Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PAS STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100420
Hospital Revenue Code	310
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

PATCH, CARDIOVASCULAR .4MM

Facility

$433.00

Hospital Charge Code	27018085
Hospital Revenue Code	278
Min. Negotiated Rate	$303.10
Max. Negotiated Rate	$368.05
Rate for Payer: Cash Price	$281.45
Rate for Payer: Community Health Alliance Commercial	$368.05
Rate for Payer: Priority Health Commercial	$303.10
Rate for Payer: Priority Health PPO	$303.10

PATCH,KUGEL 10 X 13

Facility

$6,158.00

Service Code	HCPCS C1781
Hospital Charge Code	27267128
Hospital Revenue Code	278
Min. Negotiated Rate	$4,310.60
Max. Negotiated Rate	$5,234.30
Rate for Payer: Cash Price	$4,002.70
Rate for Payer: Community Health Alliance Commercial	$5,234.30
Rate for Payer: Priority Health Commercial	$4,310.60
Rate for Payer: Priority Health PPO	$4,310.60

PATCH,VASCULAR PERIPHERAL

Facility

$332.00

Hospital Charge Code	27266179
Hospital Revenue Code	272
Min. Negotiated Rate	$232.40
Max. Negotiated Rate	$282.20
Rate for Payer: Cash Price	$215.80
Rate for Payer: Community Health Alliance Commercial	$282.20
Rate for Payer: Priority Health Commercial	$232.40
Rate for Payer: Priority Health PPO	$232.40

PATELLA

Facility

$1,581.00

Hospital Charge Code	27263505
Hospital Revenue Code	272
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$1,343.85
Rate for Payer: Cash Price	$1,027.65
Rate for Payer: Community Health Alliance Commercial	$1,343.85
Rate for Payer: Priority Health Commercial	$1,106.70
Rate for Payer: Priority Health PPO	$1,106.70

PATELLA,REAMER

Facility

$507.00

Hospital Charge Code	27263562
Hospital Revenue Code	272
Min. Negotiated Rate	$354.90
Max. Negotiated Rate	$430.95
Rate for Payer: Cash Price	$329.55
Rate for Payer: Community Health Alliance Commercial	$430.95
Rate for Payer: Priority Health Commercial	$354.90
Rate for Payer: Priority Health PPO	$354.90

PATELLAR TENDON

Facility

$8,045.00

Hospital Charge Code	27874506
Hospital Revenue Code	278
Min. Negotiated Rate	$5,631.50
Max. Negotiated Rate	$6,838.25
Rate for Payer: Cash Price	$5,229.25
Rate for Payer: Community Health Alliance Commercial	$6,838.25
Rate for Payer: Priority Health Commercial	$5,631.50
Rate for Payer: Priority Health PPO	$5,631.50

PATELLA STABILIZER

Facility

$89.00

Hospital Charge Code	27062216
Hospital Revenue Code	270
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$75.65
Rate for Payer: Cash Price	$57.85
Rate for Payer: Community Health Alliance Commercial	$75.65
Rate for Payer: Priority Health Commercial	$62.30
Rate for Payer: Priority Health PPO	$62.30

PATH CONSULT DURING SURG PROF

Facility

$103.00

Service Code	HCPCS 88329
Hospital Charge Code	9710570
Hospital Revenue Code	971
Min. Negotiated Rate	$27.84
Max. Negotiated Rate	$87.55
Rate for Payer: BCBS BCN 65	$63.28
Rate for Payer: Blue Care Network Medicare Advantage	$63.28
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Community Health Alliance Commercial	$87.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$63.28
Rate for Payer: Meridian Health Plan Medicare	$63.28
Rate for Payer: Priority Health Commercial	$72.10
Rate for Payer: Priority Health Medicaid	$63.28
Rate for Payer: Priority Health Medicare	$63.28
Rate for Payer: Priority Health PPO	$72.10
Rate for Payer: United Health Care Medicaid	$63.28
Rate for Payer: United Health Care Medicare Advantage	$27.84

PATH-IMAGE ANALYSIS GLOBAL

Facility

$418.00

Service Code	HCPCS 88358
Hospital Charge Code	3100486
Hospital Revenue Code	312
Min. Negotiated Rate	$80.42
Max. Negotiated Rate	$355.30
Rate for Payer: BCBS BCN 65	$182.76
Rate for Payer: Blue Care Network Medicare Advantage	$182.76
Rate for Payer: Cash Price	$271.70
Rate for Payer: Cash Price	$271.70
Rate for Payer: Community Health Alliance Commercial	$355.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$182.76
Rate for Payer: Meridian Health Plan Medicare	$182.76
Rate for Payer: Priority Health Commercial	$292.60
Rate for Payer: Priority Health Medicaid	$182.76
Rate for Payer: Priority Health Medicare	$182.76
Rate for Payer: Priority Health PPO	$292.60
Rate for Payer: United Health Care Medicaid	$182.76
Rate for Payer: United Health Care Medicare Advantage	$80.42

PATH INTERP FOR BLEED

Facility

$14.60

Hospital Charge Code	3101414
Hospital Revenue Code	305
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$12.41
Rate for Payer: Cash Price	$9.49
Rate for Payer: Community Health Alliance Commercial	$12.41
Rate for Payer: Priority Health Commercial	$10.22
Rate for Payer: Priority Health PPO	$10.22

PATHOLOGY LEVEL 1 TECH

Facility

$32.00

Service Code	HCPCS 88300
Hospital Charge Code	3100430
Hospital Revenue Code	310
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$31.03
Rate for Payer: BCBS BCN 65	$31.03
Rate for Payer: Blue Care Network Medicare Advantage	$31.03
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Community Health Alliance Commercial	$27.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$31.03
Rate for Payer: Meridian Health Plan Medicare	$31.03
Rate for Payer: Priority Health Commercial	$22.40
Rate for Payer: Priority Health Medicaid	$31.03
Rate for Payer: Priority Health Medicare	$31.03
Rate for Payer: Priority Health PPO	$22.40
Rate for Payer: United Health Care Medicaid	$31.03
Rate for Payer: United Health Care Medicare Advantage	$13.65

PATHOLOGY LEVEL 2 TECH

Facility

$85.00

Service Code	HCPCS 88302
Hospital Charge Code	3100440
Hospital Revenue Code	310
Min. Negotiated Rate	$17.63
Max. Negotiated Rate	$72.25
Rate for Payer: BCBS BCN 65	$40.07
Rate for Payer: Blue Care Network Medicare Advantage	$40.07
Rate for Payer: Cash Price	$55.25
Rate for Payer: Cash Price	$55.25
Rate for Payer: Community Health Alliance Commercial	$72.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$40.07
Rate for Payer: Meridian Health Plan Medicare	$40.07
Rate for Payer: Priority Health Commercial	$59.50
Rate for Payer: Priority Health Medicaid	$40.07
Rate for Payer: Priority Health Medicare	$40.07
Rate for Payer: Priority Health PPO	$59.50
Rate for Payer: United Health Care Medicaid	$40.07
Rate for Payer: United Health Care Medicare Advantage	$17.63

PATHOLOGY LEVEL 3 TECH

Facility

$121.00

Service Code	HCPCS 88304
Hospital Charge Code	3100450
Hospital Revenue Code	310
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$102.85
Rate for Payer: BCBS BCN 65	$55.90
Rate for Payer: Blue Care Network Medicare Advantage	$55.90
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Community Health Alliance Commercial	$102.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$55.90
Rate for Payer: Meridian Health Plan Medicare	$55.90
Rate for Payer: Priority Health Commercial	$84.70
Rate for Payer: Priority Health Medicaid	$55.90
Rate for Payer: Priority Health Medicare	$55.90
Rate for Payer: Priority Health PPO	$84.70
Rate for Payer: United Health Care Medicaid	$55.90
Rate for Payer: United Health Care Medicare Advantage	$24.60

PATHOLOGY LEVEL 4-KC

Facility

$35.04

Hospital Charge Code	3102682
Hospital Revenue Code	300
Min. Negotiated Rate	$24.53
Max. Negotiated Rate	$29.78
Rate for Payer: Cash Price	$22.78
Rate for Payer: Community Health Alliance Commercial	$29.78
Rate for Payer: Priority Health Commercial	$24.53
Rate for Payer: Priority Health PPO	$24.53

PATHOLOGY LEVEL 4-PROF KC

Facility

$35.36

Hospital Charge Code	3102683
Hospital Revenue Code	971
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$30.06
Rate for Payer: Cash Price	$22.98
Rate for Payer: Community Health Alliance Commercial	$30.06
Rate for Payer: Priority Health Commercial	$24.75
Rate for Payer: Priority Health PPO	$24.75

PATHOLOGY LEVEL 4 TECH

Facility

$287.00

Service Code	HCPCS 88305
Hospital Charge Code	3100460
Hospital Revenue Code	310
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$243.95
Rate for Payer: BCBS BCN 65	$55.90
Rate for Payer: Blue Care Network Medicare Advantage	$55.90
Rate for Payer: Cash Price	$186.55
Rate for Payer: Cash Price	$186.55
Rate for Payer: Community Health Alliance Commercial	$243.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$55.90
Rate for Payer: Meridian Health Plan Medicare	$55.90
Rate for Payer: Priority Health Commercial	$200.90
Rate for Payer: Priority Health Medicaid	$55.90
Rate for Payer: Priority Health Medicare	$55.90
Rate for Payer: Priority Health PPO	$200.90
Rate for Payer: United Health Care Medicaid	$55.90
Rate for Payer: United Health Care Medicare Advantage	$24.60

PATHOLOGY LEVEL 5 TECH

Facility

$219.00

Service Code	HCPCS 88307
Hospital Charge Code	3100470
Hospital Revenue Code	310
Min. Negotiated Rate	$153.30
Max. Negotiated Rate	$384.52
Rate for Payer: BCBS BCN 65	$384.52
Rate for Payer: Blue Care Network Medicare Advantage	$384.52
Rate for Payer: Cash Price	$142.35
Rate for Payer: Cash Price	$142.35
Rate for Payer: Community Health Alliance Commercial	$186.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$384.52
Rate for Payer: Meridian Health Plan Medicare	$384.52
Rate for Payer: Priority Health Commercial	$153.30
Rate for Payer: Priority Health Medicaid	$384.52
Rate for Payer: Priority Health Medicare	$384.52
Rate for Payer: Priority Health PPO	$153.30
Rate for Payer: United Health Care Medicaid	$384.52
Rate for Payer: United Health Care Medicare Advantage	$169.19

PATHOLOGY LEVEL 6 TECH

Facility

$288.00

Service Code	HCPCS 88309
Hospital Charge Code	3100480
Hospital Revenue Code	310
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$864.29
Rate for Payer: BCBS BCN 65	$864.29
Rate for Payer: Blue Care Network Medicare Advantage	$864.29
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Community Health Alliance Commercial	$244.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$864.29
Rate for Payer: Meridian Health Plan Medicare	$864.29
Rate for Payer: Priority Health Commercial	$201.60
Rate for Payer: Priority Health Medicaid	$864.29
Rate for Payer: Priority Health Medicare	$864.29
Rate for Payer: Priority Health PPO	$201.60
Rate for Payer: United Health Care Medicaid	$864.29
Rate for Payer: United Health Care Medicare Advantage	$380.29

PBC PARTIAL BLOOD COUNT

Facility

$27.00

Service Code	HCPCS 85027
Hospital Charge Code	3009080
Hospital Revenue Code	305
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$22.95
Rate for Payer: BCBS BCN 65	$6.79
Rate for Payer: Blue Care Network Medicare Advantage	$6.79
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.79
Rate for Payer: Meridian Health Plan Medicare	$6.79
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health Medicaid	$6.79
Rate for Payer: Priority Health Medicare	$6.79
Rate for Payer: Priority Health PPO	$18.90
Rate for Payer: United Health Care Medicaid	$6.79
Rate for Payer: United Health Care Medicare Advantage	$2.99

PC-1

Facility

$3.26

Hospital Charge Code	31027676
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

PC-2

Facility

$3.26

Hospital Charge Code	31027677
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

PC-3

Facility

$3.26

Hospital Charge Code	31027678
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

PCA1 (YO) AB WB

Facility

$103.92

Hospital Charge Code	3101202
Hospital Revenue Code	300
Min. Negotiated Rate	$72.74
Max. Negotiated Rate	$88.33
Rate for Payer: Cash Price	$67.55
Rate for Payer: Community Health Alliance Commercial	$88.33
Rate for Payer: Priority Health Commercial	$72.74
Rate for Payer: Priority Health PPO	$72.74

PCAP-1

Facility

$10.83

Hospital Charge Code	3101787
Hospital Revenue Code	300
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$9.21
Rate for Payer: Cash Price	$7.04
Rate for Payer: Community Health Alliance Commercial	$9.21
Rate for Payer: Priority Health Commercial	$7.58
Rate for Payer: Priority Health PPO	$7.58

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges