Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

BUR ROUND

Facility

$273.00

Hospital Charge Code	27018218
Hospital Revenue Code	270
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$232.05
Rate for Payer: Cash Price	$177.45
Rate for Payer: Community Health Alliance Commercial	$232.05
Rate for Payer: Priority Health Commercial	$191.10
Rate for Payer: Priority Health PPO	$191.10

BUR SPHERICAL

Facility

$273.00

Hospital Charge Code	27024273
Hospital Revenue Code	270
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$232.05
Rate for Payer: Cash Price	$177.45
Rate for Payer: Community Health Alliance Commercial	$232.05
Rate for Payer: Priority Health Commercial	$191.10
Rate for Payer: Priority Health PPO	$191.10

BUTABARBITAL

Facility

$34.00

Service Code	HCPCS 80345
Hospital Charge Code	3001530
Hospital Revenue Code	301
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$28.90
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health PPO	$23.80

BUTTON KIT 24FR

Facility

$730.00

Hospital Charge Code	27262269
Hospital Revenue Code	272
Min. Negotiated Rate	$511.00
Max. Negotiated Rate	$620.50
Rate for Payer: Cash Price	$474.50
Rate for Payer: Community Health Alliance Commercial	$620.50
Rate for Payer: Priority Health Commercial	$511.00
Rate for Payer: Priority Health PPO	$511.00

BV MAA-1

Facility

$47.67

Hospital Charge Code	3102083
Hospital Revenue Code	300
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$40.52
Rate for Payer: Cash Price	$30.99
Rate for Payer: Community Health Alliance Commercial	$40.52
Rate for Payer: Priority Health Commercial	$33.37
Rate for Payer: Priority Health PPO	$33.37

BV NAA-2

Facility

$47.67

Hospital Charge Code	3102084
Hospital Revenue Code	300
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$40.52
Rate for Payer: Cash Price	$30.99
Rate for Payer: Community Health Alliance Commercial	$40.52
Rate for Payer: Priority Health Commercial	$33.37
Rate for Payer: Priority Health PPO	$33.37

BV-NAA-3

Facility

$47.66

Hospital Charge Code	3102085
Hospital Revenue Code	300
Min. Negotiated Rate	$33.36
Max. Negotiated Rate	$40.51
Rate for Payer: Cash Price	$30.98
Rate for Payer: Community Health Alliance Commercial	$40.51
Rate for Payer: Priority Health Commercial	$33.36
Rate for Payer: Priority Health PPO	$33.36

C1 ESTERASE

Facility

$8.55

Service Code	HCPCS 86160
Hospital Charge Code	3001640
Hospital Revenue Code	302
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$12.60
Rate for Payer: BCBS BCN 65	$12.60
Rate for Payer: Blue Care Network Medicare Advantage	$12.60
Rate for Payer: Cash Price	$5.56
Rate for Payer: Cash Price	$5.56
Rate for Payer: Community Health Alliance Commercial	$7.27
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.60
Rate for Payer: Meridian Health Plan Medicare	$12.60
Rate for Payer: Priority Health Commercial	$5.99
Rate for Payer: Priority Health Medicaid	$12.60
Rate for Payer: Priority Health Medicare	$12.60
Rate for Payer: Priority Health PPO	$5.99
Rate for Payer: United Health Care Medicaid	$12.60
Rate for Payer: United Health Care Medicare Advantage	$5.54

C1 ESTERASE ACTIVITY

Facility

$19.34

Service Code	HCPCS 86161
Hospital Charge Code	3001650
Hospital Revenue Code	302
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$16.44
Rate for Payer: BCBS BCN 65	$12.60
Rate for Payer: Blue Care Network Medicare Advantage	$12.60
Rate for Payer: Cash Price	$12.57
Rate for Payer: Cash Price	$12.57
Rate for Payer: Community Health Alliance Commercial	$16.44
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.60
Rate for Payer: Meridian Health Plan Medicare	$12.60
Rate for Payer: Priority Health Commercial	$13.54
Rate for Payer: Priority Health Medicaid	$12.60
Rate for Payer: Priority Health Medicare	$12.60
Rate for Payer: Priority Health PPO	$13.54
Rate for Payer: United Health Care Medicaid	$12.60
Rate for Payer: United Health Care Medicare Advantage	$5.54

C1 Q COMPLEMENT

Facility

$13.11

Service Code	HCPCS 86332
Hospital Charge Code	3001655
Hospital Revenue Code	302
Min. Negotiated Rate	$9.18
Max. Negotiated Rate	$25.59
Rate for Payer: BCBS BCN 65	$25.59
Rate for Payer: Blue Care Network Medicare Advantage	$25.59
Rate for Payer: Cash Price	$8.52
Rate for Payer: Cash Price	$8.52
Rate for Payer: Community Health Alliance Commercial	$11.14
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$25.59
Rate for Payer: Meridian Health Plan Medicare	$25.59
Rate for Payer: Priority Health Commercial	$9.18
Rate for Payer: Priority Health Medicaid	$25.59
Rate for Payer: Priority Health Medicare	$25.59
Rate for Payer: Priority Health PPO	$9.18
Rate for Payer: United Health Care Medicaid	$25.59
Rate for Payer: United Health Care Medicare Advantage	$11.26

CA-1

Facility

$30.70

Service Code	HCPCS 86635
Hospital Charge Code	3005058
Hospital Revenue Code	302
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$26.09
Rate for Payer: BCBS BCN 65	$12.04
Rate for Payer: Blue Care Network Medicare Advantage	$12.04
Rate for Payer: Cash Price	$19.96
Rate for Payer: Cash Price	$19.96
Rate for Payer: Community Health Alliance Commercial	$26.09
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.04
Rate for Payer: Meridian Health Plan Medicare	$12.04
Rate for Payer: Priority Health Commercial	$21.49
Rate for Payer: Priority Health Medicaid	$12.04
Rate for Payer: Priority Health Medicare	$12.04
Rate for Payer: Priority Health PPO	$21.49
Rate for Payer: United Health Care Medicaid	$12.04
Rate for Payer: United Health Care Medicare Advantage	$5.30

CA 125

Facility

$4.70

Service Code	HCPCS 86304
Hospital Charge Code	3001660
Hospital Revenue Code	302
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$21.85
Rate for Payer: BCBS BCN 65	$21.85
Rate for Payer: Blue Care Network Medicare Advantage	$21.85
Rate for Payer: Cash Price	$3.06
Rate for Payer: Cash Price	$3.06
Rate for Payer: Community Health Alliance Commercial	$4.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.85
Rate for Payer: Meridian Health Plan Medicare	$21.85
Rate for Payer: Priority Health Commercial	$3.29
Rate for Payer: Priority Health Medicaid	$21.85
Rate for Payer: Priority Health Medicare	$21.85
Rate for Payer: Priority Health PPO	$3.29
Rate for Payer: United Health Care Medicaid	$21.85
Rate for Payer: United Health Care Medicare Advantage	$9.61

CA 15-3

Facility

$11.61

Service Code	HCPCS 86300
Hospital Charge Code	3001680
Hospital Revenue Code	302
Min. Negotiated Rate	$8.13
Max. Negotiated Rate	$21.85
Rate for Payer: BCBS BCN 65	$21.85
Rate for Payer: Blue Care Network Medicare Advantage	$21.85
Rate for Payer: Cash Price	$7.55
Rate for Payer: Cash Price	$7.55
Rate for Payer: Community Health Alliance Commercial	$9.87
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.85
Rate for Payer: Meridian Health Plan Medicare	$21.85
Rate for Payer: Priority Health Commercial	$8.13
Rate for Payer: Priority Health Medicaid	$21.85
Rate for Payer: Priority Health Medicare	$21.85
Rate for Payer: Priority Health PPO	$8.13
Rate for Payer: United Health Care Medicaid	$21.85
Rate for Payer: United Health Care Medicare Advantage	$9.61

CA 19-9

Facility

$4.00

Service Code	HCPCS 86301
Hospital Charge Code	3001700
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$21.85
Rate for Payer: BCBS BCN 65	$21.85
Rate for Payer: Blue Care Network Medicare Advantage	$21.85
Rate for Payer: Cash Price	$2.60
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.85
Rate for Payer: Meridian Health Plan Medicare	$21.85
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health Medicaid	$21.85
Rate for Payer: Priority Health Medicare	$21.85
Rate for Payer: Priority Health PPO	$2.80
Rate for Payer: United Health Care Medicaid	$21.85
Rate for Payer: United Health Care Medicare Advantage	$9.61

CA-2

Facility

$30.70

Hospital Charge Code	3102181
Hospital Revenue Code	300
Min. Negotiated Rate	$21.49
Max. Negotiated Rate	$26.09
Rate for Payer: Cash Price	$19.96
Rate for Payer: Community Health Alliance Commercial	$26.09
Rate for Payer: Priority Health Commercial	$21.49
Rate for Payer: Priority Health PPO	$21.49

CA 27-29

Facility

$4.00

Service Code	HCPCS 86300
Hospital Charge Code	3001670
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$21.85
Rate for Payer: BCBS BCN 65	$21.85
Rate for Payer: Blue Care Network Medicare Advantage	$21.85
Rate for Payer: Cash Price	$2.60
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.85
Rate for Payer: Meridian Health Plan Medicare	$21.85
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health Medicaid	$21.85
Rate for Payer: Priority Health Medicare	$21.85
Rate for Payer: Priority Health PPO	$2.80
Rate for Payer: United Health Care Medicaid	$21.85
Rate for Payer: United Health Care Medicare Advantage	$9.61

CABLE FOR BONE PLATE

Facility

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	27264462
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$612.00
Rate for Payer: Cash Price	$468.00
Rate for Payer: Community Health Alliance Commercial	$612.00
Rate for Payer: Priority Health Commercial	$504.00
Rate for Payer: Priority Health PPO	$504.00

CABLE READY BONE PLATE

Facility

$2,494.00

Service Code	HCPCS C1713
Hospital Charge Code	27264447
Hospital Revenue Code	278
Min. Negotiated Rate	$1,745.80
Max. Negotiated Rate	$2,119.90
Rate for Payer: Cash Price	$1,621.10
Rate for Payer: Community Health Alliance Commercial	$2,119.90
Rate for Payer: Priority Health Commercial	$1,745.80
Rate for Payer: Priority Health PPO	$1,745.80

CABLE READY BONE PLATE 10 HOLE

Facility

$2,805.00

Service Code	HCPCS C1713
Hospital Charge Code	27264454
Hospital Revenue Code	278
Min. Negotiated Rate	$1,963.50
Max. Negotiated Rate	$2,384.25
Rate for Payer: Cash Price	$1,823.25
Rate for Payer: Community Health Alliance Commercial	$2,384.25
Rate for Payer: Priority Health Commercial	$1,963.50
Rate for Payer: Priority Health PPO	$1,963.50

CADMIUM WHOLE BLD

Facility

$24.44

Hospital Charge Code	3100767
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

CALCITONIN

Facility

$8.00

Service Code	HCPCS 82308
Hospital Charge Code	3001740
Hospital Revenue Code	301
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$28.13
Rate for Payer: BCBS BCN 65	$28.13
Rate for Payer: Blue Care Network Medicare Advantage	$28.13
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cash Price	$5.20
Rate for Payer: Community Health Alliance Commercial	$6.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$28.13
Rate for Payer: Meridian Health Plan Medicare	$28.13
Rate for Payer: Priority Health Commercial	$5.60
Rate for Payer: Priority Health Medicaid	$28.13
Rate for Payer: Priority Health Medicare	$28.13
Rate for Payer: Priority Health PPO	$5.60
Rate for Payer: United Health Care Medicaid	$28.13
Rate for Payer: United Health Care Medicare Advantage	$12.38

CALCIUM

Facility

$33.00

Service Code	HCPCS 82340
Hospital Charge Code	3001760
Hospital Revenue Code	301
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$6.33
Rate for Payer: Blue Care Network Medicare Advantage	$6.33
Rate for Payer: Cash Price	$21.45
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.33
Rate for Payer: Meridian Health Plan Medicare	$6.33
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$6.33
Rate for Payer: Priority Health Medicare	$6.33
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$6.33
Rate for Payer: United Health Care Medicare Advantage	$2.79

CALCIUM, IONIZED

Facility

$3.50

Service Code	HCPCS 82330
Hospital Charge Code	3001780
Hospital Revenue Code	301
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$14.36
Rate for Payer: BCBS BCN 65	$14.36
Rate for Payer: Blue Care Network Medicare Advantage	$14.36
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cash Price	$2.28
Rate for Payer: Community Health Alliance Commercial	$2.98
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.36
Rate for Payer: Meridian Health Plan Medicare	$14.36
Rate for Payer: Priority Health Commercial	$2.45
Rate for Payer: Priority Health Medicaid	$14.36
Rate for Payer: Priority Health Medicare	$14.36
Rate for Payer: Priority Health PPO	$2.45
Rate for Payer: United Health Care Medicaid	$14.36
Rate for Payer: United Health Care Medicare Advantage	$6.32

CALCIUM, TIMED SPECIMAN

Facility

$2.00

Service Code	HCPCS 82340
Hospital Charge Code	3001800
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$6.33
Rate for Payer: BCBS BCN 65	$6.33
Rate for Payer: Blue Care Network Medicare Advantage	$6.33
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.33
Rate for Payer: Meridian Health Plan Medicare	$6.33
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health Medicaid	$6.33
Rate for Payer: Priority Health Medicare	$6.33
Rate for Payer: Priority Health PPO	$1.40
Rate for Payer: United Health Care Medicaid	$6.33
Rate for Payer: United Health Care Medicare Advantage	$2.79

CALCULUS-STONE QUANT

Facility

$78.00

Service Code	HCPCS 82360
Hospital Charge Code	3100110
Hospital Revenue Code	301
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$66.30
Rate for Payer: BCBS BCN 65	$13.51
Rate for Payer: Blue Care Network Medicare Advantage	$13.51
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	$13.51
Rate for Payer: Meridian Health Plan Medicare	$13.51
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health Medicaid	$13.51
Rate for Payer: Priority Health Medicare	$13.51
Rate for Payer: Priority Health PPO	$54.60
Rate for Payer: United Health Care Medicaid	$13.51
Rate for Payer: United Health Care Medicare Advantage	$5.95

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges