Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CANNABINOID MET QUANT URINE

Facility

$19.85

Service Code	HCPCS G0480
Hospital Charge Code	3100901
Hospital Revenue Code	301
Min. Negotiated Rate	$13.89
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	$12.90
Rate for Payer: Cash Price	$12.90
Rate for Payer: Community Health Alliance Commercial	$16.87
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	$13.89
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$13.89
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

CANNABINOIDS CONFIRM-SERUM

Facility

$50.00

Service Code	HCPCS G0480
Hospital Charge Code	3101060
Hospital Revenue Code	309
Min. Negotiated Rate	$35.00
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	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
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	$35.00
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

CANNABINOIDS SCREEN-SERUM

Facility

$16.00

Service Code	HCPCS G0479
Hospital Charge Code	3101061
Hospital Revenue Code	309
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

CANNABINOIDS SCREEN URINE

Facility

$16.00

Service Code	HCPCS 80307
Hospital Charge Code	3100989
Hospital Revenue Code	309
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$65.25
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
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	$11.20
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$11.20
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

CANNABINOIDS (THC) SYN W/BLOOD

Facility

$58.00

Hospital Charge Code	3101507
Hospital Revenue Code	300
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

CANNABINOIDS W CONF URINE

Facility

$7.34

Service Code	HCPCS 80307
Hospital Charge Code	3003909
Hospital Revenue Code	301
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$65.25
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$4.77
Rate for Payer: Cash Price	$4.77
Rate for Payer: Community Health Alliance Commercial	$6.24
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	$5.14
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$5.14
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

CANNULA, 6.5MM x 73MM

Facility

$117.00

Hospital Charge Code	27266294
Hospital Revenue Code	272
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$99.45
Rate for Payer: Cash Price	$76.05
Rate for Payer: Community Health Alliance Commercial	$99.45
Rate for Payer: Priority Health Commercial	$81.90
Rate for Payer: Priority Health PPO	$81.90

CANNULA, 8.4MM x 90MM

Facility

$99.00

Hospital Charge Code	27266286
Hospital Revenue Code	272
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

CANNULA,CONTOUR STANDARD TIP

Facility

$234.00

Hospital Charge Code	27019521
Hospital Revenue Code	272
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$198.90
Rate for Payer: Cash Price	$152.10
Rate for Payer: Community Health Alliance Commercial	$198.90
Rate for Payer: Priority Health Commercial	$163.80
Rate for Payer: Priority Health PPO	$163.80

CANNULA,DUCTOGRAM JABCZENSKI

Facility

$91.00

Hospital Charge Code	27263891
Hospital Revenue Code	272
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$77.35
Rate for Payer: Cash Price	$59.15
Rate for Payer: Community Health Alliance Commercial	$77.35
Rate for Payer: Priority Health Commercial	$63.70
Rate for Payer: Priority Health PPO	$63.70

CANNULA, ERCP

Facility

$294.00

Hospital Charge Code	27265718
Hospital Revenue Code	272
Min. Negotiated Rate	$205.80
Max. Negotiated Rate	$249.90
Rate for Payer: Cash Price	$191.10
Rate for Payer: Community Health Alliance Commercial	$249.90
Rate for Payer: Priority Health Commercial	$205.80
Rate for Payer: Priority Health PPO	$205.80

CANNULA,TANDEM XL

Facility

$240.00

Hospital Charge Code	27022723
Hospital Revenue Code	270
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$204.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Community Health Alliance Commercial	$204.00
Rate for Payer: Priority Health Commercial	$168.00
Rate for Payer: Priority Health PPO	$168.00

CANNULATED HEMI IMPLANT

Facility

$2,445.00

Service Code	HCPCS L8641
Hospital Charge Code	27872012
Hospital Revenue Code	278
Min. Negotiated Rate	$1,711.50
Max. Negotiated Rate	$2,078.25
Rate for Payer: Cash Price	$1,589.25
Rate for Payer: Community Health Alliance Commercial	$2,078.25
Rate for Payer: Priority Health Commercial	$1,711.50
Rate for Payer: Priority Health PPO	$1,711.50

CANNULATED SCREW 2.7 X 14

Facility

$136.00

Service Code	HCPCS C1713
Hospital Charge Code	27020933
Hospital Revenue Code	278
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$115.60
Rate for Payer: Cash Price	$88.40
Rate for Payer: Community Health Alliance Commercial	$115.60
Rate for Payer: Priority Health Commercial	$95.20
Rate for Payer: Priority Health PPO	$95.20

CAPIO SUTURE CAPTURING DEVICE

Facility

$2,550.00

Service Code	HCPCS C2631
Hospital Charge Code	27266724
Hospital Revenue Code	272
Min. Negotiated Rate	$1,785.00
Max. Negotiated Rate	$2,167.50
Rate for Payer: Cash Price	$1,657.50
Rate for Payer: Community Health Alliance Commercial	$2,167.50
Rate for Payer: Priority Health Commercial	$1,785.00
Rate for Payer: Priority Health PPO	$1,785.00

CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT (SEPARATE PROCEDURE)

Facility

$3,510.01

Service Code	CPT 28270
Hospital Revenue Code	360
Min. Negotiated Rate	$1,544.41
Max. Negotiated Rate	$3,510.01
Rate for Payer: BCBS BCN 65	$3,510.01
Rate for Payer: Blue Care Network Medicare Advantage	$3,510.01
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,510.01
Rate for Payer: Meridian Health Plan Medicare	$3,510.01
Rate for Payer: Priority Health Medicaid	$3,510.01
Rate for Payer: Priority Health Medicare	$3,510.01
Rate for Payer: United Health Care Medicaid	$3,510.01
Rate for Payer: United Health Care Medicare Advantage	$1,544.41

CAPTIFLEX SNARE

Facility

$107.00

Hospital Charge Code	27265502
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

CAPTURA HOT DISP BIOPSY FORCEP

Facility

$136.00

Hospital Charge Code	27271765
Hospital Revenue Code	272
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$115.60
Rate for Payer: Cash Price	$88.40
Rate for Payer: Community Health Alliance Commercial	$115.60
Rate for Payer: Priority Health Commercial	$95.20
Rate for Payer: Priority Health PPO	$95.20

CARBAMAZEPINE

Facility

$6.00

Service Code	HCPCS 80156
Hospital Charge Code	3001820
Hospital Revenue Code	301
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$15.30
Rate for Payer: BCBS BCN 65	$15.30
Rate for Payer: Blue Care Network Medicare Advantage	$15.30
Rate for Payer: Cash Price	$3.90
Rate for Payer: Cash Price	$3.90
Rate for Payer: Community Health Alliance Commercial	$5.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.30
Rate for Payer: Meridian Health Plan Medicare	$15.30
Rate for Payer: Priority Health Commercial	$4.20
Rate for Payer: Priority Health Medicaid	$15.30
Rate for Payer: Priority Health Medicare	$15.30
Rate for Payer: Priority Health PPO	$4.20
Rate for Payer: United Health Care Medicaid	$15.30
Rate for Payer: United Health Care Medicare Advantage	$6.73

CARBAMAZEPINE EPOXIDE LEVEL

Facility

$101.00

Service Code	HCPCS 80156
Hospital Charge Code	3001850
Hospital Revenue Code	301
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$85.85
Rate for Payer: BCBS BCN 65	$15.30
Rate for Payer: Blue Care Network Medicare Advantage	$15.30
Rate for Payer: Cash Price	$65.65
Rate for Payer: Cash Price	$65.65
Rate for Payer: Community Health Alliance Commercial	$85.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.30
Rate for Payer: Meridian Health Plan Medicare	$15.30
Rate for Payer: Priority Health Commercial	$70.70
Rate for Payer: Priority Health Medicaid	$15.30
Rate for Payer: Priority Health Medicare	$15.30
Rate for Payer: Priority Health PPO	$70.70
Rate for Payer: United Health Care Medicaid	$15.30
Rate for Payer: United Health Care Medicare Advantage	$6.73

CARBAMAZEPINE FREE

Facility

$12.37

Hospital Charge Code	3100810
Hospital Revenue Code	300
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$10.51
Rate for Payer: Cash Price	$8.04
Rate for Payer: Community Health Alliance Commercial	$10.51
Rate for Payer: Priority Health Commercial	$8.66
Rate for Payer: Priority Health PPO	$8.66

CARBAMAZEPINE FREE

Facility

$18.73

Hospital Charge Code	3101603
Hospital Revenue Code	300
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$15.92
Rate for Payer: Cash Price	$12.17
Rate for Payer: Community Health Alliance Commercial	$15.92
Rate for Payer: Priority Health Commercial	$13.11
Rate for Payer: Priority Health PPO	$13.11

CARBAMAZEPINE TOTAL

Facility

$12.36

Hospital Charge Code	3100809
Hospital Revenue Code	300
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$10.51
Rate for Payer: Cash Price	$8.03
Rate for Payer: Community Health Alliance Commercial	$10.51
Rate for Payer: Priority Health Commercial	$8.65
Rate for Payer: Priority Health PPO	$8.65

CARBOHY DEFICIENT TRANSFERRIN

Facility

$341.20

Service Code	HCPCS 82373
Hospital Charge Code	3001830
Hospital Revenue Code	301
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$290.02
Rate for Payer: BCBS BCN 65	$18.96
Rate for Payer: Blue Care Network Medicare Advantage	$18.96
Rate for Payer: Cash Price	$221.78
Rate for Payer: Cash Price	$221.78
Rate for Payer: Community Health Alliance Commercial	$290.02
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.96
Rate for Payer: Meridian Health Plan Medicare	$18.96
Rate for Payer: Priority Health Commercial	$238.84
Rate for Payer: Priority Health Medicaid	$18.96
Rate for Payer: Priority Health Medicare	$18.96
Rate for Payer: Priority Health PPO	$238.84
Rate for Payer: United Health Care Medicaid	$18.96
Rate for Payer: United Health Care Medicare Advantage	$8.34

CARBON DIOXIDE

Facility

$29.00

Service Code	HCPCS 82374
Hospital Charge Code	3001840
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$24.65
Rate for Payer: BCBS BCN 65	$5.12
Rate for Payer: Blue Care Network Medicare Advantage	$5.12
Rate for Payer: Cash Price	$18.85
Rate for Payer: Cash Price	$18.85
Rate for Payer: Community Health Alliance Commercial	$24.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.12
Rate for Payer: Meridian Health Plan Medicare	$5.12
Rate for Payer: Priority Health Commercial	$20.30
Rate for Payer: Priority Health Medicaid	$5.12
Rate for Payer: Priority Health Medicare	$5.12
Rate for Payer: Priority Health PPO	$20.30
Rate for Payer: United Health Care Medicaid	$5.12
Rate for Payer: United Health Care Medicare Advantage	$2.25

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges