Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PAIN QUANT BUPRENORPHINE

Facility

$44.00

Hospital Charge Code	3100652
Hospital Revenue Code	309
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

PAIN QUANT BUPRENORPHINE

Facility

$42.00

Service Code	HCPCS G0480
Hospital Charge Code	3100827
Hospital Revenue Code	309
Min. Negotiated Rate	$29.40
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	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
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	$29.40
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$29.40
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

PAIN QUANT BUTALBITAL

Facility

$44.00

Service Code	HCPCS G6043
Hospital Charge Code	3100665
Hospital Revenue Code	309
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

PAIN QUANT COCAINE MET

Facility

$44.00

Hospital Charge Code	3100671
Hospital Revenue Code	309
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

PAIN QUANT DIHYDROCODEINE

Facility

$44.00

Hospital Charge Code	3100646
Hospital Revenue Code	309
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

PAIN QUANT FENTANYL

Facility

$44.00

Service Code	HCPCS G0480
Hospital Charge Code	3100651
Hospital Revenue Code	309
Min. Negotiated Rate	$30.80
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	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
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	$30.80
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$30.80
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

PAIN QUANT MARIJUANA METAB

Facility

$44.00

Hospital Charge Code	3100655
Hospital Revenue Code	309
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

PAIN QUANT MEPERIDINE

Facility

$83.00

Service Code	HCPCS G0480
Hospital Charge Code	3100826
Hospital Revenue Code	309
Min. Negotiated Rate	$52.87
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	$53.95
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
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	$58.10
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$58.10
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

PAIN QUANT MEPERIDINE

Facility

$44.00

Hospital Charge Code	3100653
Hospital Revenue Code	309
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

PAIN QUANT METHADONE

Facility

$44.00

Hospital Charge Code	3100656
Hospital Revenue Code	309
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

PAIN QUANT PENTOBARBITAL

Facility

$44.00

Service Code	HCPCS G6043
Hospital Charge Code	3100666
Hospital Revenue Code	309
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

PAIN QUANT PHENOBARBITAL

Facility

$44.00

Service Code	HCPCS G6043
Hospital Charge Code	3100667
Hospital Revenue Code	309
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

PAIN QUANT SECOBARBITAL

Facility

$44.00

Service Code	HCPCS G6043
Hospital Charge Code	3100668
Hospital Revenue Code	309
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

PAIN QUANT TRAMADOL

Facility

$44.00

Hospital Charge Code	3100654
Hospital Revenue Code	309
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

PAL (PROBE FOR ASPIRATION)

Facility

$128.00

Hospital Charge Code	27019927
Hospital Revenue Code	270
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

PANCA IGG TITER BY IFA

Facility

$31.80

Hospital Charge Code	3101084
Hospital Revenue Code	300
Min. Negotiated Rate	$22.26
Max. Negotiated Rate	$27.03
Rate for Payer: Cash Price	$20.67
Rate for Payer: Community Health Alliance Commercial	$27.03
Rate for Payer: Priority Health Commercial	$22.26
Rate for Payer: Priority Health PPO	$22.26

PANCREASTATIN

Facility

$245.00

Hospital Charge Code	3102453
Hospital Revenue Code	300
Min. Negotiated Rate	$171.50
Max. Negotiated Rate	$208.25
Rate for Payer: Cash Price	$159.25
Rate for Payer: Community Health Alliance Commercial	$208.25
Rate for Payer: Priority Health Commercial	$171.50
Rate for Payer: Priority Health PPO	$171.50

PANCREATIC ELASTASE FECES

Facility

$65.00

Hospital Charge Code	3100128
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

PANCREATIC ELESTASE

Facility

$252.00

Hospital Charge Code	3000795
Hospital Revenue Code	301
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$214.20
Rate for Payer: Cash Price	$163.80
Rate for Payer: Community Health Alliance Commercial	$214.20
Rate for Payer: Priority Health Commercial	$176.40
Rate for Payer: Priority Health PPO	$176.40

PANCREATIC POLYPEPTIDE

Facility

$35.00

Hospital Charge Code	3102117
Hospital Revenue Code	300
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

PANEL 603851

Facility

$7.52

Hospital Charge Code	31027701
Hospital Revenue Code	300
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$6.39
Rate for Payer: Cash Price	$4.89
Rate for Payer: Community Health Alliance Commercial	$6.39
Rate for Payer: Priority Health Commercial	$5.26
Rate for Payer: Priority Health PPO	$5.26

PANEL 604239

Facility

$14.58

Hospital Charge Code	31027682
Hospital Revenue Code	300
Min. Negotiated Rate	$10.21
Max. Negotiated Rate	$12.39
Rate for Payer: Cash Price	$9.48
Rate for Payer: Community Health Alliance Commercial	$12.39
Rate for Payer: Priority Health Commercial	$10.21
Rate for Payer: Priority Health PPO	$10.21

PANEL 604721

Facility

$11.34

Hospital Charge Code	31027683
Hospital Revenue Code	300
Min. Negotiated Rate	$7.94
Max. Negotiated Rate	$9.64
Rate for Payer: Cash Price	$7.37
Rate for Payer: Community Health Alliance Commercial	$9.64
Rate for Payer: Priority Health Commercial	$7.94
Rate for Payer: Priority Health PPO	$7.94

PANEL 604726

Facility

$36.00

Hospital Charge Code	31027686
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

Panel Charge 603848

Facility

$9.78

Hospital Charge Code	31027675
Hospital Revenue Code	300
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$8.31
Rate for Payer: Cash Price	$6.36
Rate for Payer: Community Health Alliance Commercial	$8.31
Rate for Payer: Priority Health Commercial	$6.85
Rate for Payer: Priority Health PPO	$6.85

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges