Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

BIOPSY ABDOMINAL MASS

Facility

$650.00

Hospital Charge Code	5150728
Hospital Revenue Code	960
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$552.50
Rate for Payer: Cash Price	$422.50
Rate for Payer: Community Health Alliance Commercial	$552.50
Rate for Payer: Priority Health Commercial	$455.00
Rate for Payer: Priority Health PPO	$455.00

BIOPSY, BREAST, WITH PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET), WHEN PERFORMED, AND IMAGING OF THE BIOPSY SPECIMEN, WHEN PERFORMED, PERCUTANEOUS; FIRST LESION, INCLUDING ULTRASOUND GUIDANCE

Facility

$1,771.74

Service Code	CPT 19083
Hospital Revenue Code	360
Min. Negotiated Rate	$779.56
Max. Negotiated Rate	$1,771.74
Rate for Payer: BCBS BCN 65	$1,771.74
Rate for Payer: Blue Care Network Medicare Advantage	$1,771.74
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,771.74
Rate for Payer: Meridian Health Plan Medicare	$1,771.74
Rate for Payer: Priority Health Medicaid	$1,771.74
Rate for Payer: Priority Health Medicare	$1,771.74
Rate for Payer: United Health Care Medicaid	$1,771.74
Rate for Payer: United Health Care Medicare Advantage	$779.56

Facility

$1,771.74

Service Code	CPT 19083
Hospital Revenue Code	361
Min. Negotiated Rate	$779.56
Max. Negotiated Rate	$1,771.74
Rate for Payer: BCBS BCN 65	$1,771.74
Rate for Payer: Blue Care Network Medicare Advantage	$1,771.74
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,771.74
Rate for Payer: Meridian Health Plan Medicare	$1,771.74
Rate for Payer: Priority Health Medicaid	$1,771.74
Rate for Payer: Priority Health Medicare	$1,771.74
Rate for Payer: United Health Care Medicaid	$1,771.74
Rate for Payer: United Health Care Medicare Advantage	$779.56

BIOPSY EXTERNAL EAR

Facility

$254.08

Service Code	CPT 69100
Hospital Revenue Code	360
Min. Negotiated Rate	$111.79
Max. Negotiated Rate	$254.08
Rate for Payer: BCBS BCN 65	$254.08
Rate for Payer: Blue Care Network Medicare Advantage	$254.08
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$254.08
Rate for Payer: Meridian Health Plan Medicare	$254.08
Rate for Payer: Priority Health Medicaid	$254.08
Rate for Payer: Priority Health Medicare	$254.08
Rate for Payer: United Health Care Medicaid	$254.08
Rate for Payer: United Health Care Medicare Advantage	$111.79

BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL

Facility

$4,200.25

Service Code	CPT 38500
Hospital Revenue Code	360
Min. Negotiated Rate	$1,848.11
Max. Negotiated Rate	$4,200.25
Rate for Payer: BCBS BCN 65	$4,200.25
Rate for Payer: Blue Care Network Medicare Advantage	$4,200.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4,200.25
Rate for Payer: Meridian Health Plan Medicare	$4,200.25
Rate for Payer: Priority Health Medicaid	$4,200.25
Rate for Payer: Priority Health Medicare	$4,200.25
Rate for Payer: United Health Care Medicaid	$4,200.25
Rate for Payer: United Health Care Medicare Advantage	$1,848.11

BIOPSY/REMOVAL LYMPH NODES

Facility

$2,224.00

Hospital Charge Code	5150768
Hospital Revenue Code	960
Min. Negotiated Rate	$1,556.80
Max. Negotiated Rate	$1,890.40
Rate for Payer: Cash Price	$1,445.60
Rate for Payer: Community Health Alliance Commercial	$1,890.40
Rate for Payer: Priority Health Commercial	$1,556.80
Rate for Payer: Priority Health PPO	$1,556.80

BIOROLL

Facility

$20.00

Hospital Charge Code	27022798
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

BIOSCREW

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	27865130
Hospital Revenue Code	278
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$467.50
Rate for Payer: Cash Price	$357.50
Rate for Payer: Community Health Alliance Commercial	$467.50
Rate for Payer: Priority Health Commercial	$385.00
Rate for Payer: Priority Health PPO	$385.00

BIOSCREW, 9 X 20MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	27864348
Hospital Revenue Code	278
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$397.80
Rate for Payer: Cash Price	$304.20
Rate for Payer: Community Health Alliance Commercial	$397.80
Rate for Payer: Priority Health Commercial	$327.60
Rate for Payer: Priority Health PPO	$327.60

BIOSTINGER 13MM #V8213

Facility

$351.00

Hospital Charge Code	27264702
Hospital Revenue Code	272
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$298.35
Rate for Payer: Cash Price	$228.15
Rate for Payer: Community Health Alliance Commercial	$298.35
Rate for Payer: Priority Health Commercial	$245.70
Rate for Payer: Priority Health PPO	$245.70

BIOSTINGER INSERTER,STRAIGHT

Facility

$125.00

Hospital Charge Code	27264694
Hospital Revenue Code	272
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

BIOTIN

Facility

$7.00

Service Code	HCPCS 84591
Hospital Charge Code	3001430
Hospital Revenue Code	301
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$17.91
Rate for Payer: BCBS BCN 65	$17.91
Rate for Payer: Blue Care Network Medicare Advantage	$17.91
Rate for Payer: Cash Price	$4.55
Rate for Payer: Cash Price	$4.55
Rate for Payer: Community Health Alliance Commercial	$5.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.91
Rate for Payer: Meridian Health Plan Medicare	$17.91
Rate for Payer: Priority Health Commercial	$4.90
Rate for Payer: Priority Health Medicaid	$17.91
Rate for Payer: Priority Health Medicare	$17.91
Rate for Payer: Priority Health PPO	$4.90
Rate for Payer: United Health Care Medicaid	$17.91
Rate for Payer: United Health Care Medicare Advantage	$7.88

BIOVAOLABLE FREE TESTOSTER LC

Facility

$31.99

Hospital Charge Code	31027459
Hospital Revenue Code	300
Min. Negotiated Rate	$22.39
Max. Negotiated Rate	$27.19
Rate for Payer: Cash Price	$20.79
Rate for Payer: Community Health Alliance Commercial	$27.19
Rate for Payer: Priority Health Commercial	$22.39
Rate for Payer: Priority Health PPO	$22.39

BIPAP FIRST DAY

Facility

$427.00

Service Code	HCPCS 94660
Hospital Charge Code	4100150
Hospital Revenue Code	410
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$362.95
Rate for Payer: BCBS BCN 65	$234.91
Rate for Payer: Blue Care Network Medicare Advantage	$234.91
Rate for Payer: Cash Price	$277.55
Rate for Payer: Cash Price	$277.55
Rate for Payer: Community Health Alliance Commercial	$362.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$234.91
Rate for Payer: Meridian Health Plan Medicare	$234.91
Rate for Payer: Priority Health Commercial	$298.90
Rate for Payer: Priority Health Medicaid	$234.91
Rate for Payer: Priority Health Medicare	$234.91
Rate for Payer: Priority Health PPO	$298.90
Rate for Payer: United Health Care Medicaid	$234.91
Rate for Payer: United Health Care Medicare Advantage	$103.36

BIPAP SUBSEQUENT DAYS

Facility

$427.00

Service Code	HCPCS 94660
Hospital Charge Code	4100170
Hospital Revenue Code	410
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$362.95
Rate for Payer: BCBS BCN 65	$234.91
Rate for Payer: Blue Care Network Medicare Advantage	$234.91
Rate for Payer: Cash Price	$277.55
Rate for Payer: Cash Price	$277.55
Rate for Payer: Community Health Alliance Commercial	$362.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$234.91
Rate for Payer: Meridian Health Plan Medicare	$234.91
Rate for Payer: Priority Health Commercial	$298.90
Rate for Payer: Priority Health Medicaid	$234.91
Rate for Payer: Priority Health Medicare	$234.91
Rate for Payer: Priority Health PPO	$298.90
Rate for Payer: United Health Care Medicaid	$234.91
Rate for Payer: United Health Care Medicare Advantage	$103.36

BIT,FEMORAL DRILL 5.0MM

Facility

$524.00

Hospital Charge Code	27266005
Hospital Revenue Code	272
Min. Negotiated Rate	$366.80
Max. Negotiated Rate	$445.40
Rate for Payer: Cash Price	$340.60
Rate for Payer: Community Health Alliance Commercial	$445.40
Rate for Payer: Priority Health Commercial	$366.80
Rate for Payer: Priority Health PPO	$366.80

BK VIRUS QUANT PCR URINE

Facility

$75.00

Hospital Charge Code	3100741
Hospital Revenue Code	306
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

BLADDER SCAN

Facility

$137.00

Hospital Charge Code	4500972
Hospital Revenue Code	450
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$116.45
Rate for Payer: Cash Price	$89.05
Rate for Payer: Community Health Alliance Commercial	$116.45
Rate for Payer: Priority Health Commercial	$95.90
Rate for Payer: Priority Health PPO	$95.90

BLADE,BEAVER MICRO SHARP

Facility

$20.00

Hospital Charge Code	27021717
Hospital Revenue Code	272
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

BLADE, BEAVER SCLEROTOME

Facility

$31.00

Hospital Charge Code	27266898
Hospital Revenue Code	272
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

BLADE,BROWN DERMATOME

Facility

$54.00

Hospital Charge Code	27011260
Hospital Revenue Code	272
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$45.90
Rate for Payer: Cash Price	$35.10
Rate for Payer: Community Health Alliance Commercial	$45.90
Rate for Payer: Priority Health Commercial	$37.80
Rate for Payer: Priority Health PPO	$37.80

BLADE CUDA CURVED

Facility

$310.00

Hospital Charge Code	27024232
Hospital Revenue Code	272
Min. Negotiated Rate	$217.00
Max. Negotiated Rate	$263.50
Rate for Payer: Cash Price	$201.50
Rate for Payer: Community Health Alliance Commercial	$263.50
Rate for Payer: Priority Health Commercial	$217.00
Rate for Payer: Priority Health PPO	$217.00

BLADE GATOR STRAIGHT

Facility

$238.00

Hospital Charge Code	27024224
Hospital Revenue Code	272
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$202.30
Rate for Payer: Cash Price	$154.70
Rate for Payer: Community Health Alliance Commercial	$202.30
Rate for Payer: Priority Health Commercial	$166.60
Rate for Payer: Priority Health PPO	$166.60

BLADE,LARYNGOSCOPE MAC 3

Facility

$21.00

Hospital Charge Code	27060016
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health PPO	$14.70

BLADE,OSCILLATING

Facility

$188.00

Hospital Charge Code	27261543
Hospital Revenue Code	272
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges