Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PSEUDOCHOL-1

Facility

$3.80

Hospital Charge Code	3002664
Hospital Revenue Code	301
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$3.23
Rate for Payer: Cash Price	$2.47
Rate for Payer: Community Health Alliance Commercial	$3.23
Rate for Payer: Priority Health Commercial	$2.66
Rate for Payer: Priority Health PPO	$2.66

PSEUDOCHOL-2

Facility

$3.80

Hospital Charge Code	3002665
Hospital Revenue Code	301
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$3.23
Rate for Payer: Cash Price	$2.47
Rate for Payer: Community Health Alliance Commercial	$3.23
Rate for Payer: Priority Health Commercial	$2.66
Rate for Payer: Priority Health PPO	$2.66

PSEUDOEPHEDRINE HCL

Facility

$107.06

Hospital Charge Code	3000415
Hospital Revenue Code	301
Min. Negotiated Rate	$74.94
Max. Negotiated Rate	$91.00
Rate for Payer: Cash Price	$69.59
Rate for Payer: Community Health Alliance Commercial	$91.00
Rate for Payer: Priority Health Commercial	$74.94
Rate for Payer: Priority Health PPO	$74.94

PSITTACOSIS CHLAM AB

Facility

$222.00

Hospital Charge Code	3006517
Hospital Revenue Code	302
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$188.70
Rate for Payer: Cash Price	$144.30
Rate for Payer: Community Health Alliance Commercial	$188.70
Rate for Payer: Priority Health Commercial	$155.40
Rate for Payer: Priority Health PPO	$155.40

PSITTACOSIS CHLAM ANTIB IGG

Facility

$77.00

Service Code	HCPCS 86631
Hospital Charge Code	3006515
Hospital Revenue Code	302
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$65.45
Rate for Payer: BCBS BCN 65	$12.41
Rate for Payer: Blue Care Network Medicare Advantage	$12.41
Rate for Payer: Cash Price	$50.05
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.41
Rate for Payer: Meridian Health Plan Medicare	$12.41
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health Medicaid	$12.41
Rate for Payer: Priority Health Medicare	$12.41
Rate for Payer: Priority Health PPO	$53.90
Rate for Payer: United Health Care Medicaid	$12.41
Rate for Payer: United Health Care Medicare Advantage	$5.46

PSITTACOSIS CHLAM ANTIB IGG

Facility

$77.00

Hospital Charge Code	3006514
Hospital Revenue Code	310
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$65.45
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health PPO	$53.90

PSITTACOSIS CHLAM ANTIB IGM

Facility

$77.00

Service Code	HCPCS 86632
Hospital Charge Code	3006516
Hospital Revenue Code	302
Min. Negotiated Rate	$5.86
Max. Negotiated Rate	$65.45
Rate for Payer: BCBS BCN 65	$13.31
Rate for Payer: Blue Care Network Medicare Advantage	$13.31
Rate for Payer: Cash Price	$50.05
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.31
Rate for Payer: Meridian Health Plan Medicare	$13.31
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health Medicaid	$13.31
Rate for Payer: Priority Health Medicare	$13.31
Rate for Payer: Priority Health PPO	$53.90
Rate for Payer: United Health Care Medicaid	$13.31
Rate for Payer: United Health Care Medicare Advantage	$5.86

PTAU-1

Facility

$131.00

Hospital Charge Code	31027696
Hospital Revenue Code	300
Min. Negotiated Rate	$91.70
Max. Negotiated Rate	$111.35
Rate for Payer: Cash Price	$85.15
Rate for Payer: Community Health Alliance Commercial	$111.35
Rate for Payer: Priority Health Commercial	$91.70
Rate for Payer: Priority Health PPO	$91.70

PTAU-2

Facility

$131.00

Hospital Charge Code	31027697
Hospital Revenue Code	300
Min. Negotiated Rate	$91.70
Max. Negotiated Rate	$111.35
Rate for Payer: Cash Price	$85.15
Rate for Payer: Community Health Alliance Commercial	$111.35
Rate for Payer: Priority Health Commercial	$91.70
Rate for Payer: Priority Health PPO	$91.70

PTAU BETA AMYLOID RATIO

Facility

$262.00

Hospital Charge Code	31027695
Hospital Revenue Code	300
Min. Negotiated Rate	$183.40
Max. Negotiated Rate	$222.70
Rate for Payer: Cash Price	$170.30
Rate for Payer: Community Health Alliance Commercial	$222.70
Rate for Payer: Priority Health Commercial	$183.40
Rate for Payer: Priority Health PPO	$183.40

PTH-1

Facility

$4.03

Hospital Charge Code	3101829
Hospital Revenue Code	300
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$3.43
Rate for Payer: Cash Price	$2.62
Rate for Payer: Community Health Alliance Commercial	$3.43
Rate for Payer: Priority Health Commercial	$2.82
Rate for Payer: Priority Health PPO	$2.82

PTH, C-TERMINAL/MID REGION

Facility

$128.00

Service Code	HCPCS 83970
Hospital Charge Code	3007040
Hospital Revenue Code	301
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$108.80
Rate for Payer: BCBS BCN 65	$43.34
Rate for Payer: Blue Care Network Medicare Advantage	$43.34
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Community Health Alliance Commercial	$108.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$43.34
Rate for Payer: Meridian Health Plan Medicare	$43.34
Rate for Payer: Priority Health Commercial	$89.60
Rate for Payer: Priority Health Medicaid	$43.34
Rate for Payer: Priority Health Medicare	$43.34
Rate for Payer: Priority Health PPO	$89.60
Rate for Payer: United Health Care Medicaid	$43.34
Rate for Payer: United Health Care Medicare Advantage	$19.07

PTH NO CALCIUM

Facility

$4.80

Hospital Charge Code	3101865
Hospital Revenue Code	300
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$4.08
Rate for Payer: Cash Price	$3.12
Rate for Payer: Community Health Alliance Commercial	$4.08
Rate for Payer: Priority Health Commercial	$3.36
Rate for Payer: Priority Health PPO	$3.36

PTH, N-TERMINAL/INTACT

Facility

$4.02

Service Code	HCPCS 83970
Hospital Charge Code	3007080
Hospital Revenue Code	301
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$43.34
Rate for Payer: BCBS BCN 65	$43.34
Rate for Payer: Blue Care Network Medicare Advantage	$43.34
Rate for Payer: Cash Price	$2.61
Rate for Payer: Cash Price	$2.61
Rate for Payer: Community Health Alliance Commercial	$3.42
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$43.34
Rate for Payer: Meridian Health Plan Medicare	$43.34
Rate for Payer: Priority Health Commercial	$2.81
Rate for Payer: Priority Health Medicaid	$43.34
Rate for Payer: Priority Health Medicare	$43.34
Rate for Payer: Priority Health PPO	$2.81
Rate for Payer: United Health Care Medicaid	$43.34
Rate for Payer: United Health Care Medicare Advantage	$19.07

PTH, RELATED PEPTIDE

Facility

$14.66

Service Code	HCPCS 82397
Hospital Charge Code	3007083
Hospital Revenue Code	301
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$14.83
Rate for Payer: BCBS BCN 65	$14.83
Rate for Payer: Blue Care Network Medicare Advantage	$14.83
Rate for Payer: Cash Price	$9.53
Rate for Payer: Cash Price	$9.53
Rate for Payer: Community Health Alliance Commercial	$12.46
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.83
Rate for Payer: Meridian Health Plan Medicare	$14.83
Rate for Payer: Priority Health Commercial	$10.26
Rate for Payer: Priority Health Medicaid	$14.83
Rate for Payer: Priority Health Medicare	$14.83
Rate for Payer: Priority Health PPO	$10.26
Rate for Payer: United Health Care Medicaid	$14.83
Rate for Payer: United Health Care Medicare Advantage	$6.52

PT-LC

Facility

$2.36

Hospital Charge Code	3102576
Hospital Revenue Code	300
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$1.53
Rate for Payer: Community Health Alliance Commercial	$2.01
Rate for Payer: Priority Health Commercial	$1.65
Rate for Payer: Priority Health PPO	$1.65

PTNFT1-LC

Facility

$7.85

Hospital Charge Code	3102693
Hospital Revenue Code	300
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$6.67
Rate for Payer: Cash Price	$5.10
Rate for Payer: Community Health Alliance Commercial	$6.67
Rate for Payer: Priority Health Commercial	$5.50
Rate for Payer: Priority Health PPO	$5.50

PTNFT2-LC

Facility

$7.85

Hospital Charge Code	3102694
Hospital Revenue Code	300
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$6.67
Rate for Payer: Cash Price	$5.10
Rate for Payer: Community Health Alliance Commercial	$6.67
Rate for Payer: Priority Health Commercial	$5.50
Rate for Payer: Priority Health PPO	$5.50

PT REASSESSMENT

Facility

$115.00

Service Code	HCPCS 97164 GP59
Hospital Charge Code	4200340
Hospital Revenue Code	424
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$97.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Community Health Alliance Commercial	$97.75
Rate for Payer: Priority Health Commercial	$80.50
Rate for Payer: Priority Health PPO	$80.50

PT RE-EVALUATION

Facility

$242.00

Service Code	HCPCS 97164 GP
Hospital Charge Code	4200171
Hospital Revenue Code	424
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$205.70
Rate for Payer: Cash Price	$157.30
Rate for Payer: Community Health Alliance Commercial	$205.70
Rate for Payer: Priority Health Commercial	$169.40
Rate for Payer: Priority Health PPO	$169.40

PTT

Facility

$38.00

Service Code	HCPCS 85730
Hospital Charge Code	3006420
Hospital Revenue Code	305
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$32.30
Rate for Payer: BCBS BCN 65	$6.31
Rate for Payer: Blue Care Network Medicare Advantage	$6.31
Rate for Payer: Cash Price	$24.70
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.31
Rate for Payer: Meridian Health Plan Medicare	$6.31
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health Medicaid	$6.31
Rate for Payer: Priority Health Medicare	$6.31
Rate for Payer: Priority Health PPO	$26.60
Rate for Payer: United Health Care Medicaid	$6.31
Rate for Payer: United Health Care Medicare Advantage	$2.78

PTT-LA MIX

Facility

$16.29

Hospital Charge Code	3102064
Hospital Revenue Code	300
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$13.85
Rate for Payer: Cash Price	$10.59
Rate for Payer: Community Health Alliance Commercial	$13.85
Rate for Payer: Priority Health Commercial	$11.40
Rate for Payer: Priority Health PPO	$11.40

P. TUNGSTIC ACID STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100410
Hospital Revenue Code	310
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

PULM FUNCTION PRE & POST

Facility

$570.00

Service Code	HCPCS 94060
Hospital Charge Code	4600080
Hospital Revenue Code	460
Min. Negotiated Rate	$176.13
Max. Negotiated Rate	$484.50
Rate for Payer: BCBS BCN 65	$400.30
Rate for Payer: Blue Care Network Medicare Advantage	$400.30
Rate for Payer: Cash Price	$370.50
Rate for Payer: Cash Price	$370.50
Rate for Payer: Community Health Alliance Commercial	$484.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$400.30
Rate for Payer: Meridian Health Plan Medicare	$400.30
Rate for Payer: Priority Health Commercial	$399.00
Rate for Payer: Priority Health Medicaid	$400.30
Rate for Payer: Priority Health Medicare	$400.30
Rate for Payer: Priority Health PPO	$399.00
Rate for Payer: United Health Care Medicaid	$400.30
Rate for Payer: United Health Care Medicare Advantage	$176.13

PULM FUNCTION SCREEN

Facility

$335.00

Service Code	HCPCS 94010
Hospital Charge Code	4600070
Hospital Revenue Code	460
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$284.75
Rate for Payer: BCBS BCN 65	$231.63
Rate for Payer: Blue Care Network Medicare Advantage	$231.63
Rate for Payer: Cash Price	$217.75
Rate for Payer: Cash Price	$217.75
Rate for Payer: Community Health Alliance Commercial	$284.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$231.63
Rate for Payer: Meridian Health Plan Medicare	$231.63
Rate for Payer: Priority Health Commercial	$234.50
Rate for Payer: Priority Health Medicaid	$231.63
Rate for Payer: Priority Health Medicare	$231.63
Rate for Payer: Priority Health PPO	$234.50
Rate for Payer: United Health Care Medicaid	$231.63
Rate for Payer: United Health Care Medicare Advantage	$101.92

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges