Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

REFLEX A ANCA TITER IGG IFA

Facility

$31.80

Hospital Charge Code	3101101
Hospital Revenue Code	300
Min. Negotiated Rate	$22.26
Max. Negotiated Rate	$27.03
Rate for Payer: Cash Price	$20.67
Rate for Payer: Community Health Alliance Commercial	$27.03
Rate for Payer: Priority Health Commercial	$22.26
Rate for Payer: Priority Health PPO	$22.26

REFLEX ACHR MODULATING AB

Facility

$92.25

Hospital Charge Code	3101396
Hospital Revenue Code	300
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$78.41
Rate for Payer: Cash Price	$59.96
Rate for Payer: Community Health Alliance Commercial	$78.41
Rate for Payer: Priority Health Commercial	$64.58
Rate for Payer: Priority Health PPO	$64.58

REFLEX AMA IFA TITER IGG

Facility

$18.00

Hospital Charge Code	3101341
Hospital Revenue Code	300
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$15.30
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health PPO	$12.60

REFLEX AMA TITER, IGG IFA

Facility

$25.00

Hospital Charge Code	3101267
Hospital Revenue Code	301
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

REFLEX C ANCA TITER IGG IFA

Facility

$31.80

Hospital Charge Code	3101583
Hospital Revenue Code	300
Min. Negotiated Rate	$22.26
Max. Negotiated Rate	$27.03
Rate for Payer: Cash Price	$20.67
Rate for Payer: Community Health Alliance Commercial	$27.03
Rate for Payer: Priority Health Commercial	$22.26
Rate for Payer: Priority Health PPO	$22.26

REFLEX EMA TITER IGA IFA

Facility

$34.10

Hospital Charge Code	3101619
Hospital Revenue Code	300
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$28.98
Rate for Payer: Cash Price	$22.17
Rate for Payer: Community Health Alliance Commercial	$28.98
Rate for Payer: Priority Health Commercial	$23.87
Rate for Payer: Priority Health PPO	$23.87

REFLEX HPV LOW VOLUME

Facility

$45.10

Hospital Charge Code	3101784
Hospital Revenue Code	300
Min. Negotiated Rate	$31.57
Max. Negotiated Rate	$38.34
Rate for Payer: Cash Price	$29.32
Rate for Payer: Community Health Alliance Commercial	$38.34
Rate for Payer: Priority Health Commercial	$31.57
Rate for Payer: Priority Health PPO	$31.57

REFLEX OPIATES CONFIRM BLOOD

Facility

$30.00

Hospital Charge Code	3101775
Hospital Revenue Code	300
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$25.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health PPO	$21.00

REFLEX OXYCODONE CONFIRM BLOOD

Facility

$35.00

Hospital Charge Code	3101776
Hospital Revenue Code	300
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

REFLEX:PLA2R AB TITER,IGG

Facility

$265.00

Hospital Charge Code	3101211
Hospital Revenue Code	300
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$225.25
Rate for Payer: Cash Price	$172.25
Rate for Payer: Community Health Alliance Commercial	$225.25
Rate for Payer: Priority Health Commercial	$185.50
Rate for Payer: Priority Health PPO	$185.50

REFLEX SMOOTH MUSCLE IGG AB TI

Facility

$46.90

Hospital Charge Code	3101098
Hospital Revenue Code	300
Min. Negotiated Rate	$32.83
Max. Negotiated Rate	$39.87
Rate for Payer: Cash Price	$30.49
Rate for Payer: Community Health Alliance Commercial	$39.87
Rate for Payer: Priority Health Commercial	$32.83
Rate for Payer: Priority Health PPO	$32.83

RELOAD, LINEAR CUTTER TCR 75

Facility

$384.00

Hospital Charge Code	27019109
Hospital Revenue Code	272
Min. Negotiated Rate	$268.80
Max. Negotiated Rate	$326.40
Rate for Payer: Cash Price	$249.60
Rate for Payer: Community Health Alliance Commercial	$326.40
Rate for Payer: Priority Health Commercial	$268.80
Rate for Payer: Priority Health PPO	$268.80

RELOAD, LINEAR CUTTER #TR45W

Facility

$454.00

Hospital Charge Code	27265932
Hospital Revenue Code	272
Min. Negotiated Rate	$317.80
Max. Negotiated Rate	$385.90
Rate for Payer: Cash Price	$295.10
Rate for Payer: Community Health Alliance Commercial	$385.90
Rate for Payer: Priority Health Commercial	$317.80
Rate for Payer: Priority Health PPO	$317.80

RELOAD, LINEAR STAPLER TR30,60

Facility

$243.00

Hospital Charge Code	27019091
Hospital Revenue Code	272
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$206.55
Rate for Payer: Cash Price	$157.95
Rate for Payer: Community Health Alliance Commercial	$206.55
Rate for Payer: Priority Health Commercial	$170.10
Rate for Payer: Priority Health PPO	$170.10

REM BENIGN KERAT LES CUT OR PA

Facility

$243.00

Hospital Charge Code	5150750
Hospital Revenue Code	960
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$206.55
Rate for Payer: Cash Price	$157.95
Rate for Payer: Community Health Alliance Commercial	$206.55
Rate for Payer: Priority Health Commercial	$170.10
Rate for Payer: Priority Health PPO	$170.10

REMOVAL BY CONTOURING OF BENIGN TUMOR OF FACIAL BONE (EG, FIBROUS DYSPLASIA)

Facility

$3,556.63

Service Code	CPT 21029
Hospital Revenue Code	360
Min. Negotiated Rate	$1,564.92
Max. Negotiated Rate	$3,556.63
Rate for Payer: BCBS BCN 65	$3,556.63
Rate for Payer: Blue Care Network Medicare Advantage	$3,556.63
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,556.63
Rate for Payer: Meridian Health Plan Medicare	$3,556.63
Rate for Payer: Priority Health Medicaid	$3,556.63
Rate for Payer: Priority Health Medicare	$3,556.63
Rate for Payer: United Health Care Medicaid	$3,556.63
Rate for Payer: United Health Care Medicare Advantage	$1,564.92

REMOVAL FOREGIN BODY CORNEIAL

Facility

$122.00

Hospital Charge Code	4500942
Hospital Revenue Code	450
Min. Negotiated Rate	$85.40
Max. Negotiated Rate	$103.70
Rate for Payer: Cash Price	$79.30
Rate for Payer: Community Health Alliance Commercial	$103.70
Rate for Payer: Priority Health Commercial	$85.40
Rate for Payer: Priority Health PPO	$85.40

REMOVAL IMPACTED CERUMEN

Facility

$122.00

Hospital Charge Code	4500947
Hospital Revenue Code	450
Min. Negotiated Rate	$85.40
Max. Negotiated Rate	$103.70
Rate for Payer: Cash Price	$79.30
Rate for Payer: Community Health Alliance Commercial	$103.70
Rate for Payer: Priority Health Commercial	$85.40
Rate for Payer: Priority Health PPO	$85.40

REMOVAL OF ANAL FISSURE

Facility

$1,066.00

Hospital Charge Code	5150775
Hospital Revenue Code	960
Min. Negotiated Rate	$746.20
Max. Negotiated Rate	$906.10
Rate for Payer: Cash Price	$692.90
Rate for Payer: Community Health Alliance Commercial	$906.10
Rate for Payer: Priority Health Commercial	$746.20
Rate for Payer: Priority Health PPO	$746.20

REMOVAL OF BREAT LESION

Facility

$1,223.00

Hospital Charge Code	5150754
Hospital Revenue Code	960
Min. Negotiated Rate	$856.10
Max. Negotiated Rate	$1,039.55
Rate for Payer: Cash Price	$794.95
Rate for Payer: Community Health Alliance Commercial	$1,039.55
Rate for Payer: Priority Health Commercial	$856.10
Rate for Payer: Priority Health PPO	$856.10

REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION OF CHELATING AGENT (EG, EDTA)

Facility

$2,550.43

Service Code	CPT 65436
Hospital Revenue Code	360
Min. Negotiated Rate	$1,122.19
Max. Negotiated Rate	$2,550.43
Rate for Payer: BCBS BCN 65	$2,550.43
Rate for Payer: Blue Care Network Medicare Advantage	$2,550.43
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,550.43
Rate for Payer: Meridian Health Plan Medicare	$2,550.43
Rate for Payer: Priority Health Medicaid	$2,550.43
Rate for Payer: Priority Health Medicare	$2,550.43
Rate for Payer: United Health Care Medicaid	$2,550.43
Rate for Payer: United Health Care Medicare Advantage	$1,122.19

REMOVAL OF HYDROCELE

Facility

$885.00

Hospital Charge Code	5150779
Hospital Revenue Code	960
Min. Negotiated Rate	$619.50
Max. Negotiated Rate	$752.25
Rate for Payer: Cash Price	$575.25
Rate for Payer: Community Health Alliance Commercial	$752.25
Rate for Payer: Priority Health Commercial	$619.50
Rate for Payer: Priority Health PPO	$619.50

REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, 1 OR MORE STAGES

Facility

$2,475.70

Service Code	CPT 66840
Hospital Revenue Code	360
Min. Negotiated Rate	$1,089.31
Max. Negotiated Rate	$2,475.70
Rate for Payer: BCBS BCN 65	$2,475.70
Rate for Payer: Blue Care Network Medicare Advantage	$2,475.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,475.70
Rate for Payer: Meridian Health Plan Medicare	$2,475.70
Rate for Payer: Priority Health Medicaid	$2,475.70
Rate for Payer: Priority Health Medicare	$2,475.70
Rate for Payer: United Health Care Medicaid	$2,475.70
Rate for Payer: United Health Care Medicare Advantage	$1,089.31

REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, PHACOEMULSIFICATION), WITH ASPIRATION

Facility

$2,475.70

Service Code	CPT 66850
Hospital Revenue Code	360
Min. Negotiated Rate	$1,089.31
Max. Negotiated Rate	$2,475.70
Rate for Payer: BCBS BCN 65	$2,475.70
Rate for Payer: Blue Care Network Medicare Advantage	$2,475.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,475.70
Rate for Payer: Meridian Health Plan Medicare	$2,475.70
Rate for Payer: Priority Health Medicaid	$2,475.70
Rate for Payer: Priority Health Medicare	$2,475.70
Rate for Payer: United Health Care Medicaid	$2,475.70
Rate for Payer: United Health Care Medicare Advantage	$1,089.31

REMOVAL OF SPERM DUCT(S) PC

Facility

$968.00

Hospital Charge Code	5150746
Hospital Revenue Code	960
Min. Negotiated Rate	$677.60
Max. Negotiated Rate	$822.80
Rate for Payer: Cash Price	$629.20
Rate for Payer: Community Health Alliance Commercial	$822.80
Rate for Payer: Priority Health Commercial	$677.60
Rate for Payer: Priority Health PPO	$677.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges