Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

INSULIN LEVEL-ML

Facility

$104.00

Hospital Charge Code	3101290
Hospital Revenue Code	301
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$88.40
Rate for Payer: Cash Price	$67.60
Rate for Payer: Community Health Alliance Commercial	$88.40
Rate for Payer: Priority Health Commercial	$72.80
Rate for Payer: Priority Health PPO	$72.80

INSULIN-LIKE GROWTH FACTOR

Facility

$6.11

Hospital Charge Code	3005657
Hospital Revenue Code	301
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$5.19
Rate for Payer: Cash Price	$3.97
Rate for Payer: Community Health Alliance Commercial	$5.19
Rate for Payer: Priority Health Commercial	$4.28
Rate for Payer: Priority Health PPO	$4.28

INSULIN LIKE GROWTH FACTOR 2

Facility

$52.45

Hospital Charge Code	3101406
Hospital Revenue Code	300
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$44.58
Rate for Payer: Cash Price	$34.09
Rate for Payer: Community Health Alliance Commercial	$44.58
Rate for Payer: Priority Health Commercial	$36.72
Rate for Payer: Priority Health PPO	$36.72

INTEGRO LIPID CARRIER

Facility

$836.00

Hospital Charge Code	27871690
Hospital Revenue Code	278
Min. Negotiated Rate	$585.20
Max. Negotiated Rate	$710.60
Rate for Payer: Cash Price	$543.40
Rate for Payer: Community Health Alliance Commercial	$710.60
Rate for Payer: Priority Health Commercial	$585.20
Rate for Payer: Priority Health PPO	$585.20

INTERFERON-APLHA

Facility

$90.00

Hospital Charge Code	3100979
Hospital Revenue Code	300
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$76.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Community Health Alliance Commercial	$76.50
Rate for Payer: Priority Health Commercial	$63.00
Rate for Payer: Priority Health PPO	$63.00

INTERFERON BETA AB NUET ASSAY

Facility

$513.00

Hospital Charge Code	3000132
Hospital Revenue Code	302
Min. Negotiated Rate	$359.10
Max. Negotiated Rate	$436.05
Rate for Payer: Cash Price	$333.45
Rate for Payer: Community Health Alliance Commercial	$436.05
Rate for Payer: Priority Health Commercial	$359.10
Rate for Payer: Priority Health PPO	$359.10

INTERFERON GAMMA IFNG

Facility

$69.00

Hospital Charge Code	3100845
Hospital Revenue Code	300
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$58.65
Rate for Payer: Cash Price	$44.85
Rate for Payer: Community Health Alliance Commercial	$58.65
Rate for Payer: Priority Health Commercial	$48.30
Rate for Payer: Priority Health PPO	$48.30

INTERLEUKEN 28B X

Facility

$361.00

Hospital Charge Code	3100538
Hospital Revenue Code	301
Min. Negotiated Rate	$252.70
Max. Negotiated Rate	$306.85
Rate for Payer: Cash Price	$234.65
Rate for Payer: Community Health Alliance Commercial	$306.85
Rate for Payer: Priority Health Commercial	$252.70
Rate for Payer: Priority Health PPO	$252.70

INTERLEUKIN-10

Facility

$54.00

Hospital Charge Code	3101536
Hospital Revenue Code	300
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$45.90
Rate for Payer: Cash Price	$35.10
Rate for Payer: Community Health Alliance Commercial	$45.90
Rate for Payer: Priority Health Commercial	$37.80
Rate for Payer: Priority Health PPO	$37.80

INTERLEUKIN-12

Facility

$110.00

Hospital Charge Code	3101533
Hospital Revenue Code	300
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$93.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Community Health Alliance Commercial	$93.50
Rate for Payer: Priority Health Commercial	$77.00
Rate for Payer: Priority Health PPO	$77.00

INTERLEUKIN-13

Facility

$110.00

Hospital Charge Code	3101537
Hospital Revenue Code	300
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$93.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Community Health Alliance Commercial	$93.50
Rate for Payer: Priority Health Commercial	$77.00
Rate for Payer: Priority Health PPO	$77.00

INTERLEUKIN 1 BETA

Facility

$69.00

Hospital Charge Code	3101469
Hospital Revenue Code	300
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$58.65
Rate for Payer: Cash Price	$44.85
Rate for Payer: Community Health Alliance Commercial	$58.65
Rate for Payer: Priority Health Commercial	$48.30
Rate for Payer: Priority Health PPO	$48.30

INTERLEUKIN-2

Facility

$54.00

Hospital Charge Code	3101531
Hospital Revenue Code	300
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$45.90
Rate for Payer: Cash Price	$35.10
Rate for Payer: Community Health Alliance Commercial	$45.90
Rate for Payer: Priority Health Commercial	$37.80
Rate for Payer: Priority Health PPO	$37.80

INTERLEUKIN-2 RECEPTOR

Facility

$16.00

Hospital Charge Code	3101532
Hospital Revenue Code	300
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
Rate for Payer: Priority Health Commercial	$11.20
Rate for Payer: Priority Health PPO	$11.20

INTERLEUKIN -4

Facility

$54.00

Hospital Charge Code	3101534
Hospital Revenue Code	300
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$45.90
Rate for Payer: Cash Price	$35.10
Rate for Payer: Community Health Alliance Commercial	$45.90
Rate for Payer: Priority Health Commercial	$37.80
Rate for Payer: Priority Health PPO	$37.80

INTERLEUKIN-5

Facility

$69.00

Hospital Charge Code	3101535
Hospital Revenue Code	300
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$58.65
Rate for Payer: Cash Price	$44.85
Rate for Payer: Community Health Alliance Commercial	$58.65
Rate for Payer: Priority Health Commercial	$48.30
Rate for Payer: Priority Health PPO	$48.30

INTERLEUKIN 6

Facility

$54.00

Service Code	HCPCS 83529
Hospital Charge Code	3005453
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$45.90
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Community Health Alliance Commercial	$45.90
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	$37.80
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$37.80
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

INTERLEUKIN 8

Facility

$54.00

Hospital Charge Code	3101470
Hospital Revenue Code	300
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$45.90
Rate for Payer: Cash Price	$35.10
Rate for Payer: Community Health Alliance Commercial	$45.90
Rate for Payer: Priority Health Commercial	$37.80
Rate for Payer: Priority Health PPO	$37.80

INTERPHASE HYBRIDIZATION

Facility

$193.00

Hospital Charge Code	3100022
Hospital Revenue Code	310
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$164.05
Rate for Payer: Cash Price	$125.45
Rate for Payer: Community Health Alliance Commercial	$164.05
Rate for Payer: Priority Health Commercial	$135.10
Rate for Payer: Priority Health PPO	$135.10

INTERPHASE HYBRIDIZATION

Facility

$208.00

Hospital Charge Code	3000171
Hospital Revenue Code	310
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$176.80
Rate for Payer: Cash Price	$135.20
Rate for Payer: Community Health Alliance Commercial	$176.80
Rate for Payer: Priority Health Commercial	$145.60
Rate for Payer: Priority Health PPO	$145.60

INTERPHASE HYBRIDIZATION

Facility

$193.00

Hospital Charge Code	3100021
Hospital Revenue Code	310
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$164.05
Rate for Payer: Cash Price	$125.45
Rate for Payer: Community Health Alliance Commercial	$164.05
Rate for Payer: Priority Health Commercial	$135.10
Rate for Payer: Priority Health PPO	$135.10

INTERPHASE HYBRIDIZATION

Facility

$193.00

Hospital Charge Code	3100026
Hospital Revenue Code	310
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$164.05
Rate for Payer: Cash Price	$125.45
Rate for Payer: Community Health Alliance Commercial	$164.05
Rate for Payer: Priority Health Commercial	$135.10
Rate for Payer: Priority Health PPO	$135.10

INTERPRETATION AND REPORT

Facility

$89.00

Service Code	HCPCS G0452
Hospital Charge Code	3000172
Hospital Revenue Code	971
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$75.65
Rate for Payer: Cash Price	$57.85
Rate for Payer: Community Health Alliance Commercial	$75.65
Rate for Payer: Priority Health Commercial	$62.30
Rate for Payer: Priority Health PPO	$62.30

INTERPRETATION AND REPORT

Facility

$169.00

Hospital Charge Code	3000113
Hospital Revenue Code	301
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

INTMD RPR S/A/T/EXT 2.5CM/<

Facility

$323.00

Hospital Charge Code	5150795
Hospital Revenue Code	960
Min. Negotiated Rate	$226.10
Max. Negotiated Rate	$274.55
Rate for Payer: Cash Price	$209.95
Rate for Payer: Community Health Alliance Commercial	$274.55
Rate for Payer: Priority Health Commercial	$226.10
Rate for Payer: Priority Health PPO	$226.10

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges