Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

RIA NONANTIBODY

Facility

$37.67

Hospital Charge Code	3100045
Hospital Revenue Code	301
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$32.02
Rate for Payer: Cash Price	$24.49
Rate for Payer: Community Health Alliance Commercial	$32.02
Rate for Payer: Priority Health Commercial	$26.37
Rate for Payer: Priority Health PPO	$26.37

RIA NONANTIBODY

Facility

$75.00

Hospital Charge Code	3100043
Hospital Revenue Code	301
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

RIA NON ANTOBODY

Facility

$75.00

Hospital Charge Code	3100044
Hospital Revenue Code	301
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

RIBBELT

Facility

$188.00

Hospital Charge Code	27011247
Hospital Revenue Code	270
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$159.80
Rate for Payer: Cash Price	$122.20
Rate for Payer: Community Health Alliance Commercial	$159.80
Rate for Payer: Priority Health Commercial	$131.60
Rate for Payer: Priority Health PPO	$131.60

RIBONUCLEIC PROTEIN IgG

Facility

$4.77

Hospital Charge Code	3100013
Hospital Revenue Code	302
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$4.05
Rate for Payer: Cash Price	$3.10
Rate for Payer: Community Health Alliance Commercial	$4.05
Rate for Payer: Priority Health Commercial	$3.34
Rate for Payer: Priority Health PPO	$3.34

RIBOSOMAL P PROTEIN IgG ANTIBO

Facility

$19.00

Hospital Charge Code	3100016
Hospital Revenue Code	302
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$16.15
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health PPO	$13.30

RICELYTE 1000ML

Facility

$15.00

Hospital Charge Code	27017202
Hospital Revenue Code	270
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

RIFAMPIN 300MG CAP

Facility

$7.09

Service Code	HCPCS A9270 GY
Hospital Charge Code	2505252
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$6.03
Rate for Payer: Cash Price	$4.61
Rate for Payer: Community Health Alliance Commercial	$6.03
Rate for Payer: Priority Health Commercial	$4.96
Rate for Payer: Priority Health PPO	$4.96

RINGED GORTEX GRAFT

Facility

$3,689.00

Service Code	HCPCS C1768
Hospital Charge Code	27267359
Hospital Revenue Code	278
Min. Negotiated Rate	$2,582.30
Max. Negotiated Rate	$3,135.65
Rate for Payer: Cash Price	$2,397.85
Rate for Payer: Community Health Alliance Commercial	$3,135.65
Rate for Payer: Priority Health Commercial	$2,582.30
Rate for Payer: Priority Health PPO	$2,582.30

RITALIN LEVEL

Facility

$106.00

Service Code	HCPCS 80299
Hospital Charge Code	3007173
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$90.10
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$68.90
Rate for Payer: Cash Price	$68.90
Rate for Payer: Community Health Alliance Commercial	$90.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.57
Rate for Payer: Meridian Health Plan Medicare	$19.57
Rate for Payer: Priority Health Commercial	$74.20
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$74.20
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

RITALIN (METHYLPHENIDATE)

Facility

$105.00

Service Code	HCPCS G0480
Hospital Charge Code	3003348
Hospital Revenue Code	301
Min. Negotiated Rate	$52.87
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	$68.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
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	$73.50
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$73.50
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

RMVL NINFCT MESH HERNIA3

Facility

$1,404.00

Hospital Charge Code	5150765
Hospital Revenue Code	960
Min. Negotiated Rate	$982.80
Max. Negotiated Rate	$1,193.40
Rate for Payer: Cash Price	$912.60
Rate for Payer: Community Health Alliance Commercial	$1,193.40
Rate for Payer: Priority Health Commercial	$982.80
Rate for Payer: Priority Health PPO	$982.80

RNA POLYMERASE III AB IGG

Facility

$39.95

Hospital Charge Code	3100954
Hospital Revenue Code	300
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$33.96
Rate for Payer: Cash Price	$25.97
Rate for Payer: Community Health Alliance Commercial	$33.96
Rate for Payer: Priority Health Commercial	$27.96
Rate for Payer: Priority Health PPO	$27.96

ROCKY MOUNTAIN SPOTTED FEVER 1

Facility

$11.82

Service Code	HCPCS 86757
Hospital Charge Code	3000962
Hospital Revenue Code	300
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$20.32
Rate for Payer: BCBS BCN 65	$20.32
Rate for Payer: Blue Care Network Medicare Advantage	$20.32
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cash Price	$7.68
Rate for Payer: Community Health Alliance Commercial	$10.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$20.32
Rate for Payer: Meridian Health Plan Medicare	$20.32
Rate for Payer: Priority Health Commercial	$8.27
Rate for Payer: Priority Health Medicaid	$20.32
Rate for Payer: Priority Health Medicare	$20.32
Rate for Payer: Priority Health PPO	$8.27
Rate for Payer: United Health Care Medicaid	$20.32
Rate for Payer: United Health Care Medicare Advantage	$8.94

ROCKY MOUNTAIN SPOTTED FEVER 2

Facility

$11.82

Service Code	HCPCS 86757
Hospital Charge Code	3000963
Hospital Revenue Code	300
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$20.32
Rate for Payer: BCBS BCN 65	$20.32
Rate for Payer: Blue Care Network Medicare Advantage	$20.32
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cash Price	$7.68
Rate for Payer: Community Health Alliance Commercial	$10.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$20.32
Rate for Payer: Meridian Health Plan Medicare	$20.32
Rate for Payer: Priority Health Commercial	$8.27
Rate for Payer: Priority Health Medicaid	$20.32
Rate for Payer: Priority Health Medicare	$20.32
Rate for Payer: Priority Health PPO	$8.27
Rate for Payer: United Health Care Medicaid	$20.32
Rate for Payer: United Health Care Medicare Advantage	$8.94

ROHYPNOL, S/P

Facility

$90.00

Hospital Charge Code	3102353
Hospital Revenue Code	300
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$76.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Community Health Alliance Commercial	$76.50
Rate for Payer: Priority Health Commercial	$63.00
Rate for Payer: Priority Health PPO	$63.00

ROHYPNOL UR-1

Facility

$43.00

Service Code	HCPCS 80307
Hospital Charge Code	3007732
Hospital Revenue Code	301
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$65.25
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$27.95
Rate for Payer: Cash Price	$27.95
Rate for Payer: Community Health Alliance Commercial	$36.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$65.25
Rate for Payer: Meridian Health Plan Medicare	$65.25
Rate for Payer: Priority Health Commercial	$30.10
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$30.10
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

ROHYPNOL, UR-2

Facility

$43.00

Hospital Charge Code	3102352
Hospital Revenue Code	300
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$36.55
Rate for Payer: Cash Price	$27.95
Rate for Payer: Community Health Alliance Commercial	$36.55
Rate for Payer: Priority Health Commercial	$30.10
Rate for Payer: Priority Health PPO	$30.10

ROLLER BAR

Facility

$205.00

Hospital Charge Code	27019042
Hospital Revenue Code	270
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$174.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Community Health Alliance Commercial	$174.25
Rate for Payer: Priority Health Commercial	$143.50
Rate for Payer: Priority Health PPO	$143.50

ROMA

Facility

$292.00

Hospital Charge Code	3100843
Hospital Revenue Code	301
Min. Negotiated Rate	$204.40
Max. Negotiated Rate	$248.20
Rate for Payer: Cash Price	$189.80
Rate for Payer: Community Health Alliance Commercial	$248.20
Rate for Payer: Priority Health Commercial	$204.40
Rate for Payer: Priority Health PPO	$204.40

ROTABLATOR PERIPHERAL ADVANCER

Facility

$3,020.00

Hospital Charge Code	27017103
Hospital Revenue Code	272
Min. Negotiated Rate	$2,114.00
Max. Negotiated Rate	$2,567.00
Rate for Payer: Cash Price	$1,963.00
Rate for Payer: Community Health Alliance Commercial	$2,567.00
Rate for Payer: Priority Health Commercial	$2,114.00
Rate for Payer: Priority Health PPO	$2,114.00

ROTALINK ADVANCER

Facility

$913.00

Hospital Charge Code	27061220
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

ROTAVIRUS, DIRECT DETECTION

Facility

$8.14

Service Code	HCPCS 87425
Hospital Charge Code	3003781
Hospital Revenue Code	306
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$12.58
Rate for Payer: BCBS BCN 65	$12.58
Rate for Payer: Blue Care Network Medicare Advantage	$12.58
Rate for Payer: Cash Price	$5.29
Rate for Payer: Cash Price	$5.29
Rate for Payer: Community Health Alliance Commercial	$6.92
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.58
Rate for Payer: Meridian Health Plan Medicare	$12.58
Rate for Payer: Priority Health Commercial	$5.70
Rate for Payer: Priority Health Medicaid	$12.58
Rate for Payer: Priority Health Medicare	$12.58
Rate for Payer: Priority Health PPO	$5.70
Rate for Payer: United Health Care Medicaid	$12.58
Rate for Payer: United Health Care Medicare Advantage	$5.53

ROTH ROTATABLE RETRIEVAL NET

Facility

$345.00

Hospital Charge Code	27263455
Hospital Revenue Code	272
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$293.25
Rate for Payer: Cash Price	$224.25
Rate for Payer: Community Health Alliance Commercial	$293.25
Rate for Payer: Priority Health Commercial	$241.50
Rate for Payer: Priority Health PPO	$241.50

ROUND CUTTING BUR - CARBIDE

Facility

$128.00

Hospital Charge Code	27264264
Hospital Revenue Code	272
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$108.80
Rate for Payer: Cash Price	$83.20
Rate for Payer: Community Health Alliance Commercial	$108.80
Rate for Payer: Priority Health Commercial	$89.60
Rate for Payer: Priority Health PPO	$89.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges