Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

LASER FIBER

Facility

$783.00

Hospital Charge Code	27282269
Hospital Revenue Code	272
Min. Negotiated Rate	$548.10
Max. Negotiated Rate	$665.55
Rate for Payer: Cash Price	$508.95
Rate for Payer: Community Health Alliance Commercial	$665.55
Rate for Payer: Priority Health Commercial	$548.10
Rate for Payer: Priority Health PPO	$548.10

LASER FIBER

Facility

$650.00

Hospital Charge Code	27282105
Hospital Revenue Code	272
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$552.50
Rate for Payer: Cash Price	$422.50
Rate for Payer: Community Health Alliance Commercial	$552.50
Rate for Payer: Priority Health Commercial	$455.00
Rate for Payer: Priority Health PPO	$455.00

LASER FIBER

Facility

$650.00

Hospital Charge Code	27282022
Hospital Revenue Code	272
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$552.50
Rate for Payer: Cash Price	$422.50
Rate for Payer: Community Health Alliance Commercial	$552.50
Rate for Payer: Priority Health Commercial	$455.00
Rate for Payer: Priority Health PPO	$455.00

LASER FIBER

Facility

$2,732.00

Hospital Charge Code	27271551
Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.40
Max. Negotiated Rate	$2,322.20
Rate for Payer: Cash Price	$1,775.80
Rate for Payer: Community Health Alliance Commercial	$2,322.20
Rate for Payer: Priority Health Commercial	$1,912.40
Rate for Payer: Priority Health PPO	$1,912.40

LASER FIBER

Facility

$650.00

Hospital Charge Code	27282185
Hospital Revenue Code	272
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$552.50
Rate for Payer: Cash Price	$422.50
Rate for Payer: Community Health Alliance Commercial	$552.50
Rate for Payer: Priority Health Commercial	$455.00
Rate for Payer: Priority Health PPO	$455.00

LASER FIBER LITHOTRIPSY

Facility

$1,363.00

Hospital Charge Code	27016204
Hospital Revenue Code	272
Min. Negotiated Rate	$954.10
Max. Negotiated Rate	$1,158.55
Rate for Payer: Cash Price	$885.95
Rate for Payer: Community Health Alliance Commercial	$1,158.55
Rate for Payer: Priority Health Commercial	$954.10
Rate for Payer: Priority Health PPO	$954.10

LASER FIBER SURITEK ULTRAGOLD

Facility

$1,201.00

Hospital Charge Code	27018929
Hospital Revenue Code	272
Min. Negotiated Rate	$840.70
Max. Negotiated Rate	$1,020.85
Rate for Payer: Cash Price	$780.65
Rate for Payer: Community Health Alliance Commercial	$1,020.85
Rate for Payer: Priority Health Commercial	$840.70
Rate for Payer: Priority Health PPO	$840.70

LASER FIBRE 400MM SHARP

Facility

$494.00

Hospital Charge Code	27016568
Hospital Revenue Code	272
Min. Negotiated Rate	$345.80
Max. Negotiated Rate	$419.90
Rate for Payer: Cash Price	$321.10
Rate for Payer: Community Health Alliance Commercial	$419.90
Rate for Payer: Priority Health Commercial	$345.80
Rate for Payer: Priority Health PPO	$345.80

LASER FIBRE 600MM BARE

Facility

$859.00

Hospital Charge Code	27016543
Hospital Revenue Code	272
Min. Negotiated Rate	$601.30
Max. Negotiated Rate	$730.15
Rate for Payer: Cash Price	$558.35
Rate for Payer: Community Health Alliance Commercial	$730.15
Rate for Payer: Priority Health Commercial	$601.30
Rate for Payer: Priority Health PPO	$601.30

LASER FIBRE 800MM BARE

Facility

$510.00

Hospital Charge Code	27016535
Hospital Revenue Code	272
Min. Negotiated Rate	$357.00
Max. Negotiated Rate	$433.50
Rate for Payer: Cash Price	$331.50
Rate for Payer: Community Health Alliance Commercial	$433.50
Rate for Payer: Priority Health Commercial	$357.00
Rate for Payer: Priority Health PPO	$357.00

LASER FIBRE - SIDEFIRE

Facility

$1,640.00

Hospital Charge Code	27019026
Hospital Revenue Code	272
Min. Negotiated Rate	$1,148.00
Max. Negotiated Rate	$1,394.00
Rate for Payer: Cash Price	$1,066.00
Rate for Payer: Community Health Alliance Commercial	$1,394.00
Rate for Payer: Priority Health Commercial	$1,148.00
Rate for Payer: Priority Health PPO	$1,148.00

LC-1 (LCP-1)

Facility

$200.25

Hospital Charge Code	3102348
Hospital Revenue Code	300
Min. Negotiated Rate	$140.18
Max. Negotiated Rate	$170.21
Rate for Payer: Cash Price	$130.16
Rate for Payer: Community Health Alliance Commercial	$170.21
Rate for Payer: Priority Health Commercial	$140.18
Rate for Payer: Priority Health PPO	$140.18

LC SARS-COV-2 N

Facility

$100.00

Hospital Charge Code	3101658
Hospital Revenue Code	300
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$85.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health PPO	$70.00

LC SARS COV-2 NAA

Facility

$51.31

Hospital Charge Code	3101802
Hospital Revenue Code	300
Min. Negotiated Rate	$35.92
Max. Negotiated Rate	$43.61
Rate for Payer: Cash Price	$33.35
Rate for Payer: Community Health Alliance Commercial	$43.61
Rate for Payer: Priority Health Commercial	$35.92
Rate for Payer: Priority Health PPO	$35.92

LDH

Facility

$22.00

Hospital Charge Code	3102128
Hospital Revenue Code	300
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$18.70
Rate for Payer: Cash Price	$14.30
Rate for Payer: Community Health Alliance Commercial	$18.70
Rate for Payer: Priority Health Commercial	$15.40
Rate for Payer: Priority Health PPO	$15.40

LDH ISOENZYMES

Facility

$3.03

Service Code	HCPCS 83625
Hospital Charge Code	3005580
Hospital Revenue Code	301
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$13.43
Rate for Payer: BCBS BCN 65	$13.43
Rate for Payer: Blue Care Network Medicare Advantage	$13.43
Rate for Payer: Cash Price	$1.97
Rate for Payer: Cash Price	$1.97
Rate for Payer: Community Health Alliance Commercial	$2.58
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.43
Rate for Payer: Meridian Health Plan Medicare	$13.43
Rate for Payer: Priority Health Commercial	$2.12
Rate for Payer: Priority Health Medicaid	$13.43
Rate for Payer: Priority Health Medicare	$13.43
Rate for Payer: Priority Health PPO	$2.12
Rate for Payer: United Health Care Medicaid	$13.43
Rate for Payer: United Health Care Medicare Advantage	$5.91

LDH-LC

Facility

$2.00

Service Code	HCPCS 83615
Hospital Charge Code	3005560
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$6.34
Rate for Payer: BCBS BCN 65	$6.34
Rate for Payer: Blue Care Network Medicare Advantage	$6.34
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.34
Rate for Payer: Meridian Health Plan Medicare	$6.34
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health Medicaid	$6.34
Rate for Payer: Priority Health Medicare	$6.34
Rate for Payer: Priority Health PPO	$1.40
Rate for Payer: United Health Care Medicaid	$6.34
Rate for Payer: United Health Care Medicare Advantage	$2.79

LDI-1

Facility

$3.04

Hospital Charge Code	3101812
Hospital Revenue Code	300
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$2.58
Rate for Payer: Cash Price	$1.98
Rate for Payer: Community Health Alliance Commercial	$2.58
Rate for Payer: Priority Health Commercial	$2.13
Rate for Payer: Priority Health PPO	$2.13

LEAD

Facility

$8.00

Service Code	HCPCS 83655
Hospital Charge Code	3005720
Hospital Revenue Code	301
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$12.72
Rate for Payer: BCBS BCN 65	$12.72
Rate for Payer: Blue Care Network Medicare Advantage	$12.72
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cash Price	$5.20
Rate for Payer: Community Health Alliance Commercial	$6.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.72
Rate for Payer: Meridian Health Plan Medicare	$12.72
Rate for Payer: Priority Health Commercial	$5.60
Rate for Payer: Priority Health Medicaid	$12.72
Rate for Payer: Priority Health Medicare	$12.72
Rate for Payer: Priority Health PPO	$5.60
Rate for Payer: United Health Care Medicaid	$12.72
Rate for Payer: United Health Care Medicare Advantage	$5.59

LEAD,A MEDTRONIC

Facility

$3,855.00

Hospital Charge Code	27866302
Hospital Revenue Code	275
Min. Negotiated Rate	$2,698.50
Max. Negotiated Rate	$3,276.75
Rate for Payer: Cash Price	$2,505.75
Rate for Payer: Community Health Alliance Commercial	$3,276.75
Rate for Payer: Priority Health Commercial	$2,698.50
Rate for Payer: Priority Health PPO	$2,698.50

LEAD,CAP SURE FIX NOVUS #5076

Facility

$2,520.00

Service Code	HCPCS C1898
Hospital Charge Code	27867284
Hospital Revenue Code	275
Min. Negotiated Rate	$1,764.00
Max. Negotiated Rate	$2,142.00
Rate for Payer: Cash Price	$1,638.00
Rate for Payer: Community Health Alliance Commercial	$2,142.00
Rate for Payer: Priority Health Commercial	$1,764.00
Rate for Payer: Priority Health PPO	$1,764.00

LEAD INTRODUCER 9FR

Facility

$466.00

Service Code	HCPCS C1894
Hospital Charge Code	27268571
Hospital Revenue Code	272
Min. Negotiated Rate	$326.20
Max. Negotiated Rate	$396.10
Rate for Payer: Cash Price	$302.90
Rate for Payer: Community Health Alliance Commercial	$396.10
Rate for Payer: Priority Health Commercial	$326.20
Rate for Payer: Priority Health PPO	$326.20

LEAD,PACEMAKER,OTHER THAN VDD

Facility

$3,834.00

Service Code	HCPCS C1898
Hospital Charge Code	27865700
Hospital Revenue Code	275
Min. Negotiated Rate	$2,683.80
Max. Negotiated Rate	$3,258.90
Rate for Payer: Cash Price	$2,492.10
Rate for Payer: Community Health Alliance Commercial	$3,258.90
Rate for Payer: Priority Health Commercial	$2,683.80
Rate for Payer: Priority Health PPO	$2,683.80

LEAD,VENTRICULAR,PACEMAKER

Facility

$3,516.00

Service Code	HCPCS C1779
Hospital Charge Code	27865528
Hospital Revenue Code	275
Min. Negotiated Rate	$2,461.20
Max. Negotiated Rate	$2,988.60
Rate for Payer: Cash Price	$2,285.40
Rate for Payer: Community Health Alliance Commercial	$2,988.60
Rate for Payer: Priority Health Commercial	$2,461.20
Rate for Payer: Priority Health PPO	$2,461.20

LEADWIRE, CAPSURE FIX NOVUS

Facility

$2,446.00

Hospital Charge Code	27867797
Hospital Revenue Code	275
Min. Negotiated Rate	$1,712.20
Max. Negotiated Rate	$2,079.10
Rate for Payer: Cash Price	$1,589.90
Rate for Payer: Community Health Alliance Commercial	$2,079.10
Rate for Payer: Priority Health Commercial	$1,712.20
Rate for Payer: Priority Health PPO	$1,712.20

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges