Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)

Facility

$3,510.01

Service Code	CPT 28285
Hospital Revenue Code	360
Min. Negotiated Rate	$1,544.41
Max. Negotiated Rate	$3,510.01
Rate for Payer: BCBS BCN 65	$3,510.01
Rate for Payer: Blue Care Network Medicare Advantage	$3,510.01
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,510.01
Rate for Payer: Meridian Health Plan Medicare	$3,510.01
Rate for Payer: Priority Health Medicaid	$3,510.01
Rate for Payer: Priority Health Medicare	$3,510.01
Rate for Payer: United Health Care Medicaid	$3,510.01
Rate for Payer: United Health Care Medicare Advantage	$1,544.41

CORT FREE W/CBG

Facility

$40.93

Hospital Charge Code	31027715
Hospital Revenue Code	300
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$34.79
Rate for Payer: Cash Price	$26.60
Rate for Payer: Community Health Alliance Commercial	$34.79
Rate for Payer: Priority Health Commercial	$28.65
Rate for Payer: Priority Health PPO	$28.65

CORTICAL BONE DRILL-3.2MM

Facility

$149.00

Hospital Charge Code	27268043
Hospital Revenue Code	272
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$126.65
Rate for Payer: Cash Price	$96.85
Rate for Payer: Community Health Alliance Commercial	$126.65
Rate for Payer: Priority Health Commercial	$104.30
Rate for Payer: Priority Health PPO	$104.30

CORTICOSTEROID BINDING

Facility

$20.77

Hospital Charge Code	3102591
Hospital Revenue Code	300
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$17.65
Rate for Payer: Cash Price	$13.50
Rate for Payer: Community Health Alliance Commercial	$17.65
Rate for Payer: Priority Health Commercial	$14.54
Rate for Payer: Priority Health PPO	$14.54

CORTISOL- FREE

Facility

$10.41

Service Code	HCPCS 82530
Hospital Charge Code	3003400
Hospital Revenue Code	301
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$17.55
Rate for Payer: BCBS BCN 65	$17.55
Rate for Payer: Blue Care Network Medicare Advantage	$17.55
Rate for Payer: Cash Price	$6.77
Rate for Payer: Cash Price	$6.77
Rate for Payer: Community Health Alliance Commercial	$8.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.55
Rate for Payer: Meridian Health Plan Medicare	$17.55
Rate for Payer: Priority Health Commercial	$7.29
Rate for Payer: Priority Health Medicaid	$17.55
Rate for Payer: Priority Health Medicare	$17.55
Rate for Payer: Priority Health PPO	$7.29
Rate for Payer: United Health Care Medicaid	$17.55
Rate for Payer: United Health Care Medicare Advantage	$7.72

CORTISOL- PLASMA

Facility

$2.28

Service Code	HCPCS 82533
Hospital Charge Code	3003460
Hospital Revenue Code	301
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$17.11
Rate for Payer: BCBS BCN 65	$17.11
Rate for Payer: Blue Care Network Medicare Advantage	$17.11
Rate for Payer: Cash Price	$1.48
Rate for Payer: Cash Price	$1.48
Rate for Payer: Community Health Alliance Commercial	$1.94
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.11
Rate for Payer: Meridian Health Plan Medicare	$17.11
Rate for Payer: Priority Health Commercial	$1.60
Rate for Payer: Priority Health Medicaid	$17.11
Rate for Payer: Priority Health Medicare	$17.11
Rate for Payer: Priority Health PPO	$1.60
Rate for Payer: United Health Care Medicaid	$17.11
Rate for Payer: United Health Care Medicare Advantage	$7.53

CORTISOL TOTAL

Facility

$80.00

Hospital Charge Code	3009424
Hospital Revenue Code	301
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Community Health Alliance Commercial	$68.00
Rate for Payer: Priority Health Commercial	$56.00
Rate for Payer: Priority Health PPO	$56.00

CORTISOL TOTAL

Facility

$2.88

Hospital Charge Code	3009423
Hospital Revenue Code	301
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.45
Rate for Payer: Cash Price	$1.87
Rate for Payer: Community Health Alliance Commercial	$2.45
Rate for Payer: Priority Health Commercial	$2.02
Rate for Payer: Priority Health PPO	$2.02

CORTISOL TOTAL URINE

Facility

$63.00

Service Code	HCPCS 82533
Hospital Charge Code	3008130
Hospital Revenue Code	300
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$53.55
Rate for Payer: BCBS BCN 65	$17.11
Rate for Payer: Blue Care Network Medicare Advantage	$17.11
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Community Health Alliance Commercial	$53.55
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.11
Rate for Payer: Meridian Health Plan Medicare	$17.11
Rate for Payer: Priority Health Commercial	$44.10
Rate for Payer: Priority Health Medicaid	$17.11
Rate for Payer: Priority Health Medicare	$17.11
Rate for Payer: Priority Health PPO	$44.10
Rate for Payer: United Health Care Medicaid	$17.11
Rate for Payer: United Health Care Medicare Advantage	$7.53

CORTISONE

Facility

$15.00

Hospital Charge Code	3100743
Hospital Revenue Code	301
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

CORT W/CBG-2

Facility

$20.47

Hospital Charge Code	31027717
Hospital Revenue Code	300
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$17.40
Rate for Payer: Cash Price	$13.31
Rate for Payer: Community Health Alliance Commercial	$17.40
Rate for Payer: Priority Health Commercial	$14.33
Rate for Payer: Priority Health PPO	$14.33

CO SELF CARE/HOME MANAGEMENT

Facility

$91.00

Hospital Charge Code	4300130
Hospital Revenue Code	430
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$77.35
Rate for Payer: Cash Price	$59.15
Rate for Payer: Community Health Alliance Commercial	$77.35
Rate for Payer: Priority Health Commercial	$63.70
Rate for Payer: Priority Health PPO	$63.70

CO THERAPEUTIC EXER EA 15

Facility

$95.00

Hospital Charge Code	43000010
Hospital Revenue Code	430
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$80.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
Rate for Payer: Priority Health Commercial	$66.50
Rate for Payer: Priority Health PPO	$66.50

CO THEREPEUTIC ACITVITIES

Facility

$104.00

Hospital Charge Code	4300120
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

COTININE

Facility

$4.12

Service Code	HCPCS 80307
Hospital Charge Code	3007470
Hospital Revenue Code	301
Min. Negotiated Rate	$2.88
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	$2.68
Rate for Payer: Cash Price	$2.68
Rate for Payer: Community Health Alliance Commercial	$3.50
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	$2.88
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$2.88
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

COTTON CANNULATOME

Facility

$393.00

Hospital Charge Code	27262974
Hospital Revenue Code	272
Min. Negotiated Rate	$275.10
Max. Negotiated Rate	$334.05
Rate for Payer: Cash Price	$255.45
Rate for Payer: Community Health Alliance Commercial	$334.05
Rate for Payer: Priority Health Commercial	$275.10
Rate for Payer: Priority Health PPO	$275.10

CO ULSTRASOUND

Facility

$115.00

Hospital Charge Code	4300125
Hospital Revenue Code	430
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$97.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Community Health Alliance Commercial	$97.75
Rate for Payer: Priority Health Commercial	$80.50
Rate for Payer: Priority Health PPO	$80.50

COUNT 15-20 CELLS, 2 KARYOTYPE

Facility

$101.00

Hospital Charge Code	3102497
Hospital Revenue Code	300
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

COUT W/CBG-1

Facility

$20.46

Hospital Charge Code	31027716
Hospital Revenue Code	300
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$17.39
Rate for Payer: Cash Price	$13.30
Rate for Payer: Community Health Alliance Commercial	$17.39
Rate for Payer: Priority Health Commercial	$14.32
Rate for Payer: Priority Health PPO	$14.32

COVID AG

Facility

$100.00

Hospital Charge Code	3101660
Hospital Revenue Code	300
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$85.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Community Health Alliance Commercial	$85.00
Rate for Payer: Priority Health Commercial	$70.00
Rate for Payer: Priority Health PPO	$70.00

CO WHEEL CHAIR MANAGEMENT

Facility

$86.00

Hospital Charge Code	4300172
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 WORK CONDITION FIRST 2 HRS

Facility

$185.00

Hospital Charge Code	4300186
Hospital Revenue Code	430
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$157.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Community Health Alliance Commercial	$157.25
Rate for Payer: Priority Health Commercial	$129.50
Rate for Payer: Priority Health PPO	$129.50

CO WORK REINTEGRATION

Facility

$77.00

Hospital Charge Code	4300115
Hospital Revenue Code	430
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$65.45
Rate for Payer: Cash Price	$50.05
Rate for Payer: Community Health Alliance Commercial	$65.45
Rate for Payer: Priority Health Commercial	$53.90
Rate for Payer: Priority Health PPO	$53.90

COXACKIE VIRUS IGN (A16)

Facility

$19.29

Hospital Charge Code	3002707
Hospital Revenue Code	302
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$16.40
Rate for Payer: Cash Price	$12.54
Rate for Payer: Community Health Alliance Commercial	$16.40
Rate for Payer: Priority Health Commercial	$13.50
Rate for Payer: Priority Health PPO	$13.50

COXACKIE VIRUS IGN (A24)

Facility

$19.30

Hospital Charge Code	3002708
Hospital Revenue Code	302
Min. Negotiated Rate	$13.51
Max. Negotiated Rate	$16.41
Rate for Payer: Cash Price	$12.55
Rate for Payer: Community Health Alliance Commercial	$16.41
Rate for Payer: Priority Health Commercial	$13.51
Rate for Payer: Priority Health PPO	$13.51

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges