Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

FACTOR 7

Facility

$40.73

Service Code	HCPCS 85230
Hospital Charge Code	3002580
Hospital Revenue Code	305
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$34.62
Rate for Payer: BCBS BCN 65	$18.80
Rate for Payer: Blue Care Network Medicare Advantage	$18.80
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	$18.80
Rate for Payer: Meridian Health Plan Medicare	$18.80
Rate for Payer: Priority Health Commercial	$28.51
Rate for Payer: Priority Health Medicaid	$18.80
Rate for Payer: Priority Health Medicare	$18.80
Rate for Payer: Priority Health PPO	$28.51
Rate for Payer: United Health Care Medicaid	$18.80
Rate for Payer: United Health Care Medicare Advantage	$8.27

FACTOR 8 AHG ONE STAGE

Facility

$15.00

Service Code	HCPCS 85240
Hospital Charge Code	3003481
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	$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	$18.80
Rate for Payer: Meridian Health Plan Medicare	$18.80
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health Medicaid	$18.80
Rate for Payer: Priority Health Medicare	$18.80
Rate for Payer: Priority Health PPO	$10.50
Rate for Payer: United Health Care Medicaid	$18.80
Rate for Payer: United Health Care Medicare Advantage	$8.27

FACTOR 8 VWFACTOR,RISTO COF

Facility

$60.00

Service Code	HCPCS 85245
Hospital Charge Code	3003541
Hospital Revenue Code	305
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$51.00
Rate for Payer: BCBS BCN 65	$24.09
Rate for Payer: Blue Care Network Medicare Advantage	$24.09
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	$24.09
Rate for Payer: Meridian Health Plan Medicare	$24.09
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health Medicaid	$24.09
Rate for Payer: Priority Health Medicare	$24.09
Rate for Payer: Priority Health PPO	$42.00
Rate for Payer: United Health Care Medicaid	$24.09
Rate for Payer: United Health Care Medicare Advantage	$10.60

FACTOR 9

Facility

$16.29

Service Code	HCPCS 85250
Hospital Charge Code	3002540
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$19.99
Rate for Payer: BCBS BCN 65	$19.99
Rate for Payer: Blue Care Network Medicare Advantage	$19.99
Rate for Payer: Cash Price	$10.59
Rate for Payer: Cash Price	$10.59
Rate for Payer: Community Health Alliance Commercial	$13.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.99
Rate for Payer: Meridian Health Plan Medicare	$19.99
Rate for Payer: Priority Health Commercial	$11.40
Rate for Payer: Priority Health Medicaid	$19.99
Rate for Payer: Priority Health Medicare	$19.99
Rate for Payer: Priority Health PPO	$11.40
Rate for Payer: United Health Care Medicaid	$19.99
Rate for Payer: United Health Care Medicare Advantage	$8.80

FACTOR V LEIDEN GENOTYPE

Facility

$34.28

Hospital Charge Code	3004170
Hospital Revenue Code	301
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$29.14
Rate for Payer: Cash Price	$22.28
Rate for Payer: Community Health Alliance Commercial	$29.14
Rate for Payer: Priority Health Commercial	$24.00
Rate for Payer: Priority Health PPO	$24.00

FACTOR X ANTIGEN

Facility

$227.00

Service Code	HCPCS 85260
Hospital Charge Code	3005043
Hospital Revenue Code	305
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$192.95
Rate for Payer: BCBS BCN 65	$18.80
Rate for Payer: Blue Care Network Medicare Advantage	$18.80
Rate for Payer: Cash Price	$147.55
Rate for Payer: Cash Price	$147.55
Rate for Payer: Community Health Alliance Commercial	$192.95
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	$158.90
Rate for Payer: Priority Health Medicaid	$18.80
Rate for Payer: Priority Health Medicare	$18.80
Rate for Payer: Priority Health PPO	$158.90
Rate for Payer: United Health Care Medicaid	$18.80
Rate for Payer: United Health Care Medicare Advantage	$8.27

FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)

Facility

$3,510.01

Service Code	CPT 28060
Hospital Revenue Code	360
Min. Negotiated Rate	$1,544.41
Max. Negotiated Rate	$3,510.01
Rate for Payer: BCBS BCN 65	$3,510.01
Rate for Payer: Blue Care Network Medicare Advantage	$3,510.01
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,510.01
Rate for Payer: Meridian Health Plan Medicare	$3,510.01
Rate for Payer: Priority Health Medicaid	$3,510.01
Rate for Payer: Priority Health Medicare	$3,510.01
Rate for Payer: United Health Care Medicaid	$3,510.01
Rate for Payer: United Health Care Medicare Advantage	$1,544.41

FAT BODY FLUID

Facility

$37.75

Hospital Charge Code	3101379
Hospital Revenue Code	300
Min. Negotiated Rate	$26.43
Max. Negotiated Rate	$32.09
Rate for Payer: Cash Price	$24.54
Rate for Payer: Community Health Alliance Commercial	$32.09
Rate for Payer: Priority Health Commercial	$26.43
Rate for Payer: Priority Health PPO	$26.43

FATTY ACID PANEL

Facility

$190.00

Hospital Charge Code	3005155
Hospital Revenue Code	301
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$161.50
Rate for Payer: Cash Price	$123.50
Rate for Payer: Community Health Alliance Commercial	$161.50
Rate for Payer: Priority Health Commercial	$133.00
Rate for Payer: Priority Health PPO	$133.00

FEEDING TUBE, ENDOSCOPIC

Facility

$322.00

Hospital Charge Code	27262338
Hospital Revenue Code	272
Min. Negotiated Rate	$225.40
Max. Negotiated Rate	$273.70
Rate for Payer: Cash Price	$209.30
Rate for Payer: Community Health Alliance Commercial	$273.70
Rate for Payer: Priority Health Commercial	$225.40
Rate for Payer: Priority Health PPO	$225.40

FEEDING TUBE, NASAL JEJUNAL

Facility

$318.00

Hospital Charge Code	27264678
Hospital Revenue Code	272
Min. Negotiated Rate	$222.60
Max. Negotiated Rate	$270.30
Rate for Payer: Cash Price	$206.70
Rate for Payer: Community Health Alliance Commercial	$270.30
Rate for Payer: Priority Health Commercial	$222.60
Rate for Payer: Priority Health PPO	$222.60

FEEDING TUBE, NASAL JEJUNAL

Facility

$300.00

Hospital Charge Code	27262097
Hospital Revenue Code	272
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$255.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Community Health Alliance Commercial	$255.00
Rate for Payer: Priority Health Commercial	$210.00
Rate for Payer: Priority Health PPO	$210.00

FELBAMATE SERUM PLASMA

Facility

$11.54

Service Code	HCPCS G0480
Hospital Charge Code	3100539
Hospital Revenue Code	300
Min. Negotiated Rate	$8.08
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	$7.50
Rate for Payer: Cash Price	$7.50
Rate for Payer: Community Health Alliance Commercial	$9.81
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	$8.08
Rate for Payer: Priority Health Medicaid	$120.15
Rate for Payer: Priority Health Medicare	$120.15
Rate for Payer: Priority Health PPO	$8.08
Rate for Payer: United Health Care Medicaid	$120.15
Rate for Payer: United Health Care Medicare Advantage	$52.87

FEMORAL NAIL

Facility

$1,359.00

Service Code	HCPCS C1713
Hospital Charge Code	27060917
Hospital Revenue Code	278
Min. Negotiated Rate	$951.30
Max. Negotiated Rate	$1,155.15
Rate for Payer: Cash Price	$883.35
Rate for Payer: Community Health Alliance Commercial	$1,155.15
Rate for Payer: Priority Health Commercial	$951.30
Rate for Payer: Priority Health PPO	$951.30

FEMORAL NAIL

Facility

$985.00

Service Code	HCPCS C1713
Hospital Charge Code	27871856
Hospital Revenue Code	278
Min. Negotiated Rate	$689.50
Max. Negotiated Rate	$837.25
Rate for Payer: Cash Price	$640.25
Rate for Payer: Community Health Alliance Commercial	$837.25
Rate for Payer: Priority Health Commercial	$689.50
Rate for Payer: Priority Health PPO	$689.50

FEMORAL NAIL, LEFT

Facility

$3,264.00

Service Code	HCPCS C1713
Hospital Charge Code	27868670
Hospital Revenue Code	278
Min. Negotiated Rate	$2,284.80
Max. Negotiated Rate	$2,774.40
Rate for Payer: Cash Price	$2,121.60
Rate for Payer: Community Health Alliance Commercial	$2,774.40
Rate for Payer: Priority Health Commercial	$2,284.80
Rate for Payer: Priority Health PPO	$2,284.80

FEMORAL RECON NAIL 13MM X 36CM

Facility

$1,923.00

Service Code	HCPCS C1713
Hospital Charge Code	27066518
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.10
Max. Negotiated Rate	$1,634.55
Rate for Payer: Cash Price	$1,249.95
Rate for Payer: Community Health Alliance Commercial	$1,634.55
Rate for Payer: Priority Health Commercial	$1,346.10
Rate for Payer: Priority Health PPO	$1,346.10

FENESTRATED STEM

Facility

$1,350.00

Service Code	HCPCS C1713
Hospital Charge Code	27015727
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,147.50
Rate for Payer: Cash Price	$877.50
Rate for Payer: Community Health Alliance Commercial	$1,147.50
Rate for Payer: Priority Health Commercial	$945.00
Rate for Payer: Priority Health PPO	$945.00

FENESTRATED STEM

Facility

$1,350.00

Service Code	HCPCS C1713
Hospital Charge Code	27815727
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,147.50
Rate for Payer: Cash Price	$877.50
Rate for Payer: Community Health Alliance Commercial	$1,147.50
Rate for Payer: Priority Health Commercial	$945.00
Rate for Payer: Priority Health PPO	$945.00

FERRITIN

Facility

$45.00

Service Code	HCPCS 82728
Hospital Charge Code	3004180
Hospital Revenue Code	301
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$38.25
Rate for Payer: BCBS BCN 65	$14.31
Rate for Payer: Blue Care Network Medicare Advantage	$14.31
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.31
Rate for Payer: Meridian Health Plan Medicare	$14.31
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health Medicaid	$14.31
Rate for Payer: Priority Health Medicare	$14.31
Rate for Payer: Priority Health PPO	$31.50
Rate for Payer: United Health Care Medicaid	$14.31
Rate for Payer: United Health Care Medicare Advantage	$6.30

FERRITIN LC

Facility

$2.44

Hospital Charge Code	3102644
Hospital Revenue Code	300
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.07
Rate for Payer: Cash Price	$1.59
Rate for Payer: Community Health Alliance Commercial	$2.07
Rate for Payer: Priority Health Commercial	$1.71
Rate for Payer: Priority Health PPO	$1.71

FETAL FIBRONECTIN

Facility

$112.40

Hospital Charge Code	3005218
Hospital Revenue Code	301
Min. Negotiated Rate	$78.68
Max. Negotiated Rate	$95.54
Rate for Payer: Cash Price	$73.06
Rate for Payer: Community Health Alliance Commercial	$95.54
Rate for Payer: Priority Health Commercial	$78.68
Rate for Payer: Priority Health PPO	$78.68

FETAL LUNG LB DENSITY

Facility

$70.00

Hospital Charge Code	3100554
Hospital Revenue Code	300
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$59.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Community Health Alliance Commercial	$59.50
Rate for Payer: Priority Health Commercial	$49.00
Rate for Payer: Priority Health PPO	$49.00

FETAL SCREEN

Facility

$10.00

Service Code	HCPCS 85461
Hospital Charge Code	3004200
Hospital Revenue Code	300
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$9.83
Rate for Payer: BCBS BCN 65	$9.83
Rate for Payer: Blue Care Network Medicare Advantage	$9.83
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.83
Rate for Payer: Meridian Health Plan Medicare	$9.83
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health Medicaid	$9.83
Rate for Payer: Priority Health Medicare	$9.83
Rate for Payer: Priority Health PPO	$7.00
Rate for Payer: United Health Care Medicaid	$9.83
Rate for Payer: United Health Care Medicare Advantage	$4.32

FH-1

Facility

$4.83

Hospital Charge Code	3102525
Hospital Revenue Code	300
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$3.14
Rate for Payer: Community Health Alliance Commercial	$4.11
Rate for Payer: Priority Health Commercial	$3.38
Rate for Payer: Priority Health PPO	$3.38

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges