Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PRESSURE MONITORING KIT

Facility

$95.00

Hospital Charge Code	27017731
Hospital Revenue Code	270
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$80.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
Rate for Payer: Priority Health Commercial	$66.50
Rate for Payer: Priority Health PPO	$66.50

PRETREAT RBC CHEM OR DRUGS-R

Facility

$52.00

Hospital Charge Code	3100073
Hospital Revenue Code	300
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

PRETREAT RBC DGS

Facility

$22.00

Hospital Charge Code	31006781
Hospital Revenue Code	300
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$18.70
Rate for Payer: Cash Price	$14.30
Rate for Payer: Community Health Alliance Commercial	$18.70
Rate for Payer: Priority Health Commercial	$15.40
Rate for Payer: Priority Health PPO	$15.40

PRETREAT RBC ENZYMES-R

Facility

$21.00

Hospital Charge Code	3100072
Hospital Revenue Code	300
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health PPO	$14.70

PROBE,GOLD 7 X 210 CM

Facility

$829.00

Hospital Charge Code	27262277
Hospital Revenue Code	272
Min. Negotiated Rate	$580.30
Max. Negotiated Rate	$704.65
Rate for Payer: Cash Price	$538.85
Rate for Payer: Community Health Alliance Commercial	$704.65
Rate for Payer: Priority Health Commercial	$580.30
Rate for Payer: Priority Health PPO	$580.30

PROBE, INJECTION GOLD

Facility

$1,140.00

Hospital Charge Code	27263230
Hospital Revenue Code	272
Min. Negotiated Rate	$798.00
Max. Negotiated Rate	$969.00
Rate for Payer: Cash Price	$741.00
Rate for Payer: Community Health Alliance Commercial	$969.00
Rate for Payer: Priority Health Commercial	$798.00
Rate for Payer: Priority Health PPO	$798.00

PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH INSERTION OF TUBE OR STENT

Facility

$2,550.43

Service Code	CPT 68815
Hospital Revenue Code	360
Min. Negotiated Rate	$1,122.19
Max. Negotiated Rate	$2,550.43
Rate for Payer: BCBS BCN 65	$2,550.43
Rate for Payer: Blue Care Network Medicare Advantage	$2,550.43
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,550.43
Rate for Payer: Meridian Health Plan Medicare	$2,550.43
Rate for Payer: Priority Health Medicaid	$2,550.43
Rate for Payer: Priority Health Medicare	$2,550.43
Rate for Payer: United Health Care Medicaid	$2,550.43
Rate for Payer: United Health Care Medicare Advantage	$1,122.19

PRO BNP-LC

Facility

$45.00

Hospital Charge Code	3101951
Hospital Revenue Code	300
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

PROCAINAMIDE

Facility

$12.04

Service Code	HCPCS 80192
Hospital Charge Code	3006780
Hospital Revenue Code	301
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$17.59
Rate for Payer: BCBS BCN 65	$17.59
Rate for Payer: Blue Care Network Medicare Advantage	$17.59
Rate for Payer: Cash Price	$7.83
Rate for Payer: Cash Price	$7.83
Rate for Payer: Community Health Alliance Commercial	$10.23
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.59
Rate for Payer: Meridian Health Plan Medicare	$17.59
Rate for Payer: Priority Health Commercial	$8.43
Rate for Payer: Priority Health Medicaid	$17.59
Rate for Payer: Priority Health Medicare	$17.59
Rate for Payer: Priority Health PPO	$8.43
Rate for Payer: United Health Care Medicaid	$17.59
Rate for Payer: United Health Care Medicare Advantage	$7.74

PROCALCITONON

Facility

$70.00

Hospital Charge Code	3101237
Hospital Revenue Code	300
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

PROCESSING FEE BACTERIAL ISO

Facility

$9.50

Hospital Charge Code	3101268
Hospital Revenue Code	301
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$8.07
Rate for Payer: Cash Price	$6.18
Rate for Payer: Community Health Alliance Commercial	$8.07
Rate for Payer: Priority Health Commercial	$6.65
Rate for Payer: Priority Health PPO	$6.65

PRODERM SPRAY

Facility

$51.00

Hospital Charge Code	27019596
Hospital Revenue Code	270
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

PROGESTERONE

Facility

$3.37

Service Code	HCPCS 84144
Hospital Charge Code	3006800
Hospital Revenue Code	301
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$21.90
Rate for Payer: BCBS BCN 65	$21.90
Rate for Payer: Blue Care Network Medicare Advantage	$21.90
Rate for Payer: Cash Price	$2.19
Rate for Payer: Cash Price	$2.19
Rate for Payer: Community Health Alliance Commercial	$2.86
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.90
Rate for Payer: Meridian Health Plan Medicare	$21.90
Rate for Payer: Priority Health Commercial	$2.36
Rate for Payer: Priority Health Medicaid	$21.90
Rate for Payer: Priority Health Medicare	$21.90
Rate for Payer: Priority Health PPO	$2.36
Rate for Payer: United Health Care Medicaid	$21.90
Rate for Payer: United Health Care Medicare Advantage	$9.64

PROGESTERONE-ML

Facility

$110.00

Hospital Charge Code	3101292
Hospital Revenue Code	301
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$93.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Community Health Alliance Commercial	$93.50
Rate for Payer: Priority Health Commercial	$77.00
Rate for Payer: Priority Health PPO	$77.00

PROGESTERONE RECEPTOR ASS IHC

Facility

$270.00

Hospital Charge Code	3101016
Hospital Revenue Code	310
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$229.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Community Health Alliance Commercial	$229.50
Rate for Payer: Priority Health Commercial	$189.00
Rate for Payer: Priority Health PPO	$189.00

PROINSULIN

Facility

$28.47

Service Code	HCPCS 84206
Hospital Charge Code	3006810
Hospital Revenue Code	301
Min. Negotiated Rate	$12.33
Max. Negotiated Rate	$28.02
Rate for Payer: BCBS BCN 65	$28.02
Rate for Payer: Blue Care Network Medicare Advantage	$28.02
Rate for Payer: Cash Price	$18.51
Rate for Payer: Cash Price	$18.51
Rate for Payer: Community Health Alliance Commercial	$24.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$28.02
Rate for Payer: Meridian Health Plan Medicare	$28.02
Rate for Payer: Priority Health Commercial	$19.93
Rate for Payer: Priority Health Medicaid	$28.02
Rate for Payer: Priority Health Medicare	$28.02
Rate for Payer: Priority Health PPO	$19.93
Rate for Payer: United Health Care Medicaid	$28.02
Rate for Payer: United Health Care Medicare Advantage	$12.33

PROLACTIN

Facility

$3.26

Service Code	HCPCS 84146
Hospital Charge Code	3006820
Hospital Revenue Code	301
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$20.35
Rate for Payer: BCBS BCN 65	$20.35
Rate for Payer: Blue Care Network Medicare Advantage	$20.35
Rate for Payer: Cash Price	$2.12
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$20.35
Rate for Payer: Meridian Health Plan Medicare	$20.35
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health Medicaid	$20.35
Rate for Payer: Priority Health Medicare	$20.35
Rate for Payer: Priority Health PPO	$2.28
Rate for Payer: United Health Care Medicaid	$20.35
Rate for Payer: United Health Care Medicare Advantage	$8.95

PROLACTIN-ML

Facility

$110.00

Hospital Charge Code	3101293
Hospital Revenue Code	301
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$93.50
Rate for Payer: Cash Price	$71.50
Rate for Payer: Community Health Alliance Commercial	$93.50
Rate for Payer: Priority Health Commercial	$77.00
Rate for Payer: Priority Health PPO	$77.00

PROLIXIN

Facility

$24.44

Service Code	HCPCS G0480
Hospital Charge Code	3006830
Hospital Revenue Code	301
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$15.89
Rate for Payer: Cash Price	$15.89
Rate for Payer: Community Health Alliance Commercial	$20.77
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$17.11
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$17.11
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

PROM ANSER VDZ-1

Facility

$62.50

Hospital Charge Code	3101997
Hospital Revenue Code	300
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$53.12
Rate for Payer: Cash Price	$40.63
Rate for Payer: Community Health Alliance Commercial	$53.12
Rate for Payer: Priority Health Commercial	$43.75
Rate for Payer: Priority Health PPO	$43.75

PROM ANSER VDZ-2

Facility

$62.50

Hospital Charge Code	3101998
Hospital Revenue Code	300
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$53.12
Rate for Payer: Cash Price	$40.63
Rate for Payer: Community Health Alliance Commercial	$53.12
Rate for Payer: Priority Health Commercial	$43.75
Rate for Payer: Priority Health PPO	$43.75

PROMETHEUS ANSER UST

Facility

$2,000.00

Hospital Charge Code	3101404
Hospital Revenue Code	300
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Community Health Alliance Commercial	$1,700.00
Rate for Payer: Priority Health Commercial	$1,400.00
Rate for Payer: Priority Health PPO	$1,400.00

PROMETHEUS TPMT GENETICS

Facility

$200.00

Hospital Charge Code	3101230
Hospital Revenue Code	310
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$170.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Community Health Alliance Commercial	$170.00
Rate for Payer: Priority Health Commercial	$140.00
Rate for Payer: Priority Health PPO	$140.00

PROPOXYPHENE AND MET QUANT SER

Facility

$12.36

Service Code	HCPCS G0480
Hospital Charge Code	3003565
Hospital Revenue Code	301
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$8.03
Rate for Payer: Cash Price	$8.03
Rate for Payer: Community Health Alliance Commercial	$10.51
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$8.65
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$8.65
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

PROPOXYPHENE AND MET QUANT URI

Facility

$68.00

Service Code	HCPCS G0480
Hospital Charge Code	3100955
Hospital Revenue Code	301
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$47.60
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges