Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CDS-4

Facility

$15.73

Hospital Charge Code	3101275
Hospital Revenue Code	301
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$13.37
Rate for Payer: Cash Price	$10.22
Rate for Payer: Community Health Alliance Commercial	$13.37
Rate for Payer: Priority Health Commercial	$11.01
Rate for Payer: Priority Health PPO	$11.01

CDS-5

Facility

$15.73

Hospital Charge Code	3101276
Hospital Revenue Code	301
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$13.37
Rate for Payer: Cash Price	$10.22
Rate for Payer: Community Health Alliance Commercial	$13.37
Rate for Payer: Priority Health Commercial	$11.01
Rate for Payer: Priority Health PPO	$11.01

CDS-5

Facility

$3.75

Hospital Charge Code	3101899
Hospital Revenue Code	300
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$3.19
Rate for Payer: Cash Price	$2.44
Rate for Payer: Community Health Alliance Commercial	$3.19
Rate for Payer: Priority Health Commercial	$2.62
Rate for Payer: Priority Health PPO	$2.62

CDS-6

Facility

$15.73

Hospital Charge Code	3101277
Hospital Revenue Code	301
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$13.37
Rate for Payer: Cash Price	$10.22
Rate for Payer: Community Health Alliance Commercial	$13.37
Rate for Payer: Priority Health Commercial	$11.01
Rate for Payer: Priority Health PPO	$11.01

CDS-6

Facility

$3.75

Hospital Charge Code	3101900
Hospital Revenue Code	300
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$3.19
Rate for Payer: Cash Price	$2.44
Rate for Payer: Community Health Alliance Commercial	$3.19
Rate for Payer: Priority Health Commercial	$2.62
Rate for Payer: Priority Health PPO	$2.62

CDS-7

Facility

$15.73

Hospital Charge Code	3101278
Hospital Revenue Code	301
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$13.37
Rate for Payer: Cash Price	$10.22
Rate for Payer: Community Health Alliance Commercial	$13.37
Rate for Payer: Priority Health Commercial	$11.01
Rate for Payer: Priority Health PPO	$11.01

CDS-7

Facility

$3.75

Hospital Charge Code	3101901
Hospital Revenue Code	300
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$3.19
Rate for Payer: Cash Price	$2.44
Rate for Payer: Community Health Alliance Commercial	$3.19
Rate for Payer: Priority Health Commercial	$2.62
Rate for Payer: Priority Health PPO	$2.62

CDS-8

Facility

$15.77

Hospital Charge Code	3101279
Hospital Revenue Code	301
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$13.40
Rate for Payer: Cash Price	$10.25
Rate for Payer: Community Health Alliance Commercial	$13.40
Rate for Payer: Priority Health Commercial	$11.04
Rate for Payer: Priority Health PPO	$11.04

CDS-8

Facility

$3.75

Hospital Charge Code	3101902
Hospital Revenue Code	300
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$3.19
Rate for Payer: Cash Price	$2.44
Rate for Payer: Community Health Alliance Commercial	$3.19
Rate for Payer: Priority Health Commercial	$2.62
Rate for Payer: Priority Health PPO	$2.62

CDS-9

Facility

$3.75

Hospital Charge Code	3101903
Hospital Revenue Code	300
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$3.19
Rate for Payer: Cash Price	$2.44
Rate for Payer: Community Health Alliance Commercial	$3.19
Rate for Payer: Priority Health Commercial	$2.62
Rate for Payer: Priority Health PPO	$2.62

CDS TWO INJECTOR DIAMOND BEVEL

Facility

$2,249.00

Hospital Charge Code	27264850
Hospital Revenue Code	272
Min. Negotiated Rate	$1,574.30
Max. Negotiated Rate	$1,911.65
Rate for Payer: Cash Price	$1,461.85
Rate for Payer: Community Health Alliance Commercial	$1,911.65
Rate for Payer: Priority Health Commercial	$1,574.30
Rate for Payer: Priority Health PPO	$1,574.30

CEA

Facility

$66.00

Hospital Charge Code	3102445
Hospital Revenue Code	300
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$56.10
Rate for Payer: Cash Price	$42.90
Rate for Payer: Community Health Alliance Commercial	$56.10
Rate for Payer: Priority Health Commercial	$46.20
Rate for Payer: Priority Health PPO	$46.20

CEA BODY FLUID

Facility

$11.28

Hospital Charge Code	3100861
Hospital Revenue Code	301
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$9.59
Rate for Payer: Cash Price	$7.33
Rate for Payer: Community Health Alliance Commercial	$9.59
Rate for Payer: Priority Health Commercial	$7.90
Rate for Payer: Priority Health PPO	$7.90

CEA-LC

Facility

$3.46

Service Code	HCPCS 82378
Hospital Charge Code	3001920
Hospital Revenue Code	301
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$19.91
Rate for Payer: BCBS BCN 65	$19.91
Rate for Payer: Blue Care Network Medicare Advantage	$19.91
Rate for Payer: Cash Price	$2.25
Rate for Payer: Cash Price	$2.25
Rate for Payer: Community Health Alliance Commercial	$2.94
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.91
Rate for Payer: Meridian Health Plan Medicare	$19.91
Rate for Payer: Priority Health Commercial	$2.42
Rate for Payer: Priority Health Medicaid	$19.91
Rate for Payer: Priority Health Medicare	$19.91
Rate for Payer: Priority Health PPO	$2.42
Rate for Payer: United Health Care Medicaid	$19.91
Rate for Payer: United Health Care Medicare Advantage	$8.76

CEA-SBMF

Facility

$13.80

Hospital Charge Code	3101243
Hospital Revenue Code	301
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$11.73
Rate for Payer: Cash Price	$8.97
Rate for Payer: Community Health Alliance Commercial	$11.73
Rate for Payer: Priority Health Commercial	$9.66
Rate for Payer: Priority Health PPO	$9.66

CEA SCAN MULTIPLE AREAS

Facility

$824.00

Service Code	HCPCS 78801
Hospital Charge Code	3400051
Hospital Revenue Code	340
Min. Negotiated Rate	$188.69
Max. Negotiated Rate	$700.40
Rate for Payer: BCBS BCN 65	$428.85
Rate for Payer: Blue Care Network Medicare Advantage	$428.85
Rate for Payer: Cash Price	$535.60
Rate for Payer: Cash Price	$535.60
Rate for Payer: Community Health Alliance Commercial	$700.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$428.85
Rate for Payer: Meridian Health Plan Medicare	$428.85
Rate for Payer: Priority Health Commercial	$576.80
Rate for Payer: Priority Health Medicaid	$428.85
Rate for Payer: Priority Health Medicare	$428.85
Rate for Payer: Priority Health PPO	$576.80
Rate for Payer: United Health Care Medicaid	$428.85
Rate for Payer: United Health Care Medicare Advantage	$188.69

CEA SPECT

Facility

$824.00

Service Code	HCPCS 78803
Hospital Charge Code	3400053
Hospital Revenue Code	340
Min. Negotiated Rate	$256.29
Max. Negotiated Rate	$700.40
Rate for Payer: BCBS BCN 65	$582.47
Rate for Payer: Blue Care Network Medicare Advantage	$582.47
Rate for Payer: Cash Price	$535.60
Rate for Payer: Cash Price	$535.60
Rate for Payer: Community Health Alliance Commercial	$700.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$582.47
Rate for Payer: Meridian Health Plan Medicare	$582.47
Rate for Payer: Priority Health Commercial	$576.80
Rate for Payer: Priority Health Medicaid	$582.47
Rate for Payer: Priority Health Medicare	$582.47
Rate for Payer: Priority Health PPO	$576.80
Rate for Payer: United Health Care Medicaid	$582.47
Rate for Payer: United Health Care Medicare Advantage	$256.29

CELEXA

Facility

$150.00

Service Code	HCPCS 80332
Hospital Charge Code	3001905
Hospital Revenue Code	301
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$127.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Community Health Alliance Commercial	$127.50
Rate for Payer: Priority Health Commercial	$105.00
Rate for Payer: Priority Health PPO	$105.00

CEL/HLA 1

Facility

$56.20

Hospital Charge Code	31027508
Hospital Revenue Code	300
Min. Negotiated Rate	$39.34
Max. Negotiated Rate	$47.77
Rate for Payer: Cash Price	$36.53
Rate for Payer: Community Health Alliance Commercial	$47.77
Rate for Payer: Priority Health Commercial	$39.34
Rate for Payer: Priority Health PPO	$39.34

CEL/HLA 2

Facility

$56.20

Hospital Charge Code	31027509
Hospital Revenue Code	300
Min. Negotiated Rate	$39.34
Max. Negotiated Rate	$47.77
Rate for Payer: Cash Price	$36.53
Rate for Payer: Community Health Alliance Commercial	$47.77
Rate for Payer: Priority Health Commercial	$39.34
Rate for Payer: Priority Health PPO	$39.34

CELIAC/HLA

Facility

$112.40

Hospital Charge Code	31027507
Hospital Revenue Code	300
Min. Negotiated Rate	$78.68
Max. Negotiated Rate	$95.54
Rate for Payer: Cash Price	$73.06
Rate for Payer: Community Health Alliance Commercial	$95.54
Rate for Payer: Priority Health Commercial	$78.68
Rate for Payer: Priority Health PPO	$78.68

CELIAC HLA DQ-1

Facility

$56.20

Hospital Charge Code	3101656
Hospital Revenue Code	300
Min. Negotiated Rate	$39.34
Max. Negotiated Rate	$47.77
Rate for Payer: Cash Price	$36.53
Rate for Payer: Community Health Alliance Commercial	$47.77
Rate for Payer: Priority Health Commercial	$39.34
Rate for Payer: Priority Health PPO	$39.34

CELIAC HLA DQ-2

Facility

$56.20

Hospital Charge Code	3101657
Hospital Revenue Code	300
Min. Negotiated Rate	$39.34
Max. Negotiated Rate	$47.77
Rate for Payer: Cash Price	$36.53
Rate for Payer: Community Health Alliance Commercial	$47.77
Rate for Payer: Priority Health Commercial	$39.34
Rate for Payer: Priority Health PPO	$39.34

CELIAC PANEL

Facility

$405.00

Hospital Charge Code	3000239
Hospital Revenue Code	301
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$344.25
Rate for Payer: Cash Price	$263.25
Rate for Payer: Community Health Alliance Commercial	$344.25
Rate for Payer: Priority Health Commercial	$283.50
Rate for Payer: Priority Health PPO	$283.50

CELIAC SEROLOGY W/ REFLEX

Facility

$8.00

Hospital Charge Code	3101475
Hospital Revenue Code	300
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$6.80
Rate for Payer: Cash Price	$5.20
Rate for Payer: Community Health Alliance Commercial	$6.80
Rate for Payer: Priority Health Commercial	$5.60
Rate for Payer: Priority Health PPO	$5.60

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges