Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ATN-LC

Facility

$44.75

Hospital Charge Code	31027468
Hospital Revenue Code	300
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$38.04
Rate for Payer: Cash Price	$29.09
Rate for Payer: Community Health Alliance Commercial	$38.04
Rate for Payer: Priority Health Commercial	$31.32
Rate for Payer: Priority Health PPO	$31.32

ATN PROFILE

Facility

$179.00

Hospital Charge Code	31027464
Hospital Revenue Code	300
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$152.15
Rate for Payer: Cash Price	$116.35
Rate for Payer: Community Health Alliance Commercial	$152.15
Rate for Payer: Priority Health Commercial	$125.30
Rate for Payer: Priority Health PPO	$125.30

AU-1

Facility

$5.00

Service Code	HCPCS 82175
Hospital Charge Code	3000710
Hospital Revenue Code	301
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$19.92
Rate for Payer: BCBS BCN 65	$19.92
Rate for Payer: Blue Care Network Medicare Advantage	$19.92
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
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	$3.50
Rate for Payer: Priority Health Medicaid	$19.92
Rate for Payer: Priority Health Medicare	$19.92
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$19.92
Rate for Payer: United Health Care Medicare Advantage	$8.76

AU-2

Facility

$5.00

Hospital Charge Code	3102177
Hospital Revenue Code	300
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$4.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health PPO	$3.50

AUTO DISSECT 5 MM

Facility

$418.00

Hospital Charge Code	27016261
Hospital Revenue Code	270
Min. Negotiated Rate	$292.60
Max. Negotiated Rate	$355.30
Rate for Payer: Cash Price	$271.70
Rate for Payer: Community Health Alliance Commercial	$355.30
Rate for Payer: Priority Health Commercial	$292.60
Rate for Payer: Priority Health PPO	$292.60

AUTOIMMUNE NEUROPROFILE-LC

Facility

$700.00

Hospital Charge Code	31027407
Hospital Revenue Code	300
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$595.00
Rate for Payer: Cash Price	$455.00
Rate for Payer: Community Health Alliance Commercial	$595.00
Rate for Payer: Priority Health Commercial	$490.00
Rate for Payer: Priority Health PPO	$490.00

AUTOLOGOUS SURCHARGE

Facility

$140.00

Hospital Charge Code	3006628
Hospital Revenue Code	300
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$119.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Community Health Alliance Commercial	$119.00
Rate for Payer: Priority Health Commercial	$98.00
Rate for Payer: Priority Health PPO	$98.00

AUTOMATED RETICULOCYTE COUNT

Facility

$30.00

Hospital Charge Code	3100247
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$25.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health PPO	$21.00

AUTOTRANSFUSION 600ML

Facility

$539.00

Hospital Charge Code	27264686
Hospital Revenue Code	272
Min. Negotiated Rate	$377.30
Max. Negotiated Rate	$458.15
Rate for Payer: Cash Price	$350.35
Rate for Payer: Community Health Alliance Commercial	$458.15
Rate for Payer: Priority Health Commercial	$377.30
Rate for Payer: Priority Health PPO	$377.30

AZ-7

Facility

$3.26

Hospital Charge Code	31027547
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

AZ7-1

Facility

$3.26

Hospital Charge Code	31027541
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

AZ7-10

Facility

$3.26

Hospital Charge Code	31027550
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

AZ7-11

Facility

$3.26

Hospital Charge Code	31027551
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

AZ7-12

Facility

$3.26

Hospital Charge Code	31027552
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

AZ7-13

Facility

$3.26

Hospital Charge Code	31027553
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

AZ7-14

Facility

$3.26

Hospital Charge Code	31027554
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

AZ7-15

Facility

$3.26

Hospital Charge Code	31027555
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

AZ7-16

Facility

$3.26

Hospital Charge Code	31027556
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

AZ7-17

Facility

$3.26

Hospital Charge Code	31027557
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

AZ7-18

Facility

$3.26

Hospital Charge Code	31027558
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

AZ7-19

Facility

$3.26

Hospital Charge Code	31027559
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

AZ7-2

Facility

$3.26

Hospital Charge Code	31027542
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

AZ7-20

Facility

$3.26

Hospital Charge Code	31027560
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

AZ7-21

Facility

$3.26

Hospital Charge Code	31027561
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

AZ7-22

Facility

$3.26

Hospital Charge Code	31027562
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges