Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

DRESSING-VPM MEDIUM

Facility

$15.00

Hospital Charge Code	27010702
Hospital Revenue Code	272
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

DRESSING-VPM, SMALL

Facility

$14.00

Hospital Charge Code	27010694
Hospital Revenue Code	272
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

DRESSING, WHITE VERSA FOAM

Facility

$135.00

Hospital Charge Code	27071535
Hospital Revenue Code	272
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$114.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Community Health Alliance Commercial	$114.75
Rate for Payer: Priority Health Commercial	$94.50
Rate for Payer: Priority Health PPO	$94.50

DRILL 2-0

Facility

$208.25

Hospital Charge Code	27281767
Hospital Revenue Code	272
Min. Negotiated Rate	$145.78
Max. Negotiated Rate	$177.01
Rate for Payer: Cash Price	$135.36
Rate for Payer: Community Health Alliance Commercial	$177.01
Rate for Payer: Priority Health Commercial	$145.78
Rate for Payer: Priority Health PPO	$145.78

DRILL BIT

Facility

$143.00

Hospital Charge Code	27272005
Hospital Revenue Code	272
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$121.55
Rate for Payer: Cash Price	$92.95
Rate for Payer: Community Health Alliance Commercial	$121.55
Rate for Payer: Priority Health Commercial	$100.10
Rate for Payer: Priority Health PPO	$100.10

DRILL BIT

Facility

$607.00

Hospital Charge Code	27271913
Hospital Revenue Code	272
Min. Negotiated Rate	$424.90
Max. Negotiated Rate	$515.95
Rate for Payer: Cash Price	$394.55
Rate for Payer: Community Health Alliance Commercial	$515.95
Rate for Payer: Priority Health Commercial	$424.90
Rate for Payer: Priority Health PPO	$424.90

DRILL BIT

Facility

$193.55

Hospital Charge Code	27274818
Hospital Revenue Code	272
Min. Negotiated Rate	$135.49
Max. Negotiated Rate	$164.52
Rate for Payer: Cash Price	$125.81
Rate for Payer: Community Health Alliance Commercial	$164.52
Rate for Payer: Priority Health Commercial	$135.49
Rate for Payer: Priority Health PPO	$135.49

DRILL BIT

Facility

$116.00

Hospital Charge Code	27072005
Hospital Revenue Code	270
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$98.60
Rate for Payer: Cash Price	$75.40
Rate for Payer: Community Health Alliance Commercial	$98.60
Rate for Payer: Priority Health Commercial	$81.20
Rate for Payer: Priority Health PPO	$81.20

DRILL BIT

Facility

$102.00

Hospital Charge Code	27265601
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$86.70
Rate for Payer: Cash Price	$66.30
Rate for Payer: Community Health Alliance Commercial	$86.70
Rate for Payer: Priority Health Commercial	$71.40
Rate for Payer: Priority Health PPO	$71.40

DRILL BIT, 3.2MM

Facility

$144.00

Hospital Charge Code	27267995
Hospital Revenue Code	272
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$122.40
Rate for Payer: Cash Price	$93.60
Rate for Payer: Community Health Alliance Commercial	$122.40
Rate for Payer: Priority Health Commercial	$100.80
Rate for Payer: Priority Health PPO	$100.80

DRILL BIT, 4.3MM

Facility

$246.00

Hospital Charge Code	27267979
Hospital Revenue Code	272
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$209.10
Rate for Payer: Cash Price	$159.90
Rate for Payer: Community Health Alliance Commercial	$209.10
Rate for Payer: Priority Health Commercial	$172.20
Rate for Payer: Priority Health PPO	$172.20

DRILL BIT 4.8

Facility

$363.00

Hospital Charge Code	27271674
Hospital Revenue Code	272
Min. Negotiated Rate	$254.10
Max. Negotiated Rate	$308.55
Rate for Payer: Cash Price	$235.95
Rate for Payer: Community Health Alliance Commercial	$308.55
Rate for Payer: Priority Health Commercial	$254.10
Rate for Payer: Priority Health PPO	$254.10

DRILL BIT, BADGER 9 MM

Facility

$776.00

Hospital Charge Code	27265262
Hospital Revenue Code	272
Min. Negotiated Rate	$543.20
Max. Negotiated Rate	$659.60
Rate for Payer: Cash Price	$504.40
Rate for Payer: Community Health Alliance Commercial	$659.60
Rate for Payer: Priority Health Commercial	$543.20
Rate for Payer: Priority Health PPO	$543.20

DRILL BIT, DISPOSABLE

Facility

$402.00

Hospital Charge Code	27268191
Hospital Revenue Code	272
Min. Negotiated Rate	$281.40
Max. Negotiated Rate	$341.70
Rate for Payer: Cash Price	$261.30
Rate for Payer: Community Health Alliance Commercial	$341.70
Rate for Payer: Priority Health Commercial	$281.40
Rate for Payer: Priority Health PPO	$281.40

DRILL BIT THREE FLUTTED 2.7MM

Facility

$389.00

Hospital Charge Code	27278739
Hospital Revenue Code	272
Min. Negotiated Rate	$272.30
Max. Negotiated Rate	$330.65
Rate for Payer: Cash Price	$252.85
Rate for Payer: Community Health Alliance Commercial	$330.65
Rate for Payer: Priority Health Commercial	$272.30
Rate for Payer: Priority Health PPO	$272.30

DRILL CANNULATED 2.0MM

Facility

$428.75

Hospital Charge Code	27280967
Hospital Revenue Code	272
Min. Negotiated Rate	$300.12
Max. Negotiated Rate	$364.44
Rate for Payer: Cash Price	$278.69
Rate for Payer: Community Health Alliance Commercial	$364.44
Rate for Payer: Priority Health Commercial	$300.12
Rate for Payer: Priority Health PPO	$300.12

DRILL F TARGETING DEVICE

Facility

$438.00

Hospital Charge Code	27266419
Hospital Revenue Code	272
Min. Negotiated Rate	$306.60
Max. Negotiated Rate	$372.30
Rate for Payer: Cash Price	$284.70
Rate for Payer: Community Health Alliance Commercial	$372.30
Rate for Payer: Priority Health Commercial	$306.60
Rate for Payer: Priority Health PPO	$306.60

DRILL/REAMER

Facility

$244.00

Hospital Charge Code	27024372
Hospital Revenue Code	272
Min. Negotiated Rate	$170.80
Max. Negotiated Rate	$207.40
Rate for Payer: Cash Price	$158.60
Rate for Payer: Community Health Alliance Commercial	$207.40
Rate for Payer: Priority Health Commercial	$170.80
Rate for Payer: Priority Health PPO	$170.80

DRILL TIP

Facility

$884.00

Hospital Charge Code	27271906
Hospital Revenue Code	272
Min. Negotiated Rate	$618.80
Max. Negotiated Rate	$751.40
Rate for Payer: Cash Price	$574.60
Rate for Payer: Community Health Alliance Commercial	$751.40
Rate for Payer: Priority Health Commercial	$618.80
Rate for Payer: Priority Health PPO	$618.80

DRUG ABUSE PROFILE

Facility

$7.74

Hospital Charge Code	3102227
Hospital Revenue Code	300
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$6.58
Rate for Payer: Cash Price	$5.03
Rate for Payer: Community Health Alliance Commercial	$6.58
Rate for Payer: Priority Health Commercial	$5.42
Rate for Payer: Priority Health PPO	$5.42

DRUG QUANT NES-LACOSAMIDE

Facility

$60.00

Service Code	HCPCS G0480
Hospital Charge Code	3100505
Hospital Revenue Code	301
Min. Negotiated Rate	$42.00
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	$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	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$42.00
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

DRUG SCREEN

Facility

$358.00

Service Code	HCPCS 80307
Hospital Charge Code	3100164
Hospital Revenue Code	301
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$304.30
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$232.70
Rate for Payer: Cash Price	$232.70
Rate for Payer: Community Health Alliance Commercial	$304.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$65.25
Rate for Payer: Meridian Health Plan Medicare	$65.25
Rate for Payer: Priority Health Commercial	$250.60
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$250.60
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

DRUG SCREEN 10 W CONFIRM SERUM

Facility

$52.00

Hospital Charge Code	3101506
Hospital Revenue Code	300
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

DRUG SCREEN, 8-PANEL

Facility

$74.00

Service Code	HCPCS 80305
Hospital Charge Code	3003910
Hospital Revenue Code	301
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$62.90
Rate for Payer: BCBS BCN 65	$13.23
Rate for Payer: Blue Care Network Medicare Advantage	$13.23
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	$13.23
Rate for Payer: Meridian Health Plan Medicare	$13.23
Rate for Payer: Priority Health Commercial	$51.80
Rate for Payer: Priority Health Medicaid	$13.23
Rate for Payer: Priority Health Medicare	$13.23
Rate for Payer: Priority Health PPO	$51.80
Rate for Payer: United Health Care Medicaid	$13.23
Rate for Payer: United Health Care Medicare Advantage	$5.82

DRUG SCREEN 8 URINE

Facility

$10.01

Service Code	HCPCS 80307
Hospital Charge Code	3100912
Hospital Revenue Code	309
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$65.25
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$6.51
Rate for Payer: Cash Price	$6.51
Rate for Payer: Community Health Alliance Commercial	$8.51
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$65.25
Rate for Payer: Meridian Health Plan Medicare	$65.25
Rate for Payer: Priority Health Commercial	$7.01
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$7.01
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges