Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

AZ7-23

Facility

$3.26

Hospital Charge Code	31027563
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

AZ7-24

Facility

$3.26

Hospital Charge Code	31027564
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

AZ7-25

Facility

$3.26

Hospital Charge Code	31027565
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

AZ7-26

Facility

$3.26

Hospital Charge Code	31027566
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

AZ7-27

Facility

$3.26

Hospital Charge Code	31027567
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

AZ7-28

Facility

$3.26

Hospital Charge Code	31027568
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

AZ7-29

Facility

$3.26

Hospital Charge Code	31027569
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

AZ7-3

Facility

$3.26

Hospital Charge Code	31027543
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

AZ7-30

Facility

$3.26

Hospital Charge Code	31027570
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

AZ7-4

Facility

$3.26

Hospital Charge Code	31027544
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

AZ7-5

Facility

$3.26

Hospital Charge Code	31027545
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

AZ7-6

Facility

$3.26

Hospital Charge Code	31027546
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

AZ7-8

Facility

$3.26

Hospital Charge Code	31027548
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

AZ7-9

Facility

$3.26

Hospital Charge Code	31027549
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

B-12 BINDING CAPACITY1

Facility

$8.15

Service Code	HCPCS 82608
Hospital Charge Code	3001550
Hospital Revenue Code	301
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$15.04
Rate for Payer: BCBS BCN 65	$15.04
Rate for Payer: Blue Care Network Medicare Advantage	$15.04
Rate for Payer: Cash Price	$5.30
Rate for Payer: Cash Price	$5.30
Rate for Payer: Community Health Alliance Commercial	$6.93
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.04
Rate for Payer: Meridian Health Plan Medicare	$15.04
Rate for Payer: Priority Health Commercial	$5.71
Rate for Payer: Priority Health Medicaid	$15.04
Rate for Payer: Priority Health Medicare	$15.04
Rate for Payer: Priority Health PPO	$5.71
Rate for Payer: United Health Care Medicaid	$15.04
Rate for Payer: United Health Care Medicare Advantage	$6.62

B2 MICROGLOBULIN URINE

Facility

$8.00

Hospital Charge Code	3102460
Hospital Revenue Code	300
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$6.80
Rate for Payer: Cash Price	$5.20
Rate for Payer: Community Health Alliance Commercial	$6.80
Rate for Payer: Priority Health Commercial	$5.60
Rate for Payer: Priority Health PPO	$5.60

BA-1

Facility

$80.00

Hospital Charge Code	3102584
Hospital Revenue Code	300
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Community Health Alliance Commercial	$68.00
Rate for Payer: Priority Health Commercial	$56.00
Rate for Payer: Priority Health PPO	$56.00

BA-2

Facility

$80.00

Hospital Charge Code	3102585
Hospital Revenue Code	300
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Community Health Alliance Commercial	$68.00
Rate for Payer: Priority Health Commercial	$56.00
Rate for Payer: Priority Health PPO	$56.00

BABESIA MICROTI IGG BY IFA

Facility

$7.05

Hospital Charge Code	3100958
Hospital Revenue Code	302
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$5.99
Rate for Payer: Cash Price	$4.58
Rate for Payer: Community Health Alliance Commercial	$5.99
Rate for Payer: Priority Health Commercial	$4.93
Rate for Payer: Priority Health PPO	$4.93

BABESIA MICROTI IGM BY IFA

Facility

$7.05

Hospital Charge Code	3100981
Hospital Revenue Code	302
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$5.99
Rate for Payer: Cash Price	$4.58
Rate for Payer: Community Health Alliance Commercial	$5.99
Rate for Payer: Priority Health Commercial	$4.93
Rate for Payer: Priority Health PPO	$4.93

BABESIA SP PCR

Facility

$85.00

Hospital Charge Code	3101412
Hospital Revenue Code	300
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$72.25
Rate for Payer: Cash Price	$55.25
Rate for Payer: Community Health Alliance Commercial	$72.25
Rate for Payer: Priority Health Commercial	$59.50
Rate for Payer: Priority Health PPO	$59.50

BACK BRACE

Facility

$131.00

Hospital Charge Code	27060073
Hospital Revenue Code	270
Min. Negotiated Rate	$91.70
Max. Negotiated Rate	$111.35
Rate for Payer: Cash Price	$85.15
Rate for Payer: Community Health Alliance Commercial	$111.35
Rate for Payer: Priority Health Commercial	$91.70
Rate for Payer: Priority Health PPO	$91.70

BACK BRACE, DORSOLUMBAR

Facility

$158.00

Hospital Charge Code	27021543
Hospital Revenue Code	270
Min. Negotiated Rate	$110.60
Max. Negotiated Rate	$134.30
Rate for Payer: Cash Price	$102.70
Rate for Payer: Community Health Alliance Commercial	$134.30
Rate for Payer: Priority Health Commercial	$110.60
Rate for Payer: Priority Health PPO	$110.60

BACK BUDDY

Facility

$159.00

Hospital Charge Code	27022400
Hospital Revenue Code	270
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$135.15
Rate for Payer: Cash Price	$103.35
Rate for Payer: Community Health Alliance Commercial	$135.15
Rate for Payer: Priority Health Commercial	$111.30
Rate for Payer: Priority Health PPO	$111.30

BACK HUGGAR

Facility

$38.00

Hospital Charge Code	27060149
Hospital Revenue Code	270
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$32.30
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health PPO	$26.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges