Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

RPP-1

Facility

$61.25

Hospital Charge Code	3102534
Hospital Revenue Code	300
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$52.06
Rate for Payer: Cash Price	$39.81
Rate for Payer: Community Health Alliance Commercial	$52.06
Rate for Payer: Priority Health Commercial	$42.88
Rate for Payer: Priority Health PPO	$42.88

RPP-2

Facility

$61.25

Hospital Charge Code	3102535
Hospital Revenue Code	300
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$52.06
Rate for Payer: Cash Price	$39.81
Rate for Payer: Community Health Alliance Commercial	$52.06
Rate for Payer: Priority Health Commercial	$42.88
Rate for Payer: Priority Health PPO	$42.88

RPP-3

Facility

$61.25

Hospital Charge Code	3102536
Hospital Revenue Code	300
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$52.06
Rate for Payer: Cash Price	$39.81
Rate for Payer: Community Health Alliance Commercial	$52.06
Rate for Payer: Priority Health Commercial	$42.88
Rate for Payer: Priority Health PPO	$42.88

RPP-4

Facility

$61.25

Hospital Charge Code	3102537
Hospital Revenue Code	300
Min. Negotiated Rate	$42.88
Max. Negotiated Rate	$52.06
Rate for Payer: Cash Price	$39.81
Rate for Payer: Community Health Alliance Commercial	$52.06
Rate for Payer: Priority Health Commercial	$42.88
Rate for Payer: Priority Health PPO	$42.88

RPR

Facility

$0.81

Service Code	HCPCS 86592
Hospital Charge Code	3006840
Hospital Revenue Code	302
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$4.48
Rate for Payer: BCBS BCN 65	$4.48
Rate for Payer: Blue Care Network Medicare Advantage	$4.48
Rate for Payer: Cash Price	$0.53
Rate for Payer: Cash Price	$0.53
Rate for Payer: Community Health Alliance Commercial	$0.69
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.48
Rate for Payer: Meridian Health Plan Medicare	$4.48
Rate for Payer: Priority Health Commercial	$0.57
Rate for Payer: Priority Health Medicaid	$4.48
Rate for Payer: Priority Health Medicare	$4.48
Rate for Payer: Priority Health PPO	$0.57
Rate for Payer: United Health Care Medicaid	$4.48
Rate for Payer: United Health Care Medicare Advantage	$1.97

RPR-2

Facility

$0.82

Hospital Charge Code	3101824
Hospital Revenue Code	300
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.70
Rate for Payer: Cash Price	$0.53
Rate for Payer: Community Health Alliance Commercial	$0.70
Rate for Payer: Priority Health Commercial	$0.57
Rate for Payer: Priority Health PPO	$0.57

RPR-2 REFLEX

Facility

$0.82

Hospital Charge Code	3101825
Hospital Revenue Code	300
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.70
Rate for Payer: Cash Price	$0.53
Rate for Payer: Community Health Alliance Commercial	$0.70
Rate for Payer: Priority Health Commercial	$0.57
Rate for Payer: Priority Health PPO	$0.57

RPR AA HRN 1ST> 10 NCR/STRN

Facility

$2,355.00

Hospital Charge Code	5150793
Hospital Revenue Code	960
Min. Negotiated Rate	$1,648.50
Max. Negotiated Rate	$2,001.75
Rate for Payer: Cash Price	$1,530.75
Rate for Payer: Community Health Alliance Commercial	$2,001.75
Rate for Payer: Priority Health Commercial	$1,648.50
Rate for Payer: Priority Health PPO	$1,648.50

RPR AA HRN 1ST 3-10 NCR/STRN

Facility

$1,875.00

Hospital Charge Code	5150721
Hospital Revenue Code	960
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$1,593.75
Rate for Payer: Cash Price	$1,218.75
Rate for Payer: Community Health Alliance Commercial	$1,593.75
Rate for Payer: Priority Health Commercial	$1,312.50
Rate for Payer: Priority Health PPO	$1,312.50

RPR AA HRN 1ST <3 CM RDC PV

Facility

$1,430.00

Hospital Charge Code	5150722
Hospital Revenue Code	960
Min. Negotiated Rate	$1,001.00
Max. Negotiated Rate	$1,215.50
Rate for Payer: Cash Price	$929.50
Rate for Payer: Community Health Alliance Commercial	$1,215.50
Rate for Payer: Priority Health Commercial	$1,001.00
Rate for Payer: Priority Health PPO	$1,001.00

RPR AA HRN 3-10 RDC

Facility

$1,750.00

Hospital Charge Code	5150769
Hospital Revenue Code	960
Min. Negotiated Rate	$1,225.00
Max. Negotiated Rate	$1,487.50
Rate for Payer: Cash Price	$1,137.50
Rate for Payer: Community Health Alliance Commercial	$1,487.50
Rate for Payer: Priority Health Commercial	$1,225.00
Rate for Payer: Priority Health PPO	$1,225.00

RPR AA HRN RCR 3-10

Facility

$1,233.00

Hospital Charge Code	5150764
Hospital Revenue Code	960
Min. Negotiated Rate	$863.10
Max. Negotiated Rate	$1,048.05
Rate for Payer: Cash Price	$801.45
Rate for Payer: Community Health Alliance Commercial	$1,048.05
Rate for Payer: Priority Health Commercial	$863.10
Rate for Payer: Priority Health PPO	$863.10

RPRQNT-1

Facility

$2.44

Hospital Charge Code	3102165
Hospital Revenue Code	300
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.07
Rate for Payer: Cash Price	$1.59
Rate for Payer: Community Health Alliance Commercial	$2.07
Rate for Payer: Priority Health Commercial	$1.71
Rate for Payer: Priority Health PPO	$1.71

RPRQNT-2

Facility

$2.45

Hospital Charge Code	3102166
Hospital Revenue Code	300
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.08
Rate for Payer: Cash Price	$1.59
Rate for Payer: Community Health Alliance Commercial	$2.08
Rate for Payer: Priority Health Commercial	$1.72
Rate for Payer: Priority Health PPO	$1.72

RPR TITER

Facility

$0.81

Hospital Charge Code	3101031
Hospital Revenue Code	302
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.69
Rate for Payer: Cash Price	$0.53
Rate for Payer: Community Health Alliance Commercial	$0.69
Rate for Payer: Priority Health Commercial	$0.57
Rate for Payer: Priority Health PPO	$0.57

RSV

Facility

$66.00

Service Code	HCPCS 87420
Hospital Charge Code	3006880
Hospital Revenue Code	306
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$56.10
Rate for Payer: BCBS BCN 65	$14.61
Rate for Payer: Blue Care Network Medicare Advantage	$14.61
Rate for Payer: Cash Price	$42.90
Rate for Payer: Cash Price	$42.90
Rate for Payer: Community Health Alliance Commercial	$56.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.61
Rate for Payer: Meridian Health Plan Medicare	$14.61
Rate for Payer: Priority Health Commercial	$46.20
Rate for Payer: Priority Health Medicaid	$14.61
Rate for Payer: Priority Health Medicare	$14.61
Rate for Payer: Priority Health PPO	$46.20
Rate for Payer: United Health Care Medicaid	$14.61
Rate for Payer: United Health Care Medicare Advantage	$6.43

RSV FLU EIA PANEL

Facility

$36.00

Hospital Charge Code	3100693
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$30.60
Rate for Payer: Cash Price	$23.40
Rate for Payer: Community Health Alliance Commercial	$30.60
Rate for Payer: Priority Health Commercial	$25.20
Rate for Payer: Priority Health PPO	$25.20

RSV FLU RT-PCR

Facility

$173.10

Hospital Charge Code	3100694
Hospital Revenue Code	300
Min. Negotiated Rate	$121.17
Max. Negotiated Rate	$147.13
Rate for Payer: Cash Price	$112.52
Rate for Payer: Community Health Alliance Commercial	$147.13
Rate for Payer: Priority Health Commercial	$121.17
Rate for Payer: Priority Health PPO	$121.17

RUBELLA IgG ANTIBODY

Facility

$47.00

Service Code	HCPCS 86762
Hospital Charge Code	3007240
Hospital Revenue Code	302
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$39.95
Rate for Payer: BCBS BCN 65	$15.11
Rate for Payer: Blue Care Network Medicare Advantage	$15.11
Rate for Payer: Cash Price	$30.55
Rate for Payer: Cash Price	$30.55
Rate for Payer: Community Health Alliance Commercial	$39.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.11
Rate for Payer: Meridian Health Plan Medicare	$15.11
Rate for Payer: Priority Health Commercial	$32.90
Rate for Payer: Priority Health Medicaid	$15.11
Rate for Payer: Priority Health Medicare	$15.11
Rate for Payer: Priority Health PPO	$32.90
Rate for Payer: United Health Care Medicaid	$15.11
Rate for Payer: United Health Care Medicare Advantage	$6.65

RUBELLA IgM

Facility

$6.11

Service Code	HCPCS 86762
Hospital Charge Code	3007250
Hospital Revenue Code	302
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$15.11
Rate for Payer: BCBS BCN 65	$15.11
Rate for Payer: Blue Care Network Medicare Advantage	$15.11
Rate for Payer: Cash Price	$3.97
Rate for Payer: Cash Price	$3.97
Rate for Payer: Community Health Alliance Commercial	$5.19
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.11
Rate for Payer: Meridian Health Plan Medicare	$15.11
Rate for Payer: Priority Health Commercial	$4.28
Rate for Payer: Priority Health Medicaid	$15.11
Rate for Payer: Priority Health Medicare	$15.11
Rate for Payer: Priority Health PPO	$4.28
Rate for Payer: United Health Care Medicaid	$15.11
Rate for Payer: United Health Care Medicare Advantage	$6.65

RUBELLA TITER (RML) IGM

Facility

$2.44

Service Code	HCPCS 86762
Hospital Charge Code	3007060
Hospital Revenue Code	302
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$15.11
Rate for Payer: BCBS BCN 65	$15.11
Rate for Payer: Blue Care Network Medicare Advantage	$15.11
Rate for Payer: Cash Price	$1.59
Rate for Payer: Cash Price	$1.59
Rate for Payer: Community Health Alliance Commercial	$2.07
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.11
Rate for Payer: Meridian Health Plan Medicare	$15.11
Rate for Payer: Priority Health Commercial	$1.71
Rate for Payer: Priority Health Medicaid	$15.11
Rate for Payer: Priority Health Medicare	$15.11
Rate for Payer: Priority Health PPO	$1.71
Rate for Payer: United Health Care Medicaid	$15.11
Rate for Payer: United Health Care Medicare Advantage	$6.65

RUBEOLA IgG ANTIBODY

Facility

$2.85

Service Code	HCPCS 86765
Hospital Charge Code	3007260
Hospital Revenue Code	302
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$13.52
Rate for Payer: BCBS BCN 65	$13.52
Rate for Payer: Blue Care Network Medicare Advantage	$13.52
Rate for Payer: Cash Price	$1.85
Rate for Payer: Cash Price	$1.85
Rate for Payer: Community Health Alliance Commercial	$2.42
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.52
Rate for Payer: Meridian Health Plan Medicare	$13.52
Rate for Payer: Priority Health Commercial	$2.00
Rate for Payer: Priority Health Medicaid	$13.52
Rate for Payer: Priority Health Medicare	$13.52
Rate for Payer: Priority Health PPO	$2.00
Rate for Payer: United Health Care Medicaid	$13.52
Rate for Payer: United Health Care Medicare Advantage	$5.95

RUSSELL VIPER

Facility

$18.00

Service Code	HCPCS 85613
Hospital Charge Code	3007270
Hospital Revenue Code	305
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$15.30
Rate for Payer: BCBS BCN 65	$10.06
Rate for Payer: Blue Care Network Medicare Advantage	$10.06
Rate for Payer: Cash Price	$11.70
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.06
Rate for Payer: Meridian Health Plan Medicare	$10.06
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health Medicaid	$10.06
Rate for Payer: Priority Health Medicare	$10.06
Rate for Payer: Priority Health PPO	$12.60
Rate for Payer: United Health Care Medicaid	$10.06
Rate for Payer: United Health Care Medicare Advantage	$4.43

RUT SUP BALLOON CATHETER SET

Facility

$185.00

Hospital Charge Code	27061048
Hospital Revenue Code	272
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$157.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Community Health Alliance Commercial	$157.25
Rate for Payer: Priority Health Commercial	$129.50
Rate for Payer: Priority Health PPO	$129.50

sa-1

Facility

$297.50

Service Code	HCPCS 83520
Hospital Charge Code	3007630
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$252.88
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$193.38
Rate for Payer: Cash Price	$193.38
Rate for Payer: Community Health Alliance Commercial	$252.88
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$208.25
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$208.25
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges