Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PHENOSENSE-6

Facility

$63.33

Hospital Charge Code	3102340
Hospital Revenue Code	300
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$53.83
Rate for Payer: Cash Price	$41.16
Rate for Payer: Community Health Alliance Commercial	$53.83
Rate for Payer: Priority Health Commercial	$44.33
Rate for Payer: Priority Health PPO	$44.33

PHENOSENSE-7

Facility

$63.33

Hospital Charge Code	3102341
Hospital Revenue Code	300
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$53.83
Rate for Payer: Cash Price	$41.16
Rate for Payer: Community Health Alliance Commercial	$53.83
Rate for Payer: Priority Health Commercial	$44.33
Rate for Payer: Priority Health PPO	$44.33

PHENOSENSE-8

Facility

$63.33

Hospital Charge Code	3102342
Hospital Revenue Code	300
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$53.83
Rate for Payer: Cash Price	$41.16
Rate for Payer: Community Health Alliance Commercial	$53.83
Rate for Payer: Priority Health Commercial	$44.33
Rate for Payer: Priority Health PPO	$44.33

PHENOSENSE-9

Facility

$63.33

Hospital Charge Code	3102343
Hospital Revenue Code	300
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$53.83
Rate for Payer: Cash Price	$41.16
Rate for Payer: Community Health Alliance Commercial	$53.83
Rate for Payer: Priority Health Commercial	$44.33
Rate for Payer: Priority Health PPO	$44.33

PHENOTYPING / UNIT PER ANTIOEN

Facility

$17.00

Service Code	HCPCS 86902
Hospital Charge Code	3001100
Hospital Revenue Code	302
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$14.45
Rate for Payer: BCBS BCN 65	$6.67
Rate for Payer: Blue Care Network Medicare Advantage	$6.67
Rate for Payer: Cash Price	$11.05
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.67
Rate for Payer: Meridian Health Plan Medicare	$6.67
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health Medicaid	$6.67
Rate for Payer: Priority Health Medicare	$6.67
Rate for Payer: Priority Health PPO	$11.90
Rate for Payer: United Health Care Medicaid	$6.67
Rate for Payer: United Health Care Medicare Advantage	$2.93

PHEREGAN

Facility

$75.00

Service Code	HCPCS 80375
Hospital Charge Code	3006590
Hospital Revenue Code	301
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

PHOS-LC

Facility

$2.00

Hospital Charge Code	3102404
Hospital Revenue Code	300
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health PPO	$1.40

PHOSPHOROUS,24 HR URINE

Facility

$9.00

Service Code	HCPCS 84105
Hospital Charge Code	3000841
Hospital Revenue Code	301
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$7.65
Rate for Payer: BCBS BCN 65	$6.07
Rate for Payer: Blue Care Network Medicare Advantage	$6.07
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Community Health Alliance Commercial	$7.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.07
Rate for Payer: Meridian Health Plan Medicare	$6.07
Rate for Payer: Priority Health Commercial	$6.30
Rate for Payer: Priority Health Medicaid	$6.07
Rate for Payer: Priority Health Medicare	$6.07
Rate for Payer: Priority Health PPO	$6.30
Rate for Payer: United Health Care Medicaid	$6.07
Rate for Payer: United Health Care Medicare Advantage	$2.67

PHOSPHORUS

Facility

$22.00

Service Code	HCPCS 84100
Hospital Charge Code	3006600
Hospital Revenue Code	301
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$18.70
Rate for Payer: BCBS BCN 65	$4.98
Rate for Payer: Blue Care Network Medicare Advantage	$4.98
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$14.30
Rate for Payer: Community Health Alliance Commercial	$18.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.98
Rate for Payer: Meridian Health Plan Medicare	$4.98
Rate for Payer: Priority Health Commercial	$15.40
Rate for Payer: Priority Health Medicaid	$4.98
Rate for Payer: Priority Health Medicare	$4.98
Rate for Payer: Priority Health PPO	$15.40
Rate for Payer: United Health Care Medicaid	$4.98
Rate for Payer: United Health Care Medicare Advantage	$2.19

PHOSPHOTIDYLETHANOL

Facility

$100.00

Hospital Charge Code	3101608
Hospital Revenue Code	300
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$85.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health PPO	$70.00

PHOSPHYTIDAL AB IGA

Facility

$6.50

Hospital Charge Code	3101427
Hospital Revenue Code	300
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$5.53
Rate for Payer: Cash Price	$4.23
Rate for Payer: Community Health Alliance Commercial	$5.53
Rate for Payer: Priority Health Commercial	$4.55
Rate for Payer: Priority Health PPO	$4.55

PHOSPHYTIDAL AB IGM

Facility

$6.50

Hospital Charge Code	3101428
Hospital Revenue Code	300
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$5.53
Rate for Payer: Cash Price	$4.23
Rate for Payer: Community Health Alliance Commercial	$5.53
Rate for Payer: Priority Health Commercial	$4.55
Rate for Payer: Priority Health PPO	$4.55

PHOSPHYTIDAL SERINE AB IGG

Facility

$6.50

Hospital Charge Code	3101432
Hospital Revenue Code	300
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$5.53
Rate for Payer: Cash Price	$4.23
Rate for Payer: Community Health Alliance Commercial	$5.53
Rate for Payer: Priority Health Commercial	$4.55
Rate for Payer: Priority Health PPO	$4.55

PHYSICAL PERFORMACE TESTING

Facility

$32.00

Hospital Charge Code	4300041
Hospital Revenue Code	430
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$20.80
Rate for Payer: Community Health Alliance Commercial	$27.20
Rate for Payer: Priority Health Commercial	$22.40
Rate for Payer: Priority Health PPO	$22.40

PHYSICAL PERFORMANCE TESTING

Facility

$86.00

Service Code	HCPCS 97750 GP
Hospital Charge Code	4200590
Hospital Revenue Code	420
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$73.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Community Health Alliance Commercial	$73.10
Rate for Payer: Priority Health Commercial	$60.20
Rate for Payer: Priority Health PPO	$60.20

PHYSICAL PERFORMANCE TESTING

Facility

$32.00

Hospital Charge Code	4200373
Hospital Revenue Code	420
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$20.80
Rate for Payer: Community Health Alliance Commercial	$27.20
Rate for Payer: Priority Health Commercial	$22.40
Rate for Payer: Priority Health PPO	$22.40

PHY THERAPY EVAL HIGH COMPLEXI

Facility

$243.00

Service Code	HCPCS 97163 GP
Hospital Charge Code	4200183
Hospital Revenue Code	424
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$206.55
Rate for Payer: Cash Price	$157.95
Rate for Payer: Community Health Alliance Commercial	$206.55
Rate for Payer: Priority Health Commercial	$170.10
Rate for Payer: Priority Health PPO	$170.10

PHY THERAPY EVAL LOW COMPLEXIT

Facility

$243.00

Service Code	HCPCS 97161 GP
Hospital Charge Code	4200181
Hospital Revenue Code	424
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$206.55
Rate for Payer: Cash Price	$157.95
Rate for Payer: Community Health Alliance Commercial	$206.55
Rate for Payer: Priority Health Commercial	$170.10
Rate for Payer: Priority Health PPO	$170.10

PHY THERAPY EVAL MOD COMPLEXIT

Facility

$243.00

Service Code	HCPCS 97162 GP
Hospital Charge Code	4200182
Hospital Revenue Code	424
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$206.55
Rate for Payer: Cash Price	$157.95
Rate for Payer: Community Health Alliance Commercial	$206.55
Rate for Payer: Priority Health Commercial	$170.10
Rate for Payer: Priority Health PPO	$170.10

PICC LINE

Facility

$249.00

Hospital Charge Code	27019950
Hospital Revenue Code	272
Min. Negotiated Rate	$174.30
Max. Negotiated Rate	$211.65
Rate for Payer: Cash Price	$161.85
Rate for Payer: Community Health Alliance Commercial	$211.65
Rate for Payer: Priority Health Commercial	$174.30
Rate for Payer: Priority Health PPO	$174.30

PIGTAIL - ANGIO

Facility

$83.00

Hospital Charge Code	27015032
Hospital Revenue Code	270
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$70.55
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health PPO	$58.10

PILOT TIP 3.7MM

Facility

$352.00

Hospital Charge Code	27268480
Hospital Revenue Code	272
Min. Negotiated Rate	$246.40
Max. Negotiated Rate	$299.20
Rate for Payer: Cash Price	$228.80
Rate for Payer: Community Health Alliance Commercial	$299.20
Rate for Payer: Priority Health Commercial	$246.40
Rate for Payer: Priority Health PPO	$246.40

PIN ASSEMBLY

Facility

$154.00

Hospital Charge Code	27814068
Hospital Revenue Code	278
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$130.90
Rate for Payer: Cash Price	$100.10
Rate for Payer: Community Health Alliance Commercial	$130.90
Rate for Payer: Priority Health Commercial	$107.80
Rate for Payer: Priority Health PPO	$107.80

PIN ASSEMBLY

Facility

$154.00

Hospital Charge Code	27014068
Hospital Revenue Code	278
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$130.90
Rate for Payer: Cash Price	$100.10
Rate for Payer: Community Health Alliance Commercial	$130.90
Rate for Payer: Priority Health Commercial	$107.80
Rate for Payer: Priority Health PPO	$107.80

PIN, HIGH STRENGTH

Facility

$91.00

Hospital Charge Code	27264298
Hospital Revenue Code	272
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$77.35
Rate for Payer: Cash Price	$59.15
Rate for Payer: Community Health Alliance Commercial	$77.35
Rate for Payer: Priority Health Commercial	$63.70
Rate for Payer: Priority Health PPO	$63.70

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges