Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

LAG SCREW # 3370 2 080

Facility

$1,126.00

Service Code	HCPCS C1713
Hospital Charge Code	27866385
Hospital Revenue Code	278
Min. Negotiated Rate	$788.20
Max. Negotiated Rate	$957.10
Rate for Payer: Cash Price	$731.90
Rate for Payer: Community Health Alliance Commercial	$957.10
Rate for Payer: Priority Health Commercial	$788.20
Rate for Payer: Priority Health PPO	$788.20

LAG SCREW, COMPRESSION

Facility

$311.00

Service Code	HCPCS C1713
Hospital Charge Code	27813851
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,COMPRESSION

Facility

$311.00

Service Code	HCPCS C1713
Hospital Charge Code	27013851
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 ONE PIECE

Facility

$607.00

Service Code	HCPCS C1713
Hospital Charge Code	27868688
Hospital Revenue Code	278
Min. Negotiated Rate	$424.90
Max. Negotiated Rate	$515.95
Rate for Payer: Cash Price	$394.55
Rate for Payer: Community Health Alliance Commercial	$515.95
Rate for Payer: Priority Health Commercial	$424.90
Rate for Payer: Priority Health PPO	$424.90

LAG SCREW, ONE PIECE

Facility

$607.00

Service Code	HCPCS C1713
Hospital Charge Code	27871640
Hospital Revenue Code	278
Min. Negotiated Rate	$424.90
Max. Negotiated Rate	$515.95
Rate for Payer: Cash Price	$394.55
Rate for Payer: Community Health Alliance Commercial	$515.95
Rate for Payer: Priority Health Commercial	$424.90
Rate for Payer: Priority Health PPO	$424.90

LAG SLEEVE #THN-001

Facility

$654.00

Hospital Charge Code	27268027
Hospital Revenue Code	272
Min. Negotiated Rate	$457.80
Max. Negotiated Rate	$555.90
Rate for Payer: Cash Price	$425.10
Rate for Payer: Community Health Alliance Commercial	$555.90
Rate for Payer: Priority Health Commercial	$457.80
Rate for Payer: Priority Health PPO	$457.80

LAMBDA

Facility

$116.41

Hospital Charge Code	3101664
Hospital Revenue Code	300
Min. Negotiated Rate	$81.49
Max. Negotiated Rate	$98.95
Rate for Payer: Cash Price	$75.67
Rate for Payer: Community Health Alliance Commercial	$98.95
Rate for Payer: Priority Health Commercial	$81.49
Rate for Payer: Priority Health PPO	$81.49

LAMICTAL

Facility

$8.96

Hospital Charge Code	3016642
Hospital Revenue Code	301
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$7.62
Rate for Payer: Cash Price	$5.82
Rate for Payer: Community Health Alliance Commercial	$7.62
Rate for Payer: Priority Health Commercial	$6.27
Rate for Payer: Priority Health PPO	$6.27

LAMICTAL

Facility

$120.00

Service Code	HCPCS 80299
Hospital Charge Code	3015590
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$102.00
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
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	$84.00
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$84.00
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

LAP

Facility

$28.00

Service Code	HCPCS 83670
Hospital Charge Code	3005570
Hospital Revenue Code	301
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$23.80
Rate for Payer: BCBS BCN 65	$10.30
Rate for Payer: Blue Care Network Medicare Advantage	$10.30
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.30
Rate for Payer: Meridian Health Plan Medicare	$10.30
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health Medicaid	$10.30
Rate for Payer: Priority Health Medicare	$10.30
Rate for Payer: Priority Health PPO	$19.60
Rate for Payer: United Health Care Medicaid	$10.30
Rate for Payer: United Health Care Medicare Advantage	$4.53

LAPAROSCOPIC CHOLECYSTECTOMY

Facility

$3,895.00

Hospital Charge Code	5150683
Hospital Revenue Code	960
Min. Negotiated Rate	$2,726.50
Max. Negotiated Rate	$3,310.75
Rate for Payer: Cash Price	$2,531.75
Rate for Payer: Community Health Alliance Commercial	$3,310.75
Rate for Payer: Priority Health Commercial	$2,726.50
Rate for Payer: Priority Health PPO	$2,726.50

LAPAROSCOPIC TISSUE MORCELLATO

Facility

$1,697.00

Service Code	HCPCS C1782
Hospital Charge Code	27272721
Hospital Revenue Code	272
Min. Negotiated Rate	$1,187.90
Max. Negotiated Rate	$1,442.45
Rate for Payer: Cash Price	$1,103.05
Rate for Payer: Community Health Alliance Commercial	$1,442.45
Rate for Payer: Priority Health Commercial	$1,187.90
Rate for Payer: Priority Health PPO	$1,187.90

LAPAROSCOPY APPENDECTOMY P/C

Facility

$1,988.00

Hospital Charge Code	5150675
Hospital Revenue Code	960
Min. Negotiated Rate	$1,391.60
Max. Negotiated Rate	$1,689.80
Rate for Payer: Cash Price	$1,292.20
Rate for Payer: Community Health Alliance Commercial	$1,689.80
Rate for Payer: Priority Health Commercial	$1,391.60
Rate for Payer: Priority Health PPO	$1,391.60

LAPAROSCOPY, SURGICAL, APPENDECTOMY

Facility

$6,485.29

Service Code	CPT 44970
Hospital Revenue Code	360
Min. Negotiated Rate	$2,853.53
Max. Negotiated Rate	$6,485.29
Rate for Payer: BCBS BCN 65	$6,485.29
Rate for Payer: Blue Care Network Medicare Advantage	$6,485.29
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6,485.29
Rate for Payer: Meridian Health Plan Medicare	$6,485.29
Rate for Payer: Priority Health Medicaid	$6,485.29
Rate for Payer: Priority Health Medicare	$6,485.29
Rate for Payer: United Health Care Medicaid	$6,485.29
Rate for Payer: United Health Care Medicare Advantage	$2,853.53

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY

Facility

$6,485.29

Service Code	CPT 47562
Hospital Revenue Code	360
Min. Negotiated Rate	$2,853.53
Max. Negotiated Rate	$6,485.29
Rate for Payer: BCBS BCN 65	$6,485.29
Rate for Payer: Blue Care Network Medicare Advantage	$6,485.29
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6,485.29
Rate for Payer: Meridian Health Plan Medicare	$6,485.29
Rate for Payer: Priority Health Medicaid	$6,485.29
Rate for Payer: Priority Health Medicare	$6,485.29
Rate for Payer: United Health Care Medicaid	$6,485.29
Rate for Payer: United Health Care Medicare Advantage	$2,853.53

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY

Facility

$6,485.29

Service Code	CPT 47563
Hospital Revenue Code	360
Min. Negotiated Rate	$2,853.53
Max. Negotiated Rate	$6,485.29
Rate for Payer: BCBS BCN 65	$6,485.29
Rate for Payer: Blue Care Network Medicare Advantage	$6,485.29
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6,485.29
Rate for Payer: Meridian Health Plan Medicare	$6,485.29
Rate for Payer: Priority Health Medicaid	$6,485.29
Rate for Payer: Priority Health Medicare	$6,485.29
Rate for Payer: United Health Care Medicaid	$6,485.29
Rate for Payer: United Health Care Medicare Advantage	$2,853.53

LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA

Facility

$6,485.29

Service Code	CPT 49650
Hospital Revenue Code	360
Min. Negotiated Rate	$2,853.53
Max. Negotiated Rate	$6,485.29
Rate for Payer: BCBS BCN 65	$6,485.29
Rate for Payer: Blue Care Network Medicare Advantage	$6,485.29
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6,485.29
Rate for Payer: Meridian Health Plan Medicare	$6,485.29
Rate for Payer: Priority Health Medicaid	$6,485.29
Rate for Payer: Priority Health Medicare	$6,485.29
Rate for Payer: United Health Care Medicaid	$6,485.29
Rate for Payer: United Health Care Medicare Advantage	$2,853.53

LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA

Facility

$6,485.29

Service Code	CPT 49651
Hospital Revenue Code	360
Min. Negotiated Rate	$2,853.53
Max. Negotiated Rate	$6,485.29
Rate for Payer: BCBS BCN 65	$6,485.29
Rate for Payer: Blue Care Network Medicare Advantage	$6,485.29
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6,485.29
Rate for Payer: Meridian Health Plan Medicare	$6,485.29
Rate for Payer: Priority Health Medicaid	$6,485.29
Rate for Payer: Priority Health Medicare	$6,485.29
Rate for Payer: United Health Care Medicaid	$6,485.29
Rate for Payer: United Health Care Medicare Advantage	$2,853.53

LAP CHOLECYSTECTOMY W/ CHOLANG

Facility

$2,764.00

Hospital Charge Code	5150736
Hospital Revenue Code	960
Min. Negotiated Rate	$1,934.80
Max. Negotiated Rate	$2,349.40
Rate for Payer: Cash Price	$1,796.60
Rate for Payer: Community Health Alliance Commercial	$2,349.40
Rate for Payer: Priority Health Commercial	$1,934.80
Rate for Payer: Priority Health PPO	$1,934.80

LAP DISC #LD111

Facility

$2,000.00

Hospital Charge Code	27265833
Hospital Revenue Code	272
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Community Health Alliance Commercial	$1,700.00
Rate for Payer: Priority Health Commercial	$1,400.00
Rate for Payer: Priority Health PPO	$1,400.00

LAP ING HERNIA REPAIR P/C

Facility

$1,771.00

Hospital Charge Code	5150681
Hospital Revenue Code	960
Min. Negotiated Rate	$1,239.70
Max. Negotiated Rate	$1,505.35
Rate for Payer: Cash Price	$1,151.15
Rate for Payer: Community Health Alliance Commercial	$1,505.35
Rate for Payer: Priority Health Commercial	$1,239.70
Rate for Payer: Priority Health PPO	$1,239.70

LAP INGUINAL.RECU

Facility

$1,822.00

Hospital Charge Code	5150698
Hospital Revenue Code	960
Min. Negotiated Rate	$1,275.40
Max. Negotiated Rate	$1,548.70
Rate for Payer: Cash Price	$1,184.30
Rate for Payer: Community Health Alliance Commercial	$1,548.70
Rate for Payer: Priority Health Commercial	$1,275.40
Rate for Payer: Priority Health PPO	$1,275.40

LARGE FRAGMENT SET

Facility

$294.00

Hospital Charge Code	27018985
Hospital Revenue Code	270
Min. Negotiated Rate	$205.80
Max. Negotiated Rate	$249.90
Rate for Payer: Cash Price	$191.10
Rate for Payer: Community Health Alliance Commercial	$249.90
Rate for Payer: Priority Health Commercial	$205.80
Rate for Payer: Priority Health PPO	$205.80

LASA-P

Facility

$81.00

Service Code	HCPCS 84275
Hospital Charge Code	3004160
Hospital Revenue Code	300
Min. Negotiated Rate	$6.21
Max. Negotiated Rate	$68.85
Rate for Payer: BCBS BCN 65	$14.11
Rate for Payer: Blue Care Network Medicare Advantage	$14.11
Rate for Payer: Cash Price	$52.65
Rate for Payer: Cash Price	$52.65
Rate for Payer: Community Health Alliance Commercial	$68.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.11
Rate for Payer: Meridian Health Plan Medicare	$14.11
Rate for Payer: Priority Health Commercial	$56.70
Rate for Payer: Priority Health Medicaid	$14.11
Rate for Payer: Priority Health Medicare	$14.11
Rate for Payer: Priority Health PPO	$56.70
Rate for Payer: United Health Care Medicaid	$14.11
Rate for Payer: United Health Care Medicare Advantage	$6.21

LASER

Facility

$2,371.00

Hospital Charge Code	27282888
Hospital Revenue Code	272
Min. Negotiated Rate	$1,659.70
Max. Negotiated Rate	$2,015.35
Rate for Payer: Cash Price	$1,541.15
Rate for Payer: Community Health Alliance Commercial	$2,015.35
Rate for Payer: Priority Health Commercial	$1,659.70
Rate for Payer: Priority Health PPO	$1,659.70

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges