Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CATHETER, TROCAR 20FR

Facility

$1,212.00

Hospital Charge Code	27262929
Hospital Revenue Code	272
Min. Negotiated Rate	$848.40
Max. Negotiated Rate	$1,030.20
Rate for Payer: Cash Price	$787.80
Rate for Payer: Community Health Alliance Commercial	$1,030.20
Rate for Payer: Priority Health Commercial	$848.40
Rate for Payer: Priority Health PPO	$848.40

CATHETER, URETERAL 4 WHISTLE

Facility

$75.00

Service Code	HCPCS C1758
Hospital Charge Code	27262911
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

CATHETER - URETHRAL

Facility

$26.00

Hospital Charge Code	27010322
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

CATHETER-URETHRAL,ALL SIZES

Facility

$38.00

Hospital Charge Code	27010892
Hospital Revenue Code	272
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$32.30
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health PPO	$26.60

CATHETER, URET SPIRAL TIP 4FR

Facility

$47.00

Service Code	HCPCS C1758
Hospital Charge Code	27264512
Hospital Revenue Code	272
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

CATHETER,WEIN 5-100-.038-19

Facility

$78.00

Hospital Charge Code	27022848
Hospital Revenue Code	272
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health PPO	$54.60

CATHETER,WHISTLE TIP URETERAL

Facility

$35.00

Service Code	HCPCS C1758
Hospital Charge Code	27021311
Hospital Revenue Code	272
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

CATHETHER, EMBOLECTOMY

Facility

$248.00

Service Code	HCPCS C1757
Hospital Charge Code	27024505
Hospital Revenue Code	272
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$210.80
Rate for Payer: Cash Price	$161.20
Rate for Payer: Community Health Alliance Commercial	$210.80
Rate for Payer: Priority Health Commercial	$173.60
Rate for Payer: Priority Health PPO	$173.60

CATH INTRO KIT 8.5 FR

Facility

$244.00

Service Code	HCPCS C1894
Hospital Charge Code	27014118
Hospital Revenue Code	272
Min. Negotiated Rate	$170.80
Max. Negotiated Rate	$207.40
Rate for Payer: Cash Price	$158.60
Rate for Payer: Community Health Alliance Commercial	$207.40
Rate for Payer: Priority Health Commercial	$170.80
Rate for Payer: Priority Health PPO	$170.80

CATH,MAHURKAR 13.5FR CUFFED

Facility

$657.00

Hospital Charge Code	27266658
Hospital Revenue Code	272
Min. Negotiated Rate	$459.90
Max. Negotiated Rate	$558.45
Rate for Payer: Cash Price	$427.05
Rate for Payer: Community Health Alliance Commercial	$558.45
Rate for Payer: Priority Health Commercial	$459.90
Rate for Payer: Priority Health PPO	$459.90

CAT SCRATCH ANTIBODY

Facility

$120.00

Service Code	HCPCS 86255
Hospital Charge Code	3001895
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$102.00
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
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	$84.00
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$84.00
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

CAT SCRATCH ANTIBODY

Facility

$34.00

Service Code	HCPCS 86609
Hospital Charge Code	3001890
Hospital Revenue Code	302
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$28.90
Rate for Payer: BCBS BCN 65	$13.52
Rate for Payer: Blue Care Network Medicare Advantage	$13.52
Rate for Payer: Cash Price	$22.10
Rate for Payer: Cash Price	$22.10
Rate for Payer: Community Health Alliance Commercial	$28.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.52
Rate for Payer: Meridian Health Plan Medicare	$13.52
Rate for Payer: Priority Health Commercial	$23.80
Rate for Payer: Priority Health Medicaid	$13.52
Rate for Payer: Priority Health Medicare	$13.52
Rate for Payer: Priority Health PPO	$23.80
Rate for Payer: United Health Care Medicaid	$13.52
Rate for Payer: United Health Care Medicare Advantage	$5.95

CAT URINE 1

Facility

$9.88

Hospital Charge Code	3102112
Hospital Revenue Code	300
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$8.40
Rate for Payer: Cash Price	$6.42
Rate for Payer: Community Health Alliance Commercial	$8.40
Rate for Payer: Priority Health Commercial	$6.92
Rate for Payer: Priority Health PPO	$6.92

CAT URINE 2

Facility

$9.88

Hospital Charge Code	3102113
Hospital Revenue Code	300
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$8.40
Rate for Payer: Cash Price	$6.42
Rate for Payer: Community Health Alliance Commercial	$8.40
Rate for Payer: Priority Health Commercial	$6.92
Rate for Payer: Priority Health PPO	$6.92

CBC,AUTOMATED WITH AUTO DIFF

Facility

$56.00

Service Code	HCPCS 85025
Hospital Charge Code	3002725
Hospital Revenue Code	305
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$47.60
Rate for Payer: BCBS BCN 65	$8.16
Rate for Payer: Blue Care Network Medicare Advantage	$8.16
Rate for Payer: Cash Price	$36.40
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.16
Rate for Payer: Meridian Health Plan Medicare	$8.16
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health Medicaid	$8.16
Rate for Payer: Priority Health Medicare	$8.16
Rate for Payer: Priority Health PPO	$39.20
Rate for Payer: United Health Care Medicaid	$8.16
Rate for Payer: United Health Care Medicare Advantage	$3.59

CBC-LC

Facility

$2.02

Hospital Charge Code	3101961
Hospital Revenue Code	300
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.72
Rate for Payer: Cash Price	$1.31
Rate for Payer: Community Health Alliance Commercial	$1.72
Rate for Payer: Priority Health Commercial	$1.41
Rate for Payer: Priority Health PPO	$1.41

CBC, PLT-LC

Facility

$2.00

Hospital Charge Code	3101962
Hospital Revenue Code	300
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health PPO	$1.40

CC-1

Facility

$100.00

Hospital Charge Code	3101480
Hospital Revenue Code	300
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$85.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health PPO	$70.00

CC-1

Facility

$3.87

Hospital Charge Code	3102415
Hospital Revenue Code	300
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$3.29
Rate for Payer: Cash Price	$2.52
Rate for Payer: Community Health Alliance Commercial	$3.29
Rate for Payer: Priority Health Commercial	$2.71
Rate for Payer: Priority Health PPO	$2.71

CC-2

Facility

$4.00

Hospital Charge Code	3101481
Hospital Revenue Code	300
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$3.40
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health PPO	$2.80

CC-2

Facility

$3.88

Hospital Charge Code	3102416
Hospital Revenue Code	300
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$3.30
Rate for Payer: Cash Price	$2.52
Rate for Payer: Community Health Alliance Commercial	$3.30
Rate for Payer: Priority Health Commercial	$2.72
Rate for Payer: Priority Health PPO	$2.72

CC-3

Facility

$4.00

Hospital Charge Code	3101482
Hospital Revenue Code	300
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$3.40
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health PPO	$2.80

CC-4

Facility

$4.00

Hospital Charge Code	3101483
Hospital Revenue Code	300
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$3.40
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health PPO	$2.80

CC-5

Facility

$4.00

Hospital Charge Code	3101484
Hospital Revenue Code	300
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$3.40
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health PPO	$2.80

CC-6

Facility

$4.00

Hospital Charge Code	3101666
Hospital Revenue Code	300
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$3.40
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health PPO	$2.80

Sturgis Hospital Inc.

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All Charges