Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

INHIBIN

Facility

$81.00

Hospital Charge Code	3000542
Hospital Revenue Code	302
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$68.85
Rate for Payer: Cash Price	$52.65
Rate for Payer: Community Health Alliance Commercial	$68.85
Rate for Payer: Priority Health Commercial	$56.70
Rate for Payer: Priority Health PPO	$56.70

INHIBIN A

Facility

$35.00

Hospital Charge Code	3101653
Hospital Revenue Code	300
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

INHIBIN B

Facility

$30.00

Hospital Charge Code	3000544
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$25.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health PPO	$21.00

INITIATION OF CPAP

Facility

$427.00

Service Code	HCPCS 94660
Hospital Charge Code	4100015
Hospital Revenue Code	410
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$362.95
Rate for Payer: BCBS BCN 65	$234.91
Rate for Payer: Blue Care Network Medicare Advantage	$234.91
Rate for Payer: Cash Price	$277.55
Rate for Payer: Cash Price	$277.55
Rate for Payer: Community Health Alliance Commercial	$362.95
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	$298.90
Rate for Payer: Priority Health Medicaid	$234.91
Rate for Payer: Priority Health Medicare	$234.91
Rate for Payer: Priority Health PPO	$298.90
Rate for Payer: United Health Care Medicaid	$234.91
Rate for Payer: United Health Care Medicare Advantage	$103.36

INJECTION NEEDLE (DURASPHERE)

Facility

$71.00

Hospital Charge Code	27267185
Hospital Revenue Code	272
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

INJECTION OF SINUS TRACT

Facility

$179.00

Service Code	HCPCS 20501
Hospital Charge Code	3200181
Hospital Revenue Code	361
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$152.15
Rate for Payer: Cash Price	$116.35
Rate for Payer: Community Health Alliance Commercial	$152.15
Rate for Payer: Priority Health Commercial	$125.30
Rate for Payer: Priority Health PPO	$125.30

INJECTOR,UTERINE

Facility

$128.00

Hospital Charge Code	27022327
Hospital Revenue Code	272
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$108.80
Rate for Payer: Cash Price	$83.20
Rate for Payer: Community Health Alliance Commercial	$108.80
Rate for Payer: Priority Health Commercial	$89.60
Rate for Payer: Priority Health PPO	$89.60

INJ FOR DISKOGRAPHY-CERV/THORA

Facility

$406.00

Hospital Charge Code	3200152
Hospital Revenue Code	361
Min. Negotiated Rate	$284.20
Max. Negotiated Rate	$345.10
Rate for Payer: Cash Price	$263.90
Rate for Payer: Community Health Alliance Commercial	$345.10
Rate for Payer: Priority Health Commercial	$284.20
Rate for Payer: Priority Health PPO	$284.20

INJ FOR DISKOGRAPHY-LUMBAR

Facility

$406.00

Hospital Charge Code	3200162
Hospital Revenue Code	361
Min. Negotiated Rate	$284.20
Max. Negotiated Rate	$345.10
Rate for Payer: Cash Price	$263.90
Rate for Payer: Community Health Alliance Commercial	$345.10
Rate for Payer: Priority Health Commercial	$284.20
Rate for Payer: Priority Health PPO	$284.20

INJ.FOR HYSTEROSALPINGOGRAM

Facility

$203.00

Service Code	HCPCS 58340
Hospital Charge Code	3200221
Hospital Revenue Code	361
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

INJ.MAMMARY DUCTOGRAM

Facility

$179.00

Service Code	HCPCS 19030
Hospital Charge Code	3201375
Hospital Revenue Code	361
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$152.15
Rate for Payer: Cash Price	$116.35
Rate for Payer: Community Health Alliance Commercial	$152.15
Rate for Payer: Priority Health Commercial	$125.30
Rate for Payer: Priority Health PPO	$125.30

INJ.PYELOGRAPHY/NEPHROSTOMY

Facility

$179.00

Service Code	HCPCS 50431
Hospital Charge Code	3200591
Hospital Revenue Code	361
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$748.02
Rate for Payer: BCBS BCN 65	$748.02
Rate for Payer: Blue Care Network Medicare Advantage	$748.02
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Community Health Alliance Commercial	$152.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$748.02
Rate for Payer: Meridian Health Plan Medicare	$748.02
Rate for Payer: Priority Health Commercial	$125.30
Rate for Payer: Priority Health Medicaid	$748.02
Rate for Payer: Priority Health Medicare	$748.02
Rate for Payer: Priority Health PPO	$125.30
Rate for Payer: United Health Care Medicaid	$748.02
Rate for Payer: United Health Care Medicare Advantage	$329.13

INSECTICIDE EXPOSURE PANEL

Facility

$64.15

Hospital Charge Code	3101772
Hospital Revenue Code	300
Min. Negotiated Rate	$44.91
Max. Negotiated Rate	$54.53
Rate for Payer: Cash Price	$41.70
Rate for Payer: Community Health Alliance Commercial	$54.53
Rate for Payer: Priority Health Commercial	$44.91
Rate for Payer: Priority Health PPO	$44.91

INSERTION OF CVAD

Facility

$869.00

Hospital Charge Code	4500946
Hospital Revenue Code	450
Min. Negotiated Rate	$608.30
Max. Negotiated Rate	$738.65
Rate for Payer: Cash Price	$564.85
Rate for Payer: Community Health Alliance Commercial	$738.65
Rate for Payer: Priority Health Commercial	$608.30
Rate for Payer: Priority Health PPO	$608.30

INSERTION OF DRUG-ELUTING IMPLANT, INCLUDING PUNCTAL DILATION WHEN PERFORMED, INTO LACRIMAL CANALICULUS, EACH

Facility

$2,550.43

Service Code	CPT 68841
Hospital Revenue Code	360
Min. Negotiated Rate	$1,122.19
Max. Negotiated Rate	$2,550.43
Rate for Payer: BCBS BCN 65	$2,550.43
Rate for Payer: Blue Care Network Medicare Advantage	$2,550.43
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,550.43
Rate for Payer: Meridian Health Plan Medicare	$2,550.43
Rate for Payer: Priority Health Medicaid	$2,550.43
Rate for Payer: Priority Health Medicare	$2,550.43
Rate for Payer: United Health Care Medicaid	$2,550.43
Rate for Payer: United Health Care Medicare Advantage	$1,122.19

INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED WITH CONCURRENT CATARACT REMOVAL

Facility

$2,475.70

Service Code	CPT 66985
Hospital Revenue Code	360
Min. Negotiated Rate	$1,089.31
Max. Negotiated Rate	$2,475.70
Rate for Payer: BCBS BCN 65	$2,475.70
Rate for Payer: Blue Care Network Medicare Advantage	$2,475.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,475.70
Rate for Payer: Meridian Health Plan Medicare	$2,475.70
Rate for Payer: Priority Health Medicaid	$2,475.70
Rate for Payer: Priority Health Medicare	$2,475.70
Rate for Payer: United Health Care Medicaid	$2,475.70
Rate for Payer: United Health Care Medicare Advantage	$1,089.31

INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER

Facility

$3,387.16

Service Code	CPT 36561
Hospital Revenue Code	360
Min. Negotiated Rate	$1,490.35
Max. Negotiated Rate	$3,387.16
Rate for Payer: BCBS BCN 65	$3,387.16
Rate for Payer: Blue Care Network Medicare Advantage	$3,387.16
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,387.16
Rate for Payer: Meridian Health Plan Medicare	$3,387.16
Rate for Payer: Priority Health Medicaid	$3,387.16
Rate for Payer: Priority Health Medicare	$3,387.16
Rate for Payer: United Health Care Medicaid	$3,387.16
Rate for Payer: United Health Care Medicare Advantage	$1,490.35

INSERTION TUNNELED CV CATH PC

Facility

$1,524.00

Hospital Charge Code	5150715
Hospital Revenue Code	960
Min. Negotiated Rate	$1,066.80
Max. Negotiated Rate	$1,295.40
Rate for Payer: Cash Price	$990.60
Rate for Payer: Community Health Alliance Commercial	$1,295.40
Rate for Payer: Priority Health Commercial	$1,066.80
Rate for Payer: Priority Health PPO	$1,066.80

In situ hybrid

Facility

$126.96

Hospital Charge Code	31027473
Hospital Revenue Code	300
Min. Negotiated Rate	$88.87
Max. Negotiated Rate	$107.92
Rate for Payer: Cash Price	$82.52
Rate for Payer: Community Health Alliance Commercial	$107.92
Rate for Payer: Priority Health Commercial	$88.87
Rate for Payer: Priority Health PPO	$88.87

INSITU HYBRIDIZATION AUTO

Facility

$47.00

Hospital Charge Code	3100770
Hospital Revenue Code	301
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$39.95
Rate for Payer: Cash Price	$30.55
Rate for Payer: Community Health Alliance Commercial	$39.95
Rate for Payer: Priority Health Commercial	$32.90
Rate for Payer: Priority Health PPO	$32.90

INSITU HYBRIDIZATION AUTO

Facility

$47.00

Hospital Charge Code	3100771
Hospital Revenue Code	301
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$39.95
Rate for Payer: Cash Price	$30.55
Rate for Payer: Community Health Alliance Commercial	$39.95
Rate for Payer: Priority Health Commercial	$32.90
Rate for Payer: Priority Health PPO	$32.90

INSTABILITY BRACE

Facility

$1,348.00

Hospital Charge Code	27019067
Hospital Revenue Code	270
Min. Negotiated Rate	$943.60
Max. Negotiated Rate	$1,145.80
Rate for Payer: Cash Price	$876.20
Rate for Payer: Community Health Alliance Commercial	$1,145.80
Rate for Payer: Priority Health Commercial	$943.60
Rate for Payer: Priority Health PPO	$943.60

INSULIN ANTIBODIES

Facility

$18.24

Hospital Charge Code	3006248
Hospital Revenue Code	302
Min. Negotiated Rate	$12.77
Max. Negotiated Rate	$15.50
Rate for Payer: Cash Price	$11.86
Rate for Payer: Community Health Alliance Commercial	$15.50
Rate for Payer: Priority Health Commercial	$12.77
Rate for Payer: Priority Health PPO	$12.77

INSULIN ANTIBODY,SERUM

Facility

$90.00

Service Code	HCPCS 86337
Hospital Charge Code	3000561
Hospital Revenue Code	302
Min. Negotiated Rate	$9.89
Max. Negotiated Rate	$76.50
Rate for Payer: BCBS BCN 65	$22.48
Rate for Payer: Blue Care Network Medicare Advantage	$22.48
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Community Health Alliance Commercial	$76.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$22.48
Rate for Payer: Meridian Health Plan Medicare	$22.48
Rate for Payer: Priority Health Commercial	$63.00
Rate for Payer: Priority Health Medicaid	$22.48
Rate for Payer: Priority Health Medicare	$22.48
Rate for Payer: Priority Health PPO	$63.00
Rate for Payer: United Health Care Medicaid	$22.48
Rate for Payer: United Health Care Medicare Advantage	$9.89

INSULIN LEVEL

Facility

$3.37

Service Code	HCPCS 83525
Hospital Charge Code	3005440
Hospital Revenue Code	301
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$12.00
Rate for Payer: BCBS BCN 65	$12.00
Rate for Payer: Blue Care Network Medicare Advantage	$12.00
Rate for Payer: Cash Price	$2.19
Rate for Payer: Cash Price	$2.19
Rate for Payer: Community Health Alliance Commercial	$2.86
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.00
Rate for Payer: Meridian Health Plan Medicare	$12.00
Rate for Payer: Priority Health Commercial	$2.36
Rate for Payer: Priority Health Medicaid	$12.00
Rate for Payer: Priority Health Medicare	$12.00
Rate for Payer: Priority Health PPO	$2.36
Rate for Payer: United Health Care Medicaid	$12.00
Rate for Payer: United Health Care Medicare Advantage	$5.28

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges