Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PLATELET AGGREGATION

Facility

$137.00

Service Code	HCPCS 85576
Hospital Charge Code	3006645
Hospital Revenue Code	305
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$116.45
Rate for Payer: BCBS BCN 65	$26.16
Rate for Payer: Blue Care Network Medicare Advantage	$26.16
Rate for Payer: Cash Price	$89.05
Rate for Payer: Cash Price	$89.05
Rate for Payer: Community Health Alliance Commercial	$116.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$26.16
Rate for Payer: Meridian Health Plan Medicare	$26.16
Rate for Payer: Priority Health Commercial	$95.90
Rate for Payer: Priority Health Medicaid	$26.16
Rate for Payer: Priority Health Medicare	$26.16
Rate for Payer: Priority Health PPO	$95.90
Rate for Payer: United Health Care Medicaid	$26.16
Rate for Payer: United Health Care Medicare Advantage	$11.51

PLATELET ANTIBODY PROFILE

Facility

$41.21

Service Code	HCPCS 86022
Hospital Charge Code	3001140
Hospital Revenue Code	302
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$35.03
Rate for Payer: BCBS BCN 65	$19.29
Rate for Payer: Blue Care Network Medicare Advantage	$19.29
Rate for Payer: Cash Price	$26.79
Rate for Payer: Cash Price	$26.79
Rate for Payer: Community Health Alliance Commercial	$35.03
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.29
Rate for Payer: Meridian Health Plan Medicare	$19.29
Rate for Payer: Priority Health Commercial	$28.85
Rate for Payer: Priority Health Medicaid	$19.29
Rate for Payer: Priority Health Medicare	$19.29
Rate for Payer: Priority Health PPO	$28.85
Rate for Payer: United Health Care Medicaid	$19.29
Rate for Payer: United Health Care Medicare Advantage	$8.49

PLATELET AUTOANTIBODY PROFILE

Facility

$55.00

Service Code	HCPCS 86022
Hospital Charge Code	3006501
Hospital Revenue Code	302
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$46.75
Rate for Payer: BCBS BCN 65	$19.29
Rate for Payer: Blue Care Network Medicare Advantage	$19.29
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.29
Rate for Payer: Meridian Health Plan Medicare	$19.29
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health Medicaid	$19.29
Rate for Payer: Priority Health Medicare	$19.29
Rate for Payer: Priority Health PPO	$38.50
Rate for Payer: United Health Care Medicaid	$19.29
Rate for Payer: United Health Care Medicare Advantage	$8.49

PLATELET COUNT

Facility

$27.00

Service Code	HCPCS 85049
Hospital Charge Code	3006640
Hospital Revenue Code	305
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$22.95
Rate for Payer: BCBS BCN 65	$4.70
Rate for Payer: Blue Care Network Medicare Advantage	$4.70
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.70
Rate for Payer: Meridian Health Plan Medicare	$4.70
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health Medicaid	$4.70
Rate for Payer: Priority Health Medicare	$4.70
Rate for Payer: Priority Health PPO	$18.90
Rate for Payer: United Health Care Medicaid	$4.70
Rate for Payer: United Health Care Medicare Advantage	$2.07

PLATELET CROSSMATCH

Facility

$165.00

Hospital Charge Code	3006750
Hospital Revenue Code	390
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$140.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Community Health Alliance Commercial	$140.25
Rate for Payer: Priority Health Commercial	$115.50
Rate for Payer: Priority Health PPO	$115.50

PLATELET FUNCTION INHIBITION

Facility

$90.20

Hospital Charge Code	3100723
Hospital Revenue Code	305
Min. Negotiated Rate	$63.14
Max. Negotiated Rate	$76.67
Rate for Payer: Cash Price	$58.63
Rate for Payer: Community Health Alliance Commercial	$76.67
Rate for Payer: Priority Health Commercial	$63.14
Rate for Payer: Priority Health PPO	$63.14

PLATELET PHERESIS-HLA MATCH

Facility

$733.65

Service Code	HCPCS P9052
Hospital Charge Code	3910035
Hospital Revenue Code	390
Min. Negotiated Rate	$327.12
Max. Negotiated Rate	$743.46
Rate for Payer: BCBS BCN 65	$743.46
Rate for Payer: Blue Care Network Medicare Advantage	$743.46
Rate for Payer: Cash Price	$476.87
Rate for Payer: Cash Price	$476.87
Rate for Payer: Community Health Alliance Commercial	$623.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$743.46
Rate for Payer: Meridian Health Plan Medicare	$743.46
Rate for Payer: Priority Health Commercial	$513.55
Rate for Payer: Priority Health Medicaid	$743.46
Rate for Payer: Priority Health Medicare	$743.46
Rate for Payer: Priority Health PPO	$513.55
Rate for Payer: United Health Care Medicaid	$743.46
Rate for Payer: United Health Care Medicare Advantage	$327.12

PLATELETS BY PHERESIS

Facility

$1,547.00

Service Code	HCPCS P9035
Hospital Charge Code	3910040
Hospital Revenue Code	390
Min. Negotiated Rate	$236.35
Max. Negotiated Rate	$1,314.95
Rate for Payer: BCBS BCN 65	$537.17
Rate for Payer: Blue Care Network Medicare Advantage	$537.17
Rate for Payer: Cash Price	$1,005.55
Rate for Payer: Cash Price	$1,005.55
Rate for Payer: Community Health Alliance Commercial	$1,314.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$537.17
Rate for Payer: Meridian Health Plan Medicare	$537.17
Rate for Payer: Priority Health Commercial	$1,082.90
Rate for Payer: Priority Health Medicaid	$537.17
Rate for Payer: Priority Health Medicare	$537.17
Rate for Payer: Priority Health PPO	$1,082.90
Rate for Payer: United Health Care Medicaid	$537.17
Rate for Payer: United Health Care Medicare Advantage	$236.35

PLATELETS BY PHERESIS IRR

Facility

$2,044.00

Hospital Charge Code	3910041
Hospital Revenue Code	390
Min. Negotiated Rate	$1,430.80
Max. Negotiated Rate	$1,737.40
Rate for Payer: Cash Price	$1,328.60
Rate for Payer: Community Health Alliance Commercial	$1,737.40
Rate for Payer: Priority Health Commercial	$1,430.80
Rate for Payer: Priority Health PPO	$1,430.80

PLATE MTP

Facility

$2,192.75

Service Code	HCPCS C1713
Hospital Charge Code	27884383
Hospital Revenue Code	278
Min. Negotiated Rate	$1,534.92
Max. Negotiated Rate	$1,863.84
Rate for Payer: Cash Price	$1,425.29
Rate for Payer: Community Health Alliance Commercial	$1,863.84
Rate for Payer: Priority Health Commercial	$1,534.92
Rate for Payer: Priority Health PPO	$1,534.92

PLATE, SELF COMPRESSION

Facility

$220.00

Service Code	HCPCS C1713
Hospital Charge Code	27813946
Hospital Revenue Code	278
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$187.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Community Health Alliance Commercial	$187.00
Rate for Payer: Priority Health Commercial	$154.00
Rate for Payer: Priority Health PPO	$154.00

PLATE, SELF COMPRESSION

Facility

$220.00

Service Code	HCPCS C1713
Hospital Charge Code	27013946
Hospital Revenue Code	278
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$187.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Community Health Alliance Commercial	$187.00
Rate for Payer: Priority Health Commercial	$154.00
Rate for Payer: Priority Health PPO	$154.00

PLATE, SHOULDER 4 HOLE

Facility

$3,549.00

Service Code	HCPCS C1713
Hospital Charge Code	27872228
Hospital Revenue Code	278
Min. Negotiated Rate	$2,484.30
Max. Negotiated Rate	$3,016.65
Rate for Payer: Cash Price	$2,306.85
Rate for Payer: Community Health Alliance Commercial	$3,016.65
Rate for Payer: Priority Health Commercial	$2,484.30
Rate for Payer: Priority Health PPO	$2,484.30

PLATE T 3-HOLE

Facility

$1,960.00

Service Code	HCPCS C1713
Hospital Charge Code	27881600
Hospital Revenue Code	278
Min. Negotiated Rate	$1,372.00
Max. Negotiated Rate	$1,666.00
Rate for Payer: Cash Price	$1,274.00
Rate for Payer: Community Health Alliance Commercial	$1,666.00
Rate for Payer: Priority Health Commercial	$1,372.00
Rate for Payer: Priority Health PPO	$1,372.00

PLATE, TALON 135 X 38 4 HOLE

Facility

$969.00

Service Code	HCPCS C1713
Hospital Charge Code	27267227
Hospital Revenue Code	278
Min. Negotiated Rate	$678.30
Max. Negotiated Rate	$823.65
Rate for Payer: Cash Price	$629.85
Rate for Payer: Community Health Alliance Commercial	$823.65
Rate for Payer: Priority Health Commercial	$678.30
Rate for Payer: Priority Health PPO	$678.30

PLATE, TIBIA

Facility

$3,180.00

Service Code	HCPCS C1713
Hospital Charge Code	27871567
Hospital Revenue Code	278
Min. Negotiated Rate	$2,226.00
Max. Negotiated Rate	$2,703.00
Rate for Payer: Cash Price	$2,067.00
Rate for Payer: Community Health Alliance Commercial	$2,703.00
Rate for Payer: Priority Health Commercial	$2,226.00
Rate for Payer: Priority Health PPO	$2,226.00

PLATE,TIBIAL PROXIMAL 12 HOLE

Facility

$4,207.00

Service Code	HCPCS C1713
Hospital Charge Code	27866989
Hospital Revenue Code	278
Min. Negotiated Rate	$2,944.90
Max. Negotiated Rate	$3,575.95
Rate for Payer: Cash Price	$2,734.55
Rate for Payer: Community Health Alliance Commercial	$3,575.95
Rate for Payer: Priority Health Commercial	$2,944.90
Rate for Payer: Priority Health PPO	$2,944.90

PLATE VHS 2 HOLE VATI-ANGLE

Facility

$1,491.00

Service Code	HCPCS C1713
Hospital Charge Code	27872870
Hospital Revenue Code	278
Min. Negotiated Rate	$1,043.70
Max. Negotiated Rate	$1,267.35
Rate for Payer: Cash Price	$969.15
Rate for Payer: Community Health Alliance Commercial	$1,267.35
Rate for Payer: Priority Health Commercial	$1,043.70
Rate for Payer: Priority Health PPO	$1,043.70

PLT FUNCTION ADP

Facility

$63.80

Hospital Charge Code	3000771
Hospital Revenue Code	305
Min. Negotiated Rate	$44.66
Max. Negotiated Rate	$54.23
Rate for Payer: Cash Price	$41.47
Rate for Payer: Community Health Alliance Commercial	$54.23
Rate for Payer: Priority Health Commercial	$44.66
Rate for Payer: Priority Health PPO	$44.66

PLTPHE-ARC-FW

Facility

$2,127.59

Hospital Charge Code	3101327
Hospital Revenue Code	300
Min. Negotiated Rate	$1,489.31
Max. Negotiated Rate	$1,808.45
Rate for Payer: Cash Price	$1,382.93
Rate for Payer: Community Health Alliance Commercial	$1,808.45
Rate for Payer: Priority Health Commercial	$1,489.31
Rate for Payer: Priority Health PPO	$1,489.31

PN-1

Facility

$43.30

Hospital Charge Code	31027447
Hospital Revenue Code	300
Min. Negotiated Rate	$30.31
Max. Negotiated Rate	$36.80
Rate for Payer: Cash Price	$28.15
Rate for Payer: Community Health Alliance Commercial	$36.80
Rate for Payer: Priority Health Commercial	$30.31
Rate for Payer: Priority Health PPO	$30.31

PN-10

Facility

$43.30

Hospital Charge Code	31027456
Hospital Revenue Code	300
Min. Negotiated Rate	$30.31
Max. Negotiated Rate	$36.80
Rate for Payer: Cash Price	$28.15
Rate for Payer: Community Health Alliance Commercial	$36.80
Rate for Payer: Priority Health Commercial	$30.31
Rate for Payer: Priority Health PPO	$30.31

PN-11

Facility

$43.30

Hospital Charge Code	31027457
Hospital Revenue Code	300
Min. Negotiated Rate	$30.31
Max. Negotiated Rate	$36.80
Rate for Payer: Cash Price	$28.15
Rate for Payer: Community Health Alliance Commercial	$36.80
Rate for Payer: Priority Health Commercial	$30.31
Rate for Payer: Priority Health PPO	$30.31

PN-12

Facility

$43.70

Hospital Charge Code	31027458
Hospital Revenue Code	300
Min. Negotiated Rate	$30.59
Max. Negotiated Rate	$37.15
Rate for Payer: Cash Price	$28.41
Rate for Payer: Community Health Alliance Commercial	$37.15
Rate for Payer: Priority Health Commercial	$30.59
Rate for Payer: Priority Health PPO	$30.59

PN-2

Facility

$43.30

Hospital Charge Code	31027448
Hospital Revenue Code	300
Min. Negotiated Rate	$30.31
Max. Negotiated Rate	$36.80
Rate for Payer: Cash Price	$28.15
Rate for Payer: Community Health Alliance Commercial	$36.80
Rate for Payer: Priority Health Commercial	$30.31
Rate for Payer: Priority Health PPO	$30.31

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges