Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

BCR/ABL-1

Facility

$56.00

Hospital Charge Code	3000173
Hospital Revenue Code	310
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

BCR/ABL-2

Facility

$134.00

Hospital Charge Code	3000176
Hospital Revenue Code	310
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$113.90
Rate for Payer: Cash Price	$87.10
Rate for Payer: Community Health Alliance Commercial	$113.90
Rate for Payer: Priority Health Commercial	$93.80
Rate for Payer: Priority Health PPO	$93.80

BCR/ABL-3

Facility

$134.00

Hospital Charge Code	3000177
Hospital Revenue Code	310
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$113.90
Rate for Payer: Cash Price	$87.10
Rate for Payer: Community Health Alliance Commercial	$113.90
Rate for Payer: Priority Health Commercial	$93.80
Rate for Payer: Priority Health PPO	$93.80

BCR/ABL-4

Facility

$96.00

Hospital Charge Code	3000178
Hospital Revenue Code	310
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$81.60
Rate for Payer: Cash Price	$62.40
Rate for Payer: Community Health Alliance Commercial	$81.60
Rate for Payer: Priority Health Commercial	$67.20
Rate for Payer: Priority Health PPO	$67.20

BCRABLM-1

Facility

$50.00

Hospital Charge Code	3101116
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

BCRABLM-2

Facility

$50.00

Hospital Charge Code	3102333
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

BCR/ABL MAJOR

Facility

$316.00

Hospital Charge Code	3100682
Hospital Revenue Code	300
Min. Negotiated Rate	$221.20
Max. Negotiated Rate	$268.60
Rate for Payer: Cash Price	$205.40
Rate for Payer: Community Health Alliance Commercial	$268.60
Rate for Payer: Priority Health Commercial	$221.20
Rate for Payer: Priority Health PPO	$221.20

BCR/ABL MINOR

Facility

$213.00

Hospital Charge Code	3100683
Hospital Revenue Code	300
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$181.05
Rate for Payer: Cash Price	$138.45
Rate for Payer: Community Health Alliance Commercial	$181.05
Rate for Payer: Priority Health Commercial	$149.10
Rate for Payer: Priority Health PPO	$149.10

BCR/ABL RT PCR

Facility

$544.00

Hospital Charge Code	3001079
Hospital Revenue Code	302
Min. Negotiated Rate	$380.80
Max. Negotiated Rate	$462.40
Rate for Payer: Cash Price	$353.60
Rate for Payer: Community Health Alliance Commercial	$462.40
Rate for Payer: Priority Health Commercial	$380.80
Rate for Payer: Priority Health PPO	$380.80

BCR/ABL SCREEN

Facility

$420.00

Hospital Charge Code	3000168
Hospital Revenue Code	310
Min. Negotiated Rate	$294.00
Max. Negotiated Rate	$357.00
Rate for Payer: Cash Price	$273.00
Rate for Payer: Community Health Alliance Commercial	$357.00
Rate for Payer: Priority Health Commercial	$294.00
Rate for Payer: Priority Health PPO	$294.00

BEHAVIORAL AND QUAL ANALYSIS

Facility

$255.00

Hospital Charge Code	4400014
Hospital Revenue Code	444
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$216.75
Rate for Payer: Cash Price	$165.75
Rate for Payer: Community Health Alliance Commercial	$216.75
Rate for Payer: Priority Health Commercial	$178.50
Rate for Payer: Priority Health PPO	$178.50

BELT - ABD SUPPORT, 3-PANEL

Facility

$60.00

Hospital Charge Code	27011189
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

BELT - ABD SUPPORT, 4 PANEL

Facility

$56.00

Hospital Charge Code	27011197
Hospital Revenue Code	270
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

BELT - PELVIC TRACTION

Facility

$193.00

Hospital Charge Code	27011254
Hospital Revenue Code	270
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$164.05
Rate for Payer: Cash Price	$125.45
Rate for Payer: Community Health Alliance Commercial	$164.05
Rate for Payer: Priority Health Commercial	$135.10
Rate for Payer: Priority Health PPO	$135.10

BENADRYL

Facility

$132.00

Service Code	HCPCS 80299
Hospital Charge Code	3001275
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$112.20
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$85.80
Rate for Payer: Cash Price	$85.80
Rate for Payer: Community Health Alliance Commercial	$112.20
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	$92.40
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$92.40
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

BENZODIAZEPINE

Facility

$57.19

Service Code	HCPCS G0480
Hospital Charge Code	3100037
Hospital Revenue Code	301
Min. Negotiated Rate	$40.03
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	$37.17
Rate for Payer: Cash Price	$37.17
Rate for Payer: Community Health Alliance Commercial	$48.61
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	$40.03
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$40.03
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

BENZODIAZEPINE CONFIRM UR-LC

Facility

$20.00

Hospital Charge Code	31027374
Hospital Revenue Code	300
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

BENZODIAZEPINE QUANT URINE

Facility

$16.85

Service Code	HCPCS G0480
Hospital Charge Code	3100870
Hospital Revenue Code	300
Min. Negotiated Rate	$11.79
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	$10.95
Rate for Payer: Cash Price	$10.95
Rate for Payer: Community Health Alliance Commercial	$14.32
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	$11.79
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$11.79
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

BENZODIAZEPINES QUANT S/P

Facility

$60.00

Hospital Charge Code	3101661
Hospital Revenue Code	300
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

BENZODIAZEPONE CONF S/P

Facility

$147.91

Hospital Charge Code	3102170
Hospital Revenue Code	300
Min. Negotiated Rate	$103.54
Max. Negotiated Rate	$125.72
Rate for Payer: Cash Price	$96.14
Rate for Payer: Community Health Alliance Commercial	$125.72
Rate for Payer: Priority Health Commercial	$103.54
Rate for Payer: Priority Health PPO	$103.54

BETA-2 CLYCOPROTEIN 1 IGA

Facility

$4.07

Hospital Charge Code	3100847
Hospital Revenue Code	300
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$2.65
Rate for Payer: Community Health Alliance Commercial	$3.46
Rate for Payer: Priority Health Commercial	$2.85
Rate for Payer: Priority Health PPO	$2.85

BETA-2 GLYCOPROTEIN 1 IGG

Facility

$4.07

Hospital Charge Code	3100848
Hospital Revenue Code	300
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$2.65
Rate for Payer: Community Health Alliance Commercial	$3.46
Rate for Payer: Priority Health Commercial	$2.85
Rate for Payer: Priority Health PPO	$2.85

BETA-2 GLYCOPROTEIN IGM

Facility

$4.07

Hospital Charge Code	3100849
Hospital Revenue Code	300
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$2.65
Rate for Payer: Community Health Alliance Commercial	$3.46
Rate for Payer: Priority Health Commercial	$2.85
Rate for Payer: Priority Health PPO	$2.85

BETA-2-MICROGLOBIN

Facility

$4.00

Service Code	HCPCS 82232
Hospital Charge Code	3001280
Hospital Revenue Code	301
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$16.99
Rate for Payer: BCBS BCN 65	$16.99
Rate for Payer: Blue Care Network Medicare Advantage	$16.99
Rate for Payer: Cash Price	$2.60
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.99
Rate for Payer: Meridian Health Plan Medicare	$16.99
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health Medicaid	$16.99
Rate for Payer: Priority Health Medicare	$16.99
Rate for Payer: Priority Health PPO	$2.80
Rate for Payer: United Health Care Medicaid	$16.99
Rate for Payer: United Health Care Medicare Advantage	$7.48

BETA-2 TRANSFERRIN

Facility

$125.00

Hospital Charge Code	3102105
Hospital Revenue Code	300
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$106.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Community Health Alliance Commercial	$106.25
Rate for Payer: Priority Health Commercial	$87.50
Rate for Payer: Priority Health PPO	$87.50

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges