Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ACTH4-4

Facility

$12.14

Hospital Charge Code	3102207
Hospital Revenue Code	300
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$10.32
Rate for Payer: Cash Price	$7.89
Rate for Payer: Community Health Alliance Commercial	$10.32
Rate for Payer: Priority Health Commercial	$8.50
Rate for Payer: Priority Health PPO	$8.50

ACTICOAT ROPE

Facility

$51.00

Hospital Charge Code	27266625
Hospital Revenue Code	272
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

ACUCISE CATHETER

Facility

$1,251.00

Hospital Charge Code	27017160
Hospital Revenue Code	270
Min. Negotiated Rate	$875.70
Max. Negotiated Rate	$1,063.35
Rate for Payer: Cash Price	$813.15
Rate for Payer: Community Health Alliance Commercial	$1,063.35
Rate for Payer: Priority Health Commercial	$875.70
Rate for Payer: Priority Health PPO	$875.70

ACYLCARNITINE, QUANT

Facility

$67.75

Hospital Charge Code	30004118
Hospital Revenue Code	301
Min. Negotiated Rate	$47.42
Max. Negotiated Rate	$57.59
Rate for Payer: Cash Price	$44.04
Rate for Payer: Community Health Alliance Commercial	$57.59
Rate for Payer: Priority Health Commercial	$47.42
Rate for Payer: Priority Health PPO	$47.42

ACYLGLCINES QUANT URINE

Facility

$207.90

Hospital Charge Code	3005156
Hospital Revenue Code	301
Min. Negotiated Rate	$145.53
Max. Negotiated Rate	$176.72
Rate for Payer: Cash Price	$135.14
Rate for Payer: Community Health Alliance Commercial	$176.72
Rate for Payer: Priority Health Commercial	$145.53
Rate for Payer: Priority Health PPO	$145.53

ADA-LC1

Facility

$67.50

Hospital Charge Code	31027699
Hospital Revenue Code	300
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$57.38
Rate for Payer: Cash Price	$43.88
Rate for Payer: Community Health Alliance Commercial	$57.38
Rate for Payer: Priority Health Commercial	$47.25
Rate for Payer: Priority Health PPO	$47.25

ADA-LC2

Facility

$67.50

Hospital Charge Code	31027700
Hospital Revenue Code	300
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$57.38
Rate for Payer: Cash Price	$43.88
Rate for Payer: Community Health Alliance Commercial	$57.38
Rate for Payer: Priority Health Commercial	$47.25
Rate for Payer: Priority Health PPO	$47.25

ADALIMUMAB

Facility

$135.00

Hospital Charge Code	31027698
Hospital Revenue Code	300
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$114.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Community Health Alliance Commercial	$114.75
Rate for Payer: Priority Health Commercial	$94.50
Rate for Payer: Priority Health PPO	$94.50

ADAMTS13 AB

Facility

$170.00

Hospital Charge Code	3102185
Hospital Revenue Code	300
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$144.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Community Health Alliance Commercial	$144.50
Rate for Payer: Priority Health Commercial	$119.00
Rate for Payer: Priority Health PPO	$119.00

ADAPTER,4FR ROUND TIP URETERL

Facility

$33.00

Hospital Charge Code	27263386
Hospital Revenue Code	272
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

ADAPTERS, SIDE ARM

Facility

$44.00

Hospital Charge Code	27265676
Hospital Revenue Code	272
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

ADAPTIC DRESSING

Facility

$15.00

Hospital Charge Code	27013482
Hospital Revenue Code	270
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

ADCON-L

Facility

$2,249.00

Hospital Charge Code	27061313
Hospital Revenue Code	270
Min. Negotiated Rate	$1,574.30
Max. Negotiated Rate	$1,911.65
Rate for Payer: Cash Price	$1,461.85
Rate for Payer: Community Health Alliance Commercial	$1,911.65
Rate for Payer: Priority Health Commercial	$1,574.30
Rate for Payer: Priority Health PPO	$1,574.30

ADDITIONAL HIGH RESOLUTION STU

Facility

$171.00

Hospital Charge Code	3000717
Hospital Revenue Code	311
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$145.35
Rate for Payer: Cash Price	$111.15
Rate for Payer: Community Health Alliance Commercial	$145.35
Rate for Payer: Priority Health Commercial	$119.70
Rate for Payer: Priority Health PPO	$119.70

ADDITIONAL SPEC BEYOND 1ST 3

Facility

$39.00

Service Code	HCPCS 82952
Hospital Charge Code	3004612
Hospital Revenue Code	301
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$33.15
Rate for Payer: BCBS BCN 65	$4.12
Rate for Payer: Blue Care Network Medicare Advantage	$4.12
Rate for Payer: Cash Price	$25.35
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.12
Rate for Payer: Meridian Health Plan Medicare	$4.12
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health Medicaid	$4.12
Rate for Payer: Priority Health Medicare	$4.12
Rate for Payer: Priority Health PPO	$27.30
Rate for Payer: United Health Care Medicaid	$4.12
Rate for Payer: United Health Care Medicare Advantage	$1.81

ADDITIONAL SPEC BEYOND 1ST 3

Facility

$39.00

Service Code	HCPCS 82952
Hospital Charge Code	3004614
Hospital Revenue Code	301
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$33.15
Rate for Payer: BCBS BCN 65	$4.12
Rate for Payer: Blue Care Network Medicare Advantage	$4.12
Rate for Payer: Cash Price	$25.35
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.12
Rate for Payer: Meridian Health Plan Medicare	$4.12
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health Medicaid	$4.12
Rate for Payer: Priority Health Medicare	$4.12
Rate for Payer: Priority Health PPO	$27.30
Rate for Payer: United Health Care Medicaid	$4.12
Rate for Payer: United Health Care Medicare Advantage	$1.81

ADDITIONAL SPEC BEYOND 1ST 3

Facility

$39.00

Service Code	HCPCS 82952
Hospital Charge Code	3004613
Hospital Revenue Code	301
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$33.15
Rate for Payer: BCBS BCN 65	$4.12
Rate for Payer: Blue Care Network Medicare Advantage	$4.12
Rate for Payer: Cash Price	$25.35
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.12
Rate for Payer: Meridian Health Plan Medicare	$4.12
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health Medicaid	$4.12
Rate for Payer: Priority Health Medicare	$4.12
Rate for Payer: Priority Health PPO	$27.30
Rate for Payer: United Health Care Medicaid	$4.12
Rate for Payer: United Health Care Medicare Advantage	$1.81

ADDP-1

Facility

$22.58

Hospital Charge Code	3101674
Hospital Revenue Code	300
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$19.19
Rate for Payer: Cash Price	$14.68
Rate for Payer: Community Health Alliance Commercial	$19.19
Rate for Payer: Priority Health Commercial	$15.81
Rate for Payer: Priority Health PPO	$15.81

ADDP-2

Facility

$22.58

Hospital Charge Code	3101675
Hospital Revenue Code	300
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$19.19
Rate for Payer: Cash Price	$14.68
Rate for Payer: Community Health Alliance Commercial	$19.19
Rate for Payer: Priority Health Commercial	$15.81
Rate for Payer: Priority Health PPO	$15.81

ADDP-3

Facility

$22.59

Hospital Charge Code	3101676
Hospital Revenue Code	300
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$19.20
Rate for Payer: Cash Price	$14.68
Rate for Payer: Community Health Alliance Commercial	$19.20
Rate for Payer: Priority Health Commercial	$15.81
Rate for Payer: Priority Health PPO	$15.81

ADENOVIRUS ANTIBODY, SERUM

Facility

$9.77

Service Code	HCPCS 86603
Hospital Charge Code	3000290
Hospital Revenue Code	302
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.51
Rate for Payer: BCBS BCN 65	$13.51
Rate for Payer: Blue Care Network Medicare Advantage	$13.51
Rate for Payer: Cash Price	$6.35
Rate for Payer: Cash Price	$6.35
Rate for Payer: Community Health Alliance Commercial	$8.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.51
Rate for Payer: Meridian Health Plan Medicare	$13.51
Rate for Payer: Priority Health Commercial	$6.84
Rate for Payer: Priority Health Medicaid	$13.51
Rate for Payer: Priority Health Medicare	$13.51
Rate for Payer: Priority Health PPO	$6.84
Rate for Payer: United Health Care Medicaid	$13.51
Rate for Payer: United Health Care Medicare Advantage	$5.95

ADENOVIRUS PCR

Facility

$195.00

Hospital Charge Code	3101390
Hospital Revenue Code	300
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

ADHESION BARRIER

Facility

$665.00

Service Code	HCPCS C1765
Hospital Charge Code	27017905
Hospital Revenue Code	278
Min. Negotiated Rate	$465.50
Max. Negotiated Rate	$565.25
Rate for Payer: Cash Price	$432.25
Rate for Payer: Community Health Alliance Commercial	$565.25
Rate for Payer: Priority Health Commercial	$465.50
Rate for Payer: Priority Health PPO	$465.50

ADHESIVE PASTE FOR OSTOMY APPL

Facility

$68.00

Hospital Charge Code	27011536
Hospital Revenue Code	270
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

ADJUSTIBLE OUTRIGG FINGER KIT

Facility

$29.00

Hospital Charge Code	27019737
Hospital Revenue Code	270
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$24.65
Rate for Payer: Cash Price	$18.85
Rate for Payer: Community Health Alliance Commercial	$24.65
Rate for Payer: Priority Health Commercial	$20.30
Rate for Payer: Priority Health PPO	$20.30

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges