Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CELIA PAN-LC

Facility

$4.48

Hospital Charge Code	3102717
Hospital Revenue Code	300
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.81
Rate for Payer: Cash Price	$2.91
Rate for Payer: Community Health Alliance Commercial	$3.81
Rate for Payer: Priority Health Commercial	$3.14
Rate for Payer: Priority Health PPO	$3.14

CELIA PAN-LC

Facility

$4.49

Hospital Charge Code	3102718
Hospital Revenue Code	300
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.82
Rate for Payer: Cash Price	$2.92
Rate for Payer: Community Health Alliance Commercial	$3.82
Rate for Payer: Priority Health Commercial	$3.14
Rate for Payer: Priority Health PPO	$3.14

CELL COUNT/DIFF, FLUID

Facility

$58.00

Service Code	HCPCS 89051
Hospital Charge Code	3000936
Hospital Revenue Code	309
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$49.30
Rate for Payer: BCBS BCN 65	$5.88
Rate for Payer: Blue Care Network Medicare Advantage	$5.88
Rate for Payer: Cash Price	$37.70
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.88
Rate for Payer: Meridian Health Plan Medicare	$5.88
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health Medicaid	$5.88
Rate for Payer: Priority Health Medicare	$5.88
Rate for Payer: Priority Health PPO	$40.60
Rate for Payer: United Health Care Medicaid	$5.88
Rate for Payer: United Health Care Medicare Advantage	$2.59

CELL COUNT FLUIDS NO DIFF

Facility

$60.00

Service Code	HCPCS 89050
Hospital Charge Code	3002940
Hospital Revenue Code	300
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$51.00
Rate for Payer: BCBS BCN 65	$4.96
Rate for Payer: Blue Care Network Medicare Advantage	$4.96
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.96
Rate for Payer: Meridian Health Plan Medicare	$4.96
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health Medicaid	$4.96
Rate for Payer: Priority Health Medicare	$4.96
Rate for Payer: Priority Health PPO	$42.00
Rate for Payer: United Health Care Medicaid	$4.96
Rate for Payer: United Health Care Medicare Advantage	$2.18

CENTRASIL CVC

Facility

$252.00

Hospital Charge Code	27015180
Hospital Revenue Code	272
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$214.20
Rate for Payer: Cash Price	$163.80
Rate for Payer: Community Health Alliance Commercial	$214.20
Rate for Payer: Priority Health Commercial	$176.40
Rate for Payer: Priority Health PPO	$176.40

CENTRASIL W/J WIRE

Facility

$139.00

Hospital Charge Code	27015446
Hospital Revenue Code	272
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$118.15
Rate for Payer: Cash Price	$90.35
Rate for Payer: Community Health Alliance Commercial	$118.15
Rate for Payer: Priority Health Commercial	$97.30
Rate for Payer: Priority Health PPO	$97.30

CENTROMERE B IGG ANTIBODY

Facility

$12.22

Hospital Charge Code	3100014
Hospital Revenue Code	302
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$10.39
Rate for Payer: Cash Price	$7.94
Rate for Payer: Community Health Alliance Commercial	$10.39
Rate for Payer: Priority Health Commercial	$8.55
Rate for Payer: Priority Health PPO	$8.55

CERULOPLASMIN

Facility

$4.69

Service Code	HCPCS 82390
Hospital Charge Code	3002040
Hospital Revenue Code	301
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$11.28
Rate for Payer: BCBS BCN 65	$11.28
Rate for Payer: Blue Care Network Medicare Advantage	$11.28
Rate for Payer: Cash Price	$3.05
Rate for Payer: Cash Price	$3.05
Rate for Payer: Community Health Alliance Commercial	$3.99
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$11.28
Rate for Payer: Meridian Health Plan Medicare	$11.28
Rate for Payer: Priority Health Commercial	$3.28
Rate for Payer: Priority Health Medicaid	$11.28
Rate for Payer: Priority Health Medicare	$11.28
Rate for Payer: Priority Health PPO	$3.28
Rate for Payer: United Health Care Medicaid	$11.28
Rate for Payer: United Health Care Medicare Advantage	$4.96

CERVICAL COLLAR EXTENDER

Facility

$17.00

Hospital Charge Code	27021998
Hospital Revenue Code	270
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

CERVICAL ROLL

Facility

$58.00

Hospital Charge Code	27014084
Hospital Revenue Code	270
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

CERVICAL ROLL

Facility

$26.00

Hospital Charge Code	27021014
Hospital Revenue Code	270
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

CHAETOMIUM GLOBOSUM IGG

Facility

$13.00

Hospital Charge Code	3100924
Hospital Revenue Code	300
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$11.05
Rate for Payer: Cash Price	$8.45
Rate for Payer: Community Health Alliance Commercial	$11.05
Rate for Payer: Priority Health Commercial	$9.10
Rate for Payer: Priority Health PPO	$9.10

CHANGE IG PAP TO LB PAP

Facility

$17.10

Hospital Charge Code	3101869
Hospital Revenue Code	300
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$14.54
Rate for Payer: Cash Price	$11.12
Rate for Payer: Community Health Alliance Commercial	$14.54
Rate for Payer: Priority Health Commercial	$11.97
Rate for Payer: Priority Health PPO	$11.97

CHARGE LYME AB/LINE BLOT REF

Facility

$7.90

Hospital Charge Code	3101893
Hospital Revenue Code	300
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$6.71
Rate for Payer: Cash Price	$5.14
Rate for Payer: Community Health Alliance Commercial	$6.71
Rate for Payer: Priority Health Commercial	$5.53
Rate for Payer: Priority Health PPO	$5.53

CHARGE LYME AB/LINE BLOT REF

Facility

$7.90

Hospital Charge Code	3101894
Hospital Revenue Code	300
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$6.71
Rate for Payer: Cash Price	$5.14
Rate for Payer: Community Health Alliance Commercial	$6.71
Rate for Payer: Priority Health Commercial	$5.53
Rate for Payer: Priority Health PPO	$5.53

CHARGE ONLY HCV RT-PCR QUANT

Facility

$50.00

Hospital Charge Code	3101891
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

CHECK OUT ORTHOTIC

Facility

$32.00

Hospital Charge Code	4300043
Hospital Revenue Code	430
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$20.80
Rate for Payer: Community Health Alliance Commercial	$27.20
Rate for Payer: Priority Health Commercial	$22.40
Rate for Payer: Priority Health PPO	$22.40

CHECK OUT ORTHOTIC

Facility

$32.00

Hospital Charge Code	4200372
Hospital Revenue Code	420
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$20.80
Rate for Payer: Community Health Alliance Commercial	$27.20
Rate for Payer: Priority Health Commercial	$22.40
Rate for Payer: Priority Health PPO	$22.40

CHEST PERCUSS THERAPY, INITIAL

Facility

$236.00

Service Code	HCPCS 94667
Hospital Charge Code	4100010
Hospital Revenue Code	410
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$200.60
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$153.40
Rate for Payer: Cash Price	$153.40
Rate for Payer: Community Health Alliance Commercial	$200.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$165.20
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$165.20
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

CHEST PERCUSS THER,SUBSEQUENT

Facility

$68.00

Service Code	HCPCS 94668
Hospital Charge Code	4100012
Hospital Revenue Code	410
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$47.60
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

CHEST TUBE

Facility

$40.00

Hospital Charge Code	27265072
Hospital Revenue Code	272
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

CHEST TUBE

Facility

$47.00

Hospital Charge Code	27265080
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

CHITOTRIOSIDASE

Facility

$282.00

Hospital Charge Code	3102520
Hospital Revenue Code	300
Min. Negotiated Rate	$197.40
Max. Negotiated Rate	$239.70
Rate for Payer: Cash Price	$183.30
Rate for Payer: Community Health Alliance Commercial	$239.70
Rate for Payer: Priority Health Commercial	$197.40
Rate for Payer: Priority Health PPO	$197.40

CHL-1

Facility

$10.00

Service Code	HCPCS 87110
Hospital Charge Code	3003020
Hospital Revenue Code	306
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$20.58
Rate for Payer: BCBS BCN 65	$20.58
Rate for Payer: Blue Care Network Medicare Advantage	$20.58
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$20.58
Rate for Payer: Meridian Health Plan Medicare	$20.58
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health Medicaid	$20.58
Rate for Payer: Priority Health Medicare	$20.58
Rate for Payer: Priority Health PPO	$7.00
Rate for Payer: United Health Care Medicaid	$20.58
Rate for Payer: United Health Care Medicare Advantage	$9.06

CHL-2

Facility

$10.00

Hospital Charge Code	3102168
Hospital Revenue Code	300
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges