Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

FH-2

Facility

$4.83

Hospital Charge Code	3102526
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

FH-3

Facility

$4.84

Hospital Charge Code	3102527
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

FIB-4

Facility

$4.85

Hospital Charge Code	31027494
Hospital Revenue Code	300
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.12
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.12
Rate for Payer: Priority Health Commercial	$3.40
Rate for Payer: Priority Health PPO	$3.40

FIB-4

Facility

$4.85

Hospital Charge Code	31027495
Hospital Revenue Code	300
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.12
Rate for Payer: Cash Price	$3.15
Rate for Payer: Community Health Alliance Commercial	$4.12
Rate for Payer: Priority Health Commercial	$3.40
Rate for Payer: Priority Health PPO	$3.40

FIB-4

Facility

$4.86

Hospital Charge Code	31027496
Hospital Revenue Code	300
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.13
Rate for Payer: Cash Price	$3.16
Rate for Payer: Community Health Alliance Commercial	$4.13
Rate for Payer: Priority Health Commercial	$3.40
Rate for Payer: Priority Health PPO	$3.40

FIB-4 LC

Facility

$14.56

Hospital Charge Code	31027493
Hospital Revenue Code	300
Min. Negotiated Rate	$10.19
Max. Negotiated Rate	$12.38
Rate for Payer: Cash Price	$9.46
Rate for Payer: Community Health Alliance Commercial	$12.38
Rate for Payer: Priority Health Commercial	$10.19
Rate for Payer: Priority Health PPO	$10.19

FIBRIN DEGREDATION PRODUCT

Facility

$11.40

Hospital Charge Code	3004250
Hospital Revenue Code	305
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$9.69
Rate for Payer: Cash Price	$7.41
Rate for Payer: Community Health Alliance Commercial	$9.69
Rate for Payer: Priority Health Commercial	$7.98
Rate for Payer: Priority Health PPO	$7.98

FIBRINOGEN

Facility

$62.00

Service Code	HCPCS 85384
Hospital Charge Code	3004260
Hospital Revenue Code	305
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$52.70
Rate for Payer: BCBS BCN 65	$10.21
Rate for Payer: Blue Care Network Medicare Advantage	$10.21
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cash Price	$40.30
Rate for Payer: Community Health Alliance Commercial	$52.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.21
Rate for Payer: Meridian Health Plan Medicare	$10.21
Rate for Payer: Priority Health Commercial	$43.40
Rate for Payer: Priority Health Medicaid	$10.21
Rate for Payer: Priority Health Medicare	$10.21
Rate for Payer: Priority Health PPO	$43.40
Rate for Payer: United Health Care Medicaid	$10.21
Rate for Payer: United Health Care Medicare Advantage	$4.49

FIBRINOGEN ANTIGEN

Facility

$16.29

Service Code	HCPCS 85385
Hospital Charge Code	3004265
Hospital Revenue Code	305
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$15.18
Rate for Payer: BCBS BCN 65	$15.18
Rate for Payer: Blue Care Network Medicare Advantage	$15.18
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	$15.18
Rate for Payer: Meridian Health Plan Medicare	$15.18
Rate for Payer: Priority Health Commercial	$11.40
Rate for Payer: Priority Health Medicaid	$15.18
Rate for Payer: Priority Health Medicare	$15.18
Rate for Payer: Priority Health PPO	$11.40
Rate for Payer: United Health Care Medicaid	$15.18
Rate for Payer: United Health Care Medicare Advantage	$6.68

FIBRIN SPLIT PRODUCTS

Facility

$44.00

Hospital Charge Code	3004289
Hospital Revenue Code	305
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

FIBROBLAST GROWTH FACTOR-23

Facility

$209.20

Hospital Charge Code	31027371
Hospital Revenue Code	300
Min. Negotiated Rate	$146.44
Max. Negotiated Rate	$177.82
Rate for Payer: Cash Price	$135.98
Rate for Payer: Community Health Alliance Commercial	$177.82
Rate for Payer: Priority Health Commercial	$146.44
Rate for Payer: Priority Health PPO	$146.44

FINE NEEDLE ASPIRATION W/ GUID

Facility

$1,395.00

Hospital Charge Code	4000464
Hospital Revenue Code	361
Min. Negotiated Rate	$976.50
Max. Negotiated Rate	$1,185.75
Rate for Payer: Cash Price	$906.75
Rate for Payer: Community Health Alliance Commercial	$1,185.75
Rate for Payer: Priority Health Commercial	$976.50
Rate for Payer: Priority Health PPO	$976.50

FINGER CONTRACTURE CUSHION

Facility

$91.00

Hospital Charge Code	27022392
Hospital Revenue Code	270
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$77.35
Rate for Payer: Cash Price	$59.15
Rate for Payer: Community Health Alliance Commercial	$77.35
Rate for Payer: Priority Health Commercial	$63.70
Rate for Payer: Priority Health PPO	$63.70

FINGER COT, FOLD OVER

Facility

$14.00

Hospital Charge Code	27022426
Hospital Revenue Code	270
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$11.90
Rate for Payer: Cash Price	$9.10
Rate for Payer: Community Health Alliance Commercial	$11.90
Rate for Payer: Priority Health Commercial	$9.80
Rate for Payer: Priority Health PPO	$9.80

FINGER SPLINT

Facility

$17.00

Hospital Charge Code	27012989
Hospital Revenue Code	270
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

FISH (K20)

Facility

$264.00

Hospital Charge Code	3004421
Hospital Revenue Code	311
Min. Negotiated Rate	$184.80
Max. Negotiated Rate	$224.40
Rate for Payer: Cash Price	$171.60
Rate for Payer: Community Health Alliance Commercial	$224.40
Rate for Payer: Priority Health Commercial	$184.80
Rate for Payer: Priority Health PPO	$184.80

FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED

Facility

$2,977.57

Service Code	CPT 46200
Hospital Revenue Code	360
Min. Negotiated Rate	$1,310.13
Max. Negotiated Rate	$2,977.57
Rate for Payer: BCBS BCN 65	$2,977.57
Rate for Payer: Blue Care Network Medicare Advantage	$2,977.57
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,977.57
Rate for Payer: Meridian Health Plan Medicare	$2,977.57
Rate for Payer: Priority Health Medicaid	$2,977.57
Rate for Payer: Priority Health Medicare	$2,977.57
Rate for Payer: United Health Care Medicaid	$2,977.57
Rate for Payer: United Health Care Medicare Advantage	$1,310.13

FITE STAIN TECH

Facility

$80.00

Service Code	HCPCS 88312
Hospital Charge Code	3100195
Hospital Revenue Code	310
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$68.00
Rate for Payer: BCBS BCN 65	$55.90
Rate for Payer: Blue Care Network Medicare Advantage	$55.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Community Health Alliance Commercial	$68.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$55.90
Rate for Payer: Meridian Health Plan Medicare	$55.90
Rate for Payer: Priority Health Commercial	$56.00
Rate for Payer: Priority Health Medicaid	$55.90
Rate for Payer: Priority Health Medicare	$55.90
Rate for Payer: Priority Health PPO	$56.00
Rate for Payer: United Health Care Medicaid	$55.90
Rate for Payer: United Health Care Medicare Advantage	$24.60

FIT ZONE HEALTH ASSESSMENT

Facility

$70.00

Hospital Charge Code	3100699
Hospital Revenue Code	309
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

FIVE HIAA, UA

Facility

$8.15

Service Code	HCPCS 83497
Hospital Charge Code	3000100
Hospital Revenue Code	301
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$13.54
Rate for Payer: BCBS BCN 65	$13.54
Rate for Payer: Blue Care Network Medicare Advantage	$13.54
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	$13.54
Rate for Payer: Meridian Health Plan Medicare	$13.54
Rate for Payer: Priority Health Commercial	$5.71
Rate for Payer: Priority Health Medicaid	$13.54
Rate for Payer: Priority Health Medicare	$13.54
Rate for Payer: Priority Health PPO	$5.71
Rate for Payer: United Health Care Medicaid	$13.54
Rate for Payer: United Health Care Medicare Advantage	$5.96

FIXATOR, EXTERNAL

Facility

$9,043.00

Hospital Charge Code	27871658
Hospital Revenue Code	272
Min. Negotiated Rate	$6,330.10
Max. Negotiated Rate	$7,686.55
Rate for Payer: Cash Price	$5,877.95
Rate for Payer: Community Health Alliance Commercial	$7,686.55
Rate for Payer: Priority Health Commercial	$6,330.10
Rate for Payer: Priority Health PPO	$6,330.10

FLANGED OSTOMY POUCH

Facility

$17.00

Hospital Charge Code	27011668
Hospital Revenue Code	270
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$14.45
Rate for Payer: Cash Price	$11.05
Rate for Payer: Community Health Alliance Commercial	$14.45
Rate for Payer: Priority Health Commercial	$11.90
Rate for Payer: Priority Health PPO	$11.90

FLANGE FOR OSTOMY POUCH

Facility

$21.00

Hospital Charge Code	27011577
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$17.85
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health PPO	$14.70

FLEXIFLO STOMATE (LONG)

Facility

$338.00

Hospital Charge Code	27021584
Hospital Revenue Code	270
Min. Negotiated Rate	$236.60
Max. Negotiated Rate	$287.30
Rate for Payer: Cash Price	$219.70
Rate for Payer: Community Health Alliance Commercial	$287.30
Rate for Payer: Priority Health Commercial	$236.60
Rate for Payer: Priority Health PPO	$236.60

FLEXIFLOW STOMATE (SHORT)

Facility

$450.00

Hospital Charge Code	27021519
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$382.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Community Health Alliance Commercial	$382.50
Rate for Payer: Priority Health Commercial	$315.00
Rate for Payer: Priority Health PPO	$315.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges