Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PENROSE DRAIN - STERILE

Facility

$13.00

Hospital Charge Code	27012468
Hospital Revenue Code	270
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$11.05
Rate for Payer: Cash Price	$8.45
Rate for Payer: Community Health Alliance Commercial	$11.05
Rate for Payer: Priority Health Commercial	$9.10
Rate for Payer: Priority Health PPO	$9.10

PENTOBARNITAL

Facility

$13.32

Service Code	HCPCS G0480
Hospital Charge Code	3006415
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
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	$8.66
Rate for Payer: Cash Price	$8.66
Rate for Payer: Community Health Alliance Commercial	$11.32
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	$9.32
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$9.32
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

PEPSINOGEN 1

Facility

$175.00

Hospital Charge Code	3101798
Hospital Revenue Code	300
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$148.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Community Health Alliance Commercial	$148.75
Rate for Payer: Priority Health Commercial	$122.50
Rate for Payer: Priority Health PPO	$122.50

PEPSINOGEN 2

Facility

$240.00

Hospital Charge Code	3101799
Hospital Revenue Code	300
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$204.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Community Health Alliance Commercial	$204.00
Rate for Payer: Priority Health Commercial	$168.00
Rate for Payer: Priority Health PPO	$168.00

PERC NDL CORE BRST BX W/GUIDE

Facility

$1,519.00

Hospital Charge Code	4000262
Hospital Revenue Code	361
Min. Negotiated Rate	$1,063.30
Max. Negotiated Rate	$1,291.15
Rate for Payer: Cash Price	$987.35
Rate for Payer: Community Health Alliance Commercial	$1,291.15
Rate for Payer: Priority Health Commercial	$1,063.30
Rate for Payer: Priority Health PPO	$1,063.30

PERCUFLEX TAIL WITHOUT WIRE

Facility

$577.00

Hospital Charge Code	27060644
Hospital Revenue Code	272
Min. Negotiated Rate	$403.90
Max. Negotiated Rate	$490.45
Rate for Payer: Cash Price	$375.05
Rate for Payer: Community Health Alliance Commercial	$490.45
Rate for Payer: Priority Health Commercial	$403.90
Rate for Payer: Priority Health PPO	$403.90

PERCUTANEOUS ENDO/GASTRO/PEG/S

Facility

$365.00

Hospital Charge Code	27023325
Hospital Revenue Code	272
Min. Negotiated Rate	$255.50
Max. Negotiated Rate	$310.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Community Health Alliance Commercial	$310.25
Rate for Payer: Priority Health Commercial	$255.50
Rate for Payer: Priority Health PPO	$255.50

PERCUTANEOUS NEPHROSTOMY SETPN

Facility

$528.00

Service Code	HCPCS C1769
Hospital Charge Code	27014613
Hospital Revenue Code	272
Min. Negotiated Rate	$369.60
Max. Negotiated Rate	$448.80
Rate for Payer: Cash Price	$343.20
Rate for Payer: Community Health Alliance Commercial	$448.80
Rate for Payer: Priority Health Commercial	$369.60
Rate for Payer: Priority Health PPO	$369.60

PERFIX PLUG - LARGE

Facility

$507.00

Service Code	HCPCS C1781
Hospital Charge Code	27263120
Hospital Revenue Code	278
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

PERFIX PLUG,MEDIUM

Facility

$507.00

Service Code	HCPCS C1781
Hospital Charge Code	27263772
Hospital Revenue Code	278
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

PERFIX PLUG - X-LARGE

Facility

$607.00

Service Code	HCPCS C1781
Hospital Charge Code	27261318
Hospital Revenue Code	278
Min. Negotiated Rate	$424.90
Max. Negotiated Rate	$515.95
Rate for Payer: Cash Price	$394.55
Rate for Payer: Community Health Alliance Commercial	$515.95
Rate for Payer: Priority Health Commercial	$424.90
Rate for Payer: Priority Health PPO	$424.90

PERIGEE CYSTOCELE REPAIR MESH

Facility

$4,296.00

Service Code	HCPCS C1781
Hospital Charge Code	27871609
Hospital Revenue Code	278
Min. Negotiated Rate	$3,007.20
Max. Negotiated Rate	$3,651.60
Rate for Payer: Cash Price	$2,792.40
Rate for Payer: Community Health Alliance Commercial	$3,651.60
Rate for Payer: Priority Health Commercial	$3,007.20
Rate for Payer: Priority Health PPO	$3,007.20

PERIODIC ACID SCHIFF STAN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100490
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

PERIPHERAL SMEAR PROF FEE

Facility

$67.00

Service Code	HCPCS 85060
Hospital Charge Code	9710590
Hospital Revenue Code	971
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$56.95
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health PPO	$46.90

PERIPHERAL VASCULAR REHAB

Facility

$139.00

Hospital Charge Code	9430031
Hospital Revenue Code	943
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$118.15
Rate for Payer: Cash Price	$90.35
Rate for Payer: Community Health Alliance Commercial	$118.15
Rate for Payer: Priority Health Commercial	$97.30
Rate for Payer: Priority Health PPO	$97.30

PERTUSSIS ANTIBODY

Facility

$41.00

Service Code	HCPCS 86615
Hospital Charge Code	3000854
Hospital Revenue Code	302
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$34.85
Rate for Payer: BCBS BCN 65	$13.85
Rate for Payer: Blue Care Network Medicare Advantage	$13.85
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Community Health Alliance Commercial	$34.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.85
Rate for Payer: Meridian Health Plan Medicare	$13.85
Rate for Payer: Priority Health Commercial	$28.70
Rate for Payer: Priority Health Medicaid	$13.85
Rate for Payer: Priority Health Medicare	$13.85
Rate for Payer: Priority Health PPO	$28.70
Rate for Payer: United Health Care Medicaid	$13.85
Rate for Payer: United Health Care Medicare Advantage	$6.09

PETITE ELITE PROTECTOR WIRE GD

Facility

$503.00

Hospital Charge Code	27263359
Hospital Revenue Code	272
Min. Negotiated Rate	$352.10
Max. Negotiated Rate	$427.55
Rate for Payer: Cash Price	$326.95
Rate for Payer: Community Health Alliance Commercial	$427.55
Rate for Payer: Priority Health Commercial	$352.10
Rate for Payer: Priority Health PPO	$352.10

PFA 100 (PLATELET FUNCTION ANA

Facility

$187.00

Hospital Charge Code	3000772
Hospital Revenue Code	305
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$158.95
Rate for Payer: Cash Price	$121.55
Rate for Payer: Community Health Alliance Commercial	$158.95
Rate for Payer: Priority Health Commercial	$130.90
Rate for Payer: Priority Health PPO	$130.90

PHA ABATACEPT 250 MG VIAL

Facility

$3,222.65

Service Code	HCPCS J0129
Hospital Charge Code	2500503
Hospital Revenue Code	636
Min. Negotiated Rate	$20.68
Max. Negotiated Rate	$2,739.25
Rate for Payer: BCBS BCN 65	$47.01
Rate for Payer: Blue Care Network Medicare Advantage	$47.01
Rate for Payer: Cash Price	$2,094.72
Rate for Payer: Cash Price	$2,094.72
Rate for Payer: Community Health Alliance Commercial	$2,739.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$47.01
Rate for Payer: Meridian Health Plan Medicare	$47.01
Rate for Payer: Priority Health Commercial	$2,255.86
Rate for Payer: Priority Health Medicaid	$47.01
Rate for Payer: Priority Health Medicare	$47.01
Rate for Payer: Priority Health PPO	$2,255.86
Rate for Payer: United Health Care Medicaid	$47.01
Rate for Payer: United Health Care Medicare Advantage	$20.68

PHA ABRAXANE 100MG/50ML VIAL

Facility

$4,323.04

Service Code	HCPCS J9264
Hospital Charge Code	2509125
Hospital Revenue Code	636
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3,674.58
Rate for Payer: BCBS BCN 65	$8.59
Rate for Payer: Blue Care Network Medicare Advantage	$8.59
Rate for Payer: Cash Price	$2,809.98
Rate for Payer: Cash Price	$2,809.98
Rate for Payer: Community Health Alliance Commercial	$3,674.58
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.59
Rate for Payer: Meridian Health Plan Medicare	$8.59
Rate for Payer: Priority Health Commercial	$3,026.13
Rate for Payer: Priority Health Medicaid	$8.59
Rate for Payer: Priority Health Medicare	$8.59
Rate for Payer: Priority Health PPO	$3,026.13
Rate for Payer: United Health Care Medicaid	$8.59
Rate for Payer: United Health Care Medicare Advantage	$3.78

PHA ACETADOTE 200MG/30ML

Facility

$200.40

Service Code	HCPCS J0132
Hospital Charge Code	2510843
Hospital Revenue Code	636
Min. Negotiated Rate	$140.28
Max. Negotiated Rate	$170.34
Rate for Payer: Cash Price	$130.26
Rate for Payer: Community Health Alliance Commercial	$170.34
Rate for Payer: Priority Health Commercial	$140.28
Rate for Payer: Priority Health PPO	$140.28

PHA ACETAMINOPHEN 1000MG/100 M

Facility

$176.75

Service Code	HCPCS J0131
Hospital Charge Code	2501531
Hospital Revenue Code	636
Min. Negotiated Rate	$123.72
Max. Negotiated Rate	$150.24
Rate for Payer: Cash Price	$114.89
Rate for Payer: Community Health Alliance Commercial	$150.24
Rate for Payer: Priority Health Commercial	$123.72
Rate for Payer: Priority Health PPO	$123.72

PHA ACETAMINOPHEN 120MG SUP

Facility

$3.02

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500010
Hospital Revenue Code	637
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.57
Rate for Payer: Cash Price	$1.96
Rate for Payer: Community Health Alliance Commercial	$2.57
Rate for Payer: Priority Health Commercial	$2.11
Rate for Payer: Priority Health PPO	$2.11

PHA ACETAMINOPHEN 160 MG/5 ML

Facility

$7.24

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500015
Hospital Revenue Code	637
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$6.15
Rate for Payer: Cash Price	$4.71
Rate for Payer: Community Health Alliance Commercial	$6.15
Rate for Payer: Priority Health Commercial	$5.07
Rate for Payer: Priority Health PPO	$5.07

PHA ACETAMINOPHEN 160MG/5 ML

Facility

$10.21

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500160
Hospital Revenue Code	637
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$8.68
Rate for Payer: Cash Price	$6.64
Rate for Payer: Community Health Alliance Commercial	$8.68
Rate for Payer: Priority Health Commercial	$7.15
Rate for Payer: Priority Health PPO	$7.15

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges