Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

FORCEP,HOT BIOPSY

Facility

$2,950.00

Hospital Charge Code	27022665
Hospital Revenue Code	272
Min. Negotiated Rate	$2,065.00
Max. Negotiated Rate	$2,507.50
Rate for Payer: Cash Price	$1,917.50
Rate for Payer: Community Health Alliance Commercial	$2,507.50
Rate for Payer: Priority Health Commercial	$2,065.00
Rate for Payer: Priority Health PPO	$2,065.00

FORCEP, POSITRAP

Facility

$269.00

Hospital Charge Code	27268233
Hospital Revenue Code	272
Min. Negotiated Rate	$188.30
Max. Negotiated Rate	$228.65
Rate for Payer: Cash Price	$174.85
Rate for Payer: Community Health Alliance Commercial	$228.65
Rate for Payer: Priority Health Commercial	$188.30
Rate for Payer: Priority Health PPO	$188.30

FORCEP SEITZINGER TRIPOLAR

Facility

$573.00

Hospital Charge Code	27017640
Hospital Revenue Code	272
Min. Negotiated Rate	$401.10
Max. Negotiated Rate	$487.05
Rate for Payer: Cash Price	$372.45
Rate for Payer: Community Health Alliance Commercial	$487.05
Rate for Payer: Priority Health Commercial	$401.10
Rate for Payer: Priority Health PPO	$401.10

FORCEPS GRASPING HOOK TYPE

Facility

$345.00

Hospital Charge Code	27014860
Hospital Revenue Code	272
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$293.25
Rate for Payer: Cash Price	$224.25
Rate for Payer: Community Health Alliance Commercial	$293.25
Rate for Payer: Priority Health Commercial	$241.50
Rate for Payer: Priority Health PPO	$241.50

FOREARM IMPLANT

Facility

$502.00

Hospital Charge Code	27868522
Hospital Revenue Code	278
Min. Negotiated Rate	$351.40
Max. Negotiated Rate	$426.70
Rate for Payer: Cash Price	$326.30
Rate for Payer: Community Health Alliance Commercial	$426.70
Rate for Payer: Priority Health Commercial	$351.40
Rate for Payer: Priority Health PPO	$351.40

FOREARM SPLINT

Facility

$30.00

Hospital Charge Code	27012963
Hospital Revenue Code	270
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$25.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Community Health Alliance Commercial	$25.50
Rate for Payer: Priority Health Commercial	$21.00
Rate for Payer: Priority Health PPO	$21.00

FOSPHENYTOIN SODIUM 100MG/2ML

Facility

$189.45

Service Code	NDC 64679073001
Hospital Charge Code	2507766
Hospital Revenue Code	250
Min. Negotiated Rate	$132.62
Max. Negotiated Rate	$161.03
Rate for Payer: Cash Price	$123.14
Rate for Payer: Community Health Alliance Commercial	$161.03
Rate for Payer: Priority Health Commercial	$132.62
Rate for Payer: Priority Health PPO	$132.62

%FPSA REFLEX

Facility

$6.52

Hospital Charge Code	3102579
Hospital Revenue Code	300
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$5.54
Rate for Payer: Cash Price	$4.24
Rate for Payer: Community Health Alliance Commercial	$5.54
Rate for Payer: Priority Health Commercial	$4.56
Rate for Payer: Priority Health PPO	$4.56

Fragile X PCR Southern

Facility

$97.59

Hospital Charge Code	31027708
Hospital Revenue Code	300
Min. Negotiated Rate	$68.31
Max. Negotiated Rate	$82.95
Rate for Payer: Cash Price	$63.43
Rate for Payer: Community Health Alliance Commercial	$82.95
Rate for Payer: Priority Health Commercial	$68.31
Rate for Payer: Priority Health PPO	$68.31

FRAGILE X SYNDROME DNA PCR X

Facility

$531.00

Hospital Charge Code	3100249
Hospital Revenue Code	301
Min. Negotiated Rate	$371.70
Max. Negotiated Rate	$451.35
Rate for Payer: Cash Price	$345.15
Rate for Payer: Community Health Alliance Commercial	$451.35
Rate for Payer: Priority Health Commercial	$371.70
Rate for Payer: Priority Health PPO	$371.70

FRANCISELLA

Facility

$50.00

Service Code	HCPCS 86668
Hospital Charge Code	3004385
Hospital Revenue Code	302
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$14.87
Rate for Payer: Blue Care Network Medicare Advantage	$14.87
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Community Health Alliance Commercial	$42.50
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.87
Rate for Payer: Meridian Health Plan Medicare	$14.87
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$14.87
Rate for Payer: Priority Health Medicare	$14.87
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$14.87
Rate for Payer: United Health Care Medicare Advantage	$6.54

FREE DEPAKOTE

Facility

$16.49

Service Code	HCPCS 80165
Hospital Charge Code	3003585
Hospital Revenue Code	301
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$14.22
Rate for Payer: BCBS BCN 65	$14.22
Rate for Payer: Blue Care Network Medicare Advantage	$14.22
Rate for Payer: Cash Price	$10.72
Rate for Payer: Cash Price	$10.72
Rate for Payer: Community Health Alliance Commercial	$14.02
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.22
Rate for Payer: Meridian Health Plan Medicare	$14.22
Rate for Payer: Priority Health Commercial	$11.54
Rate for Payer: Priority Health Medicaid	$14.22
Rate for Payer: Priority Health Medicare	$14.22
Rate for Payer: Priority Health PPO	$11.54
Rate for Payer: United Health Care Medicaid	$14.22
Rate for Payer: United Health Care Medicare Advantage	$6.26

FREE DILANTIN

Facility

$6.74

Service Code	HCPCS 80186
Hospital Charge Code	3003581
Hospital Revenue Code	301
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$14.45
Rate for Payer: BCBS BCN 65	$14.45
Rate for Payer: Blue Care Network Medicare Advantage	$14.45
Rate for Payer: Cash Price	$4.38
Rate for Payer: Cash Price	$4.38
Rate for Payer: Community Health Alliance Commercial	$5.73
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$14.45
Rate for Payer: Meridian Health Plan Medicare	$14.45
Rate for Payer: Priority Health Commercial	$4.72
Rate for Payer: Priority Health Medicaid	$14.45
Rate for Payer: Priority Health Medicare	$14.45
Rate for Payer: Priority Health PPO	$4.72
Rate for Payer: United Health Care Medicaid	$14.45
Rate for Payer: United Health Care Medicare Advantage	$6.36

FREE T3

Facility

$4.00

Service Code	HCPCS 84481
Hospital Charge Code	3004400
Hospital Revenue Code	301
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$17.79
Rate for Payer: BCBS BCN 65	$17.79
Rate for Payer: Blue Care Network Medicare Advantage	$17.79
Rate for Payer: Cash Price	$2.60
Rate for Payer: Cash Price	$2.60
Rate for Payer: Community Health Alliance Commercial	$3.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.79
Rate for Payer: Meridian Health Plan Medicare	$17.79
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health Medicaid	$17.79
Rate for Payer: Priority Health Medicare	$17.79
Rate for Payer: Priority Health PPO	$2.80
Rate for Payer: United Health Care Medicaid	$17.79
Rate for Payer: United Health Care Medicare Advantage	$7.83

FREE T3-ML

Facility

$120.00

Hospital Charge Code	3101286
Hospital Revenue Code	301
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Priority Health Commercial	$84.00
Rate for Payer: Priority Health PPO	$84.00

FREE T4

Facility

$67.00

Service Code	HCPCS 84439
Hospital Charge Code	3004420
Hospital Revenue Code	301
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$56.95
Rate for Payer: BCBS BCN 65	$9.47
Rate for Payer: Blue Care Network Medicare Advantage	$9.47
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Community Health Alliance Commercial	$56.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.47
Rate for Payer: Meridian Health Plan Medicare	$9.47
Rate for Payer: Priority Health Commercial	$46.90
Rate for Payer: Priority Health Medicaid	$9.47
Rate for Payer: Priority Health Medicare	$9.47
Rate for Payer: Priority Health PPO	$46.90
Rate for Payer: United Health Care Medicaid	$9.47
Rate for Payer: United Health Care Medicare Advantage	$4.17

FREE T 4 BY DIALYSIS

Facility

$129.00

Service Code	HCPCS 84439
Hospital Charge Code	3004425
Hospital Revenue Code	301
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$109.65
Rate for Payer: BCBS BCN 65	$9.47
Rate for Payer: Blue Care Network Medicare Advantage	$9.47
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Community Health Alliance Commercial	$109.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$9.47
Rate for Payer: Meridian Health Plan Medicare	$9.47
Rate for Payer: Priority Health Commercial	$90.30
Rate for Payer: Priority Health Medicaid	$9.47
Rate for Payer: Priority Health Medicare	$9.47
Rate for Payer: Priority Health PPO	$90.30
Rate for Payer: United Health Care Medicaid	$9.47
Rate for Payer: United Health Care Medicare Advantage	$4.17

FREE T-4 LC

Facility

$2.20

Hospital Charge Code	3101846
Hospital Revenue Code	300
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.87
Rate for Payer: Cash Price	$1.43
Rate for Payer: Community Health Alliance Commercial	$1.87
Rate for Payer: Priority Health Commercial	$1.54
Rate for Payer: Priority Health PPO	$1.54

FREE TEGRETOL

Facility

$58.00

Service Code	HCPCS 80157
Hospital Charge Code	3001050
Hospital Revenue Code	301
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$49.30
Rate for Payer: BCBS BCN 65	$13.91
Rate for Payer: Blue Care Network Medicare Advantage	$13.91
Rate for Payer: Cash Price	$37.70
Rate for Payer: Cash Price	$37.70
Rate for Payer: Community Health Alliance Commercial	$49.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.91
Rate for Payer: Meridian Health Plan Medicare	$13.91
Rate for Payer: Priority Health Commercial	$40.60
Rate for Payer: Priority Health Medicaid	$13.91
Rate for Payer: Priority Health Medicare	$13.91
Rate for Payer: Priority Health PPO	$40.60
Rate for Payer: United Health Care Medicaid	$13.91
Rate for Payer: United Health Care Medicare Advantage	$6.12

FRESH FROZEN PLASMA 1 UNIT

Facility

$234.00

Service Code	HCPCS P9017
Hospital Charge Code	3910020
Hospital Revenue Code	390
Min. Negotiated Rate	$39.72
Max. Negotiated Rate	$198.90
Rate for Payer: BCBS BCN 65	$90.28
Rate for Payer: Blue Care Network Medicare Advantage	$90.28
Rate for Payer: Cash Price	$152.10
Rate for Payer: Cash Price	$152.10
Rate for Payer: Community Health Alliance Commercial	$198.90
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$90.28
Rate for Payer: Meridian Health Plan Medicare	$90.28
Rate for Payer: Priority Health Commercial	$163.80
Rate for Payer: Priority Health Medicaid	$90.28
Rate for Payer: Priority Health Medicare	$90.28
Rate for Payer: Priority Health PPO	$163.80
Rate for Payer: United Health Care Medicaid	$90.28
Rate for Payer: United Health Care Medicare Advantage	$39.72

FRESH FROZEN PLASMA THAWING

Facility

$24.00

Service Code	HCPCS 86927
Hospital Charge Code	3001060
Hospital Revenue Code	300
Min. Negotiated Rate	$16.80
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	$15.60
Rate for Payer: Cash Price	$15.60
Rate for Payer: Community Health Alliance Commercial	$20.40
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	$16.80
Rate for Payer: Priority Health Medicaid	$182.76
Rate for Payer: Priority Health Medicare	$182.76
Rate for Payer: Priority Health PPO	$16.80
Rate for Payer: United Health Care Medicaid	$182.76
Rate for Payer: United Health Care Medicare Advantage	$80.42

FROZEN SECTION STAIN

Facility

$80.00

Service Code	HCPCS 88314
Hospital Charge Code	3100245
Hospital Revenue Code	310
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Community Health Alliance Commercial	$68.00
Rate for Payer: Priority Health Commercial	$56.00
Rate for Payer: Priority Health PPO	$56.00

FRUCTOSAMINE

Facility

$4.50

Service Code	HCPCS 82985
Hospital Charge Code	3009100
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$17.60
Rate for Payer: BCBS BCN 65	$17.60
Rate for Payer: Blue Care Network Medicare Advantage	$17.60
Rate for Payer: Cash Price	$2.93
Rate for Payer: Cash Price	$2.93
Rate for Payer: Community Health Alliance Commercial	$3.83
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$17.60
Rate for Payer: Meridian Health Plan Medicare	$17.60
Rate for Payer: Priority Health Commercial	$3.15
Rate for Payer: Priority Health Medicaid	$17.60
Rate for Payer: Priority Health Medicare	$17.60
Rate for Payer: Priority Health PPO	$3.15
Rate for Payer: United Health Care Medicaid	$17.60
Rate for Payer: United Health Care Medicare Advantage	$7.74

F.S. EA ADD BLOCK TECH

Facility

$130.00

Service Code	HCPCS 88332
Hospital Charge Code	3100200
Hospital Revenue Code	310
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$110.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Community Health Alliance Commercial	$110.50
Rate for Payer: Priority Health Commercial	$91.00
Rate for Payer: Priority Health PPO	$91.00

FSH SERUM FOLLICE STIM HORMONE

Facility

$120.00

Hospital Charge Code	3101285
Hospital Revenue Code	301
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Priority Health Commercial	$84.00
Rate for Payer: Priority Health PPO	$84.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges