Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

BACK SUPPORT CUSTOM

Facility

$129.00

Hospital Charge Code	27014233
Hospital Revenue Code	270
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$109.65
Rate for Payer: Cash Price	$83.85
Rate for Payer: Community Health Alliance Commercial	$109.65
Rate for Payer: Priority Health Commercial	$90.30
Rate for Payer: Priority Health PPO	$90.30

BACLOFEN

Facility

$193.00

Hospital Charge Code	3003270
Hospital Revenue Code	301
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$164.05
Rate for Payer: Cash Price	$125.45
Rate for Payer: Community Health Alliance Commercial	$164.05
Rate for Payer: Priority Health Commercial	$135.10
Rate for Payer: Priority Health PPO	$135.10

BACTERIAL ID AND SENS AEROBE

Facility

$12.22

Hospital Charge Code	3100868
Hospital Revenue Code	306
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$10.39
Rate for Payer: Cash Price	$7.94
Rate for Payer: Community Health Alliance Commercial	$10.39
Rate for Payer: Priority Health Commercial	$8.55
Rate for Payer: Priority Health PPO	$8.55

BACTERIAL ID BY MALDI-TOF MS

Facility

$65.00

Hospital Charge Code	3101102
Hospital Revenue Code	306
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

BACTERIAL TYPING

Facility

$23.00

Service Code	HCPCS 87147
Hospital Charge Code	3003261
Hospital Revenue Code	306
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$19.55
Rate for Payer: BCBS BCN 65	$5.44
Rate for Payer: Blue Care Network Medicare Advantage	$5.44
Rate for Payer: Cash Price	$14.95
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.44
Rate for Payer: Meridian Health Plan Medicare	$5.44
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health Medicaid	$5.44
Rate for Payer: Priority Health Medicare	$5.44
Rate for Payer: Priority Health PPO	$16.10
Rate for Payer: United Health Care Medicaid	$5.44
Rate for Payer: United Health Care Medicare Advantage	$2.39

BADGER DRILL BIT

Facility

$622.00

Hospital Charge Code	27264280
Hospital Revenue Code	272
Min. Negotiated Rate	$435.40
Max. Negotiated Rate	$528.70
Rate for Payer: Cash Price	$404.30
Rate for Payer: Community Health Alliance Commercial	$528.70
Rate for Payer: Priority Health Commercial	$435.40
Rate for Payer: Priority Health PPO	$435.40

BAG,JACKSON PRATT 100CC

Facility

$26.00

Hospital Charge Code	27265759
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

BAG - OSTOMY, KARAYA/ADHESIVE

Facility

$17.00

Hospital Charge Code	27011635
Hospital Revenue Code	272
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

BAG - URETERAL DRAINAGE

Facility

$69.00

Hospital Charge Code	27010389
Hospital Revenue Code	272
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$58.65
Rate for Payer: Cash Price	$44.85
Rate for Payer: Community Health Alliance Commercial	$58.65
Rate for Payer: Priority Health Commercial	$48.30
Rate for Payer: Priority Health PPO	$48.30

BAG - URINARY DRAIN

Facility

$26.00

Hospital Charge Code	27010405
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

BAG - URIN DRAIN, LEG

Facility

$23.00

Hospital Charge Code	27010413
Hospital Revenue Code	272
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

BAG - URIN DRAIN W/METER

Facility

$60.00

Hospital Charge Code	27010397
Hospital Revenue Code	272
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

BALLOON, ANASTOMIC

Facility

$688.00

Hospital Charge Code	27263471
Hospital Revenue Code	272
Min. Negotiated Rate	$481.60
Max. Negotiated Rate	$584.80
Rate for Payer: Cash Price	$447.20
Rate for Payer: Community Health Alliance Commercial	$584.80
Rate for Payer: Priority Health Commercial	$481.60
Rate for Payer: Priority Health PPO	$481.60

BALLOON, ANGIO 4 x 2

Facility

$1,070.00

Service Code	HCPCS C1725
Hospital Charge Code	27266120
Hospital Revenue Code	272
Min. Negotiated Rate	$749.00
Max. Negotiated Rate	$909.50
Rate for Payer: Cash Price	$695.50
Rate for Payer: Community Health Alliance Commercial	$909.50
Rate for Payer: Priority Health Commercial	$749.00
Rate for Payer: Priority Health PPO	$749.00

BALLOON, ANGIO 7 x 2

Facility

$1,070.00

Service Code	HCPCS C1725
Hospital Charge Code	27266138
Hospital Revenue Code	272
Min. Negotiated Rate	$749.00
Max. Negotiated Rate	$909.50
Rate for Payer: Cash Price	$695.50
Rate for Payer: Community Health Alliance Commercial	$909.50
Rate for Payer: Priority Health Commercial	$749.00
Rate for Payer: Priority Health PPO	$749.00

BALLOON,ANGIOPLASTY

Facility

$1,117.00

Service Code	HCPCS C1725
Hospital Charge Code	27263627
Hospital Revenue Code	272
Min. Negotiated Rate	$781.90
Max. Negotiated Rate	$949.45
Rate for Payer: Cash Price	$726.05
Rate for Payer: Community Health Alliance Commercial	$949.45
Rate for Payer: Priority Health Commercial	$781.90
Rate for Payer: Priority Health PPO	$781.90

BALLOON,ANGIOPLASTY 5 MMx4CM

Facility

$951.00

Service Code	HCPCS C1725
Hospital Charge Code	27267524
Hospital Revenue Code	272
Min. Negotiated Rate	$665.70
Max. Negotiated Rate	$808.35
Rate for Payer: Cash Price	$618.15
Rate for Payer: Community Health Alliance Commercial	$808.35
Rate for Payer: Priority Health Commercial	$665.70
Rate for Payer: Priority Health PPO	$665.70

BALLOON,ANGIOPLASTY 7MM X 4CM

Facility

$951.00

Service Code	HCPCS C1725
Hospital Charge Code	27267540
Hospital Revenue Code	278
Min. Negotiated Rate	$665.70
Max. Negotiated Rate	$808.35
Rate for Payer: Cash Price	$618.15
Rate for Payer: Community Health Alliance Commercial	$808.35
Rate for Payer: Priority Health Commercial	$665.70
Rate for Payer: Priority Health PPO	$665.70

BALLOON,ANGIOPLASTY 8MM X 4CM

Facility

$951.00

Service Code	HCPCS C1725
Hospital Charge Code	27267557
Hospital Revenue Code	272
Min. Negotiated Rate	$665.70
Max. Negotiated Rate	$808.35
Rate for Payer: Cash Price	$618.15
Rate for Payer: Community Health Alliance Commercial	$808.35
Rate for Payer: Priority Health Commercial	$665.70
Rate for Payer: Priority Health PPO	$665.70

BALLOON, ANGIOPLASTY CATH

Facility

$468.00

Service Code	HCPCS C1725
Hospital Charge Code	27267532
Hospital Revenue Code	272
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$397.80
Rate for Payer: Cash Price	$304.20
Rate for Payer: Community Health Alliance Commercial	$397.80
Rate for Payer: Priority Health Commercial	$327.60
Rate for Payer: Priority Health PPO	$327.60

BALLOON,CRE MULTI DIAM.

Facility

$913.00

Hospital Charge Code	27262430
Hospital Revenue Code	272
Min. Negotiated Rate	$639.10
Max. Negotiated Rate	$776.05
Rate for Payer: Cash Price	$593.45
Rate for Payer: Community Health Alliance Commercial	$776.05
Rate for Payer: Priority Health Commercial	$639.10
Rate for Payer: Priority Health PPO	$639.10

BALLOON DILATOR

Facility

$565.00

Hospital Charge Code	27262044
Hospital Revenue Code	272
Min. Negotiated Rate	$395.50
Max. Negotiated Rate	$480.25
Rate for Payer: Cash Price	$367.25
Rate for Payer: Community Health Alliance Commercial	$480.25
Rate for Payer: Priority Health Commercial	$395.50
Rate for Payer: Priority Health PPO	$395.50

BALLOON FGS 61-70 CM

Facility

$4,085.00

Hospital Charge Code	27268423
Hospital Revenue Code	272
Min. Negotiated Rate	$2,859.50
Max. Negotiated Rate	$3,472.25
Rate for Payer: Cash Price	$2,655.25
Rate for Payer: Community Health Alliance Commercial	$3,472.25
Rate for Payer: Priority Health Commercial	$2,859.50
Rate for Payer: Priority Health PPO	$2,859.50

BALLOON INFLATOR

Facility

$1,544.00

Hospital Charge Code	27262354
Hospital Revenue Code	272
Min. Negotiated Rate	$1,080.80
Max. Negotiated Rate	$1,312.40
Rate for Payer: Cash Price	$1,003.60
Rate for Payer: Community Health Alliance Commercial	$1,312.40
Rate for Payer: Priority Health Commercial	$1,080.80
Rate for Payer: Priority Health PPO	$1,080.80

BALLOON, POWERFLEX 4 x 8

Facility

$531.00

Service Code	HCPCS C1725
Hospital Charge Code	27267552
Hospital Revenue Code	272
Min. Negotiated Rate	$371.70
Max. Negotiated Rate	$451.35
Rate for Payer: Cash Price	$345.15
Rate for Payer: Community Health Alliance Commercial	$451.35
Rate for Payer: Priority Health Commercial	$371.70
Rate for Payer: Priority Health PPO	$371.70

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges