Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PULMO-AIDE CLIENT CHRG

Facility

$79.00

Hospital Charge Code	4600100
Hospital Revenue Code	999
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

PULSE VAC IM TIP

Facility

$59.00

Hospital Charge Code	27061139
Hospital Revenue Code	272
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$50.15
Rate for Payer: Cash Price	$38.35
Rate for Payer: Community Health Alliance Commercial	$50.15
Rate for Payer: Priority Health Commercial	$41.30
Rate for Payer: Priority Health PPO	$41.30

PULUMBAR STAB BRACE

Facility

$107.00

Hospital Charge Code	27021501
Hospital Revenue Code	270
Min. Negotiated Rate	$74.90
Max. Negotiated Rate	$90.95
Rate for Payer: Cash Price	$69.55
Rate for Payer: Community Health Alliance Commercial	$90.95
Rate for Payer: Priority Health Commercial	$74.90
Rate for Payer: Priority Health PPO	$74.90

PUMP VAC SYSTEM, PLUS

Facility

$294.00

Hospital Charge Code	27016527
Hospital Revenue Code	270
Min. Negotiated Rate	$205.80
Max. Negotiated Rate	$249.90
Rate for Payer: Cash Price	$191.10
Rate for Payer: Community Health Alliance Commercial	$249.90
Rate for Payer: Priority Health Commercial	$205.80
Rate for Payer: Priority Health PPO	$205.80

PURINE AND PYRIMIDINE PANEL

Facility

$200.00

Hospital Charge Code	3100842
Hospital Revenue Code	300
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

PURSTRING, DISPOSABLE

Facility

$507.00

Hospital Charge Code	27014209
Hospital Revenue Code	272
Min. Negotiated Rate	$354.90
Max. Negotiated Rate	$430.95
Rate for Payer: Cash Price	$329.55
Rate for Payer: Community Health Alliance Commercial	$430.95
Rate for Payer: Priority Health Commercial	$354.90
Rate for Payer: Priority Health PPO	$354.90

PYRIDINOLINE DEOXY

Facility

$246.00

Hospital Charge Code	3006487
Hospital Revenue Code	301
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$209.10
Rate for Payer: Cash Price	$159.90
Rate for Payer: Community Health Alliance Commercial	$209.10
Rate for Payer: Priority Health Commercial	$172.20
Rate for Payer: Priority Health PPO	$172.20

PYRIDINOLINE DEOXY

Facility

$125.00

Hospital Charge Code	3006486
Hospital Revenue Code	301
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$106.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Community Health Alliance Commercial	$106.25
Rate for Payer: Priority Health Commercial	$87.50
Rate for Payer: Priority Health PPO	$87.50

PYRIDINOLINE DEOXY

Facility

$125.00

Hospital Charge Code	3006485
Hospital Revenue Code	301
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$106.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Community Health Alliance Commercial	$106.25
Rate for Payer: Priority Health Commercial	$87.50
Rate for Payer: Priority Health PPO	$87.50

PYRUVATE

Facility

$6.00

Service Code	HCPCS 84210
Hospital Charge Code	3007085
Hospital Revenue Code	301
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$15.20
Rate for Payer: BCBS BCN 65	$15.20
Rate for Payer: Blue Care Network Medicare Advantage	$15.20
Rate for Payer: Cash Price	$3.90
Rate for Payer: Cash Price	$3.90
Rate for Payer: Community Health Alliance Commercial	$5.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.20
Rate for Payer: Meridian Health Plan Medicare	$15.20
Rate for Payer: Priority Health Commercial	$4.20
Rate for Payer: Priority Health Medicaid	$15.20
Rate for Payer: Priority Health Medicare	$15.20
Rate for Payer: Priority Health PPO	$4.20
Rate for Payer: United Health Care Medicaid	$15.20
Rate for Payer: United Health Care Medicare Advantage	$6.69

QF-1

Facility

$28.00

Hospital Charge Code	3102148
Hospital Revenue Code	300
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

QF-2

Facility

$28.00

Hospital Charge Code	3102149
Hospital Revenue Code	300
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

QF-3

Facility

$28.00

Hospital Charge Code	3102150
Hospital Revenue Code	300
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

QF-4

Facility

$28.00

Hospital Charge Code	3102151
Hospital Revenue Code	300
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

QUAD SCREEN

Facility

$90.00

Hospital Charge Code	3007096
Hospital Revenue Code	301
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$76.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Community Health Alliance Commercial	$76.50
Rate for Payer: Priority Health Commercial	$63.00
Rate for Payer: Priority Health PPO	$63.00

QUAD SCREEN

Facility

$55.00

Service Code	HCPCS 84999
Hospital Charge Code	3007099
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$46.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health PPO	$38.50

QUAD SCREEN

Facility

$115.00

Service Code	HCPCS 82677
Hospital Charge Code	3007098
Hospital Revenue Code	301
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$97.75
Rate for Payer: BCBS BCN 65	$25.39
Rate for Payer: Blue Care Network Medicare Advantage	$25.39
Rate for Payer: Cash Price	$74.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Community Health Alliance Commercial	$97.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$25.39
Rate for Payer: Meridian Health Plan Medicare	$25.39
Rate for Payer: Priority Health Commercial	$80.50
Rate for Payer: Priority Health Medicaid	$25.39
Rate for Payer: Priority Health Medicare	$25.39
Rate for Payer: Priority Health PPO	$80.50
Rate for Payer: United Health Care Medicaid	$25.39
Rate for Payer: United Health Care Medicare Advantage	$11.17

QUADSCREEN

Facility

$332.00

Hospital Charge Code	3000543
Hospital Revenue Code	301
Min. Negotiated Rate	$232.40
Max. Negotiated Rate	$282.20
Rate for Payer: Cash Price	$215.80
Rate for Payer: Community Health Alliance Commercial	$282.20
Rate for Payer: Priority Health Commercial	$232.40
Rate for Payer: Priority Health PPO	$232.40

QUAL HETEROPHILE AB

Facility

$45.00

Hospital Charge Code	3100113
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

QUAN HETEROPHILE AB

Facility

$40.00

Hospital Charge Code	3100114
Hospital Revenue Code	300
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

QUAN MASS SPECT EA SPECIMAN

Facility

$82.00

Hospital Charge Code	3100133
Hospital Revenue Code	300
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

QUAN MASS SPECT EA SPECIMEN

Facility

$82.00

Hospital Charge Code	3100350
Hospital Revenue Code	300
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

QUICK SILVER 7FR #BCP-7A

Facility

$751.00

Hospital Charge Code	27265999
Hospital Revenue Code	272
Min. Negotiated Rate	$525.70
Max. Negotiated Rate	$638.35
Rate for Payer: Cash Price	$488.15
Rate for Payer: Community Health Alliance Commercial	$638.35
Rate for Payer: Priority Health Commercial	$525.70
Rate for Payer: Priority Health PPO	$525.70

QUICKSILVER BIPOLAR 7FR PLUG

Facility

$798.00

Hospital Charge Code	27263651
Hospital Revenue Code	272
Min. Negotiated Rate	$558.60
Max. Negotiated Rate	$678.30
Rate for Payer: Cash Price	$518.70
Rate for Payer: Community Health Alliance Commercial	$678.30
Rate for Payer: Priority Health Commercial	$558.60
Rate for Payer: Priority Health PPO	$558.60

QUICKTRACH 4.0

Facility

$646.00

Hospital Charge Code	27266732
Hospital Revenue Code	272
Min. Negotiated Rate	$452.20
Max. Negotiated Rate	$549.10
Rate for Payer: Cash Price	$419.90
Rate for Payer: Community Health Alliance Commercial	$549.10
Rate for Payer: Priority Health Commercial	$452.20
Rate for Payer: Priority Health PPO	$452.20

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges