Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CARBON MONOXIDE

Facility

$5.00

Hospital Charge Code	31027574
Hospital Revenue Code	300
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$4.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health PPO	$3.50

CARBOXYHEMOGLOBIN

Facility

$64.00

Service Code	HCPCS 82375
Hospital Charge Code	3001860
Hospital Revenue Code	301
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$54.40
Rate for Payer: BCBS BCN 65	$12.94
Rate for Payer: Blue Care Network Medicare Advantage	$12.94
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.94
Rate for Payer: Meridian Health Plan Medicare	$12.94
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health Medicaid	$12.94
Rate for Payer: Priority Health Medicare	$12.94
Rate for Payer: Priority Health PPO	$44.80
Rate for Payer: United Health Care Medicaid	$12.94
Rate for Payer: United Health Care Medicare Advantage	$5.69

CARDIAC REHAB PHASE II

Facility

$265.00

Service Code	HCPCS 93798
Hospital Charge Code	9430030
Hospital Revenue Code	943
Min. Negotiated Rate	$60.85
Max. Negotiated Rate	$225.25
Rate for Payer: BCBS BCN 65	$138.28
Rate for Payer: Blue Care Network Medicare Advantage	$138.28
Rate for Payer: Cash Price	$172.25
Rate for Payer: Cash Price	$172.25
Rate for Payer: Community Health Alliance Commercial	$225.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$138.28
Rate for Payer: Meridian Health Plan Medicare	$138.28
Rate for Payer: Priority Health Commercial	$185.50
Rate for Payer: Priority Health Medicaid	$138.28
Rate for Payer: Priority Health Medicare	$138.28
Rate for Payer: Priority Health PPO	$185.50
Rate for Payer: United Health Care Medicaid	$138.28
Rate for Payer: United Health Care Medicare Advantage	$60.85

CARDIOCASCULAR GRAFT

Facility

$620.00

Service Code	HCPCS C1768
Hospital Charge Code	27815420
Hospital Revenue Code	278
Min. Negotiated Rate	$434.00
Max. Negotiated Rate	$527.00
Rate for Payer: Cash Price	$403.00
Rate for Payer: Community Health Alliance Commercial	$527.00
Rate for Payer: Priority Health Commercial	$434.00
Rate for Payer: Priority Health PPO	$434.00

CARDIO CRP

Facility

$6.92

Service Code	HCPCS 86141
Hospital Charge Code	3001610
Hospital Revenue Code	302
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$13.60
Rate for Payer: BCBS BCN 65	$13.60
Rate for Payer: Blue Care Network Medicare Advantage	$13.60
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: Community Health Alliance Commercial	$5.88
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.60
Rate for Payer: Meridian Health Plan Medicare	$13.60
Rate for Payer: Priority Health Commercial	$4.84
Rate for Payer: Priority Health Medicaid	$13.60
Rate for Payer: Priority Health Medicare	$13.60
Rate for Payer: Priority Health PPO	$4.84
Rate for Payer: United Health Care Medicaid	$13.60
Rate for Payer: United Health Care Medicare Advantage	$5.98

CARDIOVASCULAR GRAFT

Facility

$620.00

Service Code	HCPCS C1768
Hospital Charge Code	27015420
Hospital Revenue Code	278
Min. Negotiated Rate	$434.00
Max. Negotiated Rate	$527.00
Rate for Payer: Cash Price	$403.00
Rate for Payer: Community Health Alliance Commercial	$527.00
Rate for Payer: Priority Health Commercial	$434.00
Rate for Payer: Priority Health PPO	$434.00

CAREGIVER TRAINING 1ST 30 MIN

Facility

$111.00

Hospital Charge Code	4201501
Hospital Revenue Code	420
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$94.35
Rate for Payer: Cash Price	$72.15
Rate for Payer: Community Health Alliance Commercial	$94.35
Rate for Payer: Priority Health Commercial	$77.70
Rate for Payer: Priority Health PPO	$77.70

CAREGIVER TRAINING 1ST 30 MIN

Facility

$111.00

Hospital Charge Code	4320011
Hospital Revenue Code	430
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$94.35
Rate for Payer: Cash Price	$72.15
Rate for Payer: Community Health Alliance Commercial	$94.35
Rate for Payer: Priority Health Commercial	$77.70
Rate for Payer: Priority Health PPO	$77.70

CAREGIVER TRAINING EA ADD'L 15

Facility

$60.00

Hospital Charge Code	4320012
Hospital Revenue Code	430
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

CAREGIVER TRAINING EA ADD'L 15

Facility

$60.00

Hospital Charge Code	4201502
Hospital Revenue Code	420
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

CARING REAMER

Facility

$808.00

Hospital Charge Code	27265213
Hospital Revenue Code	272
Min. Negotiated Rate	$565.60
Max. Negotiated Rate	$686.80
Rate for Payer: Cash Price	$525.20
Rate for Payer: Community Health Alliance Commercial	$686.80
Rate for Payer: Priority Health Commercial	$565.60
Rate for Payer: Priority Health PPO	$565.60

CARING REAMER

Facility

$854.00

Hospital Charge Code	27265205
Hospital Revenue Code	272
Min. Negotiated Rate	$597.80
Max. Negotiated Rate	$725.90
Rate for Payer: Cash Price	$555.10
Rate for Payer: Community Health Alliance Commercial	$725.90
Rate for Payer: Priority Health Commercial	$597.80
Rate for Payer: Priority Health PPO	$597.80

CARING REAMER 11MM

Facility

$808.00

Hospital Charge Code	27265221
Hospital Revenue Code	272
Min. Negotiated Rate	$565.60
Max. Negotiated Rate	$686.80
Rate for Payer: Cash Price	$525.20
Rate for Payer: Community Health Alliance Commercial	$686.80
Rate for Payer: Priority Health Commercial	$565.60
Rate for Payer: Priority Health PPO	$565.60

CARISOPRODOL

Facility

$15.66

Service Code	HCPCS 80369
Hospital Charge Code	3000258
Hospital Revenue Code	301
Min. Negotiated Rate	$10.96
Max. Negotiated Rate	$13.31
Rate for Payer: Cash Price	$10.18
Rate for Payer: Community Health Alliance Commercial	$13.31
Rate for Payer: Priority Health Commercial	$10.96
Rate for Payer: Priority Health PPO	$10.96

CARMITINE LEVEL, TOTAL

Facility

$20.00

Service Code	HCPCS 82379
Hospital Charge Code	3001874
Hospital Revenue Code	301
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$17.71
Rate for Payer: BCBS BCN 65	$17.71
Rate for Payer: Blue Care Network Medicare Advantage	$17.71
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.71
Rate for Payer: Meridian Health Plan Medicare	$17.71
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health Medicaid	$17.71
Rate for Payer: Priority Health Medicare	$17.71
Rate for Payer: Priority Health PPO	$14.00
Rate for Payer: United Health Care Medicaid	$17.71
Rate for Payer: United Health Care Medicare Advantage	$7.79

CARNITINE

Facility

$202.00

Service Code	HCPCS 82379
Hospital Charge Code	3001870
Hospital Revenue Code	301
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$171.70
Rate for Payer: BCBS BCN 65	$17.71
Rate for Payer: Blue Care Network Medicare Advantage	$17.71
Rate for Payer: Cash Price	$131.30
Rate for Payer: Cash Price	$131.30
Rate for Payer: Community Health Alliance Commercial	$171.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.71
Rate for Payer: Meridian Health Plan Medicare	$17.71
Rate for Payer: Priority Health Commercial	$141.40
Rate for Payer: Priority Health Medicaid	$17.71
Rate for Payer: Priority Health Medicare	$17.71
Rate for Payer: Priority Health PPO	$141.40
Rate for Payer: United Health Care Medicaid	$17.71
Rate for Payer: United Health Care Medicare Advantage	$7.79

CARNITINE, FRACTIONTED

Facility

$238.00

Hospital Charge Code	3001871
Hospital Revenue Code	301
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$202.30
Rate for Payer: Cash Price	$154.70
Rate for Payer: Community Health Alliance Commercial	$202.30
Rate for Payer: Priority Health Commercial	$166.60
Rate for Payer: Priority Health PPO	$166.60

CAROTENE

Facility

$7.52

Service Code	HCPCS 82380
Hospital Charge Code	3001880
Hospital Revenue Code	301
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$9.68
Rate for Payer: BCBS BCN 65	$9.68
Rate for Payer: Blue Care Network Medicare Advantage	$9.68
Rate for Payer: Cash Price	$4.89
Rate for Payer: Cash Price	$4.89
Rate for Payer: Community Health Alliance Commercial	$6.39
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.68
Rate for Payer: Meridian Health Plan Medicare	$9.68
Rate for Payer: Priority Health Commercial	$5.26
Rate for Payer: Priority Health Medicaid	$9.68
Rate for Payer: Priority Health Medicare	$9.68
Rate for Payer: Priority Health PPO	$5.26
Rate for Payer: United Health Care Medicaid	$9.68
Rate for Payer: United Health Care Medicare Advantage	$4.26

CARPAL CARE

Facility

$40.00

Hospital Charge Code	27021204
Hospital Revenue Code	270
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

CARPAL TUNNEL RELEASE SYSTEM

Facility

$891.00

Hospital Charge Code	27022640
Hospital Revenue Code	270
Min. Negotiated Rate	$623.70
Max. Negotiated Rate	$757.35
Rate for Payer: Cash Price	$579.15
Rate for Payer: Community Health Alliance Commercial	$757.35
Rate for Payer: Priority Health Commercial	$623.70
Rate for Payer: Priority Health PPO	$623.70

CARRY CURRENT STATUS 20-39% IM

Facility

$0.01

Service Code	HCPCS G8984 GPCJ
Hospital Charge Code	4200645
Hospital Revenue Code	420
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Community Health Alliance Commercial	$0.01
Rate for Payer: Priority Health Commercial	$0.01
Rate for Payer: Priority Health PPO	$0.01

CARSON O TIP URETERAL DILATOR

Facility

$1,058.00

Hospital Charge Code	27014720
Hospital Revenue Code	272
Min. Negotiated Rate	$740.60
Max. Negotiated Rate	$899.30
Rate for Payer: Cash Price	$687.70
Rate for Payer: Community Health Alliance Commercial	$899.30
Rate for Payer: Priority Health Commercial	$740.60
Rate for Payer: Priority Health PPO	$740.60

CASPR2

Facility

$285.00

Hospital Charge Code	3102133
Hospital Revenue Code	300
Min. Negotiated Rate	$199.50
Max. Negotiated Rate	$242.25
Rate for Payer: Cash Price	$185.25
Rate for Payer: Community Health Alliance Commercial	$242.25
Rate for Payer: Priority Health Commercial	$199.50
Rate for Payer: Priority Health PPO	$199.50

CAST SHOE

Facility

$24.00

Hospital Charge Code	27013219
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

CATECHOLAMINES,FRACT (VA)

Facility

$81.00

Service Code	HCPCS 82384
Hospital Charge Code	3000930
Hospital Revenue Code	301
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$68.85
Rate for Payer: BCBS BCN 65	$26.51
Rate for Payer: Blue Care Network Medicare Advantage	$26.51
Rate for Payer: Cash Price	$52.65
Rate for Payer: Cash Price	$52.65
Rate for Payer: Community Health Alliance Commercial	$68.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$26.51
Rate for Payer: Meridian Health Plan Medicare	$26.51
Rate for Payer: Priority Health Commercial	$56.70
Rate for Payer: Priority Health Medicaid	$26.51
Rate for Payer: Priority Health Medicare	$26.51
Rate for Payer: Priority Health PPO	$56.70
Rate for Payer: United Health Care Medicaid	$26.51
Rate for Payer: United Health Care Medicare Advantage	$11.67

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges