Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

VSLSP-3

Facility

$225.00

Hospital Charge Code	3102361
Hospital Revenue Code	300
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$191.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Community Health Alliance Commercial	$191.25
Rate for Payer: Priority Health Commercial	$157.50
Rate for Payer: Priority Health PPO	$157.50

VSLSP-4

Facility

$225.00

Hospital Charge Code	3102362
Hospital Revenue Code	300
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$191.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Community Health Alliance Commercial	$191.25
Rate for Payer: Priority Health Commercial	$157.50
Rate for Payer: Priority Health PPO	$157.50

VSLSP-5

Facility

$225.00

Hospital Charge Code	3102363
Hospital Revenue Code	300
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$191.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Community Health Alliance Commercial	$191.25
Rate for Payer: Priority Health Commercial	$157.50
Rate for Payer: Priority Health PPO	$157.50

VSLSP-6

Facility

$225.00

Hospital Charge Code	3102364
Hospital Revenue Code	300
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$191.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Community Health Alliance Commercial	$191.25
Rate for Payer: Priority Health Commercial	$157.50
Rate for Payer: Priority Health PPO	$157.50

VSLSP-7

Facility

$225.00

Hospital Charge Code	3102365
Hospital Revenue Code	300
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$191.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Community Health Alliance Commercial	$191.25
Rate for Payer: Priority Health Commercial	$157.50
Rate for Payer: Priority Health PPO	$157.50

VSLSP-8

Facility

$225.00

Hospital Charge Code	3102366
Hospital Revenue Code	300
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$191.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Community Health Alliance Commercial	$191.25
Rate for Payer: Priority Health Commercial	$157.50
Rate for Payer: Priority Health PPO	$157.50

VSM-1

Facility

$240.00

Hospital Charge Code	3102406
Hospital Revenue Code	300
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$204.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Community Health Alliance Commercial	$204.00
Rate for Payer: Priority Health Commercial	$168.00
Rate for Payer: Priority Health PPO	$168.00

VSM-2

Facility

$240.00

Hospital Charge Code	3102407
Hospital Revenue Code	300
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$204.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Community Health Alliance Commercial	$204.00
Rate for Payer: Priority Health Commercial	$168.00
Rate for Payer: Priority Health PPO	$168.00

VTS PROVU DISPOSABLE CARTRIDGE

Facility

$6,792.00

Hospital Charge Code	27262953
Hospital Revenue Code	272
Min. Negotiated Rate	$4,754.40
Max. Negotiated Rate	$5,773.20
Rate for Payer: Cash Price	$4,414.80
Rate for Payer: Community Health Alliance Commercial	$5,773.20
Rate for Payer: Priority Health Commercial	$4,754.40
Rate for Payer: Priority Health PPO	$4,754.40

VWMP-1

Facility

$38.94

Hospital Charge Code	3101975
Hospital Revenue Code	300
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$33.10
Rate for Payer: Cash Price	$25.31
Rate for Payer: Community Health Alliance Commercial	$33.10
Rate for Payer: Priority Health Commercial	$27.26
Rate for Payer: Priority Health PPO	$27.26

VWMP-2

Facility

$38.94

Hospital Charge Code	3101976
Hospital Revenue Code	300
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$33.10
Rate for Payer: Cash Price	$25.31
Rate for Payer: Community Health Alliance Commercial	$33.10
Rate for Payer: Priority Health Commercial	$27.26
Rate for Payer: Priority Health PPO	$27.26

VWMP-3

Facility

$38.94

Hospital Charge Code	3101977
Hospital Revenue Code	300
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$33.10
Rate for Payer: Cash Price	$25.31
Rate for Payer: Community Health Alliance Commercial	$33.10
Rate for Payer: Priority Health Commercial	$27.26
Rate for Payer: Priority Health PPO	$27.26

WAFER-FLANGE 1 3/4

Facility

$23.00

Hospital Charge Code	27013136
Hospital Revenue Code	270
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

WAFER STOMA ADHESIVE 4X4

Facility

$21.00

Hospital Charge Code	27055319
Hospital Revenue Code	270
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

WAFER STOMA ADHESIVE 5X5

Facility

$21.00

Hospital Charge Code	27055327
Hospital Revenue Code	270
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

WALKING HEEL

Facility

$88.00

Hospital Charge Code	27012773
Hospital Revenue Code	270
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$74.80
Rate for Payer: Cash Price	$57.20
Rate for Payer: Community Health Alliance Commercial	$74.80
Rate for Payer: Priority Health Commercial	$61.60
Rate for Payer: Priority Health PPO	$61.60

WARM N FORM

Facility

$72.00

Hospital Charge Code	27021188
Hospital Revenue Code	270
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$61.20
Rate for Payer: Cash Price	$46.80
Rate for Payer: Community Health Alliance Commercial	$61.20
Rate for Payer: Priority Health Commercial	$50.40
Rate for Payer: Priority Health PPO	$50.40

WARM N FORM 8" INSERT

Facility

$72.00

Hospital Charge Code	27021196
Hospital Revenue Code	270
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$61.20
Rate for Payer: Cash Price	$46.80
Rate for Payer: Community Health Alliance Commercial	$61.20
Rate for Payer: Priority Health Commercial	$50.40
Rate for Payer: Priority Health PPO	$50.40

WARTHIN STARRY STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100560
Hospital Revenue Code	310
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

WBC NO DIFF

Facility

$42.00

Service Code	HCPCS 85048
Hospital Charge Code	3008940
Hospital Revenue Code	305
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$35.70
Rate for Payer: BCBS BCN 65	$2.67
Rate for Payer: Blue Care Network Medicare Advantage	$2.67
Rate for Payer: Cash Price	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2.67
Rate for Payer: Meridian Health Plan Medicare	$2.67
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health Medicaid	$2.67
Rate for Payer: Priority Health Medicare	$2.67
Rate for Payer: Priority Health PPO	$29.40
Rate for Payer: United Health Care Medicaid	$2.67
Rate for Payer: United Health Care Medicare Advantage	$1.17

WEB BASKET 2 X 4

Facility

$573.00

Hospital Charge Code	27262003
Hospital Revenue Code	272
Min. Negotiated Rate	$401.10
Max. Negotiated Rate	$487.05
Rate for Payer: Cash Price	$372.45
Rate for Payer: Community Health Alliance Commercial	$487.05
Rate for Payer: Priority Health Commercial	$401.10
Rate for Payer: Priority Health PPO	$401.10

WEB BASKET 3 X 6

Facility

$539.00

Hospital Charge Code	27262011
Hospital Revenue Code	272
Min. Negotiated Rate	$377.30
Max. Negotiated Rate	$458.15
Rate for Payer: Cash Price	$350.35
Rate for Payer: Community Health Alliance Commercial	$458.15
Rate for Payer: Priority Health Commercial	$377.30
Rate for Payer: Priority Health PPO	$377.30

WEBRIL 2"

Facility

$14.00

Hospital Charge Code	27022519
Hospital Revenue Code	270
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$11.90
Rate for Payer: Cash Price	$9.10
Rate for Payer: Community Health Alliance Commercial	$11.90
Rate for Payer: Priority Health Commercial	$9.80
Rate for Payer: Priority Health PPO	$9.80

WEBRIL, 3 STERILE

Facility

$14.00

Hospital Charge Code	27018259
Hospital Revenue Code	270
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$11.90
Rate for Payer: Cash Price	$9.10
Rate for Payer: Community Health Alliance Commercial	$11.90
Rate for Payer: Priority Health Commercial	$9.80
Rate for Payer: Priority Health PPO	$9.80

WEBRIL, 4 STERILE

Facility

$15.00

Hospital Charge Code	27018267
Hospital Revenue Code	270
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges