Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

CYCLOBENZAPRINE FLEXERIL

Facility

$45.86

Hospital Charge Code	3100753
Hospital Revenue Code	301
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$38.98
Rate for Payer: Cash Price	$29.81
Rate for Payer: Community Health Alliance Commercial	$38.98
Rate for Payer: Priority Health Commercial	$32.10
Rate for Payer: Priority Health PPO	$32.10

CYCLOSPORIN-RML

Facility

$12.14

Service Code	HCPCS 80158
Hospital Charge Code	3003450
Hospital Revenue Code	301
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$18.95
Rate for Payer: BCBS BCN 65	$18.95
Rate for Payer: Blue Care Network Medicare Advantage	$18.95
Rate for Payer: Cash Price	$7.89
Rate for Payer: Cash Price	$7.89
Rate for Payer: Community Health Alliance Commercial	$10.32
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.95
Rate for Payer: Meridian Health Plan Medicare	$18.95
Rate for Payer: Priority Health Commercial	$8.50
Rate for Payer: Priority Health Medicaid	$18.95
Rate for Payer: Priority Health Medicare	$18.95
Rate for Payer: Priority Health PPO	$8.50
Rate for Payer: United Health Care Medicaid	$18.95
Rate for Payer: United Health Care Medicare Advantage	$8.34

CYCTOCATH 12 FR

Facility

$164.00

Hospital Charge Code	27013540
Hospital Revenue Code	272
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$139.40
Rate for Payer: Cash Price	$106.60
Rate for Payer: Community Health Alliance Commercial	$139.40
Rate for Payer: Priority Health Commercial	$114.80
Rate for Payer: Priority Health PPO	$114.80

CYSTATIN C

Facility

$10.00

Hospital Charge Code	3005656
Hospital Revenue Code	301
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

CYSTICF IB MUT97-LC

Facility

$126.00

Hospital Charge Code	3102686
Hospital Revenue Code	300
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$107.10
Rate for Payer: Cash Price	$81.90
Rate for Payer: Community Health Alliance Commercial	$107.10
Rate for Payer: Priority Health Commercial	$88.20
Rate for Payer: Priority Health PPO	$88.20

CYSTIC FIBROSIS

Facility

$165.00

Hospital Charge Code	3003355
Hospital Revenue Code	301
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$140.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Community Health Alliance Commercial	$140.25
Rate for Payer: Priority Health Commercial	$115.50
Rate for Payer: Priority Health PPO	$115.50

CYSTINE,URINE

Facility

$30.00

Service Code	HCPCS 82131
Hospital Charge Code	3000161
Hospital Revenue Code	301
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$25.50
Rate for Payer: BCBS BCN 65	$24.13
Rate for Payer: Blue Care Network Medicare Advantage	$24.13
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$24.13
Rate for Payer: Meridian Health Plan Medicare	$24.13
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health Medicaid	$24.13
Rate for Payer: Priority Health Medicare	$24.13
Rate for Payer: Priority Health PPO	$21.00
Rate for Payer: United Health Care Medicaid	$24.13
Rate for Payer: United Health Care Medicare Advantage	$10.62

CYTOCHROME

Facility

$203.63

Hospital Charge Code	3102610
Hospital Revenue Code	300
Min. Negotiated Rate	$142.54
Max. Negotiated Rate	$173.09
Rate for Payer: Cash Price	$132.36
Rate for Payer: Community Health Alliance Commercial	$173.09
Rate for Payer: Priority Health Commercial	$142.54
Rate for Payer: Priority Health PPO	$142.54

CYTO CULTURE ONLY

Facility

$644.00

Hospital Charge Code	3000265
Hospital Revenue Code	310
Min. Negotiated Rate	$450.80
Max. Negotiated Rate	$547.40
Rate for Payer: Cash Price	$418.60
Rate for Payer: Community Health Alliance Commercial	$547.40
Rate for Payer: Priority Health Commercial	$450.80
Rate for Payer: Priority Health PPO	$450.80

CYTOGENETICS

Facility

$1,281.00

Hospital Charge Code	3005496
Hospital Revenue Code	311
Min. Negotiated Rate	$896.70
Max. Negotiated Rate	$1,088.85
Rate for Payer: Cash Price	$832.65
Rate for Payer: Community Health Alliance Commercial	$1,088.85
Rate for Payer: Priority Health Commercial	$896.70
Rate for Payer: Priority Health PPO	$896.70

CYTOGENICS INTERPRETATION

Facility

$415.00

Service Code	HCPCS 88291
Hospital Charge Code	3005494
Hospital Revenue Code	971
Min. Negotiated Rate	$290.50
Max. Negotiated Rate	$352.75
Rate for Payer: Cash Price	$269.75
Rate for Payer: Community Health Alliance Commercial	$352.75
Rate for Payer: Priority Health Commercial	$290.50
Rate for Payer: Priority Health PPO	$290.50

CYTOLOGY BRUSH (OLYMPUS)

Facility

$174.00

Hospital Charge Code	27019489
Hospital Revenue Code	272
Min. Negotiated Rate	$121.80
Max. Negotiated Rate	$147.90
Rate for Payer: Cash Price	$113.10
Rate for Payer: Community Health Alliance Commercial	$147.90
Rate for Payer: Priority Health Commercial	$121.80
Rate for Payer: Priority Health PPO	$121.80

CYTOMEGALOVIRUS, IgM

Facility

$295.00

Service Code	HCPCS 86645
Hospital Charge Code	3002510
Hospital Revenue Code	302
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$250.75
Rate for Payer: BCBS BCN 65	$17.69
Rate for Payer: Blue Care Network Medicare Advantage	$17.69
Rate for Payer: Cash Price	$191.75
Rate for Payer: Cash Price	$191.75
Rate for Payer: Community Health Alliance Commercial	$250.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.69
Rate for Payer: Meridian Health Plan Medicare	$17.69
Rate for Payer: Priority Health Commercial	$206.50
Rate for Payer: Priority Health Medicaid	$17.69
Rate for Payer: Priority Health Medicare	$17.69
Rate for Payer: Priority Health PPO	$206.50
Rate for Payer: United Health Care Medicaid	$17.69
Rate for Payer: United Health Care Medicare Advantage	$7.78

CYTOMEGALOVIRUS ONE SPECI ONLY

Facility

$4.28

Service Code	HCPCS 86645
Hospital Charge Code	3002500
Hospital Revenue Code	306
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$17.69
Rate for Payer: BCBS BCN 65	$17.69
Rate for Payer: Blue Care Network Medicare Advantage	$17.69
Rate for Payer: Cash Price	$2.78
Rate for Payer: Cash Price	$2.78
Rate for Payer: Community Health Alliance Commercial	$3.64
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.69
Rate for Payer: Meridian Health Plan Medicare	$17.69
Rate for Payer: Priority Health Commercial	$3.00
Rate for Payer: Priority Health Medicaid	$17.69
Rate for Payer: Priority Health Medicare	$17.69
Rate for Payer: Priority Health PPO	$3.00
Rate for Payer: United Health Care Medicaid	$17.69
Rate for Payer: United Health Care Medicare Advantage	$7.78

CYTOMEGALOVIRUS PAIRED SPECIME

Facility

$41.00

Service Code	HCPCS 86644
Hospital Charge Code	3003620
Hospital Revenue Code	302
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$34.85
Rate for Payer: BCBS BCN 65	$15.11
Rate for Payer: Blue Care Network Medicare Advantage	$15.11
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	$15.11
Rate for Payer: Meridian Health Plan Medicare	$15.11
Rate for Payer: Priority Health Commercial	$28.70
Rate for Payer: Priority Health Medicaid	$15.11
Rate for Payer: Priority Health Medicare	$15.11
Rate for Payer: Priority Health PPO	$28.70
Rate for Payer: United Health Care Medicaid	$15.11
Rate for Payer: United Health Care Medicare Advantage	$6.65

CYTOPATH-DX-GYN-BETHEDSA

Facility

$38.00

Service Code	HCPCS 88164
Hospital Charge Code	3100155
Hospital Revenue Code	923
Min. Negotiated Rate	$8.57
Max. Negotiated Rate	$32.30
Rate for Payer: BCBS BCN 65	$19.47
Rate for Payer: Blue Care Network Medicare Advantage	$19.47
Rate for Payer: Cash Price	$24.70
Rate for Payer: Cash Price	$24.70
Rate for Payer: Community Health Alliance Commercial	$32.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.47
Rate for Payer: Meridian Health Plan Medicare	$19.47
Rate for Payer: Priority Health Commercial	$26.60
Rate for Payer: Priority Health Medicaid	$19.47
Rate for Payer: Priority Health Medicare	$19.47
Rate for Payer: Priority Health PPO	$26.60
Rate for Payer: United Health Care Medicaid	$19.47
Rate for Payer: United Health Care Medicare Advantage	$8.57

CYTOPATH/FLUIDS TECH

Facility

$105.00

Service Code	HCPCS 88108
Hospital Charge Code	3100160
Hospital Revenue Code	311
Min. Negotiated Rate	$17.63
Max. Negotiated Rate	$89.25
Rate for Payer: BCBS BCN 65	$40.07
Rate for Payer: Blue Care Network Medicare Advantage	$40.07
Rate for Payer: Cash Price	$68.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Community Health Alliance Commercial	$89.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$40.07
Rate for Payer: Meridian Health Plan Medicare	$40.07
Rate for Payer: Priority Health Commercial	$73.50
Rate for Payer: Priority Health Medicaid	$40.07
Rate for Payer: Priority Health Medicare	$40.07
Rate for Payer: Priority Health PPO	$73.50
Rate for Payer: United Health Care Medicaid	$40.07
Rate for Payer: United Health Care Medicare Advantage	$17.63

CYTOPATH GYN DIAGNOSITC INTER

Facility

$64.00

Hospital Charge Code	9710461
Hospital Revenue Code	971
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$54.40
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health PPO	$44.80

CYTOPATH GYN DX INTER PROF

Facility

$66.00

Service Code	HCPCS 88165 26
Hospital Charge Code	9710465
Hospital Revenue Code	923
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$56.10
Rate for Payer: Cash Price	$42.90
Rate for Payer: Community Health Alliance Commercial	$56.10
Rate for Payer: Priority Health Commercial	$46.20
Rate for Payer: Priority Health PPO	$46.20

CYTOPATH GYN SCREEN INTER PROF

Facility

$15.75

Service Code	HCPCS G0124 26
Hospital Charge Code	9710460
Hospital Revenue Code	971
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$10.24
Rate for Payer: Community Health Alliance Commercial	$13.39
Rate for Payer: Priority Health Commercial	$11.03
Rate for Payer: Priority Health PPO	$11.03

CYTOPATH NON GYN SCREEN TECH

Facility

$53.00

Service Code	HCPCS 88161
Hospital Charge Code	3100145
Hospital Revenue Code	311
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$45.05
Rate for Payer: BCBS BCN 65	$31.03
Rate for Payer: Blue Care Network Medicare Advantage	$31.03
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$31.03
Rate for Payer: Meridian Health Plan Medicare	$31.03
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$31.03
Rate for Payer: Priority Health Medicare	$31.03
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$31.03
Rate for Payer: United Health Care Medicare Advantage	$13.65

CYTOPATH SMEAR WITH INTERP

Facility

$137.00

Service Code	HCPCS 88104
Hospital Charge Code	3100167
Hospital Revenue Code	311
Min. Negotiated Rate	$17.63
Max. Negotiated Rate	$116.45
Rate for Payer: BCBS BCN 65	$40.07
Rate for Payer: Blue Care Network Medicare Advantage	$40.07
Rate for Payer: Cash Price	$89.05
Rate for Payer: Cash Price	$89.05
Rate for Payer: Community Health Alliance Commercial	$116.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$40.07
Rate for Payer: Meridian Health Plan Medicare	$40.07
Rate for Payer: Priority Health Commercial	$95.90
Rate for Payer: Priority Health Medicaid	$40.07
Rate for Payer: Priority Health Medicare	$40.07
Rate for Payer: Priority Health PPO	$95.90
Rate for Payer: United Health Care Medicaid	$40.07
Rate for Payer: United Health Care Medicare Advantage	$17.63

CYTP URINE 3-5 PROBES CMPTR

Facility

$547.00

Hospital Charge Code	3100172
Hospital Revenue Code	310
Min. Negotiated Rate	$382.90
Max. Negotiated Rate	$464.95
Rate for Payer: Cash Price	$355.55
Rate for Payer: Community Health Alliance Commercial	$464.95
Rate for Payer: Priority Health Commercial	$382.90
Rate for Payer: Priority Health PPO	$382.90

DACRON PATCH 4 X 4

Facility

$355.00

Hospital Charge Code	27014878
Hospital Revenue Code	278
Min. Negotiated Rate	$248.50
Max. Negotiated Rate	$301.75
Rate for Payer: Cash Price	$230.75
Rate for Payer: Community Health Alliance Commercial	$301.75
Rate for Payer: Priority Health Commercial	$248.50
Rate for Payer: Priority Health PPO	$248.50

DASH-480 DIRECT ACCESS SYSTEM

Facility

$1,086.00

Hospital Charge Code	27264066
Hospital Revenue Code	272
Min. Negotiated Rate	$760.20
Max. Negotiated Rate	$923.10
Rate for Payer: Cash Price	$705.90
Rate for Payer: Community Health Alliance Commercial	$923.10
Rate for Payer: Priority Health Commercial	$760.20
Rate for Payer: Priority Health PPO	$760.20

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges