Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

EXC S/N/H/F/G MAL-MRG>4CM

Facility

$1,239.00

Hospital Charge Code	5150704
Hospital Revenue Code	960
Min. Negotiated Rate	$867.30
Max. Negotiated Rate	$1,053.15
Rate for Payer: Cash Price	$805.35
Rate for Payer: Community Health Alliance Commercial	$1,053.15
Rate for Payer: Priority Health Commercial	$867.30
Rate for Payer: Priority Health PPO	$867.30

EXC TR-EXT B9+MARG

Facility

$933.00

Hospital Charge Code	5150767
Hospital Revenue Code	960
Min. Negotiated Rate	$653.10
Max. Negotiated Rate	$793.05
Rate for Payer: Cash Price	$606.45
Rate for Payer: Community Health Alliance Commercial	$793.05
Rate for Payer: Priority Health Commercial	$653.10
Rate for Payer: Priority Health PPO	$653.10

EXC TR-EXT B9+MARG 0.6-1 CM

Facility

$250.00

Hospital Charge Code	5150783
Hospital Revenue Code	960
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$212.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Community Health Alliance Commercial	$212.50
Rate for Payer: Priority Health Commercial	$175.00
Rate for Payer: Priority Health PPO	$175.00

EXC TR-EXT B9-MARG 0.6-1 CM P

Facility

$349.00

Hospital Charge Code	5150726
Hospital Revenue Code	960
Min. Negotiated Rate	$244.30
Max. Negotiated Rate	$296.65
Rate for Payer: Cash Price	$226.85
Rate for Payer: Community Health Alliance Commercial	$296.65
Rate for Payer: Priority Health Commercial	$244.30
Rate for Payer: Priority Health PPO	$244.30

EXC TR-EXT B9+MARG 2.1-3CM PC

Facility

$571.00

Hospital Charge Code	5150719
Hospital Revenue Code	960
Min. Negotiated Rate	$399.70
Max. Negotiated Rate	$485.35
Rate for Payer: Cash Price	$371.15
Rate for Payer: Community Health Alliance Commercial	$485.35
Rate for Payer: Priority Health Commercial	$399.70
Rate for Payer: Priority Health PPO	$399.70

EXC TR-EXT B9+MARG 3. 1-4 CM

Facility

$691.00

Hospital Charge Code	5150725
Hospital Revenue Code	960
Min. Negotiated Rate	$483.70
Max. Negotiated Rate	$587.35
Rate for Payer: Cash Price	$449.15
Rate for Payer: Community Health Alliance Commercial	$587.35
Rate for Payer: Priority Health Commercial	$483.70
Rate for Payer: Priority Health PPO	$483.70

EXTENDED NAIL CAP 10MM

Facility

$439.00

Hospital Charge Code	27268381
Hospital Revenue Code	272
Min. Negotiated Rate	$307.30
Max. Negotiated Rate	$373.15
Rate for Payer: Cash Price	$285.35
Rate for Payer: Community Health Alliance Commercial	$373.15
Rate for Payer: Priority Health Commercial	$307.30
Rate for Payer: Priority Health PPO	$307.30

EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG, IRIS EXPANSION DEVICE, SUTURE SUPPORT FOR INTRAOCULAR LENS, OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE; WITH INSERTION OF INTRAOCULAR (EG, TRABECULAR MESHWORK, SUPRACILIARY, SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, ONE OR MORE

Facility

$5,708.39

Service Code	CPT 66989
Hospital Revenue Code	360
Min. Negotiated Rate	$2,511.69
Max. Negotiated Rate	$5,708.39
Rate for Payer: BCBS BCN 65	$5,708.39
Rate for Payer: Blue Care Network Medicare Advantage	$5,708.39
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5,708.39
Rate for Payer: Meridian Health Plan Medicare	$5,708.39
Rate for Payer: Priority Health Medicaid	$5,708.39
Rate for Payer: Priority Health Medicare	$5,708.39
Rate for Payer: United Health Care Medicaid	$5,708.39
Rate for Payer: United Health Care Medicare Advantage	$2,511.69

Facility

$2,475.70

Service Code	CPT 66982
Hospital Revenue Code	360
Min. Negotiated Rate	$1,089.31
Max. Negotiated Rate	$2,475.70
Rate for Payer: BCBS BCN 65	$2,475.70
Rate for Payer: Blue Care Network Medicare Advantage	$2,475.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,475.70
Rate for Payer: Meridian Health Plan Medicare	$2,475.70
Rate for Payer: Priority Health Medicaid	$2,475.70
Rate for Payer: Priority Health Medicare	$2,475.70
Rate for Payer: United Health Care Medicaid	$2,475.70
Rate for Payer: United Health Care Medicare Advantage	$1,089.31

EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITH INSERTION OF INTRAOCULAR (EG, TRABECULAR MESHWORK, SUPRACILIARY, SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, ONE OR MORE

Facility

$5,708.39

Service Code	CPT 66991
Hospital Revenue Code	360
Min. Negotiated Rate	$2,511.69
Max. Negotiated Rate	$5,708.39
Rate for Payer: BCBS BCN 65	$5,708.39
Rate for Payer: Blue Care Network Medicare Advantage	$5,708.39
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5,708.39
Rate for Payer: Meridian Health Plan Medicare	$5,708.39
Rate for Payer: Priority Health Medicaid	$5,708.39
Rate for Payer: Priority Health Medicare	$5,708.39
Rate for Payer: United Health Care Medicaid	$5,708.39
Rate for Payer: United Health Care Medicare Advantage	$2,511.69

Facility

$2,475.70

Service Code	CPT 66984
Hospital Revenue Code	360
Min. Negotiated Rate	$1,089.31
Max. Negotiated Rate	$2,475.70
Rate for Payer: BCBS BCN 65	$2,475.70
Rate for Payer: Blue Care Network Medicare Advantage	$2,475.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,475.70
Rate for Payer: Meridian Health Plan Medicare	$2,475.70
Rate for Payer: Priority Health Medicaid	$2,475.70
Rate for Payer: Priority Health Medicare	$2,475.70
Rate for Payer: United Health Care Medicaid	$2,475.70
Rate for Payer: United Health Care Medicare Advantage	$1,089.31

EYE STENT

Facility

$1,102.50

Service Code	HCPCS C1783
Hospital Charge Code	27884599
Hospital Revenue Code	278
Min. Negotiated Rate	$771.75
Max. Negotiated Rate	$937.12
Rate for Payer: Cash Price	$716.63
Rate for Payer: Community Health Alliance Commercial	$937.12
Rate for Payer: Priority Health Commercial	$771.75
Rate for Payer: Priority Health PPO	$771.75

F098-IGE GLIADIN

Facility

$3.26

Hospital Charge Code	31027681
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

F433-IGE

Facility

$41.13

Hospital Charge Code	31027694
Hospital Revenue Code	300
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$34.96
Rate for Payer: Cash Price	$26.73
Rate for Payer: Community Health Alliance Commercial	$34.96
Rate for Payer: Priority Health Commercial	$28.79
Rate for Payer: Priority Health PPO	$28.79

F449-IGE SES

Facility

$41.13

Hospital Charge Code	31027680
Hospital Revenue Code	300
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$34.96
Rate for Payer: Cash Price	$26.73
Rate for Payer: Community Health Alliance Commercial	$34.96
Rate for Payer: Priority Health Commercial	$28.79
Rate for Payer: Priority Health PPO	$28.79

FA-1

Facility

$4.84

Hospital Charge Code	31027606
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.11
Rate for Payer: Priority Health Commercial	$3.39
Rate for Payer: Priority Health PPO	$3.39

FA-10

Facility

$4.84

Hospital Charge Code	31027615
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.11
Rate for Payer: Priority Health Commercial	$3.39
Rate for Payer: Priority Health PPO	$3.39

FA-11

Facility

$4.84

Hospital Charge Code	31027616
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.11
Rate for Payer: Priority Health Commercial	$3.39
Rate for Payer: Priority Health PPO	$3.39

FA-12

Facility

$4.84

Hospital Charge Code	31027617
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.11
Rate for Payer: Priority Health Commercial	$3.39
Rate for Payer: Priority Health PPO	$3.39

FA-13

Facility

$4.84

Hospital Charge Code	31027618
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.11
Rate for Payer: Priority Health Commercial	$3.39
Rate for Payer: Priority Health PPO	$3.39

FA-14

Facility

$4.84

Hospital Charge Code	31027619
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.11
Rate for Payer: Priority Health Commercial	$3.39
Rate for Payer: Priority Health PPO	$3.39

FA-15

Facility

$4.84

Hospital Charge Code	31027620
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.11
Rate for Payer: Priority Health Commercial	$3.39
Rate for Payer: Priority Health PPO	$3.39

FA-16

Facility

$1.66

Hospital Charge Code	31027639
Hospital Revenue Code	300
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.41
Rate for Payer: Cash Price	$1.08
Rate for Payer: Community Health Alliance Commercial	$1.41
Rate for Payer: Priority Health Commercial	$1.16
Rate for Payer: Priority Health PPO	$1.16

FA-16

Facility

$4.84

Hospital Charge Code	31027621
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.11
Rate for Payer: Priority Health Commercial	$3.39
Rate for Payer: Priority Health PPO	$3.39

FA-17

Facility

$4.84

Hospital Charge Code	31027622
Hospital Revenue Code	300
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.11
Rate for Payer: Priority Health Commercial	$3.39
Rate for Payer: Priority Health PPO	$3.39

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges