Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE PROCEDURE)

Facility

$1,283.69

Service Code	CPT 46040
Hospital Revenue Code	360
Min. Negotiated Rate	$564.82
Max. Negotiated Rate	$1,283.69
Rate for Payer: BCBS BCN 65	$1,283.69
Rate for Payer: Blue Care Network Medicare Advantage	$1,283.69
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,283.69
Rate for Payer: Meridian Health Plan Medicare	$1,283.69
Rate for Payer: Priority Health Medicaid	$1,283.69
Rate for Payer: Priority Health Medicare	$1,283.69
Rate for Payer: United Health Care Medicaid	$1,283.69
Rate for Payer: United Health Care Medicare Advantage	$564.82

INCISION DRAIN

Facility

$67.00

Hospital Charge Code	27022905
Hospital Revenue Code	270
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$56.95
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health PPO	$46.90

INCISION OF ANAL ABSCESS

Facility

$449.00

Hospital Charge Code	5150773
Hospital Revenue Code	960
Min. Negotiated Rate	$314.30
Max. Negotiated Rate	$381.65
Rate for Payer: Cash Price	$291.85
Rate for Payer: Community Health Alliance Commercial	$381.65
Rate for Payer: Priority Health Commercial	$314.30
Rate for Payer: Priority Health PPO	$314.30

INCISION OF ANAL SPHINCTER

Facility

$939.00

Hospital Charge Code	5150761
Hospital Revenue Code	960
Min. Negotiated Rate	$657.30
Max. Negotiated Rate	$798.15
Rate for Payer: Cash Price	$610.35
Rate for Payer: Community Health Alliance Commercial	$798.15
Rate for Payer: Priority Health Commercial	$657.30
Rate for Payer: Priority Health PPO	$657.30

INCISION OF RECTAL ABSCESS

Facility

$1,343.00

Hospital Charge Code	5150710
Hospital Revenue Code	960
Min. Negotiated Rate	$940.10
Max. Negotiated Rate	$1,141.55
Rate for Payer: Cash Price	$872.95
Rate for Payer: Community Health Alliance Commercial	$1,141.55
Rate for Payer: Priority Health Commercial	$940.10
Rate for Payer: Priority Health PPO	$940.10

INDEROL

Facility

$78.00

Service Code	HCPCS 80299
Hospital Charge Code	3005370
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$66.30
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
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	$54.60
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$54.60
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

INDIA INK-CSF

Facility

$28.00

Service Code	HCPCS 87205
Hospital Charge Code	3005910
Hospital Revenue Code	306
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$23.80
Rate for Payer: BCBS BCN 65	$4.48
Rate for Payer: Blue Care Network Medicare Advantage	$4.48
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.48
Rate for Payer: Meridian Health Plan Medicare	$4.48
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health Medicaid	$4.48
Rate for Payer: Priority Health Medicare	$4.48
Rate for Payer: Priority Health PPO	$19.60
Rate for Payer: United Health Care Medicaid	$4.48
Rate for Payer: United Health Care Medicare Advantage	$1.97

INDIRECT TITER

Facility

$82.00

Hospital Charge Code	3007450
Hospital Revenue Code	300
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$69.70
Rate for Payer: Cash Price	$53.30
Rate for Payer: Community Health Alliance Commercial	$69.70
Rate for Payer: Priority Health Commercial	$57.40
Rate for Payer: Priority Health PPO	$57.40

INDIUM

Facility

$169.00

Hospital Charge Code	3101785
Hospital Revenue Code	300
Min. Negotiated Rate	$118.30
Max. Negotiated Rate	$143.65
Rate for Payer: Cash Price	$109.85
Rate for Payer: Community Health Alliance Commercial	$143.65
Rate for Payer: Priority Health Commercial	$118.30
Rate for Payer: Priority Health PPO	$118.30

INDUCER,HICKMAN

Facility

$247.00

Hospital Charge Code	27022913
Hospital Revenue Code	272
Min. Negotiated Rate	$172.90
Max. Negotiated Rate	$209.95
Rate for Payer: Cash Price	$160.55
Rate for Payer: Community Health Alliance Commercial	$209.95
Rate for Payer: Priority Health Commercial	$172.90
Rate for Payer: Priority Health PPO	$172.90

INDWELLING PORT DUEL LUMEN

Facility

$612.50

Service Code	HCPCS C1788
Hospital Charge Code	27881303
Hospital Revenue Code	278
Min. Negotiated Rate	$428.75
Max. Negotiated Rate	$520.62
Rate for Payer: Cash Price	$398.13
Rate for Payer: Community Health Alliance Commercial	$520.62
Rate for Payer: Priority Health Commercial	$428.75
Rate for Payer: Priority Health PPO	$428.75

INFANT FEEDING TUBE

Facility

$17.00

Hospital Charge Code	27012948
Hospital Revenue Code	272
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL (IE, VISUAL) OBSERVATION; INFLUENZA

Facility

$17.38

Service Code	CPT 87804
Hospital Revenue Code	360
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$17.38
Rate for Payer: BCBS BCN 65	$17.38
Rate for Payer: Blue Care Network Medicare Advantage	$17.38
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.38
Rate for Payer: Meridian Health Plan Medicare	$17.38
Rate for Payer: Priority Health Medicaid	$17.38
Rate for Payer: Priority Health Medicare	$17.38
Rate for Payer: United Health Care Medicaid	$17.38
Rate for Payer: United Health Care Medicare Advantage	$7.65

INFECTIOUS AGENT ANTIGEN, EIA

Facility

$33.00

Service Code	HCPCS 87449
Hospital Charge Code	3005059
Hospital Revenue Code	306
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$12.58
Rate for Payer: Blue Care Network Medicare Advantage	$12.58
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	$12.58
Rate for Payer: Meridian Health Plan Medicare	$12.58
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$12.58
Rate for Payer: Priority Health Medicare	$12.58
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$12.58
Rate for Payer: United Health Care Medicare Advantage	$5.53

INFLATION DEVICE, BASIX COMPAK

Facility

$188.00

Hospital Charge Code	27264322
Hospital Revenue Code	270
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$159.80
Rate for Payer: Cash Price	$122.20
Rate for Payer: Community Health Alliance Commercial	$159.80
Rate for Payer: Priority Health Commercial	$131.60
Rate for Payer: Priority Health PPO	$131.60

INFLIXIMAB ACTIVITY

Facility

$170.00

Hospital Charge Code	3100929
Hospital Revenue Code	309
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$144.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Community Health Alliance Commercial	$144.50
Rate for Payer: Priority Health Commercial	$119.00
Rate for Payer: Priority Health PPO	$119.00

INFLIXIMAB NEUTRALIZING AB TIT

Facility

$170.00

Hospital Charge Code	3100930
Hospital Revenue Code	309
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$144.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Community Health Alliance Commercial	$144.50
Rate for Payer: Priority Health Commercial	$119.00
Rate for Payer: Priority Health PPO	$119.00

INFLUENZA A

Facility

$67.00

Service Code	HCPCS 87804
Hospital Charge Code	3005901
Hospital Revenue Code	306
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$56.95
Rate for Payer: BCBS BCN 65	$17.38
Rate for Payer: Blue Care Network Medicare Advantage	$17.38
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.38
Rate for Payer: Meridian Health Plan Medicare	$17.38
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health Medicaid	$17.38
Rate for Payer: Priority Health Medicare	$17.38
Rate for Payer: Priority Health PPO	$46.90
Rate for Payer: United Health Care Medicaid	$17.38
Rate for Payer: United Health Care Medicare Advantage	$7.65

INFLUENZA A/B

Facility

$142.00

Hospital Charge Code	3005900
Hospital Revenue Code	306
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$120.70
Rate for Payer: Cash Price	$92.30
Rate for Payer: Community Health Alliance Commercial	$120.70
Rate for Payer: Priority Health Commercial	$99.40
Rate for Payer: Priority Health PPO	$99.40

INFLUENZA A/B RNA BY QUAL PCT

Facility

$150.00

Hospital Charge Code	3101338
Hospital Revenue Code	302
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$127.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Community Health Alliance Commercial	$127.50
Rate for Payer: Priority Health Commercial	$105.00
Rate for Payer: Priority Health PPO	$105.00

INFLUENZA A SERUM

Facility

$7.05

Hospital Charge Code	3101569
Hospital Revenue Code	300
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$5.99
Rate for Payer: Cash Price	$4.58
Rate for Payer: Community Health Alliance Commercial	$5.99
Rate for Payer: Priority Health Commercial	$4.93
Rate for Payer: Priority Health PPO	$4.93

INFLUENZA B

Facility

$67.00

Service Code	HCPCS 87804
Hospital Charge Code	3005902
Hospital Revenue Code	306
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$56.95
Rate for Payer: BCBS BCN 65	$17.38
Rate for Payer: Blue Care Network Medicare Advantage	$17.38
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.38
Rate for Payer: Meridian Health Plan Medicare	$17.38
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health Medicaid	$17.38
Rate for Payer: Priority Health Medicare	$17.38
Rate for Payer: Priority Health PPO	$46.90
Rate for Payer: United Health Care Medicaid	$17.38
Rate for Payer: United Health Care Medicare Advantage	$7.65

INFLUENZA B SERUM

Facility

$7.05

Hospital Charge Code	3101570
Hospital Revenue Code	300
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$5.99
Rate for Payer: Cash Price	$4.58
Rate for Payer: Community Health Alliance Commercial	$5.99
Rate for Payer: Priority Health Commercial	$4.93
Rate for Payer: Priority Health PPO	$4.93

INHALER TREATMENT, INITIAL

Facility

$387.00

Service Code	HCPCS 94640
Hospital Charge Code	4100030
Hospital Revenue Code	410
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$328.95
Rate for Payer: BCBS BCN 65	$234.91
Rate for Payer: Blue Care Network Medicare Advantage	$234.91
Rate for Payer: Cash Price	$251.55
Rate for Payer: Cash Price	$251.55
Rate for Payer: Community Health Alliance Commercial	$328.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$234.91
Rate for Payer: Meridian Health Plan Medicare	$234.91
Rate for Payer: Priority Health Commercial	$270.90
Rate for Payer: Priority Health Medicaid	$234.91
Rate for Payer: Priority Health Medicare	$234.91
Rate for Payer: Priority Health PPO	$270.90
Rate for Payer: United Health Care Medicaid	$234.91
Rate for Payer: United Health Care Medicare Advantage	$103.36

INHALER TREATMENT SUBSEQUENT

Facility

$168.00

Service Code	HCPCS 94640
Hospital Charge Code	4100055
Hospital Revenue Code	410
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$234.91
Rate for Payer: BCBS BCN 65	$234.91
Rate for Payer: Blue Care Network Medicare Advantage	$234.91
Rate for Payer: Cash Price	$109.20
Rate for Payer: Cash Price	$109.20
Rate for Payer: Community Health Alliance Commercial	$142.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$234.91
Rate for Payer: Meridian Health Plan Medicare	$234.91
Rate for Payer: Priority Health Commercial	$117.60
Rate for Payer: Priority Health Medicaid	$234.91
Rate for Payer: Priority Health Medicare	$234.91
Rate for Payer: Priority Health PPO	$117.60
Rate for Payer: United Health Care Medicaid	$234.91
Rate for Payer: United Health Care Medicare Advantage	$103.36

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges