Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ADRENAL CORTEX ANTIBODY

Facility

$74.00

Service Code	HCPCS 86255
Hospital Charge Code	3003030
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$62.90
Rate for Payer: BCBS BCN 65	$12.65
Rate for Payer: Blue Care Network Medicare Advantage	$12.65
Rate for Payer: Cash Price	$48.10
Rate for Payer: Cash Price	$48.10
Rate for Payer: Community Health Alliance Commercial	$62.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$12.65
Rate for Payer: Meridian Health Plan Medicare	$12.65
Rate for Payer: Priority Health Commercial	$51.80
Rate for Payer: Priority Health Medicaid	$12.65
Rate for Payer: Priority Health Medicare	$12.65
Rate for Payer: Priority Health PPO	$51.80
Rate for Payer: United Health Care Medicaid	$12.65
Rate for Payer: United Health Care Medicare Advantage	$5.57

AEROBE EXTENDED INCUBATION

Facility

$8.14

Hospital Charge Code	3101971
Hospital Revenue Code	300
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$6.92
Rate for Payer: Cash Price	$5.29
Rate for Payer: Community Health Alliance Commercial	$6.92
Rate for Payer: Priority Health Commercial	$5.70
Rate for Payer: Priority Health PPO	$5.70

AEROBIC CULTURE

Facility

$8.14

Hospital Charge Code	31027575
Hospital Revenue Code	300
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$6.92
Rate for Payer: Cash Price	$5.29
Rate for Payer: Community Health Alliance Commercial	$6.92
Rate for Payer: Priority Health Commercial	$5.70
Rate for Payer: Priority Health PPO	$5.70

AEROBIC EXTENDED LC

Facility

$8.14

Hospital Charge Code	3102439
Hospital Revenue Code	300
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$6.92
Rate for Payer: Cash Price	$5.29
Rate for Payer: Community Health Alliance Commercial	$6.92
Rate for Payer: Priority Health Commercial	$5.70
Rate for Payer: Priority Health PPO	$5.70

AEROBIC ID & SENS-LC

Facility

$12.22

Hospital Charge Code	3102429
Hospital Revenue Code	300
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$10.39
Rate for Payer: Cash Price	$7.94
Rate for Payer: Community Health Alliance Commercial	$10.39
Rate for Payer: Priority Health Commercial	$8.55
Rate for Payer: Priority Health PPO	$8.55

AEROSOL INDUCED SPUTUM

Facility

$264.00

Hospital Charge Code	4100077
Hospital Revenue Code	300
Min. Negotiated Rate	$184.80
Max. Negotiated Rate	$224.40
Rate for Payer: Cash Price	$171.60
Rate for Payer: Community Health Alliance Commercial	$224.40
Rate for Payer: Priority Health Commercial	$184.80
Rate for Payer: Priority Health PPO	$184.80

AFB CULTURE AND SMEAR

Facility

$14.00

Hospital Charge Code	3100006
Hospital Revenue Code	306
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$11.90
Rate for Payer: Cash Price	$9.10
Rate for Payer: Community Health Alliance Commercial	$11.90
Rate for Payer: Priority Health Commercial	$9.80
Rate for Payer: Priority Health PPO	$9.80

AFB Identification

Facility

$10.00

Hospital Charge Code	31027713
Hospital Revenue Code	300
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health PPO	$7.00

AFB SMEAR

Facility

$24.00

Service Code	HCPCS 87206
Hospital Charge Code	3003221
Hospital Revenue Code	306
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$20.40
Rate for Payer: BCBS BCN 65	$5.66
Rate for Payer: Blue Care Network Medicare Advantage	$5.66
Rate for Payer: Cash Price	$15.60
Rate for Payer: Cash Price	$15.60
Rate for Payer: Community Health Alliance Commercial	$20.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.66
Rate for Payer: Meridian Health Plan Medicare	$5.66
Rate for Payer: Priority Health Commercial	$16.80
Rate for Payer: Priority Health Medicaid	$5.66
Rate for Payer: Priority Health Medicare	$5.66
Rate for Payer: Priority Health PPO	$16.80
Rate for Payer: United Health Care Medicaid	$5.66
Rate for Payer: United Health Care Medicare Advantage	$2.49

AFPT-1

Facility

$7.61

Hospital Charge Code	3102465
Hospital Revenue Code	300
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$6.47
Rate for Payer: Cash Price	$4.95
Rate for Payer: Community Health Alliance Commercial	$6.47
Rate for Payer: Priority Health Commercial	$5.33
Rate for Payer: Priority Health PPO	$5.33

AFPT-2

Facility

$7.61

Hospital Charge Code	3102466
Hospital Revenue Code	300
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$6.47
Rate for Payer: Cash Price	$4.95
Rate for Payer: Community Health Alliance Commercial	$6.47
Rate for Payer: Priority Health Commercial	$5.33
Rate for Payer: Priority Health PPO	$5.33

AFPT-3

Facility

$7.61

Hospital Charge Code	3102467
Hospital Revenue Code	300
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$6.47
Rate for Payer: Cash Price	$4.95
Rate for Payer: Community Health Alliance Commercial	$6.47
Rate for Payer: Priority Health Commercial	$5.33
Rate for Payer: Priority Health PPO	$5.33

AFPT-4

Facility

$7.59

Hospital Charge Code	3102468
Hospital Revenue Code	300
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$6.45
Rate for Payer: Cash Price	$4.93
Rate for Payer: Community Health Alliance Commercial	$6.45
Rate for Payer: Priority Health Commercial	$5.31
Rate for Payer: Priority Health PPO	$5.31

AGA IGA

Facility

$94.00

Hospital Charge Code	3000244
Hospital Revenue Code	301
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$79.90
Rate for Payer: Cash Price	$61.10
Rate for Payer: Community Health Alliance Commercial	$79.90
Rate for Payer: Priority Health Commercial	$65.80
Rate for Payer: Priority Health PPO	$65.80

AGA IGG

Facility

$94.00

Hospital Charge Code	3000246
Hospital Revenue Code	301
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$79.90
Rate for Payer: Cash Price	$61.10
Rate for Payer: Community Health Alliance Commercial	$79.90
Rate for Payer: Priority Health Commercial	$65.80
Rate for Payer: Priority Health PPO	$65.80

AGGRESSOR, 4.2MM

Facility

$459.00

Hospital Charge Code	27061568
Hospital Revenue Code	270
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$390.15
Rate for Payer: Cash Price	$298.35
Rate for Payer: Community Health Alliance Commercial	$390.15
Rate for Payer: Priority Health Commercial	$321.30
Rate for Payer: Priority Health PPO	$321.30

AGS3-FWRBC

Facility

$223.00

Hospital Charge Code	3101421
Hospital Revenue Code	300
Min. Negotiated Rate	$156.10
Max. Negotiated Rate	$189.55
Rate for Payer: Cash Price	$144.95
Rate for Payer: Community Health Alliance Commercial	$189.55
Rate for Payer: Priority Health Commercial	$156.10
Rate for Payer: Priority Health PPO	$156.10

AG TYPE PT-SBMF

Facility

$8.10

Hospital Charge Code	3102720
Hospital Revenue Code	300
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$6.88
Rate for Payer: Cash Price	$5.27
Rate for Payer: Community Health Alliance Commercial	$6.88
Rate for Payer: Priority Health Commercial	$5.67
Rate for Payer: Priority Health PPO	$5.67

AG TYPE UNIT-SBMF

Facility

$14.40

Hospital Charge Code	3102721
Hospital Revenue Code	300
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$12.24
Rate for Payer: Cash Price	$9.36
Rate for Payer: Community Health Alliance Commercial	$12.24
Rate for Payer: Priority Health Commercial	$10.08
Rate for Payer: Priority Health PPO	$10.08

AG TYPINGS IBC

Facility

$69.00

Hospital Charge Code	3101928
Hospital Revenue Code	300
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$58.65
Rate for Payer: Cash Price	$44.85
Rate for Payer: Community Health Alliance Commercial	$58.65
Rate for Payer: Priority Health Commercial	$48.30
Rate for Payer: Priority Health PPO	$48.30

AGUA-1

Facility

$187.50

Hospital Charge Code	3101316
Hospital Revenue Code	300
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$159.38
Rate for Payer: Cash Price	$121.88
Rate for Payer: Community Health Alliance Commercial	$159.38
Rate for Payer: Priority Health Commercial	$131.25
Rate for Payer: Priority Health PPO	$131.25

AI-2

Facility

$11.81

Hospital Charge Code	3102102
Hospital Revenue Code	300
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$10.04
Rate for Payer: Cash Price	$7.68
Rate for Payer: Community Health Alliance Commercial	$10.04
Rate for Payer: Priority Health Commercial	$8.27
Rate for Payer: Priority Health PPO	$8.27

AIRPRENE KNEE SUPPORT

Facility

$115.00

Hospital Charge Code	27060396
Hospital Revenue Code	270
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

AIRSTIRRUP

Facility

$198.00

Hospital Charge Code	27017277
Hospital Revenue Code	270
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$168.30
Rate for Payer: Cash Price	$128.70
Rate for Payer: Community Health Alliance Commercial	$168.30
Rate for Payer: Priority Health Commercial	$138.60
Rate for Payer: Priority Health PPO	$138.60

AIRWAY,NASOPHARYNGEL 26,28,30

Facility

$45.00

Hospital Charge Code	27017145
Hospital Revenue Code	270
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges