Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ORGANISM ID BY SEQUENCING

Facility

$65.00

Hospital Charge Code	3102067
Hospital Revenue Code	300
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

ORGANISM ID BY SEQUENCING

Facility

$65.00

Hospital Charge Code	3101973
Hospital Revenue Code	300
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

ORIF HIP TRAY (FREE LOCK)

Facility

$3,463.00

Hospital Charge Code	27868506
Hospital Revenue Code	278
Min. Negotiated Rate	$2,424.10
Max. Negotiated Rate	$2,943.55
Rate for Payer: Cash Price	$2,250.95
Rate for Payer: Community Health Alliance Commercial	$2,943.55
Rate for Payer: Priority Health Commercial	$2,424.10
Rate for Payer: Priority Health PPO	$2,424.10

OR PER MINUTE

Facility

$27.00

Hospital Charge Code	3600025
Hospital Revenue Code	360
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

ORTHOPEDIC POST

Facility

$634.00

Hospital Charge Code	27061584
Hospital Revenue Code	270
Min. Negotiated Rate	$443.80
Max. Negotiated Rate	$538.90
Rate for Payer: Cash Price	$412.10
Rate for Payer: Community Health Alliance Commercial	$538.90
Rate for Payer: Priority Health Commercial	$443.80
Rate for Payer: Priority Health PPO	$443.80

ORTHOSIS

Facility

$269.00

Hospital Charge Code	27017798
Hospital Revenue Code	270
Min. Negotiated Rate	$188.30
Max. Negotiated Rate	$228.65
Rate for Payer: Cash Price	$174.85
Rate for Payer: Community Health Alliance Commercial	$228.65
Rate for Payer: Priority Health Commercial	$188.30
Rate for Payer: Priority Health PPO	$188.30

ORTHOSIS,FOAM WRIST/HAND

Facility

$121.00

Hospital Charge Code	27021766
Hospital Revenue Code	270
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$102.85
Rate for Payer: Cash Price	$78.65
Rate for Payer: Community Health Alliance Commercial	$102.85
Rate for Payer: Priority Health Commercial	$84.70
Rate for Payer: Priority Health PPO	$84.70

ORTHOSORB

Facility

$623.00

Hospital Charge Code	27018408
Hospital Revenue Code	270
Min. Negotiated Rate	$436.10
Max. Negotiated Rate	$529.55
Rate for Payer: Cash Price	$404.95
Rate for Payer: Community Health Alliance Commercial	$529.55
Rate for Payer: Priority Health Commercial	$436.10
Rate for Payer: Priority Health PPO	$436.10

ORTHOSORB ABSORABLE PIN #1050

Facility

$1,410.00

Hospital Charge Code	27061402
Hospital Revenue Code	278
Min. Negotiated Rate	$987.00
Max. Negotiated Rate	$1,198.50
Rate for Payer: Cash Price	$916.50
Rate for Payer: Community Health Alliance Commercial	$1,198.50
Rate for Payer: Priority Health Commercial	$987.00
Rate for Payer: Priority Health PPO	$987.00

ORTHOSORB ABSORABLE PIN #2054

Facility

$1,025.00

Hospital Charge Code	27061410
Hospital Revenue Code	278
Min. Negotiated Rate	$717.50
Max. Negotiated Rate	$871.25
Rate for Payer: Cash Price	$666.25
Rate for Payer: Community Health Alliance Commercial	$871.25
Rate for Payer: Priority Health Commercial	$717.50
Rate for Payer: Priority Health PPO	$717.50

ORTHOTIC FITTING AND TRAINING

Facility

$120.00

Hospital Charge Code	4300042
Hospital Revenue Code	430
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Priority Health Commercial	$84.00
Rate for Payer: Priority Health PPO	$84.00

ORTHOTIC FITTING AND TRAINING

Facility

$120.00

Hospital Charge Code	4200371
Hospital Revenue Code	420
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Priority Health Commercial	$84.00
Rate for Payer: Priority Health PPO	$84.00

OSMOLALITY, SERUM

Facility

$4.89

Service Code	HCPCS 83930
Hospital Charge Code	3006360
Hospital Revenue Code	301
Min. Negotiated Rate	$3.05
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	$3.18
Rate for Payer: Cash Price	$3.18
Rate for Payer: Community Health Alliance Commercial	$4.16
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	$3.42
Rate for Payer: Priority Health Medicaid	$6.94
Rate for Payer: Priority Health Medicare	$6.94
Rate for Payer: Priority Health PPO	$3.42
Rate for Payer: United Health Care Medicaid	$6.94
Rate for Payer: United Health Care Medicare Advantage	$3.05

OSMOLALITY, STOOL

Facility

$4.89

Service Code	HCPCS 84999
Hospital Charge Code	3006370
Hospital Revenue Code	301
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$4.16
Rate for Payer: Cash Price	$3.18
Rate for Payer: Community Health Alliance Commercial	$4.16
Rate for Payer: Priority Health Commercial	$3.42
Rate for Payer: Priority Health PPO	$3.42

OSMOLALITY, URINE

Facility

$5.09

Service Code	HCPCS 83935
Hospital Charge Code	3006380
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$7.16
Rate for Payer: BCBS BCN 65	$7.16
Rate for Payer: Blue Care Network Medicare Advantage	$7.16
Rate for Payer: Cash Price	$3.31
Rate for Payer: Cash Price	$3.31
Rate for Payer: Community Health Alliance Commercial	$4.33
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.16
Rate for Payer: Meridian Health Plan Medicare	$7.16
Rate for Payer: Priority Health Commercial	$3.56
Rate for Payer: Priority Health Medicaid	$7.16
Rate for Payer: Priority Health Medicare	$7.16
Rate for Payer: Priority Health PPO	$3.56
Rate for Payer: United Health Care Medicaid	$7.16
Rate for Payer: United Health Care Medicare Advantage	$3.15

OSMOTIC FRAGILITY

Facility

$50.00

Hospital Charge Code	3100946
Hospital Revenue Code	309
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE

Facility

$3,510.01

Service Code	CPT 28119
Hospital Revenue Code	360
Min. Negotiated Rate	$1,544.41
Max. Negotiated Rate	$3,510.01
Rate for Payer: BCBS BCN 65	$3,510.01
Rate for Payer: Blue Care Network Medicare Advantage	$3,510.01
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,510.01
Rate for Payer: Meridian Health Plan Medicare	$3,510.01
Rate for Payer: Priority Health Medicaid	$3,510.01
Rate for Payer: Priority Health Medicare	$3,510.01
Rate for Payer: United Health Care Medicaid	$3,510.01
Rate for Payer: United Health Care Medicare Advantage	$1,544.41

OSTEOCALCIN

Facility

$167.00

Service Code	HCPCS 83937
Hospital Charge Code	3006390
Hospital Revenue Code	301
Min. Negotiated Rate	$13.79
Max. Negotiated Rate	$141.95
Rate for Payer: BCBS BCN 65	$31.34
Rate for Payer: Blue Care Network Medicare Advantage	$31.34
Rate for Payer: Cash Price	$108.55
Rate for Payer: Cash Price	$108.55
Rate for Payer: Community Health Alliance Commercial	$141.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$31.34
Rate for Payer: Meridian Health Plan Medicare	$31.34
Rate for Payer: Priority Health Commercial	$116.90
Rate for Payer: Priority Health Medicaid	$31.34
Rate for Payer: Priority Health Medicare	$31.34
Rate for Payer: Priority Health PPO	$116.90
Rate for Payer: United Health Care Medicaid	$31.34
Rate for Payer: United Health Care Medicare Advantage	$13.79

OSTEOGEN BONE GROWTH STIMULATO

Facility

$15,807.00

Hospital Charge Code	27871708
Hospital Revenue Code	278
Min. Negotiated Rate	$11,064.90
Max. Negotiated Rate	$13,435.95
Rate for Payer: Cash Price	$10,274.55
Rate for Payer: Community Health Alliance Commercial	$13,435.95
Rate for Payer: Priority Health Commercial	$11,064.90
Rate for Payer: Priority Health PPO	$11,064.90

OSTEOTOMY L-PLATE

Facility

$1,627.00

Hospital Charge Code	27865585
Hospital Revenue Code	278
Min. Negotiated Rate	$1,138.90
Max. Negotiated Rate	$1,382.95
Rate for Payer: Cash Price	$1,057.55
Rate for Payer: Community Health Alliance Commercial	$1,382.95
Rate for Payer: Priority Health Commercial	$1,138.90
Rate for Payer: Priority Health PPO	$1,138.90

OSTOMY ADHESIVE PAD 4 X 4

Facility

$16.00

Hospital Charge Code	27011502
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
Rate for Payer: Priority Health Commercial	$11.20
Rate for Payer: Priority Health PPO	$11.20

OSTOMY ADHESIVE PAD 8 X 8

Facility

$59.00

Hospital Charge Code	27011551
Hospital Revenue Code	270
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

OT DEV OF COGN SKILLS 1st 15 M

Facility

$72.00

Hospital Charge Code	4300095
Hospital Revenue Code	430
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$61.20
Rate for Payer: Cash Price	$46.80
Rate for Payer: Community Health Alliance Commercial	$61.20
Rate for Payer: Priority Health Commercial	$50.40
Rate for Payer: Priority Health PPO	$50.40

OT DEV OF COG SKILLS ADD'L 15

Facility

$72.00

Hospital Charge Code	4300094
Hospital Revenue Code	430
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$61.20
Rate for Payer: Cash Price	$46.80
Rate for Payer: Community Health Alliance Commercial	$61.20
Rate for Payer: Priority Health Commercial	$50.40
Rate for Payer: Priority Health PPO	$50.40

OT E-STIMULATION ATTENDED

Facility

$117.00

Hospital Charge Code	4300096
Hospital Revenue Code	430
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$99.45
Rate for Payer: Cash Price	$76.05
Rate for Payer: Community Health Alliance Commercial	$99.45
Rate for Payer: Priority Health Commercial	$81.90
Rate for Payer: Priority Health PPO	$81.90

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges