Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

FLEXIGRAFT BISECTED LIGAMENT

Facility

$6,164.00

Service Code	HCPCS C9399
Hospital Charge Code	27884839
Hospital Revenue Code	278
Min. Negotiated Rate	$4,314.80
Max. Negotiated Rate	$5,239.40
Rate for Payer: Cash Price	$4,006.60
Rate for Payer: Community Health Alliance Commercial	$5,239.40
Rate for Payer: Priority Health Commercial	$4,314.80
Rate for Payer: Priority Health PPO	$4,314.80

FLEXIPATH TROCAR

Facility

$201.00

Hospital Charge Code	27265452
Hospital Revenue Code	272
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$170.85
Rate for Payer: Cash Price	$130.65
Rate for Payer: Community Health Alliance Commercial	$170.85
Rate for Payer: Priority Health Commercial	$140.70
Rate for Payer: Priority Health PPO	$140.70

FLEX SIG *SPECIAL*

Facility

$75.00

Hospital Charge Code	3604000
Hospital Revenue Code	360
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$63.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Community Health Alliance Commercial	$63.75
Rate for Payer: Priority Health Commercial	$52.50
Rate for Payer: Priority Health PPO	$52.50

FLFFT-1-SBMF

Facility

$43.84

Hospital Charge Code	3101131
Hospital Revenue Code	301
Min. Negotiated Rate	$30.69
Max. Negotiated Rate	$37.26
Rate for Payer: Cash Price	$28.50
Rate for Payer: Community Health Alliance Commercial	$37.26
Rate for Payer: Priority Health Commercial	$30.69
Rate for Payer: Priority Health PPO	$30.69

FLFFT-2-SBMF

Facility

$43.84

Hospital Charge Code	3101132
Hospital Revenue Code	301
Min. Negotiated Rate	$30.69
Max. Negotiated Rate	$37.26
Rate for Payer: Cash Price	$28.50
Rate for Payer: Community Health Alliance Commercial	$37.26
Rate for Payer: Priority Health Commercial	$30.69
Rate for Payer: Priority Health PPO	$30.69

FLFFT-3-SBMF

Facility

$43.84

Hospital Charge Code	3101133
Hospital Revenue Code	301
Min. Negotiated Rate	$30.69
Max. Negotiated Rate	$37.26
Rate for Payer: Cash Price	$28.50
Rate for Payer: Community Health Alliance Commercial	$37.26
Rate for Payer: Priority Health Commercial	$30.69
Rate for Payer: Priority Health PPO	$30.69

FLFFT-4-SBMF

Facility

$43.84

Hospital Charge Code	3101134
Hospital Revenue Code	301
Min. Negotiated Rate	$30.69
Max. Negotiated Rate	$37.26
Rate for Payer: Cash Price	$28.50
Rate for Payer: Community Health Alliance Commercial	$37.26
Rate for Payer: Priority Health Commercial	$30.69
Rate for Payer: Priority Health PPO	$30.69

FLFFT-5 SBMF

Facility

$43.84

Hospital Charge Code	3101135
Hospital Revenue Code	301
Min. Negotiated Rate	$30.69
Max. Negotiated Rate	$37.26
Rate for Payer: Cash Price	$28.50
Rate for Payer: Community Health Alliance Commercial	$37.26
Rate for Payer: Priority Health Commercial	$30.69
Rate for Payer: Priority Health PPO	$30.69

FLFFT-6 SBMF

Facility

$43.84

Hospital Charge Code	3101136
Hospital Revenue Code	301
Min. Negotiated Rate	$30.69
Max. Negotiated Rate	$37.26
Rate for Payer: Cash Price	$28.50
Rate for Payer: Community Health Alliance Commercial	$37.26
Rate for Payer: Priority Health Commercial	$30.69
Rate for Payer: Priority Health PPO	$30.69

FLFFT-SBMF SBMF

Facility

$263.04

Hospital Charge Code	3101125
Hospital Revenue Code	301
Min. Negotiated Rate	$184.13
Max. Negotiated Rate	$223.58
Rate for Payer: Cash Price	$170.98
Rate for Payer: Community Health Alliance Commercial	$223.58
Rate for Payer: Priority Health Commercial	$184.13
Rate for Payer: Priority Health PPO	$184.13

FLIERINGA 15MM FIXATION RING

Facility

$98.00

Hospital Charge Code	27263977
Hospital Revenue Code	272
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$83.30
Rate for Payer: Cash Price	$63.70
Rate for Payer: Community Health Alliance Commercial	$83.30
Rate for Payer: Priority Health Commercial	$68.60
Rate for Payer: Priority Health PPO	$68.60

FLOSEAL HEMOSTATIC MATRIX

Facility

$471.00

Hospital Charge Code	27271715
Hospital Revenue Code	272
Min. Negotiated Rate	$329.70
Max. Negotiated Rate	$400.35
Rate for Payer: Cash Price	$306.15
Rate for Payer: Community Health Alliance Commercial	$400.35
Rate for Payer: Priority Health Commercial	$329.70
Rate for Payer: Priority Health PPO	$329.70

FLOURIDE S/P-LC

Facility

$78.00

Hospital Charge Code	31027379
Hospital Revenue Code	300
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health PPO	$54.60

FLOW CYTO 16 OR MORE

Facility

$72.00

Hospital Charge Code	3100739
Hospital Revenue Code	310
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$61.20
Rate for Payer: Cash Price	$46.80
Rate for Payer: Community Health Alliance Commercial	$61.20
Rate for Payer: Priority Health Commercial	$50.40
Rate for Payer: Priority Health PPO	$50.40

FLOW CYTOMETRY

Facility

$243.00

Hospital Charge Code	3000267
Hospital Revenue Code	310
Min. Negotiated Rate	$170.10
Max. Negotiated Rate	$206.55
Rate for Payer: Cash Price	$157.95
Rate for Payer: Community Health Alliance Commercial	$206.55
Rate for Payer: Priority Health Commercial	$170.10
Rate for Payer: Priority Health PPO	$170.10

FLOW CYTOMETRY

Facility

$784.00

Hospital Charge Code	3006224
Hospital Revenue Code	311
Min. Negotiated Rate	$548.80
Max. Negotiated Rate	$666.40
Rate for Payer: Cash Price	$509.60
Rate for Payer: Community Health Alliance Commercial	$666.40
Rate for Payer: Priority Health Commercial	$548.80
Rate for Payer: Priority Health PPO	$548.80

FLOW CYTOMETRY BAND 3

Facility

$235.00

Hospital Charge Code	3100947
Hospital Revenue Code	310
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$199.75
Rate for Payer: Cash Price	$152.75
Rate for Payer: Community Health Alliance Commercial	$199.75
Rate for Payer: Priority Health Commercial	$164.50
Rate for Payer: Priority Health PPO	$164.50

FLOW CYTOMETRY EA ADD'L 4 MARK

Facility

$60.00

Hospital Charge Code	3100738
Hospital Revenue Code	310
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

FLOW CYTOMETRY EA ADD'L 5 MARK

Facility

$60.00

Hospital Charge Code	3100737
Hospital Revenue Code	310
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

FLOW CYTOMETRY EA ADD'L MARKER

Facility

$60.00

Hospital Charge Code	3100354
Hospital Revenue Code	311
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

FLOW CYTOMETRY EA ADD'L MARKER

Facility

$60.00

Hospital Charge Code	3100353
Hospital Revenue Code	311
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$51.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Community Health Alliance Commercial	$51.00
Rate for Payer: Priority Health Commercial	$42.00
Rate for Payer: Priority Health PPO	$42.00

FLOW CYTOMETRY INTERP 2-8 MARK

Facility

$123.00

Hospital Charge Code	3100355
Hospital Revenue Code	971
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$104.55
Rate for Payer: Cash Price	$79.95
Rate for Payer: Community Health Alliance Commercial	$104.55
Rate for Payer: Priority Health Commercial	$86.10
Rate for Payer: Priority Health PPO	$86.10

FLOW CYTOMETRY TISSUE

Facility

$813.00

Hospital Charge Code	3000264
Hospital Revenue Code	310
Min. Negotiated Rate	$569.10
Max. Negotiated Rate	$691.05
Rate for Payer: Cash Price	$528.45
Rate for Payer: Community Health Alliance Commercial	$691.05
Rate for Payer: Priority Health Commercial	$569.10
Rate for Payer: Priority Health PPO	$569.10

FLOW MARKER 10

Facility

$10.12

Hospital Charge Code	3101882
Hospital Revenue Code	300
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$8.60
Rate for Payer: Cash Price	$6.58
Rate for Payer: Community Health Alliance Commercial	$8.60
Rate for Payer: Priority Health Commercial	$7.08
Rate for Payer: Priority Health PPO	$7.08

FLOW MARKER 11

Facility

$10.12

Hospital Charge Code	3101883
Hospital Revenue Code	300
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$8.60
Rate for Payer: Cash Price	$6.58
Rate for Payer: Community Health Alliance Commercial	$8.60
Rate for Payer: Priority Health Commercial	$7.08
Rate for Payer: Priority Health PPO	$7.08

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges