Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

COMPLEMENT C4A

Facility

$58.44

Hospital Charge Code	3101158
Hospital Revenue Code	302
Min. Negotiated Rate	$40.91
Max. Negotiated Rate	$49.67
Rate for Payer: Cash Price	$37.99
Rate for Payer: Community Health Alliance Commercial	$49.67
Rate for Payer: Priority Health Commercial	$40.91
Rate for Payer: Priority Health PPO	$40.91

COMPLEMENT C-7

Facility

$58.08

Service Code	HCPCS 86160
Hospital Charge Code	3003300
Hospital Revenue Code	302
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$49.37
Rate for Payer: BCBS BCN 65	$12.60
Rate for Payer: Blue Care Network Medicare Advantage	$12.60
Rate for Payer: Cash Price	$37.75
Rate for Payer: Cash Price	$37.75
Rate for Payer: Community Health Alliance Commercial	$49.37
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	$40.66
Rate for Payer: Priority Health Medicaid	$12.60
Rate for Payer: Priority Health Medicare	$12.60
Rate for Payer: Priority Health PPO	$40.66
Rate for Payer: United Health Care Medicaid	$12.60
Rate for Payer: United Health Care Medicare Advantage	$5.54

COMPLEMENT C-8

Facility

$58.08

Service Code	HCPCS 86160
Hospital Charge Code	3003360
Hospital Revenue Code	302
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$49.37
Rate for Payer: BCBS BCN 65	$12.60
Rate for Payer: Blue Care Network Medicare Advantage	$12.60
Rate for Payer: Cash Price	$37.75
Rate for Payer: Cash Price	$37.75
Rate for Payer: Community Health Alliance Commercial	$49.37
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	$40.66
Rate for Payer: Priority Health Medicaid	$12.60
Rate for Payer: Priority Health Medicare	$12.60
Rate for Payer: Priority Health PPO	$40.66
Rate for Payer: United Health Care Medicaid	$12.60
Rate for Payer: United Health Care Medicare Advantage	$5.54

COMPLEMENT COMPONENT C1Q

Facility

$9.57

Hospital Charge Code	3101118
Hospital Revenue Code	302
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$8.13
Rate for Payer: Cash Price	$6.22
Rate for Payer: Community Health Alliance Commercial	$8.13
Rate for Payer: Priority Health Commercial	$6.70
Rate for Payer: Priority Health PPO	$6.70

COMPLEMENT TOTAL (CH5O)

Facility

$4.00

Service Code	HCPCS 86162
Hospital Charge Code	3002700
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$21.34
Rate for Payer: BCBS BCN 65	$21.34
Rate for Payer: Blue Care Network Medicare Advantage	$21.34
Rate for Payer: Cash Price	$2.60
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.34
Rate for Payer: Meridian Health Plan Medicare	$21.34
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health Medicaid	$21.34
Rate for Payer: Priority Health Medicare	$21.34
Rate for Payer: Priority Health PPO	$2.80
Rate for Payer: United Health Care Medicaid	$21.34
Rate for Payer: United Health Care Medicare Advantage	$9.39

COMPLEX BILATERAL EPISTAXIS

Facility

$518.00

Hospital Charge Code	4500962
Hospital Revenue Code	450
Min. Negotiated Rate	$362.60
Max. Negotiated Rate	$440.30
Rate for Payer: Cash Price	$336.70
Rate for Payer: Community Health Alliance Commercial	$440.30
Rate for Payer: Priority Health Commercial	$362.60
Rate for Payer: Priority Health PPO	$362.60

COMPLEX PREP OF PT CELLS

Facility

$62.00

Hospital Charge Code	3101318
Hospital Revenue Code	300
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$52.70
Rate for Payer: Cash Price	$40.30
Rate for Payer: Community Health Alliance Commercial	$52.70
Rate for Payer: Priority Health Commercial	$43.40
Rate for Payer: Priority Health PPO	$43.40

COMPLEX SINGLE EPISTAXIS

Facility

$260.00

Hospital Charge Code	4500961
Hospital Revenue Code	450
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$221.00
Rate for Payer: Cash Price	$169.00
Rate for Payer: Community Health Alliance Commercial	$221.00
Rate for Payer: Priority Health Commercial	$182.00
Rate for Payer: Priority Health PPO	$182.00

COMPONENT, FEMORAL SIZE D

Facility

$6,181.00

Hospital Charge Code	27263489
Hospital Revenue Code	272
Min. Negotiated Rate	$4,326.70
Max. Negotiated Rate	$5,253.85
Rate for Payer: Cash Price	$4,017.65
Rate for Payer: Community Health Alliance Commercial	$5,253.85
Rate for Payer: Priority Health Commercial	$4,326.70
Rate for Payer: Priority Health PPO	$4,326.70

COMPONENT,TIBIAL PEGGED

Facility

$3,950.00

Hospital Charge Code	27263497
Hospital Revenue Code	272
Min. Negotiated Rate	$2,765.00
Max. Negotiated Rate	$3,357.50
Rate for Payer: Cash Price	$2,567.50
Rate for Payer: Community Health Alliance Commercial	$3,357.50
Rate for Payer: Priority Health Commercial	$2,765.00
Rate for Payer: Priority Health PPO	$2,765.00

COMPREHENSIVE DRUG PANEL

Facility

$60.10

Service Code	HCPCS 80307
Hospital Charge Code	3100884
Hospital Revenue Code	301
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$65.25
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$39.07
Rate for Payer: Cash Price	$39.07
Rate for Payer: Community Health Alliance Commercial	$51.09
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$65.25
Rate for Payer: Meridian Health Plan Medicare	$65.25
Rate for Payer: Priority Health Commercial	$42.07
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$42.07
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

COMPREHENSIVE METABOLIC PANEL

Facility

$86.00

Service Code	HCPCS 80053
Hospital Charge Code	3002730
Hospital Revenue Code	301
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$73.10
Rate for Payer: BCBS BCN 65	$11.09
Rate for Payer: Blue Care Network Medicare Advantage	$11.09
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Community Health Alliance Commercial	$73.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$11.09
Rate for Payer: Meridian Health Plan Medicare	$11.09
Rate for Payer: Priority Health Commercial	$60.20
Rate for Payer: Priority Health Medicaid	$11.09
Rate for Payer: Priority Health Medicare	$11.09
Rate for Payer: Priority Health PPO	$60.20
Rate for Payer: United Health Care Medicaid	$11.09
Rate for Payer: United Health Care Medicare Advantage	$4.88

COMPREHENSIVE METOBOLIC EXEC

Facility

$71.00

Hospital Charge Code	3002731
Hospital Revenue Code	301
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

COMPRESSION PUMP

Facility

$45.00

Service Code	HCPCS 97016 GP
Hospital Charge Code	4200220
Hospital Revenue Code	420
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

COMPRESSION SCREW

Facility

$141.00

Service Code	HCPCS C1713
Hospital Charge Code	27060834
Hospital Revenue Code	278
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$119.85
Rate for Payer: Cash Price	$91.65
Rate for Payer: Community Health Alliance Commercial	$119.85
Rate for Payer: Priority Health Commercial	$98.70
Rate for Payer: Priority Health PPO	$98.70

COMPRESSION TUBE/PLATE

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	27024299
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$595.00
Rate for Payer: Cash Price	$455.00
Rate for Payer: Community Health Alliance Commercial	$595.00
Rate for Payer: Priority Health Commercial	$490.00
Rate for Payer: Priority Health PPO	$490.00

COMPSIX KUGEL HERNIA PATCH

Facility

$1,134.00

Service Code	HCPCS C1781
Hospital Charge Code	27267805
Hospital Revenue Code	278
Min. Negotiated Rate	$793.80
Max. Negotiated Rate	$963.90
Rate for Payer: Cash Price	$737.10
Rate for Payer: Community Health Alliance Commercial	$963.90
Rate for Payer: Priority Health Commercial	$793.80
Rate for Payer: Priority Health PPO	$793.80

CONCENTRATION

Facility

$19.00

Hospital Charge Code	3004753
Hospital Revenue Code	306
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

CONCENTRATION

Facility

$9.00

Hospital Charge Code	3101948
Hospital Revenue Code	300
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$7.65
Rate for Payer: Cash Price	$5.85
Rate for Payer: Community Health Alliance Commercial	$7.65
Rate for Payer: Priority Health Commercial	$6.30
Rate for Payer: Priority Health PPO	$6.30

CO NEUROMUSC RE-ED EA 15 MI

Facility

$86.00

Hospital Charge Code	4300165
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

CONFORMER W/HOLES (MEDIUM)

Facility

$98.00

Hospital Charge Code	27263256
Hospital Revenue Code	270
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$83.30
Rate for Payer: Cash Price	$63.70
Rate for Payer: Community Health Alliance Commercial	$83.30
Rate for Payer: Priority Health Commercial	$68.60
Rate for Payer: Priority Health PPO	$68.60

CONGENITAL DISEASE SCREENING

Facility

$125.88

Hospital Charge Code	3002050
Hospital Revenue Code	301
Min. Negotiated Rate	$88.12
Max. Negotiated Rate	$107.00
Rate for Payer: Cash Price	$81.82
Rate for Payer: Community Health Alliance Commercial	$107.00
Rate for Payer: Priority Health Commercial	$88.12
Rate for Payer: Priority Health PPO	$88.12

CONNECTIVE TISSUE DISEASE PANE

Facility

$25.00

Hospital Charge Code	3101340
Hospital Revenue Code	302
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$21.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Community Health Alliance Commercial	$21.25
Rate for Payer: Priority Health Commercial	$17.50
Rate for Payer: Priority Health PPO	$17.50

CONSTRANT,REG YELLOW 10MM

Facility

$2,648.00

Hospital Charge Code	27263512
Hospital Revenue Code	272
Min. Negotiated Rate	$1,853.60
Max. Negotiated Rate	$2,250.80
Rate for Payer: Cash Price	$1,721.20
Rate for Payer: Community Health Alliance Commercial	$2,250.80
Rate for Payer: Priority Health Commercial	$1,853.60
Rate for Payer: Priority Health PPO	$1,853.60

CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY; WITH TRANSPOSITION OF TARSAL PLATE

Facility

$2,550.43

Service Code	CPT 67882
Hospital Revenue Code	360
Min. Negotiated Rate	$1,122.19
Max. Negotiated Rate	$2,550.43
Rate for Payer: BCBS BCN 65	$2,550.43
Rate for Payer: Blue Care Network Medicare Advantage	$2,550.43
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,550.43
Rate for Payer: Meridian Health Plan Medicare	$2,550.43
Rate for Payer: Priority Health Medicaid	$2,550.43
Rate for Payer: Priority Health Medicare	$2,550.43
Rate for Payer: United Health Care Medicaid	$2,550.43
Rate for Payer: United Health Care Medicare Advantage	$1,122.19

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges