Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

KSU-2

Facility

$1.64

Hospital Charge Code	3101513
Hospital Revenue Code	300
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.39
Rate for Payer: Cash Price	$1.07
Rate for Payer: Community Health Alliance Commercial	$1.39
Rate for Payer: Priority Health Commercial	$1.15
Rate for Payer: Priority Health PPO	$1.15

KSU-3

Facility

$8.14

Hospital Charge Code	3101511
Hospital Revenue Code	300
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$6.92
Rate for Payer: Cash Price	$5.29
Rate for Payer: Community Health Alliance Commercial	$6.92
Rate for Payer: Priority Health Commercial	$5.70
Rate for Payer: Priority Health PPO	$5.70

KSU-4

Facility

$1.64

Hospital Charge Code	3101514
Hospital Revenue Code	300
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.39
Rate for Payer: Cash Price	$1.07
Rate for Payer: Community Health Alliance Commercial	$1.39
Rate for Payer: Priority Health Commercial	$1.15
Rate for Payer: Priority Health PPO	$1.15

KUGEL COMPOSIX PATCH 7X9

Facility

$4,160.00

Service Code	HCPCS C1781
Hospital Charge Code	27267326
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$3,536.00
Rate for Payer: Cash Price	$2,704.00
Rate for Payer: Community Health Alliance Commercial	$3,536.00
Rate for Payer: Priority Health Commercial	$2,912.00
Rate for Payer: Priority Health PPO	$2,912.00

KUGEL HERNIA PATCH #0010201

Facility

$1,488.00

Service Code	HCPCS C1781
Hospital Charge Code	27067193
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.60
Max. Negotiated Rate	$1,264.80
Rate for Payer: Cash Price	$967.20
Rate for Payer: Community Health Alliance Commercial	$1,264.80
Rate for Payer: Priority Health Commercial	$1,041.60
Rate for Payer: Priority Health PPO	$1,041.60

KUGEL HERNIA PATCH - MEDIUM

Facility

$1,107.00

Service Code	HCPCS C1781
Hospital Charge Code	27262724
Hospital Revenue Code	278
Min. Negotiated Rate	$774.90
Max. Negotiated Rate	$940.95
Rate for Payer: Cash Price	$719.55
Rate for Payer: Community Health Alliance Commercial	$940.95
Rate for Payer: Priority Health Commercial	$774.90
Rate for Payer: Priority Health PPO	$774.90

KUGEL HERNIA PATCH - SMALL

Facility

$1,019.00

Service Code	HCPCS C1781
Hospital Charge Code	27262732
Hospital Revenue Code	278
Min. Negotiated Rate	$713.30
Max. Negotiated Rate	$866.15
Rate for Payer: Cash Price	$662.35
Rate for Payer: Community Health Alliance Commercial	$866.15
Rate for Payer: Priority Health Commercial	$713.30
Rate for Payer: Priority Health PPO	$713.30

KWIK-FORM HAND SPLINT

Facility

$140.00

Hospital Charge Code	27062758
Hospital Revenue Code	270
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$119.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Community Health Alliance Commercial	$119.00
Rate for Payer: Priority Health Commercial	$98.00
Rate for Payer: Priority Health PPO	$98.00

KWIRE 6MM

Facility

$88.00

Service Code	HCPCS C1713
Hospital Charge Code	27268993
Hospital Revenue Code	278
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

K-WIRE, JONES 228MM

Facility

$144.00

Service Code	HCPCS C1713
Hospital Charge Code	27868720
Hospital Revenue Code	278
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$122.40
Rate for Payer: Cash Price	$93.60
Rate for Payer: Community Health Alliance Commercial	$122.40
Rate for Payer: Priority Health Commercial	$100.80
Rate for Payer: Priority Health PPO	$100.80

LA-1

Facility

$11.25

Hospital Charge Code	3101458
Hospital Revenue Code	300
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$9.56
Rate for Payer: Cash Price	$7.31
Rate for Payer: Community Health Alliance Commercial	$9.56
Rate for Payer: Priority Health Commercial	$7.88
Rate for Payer: Priority Health PPO	$7.88

LA-2

Facility

$11.25

Hospital Charge Code	3101459
Hospital Revenue Code	300
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$9.56
Rate for Payer: Cash Price	$7.31
Rate for Payer: Community Health Alliance Commercial	$9.56
Rate for Payer: Priority Health Commercial	$7.88
Rate for Payer: Priority Health PPO	$7.88

LA-3

Facility

$11.25

Hospital Charge Code	3101460
Hospital Revenue Code	300
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$9.56
Rate for Payer: Cash Price	$7.31
Rate for Payer: Community Health Alliance Commercial	$9.56
Rate for Payer: Priority Health Commercial	$7.88
Rate for Payer: Priority Health PPO	$7.88

LA-4

Facility

$11.25

Hospital Charge Code	3101461
Hospital Revenue Code	300
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$9.56
Rate for Payer: Cash Price	$7.31
Rate for Payer: Community Health Alliance Commercial	$9.56
Rate for Payer: Priority Health Commercial	$7.88
Rate for Payer: Priority Health PPO	$7.88

LACSF-1

Facility

$51.50

Hospital Charge Code	3102099
Hospital Revenue Code	300
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$43.77
Rate for Payer: Cash Price	$33.48
Rate for Payer: Community Health Alliance Commercial	$43.77
Rate for Payer: Priority Health Commercial	$36.05
Rate for Payer: Priority Health PPO	$36.05

LACSF-2

Facility

$51.50

Hospital Charge Code	3102100
Hospital Revenue Code	300
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$43.77
Rate for Payer: Cash Price	$33.48
Rate for Payer: Community Health Alliance Commercial	$43.77
Rate for Payer: Priority Health Commercial	$36.05
Rate for Payer: Priority Health PPO	$36.05

LACTIC ACID CSF-SBMF

Facility

$7.33

Hospital Charge Code	3101246
Hospital Revenue Code	301
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$6.23
Rate for Payer: Cash Price	$4.76
Rate for Payer: Community Health Alliance Commercial	$6.23
Rate for Payer: Priority Health Commercial	$5.13
Rate for Payer: Priority Health PPO	$5.13

LACTIC ACID-SBMF

Facility

$5.00

Service Code	HCPCS 83605
Hospital Charge Code	3005520
Hospital Revenue Code	301
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$12.15
Rate for Payer: BCBS BCN 65	$12.15
Rate for Payer: Blue Care Network Medicare Advantage	$12.15
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	$12.15
Rate for Payer: Meridian Health Plan Medicare	$12.15
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$12.15
Rate for Payer: Priority Health Medicare	$12.15
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$12.15
Rate for Payer: United Health Care Medicare Advantage	$5.35

LACTOFERRIN FECAL QUALITATIVE

Facility

$42.00

Hospital Charge Code	3004910
Hospital Revenue Code	301
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

LACTOFERRIN FECAL QUANTITATIVE

Facility

$265.00

Hospital Charge Code	3004911
Hospital Revenue Code	301
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$225.25
Rate for Payer: Cash Price	$172.25
Rate for Payer: Community Health Alliance Commercial	$225.25
Rate for Payer: Priority Health Commercial	$185.50
Rate for Payer: Priority Health PPO	$185.50

LAG ASSEMBLY

Facility

$1,259.00

Service Code	HCPCS C1713
Hospital Charge Code	27872187
Hospital Revenue Code	278
Min. Negotiated Rate	$881.30
Max. Negotiated Rate	$1,070.15
Rate for Payer: Cash Price	$818.35
Rate for Payer: Community Health Alliance Commercial	$1,070.15
Rate for Payer: Priority Health Commercial	$881.30
Rate for Payer: Priority Health PPO	$881.30

LAG SCREW

Facility

$311.00

Service Code	HCPCS C1713
Hospital Charge Code	27814043
Hospital Revenue Code	278
Min. Negotiated Rate	$217.70
Max. Negotiated Rate	$264.35
Rate for Payer: Cash Price	$202.15
Rate for Payer: Community Health Alliance Commercial	$264.35
Rate for Payer: Priority Health Commercial	$217.70
Rate for Payer: Priority Health PPO	$217.70

LAG SCREW

Facility

$717.00

Service Code	HCPCS C1713
Hospital Charge Code	27014043
Hospital Revenue Code	278
Min. Negotiated Rate	$501.90
Max. Negotiated Rate	$609.45
Rate for Payer: Cash Price	$466.05
Rate for Payer: Community Health Alliance Commercial	$609.45
Rate for Payer: Priority Health Commercial	$501.90
Rate for Payer: Priority Health PPO	$501.90

LAG SCREW - 3 1/4

Facility

$338.00

Service Code	HCPCS C1713
Hospital Charge Code	27813854
Hospital Revenue Code	278
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$287.30
Rate for Payer: Cash Price	$219.70
Rate for Payer: Community Health Alliance Commercial	$287.30
Rate for Payer: Priority Health Commercial	$236.60
Rate for Payer: Priority Health PPO	$236.60

LAG SCREW - 3 1/4

Facility

$717.00

Service Code	HCPCS C1713
Hospital Charge Code	27013854
Hospital Revenue Code	278
Min. Negotiated Rate	$501.90
Max. Negotiated Rate	$609.45
Rate for Payer: Cash Price	$466.05
Rate for Payer: Community Health Alliance Commercial	$609.45
Rate for Payer: Priority Health Commercial	$501.90
Rate for Payer: Priority Health PPO	$501.90

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges