Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

VARICELLA ZOSTER PCR/CSF

Facility

$50.00

Hospital Charge Code	3006552
Hospital Revenue Code	306
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

VARICELLA ZOSTER VIRUS DFA

Facility

$83.00

Hospital Charge Code	3100823
Hospital Revenue Code	306
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$70.55
Rate for Payer: Cash Price	$53.95
Rate for Payer: Community Health Alliance Commercial	$70.55
Rate for Payer: Priority Health Commercial	$58.10
Rate for Payer: Priority Health PPO	$58.10

VASCU-FLO SHUNT

Facility

$701.00

Hospital Charge Code	27865064
Hospital Revenue Code	272
Min. Negotiated Rate	$490.70
Max. Negotiated Rate	$595.85
Rate for Payer: Cash Price	$455.65
Rate for Payer: Community Health Alliance Commercial	$595.85
Rate for Payer: Priority Health Commercial	$490.70
Rate for Payer: Priority Health PPO	$490.70

VASCULAR DILATOR 5FR

Facility

$56.00

Hospital Charge Code	27024026
Hospital Revenue Code	272
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

VASCULAR ENDOTHELIAL GROWTH FA

Facility

$150.00

Hospital Charge Code	3100966
Hospital Revenue Code	301
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$127.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Community Health Alliance Commercial	$127.50
Rate for Payer: Priority Health Commercial	$105.00
Rate for Payer: Priority Health PPO	$105.00

VASCULAR GRAFT

Facility

$2,198.00

Service Code	HCPCS C1768
Hospital Charge Code	27872210
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.60
Max. Negotiated Rate	$1,868.30
Rate for Payer: Cash Price	$1,428.70
Rate for Payer: Community Health Alliance Commercial	$1,868.30
Rate for Payer: Priority Health Commercial	$1,538.60
Rate for Payer: Priority Health PPO	$1,538.60

VASCULAR GRAFT

Facility

$1,979.00

Service Code	HCPCS C1768
Hospital Charge Code	27867912
Hospital Revenue Code	278
Min. Negotiated Rate	$1,385.30
Max. Negotiated Rate	$1,682.15
Rate for Payer: Cash Price	$1,286.35
Rate for Payer: Community Health Alliance Commercial	$1,682.15
Rate for Payer: Priority Health Commercial	$1,385.30
Rate for Payer: Priority Health PPO	$1,385.30

VASCULAR STRETCH GRAFT

Facility

$2,186.00

Service Code	HCPCS C1768
Hospital Charge Code	27862649
Hospital Revenue Code	278
Min. Negotiated Rate	$1,530.20
Max. Negotiated Rate	$1,858.10
Rate for Payer: Cash Price	$1,420.90
Rate for Payer: Community Health Alliance Commercial	$1,858.10
Rate for Payer: Priority Health Commercial	$1,530.20
Rate for Payer: Priority Health PPO	$1,530.20

VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)

Facility

$2,242.44

Service Code	CPT 55250
Hospital Revenue Code	360
Min. Negotiated Rate	$986.67
Max. Negotiated Rate	$2,242.44
Rate for Payer: BCBS BCN 65	$2,242.44
Rate for Payer: Blue Care Network Medicare Advantage	$2,242.44
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,242.44
Rate for Payer: Meridian Health Plan Medicare	$2,242.44
Rate for Payer: Priority Health Medicaid	$2,242.44
Rate for Payer: Priority Health Medicare	$2,242.44
Rate for Payer: United Health Care Medicaid	$2,242.44
Rate for Payer: United Health Care Medicare Advantage	$986.67

VASOACTIVE INSTESTINAL PEPTIDE

Facility

$410.80

Hospital Charge Code	3100586
Hospital Revenue Code	301
Min. Negotiated Rate	$287.56
Max. Negotiated Rate	$349.18
Rate for Payer: Cash Price	$267.02
Rate for Payer: Community Health Alliance Commercial	$349.18
Rate for Payer: Priority Health Commercial	$287.56
Rate for Payer: Priority Health PPO	$287.56

VDRL-CSF

Facility

$3.26

Service Code	HCPCS 86592
Hospital Charge Code	3008750
Hospital Revenue Code	302
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$4.48
Rate for Payer: BCBS BCN 65	$4.48
Rate for Payer: Blue Care Network Medicare Advantage	$4.48
Rate for Payer: Cash Price	$2.12
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.48
Rate for Payer: Meridian Health Plan Medicare	$4.48
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health Medicaid	$4.48
Rate for Payer: Priority Health Medicare	$4.48
Rate for Payer: Priority Health PPO	$2.28
Rate for Payer: United Health Care Medicaid	$4.48
Rate for Payer: United Health Care Medicare Advantage	$1.97

VEIN STRIPPER

Facility

$65.00

Hospital Charge Code	27014746
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$55.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health PPO	$45.50

VEIN STRIPPER, DISPOSABLE

Facility

$75.00

Hospital Charge Code	27061428
Hospital Revenue Code	272
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

VENA CAVA FILTER

Facility

$5,038.00

Service Code	HCPCS C1880
Hospital Charge Code	27061287
Hospital Revenue Code	278
Min. Negotiated Rate	$3,526.60
Max. Negotiated Rate	$4,282.30
Rate for Payer: Cash Price	$3,274.70
Rate for Payer: Community Health Alliance Commercial	$4,282.30
Rate for Payer: Priority Health Commercial	$3,526.60
Rate for Payer: Priority Health PPO	$3,526.60

VENA CAVA FILTER ENTRY KIT

Facility

$584.00

Hospital Charge Code	27061303
Hospital Revenue Code	272
Min. Negotiated Rate	$408.80
Max. Negotiated Rate	$496.40
Rate for Payer: Cash Price	$379.60
Rate for Payer: Community Health Alliance Commercial	$496.40
Rate for Payer: Priority Health Commercial	$408.80
Rate for Payer: Priority Health PPO	$408.80

VENOUA LIGATOR, DEEP DORSAL

Facility

$937.00

Hospital Charge Code	27017095
Hospital Revenue Code	272
Min. Negotiated Rate	$655.90
Max. Negotiated Rate	$796.45
Rate for Payer: Cash Price	$609.05
Rate for Payer: Community Health Alliance Commercial	$796.45
Rate for Payer: Priority Health Commercial	$655.90
Rate for Payer: Priority Health PPO	$655.90

VENTILATOR FIRST DAY

Facility

$1,143.00

Service Code	HCPCS 94002
Hospital Charge Code	4100140
Hospital Revenue Code	410
Min. Negotiated Rate	$291.60
Max. Negotiated Rate	$971.55
Rate for Payer: BCBS BCN 65	$662.73
Rate for Payer: Blue Care Network Medicare Advantage	$662.73
Rate for Payer: Cash Price	$742.95
Rate for Payer: Cash Price	$742.95
Rate for Payer: Community Health Alliance Commercial	$971.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$662.73
Rate for Payer: Meridian Health Plan Medicare	$662.73
Rate for Payer: Priority Health Commercial	$800.10
Rate for Payer: Priority Health Medicaid	$662.73
Rate for Payer: Priority Health Medicare	$662.73
Rate for Payer: Priority Health PPO	$800.10
Rate for Payer: United Health Care Medicaid	$662.73
Rate for Payer: United Health Care Medicare Advantage	$291.60

VENTILATOR SUBSEQUENT DAYS

Facility

$1,020.00

Service Code	HCPCS 94003
Hospital Charge Code	4100160
Hospital Revenue Code	410
Min. Negotiated Rate	$291.60
Max. Negotiated Rate	$867.00
Rate for Payer: BCBS BCN 65	$662.73
Rate for Payer: Blue Care Network Medicare Advantage	$662.73
Rate for Payer: Cash Price	$663.00
Rate for Payer: Cash Price	$663.00
Rate for Payer: Community Health Alliance Commercial	$867.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$662.73
Rate for Payer: Meridian Health Plan Medicare	$662.73
Rate for Payer: Priority Health Commercial	$714.00
Rate for Payer: Priority Health Medicaid	$662.73
Rate for Payer: Priority Health Medicare	$662.73
Rate for Payer: Priority Health PPO	$714.00
Rate for Payer: United Health Care Medicaid	$662.73
Rate for Payer: United Health Care Medicare Advantage	$291.60

VENT TUBE,SHAH

Facility

$58.00

Hospital Charge Code	27021980
Hospital Revenue Code	270
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$49.30
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health PPO	$40.60

VHEP1

Facility

$3.20

Hospital Charge Code	31027514
Hospital Revenue Code	300
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.72
Rate for Payer: Cash Price	$2.08
Rate for Payer: Community Health Alliance Commercial	$2.72
Rate for Payer: Priority Health Commercial	$2.24
Rate for Payer: Priority Health PPO	$2.24

VHEP2

Facility

$3.20

Hospital Charge Code	31027515
Hospital Revenue Code	300
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.72
Rate for Payer: Cash Price	$2.08
Rate for Payer: Community Health Alliance Commercial	$2.72
Rate for Payer: Priority Health Commercial	$2.24
Rate for Payer: Priority Health PPO	$2.24

VHEP3

Facility

$3.20

Hospital Charge Code	31027516
Hospital Revenue Code	300
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.72
Rate for Payer: Cash Price	$2.08
Rate for Payer: Community Health Alliance Commercial	$2.72
Rate for Payer: Priority Health Commercial	$2.24
Rate for Payer: Priority Health PPO	$2.24

VHEP4

Facility

$3.20

Hospital Charge Code	31027517
Hospital Revenue Code	300
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.72
Rate for Payer: Cash Price	$2.08
Rate for Payer: Community Health Alliance Commercial	$2.72
Rate for Payer: Priority Health Commercial	$2.24
Rate for Payer: Priority Health PPO	$2.24

VHEP5

Facility

$3.20

Hospital Charge Code	31027518
Hospital Revenue Code	300
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.72
Rate for Payer: Cash Price	$2.08
Rate for Payer: Community Health Alliance Commercial	$2.72
Rate for Payer: Priority Health Commercial	$2.24
Rate for Payer: Priority Health PPO	$2.24

VHSV-1

Facility

$20.36

Hospital Charge Code	31027577
Hospital Revenue Code	300
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$17.31
Rate for Payer: Cash Price	$13.23
Rate for Payer: Community Health Alliance Commercial	$17.31
Rate for Payer: Priority Health Commercial	$14.25
Rate for Payer: Priority Health PPO	$14.25

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges