Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PROTEIN REFRACTOMETRIC

Facility

$2.25

Service Code	HCPCS 84157
Hospital Charge Code	3006940
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$4.20
Rate for Payer: BCBS BCN 65	$4.20
Rate for Payer: Blue Care Network Medicare Advantage	$4.20
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	$4.20
Rate for Payer: Meridian Health Plan Medicare	$4.20
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health Medicaid	$4.20
Rate for Payer: Priority Health Medicare	$4.20
Rate for Payer: Priority Health PPO	$1.57
Rate for Payer: United Health Care Medicaid	$4.20
Rate for Payer: United Health Care Medicare Advantage	$1.85

PROTEIN S

Facility

$12.22

Service Code	HCPCS 85306
Hospital Charge Code	3006980
Hospital Revenue Code	305
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$16.09
Rate for Payer: BCBS BCN 65	$16.09
Rate for Payer: Blue Care Network Medicare Advantage	$16.09
Rate for Payer: Cash Price	$7.94
Rate for Payer: Cash Price	$7.94
Rate for Payer: Community Health Alliance Commercial	$10.39
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	$8.55
Rate for Payer: Priority Health Medicaid	$16.09
Rate for Payer: Priority Health Medicare	$16.09
Rate for Payer: Priority Health PPO	$8.55
Rate for Payer: United Health Care Medicaid	$16.09
Rate for Payer: United Health Care Medicare Advantage	$7.08

PROTEIN S FREE

Facility

$16.00

Service Code	HCPCS 85306
Hospital Charge Code	3006990
Hospital Revenue Code	301
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$16.09
Rate for Payer: BCBS BCN 65	$16.09
Rate for Payer: Blue Care Network Medicare Advantage	$16.09
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
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	$11.20
Rate for Payer: Priority Health Medicaid	$16.09
Rate for Payer: Priority Health Medicare	$16.09
Rate for Payer: Priority Health PPO	$11.20
Rate for Payer: United Health Care Medicaid	$16.09
Rate for Payer: United Health Care Medicare Advantage	$7.08

PROTEIN URINE 24 HR

Facility

$2.25

Hospital Charge Code	3101074
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.91
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.91
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health PPO	$1.57

PROTEIN, URINE QUAL

Facility

$19.00

Service Code	HCPCS 81002
Hospital Charge Code	3008680
Hospital Revenue Code	307
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$16.15
Rate for Payer: BCBS BCN 65	$3.65
Rate for Payer: Blue Care Network Medicare Advantage	$3.65
Rate for Payer: Cash Price	$12.35
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3.65
Rate for Payer: Meridian Health Plan Medicare	$3.65
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health Medicaid	$3.65
Rate for Payer: Priority Health Medicare	$3.65
Rate for Payer: Priority Health PPO	$13.30
Rate for Payer: United Health Care Medicaid	$3.65
Rate for Payer: United Health Care Medicare Advantage	$1.61

PROTEIN-URINE-RANDOM

Facility

$2.13

Service Code	HCPCS 84156
Hospital Charge Code	3002881
Hospital Revenue Code	301
Min. Negotiated Rate	$1.49
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	$1.38
Rate for Payer: Cash Price	$1.38
Rate for Payer: Community Health Alliance Commercial	$1.81
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	$1.49
Rate for Payer: Priority Health Medicaid	$3.85
Rate for Payer: Priority Health Medicare	$3.85
Rate for Payer: Priority Health PPO	$1.49
Rate for Payer: United Health Care Medicaid	$3.85
Rate for Payer: United Health Care Medicare Advantage	$1.70

PROTHROMBIN TIME

Facility

$29.00

Service Code	HCPCS 85610
Hospital Charge Code	3007000
Hospital Revenue Code	305
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$24.65
Rate for Payer: BCBS BCN 65	$4.50
Rate for Payer: Blue Care Network Medicare Advantage	$4.50
Rate for Payer: Cash Price	$18.85
Rate for Payer: Cash Price	$18.85
Rate for Payer: Community Health Alliance Commercial	$24.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.50
Rate for Payer: Meridian Health Plan Medicare	$4.50
Rate for Payer: Priority Health Commercial	$20.30
Rate for Payer: Priority Health Medicaid	$4.50
Rate for Payer: Priority Health Medicare	$4.50
Rate for Payer: Priority Health PPO	$20.30
Rate for Payer: United Health Care Medicaid	$4.50
Rate for Payer: United Health Care Medicare Advantage	$1.98

PROTIME MUTATION TEST

Facility

$27.51

Hospital Charge Code	3007005
Hospital Revenue Code	301
Min. Negotiated Rate	$19.26
Max. Negotiated Rate	$23.38
Rate for Payer: Cash Price	$17.88
Rate for Payer: Community Health Alliance Commercial	$23.38
Rate for Payer: Priority Health Commercial	$19.26
Rate for Payer: Priority Health PPO	$19.26

PROTOPORPHYRIN RBC

Facility

$50.00

Service Code	HCPCS 84202
Hospital Charge Code	3003361
Hospital Revenue Code	301
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$15.07
Rate for Payer: Blue Care Network Medicare Advantage	$15.07
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.07
Rate for Payer: Meridian Health Plan Medicare	$15.07
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$15.07
Rate for Payer: Priority Health Medicare	$15.07
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$15.07
Rate for Payer: United Health Care Medicare Advantage	$6.63

PROTRIPTYLINE

Facility

$41.00

Hospital Charge Code	3100711
Hospital Revenue Code	301
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$34.85
Rate for Payer: Cash Price	$26.65
Rate for Payer: Community Health Alliance Commercial	$34.85
Rate for Payer: Priority Health Commercial	$28.70
Rate for Payer: Priority Health PPO	$28.70

PROTRITYLINE URINE

Facility

$79.00

Hospital Charge Code	3100782
Hospital Revenue Code	300
Min. Negotiated Rate	$55.30
Max. Negotiated Rate	$67.15
Rate for Payer: Cash Price	$51.35
Rate for Payer: Community Health Alliance Commercial	$67.15
Rate for Payer: Priority Health Commercial	$55.30
Rate for Payer: Priority Health PPO	$55.30

PROZAC FLUNITRAZEPAM URINE

Facility

$15.22

Service Code	HCPCS 80299
Hospital Charge Code	3007010
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$19.57
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$9.89
Rate for Payer: Cash Price	$9.89
Rate for Payer: Community Health Alliance Commercial	$12.94
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.57
Rate for Payer: Meridian Health Plan Medicare	$19.57
Rate for Payer: Priority Health Commercial	$10.65
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$10.65
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

PSA DIAG-LC

Facility

$22.48

Hospital Charge Code	3006870
Hospital Revenue Code	301
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$19.11
Rate for Payer: Cash Price	$14.61
Rate for Payer: Community Health Alliance Commercial	$19.11
Rate for Payer: Priority Health Commercial	$15.74
Rate for Payer: Priority Health PPO	$15.74

PSA DIAGNOSTIC

Facility

$75.00

Hospital Charge Code	3101599
Hospital Revenue Code	301
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

PSA, DIAGNOSTIC

Facility

$4.85

Service Code	HCPCS 84153
Hospital Charge Code	3006860
Hospital Revenue Code	301
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$19.31
Rate for Payer: BCBS BCN 65	$19.31
Rate for Payer: Blue Care Network Medicare Advantage	$19.31
Rate for Payer: Cash Price	$3.15
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.12
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.31
Rate for Payer: Meridian Health Plan Medicare	$19.31
Rate for Payer: Priority Health Commercial	$3.40
Rate for Payer: Priority Health Medicaid	$19.31
Rate for Payer: Priority Health Medicare	$19.31
Rate for Payer: Priority Health PPO	$3.40
Rate for Payer: United Health Care Medicaid	$19.31
Rate for Payer: United Health Care Medicare Advantage	$8.50

PSA DIAGNOSTIC (FREE)

Facility

$4.86

Hospital Charge Code	3006861
Hospital Revenue Code	301
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.13
Rate for Payer: Cash Price	$3.16
Rate for Payer: Community Health Alliance Commercial	$4.13
Rate for Payer: Priority Health Commercial	$3.40
Rate for Payer: Priority Health PPO	$3.40

PSA FREE AND TOTAL DIAGNOSTIC

Facility

$9.71

Hospital Charge Code	3006859
Hospital Revenue Code	301
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$8.25
Rate for Payer: Cash Price	$6.31
Rate for Payer: Community Health Alliance Commercial	$8.25
Rate for Payer: Priority Health Commercial	$6.80
Rate for Payer: Priority Health PPO	$6.80

PSA FREE AND TOTAL SCREENING

Facility

$157.00

Hospital Charge Code	3006858
Hospital Revenue Code	301
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$133.45
Rate for Payer: Cash Price	$102.05
Rate for Payer: Community Health Alliance Commercial	$133.45
Rate for Payer: Priority Health Commercial	$109.90
Rate for Payer: Priority Health PPO	$109.90

PSA FREE AND TOTAL SCREEN MCR

Facility

$157.00

Hospital Charge Code	3006857
Hospital Revenue Code	301
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$133.45
Rate for Payer: Cash Price	$102.05
Rate for Payer: Community Health Alliance Commercial	$133.45
Rate for Payer: Priority Health Commercial	$109.90
Rate for Payer: Priority Health PPO	$109.90

PSA FREE"TOTAL RATIO REFLEX

Facility

$3.37

Hospital Charge Code	3102578
Hospital Revenue Code	300
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$2.86
Rate for Payer: Cash Price	$2.19
Rate for Payer: Community Health Alliance Commercial	$2.86
Rate for Payer: Priority Health Commercial	$2.36
Rate for Payer: Priority Health PPO	$2.36

PSA MCR-LC

Facility

$22.48

Service Code	HCPCS G0103
Hospital Charge Code	3102581
Hospital Revenue Code	300
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$20.28
Rate for Payer: BCBS BCN 65	$20.28
Rate for Payer: Blue Care Network Medicare Advantage	$20.28
Rate for Payer: Cash Price	$14.61
Rate for Payer: Cash Price	$14.61
Rate for Payer: Community Health Alliance Commercial	$19.11
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$20.28
Rate for Payer: Meridian Health Plan Medicare	$20.28
Rate for Payer: Priority Health Commercial	$15.74
Rate for Payer: Priority Health Medicaid	$20.28
Rate for Payer: Priority Health Medicare	$20.28
Rate for Payer: Priority Health PPO	$15.74
Rate for Payer: United Health Care Medicaid	$20.28
Rate for Payer: United Health Care Medicare Advantage	$8.92

PSA, SCREENING

Facility

$75.00

Service Code	HCPCS 84153
Hospital Charge Code	3006865
Hospital Revenue Code	301
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$63.75
Rate for Payer: BCBS BCN 65	$19.31
Rate for Payer: Blue Care Network Medicare Advantage	$19.31
Rate for Payer: Cash Price	$48.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.31
Rate for Payer: Meridian Health Plan Medicare	$19.31
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health Medicaid	$19.31
Rate for Payer: Priority Health Medicare	$19.31
Rate for Payer: Priority Health PPO	$52.50
Rate for Payer: United Health Care Medicaid	$19.31
Rate for Payer: United Health Care Medicare Advantage	$8.50

PSA, SCREENING FOR MEDICARE

Facility

$75.00

Service Code	HCPCS G0103
Hospital Charge Code	3006866
Hospital Revenue Code	301
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$63.75
Rate for Payer: BCBS BCN 65	$20.28
Rate for Payer: Blue Care Network Medicare Advantage	$20.28
Rate for Payer: Cash Price	$48.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$20.28
Rate for Payer: Meridian Health Plan Medicare	$20.28
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health Medicaid	$20.28
Rate for Payer: Priority Health Medicare	$20.28
Rate for Payer: Priority Health PPO	$52.50
Rate for Payer: United Health Care Medicaid	$20.28
Rate for Payer: United Health Care Medicare Advantage	$8.92

PSA SCREENING (FREE)

Facility

$80.00

Hospital Charge Code	3006864
Hospital Revenue Code	301
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

PSA SCREEN-LC

Facility

$22.48

Hospital Charge Code	3102580
Hospital Revenue Code	300
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$19.11
Rate for Payer: Cash Price	$14.61
Rate for Payer: Community Health Alliance Commercial	$19.11
Rate for Payer: Priority Health Commercial	$15.74
Rate for Payer: Priority Health PPO	$15.74

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges