Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PCAP-2

Facility

$10.83

Hospital Charge Code	3101788
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

PCAP-3

Facility

$10.83

Hospital Charge Code	3101789
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

PCAP-4

Facility

$10.83

Hospital Charge Code	3101790
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

PCAP-5

Facility

$10.83

Hospital Charge Code	3101791
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

PCAP-6

Facility

$11.85

Hospital Charge Code	3101792
Hospital Revenue Code	300
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$10.07
Rate for Payer: Cash Price	$7.70
Rate for Payer: Community Health Alliance Commercial	$10.07
Rate for Payer: Priority Health Commercial	$8.29
Rate for Payer: Priority Health PPO	$8.29

PC-ARC-FW

Facility

$867.10

Hospital Charge Code	3101326
Hospital Revenue Code	391
Min. Negotiated Rate	$606.97
Max. Negotiated Rate	$737.03
Rate for Payer: Cash Price	$563.62
Rate for Payer: Community Health Alliance Commercial	$737.03
Rate for Payer: Priority Health Commercial	$606.97
Rate for Payer: Priority Health PPO	$606.97

PCP QUAN ASSAY

Facility

$74.02

Service Code	HCPCS G0480
Hospital Charge Code	3100036
Hospital Revenue Code	301
Min. Negotiated Rate	$51.81
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	$48.11
Rate for Payer: Cash Price	$48.11
Rate for Payer: Community Health Alliance Commercial	$62.92
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	$51.81
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$51.81
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

PD-L1 22C3 PHARMADX ANALYSIS

Facility

$253.00

Hospital Charge Code	3101123
Hospital Revenue Code	310
Min. Negotiated Rate	$177.10
Max. Negotiated Rate	$215.05
Rate for Payer: Cash Price	$164.45
Rate for Payer: Community Health Alliance Commercial	$215.05
Rate for Payer: Priority Health Commercial	$177.10
Rate for Payer: Priority Health PPO	$177.10

PEANUT IGG4

Facility

$26.00

Hospital Charge Code	3100727
Hospital Revenue Code	302
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

PEDIATRIC ALLERGEN

Facility

$43.37

Hospital Charge Code	31027623
Hospital Revenue Code	300
Min. Negotiated Rate	$30.36
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$28.19
Rate for Payer: Community Health Alliance Commercial	$36.86
Rate for Payer: Priority Health Commercial	$30.36
Rate for Payer: Priority Health PPO	$30.36

PEG - 24 PULL

Facility

$304.00

Hospital Charge Code	27262827
Hospital Revenue Code	272
Min. Negotiated Rate	$212.80
Max. Negotiated Rate	$258.40
Rate for Payer: Cash Price	$197.60
Rate for Payer: Community Health Alliance Commercial	$258.40
Rate for Payer: Priority Health Commercial	$212.80
Rate for Payer: Priority Health PPO	$212.80

PEG, SMOOTH 2.0 X 14MM

Facility

$214.00

Service Code	HCPCS C1713
Hospital Charge Code	27868928
Hospital Revenue Code	278
Min. Negotiated Rate	$149.80
Max. Negotiated Rate	$181.90
Rate for Payer: Cash Price	$139.10
Rate for Payer: Community Health Alliance Commercial	$181.90
Rate for Payer: Priority Health Commercial	$149.80
Rate for Payer: Priority Health PPO	$149.80

PEG, SMOOTH 2.0 X 16MM

Facility

$634.00

Hospital Charge Code	27868936
Hospital Revenue Code	278
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

PEG, SMOOTH 2.0X18MM

Facility

$634.00

Service Code	HCPCS C1713
Hospital Charge Code	27872070
Hospital Revenue Code	278
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

PEG, SMOOTH 2.0 X 20MM

Facility

$214.00

Service Code	HCPCS C1713
Hospital Charge Code	27868944
Hospital Revenue Code	278
Min. Negotiated Rate	$149.80
Max. Negotiated Rate	$181.90
Rate for Payer: Cash Price	$139.10
Rate for Payer: Community Health Alliance Commercial	$181.90
Rate for Payer: Priority Health Commercial	$149.80
Rate for Payer: Priority Health PPO	$149.80

PEG, SMOOTH 2.0 X 22MM

Facility

$214.00

Service Code	HCPCS C1713
Hospital Charge Code	27868951
Hospital Revenue Code	278
Min. Negotiated Rate	$149.80
Max. Negotiated Rate	$181.90
Rate for Payer: Cash Price	$139.10
Rate for Payer: Community Health Alliance Commercial	$181.90
Rate for Payer: Priority Health Commercial	$149.80
Rate for Payer: Priority Health PPO	$149.80

PEG, STANDARD

Facility

$234.00

Service Code	HCPCS C1713
Hospital Charge Code	27872236
Hospital Revenue Code	278
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$198.90
Rate for Payer: Cash Price	$152.10
Rate for Payer: Community Health Alliance Commercial	$198.90
Rate for Payer: Priority Health Commercial	$163.80
Rate for Payer: Priority Health PPO	$163.80

PELVICAL

Facility

$1,500.00

Hospital Charge Code	27264942
Hospital Revenue Code	272
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Community Health Alliance Commercial	$1,275.00
Rate for Payer: Priority Health Commercial	$1,050.00
Rate for Payer: Priority Health PPO	$1,050.00

PELVICAL 4CM X 18CM

Facility

$1,104.00

Hospital Charge Code	27266500
Hospital Revenue Code	272
Min. Negotiated Rate	$772.80
Max. Negotiated Rate	$938.40
Rate for Payer: Cash Price	$717.60
Rate for Payer: Community Health Alliance Commercial	$938.40
Rate for Payer: Priority Health Commercial	$772.80
Rate for Payer: Priority Health PPO	$772.80

PEMPHIGOID PANEL

Facility

$583.45

Hospital Charge Code	3000906
Hospital Revenue Code	310
Min. Negotiated Rate	$408.42
Max. Negotiated Rate	$495.93
Rate for Payer: Cash Price	$379.24
Rate for Payer: Community Health Alliance Commercial	$495.93
Rate for Payer: Priority Health Commercial	$408.42
Rate for Payer: Priority Health PPO	$408.42

PENGUIN BIO SCREEN

Facility

$35.00

Hospital Charge Code	3100967
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

PENGUIN HEALTH ASSESSMENT

Facility

$35.00

Hospital Charge Code	3100824
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

PENICILLIUM CHYSOGENUM/NOTAT

Facility

$3.26

Hospital Charge Code	3100927
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

PENILE PROSTHESIS

Facility

$9,110.00

Service Code	HCPCS C1813
Hospital Charge Code	27060610
Hospital Revenue Code	278
Min. Negotiated Rate	$6,377.00
Max. Negotiated Rate	$7,743.50
Rate for Payer: Cash Price	$5,921.50
Rate for Payer: Community Health Alliance Commercial	$7,743.50
Rate for Payer: Priority Health Commercial	$6,377.00
Rate for Payer: Priority Health PPO	$6,377.00

PENILE PROSTHESIS 16CM X 13

Facility

$9,588.00

Service Code	HCPCS C1813
Hospital Charge Code	27014845
Hospital Revenue Code	278
Min. Negotiated Rate	$6,711.60
Max. Negotiated Rate	$8,149.80
Rate for Payer: Cash Price	$6,232.20
Rate for Payer: Community Health Alliance Commercial	$8,149.80
Rate for Payer: Priority Health Commercial	$6,711.60
Rate for Payer: Priority Health PPO	$6,711.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges