Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CLORAZEPATE (TRANXENE)

Facility

$13.32

Service Code	HCPCS G0480
Hospital Charge Code	3005896
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$8.66
Rate for Payer: Cash Price	$8.66
Rate for Payer: Community Health Alliance Commercial	$11.32
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$9.32
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$9.32
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

CLOST. DIFF - ANTIGEN

Facility

$32.00

Service Code	HCPCS 87449
Hospital Charge Code	3003130
Hospital Revenue Code	306
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$27.20
Rate for Payer: BCBS BCN 65	$12.58
Rate for Payer: Blue Care Network Medicare Advantage	$12.58
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Community Health Alliance Commercial	$27.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.58
Rate for Payer: Meridian Health Plan Medicare	$12.58
Rate for Payer: Priority Health Commercial	$22.40
Rate for Payer: Priority Health Medicaid	$12.58
Rate for Payer: Priority Health Medicare	$12.58
Rate for Payer: Priority Health PPO	$22.40
Rate for Payer: United Health Care Medicaid	$12.58
Rate for Payer: United Health Care Medicare Advantage	$5.53

CLOST. DIFF - TOXIN A

Facility

$45.00

Service Code	HCPCS 87324
Hospital Charge Code	3003125
Hospital Revenue Code	306
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$38.25
Rate for Payer: BCBS BCN 65	$12.58
Rate for Payer: Blue Care Network Medicare Advantage	$12.58
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.58
Rate for Payer: Meridian Health Plan Medicare	$12.58
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health Medicaid	$12.58
Rate for Payer: Priority Health Medicare	$12.58
Rate for Payer: Priority Health PPO	$31.50
Rate for Payer: United Health Care Medicaid	$12.58
Rate for Payer: United Health Care Medicare Advantage	$5.53

CLO TEST

Facility

$54.00

Service Code	HCPCS 87077
Hospital Charge Code	3003135
Hospital Revenue Code	306
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$45.90
Rate for Payer: BCBS BCN 65	$8.48
Rate for Payer: Blue Care Network Medicare Advantage	$8.48
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Community Health Alliance Commercial	$45.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.48
Rate for Payer: Meridian Health Plan Medicare	$8.48
Rate for Payer: Priority Health Commercial	$37.80
Rate for Payer: Priority Health Medicaid	$8.48
Rate for Payer: Priority Health Medicare	$8.48
Rate for Payer: Priority Health PPO	$37.80
Rate for Payer: United Health Care Medicaid	$8.48
Rate for Payer: United Health Care Medicare Advantage	$3.73

CLOZAPINE

Facility

$20.00

Service Code	HCPCS 80159
Hospital Charge Code	3002295
Hospital Revenue Code	301
Min. Negotiated Rate	$9.31
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	$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	$21.16
Rate for Payer: Meridian Health Plan Medicare	$21.16
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health Medicaid	$21.16
Rate for Payer: Priority Health Medicare	$21.16
Rate for Payer: Priority Health PPO	$14.00
Rate for Payer: United Health Care Medicaid	$21.16
Rate for Payer: United Health Care Medicare Advantage	$9.31

CMP DNA BY PCR QUANT

Facility

$63.00

Service Code	HCPCS 87497
Hospital Charge Code	3002735
Hospital Revenue Code	306
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$53.55
Rate for Payer: BCBS BCN 65	$44.98
Rate for Payer: Blue Care Network Medicare Advantage	$44.98
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$44.98
Rate for Payer: Meridian Health Plan Medicare	$44.98
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health Medicaid	$44.98
Rate for Payer: Priority Health Medicare	$44.98
Rate for Payer: Priority Health PPO	$44.10
Rate for Payer: United Health Care Medicaid	$44.98
Rate for Payer: United Health Care Medicare Advantage	$19.79

CMP-LC

Facility

$2.90

Hospital Charge Code	3101164
Hospital Revenue Code	301
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.46
Rate for Payer: Cash Price	$1.89
Rate for Payer: Community Health Alliance Commercial	$2.46
Rate for Payer: Priority Health Commercial	$2.03
Rate for Payer: Priority Health PPO	$2.03

CMPLX RPR S/A/L ADDL 5CM/>

Facility

$195.00

Hospital Charge Code	5150787
Hospital Revenue Code	960
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$165.75
Rate for Payer: Cash Price	$126.75
Rate for Payer: Community Health Alliance Commercial	$165.75
Rate for Payer: Priority Health Commercial	$136.50
Rate for Payer: Priority Health PPO	$136.50

CMS DEMYELINATING DISEASE EVAL

Facility

$1,223.00

Hospital Charge Code	3102730
Hospital Revenue Code	300
Min. Negotiated Rate	$856.10
Max. Negotiated Rate	$1,039.55
Rate for Payer: Cash Price	$794.95
Rate for Payer: Community Health Alliance Commercial	$1,039.55
Rate for Payer: Priority Health Commercial	$856.10
Rate for Payer: Priority Health PPO	$856.10

CMSPROFILE-LC1

Facility

$567.60

Hospital Charge Code	3102731
Hospital Revenue Code	300
Min. Negotiated Rate	$397.32
Max. Negotiated Rate	$482.46
Rate for Payer: Cash Price	$368.94
Rate for Payer: Community Health Alliance Commercial	$482.46
Rate for Payer: Priority Health Commercial	$397.32
Rate for Payer: Priority Health PPO	$397.32

CMSPROFILE-LC2

Facility

$567.60

Hospital Charge Code	3102732
Hospital Revenue Code	300
Min. Negotiated Rate	$397.32
Max. Negotiated Rate	$482.46
Rate for Payer: Cash Price	$368.94
Rate for Payer: Community Health Alliance Commercial	$482.46
Rate for Payer: Priority Health Commercial	$397.32
Rate for Payer: Priority Health PPO	$397.32

CMV BY PCR

Facility

$349.00

Service Code	HCPCS 87497
Hospital Charge Code	3003327
Hospital Revenue Code	306
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$296.65
Rate for Payer: BCBS BCN 65	$44.98
Rate for Payer: Blue Care Network Medicare Advantage	$44.98
Rate for Payer: Cash Price	$226.85
Rate for Payer: Cash Price	$226.85
Rate for Payer: Community Health Alliance Commercial	$296.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$44.98
Rate for Payer: Meridian Health Plan Medicare	$44.98
Rate for Payer: Priority Health Commercial	$244.30
Rate for Payer: Priority Health Medicaid	$44.98
Rate for Payer: Priority Health Medicare	$44.98
Rate for Payer: Priority Health PPO	$244.30
Rate for Payer: United Health Care Medicaid	$44.98
Rate for Payer: United Health Care Medicare Advantage	$19.79

CMV - IgG

Facility

$4.60

Service Code	HCPCS 86644
Hospital Charge Code	3003325
Hospital Revenue Code	302
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$15.11
Rate for Payer: BCBS BCN 65	$15.11
Rate for Payer: Blue Care Network Medicare Advantage	$15.11
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cash Price	$2.99
Rate for Payer: Community Health Alliance Commercial	$3.91
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.11
Rate for Payer: Meridian Health Plan Medicare	$15.11
Rate for Payer: Priority Health Commercial	$3.22
Rate for Payer: Priority Health Medicaid	$15.11
Rate for Payer: Priority Health Medicare	$15.11
Rate for Payer: Priority Health PPO	$3.22
Rate for Payer: United Health Care Medicaid	$15.11
Rate for Payer: United Health Care Medicare Advantage	$6.65

CMV NEG EACH UNIT

Facility

$68.00

Hospital Charge Code	3000251
Hospital Revenue Code	302
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

CMV PCR - URINE

Facility

$470.00

Service Code	HCPCS 87496
Hospital Charge Code	3003328
Hospital Revenue Code	306
Min. Negotiated Rate	$16.21
Max. Negotiated Rate	$399.50
Rate for Payer: BCBS BCN 65	$36.84
Rate for Payer: Blue Care Network Medicare Advantage	$36.84
Rate for Payer: Cash Price	$305.50
Rate for Payer: Cash Price	$305.50
Rate for Payer: Community Health Alliance Commercial	$399.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$36.84
Rate for Payer: Meridian Health Plan Medicare	$36.84
Rate for Payer: Priority Health Commercial	$329.00
Rate for Payer: Priority Health Medicaid	$36.84
Rate for Payer: Priority Health Medicare	$36.84
Rate for Payer: Priority Health PPO	$329.00
Rate for Payer: United Health Care Medicaid	$36.84
Rate for Payer: United Health Care Medicare Advantage	$16.21

CO2 ANALYZER

Facility

$104.00

Hospital Charge Code	27019620
Hospital Revenue Code	270
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$88.40
Rate for Payer: Cash Price	$67.60
Rate for Payer: Community Health Alliance Commercial	$88.40
Rate for Payer: Priority Health Commercial	$72.80
Rate for Payer: Priority Health PPO	$72.80

CO-4

Facility

$26.15

Hospital Charge Code	3101521
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

COAPTITE 1CC INJECTABLE SYNTHE

Facility

$608.00

Service Code	HCPCS L8606
Hospital Charge Code	27871864
Hospital Revenue Code	278
Min. Negotiated Rate	$425.60
Max. Negotiated Rate	$516.80
Rate for Payer: Cash Price	$395.20
Rate for Payer: Community Health Alliance Commercial	$516.80
Rate for Payer: Priority Health Commercial	$425.60
Rate for Payer: Priority Health PPO	$425.60

CO AQUATIC THER/EXCER EA 15

Facility

$103.00

Hospital Charge Code	4301419
Hospital Revenue Code	430
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$87.55
Rate for Payer: Cash Price	$66.95
Rate for Payer: Community Health Alliance Commercial	$87.55
Rate for Payer: Priority Health Commercial	$72.10
Rate for Payer: Priority Health PPO	$72.10

COBAN 2

Facility

$16.00

Hospital Charge Code	27015719
Hospital Revenue Code	270
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
Rate for Payer: Priority Health Commercial	$11.20
Rate for Payer: Priority Health PPO	$11.20

COBAN 3

Facility

$20.00

Hospital Charge Code	27015743
Hospital Revenue Code	270
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$17.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health PPO	$14.00

COBAN 4

Facility

$23.00

Hospital Charge Code	27013599
Hospital Revenue Code	270
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$14.95
Rate for Payer: Community Health Alliance Commercial	$19.55
Rate for Payer: Priority Health Commercial	$16.10
Rate for Payer: Priority Health PPO	$16.10

COCAINE MET QUANT URINE

Facility

$13.85

Service Code	HCPCS G0480
Hospital Charge Code	3100902
Hospital Revenue Code	301
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Community Health Alliance Commercial	$11.77
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$9.70
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$9.70
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

COCAINE,PLASMA

Facility

$100.00

Service Code	HCPCS G0480
Hospital Charge Code	3100910
Hospital Revenue Code	309
Min. Negotiated Rate	$52.87
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$70.00
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

COCAINE SCREEN URINE

Facility

$4.50

Hospital Charge Code	3101388
Hospital Revenue Code	300
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.83
Rate for Payer: Cash Price	$2.93
Rate for Payer: Community Health Alliance Commercial	$3.83
Rate for Payer: Priority Health Commercial	$3.15
Rate for Payer: Priority Health PPO	$3.15

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges