Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PINP

Facility

$65.00

Hospital Charge Code	3006795
Hospital Revenue Code	301
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

PIN WORM EXAM

Facility

$3.29

Service Code	HCPCS 87172
Hospital Charge Code	3006620
Hospital Revenue Code	306
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$4.48
Rate for Payer: BCBS BCN 65	$4.48
Rate for Payer: Blue Care Network Medicare Advantage	$4.48
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cash Price	$2.14
Rate for Payer: Community Health Alliance Commercial	$2.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.48
Rate for Payer: Meridian Health Plan Medicare	$4.48
Rate for Payer: Priority Health Commercial	$2.30
Rate for Payer: Priority Health Medicaid	$4.48
Rate for Payer: Priority Health Medicare	$4.48
Rate for Payer: Priority Health PPO	$2.30
Rate for Payer: United Health Care Medicaid	$4.48
Rate for Payer: United Health Care Medicare Advantage	$1.97

PJI-1

Facility

$19.56

Hospital Charge Code	3101262
Hospital Revenue Code	300
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$16.63
Rate for Payer: Cash Price	$12.71
Rate for Payer: Community Health Alliance Commercial	$16.63
Rate for Payer: Priority Health Commercial	$13.69
Rate for Payer: Priority Health PPO	$13.69

PJI-2

Facility

$19.56

Hospital Charge Code	3101263
Hospital Revenue Code	300
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$16.63
Rate for Payer: Cash Price	$12.71
Rate for Payer: Community Health Alliance Commercial	$16.63
Rate for Payer: Priority Health Commercial	$13.69
Rate for Payer: Priority Health PPO	$13.69

PJI-3

Facility

$19.56

Hospital Charge Code	3101269
Hospital Revenue Code	300
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$16.63
Rate for Payer: Cash Price	$12.71
Rate for Payer: Community Health Alliance Commercial	$16.63
Rate for Payer: Priority Health Commercial	$13.69
Rate for Payer: Priority Health PPO	$13.69

PKS CUTTING FORCEP

Facility

$918.75

Hospital Charge Code	27273416
Hospital Revenue Code	272
Min. Negotiated Rate	$643.12
Max. Negotiated Rate	$780.94
Rate for Payer: Cash Price	$597.19
Rate for Payer: Community Health Alliance Commercial	$780.94
Rate for Payer: Priority Health Commercial	$643.12
Rate for Payer: Priority Health PPO	$643.12

PLA2R AB W/REF TO TITER

Facility

$105.00

Hospital Charge Code	3101210
Hospital Revenue Code	300
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

PLACEMENT BREAST CLIP PERC

Facility

$1,243.00

Hospital Charge Code	4000264
Hospital Revenue Code	361
Min. Negotiated Rate	$870.10
Max. Negotiated Rate	$1,056.55
Rate for Payer: Cash Price	$807.95
Rate for Payer: Community Health Alliance Commercial	$1,056.55
Rate for Payer: Priority Health Commercial	$870.10
Rate for Payer: Priority Health PPO	$870.10

PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE; WITHOUT SUTURES

Facility

$1,069.39

Service Code	CPT 65778
Hospital Revenue Code	360
Min. Negotiated Rate	$470.53
Max. Negotiated Rate	$1,069.39
Rate for Payer: BCBS BCN 65	$1,069.39
Rate for Payer: Blue Care Network Medicare Advantage	$1,069.39
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,069.39
Rate for Payer: Meridian Health Plan Medicare	$1,069.39
Rate for Payer: Priority Health Medicaid	$1,069.39
Rate for Payer: Priority Health Medicare	$1,069.39
Rate for Payer: United Health Care Medicaid	$1,069.39
Rate for Payer: United Health Care Medicare Advantage	$470.53

PLAC TEST (LP-PLA2)

Facility

$301.00

Hospital Charge Code	3000247
Hospital Revenue Code	301
Min. Negotiated Rate	$210.70
Max. Negotiated Rate	$255.85
Rate for Payer: Cash Price	$195.65
Rate for Payer: Community Health Alliance Commercial	$255.85
Rate for Payer: Priority Health Commercial	$210.70
Rate for Payer: Priority Health PPO	$210.70

PLASMA PORPHYINS

Facility

$46.85

Service Code	HCPCS 84311
Hospital Charge Code	3006470
Hospital Revenue Code	301
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$39.82
Rate for Payer: BCBS BCN 65	$8.51
Rate for Payer: Blue Care Network Medicare Advantage	$8.51
Rate for Payer: Cash Price	$30.45
Rate for Payer: Cash Price	$30.45
Rate for Payer: Community Health Alliance Commercial	$39.82
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.51
Rate for Payer: Meridian Health Plan Medicare	$8.51
Rate for Payer: Priority Health Commercial	$32.80
Rate for Payer: Priority Health Medicaid	$8.51
Rate for Payer: Priority Health Medicare	$8.51
Rate for Payer: Priority Health PPO	$32.80
Rate for Payer: United Health Care Medicaid	$8.51
Rate for Payer: United Health Care Medicare Advantage	$3.74

PLASMINOGEN

Facility

$16.29

Service Code	HCPCS 85420
Hospital Charge Code	3009160
Hospital Revenue Code	305
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$13.85
Rate for Payer: BCBS BCN 65	$6.86
Rate for Payer: Blue Care Network Medicare Advantage	$6.86
Rate for Payer: Cash Price	$10.59
Rate for Payer: Cash Price	$10.59
Rate for Payer: Community Health Alliance Commercial	$13.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.86
Rate for Payer: Meridian Health Plan Medicare	$6.86
Rate for Payer: Priority Health Commercial	$11.40
Rate for Payer: Priority Health Medicaid	$6.86
Rate for Payer: Priority Health Medicare	$6.86
Rate for Payer: Priority Health PPO	$11.40
Rate for Payer: United Health Care Medicaid	$6.86
Rate for Payer: United Health Care Medicare Advantage	$3.02

PLASMINOGEN ACTIVATOR ANTIGEN

Facility

$88.78

Hospital Charge Code	3006218
Hospital Revenue Code	305
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$75.46
Rate for Payer: Cash Price	$57.71
Rate for Payer: Community Health Alliance Commercial	$75.46
Rate for Payer: Priority Health Commercial	$62.15
Rate for Payer: Priority Health PPO	$62.15

PLASMINOGEN ACTIVATOR INHIBITO

Facility

$20.36

Hospital Charge Code	3006219
Hospital Revenue Code	305
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$17.31
Rate for Payer: Cash Price	$13.23
Rate for Payer: Community Health Alliance Commercial	$17.31
Rate for Payer: Priority Health Commercial	$14.25
Rate for Payer: Priority Health PPO	$14.25

PLATE 10 HOLE LOCKING

Facility

$3,308.00

Service Code	HCPCS C1713
Hospital Charge Code	27271898
Hospital Revenue Code	278
Min. Negotiated Rate	$2,315.60
Max. Negotiated Rate	$2,811.80
Rate for Payer: Cash Price	$2,150.20
Rate for Payer: Community Health Alliance Commercial	$2,811.80
Rate for Payer: Priority Health Commercial	$2,315.60
Rate for Payer: Priority Health PPO	$2,315.60

PLATE, 4.5 LCP 8 HOLE

Facility

$2,830.00

Service Code	HCPCS C1713
Hospital Charge Code	27868142
Hospital Revenue Code	278
Min. Negotiated Rate	$1,981.00
Max. Negotiated Rate	$2,405.50
Rate for Payer: Cash Price	$1,839.50
Rate for Payer: Community Health Alliance Commercial	$2,405.50
Rate for Payer: Priority Health Commercial	$1,981.00
Rate for Payer: Priority Health PPO	$1,981.00

PLATE 4 HOLE

Facility

$980.00

Service Code	HCPCS C1713
Hospital Charge Code	27872195
Hospital Revenue Code	278
Min. Negotiated Rate	$686.00
Max. Negotiated Rate	$833.00
Rate for Payer: Cash Price	$637.00
Rate for Payer: Community Health Alliance Commercial	$833.00
Rate for Payer: Priority Health Commercial	$686.00
Rate for Payer: Priority Health PPO	$686.00

PLATE, 6 HOLE

Facility

$2,779.00

Service Code	HCPCS C1713
Hospital Charge Code	27868258
Hospital Revenue Code	278
Min. Negotiated Rate	$1,945.30
Max. Negotiated Rate	$2,362.15
Rate for Payer: Cash Price	$1,806.35
Rate for Payer: Community Health Alliance Commercial	$2,362.15
Rate for Payer: Priority Health Commercial	$1,945.30
Rate for Payer: Priority Health PPO	$1,945.30

PLATE, 6 HOLE (SYNTHES)

Facility

$775.00

Service Code	HCPCS C1713
Hospital Charge Code	27867920
Hospital Revenue Code	278
Min. Negotiated Rate	$542.50
Max. Negotiated Rate	$658.75
Rate for Payer: Cash Price	$503.75
Rate for Payer: Community Health Alliance Commercial	$658.75
Rate for Payer: Priority Health Commercial	$542.50
Rate for Payer: Priority Health PPO	$542.50

PLATE, CALCANEAL

Facility

$1,519.00

Service Code	HCPCS C1713
Hospital Charge Code	27867581
Hospital Revenue Code	278
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

PLATE, CONDYLAR 6 HOLE

Facility

$3,402.00

Service Code	HCPCS C1713
Hospital Charge Code	27865734
Hospital Revenue Code	278
Min. Negotiated Rate	$2,381.40
Max. Negotiated Rate	$2,891.70
Rate for Payer: Cash Price	$2,211.30
Rate for Payer: Community Health Alliance Commercial	$2,891.70
Rate for Payer: Priority Health Commercial	$2,381.40
Rate for Payer: Priority Health PPO	$2,381.40

PLATE, DVR ANATOMIC STD LEFT

Facility

$2,085.00

Service Code	HCPCS C1713
Hospital Charge Code	27872062
Hospital Revenue Code	278
Min. Negotiated Rate	$1,459.50
Max. Negotiated Rate	$1,772.25
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Community Health Alliance Commercial	$1,772.25
Rate for Payer: Priority Health Commercial	$1,459.50
Rate for Payer: Priority Health PPO	$1,459.50

PLATE, DVR ANATOMIC STD RIGHT

Facility

$2,085.00

Service Code	HCPCS C1713
Hospital Charge Code	27868969
Hospital Revenue Code	278
Min. Negotiated Rate	$1,459.50
Max. Negotiated Rate	$1,772.25
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Community Health Alliance Commercial	$1,772.25
Rate for Payer: Priority Health Commercial	$1,459.50
Rate for Payer: Priority Health PPO	$1,459.50

PLATE,LATERAL PROIMAL TIBIAL

Facility

$2,456.00

Service Code	HCPCS C1713
Hospital Charge Code	27266229
Hospital Revenue Code	278
Min. Negotiated Rate	$1,719.20
Max. Negotiated Rate	$2,087.60
Rate for Payer: Cash Price	$1,596.40
Rate for Payer: Community Health Alliance Commercial	$2,087.60
Rate for Payer: Priority Health Commercial	$1,719.20
Rate for Payer: Priority Health PPO	$1,719.20

PLATE LCP TIBIA 3.5X109MM

Facility

$4,051.00

Service Code	HCPCS C1713
Hospital Charge Code	27878656
Hospital Revenue Code	278
Min. Negotiated Rate	$2,835.70
Max. Negotiated Rate	$3,443.35
Rate for Payer: Cash Price	$2,633.15
Rate for Payer: Community Health Alliance Commercial	$3,443.35
Rate for Payer: Priority Health Commercial	$2,835.70
Rate for Payer: Priority Health PPO	$2,835.70

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges