Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

DNA PROBE EACH-50

Facility

$28.00

Hospital Charge Code	3100232
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-51

Facility

$28.00

Hospital Charge Code	3100233
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-52

Facility

$28.00

Hospital Charge Code	3100234
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-53

Facility

$28.00

Hospital Charge Code	3100236
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-54

Facility

$28.00

Hospital Charge Code	3100237
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-55

Facility

$28.00

Hospital Charge Code	3100238
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-6

Facility

$28.00

Hospital Charge Code	3100182
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-7

Facility

$28.00

Hospital Charge Code	3100183
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-8

Facility

$28.00

Hospital Charge Code	3100184
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE EACH-9

Facility

$28.00

Hospital Charge Code	3100185
Hospital Revenue Code	310
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$23.80
Rate for Payer: Cash Price	$18.20
Rate for Payer: Community Health Alliance Commercial	$23.80
Rate for Payer: Priority Health Commercial	$19.60
Rate for Payer: Priority Health PPO	$19.60

DNA PROBE,NOS

Facility

$195.00

Service Code	HCPCS 87798
Hospital Charge Code	3000012
Hospital Revenue Code	306
Min. Negotiated Rate	$16.21
Max. Negotiated Rate	$165.75
Rate for Payer: BCBS BCN 65	$36.84
Rate for Payer: Blue Care Network Medicare Advantage	$36.84
Rate for Payer: Cash Price	$126.75
Rate for Payer: Cash Price	$126.75
Rate for Payer: Community Health Alliance Commercial	$165.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$36.84
Rate for Payer: Meridian Health Plan Medicare	$36.84
Rate for Payer: Priority Health Commercial	$136.50
Rate for Payer: Priority Health Medicaid	$36.84
Rate for Payer: Priority Health Medicare	$36.84
Rate for Payer: Priority Health PPO	$136.50
Rate for Payer: United Health Care Medicaid	$36.84
Rate for Payer: United Health Care Medicare Advantage	$16.21

DNA SEQUENCING-BACTERIAL ID

Facility

$229.00

Hospital Charge Code	3009116
Hospital Revenue Code	306
Min. Negotiated Rate	$160.30
Max. Negotiated Rate	$194.65
Rate for Payer: Cash Price	$148.85
Rate for Payer: Community Health Alliance Commercial	$194.65
Rate for Payer: Priority Health Commercial	$160.30
Rate for Payer: Priority Health PPO	$160.30

DNA SS IgG ANTIBODY

Facility

$14.24

Hospital Charge Code	3005399
Hospital Revenue Code	302
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$12.10
Rate for Payer: Cash Price	$9.26
Rate for Payer: Community Health Alliance Commercial	$12.10
Rate for Payer: Priority Health Commercial	$9.97
Rate for Payer: Priority Health PPO	$9.97

DOBBHOFF NASO-JEJUNAL FEED TBE

Facility

$474.00

Hospital Charge Code	27264561
Hospital Revenue Code	272
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

DORSOLUMBAR SUPPORT #3510

Facility

$228.00

Hospital Charge Code	27022632
Hospital Revenue Code	270
Min. Negotiated Rate	$159.60
Max. Negotiated Rate	$193.80
Rate for Payer: Cash Price	$148.20
Rate for Payer: Community Health Alliance Commercial	$193.80
Rate for Payer: Priority Health Commercial	$159.60
Rate for Payer: Priority Health PPO	$159.60

DOXEPIN AND NORDOXEPIN

Facility

$14.84

Service Code	HCPCS G0480
Hospital Charge Code	3100703
Hospital Revenue Code	301
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$120.15
Rate for Payer: BCBS BCN 65	$120.15
Rate for Payer: Blue Care Network Medicare Advantage	$120.15
Rate for Payer: Cash Price	$9.65
Rate for Payer: Cash Price	$9.65
Rate for Payer: Community Health Alliance Commercial	$12.61
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$10.39
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$10.39
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

DOXEPIN URINE

Facility

$70.00

Hospital Charge Code	3100779
Hospital Revenue Code	300
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

DPYD 1905/1679/2846

Facility

$274.75

Hospital Charge Code	3100969
Hospital Revenue Code	300
Min. Negotiated Rate	$192.32
Max. Negotiated Rate	$233.54
Rate for Payer: Cash Price	$178.59
Rate for Payer: Community Health Alliance Commercial	$233.54
Rate for Payer: Priority Health Commercial	$192.32
Rate for Payer: Priority Health PPO	$192.32

DPYD 85/1590

Facility

$200.00

Hospital Charge Code	3100971
Hospital Revenue Code	300
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$170.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Community Health Alliance Commercial	$170.00
Rate for Payer: Priority Health Commercial	$140.00
Rate for Payer: Priority Health PPO	$140.00

DRAGON 3.5 END & SIDE CUTTER

Facility

$251.00

Hospital Charge Code	27268118
Hospital Revenue Code	272
Min. Negotiated Rate	$175.70
Max. Negotiated Rate	$213.35
Rate for Payer: Cash Price	$163.15
Rate for Payer: Community Health Alliance Commercial	$213.35
Rate for Payer: Priority Health Commercial	$175.70
Rate for Payer: Priority Health PPO	$175.70

DRAGON, 4.2MM #C9291

Facility

$214.00

Hospital Charge Code	27264629
Hospital Revenue Code	272
Min. Negotiated Rate	$149.80
Max. Negotiated Rate	$181.90
Rate for Payer: Cash Price	$139.10
Rate for Payer: Community Health Alliance Commercial	$181.90
Rate for Payer: Priority Health Commercial	$149.80
Rate for Payer: Priority Health PPO	$149.80

DRAINAGE OF PILONIDAL CYST PC

Facility

$558.00

Hospital Charge Code	5150720
Hospital Revenue Code	960
Min. Negotiated Rate	$390.60
Max. Negotiated Rate	$474.30
Rate for Payer: Cash Price	$362.70
Rate for Payer: Community Health Alliance Commercial	$474.30
Rate for Payer: Priority Health Commercial	$390.60
Rate for Payer: Priority Health PPO	$390.60

DRAIN,JACKSON PRATT 19FR

Facility

$40.00

Hospital Charge Code	27021287
Hospital Revenue Code	272
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$34.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Community Health Alliance Commercial	$34.00
Rate for Payer: Priority Health Commercial	$28.00
Rate for Payer: Priority Health PPO	$28.00

DRAIN-SARATOGA SUMP

Facility

$59.00

Hospital Charge Code	27012179
Hospital Revenue Code	270
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$50.15
Rate for Payer: Cash Price	$38.35
Rate for Payer: Community Health Alliance Commercial	$50.15
Rate for Payer: Priority Health Commercial	$41.30
Rate for Payer: Priority Health PPO	$41.30

DRAIN SET MULTIPUR UTA-NPAS

Facility

$342.00

Hospital Charge Code	27014548
Hospital Revenue Code	272
Min. Negotiated Rate	$239.40
Max. Negotiated Rate	$290.70
Rate for Payer: Cash Price	$222.30
Rate for Payer: Community Health Alliance Commercial	$290.70
Rate for Payer: Priority Health Commercial	$239.40
Rate for Payer: Priority Health PPO	$239.40

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges