Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

FA-2

Facility

$4.84

Hospital Charge Code	31027607
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-3

Facility

$4.84

Hospital Charge Code	31027608
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-4

Facility

$4.84

Hospital Charge Code	31027609
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-5

Facility

$4.84

Hospital Charge Code	31027610
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-6

Facility

$4.84

Hospital Charge Code	31027611
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-7

Facility

$4.84

Hospital Charge Code	31027612
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-8

Facility

$4.84

Hospital Charge Code	31027613
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-9

Facility

$4.84

Hospital Charge Code	31027614
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

FAB-1

Facility

$18.97

Hospital Charge Code	3100798
Hospital Revenue Code	300
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$16.12
Rate for Payer: Cash Price	$12.33
Rate for Payer: Community Health Alliance Commercial	$16.12
Rate for Payer: Priority Health Commercial	$13.28
Rate for Payer: Priority Health PPO	$13.28

FAB-2

Facility

$18.97

Hospital Charge Code	3100799
Hospital Revenue Code	300
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$16.12
Rate for Payer: Cash Price	$12.33
Rate for Payer: Community Health Alliance Commercial	$16.12
Rate for Payer: Priority Health Commercial	$13.28
Rate for Payer: Priority Health PPO	$13.28

FAB-3

Facility

$18.98

Hospital Charge Code	3100800
Hospital Revenue Code	300
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$16.13
Rate for Payer: Cash Price	$12.34
Rate for Payer: Community Health Alliance Commercial	$16.13
Rate for Payer: Priority Health Commercial	$13.29
Rate for Payer: Priority Health PPO	$13.29

FAB-4

Facility

$18.98

Hospital Charge Code	3100801
Hospital Revenue Code	300
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$16.13
Rate for Payer: Cash Price	$12.34
Rate for Payer: Community Health Alliance Commercial	$16.13
Rate for Payer: Priority Health Commercial	$13.29
Rate for Payer: Priority Health PPO	$13.29

FAB-5

Facility

$18.98

Hospital Charge Code	3100802
Hospital Revenue Code	300
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$16.13
Rate for Payer: Cash Price	$12.34
Rate for Payer: Community Health Alliance Commercial	$16.13
Rate for Payer: Priority Health Commercial	$13.29
Rate for Payer: Priority Health PPO	$13.29

FAB-6

Facility

$18.98

Hospital Charge Code	3100803
Hospital Revenue Code	300
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$16.13
Rate for Payer: Cash Price	$12.34
Rate for Payer: Community Health Alliance Commercial	$16.13
Rate for Payer: Priority Health Commercial	$13.29
Rate for Payer: Priority Health PPO	$13.29

FAB DID 1

Facility

$6.45

Hospital Charge Code	3102070
Hospital Revenue Code	300
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$5.48
Rate for Payer: Cash Price	$4.19
Rate for Payer: Community Health Alliance Commercial	$5.48
Rate for Payer: Priority Health Commercial	$4.51
Rate for Payer: Priority Health PPO	$4.51

FAB DID 2

Facility

$6.45

Hospital Charge Code	3102071
Hospital Revenue Code	300
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$5.48
Rate for Payer: Cash Price	$4.19
Rate for Payer: Community Health Alliance Commercial	$5.48
Rate for Payer: Priority Health Commercial	$4.51
Rate for Payer: Priority Health PPO	$4.51

FAB DID 3

Facility

$6.45

Hospital Charge Code	3102072
Hospital Revenue Code	300
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$5.48
Rate for Payer: Cash Price	$4.19
Rate for Payer: Community Health Alliance Commercial	$5.48
Rate for Payer: Priority Health Commercial	$4.51
Rate for Payer: Priority Health PPO	$4.51

FAB DID 4

Facility

$6.47

Hospital Charge Code	3102073
Hospital Revenue Code	300
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$5.50
Rate for Payer: Cash Price	$4.21
Rate for Payer: Community Health Alliance Commercial	$5.50
Rate for Payer: Priority Health Commercial	$4.53
Rate for Payer: Priority Health PPO	$4.53

F-ACTIN (SMOOTH MUSCLE) IGG

Facility

$5.29

Hospital Charge Code	3100865
Hospital Revenue Code	300
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$4.50
Rate for Payer: Cash Price	$3.44
Rate for Payer: Community Health Alliance Commercial	$4.50
Rate for Payer: Priority Health Commercial	$3.70
Rate for Payer: Priority Health PPO	$3.70

FACTOR 10

Facility

$20.00

Service Code	HCPCS 85260
Hospital Charge Code	3005001
Hospital Revenue Code	305
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$18.80
Rate for Payer: BCBS BCN 65	$18.80
Rate for Payer: Blue Care Network Medicare Advantage	$18.80
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.80
Rate for Payer: Meridian Health Plan Medicare	$18.80
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health Medicaid	$18.80
Rate for Payer: Priority Health Medicare	$18.80
Rate for Payer: Priority Health PPO	$14.00
Rate for Payer: United Health Care Medicaid	$18.80
Rate for Payer: United Health Care Medicare Advantage	$8.27

FACTOR 11

Facility

$30.00

Service Code	HCPCS 85270
Hospital Charge Code	3005021
Hospital Revenue Code	305
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$25.50
Rate for Payer: BCBS BCN 65	$18.80
Rate for Payer: Blue Care Network Medicare Advantage	$18.80
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.80
Rate for Payer: Meridian Health Plan Medicare	$18.80
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health Medicaid	$18.80
Rate for Payer: Priority Health Medicare	$18.80
Rate for Payer: Priority Health PPO	$21.00
Rate for Payer: United Health Care Medicaid	$18.80
Rate for Payer: United Health Care Medicare Advantage	$8.27

FACTOR 12

Facility

$57.02

Service Code	HCPCS 85280
Hospital Charge Code	3002620
Hospital Revenue Code	305
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$48.47
Rate for Payer: BCBS BCN 65	$20.32
Rate for Payer: Blue Care Network Medicare Advantage	$20.32
Rate for Payer: Cash Price	$37.06
Rate for Payer: Cash Price	$37.06
Rate for Payer: Community Health Alliance Commercial	$48.47
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$20.32
Rate for Payer: Meridian Health Plan Medicare	$20.32
Rate for Payer: Priority Health Commercial	$39.91
Rate for Payer: Priority Health Medicaid	$20.32
Rate for Payer: Priority Health Medicare	$20.32
Rate for Payer: Priority Health PPO	$39.91
Rate for Payer: United Health Care Medicaid	$20.32
Rate for Payer: United Health Care Medicare Advantage	$8.94

FACTOR 13

Facility

$42.76

Service Code	HCPCS 85290
Hospital Charge Code	3005041
Hospital Revenue Code	305
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$36.35
Rate for Payer: BCBS BCN 65	$17.16
Rate for Payer: Blue Care Network Medicare Advantage	$17.16
Rate for Payer: Cash Price	$27.79
Rate for Payer: Cash Price	$27.79
Rate for Payer: Community Health Alliance Commercial	$36.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.16
Rate for Payer: Meridian Health Plan Medicare	$17.16
Rate for Payer: Priority Health Commercial	$29.93
Rate for Payer: Priority Health Medicaid	$17.16
Rate for Payer: Priority Health Medicare	$17.16
Rate for Payer: Priority Health PPO	$29.93
Rate for Payer: United Health Care Medicaid	$17.16
Rate for Payer: United Health Care Medicare Advantage	$7.55

FACTOR 2 FUNCTIONAL

Facility

$15.00

Service Code	HCPCS 85210
Hospital Charge Code	3005045
Hospital Revenue Code	305
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$13.63
Rate for Payer: BCBS BCN 65	$13.63
Rate for Payer: Blue Care Network Medicare Advantage	$13.63
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.63
Rate for Payer: Meridian Health Plan Medicare	$13.63
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$13.63
Rate for Payer: Priority Health Medicare	$13.63
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$13.63
Rate for Payer: United Health Care Medicare Advantage	$6.00

FACTOR 5

Facility

$82.00

Service Code	HCPCS 85220
Hospital Charge Code	3002560
Hospital Revenue Code	305
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$69.70
Rate for Payer: BCBS BCN 65	$18.53
Rate for Payer: Blue Care Network Medicare Advantage	$18.53
Rate for Payer: Cash Price	$53.30
Rate for Payer: Cash Price	$53.30
Rate for Payer: Community Health Alliance Commercial	$69.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.53
Rate for Payer: Meridian Health Plan Medicare	$18.53
Rate for Payer: Priority Health Commercial	$57.40
Rate for Payer: Priority Health Medicaid	$18.53
Rate for Payer: Priority Health Medicare	$18.53
Rate for Payer: Priority Health PPO	$57.40
Rate for Payer: United Health Care Medicaid	$18.53
Rate for Payer: United Health Care Medicare Advantage	$8.15

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges