Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

Allergens 15

Facility

$381.90

Hospital Charge Code	31027659
Hospital Revenue Code	300
Min. Negotiated Rate	$267.33
Max. Negotiated Rate	$324.62
Rate for Payer: Cash Price	$248.24
Rate for Payer: Community Health Alliance Commercial	$324.62
Rate for Payer: Priority Health Commercial	$267.33
Rate for Payer: Priority Health PPO	$267.33

ALLERGENS ZONE7

Facility

$97.80

Hospital Charge Code	31027540
Hospital Revenue Code	300
Min. Negotiated Rate	$68.46
Max. Negotiated Rate	$83.13
Rate for Payer: Cash Price	$63.57
Rate for Payer: Community Health Alliance Commercial	$83.13
Rate for Payer: Priority Health Commercial	$68.46
Rate for Payer: Priority Health PPO	$68.46

ALLOMATRIX DR GRAFT

Facility

$2,126.00

Hospital Charge Code	27872260
Hospital Revenue Code	278
Min. Negotiated Rate	$1,488.20
Max. Negotiated Rate	$1,807.10
Rate for Payer: Cash Price	$1,381.90
Rate for Payer: Community Health Alliance Commercial	$1,807.10
Rate for Payer: Priority Health Commercial	$1,488.20
Rate for Payer: Priority Health PPO	$1,488.20

ALPHA-1-ANTITRYPSIN

Facility

$4.50

Service Code	HCPCS 82103
Hospital Charge Code	3000450
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$14.11
Rate for Payer: BCBS BCN 65	$14.11
Rate for Payer: Blue Care Network Medicare Advantage	$14.11
Rate for Payer: Cash Price	$2.93
Rate for Payer: Cash Price	$2.93
Rate for Payer: Community Health Alliance Commercial	$3.83
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.11
Rate for Payer: Meridian Health Plan Medicare	$14.11
Rate for Payer: Priority Health Commercial	$3.15
Rate for Payer: Priority Health Medicaid	$14.11
Rate for Payer: Priority Health Medicare	$14.11
Rate for Payer: Priority Health PPO	$3.15
Rate for Payer: United Health Care Medicaid	$14.11
Rate for Payer: United Health Care Medicare Advantage	$6.21

ALPHA 1 ANTITRYPSIN FECAL QUA

Facility

$71.65

Hospital Charge Code	3102505
Hospital Revenue Code	300
Min. Negotiated Rate	$50.16
Max. Negotiated Rate	$60.90
Rate for Payer: Cash Price	$46.57
Rate for Payer: Community Health Alliance Commercial	$60.90
Rate for Payer: Priority Health Commercial	$50.16
Rate for Payer: Priority Health PPO	$50.16

ALPHA-2- ANTIPLASMIN LEVEL

Facility

$40.73

Service Code	HCPCS 85410
Hospital Charge Code	3000451
Hospital Revenue Code	300
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$34.62
Rate for Payer: BCBS BCN 65	$8.10
Rate for Payer: Blue Care Network Medicare Advantage	$8.10
Rate for Payer: Cash Price	$26.47
Rate for Payer: Cash Price	$26.47
Rate for Payer: Community Health Alliance Commercial	$34.62
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.10
Rate for Payer: Meridian Health Plan Medicare	$8.10
Rate for Payer: Priority Health Commercial	$28.51
Rate for Payer: Priority Health Medicaid	$8.10
Rate for Payer: Priority Health Medicare	$8.10
Rate for Payer: Priority Health PPO	$28.51
Rate for Payer: United Health Care Medicaid	$8.10
Rate for Payer: United Health Care Medicare Advantage	$3.56

ALPHA FETO PROTEIN SBMF

Facility

$12.22

Hospital Charge Code	3101438
Hospital Revenue Code	300
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$10.39
Rate for Payer: Cash Price	$7.94
Rate for Payer: Community Health Alliance Commercial	$10.39
Rate for Payer: Priority Health Commercial	$8.55
Rate for Payer: Priority Health PPO	$8.55

ALPHA-FETO PROTEIN, SERUM

Facility

$4.07

Service Code	HCPCS 82105
Hospital Charge Code	3000540
Hospital Revenue Code	301
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$17.61
Rate for Payer: BCBS BCN 65	$17.61
Rate for Payer: Blue Care Network Medicare Advantage	$17.61
Rate for Payer: Cash Price	$2.65
Rate for Payer: Cash Price	$2.65
Rate for Payer: Community Health Alliance Commercial	$3.46
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.61
Rate for Payer: Meridian Health Plan Medicare	$17.61
Rate for Payer: Priority Health Commercial	$2.85
Rate for Payer: Priority Health Medicaid	$17.61
Rate for Payer: Priority Health Medicare	$17.61
Rate for Payer: Priority Health PPO	$2.85
Rate for Payer: United Health Care Medicaid	$17.61
Rate for Payer: United Health Care Medicare Advantage	$7.75

ALPHA-GALACTOSIDASE ACTIVITY

Facility

$325.00

Hospital Charge Code	3006629
Hospital Revenue Code	301
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$276.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Community Health Alliance Commercial	$276.25
Rate for Payer: Priority Health Commercial	$227.50
Rate for Payer: Priority Health PPO	$227.50

ALPHA SUBUNIT

Facility

$52.94

Hospital Charge Code	3101086
Hospital Revenue Code	301
Min. Negotiated Rate	$37.06
Max. Negotiated Rate	$45.00
Rate for Payer: Cash Price	$34.41
Rate for Payer: Community Health Alliance Commercial	$45.00
Rate for Payer: Priority Health Commercial	$37.06
Rate for Payer: Priority Health PPO	$37.06

ALPHA THALASSEMIA

Facility

$285.08

Hospital Charge Code	3102357
Hospital Revenue Code	300
Min. Negotiated Rate	$199.56
Max. Negotiated Rate	$242.32
Rate for Payer: Cash Price	$185.30
Rate for Payer: Community Health Alliance Commercial	$242.32
Rate for Payer: Priority Health Commercial	$199.56
Rate for Payer: Priority Health PPO	$199.56

ALUMINUM

Facility

$13.32

Service Code	HCPCS 82108
Hospital Charge Code	3000505
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$26.75
Rate for Payer: BCBS BCN 65	$26.75
Rate for Payer: Blue Care Network Medicare Advantage	$26.75
Rate for Payer: Cash Price	$8.66
Rate for Payer: Cash Price	$8.66
Rate for Payer: Community Health Alliance Commercial	$11.32
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$26.75
Rate for Payer: Meridian Health Plan Medicare	$26.75
Rate for Payer: Priority Health Commercial	$9.32
Rate for Payer: Priority Health Medicaid	$26.75
Rate for Payer: Priority Health Medicare	$26.75
Rate for Payer: Priority Health PPO	$9.32
Rate for Payer: United Health Care Medicaid	$26.75
Rate for Payer: United Health Care Medicare Advantage	$11.77

AMB BLOOD PRESSURE SCAN W/ ANA

Facility

$216.00

Hospital Charge Code	4900330
Hospital Revenue Code	920
Min. Negotiated Rate	$151.20
Max. Negotiated Rate	$183.60
Rate for Payer: Cash Price	$140.40
Rate for Payer: Community Health Alliance Commercial	$183.60
Rate for Payer: Priority Health Commercial	$151.20
Rate for Payer: Priority Health PPO	$151.20

AMB BLOOD PRESSURE SET UP

Facility

$129.00

Hospital Charge Code	4900340
Hospital Revenue Code	920
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$109.65
Rate for Payer: Cash Price	$83.85
Rate for Payer: Community Health Alliance Commercial	$109.65
Rate for Payer: Priority Health Commercial	$90.30
Rate for Payer: Priority Health PPO	$90.30

AMBULATORY ACUITY LEVEL I

Facility

$535.00

Hospital Charge Code	4900101
Hospital Revenue Code	490
Min. Negotiated Rate	$374.50
Max. Negotiated Rate	$454.75
Rate for Payer: Cash Price	$347.75
Rate for Payer: Community Health Alliance Commercial	$454.75
Rate for Payer: Priority Health Commercial	$374.50
Rate for Payer: Priority Health PPO	$374.50

AMBULATORY ACUITY LEVEL II

Facility

$2,198.00

Hospital Charge Code	3600102
Hospital Revenue Code	360
Min. Negotiated Rate	$1,538.60
Max. Negotiated Rate	$1,868.30
Rate for Payer: Cash Price	$1,428.70
Rate for Payer: Community Health Alliance Commercial	$1,868.30
Rate for Payer: Priority Health Commercial	$1,538.60
Rate for Payer: Priority Health PPO	$1,538.60

AMBULATORY ACUITY LEVEL III

Facility

$2,944.00

Hospital Charge Code	3600103
Hospital Revenue Code	360
Min. Negotiated Rate	$2,060.80
Max. Negotiated Rate	$2,502.40
Rate for Payer: Cash Price	$1,913.60
Rate for Payer: Community Health Alliance Commercial	$2,502.40
Rate for Payer: Priority Health Commercial	$2,060.80
Rate for Payer: Priority Health PPO	$2,060.80

AMBULATORY ACUITY LEVEL III

Facility

$2,675.00

Hospital Charge Code	4900103
Hospital Revenue Code	490
Min. Negotiated Rate	$1,872.50
Max. Negotiated Rate	$2,273.75
Rate for Payer: Cash Price	$1,738.75
Rate for Payer: Community Health Alliance Commercial	$2,273.75
Rate for Payer: Priority Health Commercial	$1,872.50
Rate for Payer: Priority Health PPO	$1,872.50

AMBULATORY ACUITY LEVEL IV

Facility

$5,743.00

Hospital Charge Code	3600104
Hospital Revenue Code	360
Min. Negotiated Rate	$4,020.10
Max. Negotiated Rate	$4,881.55
Rate for Payer: Cash Price	$3,732.95
Rate for Payer: Community Health Alliance Commercial	$4,881.55
Rate for Payer: Priority Health Commercial	$4,020.10
Rate for Payer: Priority Health PPO	$4,020.10

AMIDARONE LEVEL

Facility

$8.15

Service Code	HCPCS 80151
Hospital Charge Code	3000490
Hospital Revenue Code	301
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$19.57
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$5.30
Rate for Payer: Cash Price	$5.30
Rate for Payer: Community Health Alliance Commercial	$6.93
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.57
Rate for Payer: Meridian Health Plan Medicare	$19.57
Rate for Payer: Priority Health Commercial	$5.71
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$5.71
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

AMIKACIN

Facility

$27.30

Hospital Charge Code	3006648
Hospital Revenue Code	301
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$23.20
Rate for Payer: Cash Price	$17.75
Rate for Payer: Community Health Alliance Commercial	$23.20
Rate for Payer: Priority Health Commercial	$19.11
Rate for Payer: Priority Health PPO	$19.11

AMIKACIN-PEAK

Facility

$27.30

Hospital Charge Code	3101178
Hospital Revenue Code	301
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$23.20
Rate for Payer: Cash Price	$17.75
Rate for Payer: Community Health Alliance Commercial	$23.20
Rate for Payer: Priority Health Commercial	$19.11
Rate for Payer: Priority Health PPO	$19.11

AMINO ACID SCREEN,URINE

Facility

$57.00

Service Code	HCPCS 82128
Hospital Charge Code	3008140
Hospital Revenue Code	301
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$48.45
Rate for Payer: BCBS BCN 65	$14.56
Rate for Payer: Blue Care Network Medicare Advantage	$14.56
Rate for Payer: Cash Price	$37.05
Rate for Payer: Cash Price	$37.05
Rate for Payer: Community Health Alliance Commercial	$48.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.56
Rate for Payer: Meridian Health Plan Medicare	$14.56
Rate for Payer: Priority Health Commercial	$39.90
Rate for Payer: Priority Health Medicaid	$14.56
Rate for Payer: Priority Health Medicare	$14.56
Rate for Payer: Priority Health PPO	$39.90
Rate for Payer: United Health Care Medicaid	$14.56
Rate for Payer: United Health Care Medicare Advantage	$6.41

AMINO ACID URINE

Facility

$101.81

Hospital Charge Code	3003745
Hospital Revenue Code	301
Min. Negotiated Rate	$71.27
Max. Negotiated Rate	$86.54
Rate for Payer: Cash Price	$66.18
Rate for Payer: Community Health Alliance Commercial	$86.54
Rate for Payer: Priority Health Commercial	$71.27
Rate for Payer: Priority Health PPO	$71.27

AMITRIPTYLINE

Facility

$53.00

Service Code	HCPCS G0480
Hospital Charge Code	3000492
Hospital Revenue Code	301
Min. Negotiated Rate	$37.10
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	$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	$120.15
Rate for Payer: Meridian Health Plan Medicare	$120.15
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges