Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ANCP-3

Facility

$26.90

Hospital Charge Code	31027410
Hospital Revenue Code	300
Min. Negotiated Rate	$18.83
Max. Negotiated Rate	$22.86
Rate for Payer: Cash Price	$17.49
Rate for Payer: Community Health Alliance Commercial	$22.86
Rate for Payer: Priority Health Commercial	$18.83
Rate for Payer: Priority Health PPO	$18.83

ANCP-4

Facility

$26.90

Hospital Charge Code	31027411
Hospital Revenue Code	300
Min. Negotiated Rate	$18.83
Max. Negotiated Rate	$22.86
Rate for Payer: Cash Price	$17.49
Rate for Payer: Community Health Alliance Commercial	$22.86
Rate for Payer: Priority Health Commercial	$18.83
Rate for Payer: Priority Health PPO	$18.83

ANCP-5

Facility

$26.90

Hospital Charge Code	31027412
Hospital Revenue Code	300
Min. Negotiated Rate	$18.83
Max. Negotiated Rate	$22.86
Rate for Payer: Cash Price	$17.49
Rate for Payer: Community Health Alliance Commercial	$22.86
Rate for Payer: Priority Health Commercial	$18.83
Rate for Payer: Priority Health PPO	$18.83

ANCP-6

Facility

$26.90

Hospital Charge Code	31027413
Hospital Revenue Code	300
Min. Negotiated Rate	$18.83
Max. Negotiated Rate	$22.86
Rate for Payer: Cash Price	$17.49
Rate for Payer: Community Health Alliance Commercial	$22.86
Rate for Payer: Priority Health Commercial	$18.83
Rate for Payer: Priority Health PPO	$18.83

ANCP-7

Facility

$26.90

Hospital Charge Code	31027414
Hospital Revenue Code	300
Min. Negotiated Rate	$18.83
Max. Negotiated Rate	$22.86
Rate for Payer: Cash Price	$17.49
Rate for Payer: Community Health Alliance Commercial	$22.86
Rate for Payer: Priority Health Commercial	$18.83
Rate for Payer: Priority Health PPO	$18.83

ANCP-8

Facility

$26.90

Hospital Charge Code	31027415
Hospital Revenue Code	300
Min. Negotiated Rate	$18.83
Max. Negotiated Rate	$22.86
Rate for Payer: Cash Price	$17.49
Rate for Payer: Community Health Alliance Commercial	$22.86
Rate for Payer: Priority Health Commercial	$18.83
Rate for Payer: Priority Health PPO	$18.83

ANCP-9

Facility

$26.90

Hospital Charge Code	31027416
Hospital Revenue Code	300
Min. Negotiated Rate	$18.83
Max. Negotiated Rate	$22.86
Rate for Payer: Cash Price	$17.49
Rate for Payer: Community Health Alliance Commercial	$22.86
Rate for Payer: Priority Health Commercial	$18.83
Rate for Payer: Priority Health PPO	$18.83

ANDRO GLUCURONIDE

Facility

$35.12

Hospital Charge Code	3102670
Hospital Revenue Code	300
Min. Negotiated Rate	$24.58
Max. Negotiated Rate	$29.85
Rate for Payer: Cash Price	$22.83
Rate for Payer: Community Health Alliance Commercial	$29.85
Rate for Payer: Priority Health Commercial	$24.58
Rate for Payer: Priority Health PPO	$24.58

ANDROSTENEDIONE

Facility

$10.00

Service Code	HCPCS 82157
Hospital Charge Code	3000880
Hospital Revenue Code	301
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$30.74
Rate for Payer: BCBS BCN 65	$30.74
Rate for Payer: Blue Care Network Medicare Advantage	$30.74
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$30.74
Rate for Payer: Meridian Health Plan Medicare	$30.74
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health Medicaid	$30.74
Rate for Payer: Priority Health Medicare	$30.74
Rate for Payer: Priority Health PPO	$7.00
Rate for Payer: United Health Care Medicaid	$30.74
Rate for Payer: United Health Care Medicare Advantage	$13.53

ANEROBIC CULTURE AND SMEAR

Facility

$20.97

Hospital Charge Code	3004961
Hospital Revenue Code	306
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$17.82
Rate for Payer: Cash Price	$13.63
Rate for Payer: Community Health Alliance Commercial	$17.82
Rate for Payer: Priority Health Commercial	$14.68
Rate for Payer: Priority Health PPO	$14.68

ANGIO ADDITIONAL VESSEL

Facility

$1,722.00

Hospital Charge Code	3201240
Hospital Revenue Code	320
Min. Negotiated Rate	$1,205.40
Max. Negotiated Rate	$1,463.70
Rate for Payer: Cash Price	$1,119.30
Rate for Payer: Community Health Alliance Commercial	$1,463.70
Rate for Payer: Priority Health Commercial	$1,205.40
Rate for Payer: Priority Health PPO	$1,205.40

ANGIO CATH-II-PIGTAIL

Facility

$83.00

Hospital Charge Code	27015461
Hospital Revenue Code	272
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

ANGIOTENSIN CONVERTING ENZYME

Facility

$3.67

Service Code	HCPCS 82164
Hospital Charge Code	3000900
Hospital Revenue Code	301
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$15.33
Rate for Payer: BCBS BCN 65	$15.33
Rate for Payer: Blue Care Network Medicare Advantage	$15.33
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cash Price	$2.39
Rate for Payer: Community Health Alliance Commercial	$3.12
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.33
Rate for Payer: Meridian Health Plan Medicare	$15.33
Rate for Payer: Priority Health Commercial	$2.57
Rate for Payer: Priority Health Medicaid	$15.33
Rate for Payer: Priority Health Medicare	$15.33
Rate for Payer: Priority Health PPO	$2.57
Rate for Payer: United Health Care Medicaid	$15.33
Rate for Payer: United Health Care Medicare Advantage	$6.75

ANIT-UI RNP

Facility

$34.00

Hospital Charge Code	3101940
Hospital Revenue Code	300
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$28.90
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health PPO	$23.80

ANKLE FIXATION SYSTEM

Facility

$6,317.00

Hospital Charge Code	27272046
Hospital Revenue Code	272
Min. Negotiated Rate	$4,421.90
Max. Negotiated Rate	$5,369.45
Rate for Payer: Cash Price	$4,106.05
Rate for Payer: Community Health Alliance Commercial	$5,369.45
Rate for Payer: Priority Health Commercial	$4,421.90
Rate for Payer: Priority Health PPO	$4,421.90

ANKLE FOOT ORTHOSIS

Facility

$74.00

Hospital Charge Code	27021238
Hospital Revenue Code	270
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$62.90
Rate for Payer: Cash Price	$48.10
Rate for Payer: Community Health Alliance Commercial	$62.90
Rate for Payer: Priority Health Commercial	$51.80
Rate for Payer: Priority Health PPO	$51.80

ANKLE SUPPORT

Facility

$116.00

Hospital Charge Code	27014076
Hospital Revenue Code	270
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$98.60
Rate for Payer: Cash Price	$75.40
Rate for Payer: Community Health Alliance Commercial	$98.60
Rate for Payer: Priority Health Commercial	$81.20
Rate for Payer: Priority Health PPO	$81.20

ANKLE SUPPORT (SWEEDO)

Facility

$58.00

Hospital Charge Code	27021154
Hospital Revenue Code	270
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$49.30
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health PPO	$40.60

ANKLE TRANSIXING PIN RT

Facility

$7,416.00

Service Code	HCPCS C1713
Hospital Charge Code	27868811
Hospital Revenue Code	278
Min. Negotiated Rate	$5,191.20
Max. Negotiated Rate	$6,303.60
Rate for Payer: Cash Price	$4,820.40
Rate for Payer: Community Health Alliance Commercial	$6,303.60
Rate for Payer: Priority Health Commercial	$5,191.20
Rate for Payer: Priority Health PPO	$5,191.20

ANNA1 (HU) AB WB

Facility

$103.92

Hospital Charge Code	3101200
Hospital Revenue Code	300
Min. Negotiated Rate	$72.74
Max. Negotiated Rate	$88.33
Rate for Payer: Cash Price	$67.55
Rate for Payer: Community Health Alliance Commercial	$88.33
Rate for Payer: Priority Health Commercial	$72.74
Rate for Payer: Priority Health PPO	$72.74

ANNA2 (RI) AB WB

Facility

$103.92

Hospital Charge Code	3101201
Hospital Revenue Code	300
Min. Negotiated Rate	$72.74
Max. Negotiated Rate	$88.33
Rate for Payer: Cash Price	$67.55
Rate for Payer: Community Health Alliance Commercial	$88.33
Rate for Payer: Priority Health Commercial	$72.74
Rate for Payer: Priority Health PPO	$72.74

ANTI-AQUAPORIN, SPINAL

Facility

$417.29

Hospital Charge Code	31027712
Hospital Revenue Code	300
Min. Negotiated Rate	$292.10
Max. Negotiated Rate	$354.70
Rate for Payer: Cash Price	$271.24
Rate for Payer: Community Health Alliance Commercial	$354.70
Rate for Payer: Priority Health Commercial	$292.10
Rate for Payer: Priority Health PPO	$292.10

ANTIBODY, CYCLIC CITRIL PEPTID

Facility

$10.12

Service Code	HCPCS 86200
Hospital Charge Code	3000274
Hospital Revenue Code	302
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$13.60
Rate for Payer: BCBS BCN 65	$13.60
Rate for Payer: Blue Care Network Medicare Advantage	$13.60
Rate for Payer: Cash Price	$6.58
Rate for Payer: Cash Price	$6.58
Rate for Payer: Community Health Alliance Commercial	$8.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.60
Rate for Payer: Meridian Health Plan Medicare	$13.60
Rate for Payer: Priority Health Commercial	$7.08
Rate for Payer: Priority Health Medicaid	$13.60
Rate for Payer: Priority Health Medicare	$13.60
Rate for Payer: Priority Health PPO	$7.08
Rate for Payer: United Health Care Medicaid	$13.60
Rate for Payer: United Health Care Medicare Advantage	$5.98

ANTIBODY ID ASPERGILLIS 2

Facility

$70.00

Service Code	HCPCS 86606
Hospital Charge Code	3005053
Hospital Revenue Code	302
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$59.50
Rate for Payer: BCBS BCN 65	$15.80
Rate for Payer: Blue Care Network Medicare Advantage	$15.80
Rate for Payer: Cash Price	$45.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.80
Rate for Payer: Meridian Health Plan Medicare	$15.80
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health Medicaid	$15.80
Rate for Payer: Priority Health Medicare	$15.80
Rate for Payer: Priority Health PPO	$49.00
Rate for Payer: United Health Care Medicaid	$15.80
Rate for Payer: United Health Care Medicare Advantage	$6.95

ANTIBODY ID ASPERGILLIS 3

Facility

$70.00

Service Code	HCPCS 86606
Hospital Charge Code	3005054
Hospital Revenue Code	302
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$59.50
Rate for Payer: BCBS BCN 65	$15.80
Rate for Payer: Blue Care Network Medicare Advantage	$15.80
Rate for Payer: Cash Price	$45.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.80
Rate for Payer: Meridian Health Plan Medicare	$15.80
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health Medicaid	$15.80
Rate for Payer: Priority Health Medicare	$15.80
Rate for Payer: Priority Health PPO	$49.00
Rate for Payer: United Health Care Medicaid	$15.80
Rate for Payer: United Health Care Medicare Advantage	$6.95

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges