Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

INTMD RPR S/A/T/EXT 2.6-7.5

Facility

$448.00

Hospital Charge Code	5150792
Hospital Revenue Code	960
Min. Negotiated Rate	$313.60
Max. Negotiated Rate	$380.80
Rate for Payer: Cash Price	$291.20
Rate for Payer: Community Health Alliance Commercial	$380.80
Rate for Payer: Priority Health Commercial	$313.60
Rate for Payer: Priority Health PPO	$313.60

INTRA-ARC FULL RADIUS RESECTOR

Facility

$314.00

Hospital Charge Code	27264421
Hospital Revenue Code	272
Min. Negotiated Rate	$219.80
Max. Negotiated Rate	$266.90
Rate for Payer: Cash Price	$204.10
Rate for Payer: Community Health Alliance Commercial	$266.90
Rate for Payer: Priority Health Commercial	$219.80
Rate for Payer: Priority Health PPO	$219.80

INTRACONAZOLE LEVEL

Facility

$65.00

Service Code	HCPCS 80299
Hospital Charge Code	3005450
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$55.25
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
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	$45.50
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$45.50
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

INTRA INJ SENTINEL NODE

Facility

$742.00

Hospital Charge Code	3400264
Hospital Revenue Code	361
Min. Negotiated Rate	$519.40
Max. Negotiated Rate	$630.70
Rate for Payer: Cash Price	$482.30
Rate for Payer: Community Health Alliance Commercial	$630.70
Rate for Payer: Priority Health Commercial	$519.40
Rate for Payer: Priority Health PPO	$519.40

INTRAMEDULLARY HIP NAIL (ODI)

Facility

$3,022.00

Service Code	HCPCS C1713
Hospital Charge Code	27868019
Hospital Revenue Code	278
Min. Negotiated Rate	$2,115.40
Max. Negotiated Rate	$2,568.70
Rate for Payer: Cash Price	$1,964.30
Rate for Payer: Community Health Alliance Commercial	$2,568.70
Rate for Payer: Priority Health Commercial	$2,115.40
Rate for Payer: Priority Health PPO	$2,115.40

INTRAOCULAR LENS

Facility

$517.00

Service Code	HCPCS C1780
Hospital Charge Code	27012336
Hospital Revenue Code	276
Min. Negotiated Rate	$361.90
Max. Negotiated Rate	$439.45
Rate for Payer: Cash Price	$336.05
Rate for Payer: Community Health Alliance Commercial	$439.45
Rate for Payer: Priority Health Commercial	$361.90
Rate for Payer: Priority Health PPO	$361.90

INTRAOCULAR PRESSURE REDUCER

Facility

$36.00

Hospital Charge Code	27023291
Hospital Revenue Code	272
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$30.60
Rate for Payer: Cash Price	$23.40
Rate for Payer: Community Health Alliance Commercial	$30.60
Rate for Payer: Priority Health Commercial	$25.20
Rate for Payer: Priority Health PPO	$25.20

INTRASIL CVC

Facility

$139.00

Hospital Charge Code	27014985
Hospital Revenue Code	272
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$118.15
Rate for Payer: Cash Price	$90.35
Rate for Payer: Community Health Alliance Commercial	$118.15
Rate for Payer: Priority Health Commercial	$97.30
Rate for Payer: Priority Health PPO	$97.30

INTRINSIC FACTOR BLOCKING ANTI

Facility

$5.00

Service Code	HCPCS 86340
Hospital Charge Code	3000581
Hospital Revenue Code	302
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$15.83
Rate for Payer: BCBS BCN 65	$15.83
Rate for Payer: Blue Care Network Medicare Advantage	$15.83
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.83
Rate for Payer: Meridian Health Plan Medicare	$15.83
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$15.83
Rate for Payer: Priority Health Medicare	$15.83
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$15.83
Rate for Payer: United Health Care Medicare Advantage	$6.97

INTRO ANGIOPLASTY FEM/POP

Facility

$4,048.00

Service Code	HCPCS 37227
Hospital Charge Code	3203119
Hospital Revenue Code	361
Min. Negotiated Rate	$2,833.60
Max. Negotiated Rate	$3,440.80
Rate for Payer: Cash Price	$2,631.20
Rate for Payer: Community Health Alliance Commercial	$3,440.80
Rate for Payer: Priority Health Commercial	$2,833.60
Rate for Payer: Priority Health PPO	$2,833.60

INTRO ANGIOPLASTY ILIAC

Facility

$4,048.00

Service Code	HCPCS 37220
Hospital Charge Code	3203118
Hospital Revenue Code	361
Min. Negotiated Rate	$2,833.60
Max. Negotiated Rate	$3,440.80
Rate for Payer: Cash Price	$2,631.20
Rate for Payer: Community Health Alliance Commercial	$3,440.80
Rate for Payer: Priority Health Commercial	$2,833.60
Rate for Payer: Priority Health PPO	$2,833.60

INTRO AORTA DISTAL

Facility

$366.00

Service Code	HCPCS 36245
Hospital Charge Code	3203113
Hospital Revenue Code	361
Min. Negotiated Rate	$256.20
Max. Negotiated Rate	$311.10
Rate for Payer: Cash Price	$237.90
Rate for Payer: Community Health Alliance Commercial	$311.10
Rate for Payer: Priority Health Commercial	$256.20
Rate for Payer: Priority Health PPO	$256.20

INTRO AORTIC ABD

Facility

$333.00

Service Code	HCPCS 36200
Hospital Charge Code	3203112
Hospital Revenue Code	361
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$283.05
Rate for Payer: Cash Price	$216.45
Rate for Payer: Community Health Alliance Commercial	$283.05
Rate for Payer: Priority Health Commercial	$233.10
Rate for Payer: Priority Health PPO	$233.10

INTRO AORTIC ARCH

Facility

$406.00

Service Code	HCPCS 36215
Hospital Charge Code	3203111
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

INTRO CATH AORTA

Facility

$341.00

Hospital Charge Code	3203121
Hospital Revenue Code	361
Min. Negotiated Rate	$238.70
Max. Negotiated Rate	$289.85
Rate for Payer: Cash Price	$221.65
Rate for Payer: Community Health Alliance Commercial	$289.85
Rate for Payer: Priority Health Commercial	$238.70
Rate for Payer: Priority Health PPO	$238.70

INTRO CATH CAROTID

Facility

$366.00

Hospital Charge Code	3203114
Hospital Revenue Code	361
Min. Negotiated Rate	$256.20
Max. Negotiated Rate	$311.10
Rate for Payer: Cash Price	$237.90
Rate for Payer: Community Health Alliance Commercial	$311.10
Rate for Payer: Priority Health Commercial	$256.20
Rate for Payer: Priority Health PPO	$256.20

INTRO CATH-CPT FROM ABSTRACT

Facility

$386.00

Hospital Charge Code	3203150
Hospital Revenue Code	361
Min. Negotiated Rate	$270.20
Max. Negotiated Rate	$328.10
Rate for Payer: Cash Price	$250.90
Rate for Payer: Community Health Alliance Commercial	$328.10
Rate for Payer: Priority Health Commercial	$270.20
Rate for Payer: Priority Health PPO	$270.20

INTRO CATH FOR UROKIN

Facility

$1,243.00

Service Code	HCPCS 37201
Hospital Charge Code	3201231
Hospital Revenue Code	361
Min. Negotiated Rate	$870.10
Max. Negotiated Rate	$1,056.55
Rate for Payer: Cash Price	$807.95
Rate for Payer: Community Health Alliance Commercial	$1,056.55
Rate for Payer: Priority Health Commercial	$870.10
Rate for Payer: Priority Health PPO	$870.10

INTRO CATH RENAL ARTERY

Facility

$333.00

Service Code	HCPCS 36246
Hospital Charge Code	3203116
Hospital Revenue Code	361
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$283.05
Rate for Payer: Cash Price	$216.45
Rate for Payer: Community Health Alliance Commercial	$283.05
Rate for Payer: Priority Health Commercial	$233.10
Rate for Payer: Priority Health PPO	$233.10

INTRO-CATH VENA CAVA

Facility

$318.00

Service Code	HCPCS 36010
Hospital Charge Code	3201042
Hospital Revenue Code	361
Min. Negotiated Rate	$222.60
Max. Negotiated Rate	$270.30
Rate for Payer: Cash Price	$206.70
Rate for Payer: Community Health Alliance Commercial	$270.30
Rate for Payer: Priority Health Commercial	$222.60
Rate for Payer: Priority Health PPO	$222.60

INTRO CATH VERTEBRAL

Facility

$351.00

Service Code	HCPCS 36246
Hospital Charge Code	3203115
Hospital Revenue Code	361
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$298.35
Rate for Payer: Cash Price	$228.15
Rate for Payer: Community Health Alliance Commercial	$298.35
Rate for Payer: Priority Health Commercial	$245.70
Rate for Payer: Priority Health PPO	$245.70

INTRODUCER, 7F MEDTRONIC

Facility

$278.00

Service Code	HCPCS C1894
Hospital Charge Code	27266310
Hospital Revenue Code	272
Min. Negotiated Rate	$194.60
Max. Negotiated Rate	$236.30
Rate for Payer: Cash Price	$180.70
Rate for Payer: Community Health Alliance Commercial	$236.30
Rate for Payer: Priority Health Commercial	$194.60
Rate for Payer: Priority Health PPO	$194.60

INTRODUCER,BILIARY

Facility

$268.00

Service Code	HCPCS C1894
Hospital Charge Code	27263154
Hospital Revenue Code	272
Min. Negotiated Rate	$187.60
Max. Negotiated Rate	$227.80
Rate for Payer: Cash Price	$174.20
Rate for Payer: Community Health Alliance Commercial	$227.80
Rate for Payer: Priority Health Commercial	$187.60
Rate for Payer: Priority Health PPO	$187.60

INTRODUCER,CHECK FLO TM II

Facility

$231.00

Service Code	HCPCS C1894
Hospital Charge Code	27262491
Hospital Revenue Code	272
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$196.35
Rate for Payer: Cash Price	$150.15
Rate for Payer: Community Health Alliance Commercial	$196.35
Rate for Payer: Priority Health Commercial	$161.70
Rate for Payer: Priority Health PPO	$161.70

INTRODUCER, EZ

Facility

$1,139.00

Hospital Charge Code	27262415
Hospital Revenue Code	272
Min. Negotiated Rate	$797.30
Max. Negotiated Rate	$968.15
Rate for Payer: Cash Price	$740.35
Rate for Payer: Community Health Alliance Commercial	$968.15
Rate for Payer: Priority Health Commercial	$797.30
Rate for Payer: Priority Health PPO	$797.30

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges