Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CALF GARMENT

Facility

$338.00

Hospital Charge Code	27020982
Hospital Revenue Code	270
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$287.30
Rate for Payer: Cash Price	$219.70
Rate for Payer: Community Health Alliance Commercial	$287.30
Rate for Payer: Priority Health Commercial	$236.60
Rate for Payer: Priority Health PPO	$236.60

CALF GARMENT, KNEE LGTH REG

Facility

$188.00

Hospital Charge Code	27071527
Hospital Revenue Code	270
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$159.80
Rate for Payer: Cash Price	$122.20
Rate for Payer: Community Health Alliance Commercial	$159.80
Rate for Payer: Priority Health Commercial	$131.60
Rate for Payer: Priority Health PPO	$131.60

CALIFORNIA ENCEPHALITIS

Facility

$49.00

Hospital Charge Code	3001765
Hospital Revenue Code	302
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$41.65
Rate for Payer: Cash Price	$31.85
Rate for Payer: Community Health Alliance Commercial	$41.65
Rate for Payer: Priority Health Commercial	$34.30
Rate for Payer: Priority Health PPO	$34.30

CALIFORNIA ENCEPHALITIS IGG

Facility

$28.75

Hospital Charge Code	3100754
Hospital Revenue Code	302
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$24.44
Rate for Payer: Cash Price	$18.69
Rate for Payer: Community Health Alliance Commercial	$24.44
Rate for Payer: Priority Health Commercial	$20.12
Rate for Payer: Priority Health PPO	$20.12

CALIFORNIA ENCEPHALITIS IGM

Facility

$28.75

Hospital Charge Code	3100755
Hospital Revenue Code	302
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$24.44
Rate for Payer: Cash Price	$18.69
Rate for Payer: Community Health Alliance Commercial	$24.44
Rate for Payer: Priority Health Commercial	$20.12
Rate for Payer: Priority Health PPO	$20.12

CALRETICULIN EXON 9 MUT PCR

Facility

$175.00

Hospital Charge Code	3100945
Hospital Revenue Code	301
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$148.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Community Health Alliance Commercial	$148.75
Rate for Payer: Priority Health Commercial	$122.50
Rate for Payer: Priority Health PPO	$122.50

CAMP-1

Facility

$12.16

Hospital Charge Code	3101818
Hospital Revenue Code	300
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$10.34
Rate for Payer: Cash Price	$7.90
Rate for Payer: Community Health Alliance Commercial	$10.34
Rate for Payer: Priority Health Commercial	$8.51
Rate for Payer: Priority Health PPO	$8.51

CAM/PM-1

Facility

$2.45

Hospital Charge Code	3102380
Hospital Revenue Code	300
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.08
Rate for Payer: Cash Price	$1.59
Rate for Payer: Community Health Alliance Commercial	$2.08
Rate for Payer: Priority Health Commercial	$1.72
Rate for Payer: Priority Health PPO	$1.72

CAM/PM-2

Facility

$2.46

Hospital Charge Code	3102381
Hospital Revenue Code	300
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.09
Rate for Payer: Cash Price	$1.60
Rate for Payer: Community Health Alliance Commercial	$2.09
Rate for Payer: Priority Health Commercial	$1.72
Rate for Payer: Priority Health PPO	$1.72

CAMPY ANTIGEN

Facility

$58.00

Hospital Charge Code	3007741
Hospital Revenue Code	306
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$49.30
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health PPO	$40.60

CANALITH REPOSITIONING

Facility

$62.00

Service Code	HCPCS 95992 GP
Hospital Charge Code	4200035
Hospital Revenue Code	420
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$52.70
Rate for Payer: Cash Price	$40.30
Rate for Payer: Community Health Alliance Commercial	$52.70
Rate for Payer: Priority Health Commercial	$43.40
Rate for Payer: Priority Health PPO	$43.40

CANAL PRESSURIZERS

Facility

$99.00

Hospital Charge Code	27060792
Hospital Revenue Code	270
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$84.15
Rate for Payer: Cash Price	$64.35
Rate for Payer: Community Health Alliance Commercial	$84.15
Rate for Payer: Priority Health Commercial	$69.30
Rate for Payer: Priority Health PPO	$69.30

C-ANCA

Facility

$31.80

Service Code	HCPCS 86255
Hospital Charge Code	3002490
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$27.03
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$20.67
Rate for Payer: Cash Price	$20.67
Rate for Payer: Community Health Alliance Commercial	$27.03
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.65
Rate for Payer: Meridian Health Plan Medicare	$12.65
Rate for Payer: Priority Health Commercial	$22.26
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$22.26
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

CANCELLOUS CHIPS, 30CC

Facility

$1,656.00

Hospital Charge Code	27866369
Hospital Revenue Code	278
Min. Negotiated Rate	$1,159.20
Max. Negotiated Rate	$1,407.60
Rate for Payer: Cash Price	$1,076.40
Rate for Payer: Community Health Alliance Commercial	$1,407.60
Rate for Payer: Priority Health Commercial	$1,159.20
Rate for Payer: Priority Health PPO	$1,159.20

CANCELLOUS CHIPS, 60 CC

Facility

$3,402.00

Service Code	HCPCS C1762
Hospital Charge Code	27861774
Hospital Revenue Code	278
Min. Negotiated Rate	$2,381.40
Max. Negotiated Rate	$2,891.70
Rate for Payer: Cash Price	$2,211.30
Rate for Payer: Community Health Alliance Commercial	$2,891.70
Rate for Payer: Priority Health Commercial	$2,381.40
Rate for Payer: Priority Health PPO	$2,381.40

CANCELLOUS CHIPS 90CC

Facility

$4,586.00

Hospital Charge Code	27061766
Hospital Revenue Code	278
Min. Negotiated Rate	$3,210.20
Max. Negotiated Rate	$3,898.10
Rate for Payer: Cash Price	$2,980.90
Rate for Payer: Community Health Alliance Commercial	$3,898.10
Rate for Payer: Priority Health Commercial	$3,210.20
Rate for Payer: Priority Health PPO	$3,210.20

CANCELLOUS/CORTICAL CHIPS 45CC

Facility

$1,124.00

Hospital Charge Code	27019190
Hospital Revenue Code	278
Min. Negotiated Rate	$786.80
Max. Negotiated Rate	$955.40
Rate for Payer: Cash Price	$730.60
Rate for Payer: Community Health Alliance Commercial	$955.40
Rate for Payer: Priority Health Commercial	$786.80
Rate for Payer: Priority Health PPO	$786.80

CANDIDA

Facility

$25.33

Hospital Charge Code	3000533
Hospital Revenue Code	302
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$21.53
Rate for Payer: Cash Price	$16.46
Rate for Payer: Community Health Alliance Commercial	$21.53
Rate for Payer: Priority Health Commercial	$17.73
Rate for Payer: Priority Health PPO	$17.73

CANDIDA

Facility

$25.34

Hospital Charge Code	3000534
Hospital Revenue Code	302
Min. Negotiated Rate	$17.74
Max. Negotiated Rate	$21.54
Rate for Payer: Cash Price	$16.47
Rate for Payer: Community Health Alliance Commercial	$21.54
Rate for Payer: Priority Health Commercial	$17.74
Rate for Payer: Priority Health PPO	$17.74

CANDIDA

Facility

$25.33

Hospital Charge Code	3000532
Hospital Revenue Code	302
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$21.53
Rate for Payer: Cash Price	$16.46
Rate for Payer: Community Health Alliance Commercial	$21.53
Rate for Payer: Priority Health Commercial	$17.73
Rate for Payer: Priority Health PPO	$17.73

CANDIDA ANTIBODIES

Facility

$76.00

Hospital Charge Code	3000531
Hospital Revenue Code	302
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$64.60
Rate for Payer: Cash Price	$49.40
Rate for Payer: Community Health Alliance Commercial	$64.60
Rate for Payer: Priority Health Commercial	$53.20
Rate for Payer: Priority Health PPO	$53.20

CANDIDA SPECIES

Facility

$10.00

Hospital Charge Code	3002831
Hospital Revenue Code	306
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health PPO	$7.00

CANDIDA SPECIES BY PCR

Facility

$256.50

Hospital Charge Code	3101401
Hospital Revenue Code	306
Min. Negotiated Rate	$179.55
Max. Negotiated Rate	$218.03
Rate for Payer: Cash Price	$166.73
Rate for Payer: Community Health Alliance Commercial	$218.03
Rate for Payer: Priority Health Commercial	$179.55
Rate for Payer: Priority Health PPO	$179.55

CANNABINOID CONFIRM UR-LC

Facility

$14.70

Hospital Charge Code	31027372
Hospital Revenue Code	300
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$12.49
Rate for Payer: Cash Price	$9.56
Rate for Payer: Community Health Alliance Commercial	$12.49
Rate for Payer: Priority Health Commercial	$10.29
Rate for Payer: Priority Health PPO	$10.29

CANNABINOID METABOLITE Q URINE

Facility

$70.00

Service Code	HCPCS G0480
Hospital Charge Code	3100869
Hospital Revenue Code	301
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$45.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$49.00
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges