priority Health Medicare	$77.24
Rate for Payer: Priority Health PPO	$32.20
Rate for Payer: United Health Care Medicaid	$77.24
Rate for Payer: United Health Care Medicare Advantage	$33.98

IMURAN (AZATHYOPRENE)

Facility

$174.00

Service Code	HCPCS 80299
Hospital Charge Code	3005795
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$147.90
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$113.10
Rate for Payer: Cash Price	$113.10
Rate for Payer: Community Health Alliance Commercial	$147.90
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	$121.80
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$121.80
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS, TRANSANAL, UNDER ANESTHESIA

Facility

$2,977.57

Service Code	CPT 46045
Hospital Revenue Code	360
Min. Negotiated Rate	$1,310.13
Max. Negotiated Rate	$2,977.57
Rate for Payer: BCBS BCN 65	$2,977.57
Rate for Payer: Blue Care Network Medicare Advantage	$2,977.57
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,977.57
Rate for Payer: Meridian Health Plan Medicare	$2,977.57
Rate for Payer: Priority Health Medicaid	$2,977.57
Rate for Payer: Priority Health Medicare	$2,977.57
Rate for Payer: United Health Care Medicaid	$2,977.57
Rate for Payer: United Health Care Medicare Advantage	$1,310.13

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges