Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

ER INTERMEDIATE PROCEDURE

Facility

$242.00

Hospital Charge Code	4500902
Hospital Revenue Code	450
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$205.70
Rate for Payer: Cash Price	$157.30
Rate for Payer: Community Health Alliance Commercial	$205.70
Rate for Payer: Priority Health Commercial	$169.40
Rate for Payer: Priority Health PPO	$169.40

ER I.V INFUS HYDRATION EA AD'L

Facility

$112.00

Hospital Charge Code	4500053
Hospital Revenue Code	450
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$95.20
Rate for Payer: Cash Price	$72.80
Rate for Payer: Community Health Alliance Commercial	$95.20
Rate for Payer: Priority Health Commercial	$78.40
Rate for Payer: Priority Health PPO	$78.40

ER I.V. INFUSION HYDRATION

Facility

$210.00

Hospital Charge Code	4500052
Hospital Revenue Code	450
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$178.50
Rate for Payer: Cash Price	$136.50
Rate for Payer: Community Health Alliance Commercial	$178.50
Rate for Payer: Priority Health Commercial	$147.00
Rate for Payer: Priority Health PPO	$147.00

ER IV PUSH THERAPUTIC

Facility

$195.00

Service Code	HCPCS 96374
Hospital Charge Code	4500860
Hospital Revenue Code	450
Min. Negotiated Rate	$100.40
Max. Negotiated Rate	$228.18
Rate for Payer: BCBS BCN 65	$228.18
Rate for Payer: Blue Care Network Medicare Advantage	$228.18
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	$228.18
Rate for Payer: Meridian Health Plan Medicare	$228.18
Rate for Payer: Priority Health Commercial	$136.50
Rate for Payer: Priority Health Medicaid	$228.18
Rate for Payer: Priority Health Medicare	$228.18
Rate for Payer: Priority Health PPO	$136.50
Rate for Payer: United Health Care Medicaid	$228.18
Rate for Payer: United Health Care Medicare Advantage	$100.40

ER I.V. THER ADD'L SEQ INFUSIO

Facility

$135.00

Hospital Charge Code	4500851
Hospital Revenue Code	450
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

ER IV THERAPUTIC INFUSE ADD HR

Facility

$135.00

Service Code	HCPCS 96366
Hospital Charge Code	4500855
Hospital Revenue Code	450
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$114.75
Rate for Payer: BCBS BCN 65	$50.23
Rate for Payer: Blue Care Network Medicare Advantage	$50.23
Rate for Payer: Cash Price	$87.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Community Health Alliance Commercial	$114.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$50.23
Rate for Payer: Meridian Health Plan Medicare	$50.23
Rate for Payer: Priority Health Commercial	$94.50
Rate for Payer: Priority Health Medicaid	$50.23
Rate for Payer: Priority Health Medicare	$50.23
Rate for Payer: Priority Health PPO	$94.50
Rate for Payer: United Health Care Medicaid	$50.23
Rate for Payer: United Health Care Medicare Advantage	$22.10

ER IV THERAPUTIC INFUSION PHR

Facility

$292.00

Service Code	HCPCS 96365
Hospital Charge Code	4500850
Hospital Revenue Code	450
Min. Negotiated Rate	$100.40
Max. Negotiated Rate	$248.20
Rate for Payer: BCBS BCN 65	$228.18
Rate for Payer: Blue Care Network Medicare Advantage	$228.18
Rate for Payer: Cash Price	$189.80
Rate for Payer: Cash Price	$189.80
Rate for Payer: Community Health Alliance Commercial	$248.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$228.18
Rate for Payer: Meridian Health Plan Medicare	$228.18
Rate for Payer: Priority Health Commercial	$204.40
Rate for Payer: Priority Health Medicaid	$228.18
Rate for Payer: Priority Health Medicare	$228.18
Rate for Payer: Priority Health PPO	$204.40
Rate for Payer: United Health Care Medicaid	$228.18
Rate for Payer: United Health Care Medicare Advantage	$100.40

ER LOW LEVEL PROCEDURE

Facility

$147.00

Hospital Charge Code	4500900
Hospital Revenue Code	450
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$124.95
Rate for Payer: Cash Price	$95.55
Rate for Payer: Community Health Alliance Commercial	$124.95
Rate for Payer: Priority Health Commercial	$102.90
Rate for Payer: Priority Health PPO	$102.90

ER MAJOR PROCEDURE

Facility

$869.00

Hospital Charge Code	4500903
Hospital Revenue Code	450
Min. Negotiated Rate	$608.30
Max. Negotiated Rate	$738.65
Rate for Payer: Cash Price	$564.85
Rate for Payer: Community Health Alliance Commercial	$738.65
Rate for Payer: Priority Health Commercial	$608.30
Rate for Payer: Priority Health PPO	$608.30

ER MID LEVEL PROCEDURE

Facility

$304.00

Hospital Charge Code	4500950
Hospital Revenue Code	450
Min. Negotiated Rate	$212.80
Max. Negotiated Rate	$258.40
Rate for Payer: Cash Price	$197.60
Rate for Payer: Community Health Alliance Commercial	$258.40
Rate for Payer: Priority Health Commercial	$212.80
Rate for Payer: Priority Health PPO	$212.80

ER MINOR PROCEDURE

Facility

$122.00

Hospital Charge Code	4500901
Hospital Revenue Code	450
Min. Negotiated Rate	$85.40
Max. Negotiated Rate	$103.70
Rate for Payer: Cash Price	$79.30
Rate for Payer: Community Health Alliance Commercial	$103.70
Rate for Payer: Priority Health Commercial	$85.40
Rate for Payer: Priority Health PPO	$85.40

ER QUICK-CATH FOR URINE COLLEC

Facility

$44.00

Service Code	HCPCS P9612
Hospital Charge Code	4500940
Hospital Revenue Code	450
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$37.40
Rate for Payer: BCBS BCN 65	$9.81
Rate for Payer: Blue Care Network Medicare Advantage	$9.81
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.81
Rate for Payer: Meridian Health Plan Medicare	$9.81
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health Medicaid	$9.81
Rate for Payer: Priority Health Medicare	$9.81
Rate for Payer: Priority Health PPO	$30.80
Rate for Payer: United Health Care Medicaid	$9.81
Rate for Payer: United Health Care Medicare Advantage	$4.32

ER SUBQ/IM ANTIBIOTIC INJECT

Facility

$112.00

Service Code	HCPCS 96372
Hospital Charge Code	4500820
Hospital Revenue Code	450
Min. Negotiated Rate	$33.98
Max. Negotiated Rate	$95.20
Rate for Payer: BCBS BCN 65	$77.24
Rate for Payer: Blue Care Network Medicare Advantage	$77.24
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Community Health Alliance Commercial	$95.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$77.24
Rate for Payer: Meridian Health Plan Medicare	$77.24
Rate for Payer: Priority Health Commercial	$78.40
Rate for Payer: Priority Health Medicaid	$77.24
Rate for Payer: Priority Health Medicare	$77.24
Rate for Payer: Priority Health PPO	$78.40
Rate for Payer: United Health Care Medicaid	$77.24
Rate for Payer: United Health Care Medicare Advantage	$33.98

ER SUBQ/IM THERAPUTIC INJECT

Facility

$112.00

Service Code	HCPCS 96372
Hospital Charge Code	4500810
Hospital Revenue Code	450
Min. Negotiated Rate	$33.98
Max. Negotiated Rate	$95.20
Rate for Payer: BCBS BCN 65	$77.24
Rate for Payer: Blue Care Network Medicare Advantage	$77.24
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Community Health Alliance Commercial	$95.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$77.24
Rate for Payer: Meridian Health Plan Medicare	$77.24
Rate for Payer: Priority Health Commercial	$78.40
Rate for Payer: Priority Health Medicaid	$77.24
Rate for Payer: Priority Health Medicare	$77.24
Rate for Payer: Priority Health PPO	$78.40
Rate for Payer: United Health Care Medicaid	$77.24
Rate for Payer: United Health Care Medicare Advantage	$33.98

ERYTH PORPHOBILINOGEN DEAMINAS

Facility

$155.00

Hospital Charge Code	3004142
Hospital Revenue Code	301
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$131.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Community Health Alliance Commercial	$131.75
Rate for Payer: Priority Health Commercial	$108.50
Rate for Payer: Priority Health PPO	$108.50

ERYTHROPOIETIN

Facility

$7.33

Service Code	HCPCS 82668
Hospital Charge Code	3004040
Hospital Revenue Code	301
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$19.73
Rate for Payer: BCBS BCN 65	$19.73
Rate for Payer: Blue Care Network Medicare Advantage	$19.73
Rate for Payer: Cash Price	$4.76
Rate for Payer: Cash Price	$4.76
Rate for Payer: Community Health Alliance Commercial	$6.23
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.73
Rate for Payer: Meridian Health Plan Medicare	$19.73
Rate for Payer: Priority Health Commercial	$5.13
Rate for Payer: Priority Health Medicaid	$19.73
Rate for Payer: Priority Health Medicare	$19.73
Rate for Payer: Priority Health PPO	$5.13
Rate for Payer: United Health Care Medicaid	$19.73
Rate for Payer: United Health Care Medicare Advantage	$8.68

ESCISION ABDL TUM DEEP <5 CM

Facility

$1,132.00

Hospital Charge Code	5150731
Hospital Revenue Code	960
Min. Negotiated Rate	$792.40
Max. Negotiated Rate	$962.20
Rate for Payer: Cash Price	$735.80
Rate for Payer: Community Health Alliance Commercial	$962.20
Rate for Payer: Priority Health Commercial	$792.40
Rate for Payer: Priority Health PPO	$792.40

ESOPHAGEAL BOUGIES SET

Facility

$58.00

Hospital Charge Code	27060301
Hospital Revenue Code	272
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$49.30
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health PPO	$40.60

ESOPHAGEAL-NASOGASTRIC TUBE

Facility

$1,163.00

Hospital Charge Code	27060750
Hospital Revenue Code	272
Min. Negotiated Rate	$814.10
Max. Negotiated Rate	$988.55
Rate for Payer: Cash Price	$755.95
Rate for Payer: Community Health Alliance Commercial	$988.55
Rate for Payer: Priority Health Commercial	$814.10
Rate for Payer: Priority Health PPO	$814.10

ESOPHAGEAL STENT

Facility

$5,320.00

Service Code	HCPCS C1877
Hospital Charge Code	27267896
Hospital Revenue Code	278
Min. Negotiated Rate	$3,724.00
Max. Negotiated Rate	$4,522.00
Rate for Payer: Cash Price	$3,458.00
Rate for Payer: Community Health Alliance Commercial	$4,522.00
Rate for Payer: Priority Health Commercial	$3,724.00
Rate for Payer: Priority Health PPO	$3,724.00

ESOPHAGEAL STETHOSCOPE

Facility

$53.00

Hospital Charge Code	27010066
Hospital Revenue Code	270
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$45.05
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health PPO	$37.10

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$972.96

Service Code	CPT 43235
Hospital Revenue Code	360
Min. Negotiated Rate	$428.10
Max. Negotiated Rate	$972.96
Rate for Payer: BCBS BCN 65	$972.96
Rate for Payer: Blue Care Network Medicare Advantage	$972.96
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$972.96
Rate for Payer: Meridian Health Plan Medicare	$972.96
Rate for Payer: Priority Health Medicaid	$972.96
Rate for Payer: Priority Health Medicare	$972.96
Rate for Payer: United Health Care Medicaid	$972.96
Rate for Payer: United Health Care Medicare Advantage	$428.10

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$972.96

Service Code	CPT 43239
Hospital Revenue Code	360
Min. Negotiated Rate	$428.10
Max. Negotiated Rate	$972.96
Rate for Payer: BCBS BCN 65	$972.96
Rate for Payer: Blue Care Network Medicare Advantage	$972.96
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$972.96
Rate for Payer: Meridian Health Plan Medicare	$972.96
Rate for Payer: Priority Health Medicaid	$972.96
Rate for Payer: Priority Health Medicare	$972.96
Rate for Payer: United Health Care Medicaid	$972.96
Rate for Payer: United Health Care Medicare Advantage	$428.10

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD

Facility

$2,058.49

Service Code	CPT 43255
Hospital Revenue Code	360
Min. Negotiated Rate	$905.74
Max. Negotiated Rate	$2,058.49
Rate for Payer: BCBS BCN 65	$2,058.49
Rate for Payer: Blue Care Network Medicare Advantage	$2,058.49
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,058.49
Rate for Payer: Meridian Health Plan Medicare	$2,058.49
Rate for Payer: Priority Health Medicaid	$2,058.49
Rate for Payer: Priority Health Medicare	$2,058.49
Rate for Payer: United Health Care Medicaid	$2,058.49
Rate for Payer: United Health Care Medicare Advantage	$905.74

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH INSERTION OF GUIDE WIRE FOLLOWED BY PASSAGE OF DILATOR(S) THROUGH ESOPHAGUS OVER GUIDE WIRE

Facility

$972.96

Service Code	CPT 43248
Hospital Revenue Code	360
Min. Negotiated Rate	$428.10
Max. Negotiated Rate	$972.96
Rate for Payer: BCBS BCN 65	$972.96
Rate for Payer: Blue Care Network Medicare Advantage	$972.96
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$972.96
Rate for Payer: Meridian Health Plan Medicare	$972.96
Rate for Payer: Priority Health Medicaid	$972.96
Rate for Payer: Priority Health Medicare	$972.96
Rate for Payer: United Health Care Medicaid	$972.96
Rate for Payer: United Health Care Medicare Advantage	$428.10

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges