Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

RAST-GRASS

Facility

$24.00

Service Code	HCPCS 86005
Hospital Charge Code	3006533
Hospital Revenue Code	302
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$20.40
Rate for Payer: BCBS BCN 65	$8.37
Rate for Payer: Blue Care Network Medicare Advantage	$8.37
Rate for Payer: Cash Price	$15.60
Rate for Payer: Cash Price	$15.60
Rate for Payer: Community Health Alliance Commercial	$20.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.37
Rate for Payer: Meridian Health Plan Medicare	$8.37
Rate for Payer: Priority Health Commercial	$16.80
Rate for Payer: Priority Health Medicaid	$8.37
Rate for Payer: Priority Health Medicare	$8.37
Rate for Payer: Priority Health PPO	$16.80
Rate for Payer: United Health Care Medicaid	$8.37
Rate for Payer: United Health Care Medicare Advantage	$3.68

RAST GREEN BEAN

Facility

$10.10

Hospital Charge Code	3100547
Hospital Revenue Code	302
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$8.59
Rate for Payer: Cash Price	$6.57
Rate for Payer: Community Health Alliance Commercial	$8.59
Rate for Payer: Priority Health Commercial	$7.07
Rate for Payer: Priority Health PPO	$7.07

RAST GREY ALDER TREE

Facility

$10.10

Hospital Charge Code	3100746
Hospital Revenue Code	302
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$8.59
Rate for Payer: Cash Price	$6.57
Rate for Payer: Community Health Alliance Commercial	$8.59
Rate for Payer: Priority Health Commercial	$7.07
Rate for Payer: Priority Health PPO	$7.07

RAST HAZELNUT

Facility

$3.26

Hospital Charge Code	3100092
Hospital Revenue Code	302
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

RAST HAZELNUT TREE

Facility

$3.26

Hospital Charge Code	3102139
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

RAST HELMINTHOSPORIUM

Facility

$3.26

Hospital Charge Code	3101516
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

RAST HONEY BEE

Facility

$15.00

Hospital Charge Code	3006663
Hospital Revenue Code	302
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

RAST HOPS

Facility

$10.10

Hospital Charge Code	3100102
Hospital Revenue Code	302
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$8.59
Rate for Payer: Cash Price	$6.57
Rate for Payer: Community Health Alliance Commercial	$8.59
Rate for Payer: Priority Health Commercial	$7.07
Rate for Payer: Priority Health PPO	$7.07

RAST HORSE DANDER

Facility

$10.10

Hospital Charge Code	3100744
Hospital Revenue Code	302
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$8.59
Rate for Payer: Cash Price	$6.57
Rate for Payer: Community Health Alliance Commercial	$8.59
Rate for Payer: Priority Health Commercial	$7.07
Rate for Payer: Priority Health PPO	$7.07

RAST HOUSE DUST GREER

Facility

$10.10

Hospital Charge Code	3100595
Hospital Revenue Code	302
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$8.59
Rate for Payer: Cash Price	$6.57
Rate for Payer: Community Health Alliance Commercial	$8.59
Rate for Payer: Priority Health Commercial	$7.07
Rate for Payer: Priority Health PPO	$7.07

RAST HOUSE DUST HOLLISTER

Facility

$10.10

Hospital Charge Code	3100593
Hospital Revenue Code	302
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$8.59
Rate for Payer: Cash Price	$6.57
Rate for Payer: Community Health Alliance Commercial	$8.59
Rate for Payer: Priority Health Commercial	$7.07
Rate for Payer: Priority Health PPO	$7.07

RAST-INHALENT

Facility

$15.00

Service Code	HCPCS 86003
Hospital Charge Code	3006529
Hospital Revenue Code	302
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$12.75
Rate for Payer: BCBS BCN 65	$5.48
Rate for Payer: Blue Care Network Medicare Advantage	$5.48
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.48
Rate for Payer: Meridian Health Plan Medicare	$5.48
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$5.48
Rate for Payer: Priority Health Medicare	$5.48
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$5.48
Rate for Payer: United Health Care Medicare Advantage	$2.41

RAST-INSECTS-IGE

Facility

$15.00

Service Code	HCPCS 86003
Hospital Charge Code	3006539
Hospital Revenue Code	302
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$12.75
Rate for Payer: BCBS BCN 65	$5.48
Rate for Payer: Blue Care Network Medicare Advantage	$5.48
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.48
Rate for Payer: Meridian Health Plan Medicare	$5.48
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$5.48
Rate for Payer: Priority Health Medicare	$5.48
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$5.48
Rate for Payer: United Health Care Medicare Advantage	$2.41

RAST-INSECTS-IGG

Facility

$15.00

Service Code	HCPCS 86003
Hospital Charge Code	3006538
Hospital Revenue Code	302
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$12.75
Rate for Payer: BCBS BCN 65	$5.48
Rate for Payer: Blue Care Network Medicare Advantage	$5.48
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.48
Rate for Payer: Meridian Health Plan Medicare	$5.48
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$5.48
Rate for Payer: Priority Health Medicare	$5.48
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$5.48
Rate for Payer: United Health Care Medicare Advantage	$2.41

RAST INSULIN BOVINE

Facility

$20.86

Hospital Charge Code	3100598
Hospital Revenue Code	302
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$17.73
Rate for Payer: Cash Price	$13.56
Rate for Payer: Community Health Alliance Commercial	$17.73
Rate for Payer: Priority Health Commercial	$14.60
Rate for Payer: Priority Health PPO	$14.60

RAST INSULIN PORCINE

Facility

$15.00

Hospital Charge Code	3100597
Hospital Revenue Code	302
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

RAST JALAPENO

Facility

$15.00

Hospital Charge Code	3100995
Hospital Revenue Code	302
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

RAST JALAPENO PEPPER IGE

Facility

$15.00

Hospital Charge Code	3100936
Hospital Revenue Code	302
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

RAST JOHNSON GRASS

Facility

$3.26

Hospital Charge Code	3101491
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

RAST-KIWI

Facility

$10.10

Hospital Charge Code	3006581
Hospital Revenue Code	302
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$8.59
Rate for Payer: Cash Price	$6.57
Rate for Payer: Community Health Alliance Commercial	$8.59
Rate for Payer: Priority Health Commercial	$7.07
Rate for Payer: Priority Health PPO	$7.07

RAST LAMB QUARTERS

Facility

$3.26

Hospital Charge Code	3101499
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

RAST LATEX

Facility

$10.10

Service Code	HCPCS 86003
Hospital Charge Code	3001110
Hospital Revenue Code	302
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$8.59
Rate for Payer: BCBS BCN 65	$5.48
Rate for Payer: Blue Care Network Medicare Advantage	$5.48
Rate for Payer: Cash Price	$6.57
Rate for Payer: Cash Price	$6.57
Rate for Payer: Community Health Alliance Commercial	$8.59
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.48
Rate for Payer: Meridian Health Plan Medicare	$5.48
Rate for Payer: Priority Health Commercial	$7.07
Rate for Payer: Priority Health Medicaid	$5.48
Rate for Payer: Priority Health Medicare	$5.48
Rate for Payer: Priority Health PPO	$7.07
Rate for Payer: United Health Care Medicaid	$5.48
Rate for Payer: United Health Care Medicare Advantage	$2.41

RAST LETTUCE

Facility

$15.00

Hospital Charge Code	3006684
Hospital Revenue Code	302
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

RAST LIMA BEAN

Facility

$15.00

Hospital Charge Code	3100965
Hospital Revenue Code	302
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

RAST LOBSTER

Facility

$3.26

Hospital Charge Code	3006712
Hospital Revenue Code	302
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