Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

BLADE,OSCILLATOR 19.5 X 71.0

Facility

$49.00

Hospital Charge Code	27020644
Hospital Revenue Code	272
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

BLADE, RECIPRICATING

Facility

$81.00

Hospital Charge Code	27261535
Hospital Revenue Code	272
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$68.85
Rate for Payer: Cash Price	$52.65
Rate for Payer: Community Health Alliance Commercial	$68.85
Rate for Payer: Priority Health Commercial	$56.70
Rate for Payer: Priority Health PPO	$56.70

BLADE,SAGITAL SAW

Facility

$86.00

Hospital Charge Code	27061261
Hospital Revenue Code	272
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$73.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Community Health Alliance Commercial	$73.10
Rate for Payer: Priority Health Commercial	$60.20
Rate for Payer: Priority Health PPO	$60.20

BLANKET,HYPO/HYPERTHERMIA

Facility

$71.00

Hospital Charge Code	27022574
Hospital Revenue Code	270
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$60.35
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health PPO	$49.70

BLASTOMYCES

Facility

$19.66

Hospital Charge Code	3101679
Hospital Revenue Code	300
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$16.71
Rate for Payer: Cash Price	$12.78
Rate for Payer: Community Health Alliance Commercial	$16.71
Rate for Payer: Priority Health Commercial	$13.76
Rate for Payer: Priority Health PPO	$13.76

BLASTOMYCES AB BY ID SERUM

Facility

$12.22

Hospital Charge Code	3101334
Hospital Revenue Code	302
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$10.39
Rate for Payer: Cash Price	$7.94
Rate for Payer: Community Health Alliance Commercial	$10.39
Rate for Payer: Priority Health Commercial	$8.55
Rate for Payer: Priority Health PPO	$8.55

BLASTOMYCES DERM AG BY EIA

Facility

$52.00

Hospital Charge Code	3009413
Hospital Revenue Code	306
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

BLASTOMYCOSIS TO STATE

Facility

$64.00

Service Code	HCPCS 86612
Hospital Charge Code	3003281
Hospital Revenue Code	302
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$54.40
Rate for Payer: BCBS BCN 65	$13.54
Rate for Payer: Blue Care Network Medicare Advantage	$13.54
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.54
Rate for Payer: Meridian Health Plan Medicare	$13.54
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health Medicaid	$13.54
Rate for Payer: Priority Health Medicare	$13.54
Rate for Payer: Priority Health PPO	$44.80
Rate for Payer: United Health Care Medicaid	$13.54
Rate for Payer: United Health Care Medicare Advantage	$5.96

BLD TYPE RBC AG NOT ABO/RHD-R

Facility

$8.10

Hospital Charge Code	3100068
Hospital Revenue Code	300
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$6.88
Rate for Payer: Cash Price	$5.27
Rate for Payer: Community Health Alliance Commercial	$6.88
Rate for Payer: Priority Health Commercial	$5.67
Rate for Payer: Priority Health PPO	$5.67

BLD TYPE RH PHENOTYPE-R

Facility

$139.00

Hospital Charge Code	3100067
Hospital Revenue Code	300
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$118.15
Rate for Payer: Cash Price	$90.35
Rate for Payer: Community Health Alliance Commercial	$118.15
Rate for Payer: Priority Health Commercial	$97.30
Rate for Payer: Priority Health PPO	$97.30

BLEEDING TIME

Facility

$34.00

Service Code	HCPCS 85002
Hospital Charge Code	3001440
Hospital Revenue Code	305
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$28.90
Rate for Payer: BCBS BCN 65	$5.06
Rate for Payer: Blue Care Network Medicare Advantage	$5.06
Rate for Payer: Cash Price	$22.10
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.06
Rate for Payer: Meridian Health Plan Medicare	$5.06
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health Medicaid	$5.06
Rate for Payer: Priority Health Medicare	$5.06
Rate for Payer: Priority Health PPO	$23.80
Rate for Payer: United Health Care Medicaid	$5.06
Rate for Payer: United Health Care Medicare Advantage	$2.23

BLEPHAROPLASTY, UPPER EYELID;

Facility

$2,213.37

Service Code	CPT 15822
Hospital Revenue Code	360
Min. Negotiated Rate	$973.88
Max. Negotiated Rate	$2,213.37
Rate for Payer: BCBS BCN 65	$2,213.37
Rate for Payer: Blue Care Network Medicare Advantage	$2,213.37
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,213.37
Rate for Payer: Meridian Health Plan Medicare	$2,213.37
Rate for Payer: Priority Health Medicaid	$2,213.37
Rate for Payer: Priority Health Medicare	$2,213.37
Rate for Payer: United Health Care Medicaid	$2,213.37
Rate for Payer: United Health Care Medicare Advantage	$973.88

BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID

Facility

$2,213.37

Service Code	CPT 15823
Hospital Revenue Code	360
Min. Negotiated Rate	$973.88
Max. Negotiated Rate	$2,213.37
Rate for Payer: BCBS BCN 65	$2,213.37
Rate for Payer: Blue Care Network Medicare Advantage	$2,213.37
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,213.37
Rate for Payer: Meridian Health Plan Medicare	$2,213.37
Rate for Payer: Priority Health Medicaid	$2,213.37
Rate for Payer: Priority Health Medicare	$2,213.37
Rate for Payer: United Health Care Medicaid	$2,213.37
Rate for Payer: United Health Care Medicare Advantage	$973.88

B-LINE W/ELBOW AIRWAY ADAPTER

Facility

$17.00

Hospital Charge Code	27021485
Hospital Revenue Code	270
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

BLITZ SUTURE RETRIEVER

Facility

$311.00

Hospital Charge Code	27264355
Hospital Revenue Code	272
Min. Negotiated Rate	$217.70
Max. Negotiated Rate	$264.35
Rate for Payer: Cash Price	$202.15
Rate for Payer: Community Health Alliance Commercial	$264.35
Rate for Payer: Priority Health Commercial	$217.70
Rate for Payer: Priority Health PPO	$217.70

BLOOD ADMINISTRATION

Facility

$353.00

Service Code	HCPCS 36430
Hospital Charge Code	3910000
Hospital Revenue Code	391
Min. Negotiated Rate	$208.24
Max. Negotiated Rate	$473.27
Rate for Payer: BCBS BCN 65	$473.27
Rate for Payer: Blue Care Network Medicare Advantage	$473.27
Rate for Payer: Cash Price	$229.45
Rate for Payer: Cash Price	$229.45
Rate for Payer: Community Health Alliance Commercial	$300.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$473.27
Rate for Payer: Meridian Health Plan Medicare	$473.27
Rate for Payer: Priority Health Commercial	$247.10
Rate for Payer: Priority Health Medicaid	$473.27
Rate for Payer: Priority Health Medicare	$473.27
Rate for Payer: Priority Health PPO	$247.10
Rate for Payer: United Health Care Medicaid	$473.27
Rate for Payer: United Health Care Medicare Advantage	$208.24

BLOOD BAG FOR AUTOLOGOUS DONAT

Facility

$39.00

Hospital Charge Code	27050070
Hospital Revenue Code	270
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$33.15
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health PPO	$27.30

BLOOD CULTURE RAPID ID CHG ONL

Facility

$9.75

Hospital Charge Code	3102447
Hospital Revenue Code	300
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$8.29
Rate for Payer: Cash Price	$6.34
Rate for Payer: Community Health Alliance Commercial	$8.29
Rate for Payer: Priority Health Commercial	$6.83
Rate for Payer: Priority Health PPO	$6.83

BLOOD GAS, ARTERIAL

Facility

$88.00

Service Code	HCPCS 82803
Hospital Charge Code	3001460
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$74.80
Rate for Payer: BCBS BCN 65	$27.37
Rate for Payer: Blue Care Network Medicare Advantage	$27.37
Rate for Payer: Cash Price	$57.20
Rate for Payer: Cash Price	$57.20
Rate for Payer: Community Health Alliance Commercial	$74.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$27.37
Rate for Payer: Meridian Health Plan Medicare	$27.37
Rate for Payer: Priority Health Commercial	$61.60
Rate for Payer: Priority Health Medicaid	$27.37
Rate for Payer: Priority Health Medicare	$27.37
Rate for Payer: Priority Health PPO	$61.60
Rate for Payer: United Health Care Medicaid	$27.37
Rate for Payer: United Health Care Medicare Advantage	$12.04

Blood-smr, peri

Facility

$8.96

Hospital Charge Code	31027475
Hospital Revenue Code	300
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$7.62
Rate for Payer: Cash Price	$5.82
Rate for Payer: Community Health Alliance Commercial	$7.62
Rate for Payer: Priority Health Commercial	$6.27
Rate for Payer: Priority Health PPO	$6.27

BLOOD TYPING ABO-R

Facility

$5.80

Hospital Charge Code	3100065
Hospital Revenue Code	300
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$4.93
Rate for Payer: Cash Price	$3.77
Rate for Payer: Community Health Alliance Commercial	$4.93
Rate for Payer: Priority Health Commercial	$4.06
Rate for Payer: Priority Health PPO	$4.06

BLOOD TYPING RH D-R

Facility

$5.80

Hospital Charge Code	3100066
Hospital Revenue Code	300
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$4.93
Rate for Payer: Cash Price	$3.77
Rate for Payer: Community Health Alliance Commercial	$4.93
Rate for Payer: Priority Health Commercial	$4.06
Rate for Payer: Priority Health PPO	$4.06

B.M. ASPIRATION PROF

Facility

$220.00

Service Code	HCPCS 88305 26
Hospital Charge Code	9710200
Hospital Revenue Code	971
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$187.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Community Health Alliance Commercial	$187.00
Rate for Payer: Priority Health Commercial	$154.00
Rate for Payer: Priority Health PPO	$154.00

B/M Smr,Int,1st

Facility

$62.00

Hospital Charge Code	31027476
Hospital Revenue Code	300
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$52.70
Rate for Payer: Cash Price	$40.30
Rate for Payer: Community Health Alliance Commercial	$52.70
Rate for Payer: Priority Health Commercial	$43.40
Rate for Payer: Priority Health PPO	$43.40

BNP-LC

Facility

$36.65

Hospital Charge Code	3101941
Hospital Revenue Code	300
Min. Negotiated Rate	$25.66
Max. Negotiated Rate	$31.15
Rate for Payer: Cash Price	$23.82
Rate for Payer: Community Health Alliance Commercial	$31.15
Rate for Payer: Priority Health Commercial	$25.66
Rate for Payer: Priority Health PPO	$25.66

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges