Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

FLUORESCENT AB TITER EACH

Facility

$75.00

Hospital Charge Code	3100054
Hospital Revenue Code	300
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

FLUORIDE

Facility

$16.00

Hospital Charge Code	3102132
Hospital Revenue Code	300
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$13.60
Rate for Payer: Cash Price	$10.40
Rate for Payer: Community Health Alliance Commercial	$13.60
Rate for Payer: Priority Health Commercial	$11.20
Rate for Payer: Priority Health PPO	$11.20

FLUORO PC

Facility

$172.00

Hospital Charge Code	5150716
Hospital Revenue Code	960
Min. Negotiated Rate	$120.40
Max. Negotiated Rate	$146.20
Rate for Payer: Cash Price	$111.80
Rate for Payer: Community Health Alliance Commercial	$146.20
Rate for Payer: Priority Health Commercial	$120.40
Rate for Payer: Priority Health PPO	$120.40

FLUOROSCOPY (SEPARATE PROCEDURE), UP TO 1 HOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL TIME

Facility

$255.96

Service Code	CPT 76000
Hospital Revenue Code	360
Min. Negotiated Rate	$112.62
Max. Negotiated Rate	$255.96
Rate for Payer: BCBS BCN 65	$255.96
Rate for Payer: Blue Care Network Medicare Advantage	$255.96
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$255.96
Rate for Payer: Meridian Health Plan Medicare	$255.96
Rate for Payer: Priority Health Medicaid	$255.96
Rate for Payer: Priority Health Medicare	$255.96
Rate for Payer: United Health Care Medicaid	$255.96
Rate for Payer: United Health Care Medicare Advantage	$112.62

FLUROSCENT AB TITER EA

Facility

$75.00

Hospital Charge Code	3100048
Hospital Revenue Code	300
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

FLUROSCENT AB TITER EA

Facility

$75.00

Hospital Charge Code	3100055
Hospital Revenue Code	300
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

FM-1

Facility

$23.60

Hospital Charge Code	3101228
Hospital Revenue Code	300
Min. Negotiated Rate	$16.52
Max. Negotiated Rate	$20.06
Rate for Payer: Cash Price	$15.34
Rate for Payer: Community Health Alliance Commercial	$20.06
Rate for Payer: Priority Health Commercial	$16.52
Rate for Payer: Priority Health PPO	$16.52

FM-2

Facility

$23.60

Hospital Charge Code	3101229
Hospital Revenue Code	310
Min. Negotiated Rate	$16.52
Max. Negotiated Rate	$20.06
Rate for Payer: Cash Price	$15.34
Rate for Payer: Community Health Alliance Commercial	$20.06
Rate for Payer: Priority Health Commercial	$16.52
Rate for Payer: Priority Health PPO	$16.52

FMR1 GENE CHARACTERIZATION

Facility

$213.00

Hospital Charge Code	3100685
Hospital Revenue Code	301
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$181.05
Rate for Payer: Cash Price	$138.45
Rate for Payer: Community Health Alliance Commercial	$181.05
Rate for Payer: Priority Health Commercial	$149.10
Rate for Payer: Priority Health PPO	$149.10

FMR1 GENE DETECTION

Facility

$319.00

Hospital Charge Code	3100684
Hospital Revenue Code	301
Min. Negotiated Rate	$223.30
Max. Negotiated Rate	$271.15
Rate for Payer: Cash Price	$207.35
Rate for Payer: Community Health Alliance Commercial	$271.15
Rate for Payer: Priority Health Commercial	$223.30
Rate for Payer: Priority Health PPO	$223.30

FNA ASP BY PATHOLOGIST

Facility

$212.00

Service Code	HCPCS 10022
Hospital Charge Code	9710440
Hospital Revenue Code	971
Min. Negotiated Rate	$148.40
Max. Negotiated Rate	$180.20
Rate for Payer: Cash Price	$137.80
Rate for Payer: Community Health Alliance Commercial	$180.20
Rate for Payer: Priority Health Commercial	$148.40
Rate for Payer: Priority Health PPO	$148.40

FNA DEEP TISSUE W/RAD GUIDE

Facility

$101.00

Service Code	HCPCS 10021
Hospital Charge Code	3100220
Hospital Revenue Code	311
Min. Negotiated Rate	$70.70
Max. Negotiated Rate	$436.09
Rate for Payer: BCBS BCN 65	$436.09
Rate for Payer: Blue Care Network Medicare Advantage	$436.09
Rate for Payer: Cash Price	$65.65
Rate for Payer: Cash Price	$65.65
Rate for Payer: Community Health Alliance Commercial	$85.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$436.09
Rate for Payer: Meridian Health Plan Medicare	$436.09
Rate for Payer: Priority Health Commercial	$70.70
Rate for Payer: Priority Health Medicaid	$436.09
Rate for Payer: Priority Health Medicare	$436.09
Rate for Payer: Priority Health PPO	$70.70
Rate for Payer: United Health Care Medicaid	$436.09
Rate for Payer: United Health Care Medicare Advantage	$191.88

FNA, EVAL FOR ADEQUACY

Facility

$157.00

Service Code	HCPCS 88172
Hospital Charge Code	3100235
Hospital Revenue Code	311
Min. Negotiated Rate	$80.42
Max. Negotiated Rate	$182.76
Rate for Payer: BCBS BCN 65	$182.76
Rate for Payer: Blue Care Network Medicare Advantage	$182.76
Rate for Payer: Cash Price	$102.05
Rate for Payer: Cash Price	$102.05
Rate for Payer: Community Health Alliance Commercial	$133.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$182.76
Rate for Payer: Meridian Health Plan Medicare	$182.76
Rate for Payer: Priority Health Commercial	$109.90
Rate for Payer: Priority Health Medicaid	$182.76
Rate for Payer: Priority Health Medicare	$182.76
Rate for Payer: Priority Health PPO	$109.90
Rate for Payer: United Health Care Medicaid	$182.76
Rate for Payer: United Health Care Medicare Advantage	$80.42

FNA INTERPRETATION

Facility

$312.00

Hospital Charge Code	3000788
Hospital Revenue Code	310
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$265.20
Rate for Payer: Cash Price	$202.80
Rate for Payer: Community Health Alliance Commercial	$265.20
Rate for Payer: Priority Health Commercial	$218.40
Rate for Payer: Priority Health PPO	$218.40

FNA TECH

Facility

$64.00

Service Code	HCPCS 10022
Hospital Charge Code	3100230
Hospital Revenue Code	490
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$54.40
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health PPO	$44.80

FOLATE-RBC

Facility

$2.55

Service Code	HCPCS 82747
Hospital Charge Code	3004380
Hospital Revenue Code	301
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$18.53
Rate for Payer: BCBS BCN 65	$18.53
Rate for Payer: Blue Care Network Medicare Advantage	$18.53
Rate for Payer: Cash Price	$1.66
Rate for Payer: Cash Price	$1.66
Rate for Payer: Community Health Alliance Commercial	$2.17
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	$1.78
Rate for Payer: Priority Health Medicaid	$18.53
Rate for Payer: Priority Health Medicare	$18.53
Rate for Payer: Priority Health PPO	$1.78
Rate for Payer: United Health Care Medicaid	$18.53
Rate for Payer: United Health Care Medicare Advantage	$8.15

FOLATE RBC-1

Facility

$2.55

Hospital Charge Code	3101838
Hospital Revenue Code	300
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.17
Rate for Payer: Cash Price	$1.66
Rate for Payer: Community Health Alliance Commercial	$2.17
Rate for Payer: Priority Health Commercial	$1.78
Rate for Payer: Priority Health PPO	$1.78

FOLIC ACID/FOLATE

Facility

$42.00

Service Code	HCPCS 82746
Hospital Charge Code	3004360
Hospital Revenue Code	301
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$35.70
Rate for Payer: BCBS BCN 65	$15.44
Rate for Payer: Blue Care Network Medicare Advantage	$15.44
Rate for Payer: Cash Price	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Community Health Alliance Commercial	$35.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.44
Rate for Payer: Meridian Health Plan Medicare	$15.44
Rate for Payer: Priority Health Commercial	$29.40
Rate for Payer: Priority Health Medicaid	$15.44
Rate for Payer: Priority Health Medicare	$15.44
Rate for Payer: Priority Health PPO	$29.40
Rate for Payer: United Health Care Medicaid	$15.44
Rate for Payer: United Health Care Medicare Advantage	$6.79

FOLIC ACID SBMF

Facility

$2.85

Hospital Charge Code	3101247
Hospital Revenue Code	301
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.42
Rate for Payer: Cash Price	$1.85
Rate for Payer: Community Health Alliance Commercial	$2.42
Rate for Payer: Priority Health Commercial	$2.00
Rate for Payer: Priority Health PPO	$2.00

FONDAPARINUX ANTI Xa

Facility

$45.74

Hospital Charge Code	3102213
Hospital Revenue Code	300
Min. Negotiated Rate	$32.02
Max. Negotiated Rate	$38.88
Rate for Payer: Cash Price	$29.73
Rate for Payer: Community Health Alliance Commercial	$38.88
Rate for Payer: Priority Health Commercial	$32.02
Rate for Payer: Priority Health PPO	$32.02

FONTANA MASSON STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100240
Hospital Revenue Code	310
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$142.73
Rate for Payer: BCBS BCN 65	$142.73
Rate for Payer: Blue Care Network Medicare Advantage	$142.73
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Community Health Alliance Commercial	$45.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$142.73
Rate for Payer: Meridian Health Plan Medicare	$142.73
Rate for Payer: Priority Health Commercial	$37.10
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$37.10
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

Food Allergen

Facility

$82.28

Hospital Charge Code	31027605
Hospital Revenue Code	300
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$69.94
Rate for Payer: Cash Price	$53.48
Rate for Payer: Community Health Alliance Commercial	$69.94
Rate for Payer: Priority Health Commercial	$57.60
Rate for Payer: Priority Health PPO	$57.60

FOOD MIX 15

Facility

$19.70

Hospital Charge Code	3006616
Hospital Revenue Code	302
Min. Negotiated Rate	$13.79
Max. Negotiated Rate	$16.75
Rate for Payer: Cash Price	$12.81
Rate for Payer: Community Health Alliance Commercial	$16.75
Rate for Payer: Priority Health Commercial	$13.79
Rate for Payer: Priority Health PPO	$13.79

FORCEP BIPOLAR EBF01

Facility

$239.00

Hospital Charge Code	27017327
Hospital Revenue Code	272
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$203.15
Rate for Payer: Cash Price	$155.35
Rate for Payer: Community Health Alliance Commercial	$203.15
Rate for Payer: Priority Health Commercial	$167.30
Rate for Payer: Priority Health PPO	$167.30

FORCEP,BIPOLAR MACRO JAW

Facility

$414.00

Hospital Charge Code	27021972
Hospital Revenue Code	272
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$351.90
Rate for Payer: Cash Price	$269.10
Rate for Payer: Community Health Alliance Commercial	$351.90
Rate for Payer: Priority Health Commercial	$289.80
Rate for Payer: Priority Health PPO	$289.80

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges