Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

LEFLUNOMIDE

Facility

$15.00

Hospital Charge Code	3100978
Hospital Revenue Code	301
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

LEGEND ACL

Facility

$875.00

Hospital Charge Code	27061451
Hospital Revenue Code	270
Min. Negotiated Rate	$612.50
Max. Negotiated Rate	$743.75
Rate for Payer: Cash Price	$568.75
Rate for Payer: Community Health Alliance Commercial	$743.75
Rate for Payer: Priority Health Commercial	$612.50
Rate for Payer: Priority Health PPO	$612.50

LEGIONELLA AB IgG

Facility

$41.65

Hospital Charge Code	3005765
Hospital Revenue Code	302
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$35.40
Rate for Payer: Cash Price	$27.07
Rate for Payer: Community Health Alliance Commercial	$35.40
Rate for Payer: Priority Health Commercial	$29.16
Rate for Payer: Priority Health PPO	$29.16

LEGIONELLA AB IgM

Facility

$41.65

Hospital Charge Code	3005766
Hospital Revenue Code	302
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$35.40
Rate for Payer: Cash Price	$27.07
Rate for Payer: Community Health Alliance Commercial	$35.40
Rate for Payer: Priority Health Commercial	$29.16
Rate for Payer: Priority Health PPO	$29.16

LEGIONELLA AG,URINE

Facility

$14.66

Service Code	HCPCS 87449
Hospital Charge Code	3005770
Hospital Revenue Code	306
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$12.58
Rate for Payer: BCBS BCN 65	$12.58
Rate for Payer: Blue Care Network Medicare Advantage	$12.58
Rate for Payer: Cash Price	$9.53
Rate for Payer: Cash Price	$9.53
Rate for Payer: Community Health Alliance Commercial	$12.46
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.58
Rate for Payer: Meridian Health Plan Medicare	$12.58
Rate for Payer: Priority Health Commercial	$10.26
Rate for Payer: Priority Health Medicaid	$12.58
Rate for Payer: Priority Health Medicare	$12.58
Rate for Payer: Priority Health PPO	$10.26
Rate for Payer: United Health Care Medicaid	$12.58
Rate for Payer: United Health Care Medicare Advantage	$5.53

LEGIONELLA ANTIBODY

Facility

$44.00

Service Code	HCPCS 86713
Hospital Charge Code	3005760
Hospital Revenue Code	302
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$37.40
Rate for Payer: BCBS BCN 65	$16.07
Rate for Payer: Blue Care Network Medicare Advantage	$16.07
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.07
Rate for Payer: Meridian Health Plan Medicare	$16.07
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health Medicaid	$16.07
Rate for Payer: Priority Health Medicare	$16.07
Rate for Payer: Priority Health PPO	$30.80
Rate for Payer: United Health Care Medicaid	$16.07
Rate for Payer: United Health Care Medicare Advantage	$7.07

LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE PROCEDURE)

Facility

$3,510.01

Service Code	CPT 27685
Hospital Revenue Code	360
Min. Negotiated Rate	$1,544.41
Max. Negotiated Rate	$3,510.01
Rate for Payer: BCBS BCN 65	$3,510.01
Rate for Payer: Blue Care Network Medicare Advantage	$3,510.01
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,510.01
Rate for Payer: Meridian Health Plan Medicare	$3,510.01
Rate for Payer: Priority Health Medicaid	$3,510.01
Rate for Payer: Priority Health Medicare	$3,510.01
Rate for Payer: United Health Care Medicaid	$3,510.01
Rate for Payer: United Health Care Medicare Advantage	$1,544.41

LEPTIN LEVEL

Facility

$24.44

Service Code	HCPCS 83520
Hospital Charge Code	3005773
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$20.77
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$15.89
Rate for Payer: Cash Price	$15.89
Rate for Payer: Community Health Alliance Commercial	$20.77
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$17.11
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$17.11
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

LEPTOSPIRA ANTIBODY

Facility

$75.00

Service Code	HCPCS 86720
Hospital Charge Code	3005775
Hospital Revenue Code	302
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$63.75
Rate for Payer: BCBS BCN 65	$17.01
Rate for Payer: Blue Care Network Medicare Advantage	$17.01
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	$17.01
Rate for Payer: Meridian Health Plan Medicare	$17.01
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health Medicaid	$17.01
Rate for Payer: Priority Health Medicare	$17.01
Rate for Payer: Priority Health PPO	$52.50
Rate for Payer: United Health Care Medicaid	$17.01
Rate for Payer: United Health Care Medicare Advantage	$7.48

LEUKOCYTE ALK PHOS

Facility

$59.00

Service Code	HCPCS 85540
Hospital Charge Code	3005800
Hospital Revenue Code	305
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$50.15
Rate for Payer: BCBS BCN 65	$9.03
Rate for Payer: Blue Care Network Medicare Advantage	$9.03
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cash Price	$38.35
Rate for Payer: Community Health Alliance Commercial	$50.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.03
Rate for Payer: Meridian Health Plan Medicare	$9.03
Rate for Payer: Priority Health Commercial	$41.30
Rate for Payer: Priority Health Medicaid	$9.03
Rate for Payer: Priority Health Medicare	$9.03
Rate for Payer: Priority Health PPO	$41.30
Rate for Payer: United Health Care Medicaid	$9.03
Rate for Payer: United Health Care Medicare Advantage	$3.97

LEUKOCYTE LYSOSOMOL ENZYME ACT

Facility

$132.00

Hospital Charge Code	3100886
Hospital Revenue Code	301
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$112.20
Rate for Payer: Cash Price	$85.80
Rate for Payer: Community Health Alliance Commercial	$112.20
Rate for Payer: Priority Health Commercial	$92.40
Rate for Payer: Priority Health PPO	$92.40

LEUKOPOOR FILTER

Facility

$65.00

Hospital Charge Code	27050062
Hospital Revenue Code	270
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

LEUKOPOOR FILTER

Facility

$83.00

Hospital Charge Code	27024166
Hospital Revenue Code	270
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$70.55
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health PPO	$58.10

LEUKOPOOR FILTER FOR PLATELETS

Facility

$134.00

Hospital Charge Code	27050088
Hospital Revenue Code	270
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$113.90
Rate for Payer: Cash Price	$87.10
Rate for Payer: Community Health Alliance Commercial	$113.90
Rate for Payer: Priority Health Commercial	$93.80
Rate for Payer: Priority Health PPO	$93.80

LEUOKOCYTE LYSOSOMOL ENZYME

Facility

$132.00

Hospital Charge Code	3100885
Hospital Revenue Code	301
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$112.20
Rate for Payer: Cash Price	$85.80
Rate for Payer: Community Health Alliance Commercial	$112.20
Rate for Payer: Priority Health Commercial	$92.40
Rate for Payer: Priority Health PPO	$92.40

LEVEEN INFLATOR

Facility

$636.00

Hospital Charge Code	27016220
Hospital Revenue Code	270
Min. Negotiated Rate	$445.20
Max. Negotiated Rate	$540.60
Rate for Payer: Cash Price	$413.40
Rate for Payer: Community Health Alliance Commercial	$540.60
Rate for Payer: Priority Health Commercial	$445.20
Rate for Payer: Priority Health PPO	$445.20

LEVEEN INFLATOR KIT

Facility

$108.00

Hospital Charge Code	27016345
Hospital Revenue Code	270
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$91.80
Rate for Payer: Cash Price	$70.20
Rate for Payer: Community Health Alliance Commercial	$91.80
Rate for Payer: Priority Health Commercial	$75.60
Rate for Payer: Priority Health PPO	$75.60

LEVEL I EMERGENCY ROOM

Facility

$102.00

Service Code	HCPCS 99281
Hospital Charge Code	4500500
Hospital Revenue Code	450
Min. Negotiated Rate	$39.80
Max. Negotiated Rate	$90.46
Rate for Payer: BCBS BCN 65	$90.46
Rate for Payer: Blue Care Network Medicare Advantage	$90.46
Rate for Payer: Cash Price	$66.30
Rate for Payer: Cash Price	$66.30
Rate for Payer: Community Health Alliance Commercial	$86.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$90.46
Rate for Payer: Meridian Health Plan Medicare	$90.46
Rate for Payer: Priority Health Commercial	$71.40
Rate for Payer: Priority Health Medicaid	$90.46
Rate for Payer: Priority Health Medicare	$90.46
Rate for Payer: Priority Health PPO	$71.40
Rate for Payer: United Health Care Medicaid	$90.46
Rate for Payer: United Health Care Medicare Advantage	$39.80

LEVEL II EMERGENCY ROOM

Facility

$165.00

Service Code	HCPCS 99282
Hospital Charge Code	4500530
Hospital Revenue Code	450
Min. Negotiated Rate	$72.47
Max. Negotiated Rate	$164.71
Rate for Payer: BCBS BCN 65	$164.71
Rate for Payer: Blue Care Network Medicare Advantage	$164.71
Rate for Payer: Cash Price	$107.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Community Health Alliance Commercial	$140.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$164.71
Rate for Payer: Meridian Health Plan Medicare	$164.71
Rate for Payer: Priority Health Commercial	$115.50
Rate for Payer: Priority Health Medicaid	$164.71
Rate for Payer: Priority Health Medicare	$164.71
Rate for Payer: Priority Health PPO	$115.50
Rate for Payer: United Health Care Medicaid	$164.71
Rate for Payer: United Health Care Medicare Advantage	$72.47

LEVEL III EMERGENCY ROOM

Facility

$228.00

Service Code	HCPCS 99283
Hospital Charge Code	4500560
Hospital Revenue Code	450
Min. Negotiated Rate	$128.85
Max. Negotiated Rate	$292.83
Rate for Payer: BCBS BCN 65	$292.83
Rate for Payer: Blue Care Network Medicare Advantage	$292.83
Rate for Payer: Cash Price	$148.20
Rate for Payer: Cash Price	$148.20
Rate for Payer: Community Health Alliance Commercial	$193.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$292.83
Rate for Payer: Meridian Health Plan Medicare	$292.83
Rate for Payer: Priority Health Commercial	$159.60
Rate for Payer: Priority Health Medicaid	$292.83
Rate for Payer: Priority Health Medicare	$292.83
Rate for Payer: Priority Health PPO	$159.60
Rate for Payer: United Health Care Medicaid	$292.83
Rate for Payer: United Health Care Medicare Advantage	$128.85

LEVEL IV EMERGENCY ROOM

Facility

$451.00

Service Code	HCPCS 99284
Hospital Charge Code	4500590
Hospital Revenue Code	450
Min. Negotiated Rate	$196.95
Max. Negotiated Rate	$447.62
Rate for Payer: BCBS BCN 65	$447.62
Rate for Payer: Blue Care Network Medicare Advantage	$447.62
Rate for Payer: Cash Price	$293.15
Rate for Payer: Cash Price	$293.15
Rate for Payer: Community Health Alliance Commercial	$383.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$447.62
Rate for Payer: Meridian Health Plan Medicare	$447.62
Rate for Payer: Priority Health Commercial	$315.70
Rate for Payer: Priority Health Medicaid	$447.62
Rate for Payer: Priority Health Medicare	$447.62
Rate for Payer: Priority Health PPO	$315.70
Rate for Payer: United Health Care Medicaid	$447.62
Rate for Payer: United Health Care Medicare Advantage	$196.95

LEVEL V EMERGENCY ROOM

Facility

$592.00

Service Code	HCPCS 99285
Hospital Charge Code	4500620
Hospital Revenue Code	450
Min. Negotiated Rate	$281.09
Max. Negotiated Rate	$638.85
Rate for Payer: BCBS BCN 65	$638.85
Rate for Payer: Blue Care Network Medicare Advantage	$638.85
Rate for Payer: Cash Price	$384.80
Rate for Payer: Cash Price	$384.80
Rate for Payer: Community Health Alliance Commercial	$503.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$638.85
Rate for Payer: Meridian Health Plan Medicare	$638.85
Rate for Payer: Priority Health Commercial	$414.40
Rate for Payer: Priority Health Medicaid	$638.85
Rate for Payer: Priority Health Medicare	$638.85
Rate for Payer: Priority Health PPO	$414.40
Rate for Payer: United Health Care Medicaid	$638.85
Rate for Payer: United Health Care Medicare Advantage	$281.09

LEVEL VI ER CRITICAL CARE

Facility

$1,084.00

Service Code	HCPCS 99291
Hospital Charge Code	4500650
Hospital Revenue Code	450
Min. Negotiated Rate	$389.89
Max. Negotiated Rate	$921.40
Rate for Payer: BCBS BCN 65	$886.12
Rate for Payer: Blue Care Network Medicare Advantage	$886.12
Rate for Payer: Cash Price	$704.60
Rate for Payer: Cash Price	$704.60
Rate for Payer: Community Health Alliance Commercial	$921.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$886.12
Rate for Payer: Meridian Health Plan Medicare	$886.12
Rate for Payer: Priority Health Commercial	$758.80
Rate for Payer: Priority Health Medicaid	$886.12
Rate for Payer: Priority Health Medicare	$886.12
Rate for Payer: Priority Health PPO	$758.80
Rate for Payer: United Health Care Medicaid	$886.12
Rate for Payer: United Health Care Medicare Advantage	$389.89

LEVEL VI ER EA ADD 30 MIN >74M

Facility

$282.00

Service Code	HCPCS 99292
Hospital Charge Code	4500651
Hospital Revenue Code	450
Min. Negotiated Rate	$197.40
Max. Negotiated Rate	$239.70
Rate for Payer: Cash Price	$183.30
Rate for Payer: Community Health Alliance Commercial	$239.70
Rate for Payer: Priority Health Commercial	$197.40
Rate for Payer: Priority Health PPO	$197.40

LEVOFLOXACIN HEMIHYDRATE 750MG

Facility

$112.71

Service Code	HCPCS A9270 GY
Hospital Charge Code	2509945
Hospital Revenue Code	637
Min. Negotiated Rate	$78.90
Max. Negotiated Rate	$95.80
Rate for Payer: Cash Price	$73.26
Rate for Payer: Community Health Alliance Commercial	$95.80
Rate for Payer: Priority Health Commercial	$78.90
Rate for Payer: Priority Health PPO	$78.90

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges