Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE

Facility

$972.96

Service Code	CPT 49083
Hospital Revenue Code	361
Min. Negotiated Rate	$428.10
Max. Negotiated Rate	$972.96
Rate for Payer: BCBS BCN 65	$972.96
Rate for Payer: Blue Care Network Medicare Advantage	$972.96
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$972.96
Rate for Payer: Meridian Health Plan Medicare	$972.96
Rate for Payer: Priority Health Medicaid	$972.96
Rate for Payer: Priority Health Medicare	$972.96
Rate for Payer: United Health Care Medicaid	$972.96
Rate for Payer: United Health Care Medicare Advantage	$428.10

ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE

Facility

$972.96

Service Code	CPT 49083
Hospital Revenue Code	490
Min. Negotiated Rate	$428.10
Max. Negotiated Rate	$972.96
Rate for Payer: BCBS BCN 65	$972.96
Rate for Payer: Blue Care Network Medicare Advantage	$972.96
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$972.96
Rate for Payer: Meridian Health Plan Medicare	$972.96
Rate for Payer: Priority Health Medicaid	$972.96
Rate for Payer: Priority Health Medicare	$972.96
Rate for Payer: United Health Care Medicaid	$972.96
Rate for Payer: United Health Care Medicare Advantage	$428.10

ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE

Facility

$972.96

Service Code	CPT 49082
Hospital Revenue Code	360
Min. Negotiated Rate	$428.10
Max. Negotiated Rate	$972.96
Rate for Payer: BCBS BCN 65	$972.96
Rate for Payer: Blue Care Network Medicare Advantage	$972.96
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$972.96
Rate for Payer: Meridian Health Plan Medicare	$972.96
Rate for Payer: Priority Health Medicaid	$972.96
Rate for Payer: Priority Health Medicare	$972.96
Rate for Payer: United Health Care Medicaid	$972.96
Rate for Payer: United Health Care Medicare Advantage	$428.10

ABG DRAW FEE

Facility

$47.00

Hospital Charge Code	3003577
Hospital Revenue Code	300
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$39.95
Rate for Payer: Cash Price	$30.55
Rate for Payer: Community Health Alliance Commercial	$39.95
Rate for Payer: Priority Health Commercial	$32.90
Rate for Payer: Priority Health PPO	$32.90

AB; HTLV OR HIV WB

Facility

$80.00

Hospital Charge Code	3100605
Hospital Revenue Code	300
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Community Health Alliance Commercial	$68.00
Rate for Payer: Priority Health Commercial	$56.00
Rate for Payer: Priority Health PPO	$56.00

AB ID EACH REAGENT CELL

Facility

$15.00

Hospital Charge Code	31006780
Hospital Revenue Code	300
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

ABID/EA PANEL + MEDIA FWRBC

Facility

$72.00

Hospital Charge Code	3101430
Hospital Revenue Code	300
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

ABID-PEG-IBC

Facility

$105.00

Hospital Charge Code	3101926
Hospital Revenue Code	300
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$89.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health PPO	$73.50

AB ID RBC EA PANEL EA TECH R

Facility

$54.30

Hospital Charge Code	3100071
Hospital Revenue Code	300
Min. Negotiated Rate	$38.01
Max. Negotiated Rate	$46.16
Rate for Payer: Cash Price	$35.30
Rate for Payer: Community Health Alliance Commercial	$46.16
Rate for Payer: Priority Health Commercial	$38.01
Rate for Payer: Priority Health PPO	$38.01

ABLATOR, 90 DEGREE,THREE RIB

Facility

$543.00

Hospital Charge Code	27266682
Hospital Revenue Code	272
Min. Negotiated Rate	$380.10
Max. Negotiated Rate	$461.55
Rate for Payer: Cash Price	$352.95
Rate for Payer: Community Health Alliance Commercial	$461.55
Rate for Payer: Priority Health Commercial	$380.10
Rate for Payer: Priority Health PPO	$380.10

AB RUBEOLA IGM

Facility

$7.49

Hospital Charge Code	3100162
Hospital Revenue Code	300
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$6.37
Rate for Payer: Cash Price	$4.87
Rate for Payer: Community Health Alliance Commercial	$6.37
Rate for Payer: Priority Health Commercial	$5.24
Rate for Payer: Priority Health PPO	$5.24

AB SCREENING (SBMF)

Facility

$10.70

Hospital Charge Code	3102169
Hospital Revenue Code	300
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$9.10
Rate for Payer: Cash Price	$6.96
Rate for Payer: Community Health Alliance Commercial	$9.10
Rate for Payer: Priority Health Commercial	$7.49
Rate for Payer: Priority Health PPO	$7.49

AB SCREEN SALINE IBC

Facility

$36.00

Hospital Charge Code	3101927
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$30.60
Rate for Payer: Cash Price	$23.40
Rate for Payer: Community Health Alliance Commercial	$30.60
Rate for Payer: Priority Health Commercial	$25.20
Rate for Payer: Priority Health PPO	$25.20

AB SCREEN-SBMF

Facility

$10.70

Hospital Charge Code	3102722
Hospital Revenue Code	300
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$9.10
Rate for Payer: Cash Price	$6.96
Rate for Payer: Community Health Alliance Commercial	$9.10
Rate for Payer: Priority Health Commercial	$7.49
Rate for Payer: Priority Health PPO	$7.49

ABSORBABLE HEMOSTAT

Facility

$300.00

Hospital Charge Code	27012518
Hospital Revenue Code	270
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

AC BLOCKING ANTIBODY

Facility

$30.00

Service Code	HCPCS 83519
Hospital Charge Code	3000270
Hospital Revenue Code	301
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$25.50
Rate for Payer: BCBS BCN 65	$19.32
Rate for Payer: Blue Care Network Medicare Advantage	$19.32
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.32
Rate for Payer: Meridian Health Plan Medicare	$19.32
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health Medicaid	$19.32
Rate for Payer: Priority Health Medicare	$19.32
Rate for Payer: Priority Health PPO	$21.00
Rate for Payer: United Health Care Medicaid	$19.32
Rate for Payer: United Health Care Medicare Advantage	$8.50

ACCESS PORT COVER

Facility

$24.00

Hospital Charge Code	27060099
Hospital Revenue Code	270
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

ACCUGUIDE MIDLINE CATHETER

Facility

$249.00

Hospital Charge Code	26263325
Hospital Revenue Code	272
Min. Negotiated Rate	$174.30
Max. Negotiated Rate	$211.65
Rate for Payer: Cash Price	$161.85
Rate for Payer: Community Health Alliance Commercial	$211.65
Rate for Payer: Priority Health Commercial	$174.30
Rate for Payer: Priority Health PPO	$174.30

ACETAMINOPHEN

Facility

$89.00

Service Code	HCPCS 80307
Hospital Charge Code	3000200
Hospital Revenue Code	301
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$75.65
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Community Health Alliance Commercial	$75.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$65.25
Rate for Payer: Meridian Health Plan Medicare	$65.25
Rate for Payer: Priority Health Commercial	$62.30
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$62.30
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

ACETAMINOPHEN 650 MG SUP

Facility

$3.49

Service Code	HCPCS A9270 GY
Hospital Charge Code	2500025
Hospital Revenue Code	637
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$2.97
Rate for Payer: Cash Price	$2.27
Rate for Payer: Community Health Alliance Commercial	$2.97
Rate for Payer: Priority Health Commercial	$2.44
Rate for Payer: Priority Health PPO	$2.44

ACETONE, SERUM

Facility

$41.65

Service Code	HCPCS 82010
Hospital Charge Code	3000220
Hospital Revenue Code	301
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$35.40
Rate for Payer: BCBS BCN 65	$8.58
Rate for Payer: Blue Care Network Medicare Advantage	$8.58
Rate for Payer: Cash Price	$27.07
Rate for Payer: Cash Price	$27.07
Rate for Payer: Community Health Alliance Commercial	$35.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.58
Rate for Payer: Meridian Health Plan Medicare	$8.58
Rate for Payer: Priority Health Commercial	$29.16
Rate for Payer: Priority Health Medicaid	$8.58
Rate for Payer: Priority Health Medicare	$8.58
Rate for Payer: Priority Health PPO	$29.16
Rate for Payer: United Health Care Medicaid	$8.58
Rate for Payer: United Health Care Medicare Advantage	$3.77

ACE TROCHANTERICA NAIL

Facility

$706.00

Service Code	HCPCS C1713
Hospital Charge Code	27872020
Hospital Revenue Code	278
Min. Negotiated Rate	$494.20
Max. Negotiated Rate	$600.10
Rate for Payer: Cash Price	$458.90
Rate for Payer: Community Health Alliance Commercial	$600.10
Rate for Payer: Priority Health Commercial	$494.20
Rate for Payer: Priority Health PPO	$494.20

ACE TROCHANTERIC LAG SCREW

Facility

$708.00

Service Code	HCPCS C1713
Hospital Charge Code	27868845
Hospital Revenue Code	278
Min. Negotiated Rate	$495.60
Max. Negotiated Rate	$601.80
Rate for Payer: Cash Price	$460.20
Rate for Payer: Community Health Alliance Commercial	$601.80
Rate for Payer: Priority Health Commercial	$495.60
Rate for Payer: Priority Health PPO	$495.60

ACE TROCHANTERIC MAIL END CAP

Facility

$419.00

Service Code	HCPCS C1713
Hospital Charge Code	27868902
Hospital Revenue Code	278
Min. Negotiated Rate	$293.30
Max. Negotiated Rate	$356.15
Rate for Payer: Cash Price	$272.35
Rate for Payer: Community Health Alliance Commercial	$356.15
Rate for Payer: Priority Health Commercial	$293.30
Rate for Payer: Priority Health PPO	$293.30

ACE TROCHANTERIC NAIL 180 X 11

Facility

$2,397.00

Service Code	HCPCS C1713
Hospital Charge Code	2786886
Hospital Revenue Code	278
Min. Negotiated Rate	$1,677.90
Max. Negotiated Rate	$2,037.45
Rate for Payer: Cash Price	$1,558.05
Rate for Payer: Community Health Alliance Commercial	$2,037.45
Rate for Payer: Priority Health Commercial	$1,677.90
Rate for Payer: Priority Health PPO	$1,677.90

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges