Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

OPIATES 1

Facility

$16.67

Hospital Charge Code	3101354
Hospital Revenue Code	300
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$14.17
Rate for Payer: Cash Price	$10.84
Rate for Payer: Community Health Alliance Commercial	$14.17
Rate for Payer: Priority Health Commercial	$11.67
Rate for Payer: Priority Health PPO	$11.67

OPIATES 1 OR MORE URINE

Facility

$13.85

Service Code	HCPCS G6056
Hospital Charge Code	3100890
Hospital Revenue Code	300
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$11.77
Rate for Payer: Cash Price	$9.00
Rate for Payer: Community Health Alliance Commercial	$11.77
Rate for Payer: Priority Health Commercial	$9.70
Rate for Payer: Priority Health PPO	$9.70

OPIATES 2

Facility

$16.67

Hospital Charge Code	3101355
Hospital Revenue Code	300
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$14.17
Rate for Payer: Cash Price	$10.84
Rate for Payer: Community Health Alliance Commercial	$14.17
Rate for Payer: Priority Health Commercial	$11.67
Rate for Payer: Priority Health PPO	$11.67

OPIATES 3

Facility

$16.66

Hospital Charge Code	3101356
Hospital Revenue Code	300
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$14.16
Rate for Payer: Cash Price	$10.83
Rate for Payer: Community Health Alliance Commercial	$14.16
Rate for Payer: Priority Health Commercial	$11.66
Rate for Payer: Priority Health PPO	$11.66

OPIATES CONF MS UR

Facility

$13.85

Hospital Charge Code	3102463
Hospital Revenue Code	300
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$11.77
Rate for Payer: Cash Price	$9.00
Rate for Payer: Community Health Alliance Commercial	$11.77
Rate for Payer: Priority Health Commercial	$9.70
Rate for Payer: Priority Health PPO	$9.70

OPIATES LC

Facility

$7.49

Service Code	HCPCS 80307
Hospital Charge Code	3100871
Hospital Revenue Code	301
Min. Negotiated Rate	$5.24
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	$4.87
Rate for Payer: Cash Price	$4.87
Rate for Payer: Community Health Alliance Commercial	$6.37
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	$5.24
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$5.24
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

OPIATES QUANT URINE

Facility

$36.00

Hospital Charge Code	3100888
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$30.60
Rate for Payer: Cash Price	$23.40
Rate for Payer: Community Health Alliance Commercial	$30.60
Rate for Payer: Priority Health Commercial	$25.20
Rate for Payer: Priority Health PPO	$25.20

OPIOIDS SCREEN URINE

Facility

$10.00

Service Code	HCPCS 80307
Hospital Charge Code	3100872
Hospital Revenue Code	301
Min. Negotiated Rate	$7.00
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	$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	$65.25
Rate for Payer: Meridian Health Plan Medicare	$65.25
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$7.00
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

O-P PVA ONLY

Facility

$4.90

Hospital Charge Code	3102679
Hospital Revenue Code	300
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$4.17
Rate for Payer: Cash Price	$3.19
Rate for Payer: Community Health Alliance Commercial	$4.17
Rate for Payer: Priority Health Commercial	$3.43
Rate for Payer: Priority Health PPO	$3.43

OP ROUTINE GIARDIA/CRYPTO AG

Facility

$128.00

Hospital Charge Code	3003623
Hospital Revenue Code	306
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$108.80
Rate for Payer: Cash Price	$83.20
Rate for Payer: Community Health Alliance Commercial	$108.80
Rate for Payer: Priority Health Commercial	$89.60
Rate for Payer: Priority Health PPO	$89.60

OPT-1

Facility

$4.37

Hospital Charge Code	3102121
Hospital Revenue Code	300
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.71
Rate for Payer: Cash Price	$2.84
Rate for Payer: Community Health Alliance Commercial	$3.71
Rate for Payer: Priority Health Commercial	$3.06
Rate for Payer: Priority Health PPO	$3.06

OPT-2

Facility

$4.38

Hospital Charge Code	3102122
Hospital Revenue Code	300
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$3.72
Rate for Payer: Cash Price	$2.85
Rate for Payer: Community Health Alliance Commercial	$3.72
Rate for Payer: Priority Health Commercial	$3.07
Rate for Payer: Priority Health PPO	$3.07

OPTHALMIC DRESSING TRAY

Facility

$180.00

Hospital Charge Code	27015644
Hospital Revenue Code	270
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$153.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Community Health Alliance Commercial	$153.00
Rate for Payer: Priority Health Commercial	$126.00
Rate for Payer: Priority Health PPO	$126.00

OPTIFIX/SORBAFIX FIXATION SYS

Facility

$1,432.03

Hospital Charge Code	27284415
Hospital Revenue Code	272
Min. Negotiated Rate	$1,002.42
Max. Negotiated Rate	$1,217.23
Rate for Payer: Cash Price	$930.82
Rate for Payer: Community Health Alliance Commercial	$1,217.23
Rate for Payer: Priority Health Commercial	$1,002.42
Rate for Payer: Priority Health PPO	$1,002.42

OPTILUME PROSTRATE SYSTEM

Facility

$1,918.00

Hospital Charge Code	27016972
Hospital Revenue Code	270
Min. Negotiated Rate	$1,342.60
Max. Negotiated Rate	$1,630.30
Rate for Payer: Cash Price	$1,246.70
Rate for Payer: Community Health Alliance Commercial	$1,630.30
Rate for Payer: Priority Health Commercial	$1,342.60
Rate for Payer: Priority Health PPO	$1,342.60

OPTIPORE

Facility

$18.00

Hospital Charge Code	27016469
Hospital Revenue Code	270
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$15.30
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health PPO	$12.60

OR ACUITY LEVEL I

Facility

$2,095.00

Hospital Charge Code	3600011
Hospital Revenue Code	360
Min. Negotiated Rate	$1,466.50
Max. Negotiated Rate	$1,780.75
Rate for Payer: Cash Price	$1,361.75
Rate for Payer: Community Health Alliance Commercial	$1,780.75
Rate for Payer: Priority Health Commercial	$1,466.50
Rate for Payer: Priority Health PPO	$1,466.50

OR ACUITY LEVEL II

Facility

$2,285.00

Hospital Charge Code	3600012
Hospital Revenue Code	360
Min. Negotiated Rate	$1,599.50
Max. Negotiated Rate	$1,942.25
Rate for Payer: Cash Price	$1,485.25
Rate for Payer: Community Health Alliance Commercial	$1,942.25
Rate for Payer: Priority Health Commercial	$1,599.50
Rate for Payer: Priority Health PPO	$1,599.50

OR ACUITY LEVEL III

Facility

$3,073.00

Hospital Charge Code	3600013
Hospital Revenue Code	360
Min. Negotiated Rate	$2,151.10
Max. Negotiated Rate	$2,612.05
Rate for Payer: Cash Price	$1,997.45
Rate for Payer: Community Health Alliance Commercial	$2,612.05
Rate for Payer: Priority Health Commercial	$2,151.10
Rate for Payer: Priority Health PPO	$2,151.10

OR ACUITY LEVEL IV

Facility

$3,511.00

Hospital Charge Code	3600014
Hospital Revenue Code	360
Min. Negotiated Rate	$2,457.70
Max. Negotiated Rate	$2,984.35
Rate for Payer: Cash Price	$2,282.15
Rate for Payer: Community Health Alliance Commercial	$2,984.35
Rate for Payer: Priority Health Commercial	$2,457.70
Rate for Payer: Priority Health PPO	$2,457.70

ORAL FUNCTION TREAT 92526 NO Q

Facility

$157.00

Service Code	HCPCS 92526 GN
Hospital Charge Code	4400030
Hospital Revenue Code	440
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

ORBITAL IMPLANT 16MM

Facility

$2,950.00

Hospital Charge Code	27021600
Hospital Revenue Code	278
Min. Negotiated Rate	$2,065.00
Max. Negotiated Rate	$2,507.50
Rate for Payer: Cash Price	$1,917.50
Rate for Payer: Community Health Alliance Commercial	$2,507.50
Rate for Payer: Priority Health Commercial	$2,065.00
Rate for Payer: Priority Health PPO	$2,065.00

ORGANIC ACID PLASMA

Facility

$205.00

Hospital Charge Code	3101614
Hospital Revenue Code	300
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$174.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Community Health Alliance Commercial	$174.25
Rate for Payer: Priority Health Commercial	$143.50
Rate for Payer: Priority Health PPO	$143.50

ORGANIC ACID,QUANTITATIVE

Facility

$20.00

Service Code	HCPCS 83918
Hospital Charge Code	3006355
Hospital Revenue Code	301
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$24.78
Rate for Payer: BCBS BCN 65	$24.78
Rate for Payer: Blue Care Network Medicare Advantage	$24.78
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$24.78
Rate for Payer: Meridian Health Plan Medicare	$24.78
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health Medicaid	$24.78
Rate for Payer: Priority Health Medicare	$24.78
Rate for Payer: Priority Health PPO	$14.00
Rate for Payer: United Health Care Medicaid	$24.78
Rate for Payer: United Health Care Medicare Advantage	$10.90

ORGANISM ID BACTERIA

Facility

$6.95

Hospital Charge Code	3101959
Hospital Revenue Code	300
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$5.91
Rate for Payer: Cash Price	$4.52
Rate for Payer: Community Health Alliance Commercial	$5.91
Rate for Payer: Priority Health Commercial	$4.87
Rate for Payer: Priority Health PPO	$4.87

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges