Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CULTURE, MISC

Facility

$79.00

Service Code	HCPCS 87070
Hospital Charge Code	3003480
Hospital Revenue Code	306
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$67.15
Rate for Payer: BCBS BCN 65	$9.05
Rate for Payer: Blue Care Network Medicare Advantage	$9.05
Rate for Payer: Cash Price	$51.35
Rate for Payer: Cash Price	$51.35
Rate for Payer: Community Health Alliance Commercial	$67.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.05
Rate for Payer: Meridian Health Plan Medicare	$9.05
Rate for Payer: Priority Health Commercial	$55.30
Rate for Payer: Priority Health Medicaid	$9.05
Rate for Payer: Priority Health Medicare	$9.05
Rate for Payer: Priority Health PPO	$55.30
Rate for Payer: United Health Care Medicaid	$9.05
Rate for Payer: United Health Care Medicare Advantage	$3.98

CULTURE, MYCOPLASMA

Facility

$40.00

Service Code	HCPCS 87109
Hospital Charge Code	3008540
Hospital Revenue Code	306
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$34.00
Rate for Payer: BCBS BCN 65	$16.16
Rate for Payer: Blue Care Network Medicare Advantage	$16.16
Rate for Payer: Cash Price	$26.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$16.16
Rate for Payer: Meridian Health Plan Medicare	$16.16
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health Medicaid	$16.16
Rate for Payer: Priority Health Medicare	$16.16
Rate for Payer: Priority Health PPO	$28.00
Rate for Payer: United Health Care Medicaid	$16.16
Rate for Payer: United Health Care Medicare Advantage	$7.11

CULTURE, NP

Facility

$79.00

Service Code	HCPCS 87070
Hospital Charge Code	3003420
Hospital Revenue Code	306
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$67.15
Rate for Payer: BCBS BCN 65	$9.05
Rate for Payer: Blue Care Network Medicare Advantage	$9.05
Rate for Payer: Cash Price	$51.35
Rate for Payer: Cash Price	$51.35
Rate for Payer: Community Health Alliance Commercial	$67.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.05
Rate for Payer: Meridian Health Plan Medicare	$9.05
Rate for Payer: Priority Health Commercial	$55.30
Rate for Payer: Priority Health Medicaid	$9.05
Rate for Payer: Priority Health Medicare	$9.05
Rate for Payer: Priority Health PPO	$55.30
Rate for Payer: United Health Care Medicaid	$9.05
Rate for Payer: United Health Care Medicare Advantage	$3.98

CULTURE, PERTUSSIS

Facility

$75.00

Hospital Charge Code	3003440
Hospital Revenue Code	306
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

CULTURE SPUTUM (GS)-LC

Facility

$5.93

Hospital Charge Code	3102421
Hospital Revenue Code	300
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$5.04
Rate for Payer: Cash Price	$3.85
Rate for Payer: Community Health Alliance Commercial	$5.04
Rate for Payer: Priority Health Commercial	$4.15
Rate for Payer: Priority Health PPO	$4.15

CULTURE SPUTUM (REFLEX) LC

Facility

$8.99

Hospital Charge Code	3102422
Hospital Revenue Code	300
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$7.64
Rate for Payer: Cash Price	$5.84
Rate for Payer: Community Health Alliance Commercial	$7.64
Rate for Payer: Priority Health Commercial	$6.29
Rate for Payer: Priority Health PPO	$6.29

CULTURE, STOOL

Facility

$95.00

Service Code	HCPCS 87045
Hospital Charge Code	3003500
Hospital Revenue Code	306
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$80.75
Rate for Payer: BCBS BCN 65	$9.91
Rate for Payer: Blue Care Network Medicare Advantage	$9.91
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Community Health Alliance Commercial	$80.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.91
Rate for Payer: Meridian Health Plan Medicare	$9.91
Rate for Payer: Priority Health Commercial	$66.50
Rate for Payer: Priority Health Medicaid	$9.91
Rate for Payer: Priority Health Medicare	$9.91
Rate for Payer: Priority Health PPO	$66.50
Rate for Payer: United Health Care Medicaid	$9.91
Rate for Payer: United Health Care Medicare Advantage	$4.36

CULTURE, STOOL EACH PLATE

Facility

$28.00

Service Code	HCPCS 87046
Hospital Charge Code	3003505
Hospital Revenue Code	306
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$23.80
Rate for Payer: BCBS BCN 65	$9.91
Rate for Payer: Blue Care Network Medicare Advantage	$9.91
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.91
Rate for Payer: Meridian Health Plan Medicare	$9.91
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health Medicaid	$9.91
Rate for Payer: Priority Health Medicare	$9.91
Rate for Payer: Priority Health PPO	$19.60
Rate for Payer: United Health Care Medicaid	$9.91
Rate for Payer: United Health Care Medicare Advantage	$4.36

CULTURE, THROAT

Facility

$80.00

Service Code	HCPCS 87070
Hospital Charge Code	3003520
Hospital Revenue Code	306
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$68.00
Rate for Payer: BCBS BCN 65	$9.05
Rate for Payer: Blue Care Network Medicare Advantage	$9.05
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Community Health Alliance Commercial	$68.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.05
Rate for Payer: Meridian Health Plan Medicare	$9.05
Rate for Payer: Priority Health Commercial	$56.00
Rate for Payer: Priority Health Medicaid	$9.05
Rate for Payer: Priority Health Medicare	$9.05
Rate for Payer: Priority Health PPO	$56.00
Rate for Payer: United Health Care Medicaid	$9.05
Rate for Payer: United Health Care Medicare Advantage	$3.98

CULTURE THROAT LC

Facility

$4.95

Hospital Charge Code	3102419
Hospital Revenue Code	300
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$4.21
Rate for Payer: Cash Price	$3.22
Rate for Payer: Community Health Alliance Commercial	$4.21
Rate for Payer: Priority Health Commercial	$3.46
Rate for Payer: Priority Health PPO	$3.46

CULTURE TYPING LA

Facility

$7.00

Hospital Charge Code	3101195
Hospital Revenue Code	306
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$5.95
Rate for Payer: Cash Price	$4.55
Rate for Payer: Community Health Alliance Commercial	$5.95
Rate for Payer: Priority Health Commercial	$4.90
Rate for Payer: Priority Health PPO	$4.90

CULTURE, URINE

Facility

$56.00

Service Code	HCPCS 87086
Hospital Charge Code	3003540
Hospital Revenue Code	306
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$47.60
Rate for Payer: BCBS BCN 65	$8.47
Rate for Payer: Blue Care Network Medicare Advantage	$8.47
Rate for Payer: Cash Price	$36.40
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.47
Rate for Payer: Meridian Health Plan Medicare	$8.47
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health Medicaid	$8.47
Rate for Payer: Priority Health Medicare	$8.47
Rate for Payer: Priority Health PPO	$39.20
Rate for Payer: United Health Care Medicaid	$8.47
Rate for Payer: United Health Care Medicare Advantage	$3.73

CULTURE URINE LC

Facility

$6.77

Hospital Charge Code	3102418
Hospital Revenue Code	300
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$5.75
Rate for Payer: Cash Price	$4.40
Rate for Payer: Community Health Alliance Commercial	$5.75
Rate for Payer: Priority Health Commercial	$4.74
Rate for Payer: Priority Health PPO	$4.74

CULTURE, VIRAL

Facility

$55.00

Service Code	HCPCS 87252
Hospital Charge Code	3003560
Hospital Revenue Code	306
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$46.75
Rate for Payer: BCBS BCN 65	$27.37
Rate for Payer: Blue Care Network Medicare Advantage	$27.37
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$27.37
Rate for Payer: Meridian Health Plan Medicare	$27.37
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health Medicaid	$27.37
Rate for Payer: Priority Health Medicare	$27.37
Rate for Payer: Priority Health PPO	$38.50
Rate for Payer: United Health Care Medicaid	$27.37
Rate for Payer: United Health Care Medicare Advantage	$12.04

CULTURE VIRAL NON-RESP

Facility

$108.00

Hospital Charge Code	3100825
Hospital Revenue Code	306
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$91.80
Rate for Payer: Cash Price	$70.20
Rate for Payer: Community Health Alliance Commercial	$91.80
Rate for Payer: Priority Health Commercial	$75.60
Rate for Payer: Priority Health PPO	$75.60

CURETTAGE OR CAUTERY OF ANAL FISSURE, INCLUDING DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE); SUBSEQUENT

Facility

$997.61

Service Code	CPT 46942
Hospital Revenue Code	360
Min. Negotiated Rate	$438.95
Max. Negotiated Rate	$997.61
Rate for Payer: BCBS BCN 65	$997.61
Rate for Payer: Blue Care Network Medicare Advantage	$997.61
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$997.61
Rate for Payer: Meridian Health Plan Medicare	$997.61
Rate for Payer: Priority Health Medicaid	$997.61
Rate for Payer: Priority Health Medicare	$997.61
Rate for Payer: United Health Care Medicaid	$997.61
Rate for Payer: United Health Care Medicare Advantage	$438.95

CURVED STAPLER CDH21

Facility

$836.00

Hospital Charge Code	27018614
Hospital Revenue Code	272
Min. Negotiated Rate	$585.20
Max. Negotiated Rate	$710.60
Rate for Payer: Cash Price	$543.40
Rate for Payer: Community Health Alliance Commercial	$710.60
Rate for Payer: Priority Health Commercial	$585.20
Rate for Payer: Priority Health PPO	$585.20

CURVED STAPLER CDH25

Facility

$1,362.00

Hospital Charge Code	27018606
Hospital Revenue Code	272
Min. Negotiated Rate	$953.40
Max. Negotiated Rate	$1,157.70
Rate for Payer: Cash Price	$885.30
Rate for Payer: Community Health Alliance Commercial	$1,157.70
Rate for Payer: Priority Health Commercial	$953.40
Rate for Payer: Priority Health PPO	$953.40

CURVED STAPLER CDH29

Facility

$1,257.00

Hospital Charge Code	27018598
Hospital Revenue Code	272
Min. Negotiated Rate	$879.90
Max. Negotiated Rate	$1,068.45
Rate for Payer: Cash Price	$817.05
Rate for Payer: Community Health Alliance Commercial	$1,068.45
Rate for Payer: Priority Health Commercial	$879.90
Rate for Payer: Priority Health PPO	$879.90

CUTTER FULL RADIUS

Facility

$286.00

Hospital Charge Code	27018291
Hospital Revenue Code	272
Min. Negotiated Rate	$200.20
Max. Negotiated Rate	$243.10
Rate for Payer: Cash Price	$185.90
Rate for Payer: Community Health Alliance Commercial	$243.10
Rate for Payer: Priority Health Commercial	$200.20
Rate for Payer: Priority Health PPO	$200.20

CVC INSERTION TRAY

Facility

$188.00

Hospital Charge Code	27012930
Hospital Revenue Code	272
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$159.80
Rate for Payer: Cash Price	$122.20
Rate for Payer: Community Health Alliance Commercial	$159.80
Rate for Payer: Priority Health Commercial	$131.60
Rate for Payer: Priority Health PPO	$131.60

CVC TRAY 16GAX20CM

Facility

$234.00

Hospital Charge Code	27014910
Hospital Revenue Code	272
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$198.90
Rate for Payer: Cash Price	$152.10
Rate for Payer: Community Health Alliance Commercial	$198.90
Rate for Payer: Priority Health Commercial	$163.80
Rate for Payer: Priority Health PPO	$163.80

C V P INSERT TRAY

Facility

$115.00

Hospital Charge Code	27060442
Hospital Revenue Code	272
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

CYANIDE

Facility

$60.00

Service Code	HCPCS 82600
Hospital Charge Code	3003590
Hospital Revenue Code	301
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$51.00
Rate for Payer: BCBS BCN 65	$20.37
Rate for Payer: Blue Care Network Medicare Advantage	$20.37
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$20.37
Rate for Payer: Meridian Health Plan Medicare	$20.37
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health Medicaid	$20.37
Rate for Payer: Priority Health Medicare	$20.37
Rate for Payer: Priority Health PPO	$42.00
Rate for Payer: United Health Care Medicaid	$20.37
Rate for Payer: United Health Care Medicare Advantage	$8.96

CYCLIC AMP

Facility

$28.51

Service Code	HCPCS 82030
Hospital Charge Code	3000121
Hospital Revenue Code	301
Min. Negotiated Rate	$11.92
Max. Negotiated Rate	$27.09
Rate for Payer: BCBS BCN 65	$27.09
Rate for Payer: Blue Care Network Medicare Advantage	$27.09
Rate for Payer: Cash Price	$18.53
Rate for Payer: Cash Price	$18.53
Rate for Payer: Community Health Alliance Commercial	$24.23
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$27.09
Rate for Payer: Meridian Health Plan Medicare	$27.09
Rate for Payer: Priority Health Commercial	$19.96
Rate for Payer: Priority Health Medicaid	$27.09
Rate for Payer: Priority Health Medicare	$27.09
Rate for Payer: Priority Health PPO	$19.96
Rate for Payer: United Health Care Medicaid	$27.09
Rate for Payer: United Health Care Medicare Advantage	$11.92

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges