Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

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

BETA-HCG, QUANT

Facility

$74.00

Service Code	HCPCS 84702
Hospital Charge Code	3001300
Hospital Revenue Code	301
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$62.90
Rate for Payer: BCBS BCN 65	$15.80
Rate for Payer: Blue Care Network Medicare Advantage	$15.80
Rate for Payer: Cash Price	$48.10
Rate for Payer: Cash Price	$48.10
Rate for Payer: Community Health Alliance Commercial	$62.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.80
Rate for Payer: Meridian Health Plan Medicare	$15.80
Rate for Payer: Priority Health Commercial	$51.80
Rate for Payer: Priority Health Medicaid	$15.80
Rate for Payer: Priority Health Medicare	$15.80
Rate for Payer: Priority Health PPO	$51.80
Rate for Payer: United Health Care Medicaid	$15.80
Rate for Payer: United Health Care Medicare Advantage	$6.95

BETA-HCG QUANT SBMF

Facility

$5.00

Hospital Charge Code	3101150
Hospital Revenue Code	301
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$4.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health PPO	$3.50

BETA HYDROXYBUTYRIC ACID

Facility

$36.00

Hospital Charge Code	3000668
Hospital Revenue Code	301
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

BFCUL/GS-1

Facility

$7.95

Hospital Charge Code	3102441
Hospital Revenue Code	300
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$6.76
Rate for Payer: Cash Price	$5.17
Rate for Payer: Community Health Alliance Commercial	$6.76
Rate for Payer: Priority Health Commercial	$5.57
Rate for Payer: Priority Health PPO	$5.57

BFCUL/GS-2

Facility

$7.96

Hospital Charge Code	3102442
Hospital Revenue Code	300
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$6.77
Rate for Payer: Cash Price	$5.17
Rate for Payer: Community Health Alliance Commercial	$6.77
Rate for Payer: Priority Health Commercial	$5.57
Rate for Payer: Priority Health PPO	$5.57

BFCULSP-1

Facility

$16.00

Hospital Charge Code	3102443
Hospital Revenue Code	300
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
Rate for Payer: Priority Health Commercial	$11.20
Rate for Payer: Priority Health PPO	$11.20

BFCULSP-2

Facility

$16.00

Hospital Charge Code	3102444
Hospital Revenue Code	300
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
Rate for Payer: Priority Health Commercial	$11.20
Rate for Payer: Priority Health PPO	$11.20

BF LOW

Facility

$2.25

Hospital Charge Code	3101805
Hospital Revenue Code	300
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.91
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.91
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health PPO	$1.57

BF URIC ACID

Facility

$2.65

Hospital Charge Code	3101952
Hospital Revenue Code	300
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.25
Rate for Payer: Cash Price	$1.72
Rate for Payer: Community Health Alliance Commercial	$2.25
Rate for Payer: Priority Health Commercial	$1.85
Rate for Payer: Priority Health PPO	$1.85

B HENSELAE IGG

Facility

$3.66

Hospital Charge Code	3100982
Hospital Revenue Code	302
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.11
Rate for Payer: Cash Price	$2.38
Rate for Payer: Community Health Alliance Commercial	$3.11
Rate for Payer: Priority Health Commercial	$2.56
Rate for Payer: Priority Health PPO	$2.56

B HENSELAE IGM

Facility

$3.66

Hospital Charge Code	3100983
Hospital Revenue Code	302
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.11
Rate for Payer: Cash Price	$2.38
Rate for Payer: Community Health Alliance Commercial	$3.11
Rate for Payer: Priority Health Commercial	$2.56
Rate for Payer: Priority Health PPO	$2.56

B HERMSII IGG

Facility

$40.00

Hospital Charge Code	3100986
Hospital Revenue Code	302
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

B HERMSII IGM

Facility

$40.00

Hospital Charge Code	3100987
Hospital Revenue Code	302
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

BHIGG-1

Facility

$7.34

Hospital Charge Code	3101835
Hospital Revenue Code	300
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$6.24
Rate for Payer: Cash Price	$4.77
Rate for Payer: Community Health Alliance Commercial	$6.24
Rate for Payer: Priority Health Commercial	$5.14
Rate for Payer: Priority Health PPO	$5.14

BHIGM-2

Facility

$7.34

Hospital Charge Code	3101836
Hospital Revenue Code	300
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$6.24
Rate for Payer: Cash Price	$4.77
Rate for Payer: Community Health Alliance Commercial	$6.24
Rate for Payer: Priority Health Commercial	$5.14
Rate for Payer: Priority Health PPO	$5.14

BILE ACIDS

Facility

$49.00

Hospital Charge Code	3001315
Hospital Revenue Code	301
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$41.65
Rate for Payer: Cash Price	$31.85
Rate for Payer: Community Health Alliance Commercial	$41.65
Rate for Payer: Priority Health Commercial	$34.30
Rate for Payer: Priority Health PPO	$34.30

BILE ACIDS FRACTIONATED LCMS

Facility

$190.00

Hospital Charge Code	3100860
Hospital Revenue Code	301
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$161.50
Rate for Payer: Cash Price	$123.50
Rate for Payer: Community Health Alliance Commercial	$161.50
Rate for Payer: Priority Health Commercial	$133.00
Rate for Payer: Priority Health PPO	$133.00

BILIARY BALLOON #4594

Facility

$1,111.00

Service Code	HCPCS C1725
Hospital Charge Code	27265965
Hospital Revenue Code	272
Min. Negotiated Rate	$777.70
Max. Negotiated Rate	$944.35
Rate for Payer: Cash Price	$722.15
Rate for Payer: Community Health Alliance Commercial	$944.35
Rate for Payer: Priority Health Commercial	$777.70
Rate for Payer: Priority Health PPO	$777.70

BILIARY BRUSH

Facility

$256.00

Hospital Charge Code	27262029
Hospital Revenue Code	272
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$217.60
Rate for Payer: Cash Price	$166.40
Rate for Payer: Community Health Alliance Commercial	$217.60
Rate for Payer: Priority Health Commercial	$179.20
Rate for Payer: Priority Health PPO	$179.20

BILI-LC

Facility

$2.25

Hospital Charge Code	3102178
Hospital Revenue Code	300
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.91
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.91
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health PPO	$1.57

BILIRUBIN, DIRECT

Facility

$33.00

Service Code	HCPCS 82248
Hospital Charge Code	3001360
Hospital Revenue Code	301
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$5.27
Rate for Payer: Blue Care Network Medicare Advantage	$5.27
Rate for Payer: Cash Price	$21.45
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.27
Rate for Payer: Meridian Health Plan Medicare	$5.27
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$5.27
Rate for Payer: Priority Health Medicare	$5.27
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$5.27
Rate for Payer: United Health Care Medicare Advantage	$2.32

BILIRUBIN, TOTAL

Facility

$34.90

Service Code	HCPCS 82247
Hospital Charge Code	3001420
Hospital Revenue Code	301
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$29.66
Rate for Payer: BCBS BCN 65	$5.27
Rate for Payer: Blue Care Network Medicare Advantage	$5.27
Rate for Payer: Cash Price	$22.69
Rate for Payer: Cash Price	$22.69
Rate for Payer: Community Health Alliance Commercial	$29.66
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.27
Rate for Payer: Meridian Health Plan Medicare	$5.27
Rate for Payer: Priority Health Commercial	$24.43
Rate for Payer: Priority Health Medicaid	$5.27
Rate for Payer: Priority Health Medicare	$5.27
Rate for Payer: Priority Health PPO	$24.43
Rate for Payer: United Health Care Medicaid	$5.27
Rate for Payer: United Health Care Medicare Advantage	$2.32

BILL ONLY REFLEX SMOOTH MUSCLE

Facility

$25.00

Hospital Charge Code	3101386
Hospital Revenue Code	300
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

BIOIMPEDANCE CARDIOGRAPHY

Facility

$129.00

Hospital Charge Code	4800050
Hospital Revenue Code	480
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$109.65
Rate for Payer: Cash Price	$83.85
Rate for Payer: Community Health Alliance Commercial	$109.65
Rate for Payer: Priority Health Commercial	$90.30
Rate for Payer: Priority Health PPO	$90.30

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges