Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

BODY FLUID

Facility

$2.25

Hospital Charge Code	3000627
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.91
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.91
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health PPO	$1.57

BODY FLUID CHLORIDE

Facility

$32.00

Hospital Charge Code	3000629
Hospital Revenue Code	301
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$20.80
Rate for Payer: Community Health Alliance Commercial	$27.20
Rate for Payer: Priority Health Commercial	$22.40
Rate for Payer: Priority Health PPO	$22.40

BODY FLUID LACTIC ACID

Facility

$35.80

Hospital Charge Code	3101245
Hospital Revenue Code	301
Min. Negotiated Rate	$25.06
Max. Negotiated Rate	$30.43
Rate for Payer: Cash Price	$23.27
Rate for Payer: Community Health Alliance Commercial	$30.43
Rate for Payer: Priority Health Commercial	$25.06
Rate for Payer: Priority Health PPO	$25.06

BODY FLUID POTASSIUM

Facility

$2.59

Hospital Charge Code	3000628
Hospital Revenue Code	301
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.20
Rate for Payer: Cash Price	$1.68
Rate for Payer: Community Health Alliance Commercial	$2.20
Rate for Payer: Priority Health Commercial	$1.81
Rate for Payer: Priority Health PPO	$1.81

BOLT, LOCKING 3.9MM

Facility

$365.00

Service Code	HCPCS C1713
Hospital Charge Code	27868183
Hospital Revenue Code	278
Min. Negotiated Rate	$255.50
Max. Negotiated Rate	$310.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Community Health Alliance Commercial	$310.25
Rate for Payer: Priority Health Commercial	$255.50
Rate for Payer: Priority Health PPO	$255.50

BONE BIOPSY NEEDLE

Facility

$959.00

Hospital Charge Code	27022897
Hospital Revenue Code	272
Min. Negotiated Rate	$671.30
Max. Negotiated Rate	$815.15
Rate for Payer: Cash Price	$623.35
Rate for Payer: Community Health Alliance Commercial	$815.15
Rate for Payer: Priority Health Commercial	$671.30
Rate for Payer: Priority Health PPO	$671.30

BONE CEMENT RADIOPAQUE

Facility

$275.00

Hospital Charge Code	27013813
Hospital Revenue Code	270
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$233.75
Rate for Payer: Cash Price	$178.75
Rate for Payer: Community Health Alliance Commercial	$233.75
Rate for Payer: Priority Health Commercial	$192.50
Rate for Payer: Priority Health PPO	$192.50

BONE GRAFT

Facility

$2,996.00

Service Code	HCPCS C1713
Hospital Charge Code	27023234
Hospital Revenue Code	278
Min. Negotiated Rate	$2,097.20
Max. Negotiated Rate	$2,546.60
Rate for Payer: Cash Price	$1,947.40
Rate for Payer: Community Health Alliance Commercial	$2,546.60
Rate for Payer: Priority Health Commercial	$2,097.20
Rate for Payer: Priority Health PPO	$2,097.20

BONE GRAFT,TRI-CORT 2.5 X 1.5

Facility

$1,727.00

Service Code	HCPCS C1713
Hospital Charge Code	27060371
Hospital Revenue Code	278
Min. Negotiated Rate	$1,208.90
Max. Negotiated Rate	$1,467.95
Rate for Payer: Cash Price	$1,122.55
Rate for Payer: Community Health Alliance Commercial	$1,467.95
Rate for Payer: Priority Health Commercial	$1,208.90
Rate for Payer: Priority Health PPO	$1,208.90

BONE GRAFT,TRI-CORT 2 X 3

Facility

$1,274.00

Service Code	HCPCS C1713
Hospital Charge Code	27060389
Hospital Revenue Code	278
Min. Negotiated Rate	$891.80
Max. Negotiated Rate	$1,082.90
Rate for Payer: Cash Price	$828.10
Rate for Payer: Community Health Alliance Commercial	$1,082.90
Rate for Payer: Priority Health Commercial	$891.80
Rate for Payer: Priority Health PPO	$891.80

BONE GROWTH STIMULATOR

Facility

$7,075.00

Service Code	HCPCS C1713
Hospital Charge Code	27864199
Hospital Revenue Code	278
Min. Negotiated Rate	$4,952.50
Max. Negotiated Rate	$6,013.75
Rate for Payer: Cash Price	$4,598.75
Rate for Payer: Community Health Alliance Commercial	$6,013.75
Rate for Payer: Priority Health Commercial	$4,952.50
Rate for Payer: Priority Health PPO	$4,952.50

BONE MARROW BIOSPY ASP PROF

Facility

$187.00

Service Code	HCPCS 88305 26
Hospital Charge Code	9710210
Hospital Revenue Code	971
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$158.95
Rate for Payer: Cash Price	$121.55
Rate for Payer: Community Health Alliance Commercial	$158.95
Rate for Payer: Priority Health Commercial	$130.90
Rate for Payer: Priority Health PPO	$130.90

BONE MARROW-CYTO

Facility

$672.00

Hospital Charge Code	3000266
Hospital Revenue Code	310
Min. Negotiated Rate	$470.40
Max. Negotiated Rate	$571.20
Rate for Payer: Cash Price	$436.80
Rate for Payer: Community Health Alliance Commercial	$571.20
Rate for Payer: Priority Health Commercial	$470.40
Rate for Payer: Priority Health PPO	$470.40

BONE MARROW FLOW

Facility

$592.00

Hospital Charge Code	3000269
Hospital Revenue Code	310
Min. Negotiated Rate	$414.40
Max. Negotiated Rate	$503.20
Rate for Payer: Cash Price	$384.80
Rate for Payer: Community Health Alliance Commercial	$503.20
Rate for Payer: Priority Health Commercial	$414.40
Rate for Payer: Priority Health PPO	$414.40

BONE PLATE, 6 HOLE #2232-03-01

Facility

$1,864.00

Service Code	HCPCS C1713
Hospital Charge Code	27264439
Hospital Revenue Code	278
Min. Negotiated Rate	$1,304.80
Max. Negotiated Rate	$1,584.40
Rate for Payer: Cash Price	$1,211.60
Rate for Payer: Community Health Alliance Commercial	$1,584.40
Rate for Payer: Priority Health Commercial	$1,304.80
Rate for Payer: Priority Health PPO	$1,304.80

BONE SCREW

Facility

$406.00

Service Code	HCPCS C1713
Hospital Charge Code	27865593
Hospital Revenue Code	278
Min. Negotiated Rate	$284.20
Max. Negotiated Rate	$345.10
Rate for Payer: Cash Price	$263.90
Rate for Payer: Community Health Alliance Commercial	$345.10
Rate for Payer: Priority Health Commercial	$284.20
Rate for Payer: Priority Health PPO	$284.20

BONE SCREW

Facility

$518.00

Service Code	HCPCS C1713
Hospital Charge Code	27264249
Hospital Revenue Code	278
Min. Negotiated Rate	$362.60
Max. Negotiated Rate	$440.30
Rate for Payer: Cash Price	$336.70
Rate for Payer: Community Health Alliance Commercial	$440.30
Rate for Payer: Priority Health Commercial	$362.60
Rate for Payer: Priority Health PPO	$362.60

BONE SPECIFIC ALKALINE PLUS

Facility

$24.44

Hospital Charge Code	30009410
Hospital Revenue Code	301
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$20.77
Rate for Payer: Cash Price	$15.89
Rate for Payer: Community Health Alliance Commercial	$20.77
Rate for Payer: Priority Health Commercial	$17.11
Rate for Payer: Priority Health PPO	$17.11

BONE WEDGE

Facility

$1,916.00

Hospital Charge Code	27268795
Hospital Revenue Code	272
Min. Negotiated Rate	$1,341.20
Max. Negotiated Rate	$1,628.60
Rate for Payer: Cash Price	$1,245.40
Rate for Payer: Community Health Alliance Commercial	$1,628.60
Rate for Payer: Priority Health Commercial	$1,341.20
Rate for Payer: Priority Health PPO	$1,341.20

BORDETELLA PETRUSSIS ANTI 3

Facility

$80.00

Service Code	HCPCS 86615
Hospital Charge Code	3000853
Hospital Revenue Code	302
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$68.00
Rate for Payer: BCBS BCN 65	$13.85
Rate for Payer: Blue Care Network Medicare Advantage	$13.85
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Community Health Alliance Commercial	$68.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.85
Rate for Payer: Meridian Health Plan Medicare	$13.85
Rate for Payer: Priority Health Commercial	$56.00
Rate for Payer: Priority Health Medicaid	$13.85
Rate for Payer: Priority Health Medicare	$13.85
Rate for Payer: Priority Health PPO	$56.00
Rate for Payer: United Health Care Medicaid	$13.85
Rate for Payer: United Health Care Medicare Advantage	$6.09

BOTTLE - EMPTY EVAC 1000ML

Facility

$53.00

Hospital Charge Code	27013631
Hospital Revenue Code	270
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$45.05
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health PPO	$37.10

B PERTUSSIS IGG

Facility

$16.49

Service Code	HCPCS 86615
Hospital Charge Code	3000852
Hospital Revenue Code	302
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$14.02
Rate for Payer: BCBS BCN 65	$13.85
Rate for Payer: Blue Care Network Medicare Advantage	$13.85
Rate for Payer: Cash Price	$10.72
Rate for Payer: Cash Price	$10.72
Rate for Payer: Community Health Alliance Commercial	$14.02
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.85
Rate for Payer: Meridian Health Plan Medicare	$13.85
Rate for Payer: Priority Health Commercial	$11.54
Rate for Payer: Priority Health Medicaid	$13.85
Rate for Payer: Priority Health Medicare	$13.85
Rate for Payer: Priority Health PPO	$11.54
Rate for Payer: United Health Care Medicaid	$13.85
Rate for Payer: United Health Care Medicare Advantage	$6.09

B PERTUSSIS IGM

Facility

$14.99

Service Code	HCPCS 86615
Hospital Charge Code	3000851
Hospital Revenue Code	302
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$13.85
Rate for Payer: BCBS BCN 65	$13.85
Rate for Payer: Blue Care Network Medicare Advantage	$13.85
Rate for Payer: Cash Price	$9.74
Rate for Payer: Cash Price	$9.74
Rate for Payer: Community Health Alliance Commercial	$12.74
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.85
Rate for Payer: Meridian Health Plan Medicare	$13.85
Rate for Payer: Priority Health Commercial	$10.49
Rate for Payer: Priority Health Medicaid	$13.85
Rate for Payer: Priority Health Medicare	$13.85
Rate for Payer: Priority Health PPO	$10.49
Rate for Payer: United Health Care Medicaid	$13.85
Rate for Payer: United Health Care Medicare Advantage	$6.09

B QUINTANA IGG

Facility

$3.68

Hospital Charge Code	3100985
Hospital Revenue Code	302
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$3.13
Rate for Payer: Cash Price	$2.39
Rate for Payer: Community Health Alliance Commercial	$3.13
Rate for Payer: Priority Health Commercial	$2.58
Rate for Payer: Priority Health PPO	$2.58

B QUINTANIA IGM

Facility

$3.66

Hospital Charge Code	3100984
Hospital Revenue Code	302
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.11
Rate for Payer: Cash Price	$2.38
Rate for Payer: Community Health Alliance Commercial	$3.11
Rate for Payer: Priority Health Commercial	$2.56
Rate for Payer: Priority Health PPO	$2.56

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges