Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

BALLOON, RAPID EXCHANGE

Facility

$659.00

Service Code	HCPCS C1725
Hospital Charge Code	27264017
Hospital Revenue Code	272
Min. Negotiated Rate	$461.30
Max. Negotiated Rate	$560.15
Rate for Payer: Cash Price	$428.35
Rate for Payer: Community Health Alliance Commercial	$560.15
Rate for Payer: Priority Health Commercial	$461.30
Rate for Payer: Priority Health PPO	$461.30

BALLOON REPLACEMENT TUBE

Facility

$111.00

Hospital Charge Code	27263394
Hospital Revenue Code	272
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$94.35
Rate for Payer: Cash Price	$72.15
Rate for Payer: Community Health Alliance Commercial	$94.35
Rate for Payer: Priority Health Commercial	$77.70
Rate for Payer: Priority Health PPO	$77.70

BALLOON, RETRIEVAL

Facility

$388.00

Hospital Charge Code	27016766
Hospital Revenue Code	272
Min. Negotiated Rate	$271.60
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$252.20
Rate for Payer: Community Health Alliance Commercial	$329.80
Rate for Payer: Priority Health Commercial	$271.60
Rate for Payer: Priority Health PPO	$271.60

BALLOON, SMASH

Facility

$1,090.00

Hospital Charge Code	27061881
Hospital Revenue Code	272
Min. Negotiated Rate	$763.00
Max. Negotiated Rate	$926.50
Rate for Payer: Cash Price	$708.50
Rate for Payer: Community Health Alliance Commercial	$926.50
Rate for Payer: Priority Health Commercial	$763.00
Rate for Payer: Priority Health PPO	$763.00

BALLOON URETERAL DILATOR

Facility

$367.00

Service Code	HCPCS C1726
Hospital Charge Code	27014670
Hospital Revenue Code	272
Min. Negotiated Rate	$256.90
Max. Negotiated Rate	$311.95
Rate for Payer: Cash Price	$238.55
Rate for Payer: Community Health Alliance Commercial	$311.95
Rate for Payer: Priority Health Commercial	$256.90
Rate for Payer: Priority Health PPO	$256.90

BANANA KNIFE #6984

Facility

$53.00

Hospital Charge Code	27264884
Hospital Revenue Code	272
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$45.05
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health PPO	$37.10

BANDAGE-ACE, N/S, ALL SIZES

Facility

$20.00

Hospital Charge Code	27010926
Hospital Revenue Code	270
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$17.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health PPO	$14.00

BANDAGE-ACE, STERILE, ALL SIZE

Facility

$23.00

Hospital Charge Code	27020370
Hospital Revenue Code	270
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

BANDAGE COMPRESSION

Facility

$42.00

Hospital Charge Code	27278012
Hospital Revenue Code	272
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

BANDAGE,ELASTIC 6" STERILE

Facility

$38.00

Hospital Charge Code	27011411
Hospital Revenue Code	270
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

BANDAGE,LATEX FREE

Facility

$26.00

Hospital Charge Code	27021873
Hospital Revenue Code	270
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

BANDANGE ELASTIC 3" STERILE

Facility

$31.00

Hospital Charge Code	27011403
Hospital Revenue Code	270
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$26.35
Rate for Payer: Cash Price	$20.15
Rate for Payer: Community Health Alliance Commercial	$26.35
Rate for Payer: Priority Health Commercial	$21.70
Rate for Payer: Priority Health PPO	$21.70

BARBIT CONF URINE

Facility

$13.85

Hospital Charge Code	3101943
Hospital Revenue Code	300
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$11.77
Rate for Payer: Cash Price	$9.00
Rate for Payer: Community Health Alliance Commercial	$11.77
Rate for Payer: Priority Health Commercial	$9.70
Rate for Payer: Priority Health PPO	$9.70

BARBITURATE SCR URINE

Facility

$8.06

Hospital Charge Code	3101387
Hospital Revenue Code	300
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$6.85
Rate for Payer: Cash Price	$5.24
Rate for Payer: Community Health Alliance Commercial	$6.85
Rate for Payer: Priority Health Commercial	$5.64
Rate for Payer: Priority Health PPO	$5.64

BARBITURATES QUANT URINE

Facility

$52.00

Service Code	HCPCS G0480
Hospital Charge Code	3100900
Hospital Revenue Code	301
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$33.80
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$36.40
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

BARIUM SWALLOW VIDEO

Facility

$149.00

Hospital Charge Code	3200835
Hospital Revenue Code	320
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$126.65
Rate for Payer: Cash Price	$96.85
Rate for Payer: Community Health Alliance Commercial	$126.65
Rate for Payer: Priority Health Commercial	$104.30
Rate for Payer: Priority Health PPO	$104.30

BARTONELLA SPECIES PCR

Facility

$150.00

Hospital Charge Code	3101571
Hospital Revenue Code	300
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$127.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Community Health Alliance Commercial	$127.50
Rate for Payer: Priority Health Commercial	$105.00
Rate for Payer: Priority Health PPO	$105.00

BASIC METABOLIC PANEL

Facility

$57.00

Service Code	HCPCS 80048
Hospital Charge Code	3001270
Hospital Revenue Code	301
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$48.45
Rate for Payer: BCBS BCN 65	$8.88
Rate for Payer: Blue Care Network Medicare Advantage	$8.88
Rate for Payer: Cash Price	$37.05
Rate for Payer: Cash Price	$37.05
Rate for Payer: Community Health Alliance Commercial	$48.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.88
Rate for Payer: Meridian Health Plan Medicare	$8.88
Rate for Payer: Priority Health Commercial	$39.90
Rate for Payer: Priority Health Medicaid	$8.88
Rate for Payer: Priority Health Medicare	$8.88
Rate for Payer: Priority Health PPO	$39.90
Rate for Payer: United Health Care Medicaid	$8.88
Rate for Payer: United Health Care Medicare Advantage	$3.91

BASIC METABOLIC PANEL-LC

Facility

$2.74

Hospital Charge Code	3101165
Hospital Revenue Code	301
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$2.33
Rate for Payer: Cash Price	$1.78
Rate for Payer: Community Health Alliance Commercial	$2.33
Rate for Payer: Priority Health Commercial	$1.92
Rate for Payer: Priority Health PPO	$1.92

BASKET GEMINI STONE RETRIEVAL

Facility

$745.00

Hospital Charge Code	27023317
Hospital Revenue Code	270
Min. Negotiated Rate	$521.50
Max. Negotiated Rate	$633.25
Rate for Payer: Cash Price	$484.25
Rate for Payer: Community Health Alliance Commercial	$633.25
Rate for Payer: Priority Health Commercial	$521.50
Rate for Payer: Priority Health PPO	$521.50

BASKET SEGURA

Facility

$671.00

Hospital Charge Code	27014787
Hospital Revenue Code	270
Min. Negotiated Rate	$469.70
Max. Negotiated Rate	$570.35
Rate for Payer: Cash Price	$436.15
Rate for Payer: Community Health Alliance Commercial	$570.35
Rate for Payer: Priority Health Commercial	$469.70
Rate for Payer: Priority Health PPO	$469.70

BCC-1

Facility

$163.00

Hospital Charge Code	3101313
Hospital Revenue Code	300
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$138.55
Rate for Payer: Cash Price	$105.95
Rate for Payer: Community Health Alliance Commercial	$138.55
Rate for Payer: Priority Health Commercial	$114.10
Rate for Payer: Priority Health PPO	$114.10

BCC-2

Facility

$163.00

Hospital Charge Code	3101314
Hospital Revenue Code	300
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$138.55
Rate for Payer: Cash Price	$105.95
Rate for Payer: Community Health Alliance Commercial	$138.55
Rate for Payer: Priority Health Commercial	$114.10
Rate for Payer: Priority Health PPO	$114.10

B-CELL CD 20

Facility

$265.00

Hospital Charge Code	31027655
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

B CELLS TOTAL COUNT

Facility

$17.00

Hospital Charge Code	3100173
Hospital Revenue Code	302
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges