Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PRO SHIELD

Facility

$159.00

Hospital Charge Code	27021956
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

PROSTATE BALLOON SYSTEM

Facility

$1,892.00

Hospital Charge Code	27016709
Hospital Revenue Code	272
Min. Negotiated Rate	$1,324.40
Max. Negotiated Rate	$1,608.20
Rate for Payer: Cash Price	$1,229.80
Rate for Payer: Community Health Alliance Commercial	$1,608.20
Rate for Payer: Priority Health Commercial	$1,324.40
Rate for Payer: Priority Health PPO	$1,324.40

PROSTATE BIOPSY 1

Facility

$16.76

Hospital Charge Code	3101213
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BIOPSY 10

Facility

$16.76

Hospital Charge Code	3101222
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BIOPSY 11

Facility

$16.76

Hospital Charge Code	3101223
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BIOPSY 12

Facility

$16.76

Hospital Charge Code	3101224
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BIOPSY 3

Facility

$16.76

Hospital Charge Code	3101215
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BIOPSY 4

Facility

$16.76

Hospital Charge Code	3101216
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BIOPSY 5

Facility

$16.76

Hospital Charge Code	3101217
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BIOPSY 6

Facility

$16.76

Hospital Charge Code	3101218
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BIOPSY 7

Facility

$16.76

Hospital Charge Code	3101219
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BIOPSY 8

Facility

$16.76

Hospital Charge Code	3101220
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BIOPSY 9

Facility

$16.76

Hospital Charge Code	3101221
Hospital Revenue Code	310
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$14.25
Rate for Payer: Cash Price	$10.89
Rate for Payer: Community Health Alliance Commercial	$14.25
Rate for Payer: Priority Health Commercial	$11.73
Rate for Payer: Priority Health PPO	$11.73

PROSTATE BOPSY 2

Facility

$16.86

Hospital Charge Code	3101214
Hospital Revenue Code	310
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$14.33
Rate for Payer: Cash Price	$10.96
Rate for Payer: Community Health Alliance Commercial	$14.33
Rate for Payer: Priority Health Commercial	$11.80
Rate for Payer: Priority Health PPO	$11.80

PROSTHESIS, PENILE

Facility

$9,757.00

Service Code	HCPCS C2622
Hospital Charge Code	27868084
Hospital Revenue Code	278
Min. Negotiated Rate	$6,829.90
Max. Negotiated Rate	$8,293.45
Rate for Payer: Cash Price	$6,342.05
Rate for Payer: Community Health Alliance Commercial	$8,293.45
Rate for Payer: Priority Health Commercial	$6,829.90
Rate for Payer: Priority Health PPO	$6,829.90

PROSTHETIC FIT & TRAIN

Facility

$104.00

Service Code	HCPCS 97761 GP
Hospital Charge Code	4200280
Hospital Revenue Code	420
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$88.40
Rate for Payer: Cash Price	$67.60
Rate for Payer: Community Health Alliance Commercial	$88.40
Rate for Payer: Priority Health Commercial	$72.80
Rate for Payer: Priority Health PPO	$72.80

PROSTHETIC TRAINING

Facility

$104.00

Hospital Charge Code	4200374
Hospital Revenue Code	420
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$88.40
Rate for Payer: Cash Price	$67.60
Rate for Payer: Community Health Alliance Commercial	$88.40
Rate for Payer: Priority Health Commercial	$72.80
Rate for Payer: Priority Health PPO	$72.80

PROSTHETIC TRAINING

Facility

$104.00

Hospital Charge Code	4300044
Hospital Revenue Code	430
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$88.40
Rate for Payer: Cash Price	$67.60
Rate for Payer: Community Health Alliance Commercial	$88.40
Rate for Payer: Priority Health Commercial	$72.80
Rate for Payer: Priority Health PPO	$72.80

PROTECTIVE CAP FOR 5MM PINS

Facility

$122.00

Hospital Charge Code	27878250
Hospital Revenue Code	278
Min. Negotiated Rate	$85.40
Max. Negotiated Rate	$103.70
Rate for Payer: Cash Price	$79.30
Rate for Payer: Community Health Alliance Commercial	$103.70
Rate for Payer: Priority Health Commercial	$85.40
Rate for Payer: Priority Health PPO	$85.40

PROTEIN

Facility

$33.00

Service Code	HCPCS 84155
Hospital Charge Code	3008100
Hospital Revenue Code	301
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$3.85
Rate for Payer: Blue Care Network Medicare Advantage	$3.85
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	$3.85
Rate for Payer: Meridian Health Plan Medicare	$3.85
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$3.85
Rate for Payer: Priority Health Medicare	$3.85
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$3.85
Rate for Payer: United Health Care Medicare Advantage	$1.70

PROTEIN 24 URINE/CSF

Facility

$2.25

Service Code	HCPCS 84156
Hospital Charge Code	3008120
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.85
Rate for Payer: BCBS BCN 65	$3.85
Rate for Payer: Blue Care Network Medicare Advantage	$3.85
Rate for Payer: Cash Price	$1.46
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.91
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.85
Rate for Payer: Meridian Health Plan Medicare	$3.85
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health Medicaid	$3.85
Rate for Payer: Priority Health Medicare	$3.85
Rate for Payer: Priority Health PPO	$1.57
Rate for Payer: United Health Care Medicaid	$3.85
Rate for Payer: United Health Care Medicare Advantage	$1.70

PROTEINASE -3 IgG ANTIBODY

Facility

$56.00

Hospital Charge Code	3100031
Hospital Revenue Code	301
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

PROTEIN C

Facility

$14.10

Service Code	HCPCS 85303
Hospital Charge Code	3006900
Hospital Revenue Code	305
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$14.53
Rate for Payer: BCBS BCN 65	$14.53
Rate for Payer: Blue Care Network Medicare Advantage	$14.53
Rate for Payer: Cash Price	$9.17
Rate for Payer: Cash Price	$9.17
Rate for Payer: Community Health Alliance Commercial	$11.98
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.53
Rate for Payer: Meridian Health Plan Medicare	$14.53
Rate for Payer: Priority Health Commercial	$9.87
Rate for Payer: Priority Health Medicaid	$14.53
Rate for Payer: Priority Health Medicare	$14.53
Rate for Payer: Priority Health PPO	$9.87
Rate for Payer: United Health Care Medicaid	$14.53
Rate for Payer: United Health Care Medicare Advantage	$6.39

PROTEIN C, ACTIVATED

Facility

$36.65

Service Code	HCPCS 85307
Hospital Charge Code	3006910
Hospital Revenue Code	305
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$31.15
Rate for Payer: BCBS BCN 65	$16.09
Rate for Payer: Blue Care Network Medicare Advantage	$16.09
Rate for Payer: Cash Price	$23.82
Rate for Payer: Cash Price	$23.82
Rate for Payer: Community Health Alliance Commercial	$31.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.09
Rate for Payer: Meridian Health Plan Medicare	$16.09
Rate for Payer: Priority Health Commercial	$25.66
Rate for Payer: Priority Health Medicaid	$16.09
Rate for Payer: Priority Health Medicare	$16.09
Rate for Payer: Priority Health PPO	$25.66
Rate for Payer: United Health Care Medicaid	$16.09
Rate for Payer: United Health Care Medicare Advantage	$7.08

PROTEIN C TOTAL AG

Facility

$7.00

Hospital Charge Code	3101130
Hospital Revenue Code	305
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$5.95
Rate for Payer: Cash Price	$4.55
Rate for Payer: Community Health Alliance Commercial	$5.95
Rate for Payer: Priority Health Commercial	$4.90
Rate for Payer: Priority Health PPO	$4.90

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges