Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

JOINT, GREAT TOE M-P MED 20MM

Facility

$2,864.00

Service Code	HCPCS C1776
Hospital Charge Code	27868589
Hospital Revenue Code	278
Min. Negotiated Rate	$2,004.80
Max. Negotiated Rate	$2,434.40
Rate for Payer: Cash Price	$1,861.60
Rate for Payer: Community Health Alliance Commercial	$2,434.40
Rate for Payer: Priority Health Commercial	$2,004.80
Rate for Payer: Priority Health PPO	$2,004.80

JUMBO SNARE #6030

Facility

$115.00

Service Code	HCPCS C1773
Hospital Charge Code	27267052
Hospital Revenue Code	272
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$97.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Community Health Alliance Commercial	$97.75
Rate for Payer: Priority Health Commercial	$80.50
Rate for Payer: Priority Health PPO	$80.50

KAPPA

Facility

$259.16

Hospital Charge Code	3101665
Hospital Revenue Code	300
Min. Negotiated Rate	$181.41
Max. Negotiated Rate	$220.29
Rate for Payer: Cash Price	$168.45
Rate for Payer: Community Health Alliance Commercial	$220.29
Rate for Payer: Priority Health Commercial	$181.41
Rate for Payer: Priority Health PPO	$181.41

KARYOT EA STUDY

Facility

$39.00

Hospital Charge Code	3100622
Hospital Revenue Code	311
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$33.15
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health PPO	$27.30

KARYOT EA STUDY

Facility

$39.00

Hospital Charge Code	3100620
Hospital Revenue Code	311
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$33.15
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health PPO	$27.30

KARYOT EA STUDY

Facility

$39.00

Hospital Charge Code	3100621
Hospital Revenue Code	311
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$33.15
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health PPO	$27.30

KARYOT EA STUDY

Facility

$39.00

Hospital Charge Code	3100619
Hospital Revenue Code	311
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$33.15
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health PPO	$27.30

KARYOTYPES 15-20 CELLS

Facility

$615.00

Hospital Charge Code	3000718
Hospital Revenue Code	311
Min. Negotiated Rate	$430.50
Max. Negotiated Rate	$522.75
Rate for Payer: Cash Price	$399.75
Rate for Payer: Community Health Alliance Commercial	$522.75
Rate for Payer: Priority Health Commercial	$430.50
Rate for Payer: Priority Health PPO	$430.50

KATZ EXTRACTOR FOREIGN BODY

Facility

$222.22

Hospital Charge Code	27284471
Hospital Revenue Code	272
Min. Negotiated Rate	$155.55
Max. Negotiated Rate	$188.89
Rate for Payer: Cash Price	$144.44
Rate for Payer: Community Health Alliance Commercial	$188.89
Rate for Payer: Priority Health Commercial	$155.55
Rate for Payer: Priority Health PPO	$155.55

KEPPRA (LEVETIRACETAN)

Facility

$10.59

Service Code	HCPCS 80177
Hospital Charge Code	3005537
Hospital Revenue Code	301
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$13.91
Rate for Payer: BCBS BCN 65	$13.91
Rate for Payer: Blue Care Network Medicare Advantage	$13.91
Rate for Payer: Cash Price	$6.88
Rate for Payer: Cash Price	$6.88
Rate for Payer: Community Health Alliance Commercial	$9.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.91
Rate for Payer: Meridian Health Plan Medicare	$13.91
Rate for Payer: Priority Health Commercial	$7.41
Rate for Payer: Priority Health Medicaid	$13.91
Rate for Payer: Priority Health Medicare	$13.91
Rate for Payer: Priority Health PPO	$7.41
Rate for Payer: United Health Care Medicaid	$13.91
Rate for Payer: United Health Care Medicare Advantage	$6.12

KERASTAN STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100320
Hospital Revenue Code	310
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

KERLIX PACKING SPONGE

Facility

$26.00

Hospital Charge Code	27012476
Hospital Revenue Code	270
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

KETOGENIC STEROIDS,17,24HR UR

Facility

$50.00

Service Code	HCPCS 83582
Hospital Charge Code	3000320
Hospital Revenue Code	301
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$16.24
Rate for Payer: Blue Care Network Medicare Advantage	$16.24
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.24
Rate for Payer: Meridian Health Plan Medicare	$16.24
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$16.24
Rate for Payer: Priority Health Medicare	$16.24
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$16.24
Rate for Payer: United Health Care Medicare Advantage	$7.15

KETOSTEROIDS 17-24HR UR

Facility

$75.00

Service Code	HCPCS 83586
Hospital Charge Code	3000180
Hospital Revenue Code	301
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$63.75
Rate for Payer: BCBS BCN 65	$13.44
Rate for Payer: Blue Care Network Medicare Advantage	$13.44
Rate for Payer: Cash Price	$48.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.44
Rate for Payer: Meridian Health Plan Medicare	$13.44
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health Medicaid	$13.44
Rate for Payer: Priority Health Medicare	$13.44
Rate for Payer: Priority Health PPO	$52.50
Rate for Payer: United Health Care Medicaid	$13.44
Rate for Payer: United Health Care Medicare Advantage	$5.91

KIRSCHNER WIRE

Facility

$33.00

Hospital Charge Code	27024356
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$28.05
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health PPO	$23.10

KIT, ACUCISE #BK020

Facility

$10,454.00

Hospital Charge Code	27265981
Hospital Revenue Code	272
Min. Negotiated Rate	$7,317.80
Max. Negotiated Rate	$8,885.90
Rate for Payer: Cash Price	$6,795.10
Rate for Payer: Community Health Alliance Commercial	$8,885.90
Rate for Payer: Priority Health Commercial	$7,317.80
Rate for Payer: Priority Health PPO	$7,317.80

KIT,BONE CEMENT PREPARATION

Facility

$603.00

Hospital Charge Code	27262628
Hospital Revenue Code	270
Min. Negotiated Rate	$422.10
Max. Negotiated Rate	$512.55
Rate for Payer: Cash Price	$391.95
Rate for Payer: Community Health Alliance Commercial	$512.55
Rate for Payer: Priority Health Commercial	$422.10
Rate for Payer: Priority Health PPO	$422.10

KIT,CATHERIZATION,FEMORAL

Facility

$129.00

Hospital Charge Code	27018838
Hospital Revenue Code	272
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$109.65
Rate for Payer: Cash Price	$83.85
Rate for Payer: Community Health Alliance Commercial	$109.65
Rate for Payer: Priority Health Commercial	$90.30
Rate for Payer: Priority Health PPO	$90.30

KIT,CENTRAL LINE DRESSING CHG

Facility

$23.00

Hospital Charge Code	27266674
Hospital Revenue Code	272
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

KIT, CENTRAL VEIN CATH INTRO

Facility

$165.00

Hospital Charge Code	27011072
Hospital Revenue Code	272
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$140.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Community Health Alliance Commercial	$140.25
Rate for Payer: Priority Health Commercial	$115.50
Rate for Payer: Priority Health PPO	$115.50

KIT, CHEST TUBE DRAINAGE

Facility

$297.00

Hospital Charge Code	27011064
Hospital Revenue Code	272
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$252.45
Rate for Payer: Cash Price	$193.05
Rate for Payer: Community Health Alliance Commercial	$252.45
Rate for Payer: Priority Health Commercial	$207.90
Rate for Payer: Priority Health PPO	$207.90

KIT,COLOSTOMY/ILEOSTOMY

Facility

$67.00

Hospital Charge Code	27021527
Hospital Revenue Code	272
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

KIT, CVC

Facility

$251.00

Hospital Charge Code	27018903
Hospital Revenue Code	272
Min. Negotiated Rate	$175.70
Max. Negotiated Rate	$213.35
Rate for Payer: Cash Price	$163.15
Rate for Payer: Community Health Alliance Commercial	$213.35
Rate for Payer: Priority Health Commercial	$175.70
Rate for Payer: Priority Health PPO	$175.70

KIT,CVC 2 LUMEN PEDIATRIC

Facility

$259.00

Hospital Charge Code	27262285
Hospital Revenue Code	272
Min. Negotiated Rate	$181.30
Max. Negotiated Rate	$220.15
Rate for Payer: Cash Price	$168.35
Rate for Payer: Community Health Alliance Commercial	$220.15
Rate for Payer: Priority Health Commercial	$181.30
Rate for Payer: Priority Health PPO	$181.30

KIT CVC PRESSURE INJECTABLE

Facility

$250.98

Hospital Charge Code	27284143
Hospital Revenue Code	272
Min. Negotiated Rate	$175.69
Max. Negotiated Rate	$213.33
Rate for Payer: Cash Price	$163.14
Rate for Payer: Community Health Alliance Commercial	$213.33
Rate for Payer: Priority Health Commercial	$175.69
Rate for Payer: Priority Health PPO	$175.69

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges