Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

UDP (UGTIAI)

Facility

$244.35

Hospital Charge Code	3100968
Hospital Revenue Code	300
Min. Negotiated Rate	$171.04
Max. Negotiated Rate	$207.70
Rate for Payer: Cash Price	$158.83
Rate for Payer: Community Health Alliance Commercial	$207.70
Rate for Payer: Priority Health Commercial	$171.04
Rate for Payer: Priority Health PPO	$171.04

UDS 10, ur

Facility

$118.00

Service Code	HCPCS 80307
Hospital Charge Code	3100911
Hospital Revenue Code	309
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$100.30
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$76.70
Rate for Payer: Cash Price	$76.70
Rate for Payer: Community Health Alliance Commercial	$100.30
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	$82.60
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$82.60
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

UDS 10 W/CONFIRMATION

Facility

$123.00

Hospital Charge Code	3102350
Hospital Revenue Code	300
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$104.55
Rate for Payer: Cash Price	$79.95
Rate for Payer: Community Health Alliance Commercial	$104.55
Rate for Payer: Priority Health Commercial	$86.10
Rate for Payer: Priority Health PPO	$86.10

UDS 8 W/ CONFIRMATION

Facility

$87.50

Hospital Charge Code	3102349
Hospital Revenue Code	300
Min. Negotiated Rate	$61.25
Max. Negotiated Rate	$74.38
Rate for Payer: Cash Price	$56.88
Rate for Payer: Community Health Alliance Commercial	$74.38
Rate for Payer: Priority Health Commercial	$61.25
Rate for Payer: Priority Health PPO	$61.25

UDS COLLECTION FEE

Facility

$17.00

Service Code	HCPCS 84999
Hospital Charge Code	3008410
Hospital Revenue Code	301
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

UGP

Facility

$91.00

Service Code	HCPCS 86316
Hospital Charge Code	3008400
Hospital Revenue Code	302
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$77.35
Rate for Payer: BCBS BCN 65	$21.85
Rate for Payer: Blue Care Network Medicare Advantage	$21.85
Rate for Payer: Cash Price	$59.15
Rate for Payer: Cash Price	$59.15
Rate for Payer: Community Health Alliance Commercial	$77.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.85
Rate for Payer: Meridian Health Plan Medicare	$21.85
Rate for Payer: Priority Health Commercial	$63.70
Rate for Payer: Priority Health Medicaid	$21.85
Rate for Payer: Priority Health Medicare	$21.85
Rate for Payer: Priority Health PPO	$63.70
Rate for Payer: United Health Care Medicaid	$21.85
Rate for Payer: United Health Care Medicare Advantage	$9.61

UIBC-LC

Facility

$2.85

Hospital Charge Code	3102131
Hospital Revenue Code	300
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.42
Rate for Payer: Cash Price	$1.85
Rate for Payer: Community Health Alliance Commercial	$2.42
Rate for Payer: Priority Health Commercial	$2.00
Rate for Payer: Priority Health PPO	$2.00

ULTRABLATER 90 DEGREE 3 RIB

Facility

$328.00

Hospital Charge Code	27266591
Hospital Revenue Code	272
Min. Negotiated Rate	$229.60
Max. Negotiated Rate	$278.80
Rate for Payer: Cash Price	$213.20
Rate for Payer: Community Health Alliance Commercial	$278.80
Rate for Payer: Priority Health Commercial	$229.60
Rate for Payer: Priority Health PPO	$229.60

ULTRAFIX RC 2.9MM

Facility

$2,046.00

Hospital Charge Code	27864983
Hospital Revenue Code	278
Min. Negotiated Rate	$1,432.20
Max. Negotiated Rate	$1,739.10
Rate for Payer: Cash Price	$1,329.90
Rate for Payer: Community Health Alliance Commercial	$1,739.10
Rate for Payer: Priority Health Commercial	$1,432.20
Rate for Payer: Priority Health PPO	$1,432.20

ULTRAFIX RC STITCH PAK

Facility

$816.00

Hospital Charge Code	27265916
Hospital Revenue Code	272
Min. Negotiated Rate	$571.20
Max. Negotiated Rate	$693.60
Rate for Payer: Cash Price	$530.40
Rate for Payer: Community Health Alliance Commercial	$693.60
Rate for Payer: Priority Health Commercial	$571.20
Rate for Payer: Priority Health PPO	$571.20

ULTRASENSITIVE ESTRADIOL

Facility

$24.44

Hospital Charge Code	3006998
Hospital Revenue Code	301
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$20.77
Rate for Payer: Cash Price	$15.89
Rate for Payer: Community Health Alliance Commercial	$20.77
Rate for Payer: Priority Health Commercial	$17.11
Rate for Payer: Priority Health PPO	$17.11

ULTRASOUND EACH 15 MINUTES

Facility

$35.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	4200440
Hospital Revenue Code	420
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

UMBILICAL ARTERY CATHETER

Facility

$61.00

Hospital Charge Code	27012831
Hospital Revenue Code	272
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$51.85
Rate for Payer: Cash Price	$39.65
Rate for Payer: Community Health Alliance Commercial	$51.85
Rate for Payer: Priority Health Commercial	$42.70
Rate for Payer: Priority Health PPO	$42.70

UMBILI-CATH 5FR

Facility

$135.00

Hospital Charge Code	27262773
Hospital Revenue Code	272
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$114.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Community Health Alliance Commercial	$114.75
Rate for Payer: Priority Health Commercial	$94.50
Rate for Payer: Priority Health PPO	$94.50

UNILATERAL 3MM DCP KIT

Facility

$846.00

Hospital Charge Code	27268712
Hospital Revenue Code	272
Min. Negotiated Rate	$592.20
Max. Negotiated Rate	$719.10
Rate for Payer: Cash Price	$549.90
Rate for Payer: Community Health Alliance Commercial	$719.10
Rate for Payer: Priority Health Commercial	$592.20
Rate for Payer: Priority Health PPO	$592.20

UNIT LRAS1

Facility

$283.65

Hospital Charge Code	3102012
Hospital Revenue Code	300
Min. Negotiated Rate	$198.56
Max. Negotiated Rate	$241.10
Rate for Payer: Cash Price	$184.37
Rate for Payer: Community Health Alliance Commercial	$241.10
Rate for Payer: Priority Health Commercial	$198.56
Rate for Payer: Priority Health PPO	$198.56

UNIVERSAL FEEDING ADAPTER

Facility

$24.00

Hospital Charge Code	27264413
Hospital Revenue Code	272
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$20.40
Rate for Payer: Cash Price	$15.60
Rate for Payer: Community Health Alliance Commercial	$20.40
Rate for Payer: Priority Health Commercial	$16.80
Rate for Payer: Priority Health PPO	$16.80

UNIVERSAL FOREARM SPLINT VELCR

Facility

$30.00

Hospital Charge Code	27012971
Hospital Revenue Code	270
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$25.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health PPO	$21.00

UNLISTED PROCEDURE, RECTUM

Facility

$997.61

Service Code	CPT 45999
Hospital Revenue Code	360
Min. Negotiated Rate	$438.95
Max. Negotiated Rate	$997.61
Rate for Payer: BCBS BCN 65	$997.61
Rate for Payer: Blue Care Network Medicare Advantage	$997.61
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$997.61
Rate for Payer: Meridian Health Plan Medicare	$997.61
Rate for Payer: Priority Health Medicaid	$997.61
Rate for Payer: Priority Health Medicare	$997.61
Rate for Payer: United Health Care Medicaid	$997.61
Rate for Payer: United Health Care Medicare Advantage	$438.95

UNNA BOOT

Facility

$57.00

Hospital Charge Code	27019158
Hospital Revenue Code	270
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$48.45
Rate for Payer: Cash Price	$37.05
Rate for Payer: Community Health Alliance Commercial	$48.45
Rate for Payer: Priority Health Commercial	$39.90
Rate for Payer: Priority Health PPO	$39.90

UNNA BOOT KIT 4" W/COFLEX

Facility

$57.00

Hospital Charge Code	27076477
Hospital Revenue Code	270
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$48.45
Rate for Payer: Cash Price	$37.05
Rate for Payer: Community Health Alliance Commercial	$48.45
Rate for Payer: Priority Health Commercial	$39.90
Rate for Payer: Priority Health PPO	$39.90

UNSPECIFIED THERAPEUTIC PROCED

Facility

$128.00

Service Code	HCPCS 97139 GP
Hospital Charge Code	4200011
Hospital Revenue Code	420
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

UPDRAFT NEBULIZER INITIAL

Facility

$387.00

Service Code	HCPCS 94640
Hospital Charge Code	4100035
Hospital Revenue Code	410
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$328.95
Rate for Payer: BCBS BCN 65	$234.91
Rate for Payer: Blue Care Network Medicare Advantage	$234.91
Rate for Payer: Cash Price	$251.55
Rate for Payer: Cash Price	$251.55
Rate for Payer: Community Health Alliance Commercial	$328.95
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	$270.90
Rate for Payer: Priority Health Medicaid	$234.91
Rate for Payer: Priority Health Medicare	$234.91
Rate for Payer: Priority Health PPO	$270.90
Rate for Payer: United Health Care Medicaid	$234.91
Rate for Payer: United Health Care Medicare Advantage	$103.36

UPDRAFT NEBULIZER, SUBSEQUENT

Facility

$168.00

Service Code	HCPCS 94640
Hospital Charge Code	4100090
Hospital Revenue Code	410
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$234.91
Rate for Payer: BCBS BCN 65	$234.91
Rate for Payer: Blue Care Network Medicare Advantage	$234.91
Rate for Payer: Cash Price	$109.20
Rate for Payer: Cash Price	$109.20
Rate for Payer: Community Health Alliance Commercial	$142.80
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	$117.60
Rate for Payer: Priority Health Medicaid	$234.91
Rate for Payer: Priority Health Medicare	$234.91
Rate for Payer: Priority Health PPO	$117.60
Rate for Payer: United Health Care Medicaid	$234.91
Rate for Payer: United Health Care Medicare Advantage	$103.36

UPPER GI ENDOSCOPY PC

Facility

$504.00

Hospital Charge Code	5150713
Hospital Revenue Code	960
Min. Negotiated Rate	$352.80
Max. Negotiated Rate	$428.40
Rate for Payer: Cash Price	$327.60
Rate for Payer: Community Health Alliance Commercial	$428.40
Rate for Payer: Priority Health Commercial	$352.80
Rate for Payer: Priority Health PPO	$352.80

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges