Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CONSULTATION,PROF(OUT SERVICE)

Facility

$417.00

Service Code	HCPCS 88325 26
Hospital Charge Code	9710610
Hospital Revenue Code	971
Min. Negotiated Rate	$291.90
Max. Negotiated Rate	$354.45
Rate for Payer: Cash Price	$271.05
Rate for Payer: Community Health Alliance Commercial	$354.45
Rate for Payer: Priority Health Commercial	$291.90
Rate for Payer: Priority Health PPO	$291.90

CON'T BREATHING TX EA ADD'L HR

Facility

$141.00

Hospital Charge Code	4100076
Hospital Revenue Code	410
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

CONTINUOUS BREATHING TREATMENT

Facility

$141.00

Hospital Charge Code	4100075
Hospital Revenue Code	410
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

CONTRAST BATHS EACH 15 MINUTES

Facility

$33.00

Service Code	HCPCS 97034 GP
Hospital Charge Code	4200051
Hospital Revenue Code	420
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$28.05
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health PPO	$23.10

CONTROL PUMP FGS

Facility

$7,438.00

Hospital Charge Code	27268415
Hospital Revenue Code	272
Min. Negotiated Rate	$5,206.60
Max. Negotiated Rate	$6,322.30
Rate for Payer: Cash Price	$4,834.70
Rate for Payer: Community Health Alliance Commercial	$6,322.30
Rate for Payer: Priority Health Commercial	$5,206.60
Rate for Payer: Priority Health PPO	$5,206.60

COOMBS DIRECT IGG SBMF

Facility

$16.10

Hospital Charge Code	3101149
Hospital Revenue Code	300
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$13.69
Rate for Payer: Cash Price	$10.47
Rate for Payer: Community Health Alliance Commercial	$13.69
Rate for Payer: Priority Health Commercial	$11.27
Rate for Payer: Priority Health PPO	$11.27

COOMBS, DIRECT-R

Facility

$42.00

Hospital Charge Code	3100069
Hospital Revenue Code	300
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

COOMBS DIRECT SBMF

Facility

$16.10

Hospital Charge Code	3101148
Hospital Revenue Code	300
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$13.69
Rate for Payer: Cash Price	$10.47
Rate for Payer: Community Health Alliance Commercial	$13.69
Rate for Payer: Priority Health Commercial	$11.27
Rate for Payer: Priority Health PPO	$11.27

COOMBS TEST INDIRECT TITER-R

Facility

$50.00

Hospital Charge Code	3100079
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

CO ORTHOTIC FIT AND TRAINING

Facility

$120.00

Hospital Charge Code	4300142
Hospital Revenue Code	430
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$102.00
Rate for Payer: Priority Health PPO	$84.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Priority Health Commercial	$84.00

CO PARAFFIN BATH

Facility

$56.00

Hospital Charge Code	4300155
Hospital Revenue Code	430
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

COPOLYMER 40GM

Facility

$273.00

Hospital Charge Code	27060842
Hospital Revenue Code	270
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$232.05
Rate for Payer: Cash Price	$177.45
Rate for Payer: Community Health Alliance Commercial	$232.05
Rate for Payer: Priority Health Commercial	$191.10
Rate for Payer: Priority Health PPO	$191.10

COPOLYMER 80 GM

Facility

$489.00

Hospital Charge Code	27060859
Hospital Revenue Code	270
Min. Negotiated Rate	$342.30
Max. Negotiated Rate	$415.65
Rate for Payer: Cash Price	$317.85
Rate for Payer: Community Health Alliance Commercial	$415.65
Rate for Payer: Priority Health Commercial	$342.30
Rate for Payer: Priority Health PPO	$342.30

COPPER FREE DIRECT

Facility

$90.00

Hospital Charge Code	3101082
Hospital Revenue Code	301
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$76.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Community Health Alliance Commercial	$76.50
Rate for Payer: Priority Health Commercial	$63.00
Rate for Payer: Priority Health PPO	$63.00

COPPER RBC

Facility

$21.25

Hospital Charge Code	3101410
Hospital Revenue Code	300
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$18.06
Rate for Payer: Cash Price	$13.81
Rate for Payer: Community Health Alliance Commercial	$18.06
Rate for Payer: Priority Health Commercial	$14.88
Rate for Payer: Priority Health PPO	$14.88

COPPER RBC AND PLASMA

Facility

$26.25

Hospital Charge Code	3101548
Hospital Revenue Code	300
Min. Negotiated Rate	$18.38
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$17.06
Rate for Payer: Community Health Alliance Commercial	$22.31
Rate for Payer: Priority Health Commercial	$18.38
Rate for Payer: Priority Health PPO	$18.38

COPPER, SE

Facility

$5.00

Service Code	HCPCS 82525
Hospital Charge Code	3002740
Hospital Revenue Code	301
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$13.03
Rate for Payer: BCBS BCN 65	$13.03
Rate for Payer: Blue Care Network Medicare Advantage	$13.03
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.03
Rate for Payer: Meridian Health Plan Medicare	$13.03
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health Medicaid	$13.03
Rate for Payer: Priority Health Medicare	$13.03
Rate for Payer: Priority Health PPO	$3.50
Rate for Payer: United Health Care Medicaid	$13.03
Rate for Payer: United Health Care Medicare Advantage	$5.73

COPPER WHOLE BLOOD

Facility

$35.60

Hospital Charge Code	3102592
Hospital Revenue Code	300
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$30.26
Rate for Payer: Cash Price	$23.14
Rate for Payer: Community Health Alliance Commercial	$30.26
Rate for Payer: Priority Health Commercial	$24.92
Rate for Payer: Priority Health PPO	$24.92

CO PROSTHETIC TRAINING

Facility

$104.00

Hospital Charge Code	4300144
Hospital Revenue Code	430
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

CORDARONE

Facility

$129.00

Service Code	HCPCS 80299
Hospital Charge Code	3002750
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$109.65
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Community Health Alliance Commercial	$109.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.57
Rate for Payer: Meridian Health Plan Medicare	$19.57
Rate for Payer: Priority Health Commercial	$90.30
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$90.30
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

CORDIS, AVIATOR BALLOON

Facility

$977.00

Service Code	HCPCS C1725
Hospital Charge Code	27271848
Hospital Revenue Code	272
Min. Negotiated Rate	$683.90
Max. Negotiated Rate	$830.45
Rate for Payer: Cash Price	$635.05
Rate for Payer: Community Health Alliance Commercial	$830.45
Rate for Payer: Priority Health Commercial	$683.90
Rate for Payer: Priority Health PPO	$683.90

CORNEAL TISSUE IMPLANT

Facility

$7,254.00

Hospital Charge Code	27060974
Hospital Revenue Code	278
Min. Negotiated Rate	$5,077.80
Max. Negotiated Rate	$6,165.90
Rate for Payer: Cash Price	$4,715.10
Rate for Payer: Community Health Alliance Commercial	$6,165.90
Rate for Payer: Priority Health Commercial	$5,077.80
Rate for Payer: Priority Health PPO	$5,077.80

CORNEAL TREPHINE (ALL SIZES)

Facility

$300.00

Hospital Charge Code	27865569
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$255.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Community Health Alliance Commercial	$255.00
Rate for Payer: Priority Health Commercial	$210.00
Rate for Payer: Priority Health PPO	$210.00

CORN IGG4

Facility

$26.00

Hospital Charge Code	3100724
Hospital Revenue Code	302
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

CORONAVIRUS

Facility

$51.31

Hospital Charge Code	3101622
Hospital Revenue Code	300
Min. Negotiated Rate	$35.92
Max. Negotiated Rate	$43.61
Rate for Payer: Cash Price	$33.35
Rate for Payer: Community Health Alliance Commercial	$43.61
Rate for Payer: Priority Health Commercial	$35.92
Rate for Payer: Priority Health PPO	$35.92

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges