Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CK/MB

Facility

$75.00

Service Code	HCPCS 82553
Hospital Charge Code	3003200
Hospital Revenue Code	301
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$63.75
Rate for Payer: BCBS BCN 65	$12.13
Rate for Payer: Blue Care Network Medicare Advantage	$12.13
Rate for Payer: Cash Price	$48.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.13
Rate for Payer: Meridian Health Plan Medicare	$12.13
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health Medicaid	$12.13
Rate for Payer: Priority Health Medicare	$12.13
Rate for Payer: Priority Health PPO	$52.50
Rate for Payer: United Health Care Medicaid	$12.13
Rate for Payer: United Health Care Medicare Advantage	$5.34

CK/MB-SBMF

Facility

$22.48

Hospital Charge Code	3101436
Hospital Revenue Code	300
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$19.11
Rate for Payer: Cash Price	$14.61
Rate for Payer: Community Health Alliance Commercial	$19.11
Rate for Payer: Priority Health Commercial	$15.74
Rate for Payer: Priority Health PPO	$15.74

CLADOSPORIUM HERBARUM IGG

Facility

$3.26

Hospital Charge Code	3100926
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

CLAMP, ANKLE

Facility

$4,594.00

Service Code	HCPCS C1713
Hospital Charge Code	27871666
Hospital Revenue Code	278
Min. Negotiated Rate	$3,215.80
Max. Negotiated Rate	$3,904.90
Rate for Payer: Cash Price	$2,986.10
Rate for Payer: Community Health Alliance Commercial	$3,904.90
Rate for Payer: Priority Health Commercial	$3,215.80
Rate for Payer: Priority Health PPO	$3,215.80

CLASS 1 AB ID

Facility

$210.00

Hospital Charge Code	3101323
Hospital Revenue Code	300
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$178.50
Rate for Payer: Cash Price	$136.50
Rate for Payer: Community Health Alliance Commercial	$178.50
Rate for Payer: Priority Health Commercial	$147.00
Rate for Payer: Priority Health PPO	$147.00

CLAVICLE BRACE

Facility

$24.00

Hospital Charge Code	27013235
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

Cl ESTERASE INHIBITER QUAL

Facility

$101.00

Service Code	HCPCS 86161
Hospital Charge Code	3003138
Hospital Revenue Code	302
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$85.85
Rate for Payer: BCBS BCN 65	$12.60
Rate for Payer: Blue Care Network Medicare Advantage	$12.60
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	$12.60
Rate for Payer: Meridian Health Plan Medicare	$12.60
Rate for Payer: Priority Health Commercial	$70.70
Rate for Payer: Priority Health Medicaid	$12.60
Rate for Payer: Priority Health Medicare	$12.60
Rate for Payer: Priority Health PPO	$70.70
Rate for Payer: United Health Care Medicaid	$12.60
Rate for Payer: United Health Care Medicare Advantage	$5.54

CLIN EVAL OF SWALL 92611 DNB

Facility

$209.00

Service Code	HCPCS 92611 GN
Hospital Charge Code	4400043
Hospital Revenue Code	440
Min. Negotiated Rate	$146.30
Max. Negotiated Rate	$177.65
Rate for Payer: Cash Price	$135.85
Rate for Payer: Community Health Alliance Commercial	$177.65
Rate for Payer: Priority Health Commercial	$146.30
Rate for Payer: Priority Health PPO	$146.30

CLIN EVAL OF SWALLOW 92610 NOQ

Facility

$209.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	4400040
Hospital Revenue Code	440
Min. Negotiated Rate	$146.30
Max. Negotiated Rate	$177.65
Rate for Payer: Cash Price	$135.85
Rate for Payer: Community Health Alliance Commercial	$177.65
Rate for Payer: Priority Health Commercial	$146.30
Rate for Payer: Priority Health PPO	$146.30

CLIP APPLIER LIGAMAX

Facility

$208.25

Hospital Charge Code	27275090
Hospital Revenue Code	272
Min. Negotiated Rate	$145.78
Max. Negotiated Rate	$177.01
Rate for Payer: Cash Price	$135.36
Rate for Payer: Community Health Alliance Commercial	$177.01
Rate for Payer: Priority Health Commercial	$145.78
Rate for Payer: Priority Health PPO	$145.78

CLIP FIXING DEV

Facility

$44.00

Hospital Charge Code	27265429
Hospital Revenue Code	272
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

CLIP FIXING DEVICE

Facility

$1,027.00

Hospital Charge Code	27265015
Hospital Revenue Code	272
Min. Negotiated Rate	$718.90
Max. Negotiated Rate	$872.95
Rate for Payer: Cash Price	$667.55
Rate for Payer: Community Health Alliance Commercial	$872.95
Rate for Payer: Priority Health Commercial	$718.90
Rate for Payer: Priority Health PPO	$718.90

CLIP-LEAD WIRE

Facility

$67.00

Hospital Charge Code	27023150
Hospital Revenue Code	270
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$56.95
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health PPO	$46.90

CLIP,OLYMPUS

Facility

$42.00

Hospital Charge Code	27263822
Hospital Revenue Code	272
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$35.70
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health PPO	$29.40

CLIPPING DEVICE ENDOSCOPIC

Facility

$218.05

Hospital Charge Code	27275214
Hospital Revenue Code	272
Min. Negotiated Rate	$152.63
Max. Negotiated Rate	$185.34
Rate for Payer: Cash Price	$141.73
Rate for Payer: Community Health Alliance Commercial	$185.34
Rate for Payer: Priority Health Commercial	$152.63
Rate for Payer: Priority Health PPO	$152.63

CLL-1

Facility

$105.71

Hospital Charge Code	3101449
Hospital Revenue Code	310
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$89.85
Rate for Payer: Cash Price	$68.71
Rate for Payer: Community Health Alliance Commercial	$89.85
Rate for Payer: Priority Health Commercial	$74.00
Rate for Payer: Priority Health PPO	$74.00

CLL-2

Facility

$105.71

Hospital Charge Code	3101450
Hospital Revenue Code	310
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$89.85
Rate for Payer: Cash Price	$68.71
Rate for Payer: Community Health Alliance Commercial	$89.85
Rate for Payer: Priority Health Commercial	$74.00
Rate for Payer: Priority Health PPO	$74.00

CLL-3

Facility

$105.71

Hospital Charge Code	3101451
Hospital Revenue Code	310
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$89.85
Rate for Payer: Cash Price	$68.71
Rate for Payer: Community Health Alliance Commercial	$89.85
Rate for Payer: Priority Health Commercial	$74.00
Rate for Payer: Priority Health PPO	$74.00

CLL-4

Facility

$105.71

Hospital Charge Code	3101452
Hospital Revenue Code	310
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$89.85
Rate for Payer: Cash Price	$68.71
Rate for Payer: Community Health Alliance Commercial	$89.85
Rate for Payer: Priority Health Commercial	$74.00
Rate for Payer: Priority Health PPO	$74.00

CLL-5

Facility

$105.71

Hospital Charge Code	3101453
Hospital Revenue Code	310
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$89.85
Rate for Payer: Cash Price	$68.71
Rate for Payer: Community Health Alliance Commercial	$89.85
Rate for Payer: Priority Health Commercial	$74.00
Rate for Payer: Priority Health PPO	$74.00

CLL-6

Facility

$105.71

Hospital Charge Code	3101454
Hospital Revenue Code	310
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$89.85
Rate for Payer: Cash Price	$68.71
Rate for Payer: Community Health Alliance Commercial	$89.85
Rate for Payer: Priority Health Commercial	$74.00
Rate for Payer: Priority Health PPO	$74.00

CLL-7

Facility

$105.74

Hospital Charge Code	3101455
Hospital Revenue Code	310
Min. Negotiated Rate	$74.02
Max. Negotiated Rate	$89.88
Rate for Payer: Cash Price	$68.73
Rate for Payer: Community Health Alliance Commercial	$89.88
Rate for Payer: Priority Health Commercial	$74.02
Rate for Payer: Priority Health PPO	$74.02

CLOBAZAM

Facility

$71.00

Hospital Charge Code	3101654
Hospital Revenue Code	300
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$60.35
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health PPO	$49.70

CLOMIPRAMINE URINE

Facility

$79.00

Hospital Charge Code	3100783
Hospital Revenue Code	300
Min. Negotiated Rate	$55.30
Max. Negotiated Rate	$67.15
Rate for Payer: Cash Price	$51.35
Rate for Payer: Community Health Alliance Commercial	$67.15
Rate for Payer: Priority Health Commercial	$55.30
Rate for Payer: Priority Health PPO	$55.30

CLONOPIN LEVEL

Facility

$11.54

Service Code	HCPCS 80159
Hospital Charge Code	3005121
Hospital Revenue Code	301
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$21.16
Rate for Payer: BCBS BCN 65	$21.16
Rate for Payer: Blue Care Network Medicare Advantage	$21.16
Rate for Payer: Cash Price	$7.50
Rate for Payer: Cash Price	$7.50
Rate for Payer: Community Health Alliance Commercial	$9.81
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.16
Rate for Payer: Meridian Health Plan Medicare	$21.16
Rate for Payer: Priority Health Commercial	$8.08
Rate for Payer: Priority Health Medicaid	$21.16
Rate for Payer: Priority Health Medicare	$21.16
Rate for Payer: Priority Health PPO	$8.08
Rate for Payer: United Health Care Medicaid	$21.16
Rate for Payer: United Health Care Medicare Advantage	$9.31

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges