Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

WNV-IgM

Facility

$19.00

Service Code	HCPCS 86788
Hospital Charge Code	3008897
Hospital Revenue Code	302
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$17.69
Rate for Payer: BCBS BCN 65	$17.69
Rate for Payer: Blue Care Network Medicare Advantage	$17.69
Rate for Payer: Cash Price	$12.35
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.69
Rate for Payer: Meridian Health Plan Medicare	$17.69
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health Medicaid	$17.69
Rate for Payer: Priority Health Medicare	$17.69
Rate for Payer: Priority Health PPO	$13.30
Rate for Payer: United Health Care Medicaid	$17.69
Rate for Payer: United Health Care Medicare Advantage	$7.78

WORK CONDITIONING ADDTL HOUR

Facility

$93.00

Service Code	HCPCS 97546 GP
Hospital Charge Code	4200500
Hospital Revenue Code	420
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$79.05
Rate for Payer: Cash Price	$60.45
Rate for Payer: Community Health Alliance Commercial	$79.05
Rate for Payer: Priority Health Commercial	$65.10
Rate for Payer: Priority Health PPO	$65.10

WORK CONDITIONING FIRST 2 HRS

Facility

$185.00

Service Code	HCPCS 97545 GP
Hospital Charge Code	4200490
Hospital Revenue Code	420
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$157.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Community Health Alliance Commercial	$157.25
Rate for Payer: Priority Health Commercial	$129.50
Rate for Payer: Priority Health PPO	$129.50

WORK CONDITIONING FIRST 2 HRS

Facility

$185.00

Hospital Charge Code	4300086
Hospital Revenue Code	430
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$157.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Community Health Alliance Commercial	$157.25
Rate for Payer: Priority Health Commercial	$129.50
Rate for Payer: Priority Health PPO	$129.50

WORK REINTEGRATION

Facility

$77.00

Hospital Charge Code	4300015
Hospital Revenue Code	430
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

WORM INDENTIFICATION

Facility

$44.00

Service Code	HCPCS 87177
Hospital Charge Code	3008920
Hospital Revenue Code	306
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$37.40
Rate for Payer: BCBS BCN 65	$9.35
Rate for Payer: Blue Care Network Medicare Advantage	$9.35
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.35
Rate for Payer: Meridian Health Plan Medicare	$9.35
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health Medicaid	$9.35
Rate for Payer: Priority Health Medicare	$9.35
Rate for Payer: Priority Health PPO	$30.80
Rate for Payer: United Health Care Medicaid	$9.35
Rate for Payer: United Health Care Medicare Advantage	$4.11

WOUND CARE NON-SELECT

Facility

$112.00

Service Code	HCPCS 97602 GP
Hospital Charge Code	4200073
Hospital Revenue Code	420
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$95.20
Rate for Payer: Cash Price	$72.80
Rate for Payer: Community Health Alliance Commercial	$95.20
Rate for Payer: Priority Health Commercial	$78.40
Rate for Payer: Priority Health PPO	$78.40

WOUND SUCTION UNIT

Facility

$220.00

Hospital Charge Code	27010777
Hospital Revenue Code	270
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

WRIGHT'S (GIEMSA) STAIN TECH

Facility

$78.00

Service Code	HCPCS 88312
Hospital Charge Code	3100570
Hospital Revenue Code	310
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$66.30
Rate for Payer: BCBS BCN 65	$55.90
Rate for Payer: Blue Care Network Medicare Advantage	$55.90
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$55.90
Rate for Payer: Meridian Health Plan Medicare	$55.90
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health Medicaid	$55.90
Rate for Payer: Priority Health Medicare	$55.90
Rate for Payer: Priority Health PPO	$54.60
Rate for Payer: United Health Care Medicaid	$55.90
Rate for Payer: United Health Care Medicare Advantage	$24.60

WRIST BRACE

Facility

$25.00

Hospital Charge Code	27064744
Hospital Revenue Code	272
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

WRIST BRACE (ALL SIZES)

Facility

$25.00

Hospital Charge Code	27064710
Hospital Revenue Code	270
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

WRIST EXTENSION ASSIST

Facility

$157.00

Hospital Charge Code	27061352
Hospital Revenue Code	270
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$133.45
Rate for Payer: Cash Price	$102.05
Rate for Payer: Community Health Alliance Commercial	$133.45
Rate for Payer: Priority Health Commercial	$109.90
Rate for Payer: Priority Health PPO	$109.90

WRIST FIX SYSTEM

Facility

$2,667.00

Hospital Charge Code	27266757
Hospital Revenue Code	272
Min. Negotiated Rate	$1,866.90
Max. Negotiated Rate	$2,266.95
Rate for Payer: Cash Price	$1,733.55
Rate for Payer: Community Health Alliance Commercial	$2,266.95
Rate for Payer: Priority Health Commercial	$1,866.90
Rate for Payer: Priority Health PPO	$1,866.90

X AB0-RH-IBC

Facility

$39.00

Hospital Charge Code	3101932
Hospital Revenue Code	300
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

X ACTH STIM TEST (4 LEVEL)

Facility

$48.56

Hospital Charge Code	3000419
Hospital Revenue Code	300
Min. Negotiated Rate	$33.99
Max. Negotiated Rate	$41.28
Rate for Payer: Cash Price	$31.56
Rate for Payer: Community Health Alliance Commercial	$41.28
Rate for Payer: Priority Health Commercial	$33.99
Rate for Payer: Priority Health PPO	$33.99

X ACTH STIMULATION TEST 3 LEVE

Facility

$17.25

Hospital Charge Code	3100556
Hospital Revenue Code	300
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$14.66
Rate for Payer: Cash Price	$11.21
Rate for Payer: Community Health Alliance Commercial	$14.66
Rate for Payer: Priority Health Commercial	$12.07
Rate for Payer: Priority Health PPO	$12.07

X ADALIMUMAB + AB

Facility

$300.00

Hospital Charge Code	3102338
Hospital Revenue Code	300
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$255.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Community Health Alliance Commercial	$255.00
Rate for Payer: Priority Health Commercial	$210.00
Rate for Payer: Priority Health PPO	$210.00

X AEROBIC CULTURE AND GRAM STA

Facility

$14.45

Hospital Charge Code	3102449
Hospital Revenue Code	300
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$12.28
Rate for Payer: Cash Price	$9.39
Rate for Payer: Community Health Alliance Commercial	$12.28
Rate for Payer: Priority Health Commercial	$10.12
Rate for Payer: Priority Health PPO	$10.12

X AFP-TETRA

Facility

$30.42

Hospital Charge Code	3102464
Hospital Revenue Code	300
Min. Negotiated Rate	$21.29
Max. Negotiated Rate	$25.86
Rate for Payer: Cash Price	$19.77
Rate for Payer: Community Health Alliance Commercial	$25.86
Rate for Payer: Priority Health Commercial	$21.29
Rate for Payer: Priority Health PPO	$21.29

X ALA DELTA RANDOM URINE

Facility

$198.25

Hospital Charge Code	3102434
Hospital Revenue Code	300
Min. Negotiated Rate	$138.78
Max. Negotiated Rate	$168.51
Rate for Payer: Cash Price	$128.86
Rate for Payer: Community Health Alliance Commercial	$168.51
Rate for Payer: Priority Health Commercial	$138.78
Rate for Payer: Priority Health PPO	$138.78

X ALDOSTERONE RENIN ACTIVITY

Facility

$9.23

Hospital Charge Code	3100732
Hospital Revenue Code	301
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$7.85
Rate for Payer: Cash Price	$6.00
Rate for Payer: Community Health Alliance Commercial	$7.85
Rate for Payer: Priority Health Commercial	$6.46
Rate for Payer: Priority Health PPO	$6.46

X ALKALINE PHOSPHATASE ISONZYM

Facility

$5.00

Hospital Charge Code	3101096
Hospital Revenue Code	302
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$4.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health PPO	$3.50

X ALLERGAN PROFILE W/REFLEX

Facility

$82.49

Hospital Charge Code	3102645
Hospital Revenue Code	300
Min. Negotiated Rate	$57.74
Max. Negotiated Rate	$70.12
Rate for Payer: Cash Price	$53.62
Rate for Payer: Community Health Alliance Commercial	$70.12
Rate for Payer: Priority Health Commercial	$57.74
Rate for Payer: Priority Health PPO	$57.74

X ALPHA-1 ANTITRYPSIN PHENOTYP

Facility

$14.51

Hospital Charge Code	3102377
Hospital Revenue Code	300
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$12.33
Rate for Payer: Cash Price	$9.43
Rate for Payer: Community Health Alliance Commercial	$12.33
Rate for Payer: Priority Health Commercial	$10.16
Rate for Payer: Priority Health PPO	$10.16

X ALPHALANTI TRYPSIN PHENOTYPI

Facility

$140.00

Hospital Charge Code	3100769
Hospital Revenue Code	301
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$119.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Community Health Alliance Commercial	$119.00
Rate for Payer: Priority Health Commercial	$98.00
Rate for Payer: Priority Health PPO	$98.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges