Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PN-3

Facility

$43.30

Hospital Charge Code	31027449
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-4

Facility

$43.30

Hospital Charge Code	31027450
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-5

Facility

$43.30

Hospital Charge Code	31027451
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-6

Facility

$43.30

Hospital Charge Code	31027452
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-7

Facility

$43.30

Hospital Charge Code	31027453
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-8

Facility

$43.30

Hospital Charge Code	31027454
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-9

Facility

$43.30

Hospital Charge Code	31027455
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

PNEUM-1

Facility

$5.83

Hospital Charge Code	3102037
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-10

Facility

$5.83

Hospital Charge Code	3102046
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-11

Facility

$5.83

Hospital Charge Code	3102047
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-12

Facility

$5.83

Hospital Charge Code	3102048
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-13

Facility

$5.83

Hospital Charge Code	3102049
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-14

Facility

$5.93

Hospital Charge Code	3102050
Hospital Revenue Code	300
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$5.04
Rate for Payer: Cash Price	$3.85
Rate for Payer: Community Health Alliance Commercial	$5.04
Rate for Payer: Priority Health Commercial	$4.15
Rate for Payer: Priority Health PPO	$4.15

PNEUM-2

Facility

$5.83

Hospital Charge Code	3102038
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-3

Facility

$5.83

Hospital Charge Code	3102039
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-4

Facility

$5.83

Hospital Charge Code	3102040
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-5

Facility

$5.83

Hospital Charge Code	3102041
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-6

Facility

$5.83

Hospital Charge Code	3102042
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-7

Facility

$5.83

Hospital Charge Code	3102043
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-8

Facility

$5.83

Hospital Charge Code	3102044
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUM-9

Facility

$5.83

Hospital Charge Code	3102045
Hospital Revenue Code	300
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.79
Rate for Payer: Community Health Alliance Commercial	$4.96
Rate for Payer: Priority Health Commercial	$4.08
Rate for Payer: Priority Health PPO	$4.08

PNEUMOCOCCAL ANTIBODY

Facility

$100.00

Service Code	HCPCS 86609
Hospital Charge Code	3006510
Hospital Revenue Code	302
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$85.00
Rate for Payer: BCBS BCN 65	$13.52
Rate for Payer: Blue Care Network Medicare Advantage	$13.52
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.52
Rate for Payer: Meridian Health Plan Medicare	$13.52
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health Medicaid	$13.52
Rate for Payer: Priority Health Medicare	$13.52
Rate for Payer: Priority Health PPO	$70.00
Rate for Payer: United Health Care Medicaid	$13.52
Rate for Payer: United Health Care Medicare Advantage	$5.95

PNEUMONITIS CARNII

Facility

$21.00

Service Code	HCPCS 87205
Hospital Charge Code	3006513
Hospital Revenue Code	306
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$17.85
Rate for Payer: BCBS BCN 65	$4.48
Rate for Payer: Blue Care Network Medicare Advantage	$4.48
Rate for Payer: Cash Price	$13.65
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
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	$14.70
Rate for Payer: Priority Health Medicaid	$4.48
Rate for Payer: Priority Health Medicare	$4.48
Rate for Payer: Priority Health PPO	$14.70
Rate for Payer: United Health Care Medicaid	$4.48
Rate for Payer: United Health Care Medicare Advantage	$1.97

PNEUMO SEROPTYPE 17F IGG

Facility

$5.42

Hospital Charge Code	3101050
Hospital Revenue Code	300
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$4.61
Rate for Payer: Cash Price	$3.52
Rate for Payer: Community Health Alliance Commercial	$4.61
Rate for Payer: Priority Health Commercial	$3.79
Rate for Payer: Priority Health PPO	$3.79

PNEUMO SEROTYPE 10A IGG PNX

Facility

$1.37

Hospital Charge Code	3101045
Hospital Revenue Code	300
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.89
Rate for Payer: Community Health Alliance Commercial	$1.16
Rate for Payer: Priority Health Commercial	$0.96
Rate for Payer: Priority Health PPO	$0.96

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges