Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PNH-3

Facility

$21.16

Hospital Charge Code	3101373
Hospital Revenue Code	310
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$17.99
Rate for Payer: Cash Price	$13.75
Rate for Payer: Community Health Alliance Commercial	$17.99
Rate for Payer: Priority Health Commercial	$14.81
Rate for Payer: Priority Health PPO	$14.81

PNH-4

Facility

$21.16

Hospital Charge Code	3101374
Hospital Revenue Code	310
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$17.99
Rate for Payer: Cash Price	$13.75
Rate for Payer: Community Health Alliance Commercial	$17.99
Rate for Payer: Priority Health Commercial	$14.81
Rate for Payer: Priority Health PPO	$14.81

PNH-5

Facility

$21.16

Hospital Charge Code	3101375
Hospital Revenue Code	310
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$17.99
Rate for Payer: Cash Price	$13.75
Rate for Payer: Community Health Alliance Commercial	$17.99
Rate for Payer: Priority Health Commercial	$14.81
Rate for Payer: Priority Health PPO	$14.81

PNH-6

Facility

$21.16

Hospital Charge Code	3101376
Hospital Revenue Code	310
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$17.99
Rate for Payer: Cash Price	$13.75
Rate for Payer: Community Health Alliance Commercial	$17.99
Rate for Payer: Priority Health Commercial	$14.81
Rate for Payer: Priority Health PPO	$14.81

PNH-7

Facility

$21.17

Hospital Charge Code	3101377
Hospital Revenue Code	310
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$17.99
Rate for Payer: Cash Price	$13.76
Rate for Payer: Community Health Alliance Commercial	$17.99
Rate for Payer: Priority Health Commercial	$14.82
Rate for Payer: Priority Health PPO	$14.82

PNP1-1

Facility

$277.25

Hospital Charge Code	3102400
Hospital Revenue Code	300
Min. Negotiated Rate	$194.07
Max. Negotiated Rate	$235.66
Rate for Payer: Cash Price	$180.21
Rate for Payer: Community Health Alliance Commercial	$235.66
Rate for Payer: Priority Health Commercial	$194.07
Rate for Payer: Priority Health PPO	$194.07

PNP1-2

Facility

$277.25

Hospital Charge Code	3102401
Hospital Revenue Code	300
Min. Negotiated Rate	$194.07
Max. Negotiated Rate	$235.66
Rate for Payer: Cash Price	$180.21
Rate for Payer: Community Health Alliance Commercial	$235.66
Rate for Payer: Priority Health Commercial	$194.07
Rate for Payer: Priority Health PPO	$194.07

PNP1-3

Facility

$277.25

Hospital Charge Code	3102402
Hospital Revenue Code	300
Min. Negotiated Rate	$194.07
Max. Negotiated Rate	$235.66
Rate for Payer: Cash Price	$180.21
Rate for Payer: Community Health Alliance Commercial	$235.66
Rate for Payer: Priority Health Commercial	$194.07
Rate for Payer: Priority Health PPO	$194.07

POLAR CARE 500 COMBO KIT

Facility

$914.00

Hospital Charge Code	27067268
Hospital Revenue Code	272
Min. Negotiated Rate	$639.80
Max. Negotiated Rate	$776.90
Rate for Payer: Cash Price	$594.10
Rate for Payer: Community Health Alliance Commercial	$776.90
Rate for Payer: Priority Health Commercial	$639.80
Rate for Payer: Priority Health PPO	$639.80

POLIOVIRUS ANTIBODIES

Facility

$132.00

Hospital Charge Code	3100857
Hospital Revenue Code	302
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$112.20
Rate for Payer: Cash Price	$85.80
Rate for Payer: Community Health Alliance Commercial	$112.20
Rate for Payer: Priority Health Commercial	$92.40
Rate for Payer: Priority Health PPO	$92.40

POLIOVIRUS TYPE 1 AB

Facility

$44.00

Hospital Charge Code	3100854
Hospital Revenue Code	302
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

POLIOVIRUS TYPE 2 AB

Facility

$44.00

Hospital Charge Code	3100855
Hospital Revenue Code	302
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

POLIOVIRUS TYPE 3 AB

Facility

$44.00

Hospital Charge Code	3100856
Hospital Revenue Code	302
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

POLYROTICULATOR

Facility

$769.00

Hospital Charge Code	27024281
Hospital Revenue Code	272
Min. Negotiated Rate	$538.30
Max. Negotiated Rate	$653.65
Rate for Payer: Cash Price	$499.85
Rate for Payer: Community Health Alliance Commercial	$653.65
Rate for Payer: Priority Health Commercial	$538.30
Rate for Payer: Priority Health PPO	$538.30

POLY SURGICLIP - MED

Facility

$228.00

Hospital Charge Code	27014217
Hospital Revenue Code	272
Min. Negotiated Rate	$159.60
Max. Negotiated Rate	$193.80
Rate for Payer: Cash Price	$148.20
Rate for Payer: Community Health Alliance Commercial	$193.80
Rate for Payer: Priority Health Commercial	$159.60
Rate for Payer: Priority Health PPO	$159.60

POMPE DISEASE (GAA)

Facility

$207.50

Hospital Charge Code	3101381
Hospital Revenue Code	300
Min. Negotiated Rate	$145.25
Max. Negotiated Rate	$176.38
Rate for Payer: Cash Price	$134.88
Rate for Payer: Community Health Alliance Commercial	$176.38
Rate for Payer: Priority Health Commercial	$145.25
Rate for Payer: Priority Health PPO	$145.25

POOLING OF PLATELETS

Facility

$170.00

Service Code	HCPCS 86965
Hospital Charge Code	3002081
Hospital Revenue Code	300
Min. Negotiated Rate	$80.42
Max. Negotiated Rate	$182.76
Rate for Payer: BCBS BCN 65	$182.76
Rate for Payer: Blue Care Network Medicare Advantage	$182.76
Rate for Payer: Cash Price	$110.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Community Health Alliance Commercial	$144.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$182.76
Rate for Payer: Meridian Health Plan Medicare	$182.76
Rate for Payer: Priority Health Commercial	$119.00
Rate for Payer: Priority Health Medicaid	$182.76
Rate for Payer: Priority Health Medicare	$182.76
Rate for Payer: Priority Health PPO	$119.00
Rate for Payer: United Health Care Medicaid	$182.76
Rate for Payer: United Health Care Medicare Advantage	$80.42

PORHOBILINOGEN DEAMINASE

Facility

$288.00

Service Code	HCPCS 84311
Hospital Charge Code	3000931
Hospital Revenue Code	301
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$244.80
Rate for Payer: BCBS BCN 65	$8.51
Rate for Payer: Blue Care Network Medicare Advantage	$8.51
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Community Health Alliance Commercial	$244.80
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	$201.60
Rate for Payer: Priority Health Medicaid	$8.51
Rate for Payer: Priority Health Medicare	$8.51
Rate for Payer: Priority Health PPO	$201.60
Rate for Payer: United Health Care Medicaid	$8.51
Rate for Payer: United Health Care Medicare Advantage	$3.74

PORPHOBILINOGEN 24 HR URINE

Facility

$6.37

Service Code	HCPCS 84110
Hospital Charge Code	3000921
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$8.86
Rate for Payer: BCBS BCN 65	$8.86
Rate for Payer: Blue Care Network Medicare Advantage	$8.86
Rate for Payer: Cash Price	$4.14
Rate for Payer: Cash Price	$4.14
Rate for Payer: Community Health Alliance Commercial	$5.41
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.86
Rate for Payer: Meridian Health Plan Medicare	$8.86
Rate for Payer: Priority Health Commercial	$4.46
Rate for Payer: Priority Health Medicaid	$8.86
Rate for Payer: Priority Health Medicare	$8.86
Rate for Payer: Priority Health PPO	$4.46
Rate for Payer: United Health Care Medicaid	$8.86
Rate for Payer: United Health Care Medicare Advantage	$3.90

PORPHOBILINOGEN UR RANDOM

Facility

$6.23

Hospital Charge Code	3000922
Hospital Revenue Code	301
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$5.30
Rate for Payer: Cash Price	$4.05
Rate for Payer: Community Health Alliance Commercial	$5.30
Rate for Payer: Priority Health Commercial	$4.36
Rate for Payer: Priority Health PPO	$4.36

PORPHRYNS EVAL

Facility

$215.40

Service Code	HCPCS 84311
Hospital Charge Code	3004390
Hospital Revenue Code	301
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$183.09
Rate for Payer: BCBS BCN 65	$8.51
Rate for Payer: Blue Care Network Medicare Advantage	$8.51
Rate for Payer: Cash Price	$140.01
Rate for Payer: Cash Price	$140.01
Rate for Payer: Community Health Alliance Commercial	$183.09
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	$150.78
Rate for Payer: Priority Health Medicaid	$8.51
Rate for Payer: Priority Health Medicare	$8.51
Rate for Payer: Priority Health PPO	$150.78
Rate for Payer: United Health Care Medicaid	$8.51
Rate for Payer: United Health Care Medicare Advantage	$3.74

PORPHYRIN R URINE

Facility

$8.65

Service Code	HCPCS 84120
Hospital Charge Code	3000941
Hospital Revenue Code	301
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$15.45
Rate for Payer: BCBS BCN 65	$15.45
Rate for Payer: Blue Care Network Medicare Advantage	$15.45
Rate for Payer: Cash Price	$5.62
Rate for Payer: Cash Price	$5.62
Rate for Payer: Community Health Alliance Commercial	$7.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.45
Rate for Payer: Meridian Health Plan Medicare	$15.45
Rate for Payer: Priority Health Commercial	$6.05
Rate for Payer: Priority Health Medicaid	$15.45
Rate for Payer: Priority Health Medicare	$15.45
Rate for Payer: Priority Health PPO	$6.05
Rate for Payer: United Health Care Medicaid	$15.45
Rate for Payer: United Health Care Medicare Advantage	$6.80

PORPHYRINS 24 HR URINE

Facility

$16.00

Hospital Charge Code	3102408
Hospital Revenue Code	300
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
Rate for Payer: Priority Health Commercial	$11.20
Rate for Payer: Priority Health PPO	$11.20

PORPHYRINS FECAL

Facility

$198.90

Service Code	HCPCS 84126
Hospital Charge Code	3004175
Hospital Revenue Code	301
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$169.06
Rate for Payer: BCBS BCN 65	$41.07
Rate for Payer: Blue Care Network Medicare Advantage	$41.07
Rate for Payer: Cash Price	$129.29
Rate for Payer: Cash Price	$129.29
Rate for Payer: Community Health Alliance Commercial	$169.06
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$41.07
Rate for Payer: Meridian Health Plan Medicare	$41.07
Rate for Payer: Priority Health Commercial	$139.23
Rate for Payer: Priority Health Medicaid	$41.07
Rate for Payer: Priority Health Medicare	$41.07
Rate for Payer: Priority Health PPO	$139.23
Rate for Payer: United Health Care Medicaid	$41.07
Rate for Payer: United Health Care Medicare Advantage	$18.07

PORPHYRINS,PLASMA

Facility

$260.00

Service Code	HCPCS 82491
Hospital Charge Code	3006609
Hospital Revenue Code	301
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$221.00
Rate for Payer: Cash Price	$169.00
Rate for Payer: Community Health Alliance Commercial	$221.00
Rate for Payer: Priority Health Commercial	$182.00
Rate for Payer: Priority Health PPO	$182.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges