Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

DAT AHG IBC

Facility

$50.00

Hospital Charge Code	3101930
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health PPO	$35.00

DAT-FWRBC

Facility

$26.00

Hospital Charge Code	3101419
Hospital Revenue Code	300
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$16.90
Rate for Payer: Community Health Alliance Commercial	$22.10
Rate for Payer: Priority Health Commercial	$18.20
Rate for Payer: Priority Health PPO	$18.20

DAT-MONO-1

Facility

$16.66

Hospital Charge Code	3101936
Hospital Revenue Code	300
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$14.16
Rate for Payer: Cash Price	$10.83
Rate for Payer: Community Health Alliance Commercial	$14.16
Rate for Payer: Priority Health Commercial	$11.66
Rate for Payer: Priority Health PPO	$11.66

DAT-MONO-3

Facility

$16.68

Hospital Charge Code	3101938
Hospital Revenue Code	300
Min. Negotiated Rate	$11.68
Max. Negotiated Rate	$14.18
Rate for Payer: Cash Price	$10.84
Rate for Payer: Community Health Alliance Commercial	$14.18
Rate for Payer: Priority Health Commercial	$11.68
Rate for Payer: Priority Health PPO	$11.68

DAT-NONO-2

Facility

$16.66

Hospital Charge Code	3101937
Hospital Revenue Code	300
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$14.16
Rate for Payer: Cash Price	$10.83
Rate for Payer: Community Health Alliance Commercial	$14.16
Rate for Payer: Priority Health Commercial	$11.66
Rate for Payer: Priority Health PPO	$11.66

D-DIMERS

Facility

$98.00

Service Code	HCPCS 85378
Hospital Charge Code	3000181
Hospital Revenue Code	305
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$83.30
Rate for Payer: BCBS BCN 65	$10.21
Rate for Payer: Blue Care Network Medicare Advantage	$10.21
Rate for Payer: Cash Price	$63.70
Rate for Payer: Cash Price	$63.70
Rate for Payer: Community Health Alliance Commercial	$83.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.21
Rate for Payer: Meridian Health Plan Medicare	$10.21
Rate for Payer: Priority Health Commercial	$68.60
Rate for Payer: Priority Health Medicaid	$10.21
Rate for Payer: Priority Health Medicare	$10.21
Rate for Payer: Priority Health PPO	$68.60
Rate for Payer: United Health Care Medicaid	$10.21
Rate for Payer: United Health Care Medicare Advantage	$4.49

DEACTIVATION PACKAGE #72400095

Facility

$234.00

Hospital Charge Code	27063187
Hospital Revenue Code	270
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

DEAVER T-TUBE DRAIN

Facility

$56.00

Hospital Charge Code	27011460
Hospital Revenue Code	272
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$36.40
Rate for Payer: Community Health Alliance Commercial	$47.60
Rate for Payer: Priority Health Commercial	$39.20
Rate for Payer: Priority Health PPO	$39.20

DEB MUSC/FASCIA 20 SQ CM

Facility

$886.00

Hospital Charge Code	5150705
Hospital Revenue Code	960
Min. Negotiated Rate	$620.20
Max. Negotiated Rate	$753.10
Rate for Payer: Cash Price	$575.90
Rate for Payer: Community Health Alliance Commercial	$753.10
Rate for Payer: Priority Health Commercial	$620.20
Rate for Payer: Priority Health PPO	$620.20

DEBRIDEMENT SUBCUTANEOUS P/C

Facility

$474.00

Hospital Charge Code	5150688
Hospital Revenue Code	960
Min. Negotiated Rate	$331.80
Max. Negotiated Rate	$402.90
Rate for Payer: Cash Price	$308.10
Rate for Payer: Community Health Alliance Commercial	$402.90
Rate for Payer: Priority Health Commercial	$331.80
Rate for Payer: Priority Health PPO	$331.80

DEBRIDEMENT SURFACE AREA<20 CM

Facility

$92.00

Service Code	HCPCS 97597
Hospital Charge Code	4200071
Hospital Revenue Code	420
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$215.23
Rate for Payer: BCBS BCN 65	$215.23
Rate for Payer: Blue Care Network Medicare Advantage	$215.23
Rate for Payer: Cash Price	$59.80
Rate for Payer: Cash Price	$59.80
Rate for Payer: Community Health Alliance Commercial	$78.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$215.23
Rate for Payer: Meridian Health Plan Medicare	$215.23
Rate for Payer: Priority Health Commercial	$64.40
Rate for Payer: Priority Health Medicaid	$215.23
Rate for Payer: Priority Health Medicare	$215.23
Rate for Payer: Priority Health PPO	$64.40
Rate for Payer: United Health Care Medicaid	$215.23
Rate for Payer: United Health Care Medicare Advantage	$94.70

DEBRIDEMENT SURFACE AREA>20 CM

Facility

$128.00

Service Code	HCPCS 97598 GP
Hospital Charge Code	4200072
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

DEB SUBQ TISSUE 20 SC CM

Facility

$495.00

Hospital Charge Code	5150734
Hospital Revenue Code	960
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$420.75
Rate for Payer: Cash Price	$321.75
Rate for Payer: Community Health Alliance Commercial	$420.75
Rate for Payer: Priority Health Commercial	$346.50
Rate for Payer: Priority Health PPO	$346.50

Decalcification 1st

Facility

$19.00

Hospital Charge Code	31027479
Hospital Revenue Code	300
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$16.15
Rate for Payer: Cash Price	$12.35
Rate for Payer: Community Health Alliance Commercial	$16.15
Rate for Payer: Priority Health Commercial	$13.30
Rate for Payer: Priority Health PPO	$13.30

DECALCIFICATION BONE & B.M.TEC

Facility

$45.00

Service Code	HCPCS 88311
Hospital Charge Code	3100170
Hospital Revenue Code	310
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

DEFLUX IML SYRINGE

Facility

$2,921.00

Service Code	HCPCS L8604
Hospital Charge Code	27872137
Hospital Revenue Code	278
Min. Negotiated Rate	$2,044.70
Max. Negotiated Rate	$2,482.85
Rate for Payer: Cash Price	$1,898.65
Rate for Payer: Community Health Alliance Commercial	$2,482.85
Rate for Payer: Priority Health Commercial	$2,044.70
Rate for Payer: Priority Health PPO	$2,044.70

DELIVERY SYSTEM FOR COLD INJEC

Facility

$227.00

Hospital Charge Code	27011056
Hospital Revenue Code	270
Min. Negotiated Rate	$158.90
Max. Negotiated Rate	$192.95
Rate for Payer: Cash Price	$147.55
Rate for Payer: Community Health Alliance Commercial	$192.95
Rate for Payer: Priority Health Commercial	$158.90
Rate for Payer: Priority Health PPO	$158.90

DELTA OD,AMNIOTIC FLUID

Facility

$94.00

Service Code	HCPCS 82143
Hospital Charge Code	3003650
Hospital Revenue Code	301
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$79.90
Rate for Payer: BCBS BCN 65	$9.82
Rate for Payer: Blue Care Network Medicare Advantage	$9.82
Rate for Payer: Cash Price	$61.10
Rate for Payer: Cash Price	$61.10
Rate for Payer: Community Health Alliance Commercial	$79.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.82
Rate for Payer: Meridian Health Plan Medicare	$9.82
Rate for Payer: Priority Health Commercial	$65.80
Rate for Payer: Priority Health Medicaid	$9.82
Rate for Payer: Priority Health Medicare	$9.82
Rate for Payer: Priority Health PPO	$65.80
Rate for Payer: United Health Care Medicaid	$9.82
Rate for Payer: United Health Care Medicare Advantage	$4.32

DENGUE FEVER Ab,IgG/IgM 1

Facility

$65.00

Service Code	HCPCS 86790
Hospital Charge Code	3003671
Hospital Revenue Code	302
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$55.25
Rate for Payer: BCBS BCN 65	$13.52
Rate for Payer: Blue Care Network Medicare Advantage	$13.52
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.52
Rate for Payer: Meridian Health Plan Medicare	$13.52
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health Medicaid	$13.52
Rate for Payer: Priority Health Medicare	$13.52
Rate for Payer: Priority Health PPO	$45.50
Rate for Payer: United Health Care Medicaid	$13.52
Rate for Payer: United Health Care Medicare Advantage	$5.95

DENGUE FEVER Ab,IgG/IgM 2

Facility

$65.00

Service Code	HCPCS 86790
Hospital Charge Code	3003672
Hospital Revenue Code	302
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$55.25
Rate for Payer: BCBS BCN 65	$13.52
Rate for Payer: Blue Care Network Medicare Advantage	$13.52
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Community Health Alliance Commercial	$55.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.52
Rate for Payer: Meridian Health Plan Medicare	$13.52
Rate for Payer: Priority Health Commercial	$45.50
Rate for Payer: Priority Health Medicaid	$13.52
Rate for Payer: Priority Health Medicare	$13.52
Rate for Payer: Priority Health PPO	$45.50
Rate for Payer: United Health Care Medicaid	$13.52
Rate for Payer: United Health Care Medicare Advantage	$5.95

DEOXYCORTICOSTERONE

Facility

$53.35

Hospital Charge Code	3102671
Hospital Revenue Code	300
Min. Negotiated Rate	$37.34
Max. Negotiated Rate	$45.35
Rate for Payer: Cash Price	$34.68
Rate for Payer: Community Health Alliance Commercial	$45.35
Rate for Payer: Priority Health Commercial	$37.34
Rate for Payer: Priority Health PPO	$37.34

DEOXYCORTISOL,II

Facility

$24.23

Service Code	HCPCS 82634
Hospital Charge Code	3003800
Hospital Revenue Code	301
Min. Negotiated Rate	$13.53
Max. Negotiated Rate	$30.74
Rate for Payer: BCBS BCN 65	$30.74
Rate for Payer: Blue Care Network Medicare Advantage	$30.74
Rate for Payer: Cash Price	$15.75
Rate for Payer: Cash Price	$15.75
Rate for Payer: Community Health Alliance Commercial	$20.60
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$30.74
Rate for Payer: Meridian Health Plan Medicare	$30.74
Rate for Payer: Priority Health Commercial	$16.96
Rate for Payer: Priority Health Medicaid	$30.74
Rate for Payer: Priority Health Medicare	$30.74
Rate for Payer: Priority Health PPO	$16.96
Rate for Payer: United Health Care Medicaid	$30.74
Rate for Payer: United Health Care Medicare Advantage	$13.53

DEPAKENE (VALPROIC ACID)

Facility

$60.00

Service Code	HCPCS 80164
Hospital Charge Code	3008720
Hospital Revenue Code	301
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$51.00
Rate for Payer: BCBS BCN 65	$14.22
Rate for Payer: Blue Care Network Medicare Advantage	$14.22
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	$14.22
Rate for Payer: Meridian Health Plan Medicare	$14.22
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health Medicaid	$14.22
Rate for Payer: Priority Health Medicare	$14.22
Rate for Payer: Priority Health PPO	$42.00
Rate for Payer: United Health Care Medicaid	$14.22
Rate for Payer: United Health Care Medicare Advantage	$6.26

DEPAKENE (VALPROIC ACID)SBMF

Facility

$4.50

Hospital Charge Code	3101144
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.83
Rate for Payer: Cash Price	$2.93
Rate for Payer: Community Health Alliance Commercial	$3.83
Rate for Payer: Priority Health Commercial	$3.15
Rate for Payer: Priority Health PPO	$3.15

DERMABOND

Facility

$39.47

Hospital Charge Code	27065056
Hospital Revenue Code	272
Min. Negotiated Rate	$27.63
Max. Negotiated Rate	$33.55
Rate for Payer: Cash Price	$25.66
Rate for Payer: Community Health Alliance Commercial	$33.55
Rate for Payer: Priority Health Commercial	$27.63
Rate for Payer: Priority Health PPO	$27.63

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges