Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

LIPID + LDL DIRECT

Facility

$152.50

Hospital Charge Code	3102388
Hospital Revenue Code	300
Min. Negotiated Rate	$106.75
Max. Negotiated Rate	$129.62
Rate for Payer: Cash Price	$99.13
Rate for Payer: Community Health Alliance Commercial	$129.62
Rate for Payer: Priority Health Commercial	$106.75
Rate for Payer: Priority Health PPO	$106.75

LIPID PANEL

Facility

$33.00

Hospital Charge Code	3101127
Hospital Revenue Code	301
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$28.05
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health PPO	$23.10

LIPID PANEL

Facility

$95.00

Service Code	HCPCS 80061
Hospital Charge Code	3000721
Hospital Revenue Code	301
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$80.75
Rate for Payer: BCBS BCN 65	$14.06
Rate for Payer: Blue Care Network Medicare Advantage	$14.06
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.06
Rate for Payer: Meridian Health Plan Medicare	$14.06
Rate for Payer: Priority Health Commercial	$66.50
Rate for Payer: Priority Health Medicaid	$14.06
Rate for Payer: Priority Health Medicare	$14.06
Rate for Payer: Priority Health PPO	$66.50
Rate for Payer: United Health Care Medicaid	$14.06
Rate for Payer: United Health Care Medicare Advantage	$6.19

LIPID PANEL-LC

Facility

$3.37

Hospital Charge Code	3101840
Hospital Revenue Code	300
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$2.86
Rate for Payer: Cash Price	$2.19
Rate for Payer: Community Health Alliance Commercial	$2.86
Rate for Payer: Priority Health Commercial	$2.36
Rate for Payer: Priority Health PPO	$2.36

LIPITOR 40 MG TABLET

Facility

$3.59

Service Code	HCPCS A9270 GY
Hospital Charge Code	2507777
Hospital Revenue Code	637
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$3.05
Rate for Payer: Cash Price	$2.33
Rate for Payer: Community Health Alliance Commercial	$3.05
Rate for Payer: Priority Health Commercial	$2.51
Rate for Payer: Priority Health PPO	$2.51

LIPOPROTEIN A

Facility

$39.00

Hospital Charge Code	3100552
Hospital Revenue Code	301
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$33.15
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health PPO	$27.30

LIPOPROTEIN B

Facility

$6.72

Service Code	HCPCS 82172
Hospital Charge Code	3003845
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$22.14
Rate for Payer: BCBS BCN 65	$22.14
Rate for Payer: Blue Care Network Medicare Advantage	$22.14
Rate for Payer: Cash Price	$4.37
Rate for Payer: Cash Price	$4.37
Rate for Payer: Community Health Alliance Commercial	$5.71
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$22.14
Rate for Payer: Meridian Health Plan Medicare	$22.14
Rate for Payer: Priority Health Commercial	$4.70
Rate for Payer: Priority Health Medicaid	$22.14
Rate for Payer: Priority Health Medicare	$22.14
Rate for Payer: Priority Health PPO	$4.70
Rate for Payer: United Health Care Medicaid	$22.14
Rate for Payer: United Health Care Medicare Advantage	$9.74

LIPOPROTEIN BLD BY NMR

Facility

$22.00

Hospital Charge Code	3100716
Hospital Revenue Code	301
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

LIPOPROTEIN SUBCLASS

Facility

$85.00

Service Code	HCPCS 83701 90
Hospital Charge Code	3008145
Hospital Revenue Code	301
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$72.25
Rate for Payer: Cash Price	$55.25
Rate for Payer: Community Health Alliance Commercial	$72.25
Rate for Payer: Priority Health Commercial	$59.50
Rate for Payer: Priority Health PPO	$59.50

LISTERIA IgG

Facility

$152.00

Service Code	HCPCS 86723
Hospital Charge Code	3005870
Hospital Revenue Code	302
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$129.20
Rate for Payer: BCBS BCN 65	$13.85
Rate for Payer: Blue Care Network Medicare Advantage	$13.85
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Community Health Alliance Commercial	$129.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.85
Rate for Payer: Meridian Health Plan Medicare	$13.85
Rate for Payer: Priority Health Commercial	$106.40
Rate for Payer: Priority Health Medicaid	$13.85
Rate for Payer: Priority Health Medicare	$13.85
Rate for Payer: Priority Health PPO	$106.40
Rate for Payer: United Health Care Medicaid	$13.85
Rate for Payer: United Health Care Medicare Advantage	$6.09

LITHIUM

Facility

$3.37

Service Code	HCPCS 80178
Hospital Charge Code	3005860
Hospital Revenue Code	301
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$6.94
Rate for Payer: BCBS BCN 65	$6.94
Rate for Payer: Blue Care Network Medicare Advantage	$6.94
Rate for Payer: Cash Price	$2.19
Rate for Payer: Cash Price	$2.19
Rate for Payer: Community Health Alliance Commercial	$2.86
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.94
Rate for Payer: Meridian Health Plan Medicare	$6.94
Rate for Payer: Priority Health Commercial	$2.36
Rate for Payer: Priority Health Medicaid	$6.94
Rate for Payer: Priority Health Medicare	$6.94
Rate for Payer: Priority Health PPO	$2.36
Rate for Payer: United Health Care Medicaid	$6.94
Rate for Payer: United Health Care Medicare Advantage	$3.05

LIVER CYTOSOLIC ANTIGEN TYPE 1

Facility

$59.00

Hospital Charge Code	3100853
Hospital Revenue Code	300
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$50.15
Rate for Payer: Cash Price	$38.35
Rate for Payer: Community Health Alliance Commercial	$50.15
Rate for Payer: Priority Health Commercial	$41.30
Rate for Payer: Priority Health PPO	$41.30

LIVER FIBROSIS

Facility

$140.00

Hospital Charge Code	31027679
Hospital Revenue Code	300
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

LIVER PANEL LC

Facility

$2.55

Hospital Charge Code	3102551
Hospital Revenue Code	300
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.17
Rate for Payer: Cash Price	$1.66
Rate for Payer: Community Health Alliance Commercial	$2.17
Rate for Payer: Priority Health Commercial	$1.78
Rate for Payer: Priority Health PPO	$1.78

LMB FINGER HUGGER

Facility

$56.00

Hospital Charge Code	27062190
Hospital Revenue Code	270
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

L METHAMPHETAMINE

Facility

$15.00

Service Code	HCPCS G0480
Hospital Charge Code	3101574
Hospital Revenue Code	300
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

LOCKING NAIL TROCHANTERIC

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Charge Code	27866559
Hospital Revenue Code	278
Min. Negotiated Rate	$2,146.20
Max. Negotiated Rate	$2,606.10
Rate for Payer: Cash Price	$1,992.90
Rate for Payer: Community Health Alliance Commercial	$2,606.10
Rate for Payer: Priority Health Commercial	$2,146.20
Rate for Payer: Priority Health PPO	$2,146.20

LONG GAMMA NAIL, LEFT

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Charge Code	27866377
Hospital Revenue Code	278
Min. Negotiated Rate	$3,501.40
Max. Negotiated Rate	$4,251.70
Rate for Payer: Cash Price	$3,251.30
Rate for Payer: Community Health Alliance Commercial	$4,251.70
Rate for Payer: Priority Health Commercial	$3,501.40
Rate for Payer: Priority Health PPO	$3,501.40

LOOP OSTOMY BRIDGE #7767

Facility

$17.00

Hospital Charge Code	27264041
Hospital Revenue Code	272
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

LORAZAPAM

Facility

$54.00

Service Code	HCPCS G0480
Hospital Charge Code	3002256
Hospital Revenue Code	301
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Community Health Alliance Commercial	$45.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$37.80
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$37.80
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

LP-1

Facility

$7.28

Hospital Charge Code	3101576
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$6.19
Rate for Payer: Cash Price	$4.73
Rate for Payer: Community Health Alliance Commercial	$6.19
Rate for Payer: Priority Health Commercial	$5.10
Rate for Payer: Priority Health PPO	$5.10

LP-2

Facility

$7.28

Hospital Charge Code	3101577
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$6.19
Rate for Payer: Cash Price	$4.73
Rate for Payer: Community Health Alliance Commercial	$6.19
Rate for Payer: Priority Health Commercial	$5.10
Rate for Payer: Priority Health PPO	$5.10

LP-3

Facility

$7.28

Hospital Charge Code	3101578
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$6.19
Rate for Payer: Cash Price	$4.73
Rate for Payer: Community Health Alliance Commercial	$6.19
Rate for Payer: Priority Health Commercial	$5.10
Rate for Payer: Priority Health PPO	$5.10

LP-4

Facility

$7.28

Hospital Charge Code	3101579
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$6.19
Rate for Payer: Cash Price	$4.73
Rate for Payer: Community Health Alliance Commercial	$6.19
Rate for Payer: Priority Health Commercial	$5.10
Rate for Payer: Priority Health PPO	$5.10

LP-5

Facility

$7.28

Hospital Charge Code	3101580
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$6.19
Rate for Payer: Cash Price	$4.73
Rate for Payer: Community Health Alliance Commercial	$6.19
Rate for Payer: Priority Health Commercial	$5.10
Rate for Payer: Priority Health PPO	$5.10

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges