Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

INTRODUCER,HICKMAN 10FR

Facility

$222.00

Service Code	HCPCS C1894
Hospital Charge Code	27024208
Hospital Revenue Code	272
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$188.70
Rate for Payer: Cash Price	$144.30
Rate for Payer: Community Health Alliance Commercial	$188.70
Rate for Payer: Priority Health Commercial	$155.40
Rate for Payer: Priority Health PPO	$155.40

INTRODUCER, OASIS STENT SYSTEM

Facility

$243.00

Hospital Charge Code	27263916
Hospital Revenue Code	272
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$206.55
Rate for Payer: Cash Price	$157.95
Rate for Payer: Community Health Alliance Commercial	$206.55
Rate for Payer: Priority Health Commercial	$170.10
Rate for Payer: Priority Health PPO	$170.10

INTRODUCER, PERCUTANROUS

Facility

$317.00

Service Code	HCPCS C1894
Hospital Charge Code	27061907
Hospital Revenue Code	272
Min. Negotiated Rate	$221.90
Max. Negotiated Rate	$269.45
Rate for Payer: Cash Price	$206.05
Rate for Payer: Community Health Alliance Commercial	$269.45
Rate for Payer: Priority Health Commercial	$221.90
Rate for Payer: Priority Health PPO	$221.90

INTRODUCER, PLUS SHEATH

Facility

$88.00

Service Code	HCPCS C1894
Hospital Charge Code	27060743
Hospital Revenue Code	272
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$74.80
Rate for Payer: Cash Price	$57.20
Rate for Payer: Community Health Alliance Commercial	$74.80
Rate for Payer: Priority Health Commercial	$61.60
Rate for Payer: Priority Health PPO	$61.60

INTRODUCER, PLUS SHEATH

Facility

$81.00

Service Code	HCPCS C1894
Hospital Charge Code	27019760
Hospital Revenue Code	272
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

INTRODUCER, SAFESHEATH 7FR

Facility

$168.00

Service Code	HCPCS C1894
Hospital Charge Code	27267144
Hospital Revenue Code	272
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$142.80
Rate for Payer: Cash Price	$109.20
Rate for Payer: Community Health Alliance Commercial	$142.80
Rate for Payer: Priority Health Commercial	$117.60
Rate for Payer: Priority Health PPO	$117.60

INTRODUCER SET

Facility

$167.00

Hospital Charge Code	27262509
Hospital Revenue Code	272
Min. Negotiated Rate	$116.90
Max. Negotiated Rate	$141.95
Rate for Payer: Cash Price	$108.55
Rate for Payer: Community Health Alliance Commercial	$141.95
Rate for Payer: Priority Health Commercial	$116.90
Rate for Payer: Priority Health PPO	$116.90

INTRODUCER SET, CHECK-FLO BLUE

Facility

$176.00

Service Code	HCPCS C1894
Hospital Charge Code	27019687
Hospital Revenue Code	272
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$149.60
Rate for Payer: Cash Price	$114.40
Rate for Payer: Community Health Alliance Commercial	$149.60
Rate for Payer: Priority Health Commercial	$123.20
Rate for Payer: Priority Health PPO	$123.20

INTRODUCER, SHEATH/DIALATOR

Facility

$626.00

Service Code	HCPCS C1894
Hospital Charge Code	27061295
Hospital Revenue Code	272
Min. Negotiated Rate	$438.20
Max. Negotiated Rate	$532.10
Rate for Payer: Cash Price	$406.90
Rate for Payer: Community Health Alliance Commercial	$532.10
Rate for Payer: Priority Health Commercial	$438.20
Rate for Payer: Priority Health PPO	$438.20

INTRO IVC FILTER

Facility

$3,333.00

Service Code	HCPCS 37620
Hospital Charge Code	3201023
Hospital Revenue Code	361
Min. Negotiated Rate	$2,333.10
Max. Negotiated Rate	$2,833.05
Rate for Payer: Cash Price	$2,166.45
Rate for Payer: Community Health Alliance Commercial	$2,833.05
Rate for Payer: Priority Health Commercial	$2,333.10
Rate for Payer: Priority Health PPO	$2,333.10

INTUBATION

Facility

$1,515.00

Hospital Charge Code	4500945
Hospital Revenue Code	450
Min. Negotiated Rate	$1,060.50
Max. Negotiated Rate	$1,287.75
Rate for Payer: Cash Price	$984.75
Rate for Payer: Community Health Alliance Commercial	$1,287.75
Rate for Payer: Priority Health Commercial	$1,060.50
Rate for Payer: Priority Health PPO	$1,060.50

IODINE

Facility

$45.00

Service Code	HCPCS 83789
Hospital Charge Code	3005455
Hospital Revenue Code	301
Min. Negotiated Rate	$11.14
Max. Negotiated Rate	$38.25
Rate for Payer: BCBS BCN 65	$25.32
Rate for Payer: Blue Care Network Medicare Advantage	$25.32
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$25.32
Rate for Payer: Meridian Health Plan Medicare	$25.32
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health Medicaid	$25.32
Rate for Payer: Priority Health Medicare	$25.32
Rate for Payer: Priority Health PPO	$31.50
Rate for Payer: United Health Care Medicaid	$25.32
Rate for Payer: United Health Care Medicare Advantage	$11.14

IODINE URINE

Facility

$45.00

Hospital Charge Code	3100035
Hospital Revenue Code	301
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

IODOFLEX PAD

Facility

$459.00

Hospital Charge Code	27065635
Hospital Revenue Code	270
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$390.15
Rate for Payer: Cash Price	$298.35
Rate for Payer: Community Health Alliance Commercial	$390.15
Rate for Payer: Priority Health Commercial	$321.30
Rate for Payer: Priority Health PPO	$321.30

IODOSORB GEL 40GM

Facility

$459.00

Hospital Charge Code	27065627
Hospital Revenue Code	270
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$390.15
Rate for Payer: Cash Price	$298.35
Rate for Payer: Community Health Alliance Commercial	$390.15
Rate for Payer: Priority Health Commercial	$321.30
Rate for Payer: Priority Health PPO	$321.30

IONTOPHORESIS EACH 15 MIN

Facility

$97.00

Hospital Charge Code	4300051
Hospital Revenue Code	430
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.05
Rate for Payer: Community Health Alliance Commercial	$82.45
Rate for Payer: Priority Health Commercial	$67.90
Rate for Payer: Priority Health PPO	$67.90

IONTOPHORESIS EACH 15 MIN

Facility

$53.00

Hospital Charge Code	4300021
Hospital Revenue Code	430
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$45.05
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health PPO	$37.10

IONTOPHORESIS EACH 15 MIN

Facility

$53.00

Service Code	HCPCS 97033 GP
Hospital Charge Code	4200180
Hospital Revenue Code	420
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$45.05
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health PPO	$37.10

IOPANIDOL 50 ML

Facility

$111.92

Service Code	HCPCS Q9967
Hospital Charge Code	3500006
Hospital Revenue Code	250
Min. Negotiated Rate	$78.34
Max. Negotiated Rate	$95.13
Rate for Payer: Cash Price	$72.75
Rate for Payer: Community Health Alliance Commercial	$95.13
Rate for Payer: Priority Health Commercial	$78.34
Rate for Payer: Priority Health PPO	$78.34

IP CONSULATION LOW COMPLEXITY

Facility

$770.00

Hospital Charge Code	5150684
Hospital Revenue Code	960
Min. Negotiated Rate	$539.00
Max. Negotiated Rate	$654.50
Rate for Payer: Cash Price	$500.50
Rate for Payer: Community Health Alliance Commercial	$654.50
Rate for Payer: Priority Health Commercial	$539.00
Rate for Payer: Priority Health PPO	$539.00

IP CONSULTATION MOD COMPLEX PC

Facility

$940.00

Hospital Charge Code	5150679
Hospital Revenue Code	960
Min. Negotiated Rate	$658.00
Max. Negotiated Rate	$799.00
Rate for Payer: Cash Price	$611.00
Rate for Payer: Community Health Alliance Commercial	$799.00
Rate for Payer: Priority Health Commercial	$658.00
Rate for Payer: Priority Health PPO	$658.00

IP CONSULT STRAIGHTFORWARD

Facility

$550.00

Hospital Charge Code	5150711
Hospital Revenue Code	960
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$467.50
Rate for Payer: Cash Price	$357.50
Rate for Payer: Community Health Alliance Commercial	$467.50
Rate for Payer: Priority Health Commercial	$385.00
Rate for Payer: Priority Health PPO	$385.00

IPPB TREATMENT

Facility

$387.00

Service Code	HCPCS 94650
Hospital Charge Code	4600040
Hospital Revenue Code	410
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$328.95
Rate for Payer: Cash Price	$251.55
Rate for Payer: Community Health Alliance Commercial	$328.95
Rate for Payer: Priority Health Commercial	$270.90
Rate for Payer: Priority Health PPO	$270.90

IRON BINDING CAPACITY

Facility

$31.00

Service Code	HCPCS 83550
Hospital Charge Code	3005460
Hospital Revenue Code	301
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$26.35
Rate for Payer: BCBS BCN 65	$9.18
Rate for Payer: Blue Care Network Medicare Advantage	$9.18
Rate for Payer: Cash Price	$20.15
Rate for Payer: Cash Price	$20.15
Rate for Payer: Community Health Alliance Commercial	$26.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.18
Rate for Payer: Meridian Health Plan Medicare	$9.18
Rate for Payer: Priority Health Commercial	$21.70
Rate for Payer: Priority Health Medicaid	$9.18
Rate for Payer: Priority Health Medicare	$9.18
Rate for Payer: Priority Health PPO	$21.70
Rate for Payer: United Health Care Medicaid	$9.18
Rate for Payer: United Health Care Medicare Advantage	$4.04

IRON-LC

Facility

$2.25

Hospital Charge Code	3101197
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.91
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.91
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health PPO	$1.57

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges