Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

QUICK-VAC MIXING SYSTEM

Facility

$464.00

Hospital Charge Code	27262293
Hospital Revenue Code	272
Min. Negotiated Rate	$324.80
Max. Negotiated Rate	$394.40
Rate for Payer: Cash Price	$301.60
Rate for Payer: Community Health Alliance Commercial	$394.40
Rate for Payer: Priority Health Commercial	$324.80
Rate for Payer: Priority Health PPO	$324.80

QUINIDINE

Facility

$71.00

Service Code	HCPCS 80194
Hospital Charge Code	3007100
Hospital Revenue Code	301
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$60.35
Rate for Payer: BCBS BCN 65	$15.33
Rate for Payer: Blue Care Network Medicare Advantage	$15.33
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.33
Rate for Payer: Meridian Health Plan Medicare	$15.33
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health Medicaid	$15.33
Rate for Payer: Priority Health Medicare	$15.33
Rate for Payer: Priority Health PPO	$49.70
Rate for Payer: United Health Care Medicaid	$15.33
Rate for Payer: United Health Care Medicare Advantage	$6.75

QUININE

Facility

$102.00

Service Code	HCPCS 84228
Hospital Charge Code	3007110
Hospital Revenue Code	301
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$86.70
Rate for Payer: BCBS BCN 65	$12.21
Rate for Payer: Blue Care Network Medicare Advantage	$12.21
Rate for Payer: Cash Price	$66.30
Rate for Payer: Cash Price	$66.30
Rate for Payer: Community Health Alliance Commercial	$86.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.21
Rate for Payer: Meridian Health Plan Medicare	$12.21
Rate for Payer: Priority Health Commercial	$71.40
Rate for Payer: Priority Health Medicaid	$12.21
Rate for Payer: Priority Health Medicare	$12.21
Rate for Payer: Priority Health PPO	$71.40
Rate for Payer: United Health Care Medicaid	$12.21
Rate for Payer: United Health Care Medicare Advantage	$5.37

R.A.

Facility

$3.00

Service Code	HCPCS 86431
Hospital Charge Code	3007200
Hospital Revenue Code	302
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$5.95
Rate for Payer: BCBS BCN 65	$5.95
Rate for Payer: Blue Care Network Medicare Advantage	$5.95
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.95
Rate for Payer: Community Health Alliance Commercial	$2.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.95
Rate for Payer: Meridian Health Plan Medicare	$5.95
Rate for Payer: Priority Health Commercial	$2.10
Rate for Payer: Priority Health Medicaid	$5.95
Rate for Payer: Priority Health Medicare	$5.95
Rate for Payer: Priority Health PPO	$2.10
Rate for Payer: United Health Care Medicaid	$5.95
Rate for Payer: United Health Care Medicare Advantage	$2.62

RA-1

Facility

$211.50

Hospital Charge Code	3102412
Hospital Revenue Code	300
Min. Negotiated Rate	$148.05
Max. Negotiated Rate	$179.78
Rate for Payer: Cash Price	$137.48
Rate for Payer: Community Health Alliance Commercial	$179.78
Rate for Payer: Priority Health Commercial	$148.05
Rate for Payer: Priority Health PPO	$148.05

RA-1

Facility

$14.37

Hospital Charge Code	3102499
Hospital Revenue Code	300
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$12.21
Rate for Payer: Cash Price	$9.34
Rate for Payer: Community Health Alliance Commercial	$12.21
Rate for Payer: Priority Health Commercial	$10.06
Rate for Payer: Priority Health PPO	$10.06

RA-2

Facility

$211.50

Hospital Charge Code	3102413
Hospital Revenue Code	300
Min. Negotiated Rate	$148.05
Max. Negotiated Rate	$179.78
Rate for Payer: Cash Price	$137.48
Rate for Payer: Community Health Alliance Commercial	$179.78
Rate for Payer: Priority Health Commercial	$148.05
Rate for Payer: Priority Health PPO	$148.05

RA-2

Facility

$14.37

Hospital Charge Code	3102500
Hospital Revenue Code	300
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$12.21
Rate for Payer: Cash Price	$9.34
Rate for Payer: Community Health Alliance Commercial	$12.21
Rate for Payer: Priority Health Commercial	$10.06
Rate for Payer: Priority Health PPO	$10.06

RA-3

Facility

$14.38

Hospital Charge Code	3102501
Hospital Revenue Code	300
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$12.22
Rate for Payer: Cash Price	$9.35
Rate for Payer: Community Health Alliance Commercial	$12.22
Rate for Payer: Priority Health Commercial	$10.07
Rate for Payer: Priority Health PPO	$10.07

RABIE AB SCREEN RFFIT

Facility

$72.47

Hospital Charge Code	3101437
Hospital Revenue Code	300
Min. Negotiated Rate	$50.73
Max. Negotiated Rate	$61.60
Rate for Payer: Cash Price	$47.11
Rate for Payer: Community Health Alliance Commercial	$61.60
Rate for Payer: Priority Health Commercial	$50.73
Rate for Payer: Priority Health PPO	$50.73

RABIES IGG ELISA

Facility

$57.00

Hospital Charge Code	3101032
Hospital Revenue Code	302
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$48.45
Rate for Payer: Cash Price	$37.05
Rate for Payer: Community Health Alliance Commercial	$48.45
Rate for Payer: Priority Health Commercial	$39.90
Rate for Payer: Priority Health PPO	$39.90

RABINOV SIALOGRAPHY SET

Facility

$60.00

Hospital Charge Code	62160256
Hospital Revenue Code	621
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

RADIAL ARTERY CATHETER

Facility

$45.00

Hospital Charge Code	27015230
Hospital Revenue Code	272
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

RADIAL ARTERY CATHETER SET

Facility

$38.00

Hospital Charge Code	27061964
Hospital Revenue Code	272
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$32.30
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health PPO	$26.60

RADIAL ARTERY CATH KIT

Facility

$126.00

Hospital Charge Code	27015222
Hospital Revenue Code	272
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$107.10
Rate for Payer: Cash Price	$81.90
Rate for Payer: Community Health Alliance Commercial	$107.10
Rate for Payer: Priority Health Commercial	$88.20
Rate for Payer: Priority Health PPO	$88.20

RADIAL BAR WRIST COCK-UP

Facility

$46.00

Hospital Charge Code	27021915
Hospital Revenue Code	270
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

RADIAL JAW 3 BIOPSY FORCEP

Facility

$92.00

Hospital Charge Code	27265031
Hospital Revenue Code	272
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$78.20
Rate for Payer: Cash Price	$59.80
Rate for Payer: Community Health Alliance Commercial	$78.20
Rate for Payer: Priority Health Commercial	$64.40
Rate for Payer: Priority Health PPO	$64.40

RADIAL JAW BIOPSY FORCEPS

Facility

$351.00

Hospital Charge Code	27265437
Hospital Revenue Code	272
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$298.35
Rate for Payer: Cash Price	$228.15
Rate for Payer: Community Health Alliance Commercial	$298.35
Rate for Payer: Priority Health Commercial	$245.70
Rate for Payer: Priority Health PPO	$245.70

RADIOLUCENT TARGETING DEVICE

Facility

$640.00

Hospital Charge Code	27866401
Hospital Revenue Code	272
Min. Negotiated Rate	$448.00
Max. Negotiated Rate	$544.00
Rate for Payer: Cash Price	$416.00
Rate for Payer: Community Health Alliance Commercial	$544.00
Rate for Payer: Priority Health Commercial	$448.00
Rate for Payer: Priority Health PPO	$448.00

RAE ENDO - T TUBES - ALL SIZES

Facility

$51.00

Hospital Charge Code	27010595
Hospital Revenue Code	272
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

RAMPAMUNE/RAMPAMYCIN

Facility

$16.86

Service Code	HCPCS 80195
Hospital Charge Code	3007120
Hospital Revenue Code	300
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$14.42
Rate for Payer: BCBS BCN 65	$14.42
Rate for Payer: Blue Care Network Medicare Advantage	$14.42
Rate for Payer: Cash Price	$10.96
Rate for Payer: Cash Price	$10.96
Rate for Payer: Community Health Alliance Commercial	$14.33
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.42
Rate for Payer: Meridian Health Plan Medicare	$14.42
Rate for Payer: Priority Health Commercial	$11.80
Rate for Payer: Priority Health Medicaid	$14.42
Rate for Payer: Priority Health Medicare	$14.42
Rate for Payer: Priority Health PPO	$11.80
Rate for Payer: United Health Care Medicaid	$14.42
Rate for Payer: United Health Care Medicare Advantage	$6.34

RANDOM URINE PHOSPHORUS

Facility

$2.00

Service Code	HCPCS 84105
Hospital Charge Code	3006525
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$6.07
Rate for Payer: BCBS BCN 65	$6.07
Rate for Payer: Blue Care Network Medicare Advantage	$6.07
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.07
Rate for Payer: Meridian Health Plan Medicare	$6.07
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health Medicaid	$6.07
Rate for Payer: Priority Health Medicare	$6.07
Rate for Payer: Priority Health PPO	$1.40
Rate for Payer: United Health Care Medicaid	$6.07
Rate for Payer: United Health Care Medicare Advantage	$2.67

RANDOM VANCOMYCIN

Facility

$11.24

Hospital Charge Code	3102557
Hospital Revenue Code	300
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$9.55
Rate for Payer: Cash Price	$7.31
Rate for Payer: Community Health Alliance Commercial	$9.55
Rate for Payer: Priority Health Commercial	$7.87
Rate for Payer: Priority Health PPO	$7.87

RAPID REFILL CONTINUOUS INJECT

Facility

$96.00

Hospital Charge Code	27264959
Hospital Revenue Code	272
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$81.60
Rate for Payer: Cash Price	$62.40
Rate for Payer: Community Health Alliance Commercial	$81.60
Rate for Payer: Priority Health Commercial	$67.20
Rate for Payer: Priority Health PPO	$67.20

RASH PHOMA BETAE

Facility

$3.26

Hospital Charge Code	3102143
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges