Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CP-13

Facility

$26.15

Hospital Charge Code	3101530
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

CP-2

Facility

$60.00

Hospital Charge Code	3101466
Hospital Revenue Code	300
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

CP-2

Facility

$26.15

Hospital Charge Code	3101519
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

CP-3

Facility

$26.15

Hospital Charge Code	3101520
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

CP-3

Facility

$60.00

Hospital Charge Code	3101467
Hospital Revenue Code	300
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

CP-4

Facility

$60.00

Hospital Charge Code	3101468
Hospital Revenue Code	300
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

CP-5

Facility

$26.15

Hospital Charge Code	3101522
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

CP-6

Facility

$26.15

Hospital Charge Code	3101523
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

CP-7

Facility

$26.15

Hospital Charge Code	3101524
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

CP-8

Facility

$26.15

Hospital Charge Code	3101525
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

CP-9

Facility

$26.15

Hospital Charge Code	3101526
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$22.23
Rate for Payer: Cash Price	$17.00
Rate for Payer: Community Health Alliance Commercial	$22.23
Rate for Payer: Priority Health Commercial	$18.30
Rate for Payer: Priority Health PPO	$18.30

C-PEPTIDE

Facility

$3.65

Service Code	HCPCS 84681
Hospital Charge Code	3001600
Hospital Revenue Code	301
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$21.85
Rate for Payer: BCBS BCN 65	$21.85
Rate for Payer: Blue Care Network Medicare Advantage	$21.85
Rate for Payer: Cash Price	$2.37
Rate for Payer: Cash Price	$2.37
Rate for Payer: Community Health Alliance Commercial	$3.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$21.85
Rate for Payer: Meridian Health Plan Medicare	$21.85
Rate for Payer: Priority Health Commercial	$2.56
Rate for Payer: Priority Health Medicaid	$21.85
Rate for Payer: Priority Health Medicare	$21.85
Rate for Payer: Priority Health PPO	$2.56
Rate for Payer: United Health Care Medicaid	$21.85
Rate for Payer: United Health Care Medicare Advantage	$9.61

CPK

Facility

$41.00

Service Code	HCPCS 82550
Hospital Charge Code	3002780
Hospital Revenue Code	301
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$34.85
Rate for Payer: BCBS BCN 65	$6.84
Rate for Payer: Blue Care Network Medicare Advantage	$6.84
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Community Health Alliance Commercial	$34.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$6.84
Rate for Payer: Meridian Health Plan Medicare	$6.84
Rate for Payer: Priority Health Commercial	$28.70
Rate for Payer: Priority Health Medicaid	$6.84
Rate for Payer: Priority Health Medicare	$6.84
Rate for Payer: Priority Health PPO	$28.70
Rate for Payer: United Health Care Medicaid	$6.84
Rate for Payer: United Health Care Medicare Advantage	$3.01

CPK ELECTROPHORESIS NOT CK/MB

Facility

$2.82

Service Code	HCPCS 82552
Hospital Charge Code	3002800
Hospital Revenue Code	301
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$14.06
Rate for Payer: BCBS BCN 65	$14.06
Rate for Payer: Blue Care Network Medicare Advantage	$14.06
Rate for Payer: Cash Price	$1.83
Rate for Payer: Cash Price	$1.83
Rate for Payer: Community Health Alliance Commercial	$2.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.06
Rate for Payer: Meridian Health Plan Medicare	$14.06
Rate for Payer: Priority Health Commercial	$1.97
Rate for Payer: Priority Health Medicaid	$14.06
Rate for Payer: Priority Health Medicare	$14.06
Rate for Payer: Priority Health PPO	$1.97
Rate for Payer: United Health Care Medicaid	$14.06
Rate for Payer: United Health Care Medicare Advantage	$6.19

CPK-SBMF

Facility

$2.00

Hospital Charge Code	3101250
Hospital Revenue Code	301
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.30
Rate for Payer: Community Health Alliance Commercial	$1.70
Rate for Payer: Priority Health Commercial	$1.40
Rate for Payer: Priority Health PPO	$1.40

CPR MINI SCORPION IMPLANT

Facility

$2,682.75

Service Code	HCPCS C1713
Hospital Charge Code	27878466
Hospital Revenue Code	278
Min. Negotiated Rate	$1,877.92
Max. Negotiated Rate	$2,280.34
Rate for Payer: Cash Price	$1,743.79
Rate for Payer: Community Health Alliance Commercial	$2,280.34
Rate for Payer: Priority Health Commercial	$1,877.92
Rate for Payer: Priority Health PPO	$1,877.92

CPTT-LA INC MIX

Facility

$53.76

Hospital Charge Code	3102554
Hospital Revenue Code	300
Min. Negotiated Rate	$37.63
Max. Negotiated Rate	$45.70
Rate for Payer: Cash Price	$34.94
Rate for Payer: Community Health Alliance Commercial	$45.70
Rate for Payer: Priority Health Commercial	$37.63
Rate for Payer: Priority Health PPO	$37.63

CQ AQUATIC THERAPY EA 15 MIN

Facility

$103.00

Hospital Charge Code	4200193
Hospital Revenue Code	420
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$87.55
Rate for Payer: Cash Price	$66.95
Rate for Payer: Community Health Alliance Commercial	$87.55
Rate for Payer: Priority Health Commercial	$72.10
Rate for Payer: Priority Health PPO	$72.10

CQ CANALITH REPOSITIONING

Facility

$62.00

Hospital Charge Code	4200135
Hospital Revenue Code	420
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

CQ CHECK OUT ORTHOTIC

Facility

$32.00

Hospital Charge Code	4201372
Hospital Revenue Code	420
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$20.80
Rate for Payer: Community Health Alliance Commercial	$27.20
Rate for Payer: Priority Health Commercial	$22.40
Rate for Payer: Priority Health PPO	$22.40

CQ CONTRAST BATHS EACH 15 MIN

Facility

$33.00

Hospital Charge Code	4200151
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

CQ DEBRIDE SURFACE ARE <20 CM

Facility

$92.00

Hospital Charge Code	4200271
Hospital Revenue Code	420
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$78.20
Rate for Payer: Cash Price	$59.80
Rate for Payer: Community Health Alliance Commercial	$78.20
Rate for Payer: Priority Health Commercial	$64.40
Rate for Payer: Priority Health PPO	$64.40

CQ DEBRIDE SURFACE AREA >20CM

Facility

$128.00

Hospital Charge Code	4200172
Hospital Revenue Code	420
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$108.80
Rate for Payer: Cash Price	$83.20
Rate for Payer: Community Health Alliance Commercial	$108.80
Rate for Payer: Priority Health Commercial	$89.60
Rate for Payer: Priority Health PPO	$89.60

CQ ELECTRICAL STIM-UNATTENDED

Facility

$142.00

Hospital Charge Code	4200191
Hospital Revenue Code	420
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$120.70
Rate for Payer: Cash Price	$92.30
Rate for Payer: Community Health Alliance Commercial	$120.70
Rate for Payer: Priority Health Commercial	$99.40
Rate for Payer: Priority Health PPO	$99.40

CQ ELECT STIM UNATTENDED WOUN

Facility

$115.00

Hospital Charge Code	4200199
Hospital Revenue Code	420
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

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges