Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

LP-6

Facility

$7.29

Hospital Charge Code	3101581
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$6.20
Rate for Payer: Cash Price	$4.74
Rate for Payer: Community Health Alliance Commercial	$6.20
Rate for Payer: Priority Health Commercial	$5.10
Rate for Payer: Priority Health PPO	$5.10

LPPLA2

Facility

$20.00

Hospital Charge Code	3102572
Hospital Revenue Code	300
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$17.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health PPO	$14.00

LSD URINE

Facility

$8.06

Service Code	HCPCS 80307
Hospital Charge Code	3005895
Hospital Revenue Code	301
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$65.25
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$5.24
Rate for Payer: Cash Price	$5.24
Rate for Payer: Community Health Alliance Commercial	$6.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$65.25
Rate for Payer: Meridian Health Plan Medicare	$65.25
Rate for Payer: Priority Health Commercial	$5.64
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$5.64
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

LSP-1

Facility

$92.50

Hospital Charge Code	3100116
Hospital Revenue Code	300
Min. Negotiated Rate	$64.75
Max. Negotiated Rate	$78.62
Rate for Payer: Cash Price	$60.13
Rate for Payer: Community Health Alliance Commercial	$78.62
Rate for Payer: Priority Health Commercial	$64.75
Rate for Payer: Priority Health PPO	$64.75

LSP-2

Facility

$92.50

Hospital Charge Code	3102387
Hospital Revenue Code	300
Min. Negotiated Rate	$64.75
Max. Negotiated Rate	$78.62
Rate for Payer: Cash Price	$60.13
Rate for Payer: Community Health Alliance Commercial	$78.62
Rate for Payer: Priority Health Commercial	$64.75
Rate for Payer: Priority Health PPO	$64.75

L/S WRAPAROUND, LARGE

Facility

$65.00

Hospital Charge Code	27060057
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

L/S WRAPAROUND, MEDIUM

Facility

$70.00

Hospital Charge Code	27060081
Hospital Revenue Code	270
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

LTI HEALTH ASSESSMENT

Facility

$70.00

Hospital Charge Code	3000062
Hospital Revenue Code	309
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

LU-1

Facility

$1.65

Hospital Charge Code	3102390
Hospital Revenue Code	300
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.40
Rate for Payer: Cash Price	$1.07
Rate for Payer: Community Health Alliance Commercial	$1.40
Rate for Payer: Priority Health Commercial	$1.16
Rate for Payer: Priority Health PPO	$1.16

LUMBAR NIGHT ROLL

Facility

$44.00

Hospital Charge Code	27019836
Hospital Revenue Code	270
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

LUMBAR PUNCTURE

Facility

$869.00

Hospital Charge Code	4500944
Hospital Revenue Code	450
Min. Negotiated Rate	$608.30
Max. Negotiated Rate	$738.65
Rate for Payer: Cash Price	$564.85
Rate for Payer: Community Health Alliance Commercial	$738.65
Rate for Payer: Priority Health Commercial	$608.30
Rate for Payer: Priority Health PPO	$608.30

LUMBAR ROLL HARNESS

Facility

$44.00

Hospital Charge Code	27015537
Hospital Revenue Code	270
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

LUMBAR ROLL, MCKENZIE

Facility

$25.00

Hospital Charge Code	27020891
Hospital Revenue Code	270
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

LUNG PANAL TISSUE

Facility

$915.00

Hospital Charge Code	3100829
Hospital Revenue Code	310
Min. Negotiated Rate	$640.50
Max. Negotiated Rate	$777.75
Rate for Payer: Cash Price	$594.75
Rate for Payer: Community Health Alliance Commercial	$777.75
Rate for Payer: Priority Health Commercial	$640.50
Rate for Payer: Priority Health PPO	$640.50

LUNG PANEL 1

Facility

$182.50

Hospital Charge Code	3101364
Hospital Revenue Code	310
Min. Negotiated Rate	$127.75
Max. Negotiated Rate	$155.12
Rate for Payer: Cash Price	$118.63
Rate for Payer: Community Health Alliance Commercial	$155.12
Rate for Payer: Priority Health Commercial	$127.75
Rate for Payer: Priority Health PPO	$127.75

LUNG PANEL 2

Facility

$182.50

Hospital Charge Code	3101365
Hospital Revenue Code	310
Min. Negotiated Rate	$127.75
Max. Negotiated Rate	$155.12
Rate for Payer: Cash Price	$118.63
Rate for Payer: Community Health Alliance Commercial	$155.12
Rate for Payer: Priority Health Commercial	$127.75
Rate for Payer: Priority Health PPO	$127.75

LUNG PANEL 3

Facility

$182.50

Hospital Charge Code	3101366
Hospital Revenue Code	310
Min. Negotiated Rate	$127.75
Max. Negotiated Rate	$155.12
Rate for Payer: Cash Price	$118.63
Rate for Payer: Community Health Alliance Commercial	$155.12
Rate for Payer: Priority Health Commercial	$127.75
Rate for Payer: Priority Health PPO	$127.75

LUNG PANEL 4

Facility

$182.50

Hospital Charge Code	3101367
Hospital Revenue Code	310
Min. Negotiated Rate	$127.75
Max. Negotiated Rate	$155.12
Rate for Payer: Cash Price	$118.63
Rate for Payer: Community Health Alliance Commercial	$155.12
Rate for Payer: Priority Health Commercial	$127.75
Rate for Payer: Priority Health PPO	$127.75

LUNG PANEL 5

Facility

$182.50

Hospital Charge Code	3101368
Hospital Revenue Code	310
Min. Negotiated Rate	$127.75
Max. Negotiated Rate	$155.12
Rate for Payer: Cash Price	$118.63
Rate for Payer: Community Health Alliance Commercial	$155.12
Rate for Payer: Priority Health Commercial	$127.75
Rate for Payer: Priority Health PPO	$127.75

LUNG PANEL 6

Facility

$182.50

Hospital Charge Code	3101369
Hospital Revenue Code	310
Min. Negotiated Rate	$127.75
Max. Negotiated Rate	$155.12
Rate for Payer: Cash Price	$118.63
Rate for Payer: Community Health Alliance Commercial	$155.12
Rate for Payer: Priority Health Commercial	$127.75
Rate for Payer: Priority Health PPO	$127.75

LUPIS COMP P-7

Facility

$12.45

Hospital Charge Code	3102212
Hospital Revenue Code	300
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$10.58
Rate for Payer: Cash Price	$8.09
Rate for Payer: Community Health Alliance Commercial	$10.58
Rate for Payer: Priority Health Commercial	$8.71
Rate for Payer: Priority Health PPO	$8.71

LUPUS ANTICOAGULANT

Facility

$87.00

Service Code	HCPCS 85300
Hospital Charge Code	3000681
Hospital Revenue Code	305
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$73.95
Rate for Payer: BCBS BCN 65	$12.44
Rate for Payer: Blue Care Network Medicare Advantage	$12.44
Rate for Payer: Cash Price	$56.55
Rate for Payer: Cash Price	$56.55
Rate for Payer: Community Health Alliance Commercial	$73.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.44
Rate for Payer: Meridian Health Plan Medicare	$12.44
Rate for Payer: Priority Health Commercial	$60.90
Rate for Payer: Priority Health Medicaid	$12.44
Rate for Payer: Priority Health Medicare	$12.44
Rate for Payer: Priority Health PPO	$60.90
Rate for Payer: United Health Care Medicaid	$12.44
Rate for Payer: United Health Care Medicare Advantage	$5.47

LUTEINIZING HORMONE-PED

Facility

$21.18

Hospital Charge Code	3102672
Hospital Revenue Code	300
Min. Negotiated Rate	$14.83
Max. Negotiated Rate	$18.00
Rate for Payer: Cash Price	$13.77
Rate for Payer: Community Health Alliance Commercial	$18.00
Rate for Payer: Priority Health Commercial	$14.83
Rate for Payer: Priority Health PPO	$14.83

LUTEINIZING RELEASING FACTOR

Facility

$196.29

Hospital Charge Code	3100129
Hospital Revenue Code	300
Min. Negotiated Rate	$137.40
Max. Negotiated Rate	$166.85
Rate for Payer: Cash Price	$127.59
Rate for Payer: Community Health Alliance Commercial	$166.85
Rate for Payer: Priority Health Commercial	$137.40
Rate for Payer: Priority Health PPO	$137.40

LUTENIZING HORMONE SERUM (LH)

Facility

$3.26

Service Code	HCPCS 83002
Hospital Charge Code	3005920
Hospital Revenue Code	301
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$19.45
Rate for Payer: BCBS BCN 65	$19.45
Rate for Payer: Blue Care Network Medicare Advantage	$19.45
Rate for Payer: Cash Price	$2.12
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.45
Rate for Payer: Meridian Health Plan Medicare	$19.45
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health Medicaid	$19.45
Rate for Payer: Priority Health Medicare	$19.45
Rate for Payer: Priority Health PPO	$2.28
Rate for Payer: United Health Care Medicaid	$19.45
Rate for Payer: United Health Care Medicare Advantage	$8.56

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges