Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

WEBRIL, 6 STERILE

Facility

$21.00

Hospital Charge Code	27018275
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

Weeds-1

Facility

$3.26

Hospital Charge Code	31027600
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Weeds-2

Facility

$3.26

Hospital Charge Code	31027601
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Weeds-3

Facility

$3.26

Hospital Charge Code	31027602
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Weeds-4

Facility

$3.26

Hospital Charge Code	31027603
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Weeds-5

Facility

$3.26

Hospital Charge Code	31027604
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

Weeds Allergen

Facility

$16.30

Hospital Charge Code	31027599
Hospital Revenue Code	300
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$13.86
Rate for Payer: Cash Price	$10.60
Rate for Payer: Community Health Alliance Commercial	$13.86
Rate for Payer: Priority Health Commercial	$11.41
Rate for Payer: Priority Health PPO	$11.41

WELLNESS PANEL

Facility

$208.00

Hospital Charge Code	3009429
Hospital Revenue Code	300
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$176.80
Rate for Payer: Cash Price	$135.20
Rate for Payer: Community Health Alliance Commercial	$176.80
Rate for Payer: Priority Health Commercial	$145.60
Rate for Payer: Priority Health PPO	$145.60

WELLNESS SCREEN-HEALTH FAIR

Facility

$24.00

Hospital Charge Code	3000099
Hospital Revenue Code	301
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

WESTERN EQUINE ENCEPHALITIS IG

Facility

$28.75

Hospital Charge Code	3100760
Hospital Revenue Code	302
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$24.44
Rate for Payer: Cash Price	$18.69
Rate for Payer: Community Health Alliance Commercial	$24.44
Rate for Payer: Priority Health Commercial	$20.12
Rate for Payer: Priority Health PPO	$20.12

WESTERN EQUINE ENCEPHALITIS IG

Facility

$28.75

Hospital Charge Code	3100761
Hospital Revenue Code	302
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$24.44
Rate for Payer: Cash Price	$18.69
Rate for Payer: Community Health Alliance Commercial	$24.44
Rate for Payer: Priority Health Commercial	$20.12
Rate for Payer: Priority Health PPO	$20.12

WEST-NILE VIRUS RNA

Facility

$180.00

Hospital Charge Code	3001492
Hospital Revenue Code	306
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$153.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Community Health Alliance Commercial	$153.00
Rate for Payer: Priority Health Commercial	$126.00
Rate for Payer: Priority Health PPO	$126.00

WET MOUNT PARASITE

Facility

$39.00

Service Code	HCPCS 87015
Hospital Charge Code	3008900
Hospital Revenue Code	306
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$33.15
Rate for Payer: BCBS BCN 65	$7.01
Rate for Payer: Blue Care Network Medicare Advantage	$7.01
Rate for Payer: Cash Price	$25.35
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.01
Rate for Payer: Meridian Health Plan Medicare	$7.01
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health Medicaid	$7.01
Rate for Payer: Priority Health Medicare	$7.01
Rate for Payer: Priority Health PPO	$27.30
Rate for Payer: United Health Care Medicaid	$7.01
Rate for Payer: United Health Care Medicare Advantage	$3.09

WHEAT IGG4

Facility

$26.00

Hospital Charge Code	3100729
Hospital Revenue Code	302
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

WHEEL CHAIR MANAGEMENT

Facility

$86.00

Hospital Charge Code	4200472
Hospital Revenue Code	420
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

WHEEL CHAIR MANAGEMENT

Facility

$86.00

Hospital Charge Code	4300072
Hospital Revenue Code	430
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

WHIRLPOOL

Facility

$49.00

Service Code	HCPCS 97022 GP
Hospital Charge Code	4200450
Hospital Revenue Code	420
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

WIRE GUIDE CURVED ROSEN

Facility

$77.00

Hospital Charge Code	27014514
Hospital Revenue Code	272
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$65.45
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health PPO	$53.90

WIREGUIDE,ROADRUNNER ANGLED

Facility

$573.00

Hospital Charge Code	27261596
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

WIRE GUIDE,SAVARY GILLIARD

Facility

$411.00

Hospital Charge Code	27264991
Hospital Revenue Code	272
Min. Negotiated Rate	$287.70
Max. Negotiated Rate	$349.35
Rate for Payer: Cash Price	$267.15
Rate for Payer: Community Health Alliance Commercial	$349.35
Rate for Payer: Priority Health Commercial	$287.70
Rate for Payer: Priority Health PPO	$287.70

WIRE GUIDE TFE COATED

Facility

$191.00

Hospital Charge Code	27264652
Hospital Revenue Code	272
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$124.15
Rate for Payer: Community Health Alliance Commercial	$162.35
Rate for Payer: Priority Health Commercial	$133.70
Rate for Payer: Priority Health PPO	$133.70

WIRE GUIDE #THSF-35-250-BH

Facility

$88.00

Hospital Charge Code	27014522
Hospital Revenue Code	272
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

WIRE GUIDE #THSF-35-260-BH

Facility

$684.00

Hospital Charge Code	27014464
Hospital Revenue Code	272
Min. Negotiated Rate	$478.80
Max. Negotiated Rate	$581.40
Rate for Payer: Cash Price	$444.60
Rate for Payer: Community Health Alliance Commercial	$581.40
Rate for Payer: Priority Health Commercial	$478.80
Rate for Payer: Priority Health PPO	$478.80

WIRE,KIRSCHNER 03.2X450MM

Facility

$345.00

Hospital Charge Code	27866542
Hospital Revenue Code	278
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$293.25
Rate for Payer: Cash Price	$224.25
Rate for Payer: Community Health Alliance Commercial	$293.25
Rate for Payer: Priority Health Commercial	$241.50
Rate for Payer: Priority Health PPO	$241.50

WNV-Igg

Facility

$19.00

Hospital Charge Code	3008898
Hospital Revenue Code	302
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$16.15
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health PPO	$13.30

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges