Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

COCCIDIOIDES TO STATE

Facility

$79.00

Service Code	HCPCS 86635
Hospital Charge Code	3003240
Hospital Revenue Code	302
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$67.15
Rate for Payer: BCBS BCN 65	$12.04
Rate for Payer: Blue Care Network Medicare Advantage	$12.04
Rate for Payer: Cash Price	$51.35
Rate for Payer: Cash Price	$51.35
Rate for Payer: Community Health Alliance Commercial	$67.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.04
Rate for Payer: Meridian Health Plan Medicare	$12.04
Rate for Payer: Priority Health Commercial	$55.30
Rate for Payer: Priority Health Medicaid	$12.04
Rate for Payer: Priority Health Medicare	$12.04
Rate for Payer: Priority Health PPO	$55.30
Rate for Payer: United Health Care Medicaid	$12.04
Rate for Payer: United Health Care Medicare Advantage	$5.30

CO CHECK OUT ORTHOTIC

Facility

$32.00

Hospital Charge Code	4300143
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

COCIDIOIDES IGG

Facility

$45.25

Hospital Charge Code	3100584
Hospital Revenue Code	302
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$38.46
Rate for Payer: Cash Price	$29.41
Rate for Payer: Community Health Alliance Commercial	$38.46
Rate for Payer: Priority Health Commercial	$31.68
Rate for Payer: Priority Health PPO	$31.68

COCIDIOIDES IGM

Facility

$45.25

Hospital Charge Code	3100585
Hospital Revenue Code	302
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$38.46
Rate for Payer: Cash Price	$29.41
Rate for Payer: Community Health Alliance Commercial	$38.46
Rate for Payer: Priority Health Commercial	$31.68
Rate for Payer: Priority Health PPO	$31.68

CODE ZERO - RESPIRATORY

Facility

$1,062.00

Service Code	HCPCS 92950
Hospital Charge Code	4800000
Hospital Revenue Code	480
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$902.70
Rate for Payer: BCBS BCN 65	$231.63
Rate for Payer: Blue Care Network Medicare Advantage	$231.63
Rate for Payer: Cash Price	$690.30
Rate for Payer: Cash Price	$690.30
Rate for Payer: Community Health Alliance Commercial	$902.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$231.63
Rate for Payer: Meridian Health Plan Medicare	$231.63
Rate for Payer: Priority Health Commercial	$743.40
Rate for Payer: Priority Health Medicaid	$231.63
Rate for Payer: Priority Health Medicare	$231.63
Rate for Payer: Priority Health PPO	$743.40
Rate for Payer: United Health Care Medicaid	$231.63
Rate for Payer: United Health Care Medicare Advantage	$101.92

COENZYME Q 10

Facility

$19.00

Hospital Charge Code	3101456
Hospital Revenue Code	300
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$16.15
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health PPO	$13.30

CO E STIMULATION ATTENDED

Facility

$117.00

Hospital Charge Code	4300196
Hospital Revenue Code	430
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$99.45
Rate for Payer: Cash Price	$76.05
Rate for Payer: Community Health Alliance Commercial	$99.45
Rate for Payer: Priority Health Commercial	$81.90
Rate for Payer: Priority Health PPO	$81.90

CO E-STIMULATION UNATTENDED

Facility

$142.00

Service Code	HCPCS G0283 GOCO
Hospital Charge Code	4300197
Hospital Revenue Code	430
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$120.70
Rate for Payer: Cash Price	$92.30
Rate for Payer: Community Health Alliance Commercial	$120.70
Rate for Payer: Priority Health Commercial	$99.40
Rate for Payer: Priority Health PPO	$99.40

COGNITIVE SKLS DEV 97532 Q15M

Facility

$56.00

Service Code	HCPCS 97129 GN
Hospital Charge Code	4400045
Hospital Revenue Code	440
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

CO ICE MASSAGE

Facility

$42.00

Hospital Charge Code	4300198
Hospital Revenue Code	430
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

CO IOTOPHORESIS EACH 15 MIN

Facility

$97.00

Hospital Charge Code	4300121
Hospital Revenue Code	430
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.05
Rate for Payer: Community Health Alliance Commercial	$82.45
Rate for Payer: Priority Health Commercial	$67.90
Rate for Payer: Priority Health PPO	$67.90

COLBALT

Facility

$21.99

Service Code	HCPCS 83018
Hospital Charge Code	3002300
Hospital Revenue Code	301
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$23.06
Rate for Payer: BCBS BCN 65	$23.06
Rate for Payer: Blue Care Network Medicare Advantage	$23.06
Rate for Payer: Cash Price	$14.29
Rate for Payer: Cash Price	$14.29
Rate for Payer: Community Health Alliance Commercial	$18.69
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$23.06
Rate for Payer: Meridian Health Plan Medicare	$23.06
Rate for Payer: Priority Health Commercial	$15.39
Rate for Payer: Priority Health Medicaid	$23.06
Rate for Payer: Priority Health Medicare	$23.06
Rate for Payer: Priority Health PPO	$15.39
Rate for Payer: United Health Care Medicaid	$23.06
Rate for Payer: United Health Care Medicare Advantage	$10.15

COLD AGGLUTININ FWRBC

Facility

$51.00

Hospital Charge Code	3101429
Hospital Revenue Code	300
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

COLD AGGLUTININS SCREEN

Facility

$45.00

Service Code	HCPCS 86156
Hospital Charge Code	3002640
Hospital Revenue Code	302
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$38.25
Rate for Payer: BCBS BCN 65	$8.47
Rate for Payer: Blue Care Network Medicare Advantage	$8.47
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	$8.47
Rate for Payer: Meridian Health Plan Medicare	$8.47
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health Medicaid	$8.47
Rate for Payer: Priority Health Medicare	$8.47
Rate for Payer: Priority Health PPO	$31.50
Rate for Payer: United Health Care Medicaid	$8.47
Rate for Payer: United Health Care Medicare Advantage	$3.73

COLD AGGLUTININS TITER

Facility

$53.00

Service Code	HCPCS 86157
Hospital Charge Code	3003260
Hospital Revenue Code	302
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$45.05
Rate for Payer: BCBS BCN 65	$8.46
Rate for Payer: Blue Care Network Medicare Advantage	$8.46
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.46
Rate for Payer: Meridian Health Plan Medicare	$8.46
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$8.46
Rate for Payer: Priority Health Medicare	$8.46
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$8.46
Rate for Payer: United Health Care Medicare Advantage	$3.72

COLD AGGLUTININ TITER LC

Facility

$4.07

Hospital Charge Code	3102029
Hospital Revenue Code	300
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$2.65
Rate for Payer: Community Health Alliance Commercial	$3.46
Rate for Payer: Priority Health Commercial	$2.85
Rate for Payer: Priority Health PPO	$2.85

COLLAGEN IMPLANT

Facility

$1,448.00

Service Code	HCPCS C1763
Hospital Charge Code	27017012
Hospital Revenue Code	278
Min. Negotiated Rate	$1,013.60
Max. Negotiated Rate	$1,230.80
Rate for Payer: Cash Price	$941.20
Rate for Payer: Community Health Alliance Commercial	$1,230.80
Rate for Payer: Priority Health Commercial	$1,013.60
Rate for Payer: Priority Health PPO	$1,013.60

COLLAGEN IMPLANT

Facility

$762.00

Hospital Charge Code	27817012
Hospital Revenue Code	278
Min. Negotiated Rate	$533.40
Max. Negotiated Rate	$647.70
Rate for Payer: Cash Price	$495.30
Rate for Payer: Community Health Alliance Commercial	$647.70
Rate for Payer: Priority Health Commercial	$533.40
Rate for Payer: Priority Health PPO	$533.40

COLLAR FOAM CERVICAL

Facility

$51.00

Hospital Charge Code	27013185
Hospital Revenue Code	270
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

COLON CYTO BRUSH #CCB-7-240-3

Facility

$58.00

Hospital Charge Code	27263669
Hospital Revenue Code	272
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

COLON DECOMPRESSION SET

Facility

$432.00

Hospital Charge Code	27265817
Hospital Revenue Code	272
Min. Negotiated Rate	$302.40
Max. Negotiated Rate	$367.20
Rate for Payer: Cash Price	$280.80
Rate for Payer: Community Health Alliance Commercial	$367.20
Rate for Payer: Priority Health Commercial	$302.40
Rate for Payer: Priority Health PPO	$302.40

COLONOSCOPY AND BIOPSY P/C

Facility

$851.00

Hospital Charge Code	5150682
Hospital Revenue Code	960
Min. Negotiated Rate	$595.70
Max. Negotiated Rate	$723.35
Rate for Payer: Cash Price	$553.15
Rate for Payer: Community Health Alliance Commercial	$723.35
Rate for Payer: Priority Health Commercial	$595.70
Rate for Payer: Priority Health PPO	$595.70

COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$997.61

Service Code	CPT 45378
Hospital Revenue Code	360
Min. Negotiated Rate	$438.95
Max. Negotiated Rate	$997.61
Rate for Payer: BCBS BCN 65	$997.61
Rate for Payer: Blue Care Network Medicare Advantage	$997.61
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$997.61
Rate for Payer: Meridian Health Plan Medicare	$997.61
Rate for Payer: Priority Health Medicaid	$997.61
Rate for Payer: Priority Health Medicare	$997.61
Rate for Payer: United Health Care Medicaid	$997.61
Rate for Payer: United Health Care Medicare Advantage	$438.95

COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$1,283.69

Service Code	CPT 45380
Hospital Revenue Code	360
Min. Negotiated Rate	$564.82
Max. Negotiated Rate	$1,283.69
Rate for Payer: BCBS BCN 65	$1,283.69
Rate for Payer: Blue Care Network Medicare Advantage	$1,283.69
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,283.69
Rate for Payer: Meridian Health Plan Medicare	$1,283.69
Rate for Payer: Priority Health Medicaid	$1,283.69
Rate for Payer: Priority Health Medicare	$1,283.69
Rate for Payer: United Health Care Medicaid	$1,283.69
Rate for Payer: United Health Care Medicare Advantage	$564.82

COLONOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD

Facility

$1,283.69

Service Code	CPT 45382
Hospital Revenue Code	360
Min. Negotiated Rate	$564.82
Max. Negotiated Rate	$1,283.69
Rate for Payer: BCBS BCN 65	$1,283.69
Rate for Payer: Blue Care Network Medicare Advantage	$1,283.69
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$1,283.69
Rate for Payer: Meridian Health Plan Medicare	$1,283.69
Rate for Payer: Priority Health Medicaid	$1,283.69
Rate for Payer: Priority Health Medicare	$1,283.69
Rate for Payer: United Health Care Medicaid	$1,283.69
Rate for Payer: United Health Care Medicare Advantage	$564.82

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges