Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

BRACE,IROM ELBOW

Facility

$230.00

Hospital Charge Code	27061469
Hospital Revenue Code	270
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$195.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Community Health Alliance Commercial	$195.50
Rate for Payer: Priority Health Commercial	$161.00
Rate for Payer: Priority Health PPO	$161.00

BRAF CODON 600-1

Facility

$160.00

Hospital Charge Code	3101347
Hospital Revenue Code	310
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Community Health Alliance Commercial	$136.00
Rate for Payer: Priority Health Commercial	$112.00
Rate for Payer: Priority Health PPO	$112.00

BRAF CODON 600-2

Facility

$160.00

Hospital Charge Code	3101348
Hospital Revenue Code	310
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Community Health Alliance Commercial	$136.00
Rate for Payer: Priority Health Commercial	$112.00
Rate for Payer: Priority Health PPO	$112.00

BRAF MUTATION ANALYSIS

Facility

$77.00

Hospital Charge Code	3100830
Hospital Revenue Code	310
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

BRAIN NATRIURTIC POLYUPEPTIDE

Facility

$150.00

Service Code	HCPCS 83880
Hospital Charge Code	3001470
Hospital Revenue Code	301
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$127.50
Rate for Payer: BCBS BCN 65	$41.22
Rate for Payer: Blue Care Network Medicare Advantage	$41.22
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Community Health Alliance Commercial	$127.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$41.22
Rate for Payer: Meridian Health Plan Medicare	$41.22
Rate for Payer: Priority Health Commercial	$105.00
Rate for Payer: Priority Health Medicaid	$41.22
Rate for Payer: Priority Health Medicare	$41.22
Rate for Payer: Priority Health PPO	$105.00
Rate for Payer: United Health Care Medicaid	$41.22
Rate for Payer: United Health Care Medicare Advantage	$18.14

BRCA1 & BRCA2 SEQ DEL/DUPLICAT

Facility

$1,500.00

Hospital Charge Code	3101329
Hospital Revenue Code	300
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Community Health Alliance Commercial	$1,275.00
Rate for Payer: Priority Health Commercial	$1,050.00
Rate for Payer: Priority Health PPO	$1,050.00

BREAKAWAY GUIDE PIN

Facility

$160.00

Hospital Charge Code	27265619
Hospital Revenue Code	272
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Community Health Alliance Commercial	$136.00
Rate for Payer: Priority Health Commercial	$112.00
Rate for Payer: Priority Health PPO	$112.00

BREAST PADS

Facility

$15.00

Hospital Charge Code	27011346
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

BRITE TIP SHEATH 10F 23CM

Facility

$107.00

Service Code	HCPCS C1894
Hospital Charge Code	27267409
Hospital Revenue Code	272
Min. Negotiated Rate	$74.90
Max. Negotiated Rate	$90.95
Rate for Payer: Cash Price	$69.55
Rate for Payer: Community Health Alliance Commercial	$90.95
Rate for Payer: Priority Health Commercial	$74.90
Rate for Payer: Priority Health PPO	$74.90

BRUCEILA ABORTUS

Facility

$42.00

Hospital Charge Code	3008525
Hospital Revenue Code	302
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

BRUCELLA

Facility

$13.84

Hospital Charge Code	3000428
Hospital Revenue Code	300
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$11.76
Rate for Payer: Cash Price	$9.00
Rate for Payer: Community Health Alliance Commercial	$11.76
Rate for Payer: Priority Health Commercial	$9.69
Rate for Payer: Priority Health PPO	$9.69

BRUCELLA

Facility

$13.85

Hospital Charge Code	3000429
Hospital Revenue Code	300
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$11.77
Rate for Payer: Cash Price	$9.00
Rate for Payer: Community Health Alliance Commercial	$11.77
Rate for Payer: Priority Health Commercial	$9.70
Rate for Payer: Priority Health PPO	$9.70

BRUCELLA ELISA

Facility

$27.69

Hospital Charge Code	3000430
Hospital Revenue Code	301
Min. Negotiated Rate	$19.38
Max. Negotiated Rate	$23.54
Rate for Payer: Cash Price	$18.00
Rate for Payer: Community Health Alliance Commercial	$23.54
Rate for Payer: Priority Health Commercial	$19.38
Rate for Payer: Priority Health PPO	$19.38

BRUSH, CYTOLOGY (PEDIATRIC)

Facility

$42.00

Hospital Charge Code	27262224
Hospital Revenue Code	272
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

BT-LC1

Facility

$16.00

Hospital Charge Code	31027460
Hospital Revenue Code	300
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
Rate for Payer: Priority Health Commercial	$11.20
Rate for Payer: Priority Health PPO	$11.20

BT-LC2

Facility

$15.99

Hospital Charge Code	31027461
Hospital Revenue Code	300
Min. Negotiated Rate	$11.19
Max. Negotiated Rate	$13.59
Rate for Payer: Cash Price	$10.39
Rate for Payer: Community Health Alliance Commercial	$13.59
Rate for Payer: Priority Health Commercial	$11.19
Rate for Payer: Priority Health PPO	$11.19

BULLOUS PEMPHIGOID ANTIGENS

Facility

$252.00

Hospital Charge Code	3000909
Hospital Revenue Code	301
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$214.20
Rate for Payer: Cash Price	$163.80
Rate for Payer: Community Health Alliance Commercial	$214.20
Rate for Payer: Priority Health Commercial	$176.40
Rate for Payer: Priority Health PPO	$176.40

BUN

Facility

$22.00

Service Code	HCPCS 84520
Hospital Charge Code	3001520
Hospital Revenue Code	301
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$18.70
Rate for Payer: BCBS BCN 65	$4.15
Rate for Payer: Blue Care Network Medicare Advantage	$4.15
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$14.30
Rate for Payer: Community Health Alliance Commercial	$18.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.15
Rate for Payer: Meridian Health Plan Medicare	$4.15
Rate for Payer: Priority Health Commercial	$15.40
Rate for Payer: Priority Health Medicaid	$4.15
Rate for Payer: Priority Health Medicare	$4.15
Rate for Payer: Priority Health PPO	$15.40
Rate for Payer: United Health Care Medicaid	$4.15
Rate for Payer: United Health Care Medicare Advantage	$1.82

BUPROPION SERUM PLASMA

Facility

$88.00

Service Code	HCPCS 80299
Hospital Charge Code	3008895
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$74.80
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$57.20
Rate for Payer: Cash Price	$57.20
Rate for Payer: Community Health Alliance Commercial	$74.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.57
Rate for Payer: Meridian Health Plan Medicare	$19.57
Rate for Payer: Priority Health Commercial	$61.60
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$61.60
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

BURKITT LYMPHOMA PANEL/FISH

Facility

$800.00

Hospital Charge Code	3101117
Hospital Revenue Code	312
Min. Negotiated Rate	$560.00
Max. Negotiated Rate	$680.00
Rate for Payer: Cash Price	$520.00
Rate for Payer: Community Health Alliance Commercial	$680.00
Rate for Payer: Priority Health Commercial	$560.00
Rate for Payer: Priority Health PPO	$560.00

BURKITT LYMPHOMA PANEL/FISH TC

Facility

$120.66

Hospital Charge Code	3101232
Hospital Revenue Code	312
Min. Negotiated Rate	$84.46
Max. Negotiated Rate	$102.56
Rate for Payer: Cash Price	$78.43
Rate for Payer: Community Health Alliance Commercial	$102.56
Rate for Payer: Priority Health Commercial	$84.46
Rate for Payer: Priority Health PPO	$84.46

BURN DRESSING PACK

Facility

$56.00

Hospital Charge Code	27020321
Hospital Revenue Code	270
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

BURR OAK HEALTH ASSESSMENT FEM

Facility

$155.00

Hospital Charge Code	3000079
Hospital Revenue Code	309
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$131.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Community Health Alliance Commercial	$131.75
Rate for Payer: Priority Health Commercial	$108.50
Rate for Payer: Priority Health PPO	$108.50

BURR OAK HEALTH ASSESSMENT MAL

Facility

$155.00

Hospital Charge Code	3000078
Hospital Revenue Code	309
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$131.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Community Health Alliance Commercial	$131.75
Rate for Payer: Priority Health Commercial	$108.50
Rate for Payer: Priority Health PPO	$108.50

BURR OAK TOOL NON LABS

Facility

$82.00

Hospital Charge Code	3000080
Hospital Revenue Code	309
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$69.70
Rate for Payer: Cash Price	$53.30
Rate for Payer: Community Health Alliance Commercial	$69.70
Rate for Payer: Priority Health Commercial	$57.40
Rate for Payer: Priority Health PPO	$57.40

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges