Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE

Facility

$1,283.69

Service Code	CPT 45381
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 REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS

Facility

$1,283.69

Service Code	CPT 45384
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 REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$1,283.69

Service Code	CPT 45385
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 SUBMUCOUS NJX

Facility

$1,605.00

Hospital Charge Code	5150700
Hospital Revenue Code	960
Min. Negotiated Rate	$1,123.50
Max. Negotiated Rate	$1,364.25
Rate for Payer: Cash Price	$1,043.25
Rate for Payer: Community Health Alliance Commercial	$1,364.25
Rate for Payer: Priority Health Commercial	$1,123.50
Rate for Payer: Priority Health PPO	$1,123.50

COLONOSCOPY THROUGH STOMA

Facility

$1,152.00

Hospital Charge Code	5150774
Hospital Revenue Code	960
Min. Negotiated Rate	$806.40
Max. Negotiated Rate	$979.20
Rate for Payer: Cash Price	$748.80
Rate for Payer: Community Health Alliance Commercial	$979.20
Rate for Payer: Priority Health Commercial	$806.40
Rate for Payer: Priority Health PPO	$806.40

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

Facility

$997.61

Service Code	CPT 44388
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 WITH CONTROL BLEED

Facility

$1,605.00

Hospital Charge Code	5150755
Hospital Revenue Code	960
Min. Negotiated Rate	$1,123.50
Max. Negotiated Rate	$1,364.25
Rate for Payer: Cash Price	$1,043.25
Rate for Payer: Community Health Alliance Commercial	$1,364.25
Rate for Payer: Priority Health Commercial	$1,123.50
Rate for Payer: Priority Health PPO	$1,123.50

COLONOSCOPY WITH LESION REM

Facility

$1,599.00

Hospital Charge Code	5150708
Hospital Revenue Code	960
Min. Negotiated Rate	$1,119.30
Max. Negotiated Rate	$1,359.15
Rate for Payer: Cash Price	$1,039.35
Rate for Payer: Community Health Alliance Commercial	$1,359.15
Rate for Payer: Priority Health Commercial	$1,119.30
Rate for Payer: Priority Health PPO	$1,119.30

COLONOSCOPY W/LES REMOVAL P/C

Facility

$822.00

Hospital Charge Code	5150686
Hospital Revenue Code	960
Min. Negotiated Rate	$575.40
Max. Negotiated Rate	$698.70
Rate for Payer: Cash Price	$534.30
Rate for Payer: Community Health Alliance Commercial	$698.70
Rate for Payer: Priority Health Commercial	$575.40
Rate for Payer: Priority Health PPO	$575.40

COLONOSCOPY W/RESECTION

Facility

$1,893.00

Hospital Charge Code	5150740
Hospital Revenue Code	960
Min. Negotiated Rate	$1,325.10
Max. Negotiated Rate	$1,609.05
Rate for Payer: Cash Price	$1,230.45
Rate for Payer: Community Health Alliance Commercial	$1,609.05
Rate for Payer: Priority Health Commercial	$1,325.10
Rate for Payer: Priority Health PPO	$1,325.10

COLONOSCPY W/ABLATION PC

Facility

$1,893.00

Hospital Charge Code	5150741
Hospital Revenue Code	960
Min. Negotiated Rate	$1,325.10
Max. Negotiated Rate	$1,609.05
Rate for Payer: Cash Price	$1,230.45
Rate for Payer: Community Health Alliance Commercial	$1,609.05
Rate for Payer: Priority Health Commercial	$1,325.10
Rate for Payer: Priority Health PPO	$1,325.10

COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK

Facility

$997.61

Service Code	CPT G0105
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

COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK

Facility

$997.61

Service Code	CPT G0121
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

COLOSTOMY IRRIGATION SET

Facility

$101.00

Hospital Charge Code	27011569
Hospital Revenue Code	270
Min. Negotiated Rate	$70.70
Max. Negotiated Rate	$85.85
Rate for Payer: Cash Price	$65.65
Rate for Payer: Community Health Alliance Commercial	$85.85
Rate for Payer: Priority Health Commercial	$70.70
Rate for Payer: Priority Health PPO	$70.70

COLOSTOMY KIT 2 3/4

Facility

$146.00

Hospital Charge Code	27016659
Hospital Revenue Code	270
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$124.10
Rate for Payer: Cash Price	$94.90
Rate for Payer: Community Health Alliance Commercial	$124.10
Rate for Payer: Priority Health Commercial	$102.20
Rate for Payer: Priority Health PPO	$102.20

COLOSTOMY KIT 4

Facility

$231.00

Hospital Charge Code	27016287
Hospital Revenue Code	270
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$196.35
Rate for Payer: Cash Price	$150.15
Rate for Payer: Community Health Alliance Commercial	$196.35
Rate for Payer: Priority Health Commercial	$161.70
Rate for Payer: Priority Health PPO	$161.70

COLOSTOMY POUCH

Facility

$19.00

Hospital Charge Code	27018952
Hospital Revenue Code	270
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

COLOSTOMY WAFER

Facility

$71.00

Hospital Charge Code	27018945
Hospital Revenue Code	270
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

CO MANUAL THERAPY EA 15 MINS

Facility

$86.00

Hospital Charge Code	4300185
Hospital Revenue Code	430
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$73.10
Rate for Payer: Cash Price	$55.90
Rate for Payer: Community Health Alliance Commercial	$73.10
Rate for Payer: Priority Health Commercial	$60.20
Rate for Payer: Priority Health PPO	$60.20

CO MASSAGE EACH 15 MINUTES

Facility

$89.00

Hospital Charge Code	4300175
Hospital Revenue Code	430
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$75.65
Rate for Payer: Cash Price	$57.85
Rate for Payer: Community Health Alliance Commercial	$75.65
Rate for Payer: Priority Health Commercial	$62.30
Rate for Payer: Priority Health PPO	$62.30

COMBITUBE

Facility

$352.00

Hospital Charge Code	27061667
Hospital Revenue Code	270
Min. Negotiated Rate	$246.40
Max. Negotiated Rate	$299.20
Rate for Payer: Cash Price	$228.80
Rate for Payer: Community Health Alliance Commercial	$299.20
Rate for Payer: Priority Health Commercial	$246.40
Rate for Payer: Priority Health PPO	$246.40

COMBO CATH

Facility

$365.00

Hospital Charge Code	27261782
Hospital Revenue Code	272
Min. Negotiated Rate	$255.50
Max. Negotiated Rate	$310.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Community Health Alliance Commercial	$310.25
Rate for Payer: Priority Health Commercial	$255.50
Rate for Payer: Priority Health PPO	$255.50

COMPLEMENT C-2

Facility

$17.92

Service Code	HCPCS 86160
Hospital Charge Code	3003350
Hospital Revenue Code	302
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$15.23
Rate for Payer: BCBS BCN 65	$12.60
Rate for Payer: Blue Care Network Medicare Advantage	$12.60
Rate for Payer: Cash Price	$11.65
Rate for Payer: Cash Price	$11.65
Rate for Payer: Community Health Alliance Commercial	$15.23
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	$12.54
Rate for Payer: Priority Health Medicaid	$12.60
Rate for Payer: Priority Health Medicare	$12.60
Rate for Payer: Priority Health PPO	$12.54
Rate for Payer: United Health Care Medicaid	$12.60
Rate for Payer: United Health Care Medicare Advantage	$5.54

COMPLEMENT C-3

Facility

$2.85

Service Code	HCPCS 86160
Hospital Charge Code	3002660
Hospital Revenue Code	302
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$12.60
Rate for Payer: BCBS BCN 65	$12.60
Rate for Payer: Blue Care Network Medicare Advantage	$12.60
Rate for Payer: Cash Price	$1.85
Rate for Payer: Cash Price	$1.85
Rate for Payer: Community Health Alliance Commercial	$2.42
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	$2.00
Rate for Payer: Priority Health Medicaid	$12.60
Rate for Payer: Priority Health Medicare	$12.60
Rate for Payer: Priority Health PPO	$2.00
Rate for Payer: United Health Care Medicaid	$12.60
Rate for Payer: United Health Care Medicare Advantage	$5.54

COMPLEMENT C-4

Facility

$2.85

Service Code	HCPCS 86160
Hospital Charge Code	3002680
Hospital Revenue Code	302
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$12.60
Rate for Payer: BCBS BCN 65	$12.60
Rate for Payer: Blue Care Network Medicare Advantage	$12.60
Rate for Payer: Cash Price	$1.85
Rate for Payer: Cash Price	$1.85
Rate for Payer: Community Health Alliance Commercial	$2.42
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	$2.00
Rate for Payer: Priority Health Medicaid	$12.60
Rate for Payer: Priority Health Medicare	$12.60
Rate for Payer: Priority Health PPO	$2.00
Rate for Payer: United Health Care Medicaid	$12.60
Rate for Payer: United Health Care Medicare Advantage	$5.54

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges