Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

LF-1

Facility

$33.75

Hospital Charge Code	3101298
Hospital Revenue Code	301
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$28.69
Rate for Payer: Cash Price	$21.94
Rate for Payer: Community Health Alliance Commercial	$28.69
Rate for Payer: Priority Health Commercial	$23.62
Rate for Payer: Priority Health PPO	$23.62

LF-2

Facility

$33.75

Hospital Charge Code	3101299
Hospital Revenue Code	301
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$28.69
Rate for Payer: Cash Price	$21.94
Rate for Payer: Community Health Alliance Commercial	$28.69
Rate for Payer: Priority Health Commercial	$23.62
Rate for Payer: Priority Health PPO	$23.62

LF-3

Facility

$33.75

Hospital Charge Code	3101300
Hospital Revenue Code	301
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$28.69
Rate for Payer: Cash Price	$21.94
Rate for Payer: Community Health Alliance Commercial	$28.69
Rate for Payer: Priority Health Commercial	$23.62
Rate for Payer: Priority Health PPO	$23.62

LF-4

Facility

$33.75

Hospital Charge Code	3101301
Hospital Revenue Code	301
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$28.69
Rate for Payer: Cash Price	$21.94
Rate for Payer: Community Health Alliance Commercial	$28.69
Rate for Payer: Priority Health Commercial	$23.62
Rate for Payer: Priority Health PPO	$23.62

LHON 1

Facility

$1,631.59

Hospital Charge Code	3101444
Hospital Revenue Code	300
Min. Negotiated Rate	$1,142.11
Max. Negotiated Rate	$1,386.85
Rate for Payer: Cash Price	$1,060.53
Rate for Payer: Community Health Alliance Commercial	$1,386.85
Rate for Payer: Priority Health Commercial	$1,142.11
Rate for Payer: Priority Health PPO	$1,142.11

LHON 2

Facility

$1,631.59

Hospital Charge Code	3101445
Hospital Revenue Code	300
Min. Negotiated Rate	$1,142.11
Max. Negotiated Rate	$1,386.85
Rate for Payer: Cash Price	$1,060.53
Rate for Payer: Community Health Alliance Commercial	$1,386.85
Rate for Payer: Priority Health Commercial	$1,142.11
Rate for Payer: Priority Health PPO	$1,142.11

LHON 3

Facility

$1,631.58

Hospital Charge Code	3101446
Hospital Revenue Code	300
Min. Negotiated Rate	$1,142.11
Max. Negotiated Rate	$1,386.84
Rate for Payer: Cash Price	$1,060.53
Rate for Payer: Community Health Alliance Commercial	$1,386.84
Rate for Payer: Priority Health Commercial	$1,142.11
Rate for Payer: Priority Health PPO	$1,142.11

LIBERTY THUMB SPICA

Facility

$60.00

Hospital Charge Code	27060462
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

LIDOCAINE

Facility

$42.00

Service Code	HCPCS 80176
Hospital Charge Code	3005820
Hospital Revenue Code	301
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$35.70
Rate for Payer: BCBS BCN 65	$15.42
Rate for Payer: Blue Care Network Medicare Advantage	$15.42
Rate for Payer: Cash Price	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.42
Rate for Payer: Meridian Health Plan Medicare	$15.42
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health Medicaid	$15.42
Rate for Payer: Priority Health Medicare	$15.42
Rate for Payer: Priority Health PPO	$29.40
Rate for Payer: United Health Care Medicaid	$15.42
Rate for Payer: United Health Care Medicare Advantage	$6.79

LIGATOR,SAEED MULTI-BAND

Facility

$836.00

Hospital Charge Code	27262636
Hospital Revenue Code	272
Min. Negotiated Rate	$585.20
Max. Negotiated Rate	$710.60
Rate for Payer: Cash Price	$543.40
Rate for Payer: Community Health Alliance Commercial	$710.60
Rate for Payer: Priority Health Commercial	$585.20
Rate for Payer: Priority Health PPO	$585.20

LIGGM-1

Facility

$7.50

Hospital Charge Code	3102224
Hospital Revenue Code	300
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$6.38
Rate for Payer: Cash Price	$4.88
Rate for Payer: Community Health Alliance Commercial	$6.38
Rate for Payer: Priority Health Commercial	$5.25
Rate for Payer: Priority Health PPO	$5.25

LIGGM-2

Facility

$7.50

Hospital Charge Code	3102225
Hospital Revenue Code	300
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$6.38
Rate for Payer: Cash Price	$4.88
Rate for Payer: Community Health Alliance Commercial	$6.38
Rate for Payer: Priority Health Commercial	$5.25
Rate for Payer: Priority Health PPO	$5.25

LIGHT GREEN STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100330
Hospital Revenue Code	310
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

LINDEMANN BURR

Facility

$111.00

Hospital Charge Code	27061758
Hospital Revenue Code	270
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$94.35
Rate for Payer: Cash Price	$72.15
Rate for Payer: Community Health Alliance Commercial	$94.35
Rate for Payer: Priority Health Commercial	$77.70
Rate for Payer: Priority Health PPO	$77.70

LINEAR CUTTER RELOAD, TCR55

Facility

$157.00

Hospital Charge Code	27018523
Hospital Revenue Code	272
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$133.45
Rate for Payer: Cash Price	$102.05
Rate for Payer: Community Health Alliance Commercial	$133.45
Rate for Payer: Priority Health Commercial	$109.90
Rate for Payer: Priority Health PPO	$109.90

LINEAR CUTTER, TLC 75

Facility

$507.00

Hospital Charge Code	27018515
Hospital Revenue Code	272
Min. Negotiated Rate	$354.90
Max. Negotiated Rate	$430.95
Rate for Payer: Cash Price	$329.55
Rate for Payer: Community Health Alliance Commercial	$430.95
Rate for Payer: Priority Health Commercial	$354.90
Rate for Payer: Priority Health PPO	$354.90

LINEAR RELOAD, TR30

Facility

$140.00

Hospital Charge Code	27018564
Hospital Revenue Code	272
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

LINEAR RELOAD, TR60

Facility

$154.00

Hospital Charge Code	27018572
Hospital Revenue Code	272
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$130.90
Rate for Payer: Cash Price	$100.10
Rate for Payer: Community Health Alliance Commercial	$130.90
Rate for Payer: Priority Health Commercial	$107.80
Rate for Payer: Priority Health PPO	$107.80

LINEAR RELOAD, TR90

Facility

$161.00

Hospital Charge Code	27018580
Hospital Revenue Code	272
Min. Negotiated Rate	$112.70
Max. Negotiated Rate	$136.85
Rate for Payer: Cash Price	$104.65
Rate for Payer: Community Health Alliance Commercial	$136.85
Rate for Payer: Priority Health Commercial	$112.70
Rate for Payer: Priority Health PPO	$112.70

LINEAR STAPLER, TL30

Facility

$449.00

Hospital Charge Code	27018481
Hospital Revenue Code	272
Min. Negotiated Rate	$314.30
Max. Negotiated Rate	$381.65
Rate for Payer: Cash Price	$291.85
Rate for Payer: Community Health Alliance Commercial	$381.65
Rate for Payer: Priority Health Commercial	$314.30
Rate for Payer: Priority Health PPO	$314.30

LINEAR STAPLER, TL60

Facility

$464.00

Hospital Charge Code	27018499
Hospital Revenue Code	272
Min. Negotiated Rate	$324.80
Max. Negotiated Rate	$394.40
Rate for Payer: Cash Price	$301.60
Rate for Payer: Community Health Alliance Commercial	$394.40
Rate for Payer: Priority Health Commercial	$324.80
Rate for Payer: Priority Health PPO	$324.80

LINEAR STAPLER, TL90

Facility

$493.00

Hospital Charge Code	27018507
Hospital Revenue Code	272
Min. Negotiated Rate	$345.10
Max. Negotiated Rate	$419.05
Rate for Payer: Cash Price	$320.45
Rate for Payer: Community Health Alliance Commercial	$419.05
Rate for Payer: Priority Health Commercial	$345.10
Rate for Payer: Priority Health PPO	$345.10

LIPASE

Facility

$36.25

Service Code	HCPCS 83690
Hospital Charge Code	3005840
Hospital Revenue Code	301
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$30.81
Rate for Payer: BCBS BCN 65	$7.23
Rate for Payer: Blue Care Network Medicare Advantage	$7.23
Rate for Payer: Cash Price	$23.56
Rate for Payer: Cash Price	$23.56
Rate for Payer: Community Health Alliance Commercial	$30.81
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.23
Rate for Payer: Meridian Health Plan Medicare	$7.23
Rate for Payer: Priority Health Commercial	$25.38
Rate for Payer: Priority Health Medicaid	$7.23
Rate for Payer: Priority Health Medicare	$7.23
Rate for Payer: Priority Health PPO	$25.38
Rate for Payer: United Health Care Medicaid	$7.23
Rate for Payer: United Health Care Medicare Advantage	$3.18

LIPASE SBMF

Facility

$3.46

Hospital Charge Code	3101490
Hospital Revenue Code	300
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$2.94
Rate for Payer: Cash Price	$2.25
Rate for Payer: Community Health Alliance Commercial	$2.94
Rate for Payer: Priority Health Commercial	$2.42
Rate for Payer: Priority Health PPO	$2.42

LIPID EXEC

Facility

$55.00

Hospital Charge Code	3000722
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$46.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health PPO	$38.50

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges