Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

AQUATIC THER/EXCERCISES EA 15

Facility

$103.00

Hospital Charge Code	4300419
Hospital Revenue Code	430
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$87.55
Rate for Payer: Cash Price	$66.95
Rate for Payer: Community Health Alliance Commercial	$87.55
Rate for Payer: Priority Health Commercial	$72.10
Rate for Payer: Priority Health PPO	$72.10

AR-1

Facility

$12.72

Hospital Charge Code	3102675
Hospital Revenue Code	300
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$10.81
Rate for Payer: Cash Price	$8.27
Rate for Payer: Community Health Alliance Commercial	$10.81
Rate for Payer: Priority Health Commercial	$8.90
Rate for Payer: Priority Health PPO	$8.90

AR-2

Facility

$6.36

Hospital Charge Code	3102676
Hospital Revenue Code	300
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$5.41
Rate for Payer: Cash Price	$4.13
Rate for Payer: Community Health Alliance Commercial	$5.41
Rate for Payer: Priority Health Commercial	$4.45
Rate for Payer: Priority Health PPO	$4.45

ARBOVIRUS IFF/IGM CSF 4

Facility

$27.00

Hospital Charge Code	3102055
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

ARBOVIRUS IGG/IGM CFS 6

Facility

$27.00

Hospital Charge Code	3102057
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

ARBOVIRUS IGG/IGM CFS 7

Facility

$27.00

Hospital Charge Code	3102058
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

ARBOVIRUS IGG/IGM CSF 10

Facility

$27.00

Hospital Charge Code	3102061
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

ARBOVIRUS IGG/IGM CSF 3

Facility

$27.00

Hospital Charge Code	3102054
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

ARBOVIRUS IGG/IGM CSF 5

Facility

$27.00

Hospital Charge Code	3102056
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

ARBOVIRUS IGG/IGM CSF 8

Facility

$27.00

Hospital Charge Code	3102059
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

ARBOVIRUS IGG/IGM CSF 9

Facility

$27.00

Hospital Charge Code	3102060
Hospital Revenue Code	300
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$22.95
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health PPO	$18.90

ARIPIPAZOLE

Facility

$168.00

Hospital Charge Code	3000104
Hospital Revenue Code	301
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$142.80
Rate for Payer: Cash Price	$109.20
Rate for Payer: Community Health Alliance Commercial	$142.80
Rate for Payer: Priority Health Commercial	$117.60
Rate for Payer: Priority Health PPO	$117.60

ARISTA FLEXTIP APPLICATOR XL

Facility

$97.00

Hospital Charge Code	27276855
Hospital Revenue Code	272
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.05
Rate for Payer: Community Health Alliance Commercial	$82.45
Rate for Payer: Priority Health Commercial	$67.90
Rate for Payer: Priority Health PPO	$67.90

ARIS, TRANS-OBTURATOR TAPE

Facility

$2,919.00

Service Code	HCPCS C1781
Hospital Charge Code	27871624
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.30
Max. Negotiated Rate	$2,481.15
Rate for Payer: Cash Price	$1,897.35
Rate for Payer: Community Health Alliance Commercial	$2,481.15
Rate for Payer: Priority Health Commercial	$2,043.30
Rate for Payer: Priority Health PPO	$2,043.30

ARM BAND

Facility

$51.00

Hospital Charge Code	27021576
Hospital Revenue Code	270
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

ARM BAND, TENNIS ELBOW

Facility

$46.00

Hospital Charge Code	27012576
Hospital Revenue Code	270
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

ARSENIC,HAIR ANALYSIS

Facility

$216.50

Service Code	HCPCS 82175
Hospital Charge Code	3000715
Hospital Revenue Code	301
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$184.03
Rate for Payer: BCBS BCN 65	$19.92
Rate for Payer: Blue Care Network Medicare Advantage	$19.92
Rate for Payer: Cash Price	$140.73
Rate for Payer: Cash Price	$140.73
Rate for Payer: Community Health Alliance Commercial	$184.03
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.92
Rate for Payer: Meridian Health Plan Medicare	$19.92
Rate for Payer: Priority Health Commercial	$151.55
Rate for Payer: Priority Health Medicaid	$19.92
Rate for Payer: Priority Health Medicare	$19.92
Rate for Payer: Priority Health PPO	$151.55
Rate for Payer: United Health Care Medicaid	$19.92
Rate for Payer: United Health Care Medicare Advantage	$8.76

ARTERIAL LINE KIT

Facility

$286.00

Hospital Charge Code	27022301
Hospital Revenue Code	272
Min. Negotiated Rate	$200.20
Max. Negotiated Rate	$243.10
Rate for Payer: Cash Price	$185.90
Rate for Payer: Community Health Alliance Commercial	$243.10
Rate for Payer: Priority Health Commercial	$200.20
Rate for Payer: Priority Health PPO	$200.20

ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD FOR DIAGNOSIS

Facility

$142.73

Service Code	CPT 36600
Hospital Revenue Code	361
Min. Negotiated Rate	$62.80
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: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

ARTHREX 1.6 GUIDEWIRE

Facility

$36.75

Hospital Charge Code	27276988
Hospital Revenue Code	272
Min. Negotiated Rate	$25.73
Max. Negotiated Rate	$31.24
Rate for Payer: Cash Price	$23.89
Rate for Payer: Community Health Alliance Commercial	$31.24
Rate for Payer: Priority Health Commercial	$25.73
Rate for Payer: Priority Health PPO	$25.73

ARTHREX BB-TAK

Facility

$122.50

Service Code	HCPCS C1713
Hospital Charge Code	27878879
Hospital Revenue Code	278
Min. Negotiated Rate	$85.75
Max. Negotiated Rate	$104.12
Rate for Payer: Cash Price	$79.63
Rate for Payer: Community Health Alliance Commercial	$104.12
Rate for Payer: Priority Health Commercial	$85.75
Rate for Payer: Priority Health PPO	$85.75

ARTHROSCOPIC BLADE DISP.

Facility

$197.00

Hospital Charge Code	27013789
Hospital Revenue Code	272
Min. Negotiated Rate	$137.90
Max. Negotiated Rate	$167.45
Rate for Payer: Cash Price	$128.05
Rate for Payer: Community Health Alliance Commercial	$167.45
Rate for Payer: Priority Health Commercial	$137.90
Rate for Payer: Priority Health PPO	$137.90

ARTISTA-USA 3GM

Facility

$514.75

Hospital Charge Code	27276699
Hospital Revenue Code	272
Min. Negotiated Rate	$360.32
Max. Negotiated Rate	$437.54
Rate for Payer: Cash Price	$334.59
Rate for Payer: Community Health Alliance Commercial	$437.54
Rate for Payer: Priority Health Commercial	$360.32
Rate for Payer: Priority Health PPO	$360.32

ARYLSULFATASE A, LEUKOCYTES

Facility

$160.00

Hospital Charge Code	3100601
Hospital Revenue Code	301
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Community Health Alliance Commercial	$136.00
Rate for Payer: Priority Health Commercial	$112.00
Rate for Payer: Priority Health PPO	$112.00

ASAP BIOP SYS W/DELTA CUT NEED

Facility

$188.00

Hospital Charge Code	27060198
Hospital Revenue Code	272
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$159.80
Rate for Payer: Cash Price	$122.20
Rate for Payer: Community Health Alliance Commercial	$159.80
Rate for Payer: Priority Health Commercial	$131.60
Rate for Payer: Priority Health PPO	$131.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges