Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ANTI-STRIATED MUSCLE

Facility

$119.00

Service Code	HCPCS 86255
Hospital Charge Code	3003075
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$101.15
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$77.35
Rate for Payer: Cash Price	$77.35
Rate for Payer: Community Health Alliance Commercial	$101.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.65
Rate for Payer: Meridian Health Plan Medicare	$12.65
Rate for Payer: Priority Health Commercial	$83.30
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$83.30
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

ANTISTRIATED MUSCLE AB

Facility

$8.99

Hospital Charge Code	3004917
Hospital Revenue Code	302
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$7.64
Rate for Payer: Cash Price	$5.84
Rate for Payer: Community Health Alliance Commercial	$7.64
Rate for Payer: Priority Health Commercial	$6.29
Rate for Payer: Priority Health PPO	$6.29

ANTITHROMBIN ANTIGEN-LC

Facility

$8.15

Hospital Charge Code	31027369
Hospital Revenue Code	300
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$6.93
Rate for Payer: Cash Price	$5.30
Rate for Payer: Community Health Alliance Commercial	$6.93
Rate for Payer: Priority Health Commercial	$5.71
Rate for Payer: Priority Health PPO	$5.71

ANTITHROMBIN III

Facility

$14.50

Service Code	HCPCS 85300
Hospital Charge Code	3001220
Hospital Revenue Code	305
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$12.44
Rate for Payer: BCBS BCN 65	$12.44
Rate for Payer: Blue Care Network Medicare Advantage	$12.44
Rate for Payer: Cash Price	$9.43
Rate for Payer: Cash Price	$9.43
Rate for Payer: Community Health Alliance Commercial	$12.32
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	$10.15
Rate for Payer: Priority Health Medicaid	$12.44
Rate for Payer: Priority Health Medicare	$12.44
Rate for Payer: Priority Health PPO	$10.15
Rate for Payer: United Health Care Medicaid	$12.44
Rate for Payer: United Health Care Medicare Advantage	$5.47

ANTI-THYROGLOBULIN ANTIBODY

Facility

$6.74

Service Code	HCPCS 86800
Hospital Charge Code	3003081
Hospital Revenue Code	302
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$16.71
Rate for Payer: BCBS BCN 65	$16.71
Rate for Payer: Blue Care Network Medicare Advantage	$16.71
Rate for Payer: Cash Price	$4.38
Rate for Payer: Cash Price	$4.38
Rate for Payer: Community Health Alliance Commercial	$5.73
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.71
Rate for Payer: Meridian Health Plan Medicare	$16.71
Rate for Payer: Priority Health Commercial	$4.72
Rate for Payer: Priority Health Medicaid	$16.71
Rate for Payer: Priority Health Medicare	$16.71
Rate for Payer: Priority Health PPO	$4.72
Rate for Payer: United Health Care Medicaid	$16.71
Rate for Payer: United Health Care Medicare Advantage	$7.35

ANTI-TRYPSIN (ALPHA)

Facility

$55.00

Service Code	HCPCS 82103
Hospital Charge Code	3000520
Hospital Revenue Code	301
Min. Negotiated Rate	$6.21
Max. Negotiated Rate	$46.75
Rate for Payer: BCBS BCN 65	$14.11
Rate for Payer: Blue Care Network Medicare Advantage	$14.11
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.11
Rate for Payer: Meridian Health Plan Medicare	$14.11
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health Medicaid	$14.11
Rate for Payer: Priority Health Medicare	$14.11
Rate for Payer: Priority Health PPO	$38.50
Rate for Payer: United Health Care Medicaid	$14.11
Rate for Payer: United Health Care Medicare Advantage	$6.21

ANTI XA

Facility

$40.73

Hospital Charge Code	3005808
Hospital Revenue Code	305
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$34.62
Rate for Payer: Cash Price	$26.47
Rate for Payer: Community Health Alliance Commercial	$34.62
Rate for Payer: Priority Health Commercial	$28.51
Rate for Payer: Priority Health PPO	$28.51

ANTI-YO

Facility

$181.00

Service Code	HCPCS 86255
Hospital Charge Code	3003715
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$153.85
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$117.65
Rate for Payer: Cash Price	$117.65
Rate for Payer: Community Health Alliance Commercial	$153.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.65
Rate for Payer: Meridian Health Plan Medicare	$12.65
Rate for Payer: Priority Health Commercial	$126.70
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$126.70
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

APCR-1

Facility

$158.15

Hospital Charge Code	3101980
Hospital Revenue Code	300
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$134.43
Rate for Payer: Cash Price	$102.80
Rate for Payer: Community Health Alliance Commercial	$134.43
Rate for Payer: Priority Health Commercial	$110.70
Rate for Payer: Priority Health PPO	$110.70

APCR-2

Facility

$158.15

Hospital Charge Code	3101981
Hospital Revenue Code	300
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$134.43
Rate for Payer: Cash Price	$102.80
Rate for Payer: Community Health Alliance Commercial	$134.43
Rate for Payer: Priority Health Commercial	$110.70
Rate for Payer: Priority Health PPO	$110.70

APCR-3

Facility

$158.15

Hospital Charge Code	3101982
Hospital Revenue Code	300
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$134.43
Rate for Payer: Cash Price	$102.80
Rate for Payer: Community Health Alliance Commercial	$134.43
Rate for Payer: Priority Health Commercial	$110.70
Rate for Payer: Priority Health PPO	$110.70

APCR-4

Facility

$158.15

Hospital Charge Code	3101983
Hospital Revenue Code	300
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$134.43
Rate for Payer: Cash Price	$102.80
Rate for Payer: Community Health Alliance Commercial	$134.43
Rate for Payer: Priority Health Commercial	$110.70
Rate for Payer: Priority Health PPO	$110.70

APCR-5

Facility

$158.15

Hospital Charge Code	3101984
Hospital Revenue Code	300
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$134.43
Rate for Payer: Cash Price	$102.80
Rate for Payer: Community Health Alliance Commercial	$134.43
Rate for Payer: Priority Health Commercial	$110.70
Rate for Payer: Priority Health PPO	$110.70

APCR-6

Facility

$158.15

Hospital Charge Code	3101985
Hospital Revenue Code	300
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$134.43
Rate for Payer: Cash Price	$102.80
Rate for Payer: Community Health Alliance Commercial	$134.43
Rate for Payer: Priority Health Commercial	$110.70
Rate for Payer: Priority Health PPO	$110.70

APO E GENOTYPING

Facility

$130.15

Hospital Charge Code	3000975
Hospital Revenue Code	301
Min. Negotiated Rate	$91.11
Max. Negotiated Rate	$110.63
Rate for Payer: Cash Price	$84.60
Rate for Payer: Community Health Alliance Commercial	$110.63
Rate for Payer: Priority Health Commercial	$91.11
Rate for Payer: Priority Health PPO	$91.11

APOLIPOPROTEIN B100

Facility

$76.00

Hospital Charge Code	3100606
Hospital Revenue Code	301
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$64.60
Rate for Payer: Cash Price	$49.40
Rate for Payer: Community Health Alliance Commercial	$64.60
Rate for Payer: Priority Health Commercial	$53.20
Rate for Payer: Priority Health PPO	$53.20

APOLIPOPROTEIN (LPa)

Facility

$8.76

Service Code	HCPCS 83695
Hospital Charge Code	3000707
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$15.04
Rate for Payer: BCBS BCN 65	$15.04
Rate for Payer: Blue Care Network Medicare Advantage	$15.04
Rate for Payer: Cash Price	$5.69
Rate for Payer: Cash Price	$5.69
Rate for Payer: Community Health Alliance Commercial	$7.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.04
Rate for Payer: Meridian Health Plan Medicare	$15.04
Rate for Payer: Priority Health Commercial	$6.13
Rate for Payer: Priority Health Medicaid	$15.04
Rate for Payer: Priority Health Medicare	$15.04
Rate for Payer: Priority Health PPO	$6.13
Rate for Payer: United Health Care Medicaid	$15.04
Rate for Payer: United Health Care Medicare Advantage	$6.62

APPLICATION LONG ARM SPLINT

Facility

$147.00

Hospital Charge Code	4501202
Hospital Revenue Code	450
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$124.95
Rate for Payer: Cash Price	$95.55
Rate for Payer: Community Health Alliance Commercial	$124.95
Rate for Payer: Priority Health Commercial	$102.90
Rate for Payer: Priority Health PPO	$102.90

APPLICATION LONG LEG SPLINT

Facility

$147.00

Hospital Charge Code	4501200
Hospital Revenue Code	450
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$124.95
Rate for Payer: Cash Price	$95.55
Rate for Payer: Community Health Alliance Commercial	$124.95
Rate for Payer: Priority Health Commercial	$102.90
Rate for Payer: Priority Health PPO	$102.90

APPLICATION SHORT ARM (DYNAMIC

Facility

$147.00

Hospital Charge Code	4501204
Hospital Revenue Code	450
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$124.95
Rate for Payer: Cash Price	$95.55
Rate for Payer: Community Health Alliance Commercial	$124.95
Rate for Payer: Priority Health Commercial	$102.90
Rate for Payer: Priority Health PPO	$102.90

APPLICATION SHORT ARM (STATIC)

Facility

$147.00

Hospital Charge Code	4501203
Hospital Revenue Code	450
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$124.95
Rate for Payer: Cash Price	$95.55
Rate for Payer: Community Health Alliance Commercial	$124.95
Rate for Payer: Priority Health Commercial	$102.90
Rate for Payer: Priority Health PPO	$102.90

APPLICATION SHORT LEG SPLINT

Facility

$147.00

Hospital Charge Code	4501201
Hospital Revenue Code	450
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$124.95
Rate for Payer: Cash Price	$95.55
Rate for Payer: Community Health Alliance Commercial	$124.95
Rate for Payer: Priority Health Commercial	$102.90
Rate for Payer: Priority Health PPO	$102.90

APRA7-1

Facility

$3.26

Hospital Charge Code	3102646
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

APRA7-10

Facility

$3.26

Hospital Charge Code	3102655
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

APRA7-11

Facility

$3.26

Hospital Charge Code	3102656
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges