Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PORTACATH

Facility

$40.00

Hospital Charge Code	27015347
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

PORT-A-CATH IVP

Facility

$1,500.00

Service Code	HCPCS C1788
Hospital Charge Code	27015156
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Community Health Alliance Commercial	$1,275.00
Rate for Payer: Priority Health Commercial	$1,050.00
Rate for Payer: Priority Health PPO	$1,050.00

PORT FLUSHING

Facility

$56.00

Hospital Charge Code	4501024
Hospital Revenue Code	450
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

PORT REMOVAL

Facility

$875.00

Hospital Charge Code	5051756
Hospital Revenue Code	960
Min. Negotiated Rate	$612.50
Max. Negotiated Rate	$743.75
Rate for Payer: Cash Price	$568.75
Rate for Payer: Community Health Alliance Commercial	$743.75
Rate for Payer: Priority Health Commercial	$612.50
Rate for Payer: Priority Health PPO	$612.50

POSACONAZOLE

Facility

$64.00

Hospital Charge Code	3102459
Hospital Revenue Code	300
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$54.40
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health PPO	$44.80

POST GLUCOSE DOSE, INC GLUCOSE

Facility

$42.00

Service Code	HCPCS 82950
Hospital Charge Code	3006650
Hospital Revenue Code	301
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$35.70
Rate for Payer: BCBS BCN 65	$4.99
Rate for Payer: Blue Care Network Medicare Advantage	$4.99
Rate for Payer: Cash Price	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.99
Rate for Payer: Meridian Health Plan Medicare	$4.99
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health Medicaid	$4.99
Rate for Payer: Priority Health Medicare	$4.99
Rate for Payer: Priority Health PPO	$29.40
Rate for Payer: United Health Care Medicaid	$4.99
Rate for Payer: United Health Care Medicare Advantage	$2.19

POSTURE CORRECTOR

Facility

$42.00

Hospital Charge Code	27022525
Hospital Revenue Code	270
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

POSTURE SUPPORT

Facility

$60.00

Hospital Charge Code	27021949
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

POTASSIUM

Facility

$27.00

Service Code	HCPCS 84132
Hospital Charge Code	3006700
Hospital Revenue Code	301
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$22.95
Rate for Payer: BCBS BCN 65	$5.00
Rate for Payer: Blue Care Network Medicare Advantage	$5.00
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	$5.00
Rate for Payer: Meridian Health Plan Medicare	$5.00
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health Medicaid	$5.00
Rate for Payer: Priority Health Medicare	$5.00
Rate for Payer: Priority Health PPO	$18.90
Rate for Payer: United Health Care Medicaid	$5.00
Rate for Payer: United Health Care Medicare Advantage	$2.20

POTASSIUM,24HR QUANT

Facility

$2.00

Service Code	HCPCS 84133
Hospital Charge Code	3009120
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$4.97
Rate for Payer: BCBS BCN 65	$4.97
Rate for Payer: Blue Care Network Medicare Advantage	$4.97
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.97
Rate for Payer: Meridian Health Plan Medicare	$4.97
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health Medicaid	$4.97
Rate for Payer: Priority Health Medicare	$4.97
Rate for Payer: Priority Health PPO	$1.40
Rate for Payer: United Health Care Medicaid	$4.97
Rate for Payer: United Health Care Medicare Advantage	$2.19

POTASSIUM RBC

Facility

$82.00

Hospital Charge Code	3100867
Hospital Revenue Code	301
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$69.70
Rate for Payer: Cash Price	$53.30
Rate for Payer: Community Health Alliance Commercial	$69.70
Rate for Payer: Priority Health Commercial	$57.40
Rate for Payer: Priority Health PPO	$57.40

POTASSIUM, STOOL

Facility

$43.45

Service Code	HCPCS 84999
Hospital Charge Code	3006710
Hospital Revenue Code	301
Min. Negotiated Rate	$30.41
Max. Negotiated Rate	$36.93
Rate for Payer: Cash Price	$28.24
Rate for Payer: Community Health Alliance Commercial	$36.93
Rate for Payer: Priority Health Commercial	$30.41
Rate for Payer: Priority Health PPO	$30.41

POTASSIUM, URINE RANDOM

Facility

$22.00

Service Code	HCPCS 84133
Hospital Charge Code	3006720
Hospital Revenue Code	301
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$18.70
Rate for Payer: BCBS BCN 65	$4.97
Rate for Payer: Blue Care Network Medicare Advantage	$4.97
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$14.30
Rate for Payer: Community Health Alliance Commercial	$18.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.97
Rate for Payer: Meridian Health Plan Medicare	$4.97
Rate for Payer: Priority Health Commercial	$15.40
Rate for Payer: Priority Health Medicaid	$4.97
Rate for Payer: Priority Health Medicare	$4.97
Rate for Payer: Priority Health PPO	$15.40
Rate for Payer: United Health Care Medicaid	$4.97
Rate for Payer: United Health Care Medicare Advantage	$2.19

POT URINE 24 HOUR

Facility

$2.00

Hospital Charge Code	3102003
Hospital Revenue Code	300
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health PPO	$1.40

POWERED LDS-15W

Facility

$473.00

Hospital Charge Code	27017418
Hospital Revenue Code	270
Min. Negotiated Rate	$331.10
Max. Negotiated Rate	$402.05
Rate for Payer: Cash Price	$307.45
Rate for Payer: Community Health Alliance Commercial	$402.05
Rate for Payer: Priority Health Commercial	$331.10
Rate for Payer: Priority Health PPO	$331.10

PR3

Facility

$6.00

Hospital Charge Code	3102158
Hospital Revenue Code	300
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$5.10
Rate for Payer: Cash Price	$3.90
Rate for Payer: Community Health Alliance Commercial	$5.10
Rate for Payer: Priority Health Commercial	$4.20
Rate for Payer: Priority Health PPO	$4.20

PRE-ALBUMIN

Facility

$4.00

Service Code	HCPCS 84134
Hospital Charge Code	3007090
Hospital Revenue Code	301
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$15.32
Rate for Payer: BCBS BCN 65	$15.32
Rate for Payer: Blue Care Network Medicare Advantage	$15.32
Rate for Payer: Cash Price	$2.60
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.32
Rate for Payer: Meridian Health Plan Medicare	$15.32
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health Medicaid	$15.32
Rate for Payer: Priority Health Medicare	$15.32
Rate for Payer: Priority Health PPO	$2.80
Rate for Payer: United Health Care Medicaid	$15.32
Rate for Payer: United Health Care Medicare Advantage	$6.74

PREGABALIN-LYRICA

Facility

$34.00

Hospital Charge Code	3006726
Hospital Revenue Code	301
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$28.90
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health PPO	$23.80

PREGNANALONE

Facility

$26.23

Hospital Charge Code	3000674
Hospital Revenue Code	301
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$22.30
Rate for Payer: Cash Price	$17.05
Rate for Payer: Community Health Alliance Commercial	$22.30
Rate for Payer: Priority Health Commercial	$18.36
Rate for Payer: Priority Health PPO	$18.36

PREGNANCY TEST

Facility

$33.00

Service Code	HCPCS 84703
Hospital Charge Code	3005040
Hospital Revenue Code	301
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$7.90
Rate for Payer: Blue Care Network Medicare Advantage	$7.90
Rate for Payer: Cash Price	$21.45
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.90
Rate for Payer: Meridian Health Plan Medicare	$7.90
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$7.90
Rate for Payer: Priority Health Medicare	$7.90
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$7.90
Rate for Payer: United Health Care Medicare Advantage	$3.47

PRENATAL PLOIDY DETECTION

Facility

$670.00

Hospital Charge Code	3000169
Hospital Revenue Code	310
Min. Negotiated Rate	$469.00
Max. Negotiated Rate	$569.50
Rate for Payer: Cash Price	$435.50
Rate for Payer: Community Health Alliance Commercial	$569.50
Rate for Payer: Priority Health Commercial	$469.00
Rate for Payer: Priority Health PPO	$469.00

PRENATAL PROFILE

Facility

$240.98

Hospital Charge Code	3009010
Hospital Revenue Code	301
Min. Negotiated Rate	$168.69
Max. Negotiated Rate	$204.83
Rate for Payer: Cash Price	$156.64
Rate for Payer: Community Health Alliance Commercial	$204.83
Rate for Payer: Priority Health Commercial	$168.69
Rate for Payer: Priority Health PPO	$168.69

PREP RPR

Facility

$1.63

Hospital Charge Code	31027532
Hospital Revenue Code	300
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.39
Rate for Payer: Cash Price	$1.06
Rate for Payer: Community Health Alliance Commercial	$1.39
Rate for Payer: Priority Health Commercial	$1.14
Rate for Payer: Priority Health PPO	$1.14

PREP-TP TOTAL

Facility

$4.89

Hospital Charge Code	31027571
Hospital Revenue Code	300
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$4.16
Rate for Payer: Cash Price	$3.18
Rate for Payer: Community Health Alliance Commercial	$4.16
Rate for Payer: Priority Health Commercial	$3.42
Rate for Payer: Priority Health PPO	$3.42

PRESSURE INFLATOR SYRINGE 1OCC

Facility

$124.00

Hospital Charge Code	27014852
Hospital Revenue Code	270
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$105.40
Rate for Payer: Cash Price	$80.60
Rate for Payer: Community Health Alliance Commercial	$105.40
Rate for Payer: Priority Health Commercial	$86.80
Rate for Payer: Priority Health PPO	$86.80

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges