Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

FSH SERUM-FOLLICLE STIM HORMO

Facility

$4.00

Service Code	HCPCS 83001
Hospital Charge Code	3004460
Hospital Revenue Code	301
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$19.51
Rate for Payer: BCBS BCN 65	$19.51
Rate for Payer: Blue Care Network Medicare Advantage	$19.51
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	$19.51
Rate for Payer: Meridian Health Plan Medicare	$19.51
Rate for Payer: Priority Health Commercial	$2.80
Rate for Payer: Priority Health Medicaid	$19.51
Rate for Payer: Priority Health Medicare	$19.51
Rate for Payer: Priority Health PPO	$2.80
Rate for Payer: United Health Care Medicaid	$19.51
Rate for Payer: United Health Care Medicare Advantage	$8.58

FSH - URINE

Facility

$175.00

Service Code	HCPCS 83001
Hospital Charge Code	3004470
Hospital Revenue Code	301
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$148.75
Rate for Payer: BCBS BCN 65	$19.51
Rate for Payer: Blue Care Network Medicare Advantage	$19.51
Rate for Payer: Cash Price	$113.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Community Health Alliance Commercial	$148.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.51
Rate for Payer: Meridian Health Plan Medicare	$19.51
Rate for Payer: Priority Health Commercial	$122.50
Rate for Payer: Priority Health Medicaid	$19.51
Rate for Payer: Priority Health Medicare	$19.51
Rate for Payer: Priority Health PPO	$122.50
Rate for Payer: United Health Care Medicaid	$19.51
Rate for Payer: United Health Care Medicare Advantage	$8.58

F.S. TECH

Facility

$198.00

Service Code	HCPCS 88331
Hospital Charge Code	3100210
Hospital Revenue Code	310
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	$128.70
Rate for Payer: Cash Price	$128.70
Rate for Payer: Community Health Alliance Commercial	$168.30
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	$138.60
Rate for Payer: Priority Health Medicaid	$182.76
Rate for Payer: Priority Health Medicare	$182.76
Rate for Payer: Priority Health PPO	$138.60
Rate for Payer: United Health Care Medicaid	$182.76
Rate for Payer: United Health Care Medicare Advantage	$80.42

FT-1

Facility

$39.57

Hospital Charge Code	3102370
Hospital Revenue Code	300
Min. Negotiated Rate	$27.70
Max. Negotiated Rate	$33.63
Rate for Payer: Cash Price	$25.72
Rate for Payer: Community Health Alliance Commercial	$33.63
Rate for Payer: Priority Health Commercial	$27.70
Rate for Payer: Priority Health PPO	$27.70

FT-2

Facility

$39.58

Hospital Charge Code	3102371
Hospital Revenue Code	300
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$33.64
Rate for Payer: Cash Price	$25.73
Rate for Payer: Community Health Alliance Commercial	$33.64
Rate for Payer: Priority Health Commercial	$27.71
Rate for Payer: Priority Health PPO	$27.71

FTA-RML

Facility

$4.89

Service Code	HCPCS 86780
Hospital Charge Code	3005050
Hospital Revenue Code	302
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$13.90
Rate for Payer: BCBS BCN 65	$13.90
Rate for Payer: Blue Care Network Medicare Advantage	$13.90
Rate for Payer: Cash Price	$3.18
Rate for Payer: Cash Price	$3.18
Rate for Payer: Community Health Alliance Commercial	$4.16
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.90
Rate for Payer: Meridian Health Plan Medicare	$13.90
Rate for Payer: Priority Health Commercial	$3.42
Rate for Payer: Priority Health Medicaid	$13.90
Rate for Payer: Priority Health Medicare	$13.90
Rate for Payer: Priority Health PPO	$3.42
Rate for Payer: United Health Care Medicaid	$13.90
Rate for Payer: United Health Care Medicare Advantage	$6.12

FTI-1

Facility

$4.88

Service Code	HCPCS 83527
Hospital Charge Code	3004394
Hospital Revenue Code	301
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$13.60
Rate for Payer: BCBS BCN 65	$13.60
Rate for Payer: Blue Care Network Medicare Advantage	$13.60
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cash Price	$3.17
Rate for Payer: Community Health Alliance Commercial	$4.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.60
Rate for Payer: Meridian Health Plan Medicare	$13.60
Rate for Payer: Priority Health Commercial	$3.42
Rate for Payer: Priority Health Medicaid	$13.60
Rate for Payer: Priority Health Medicare	$13.60
Rate for Payer: Priority Health PPO	$3.42
Rate for Payer: United Health Care Medicaid	$13.60
Rate for Payer: United Health Care Medicare Advantage	$5.98

FTI-2

Facility

$4.89

Hospital Charge Code	3102335
Hospital Revenue Code	300
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$4.16
Rate for Payer: Cash Price	$3.18
Rate for Payer: Community Health Alliance Commercial	$4.16
Rate for Payer: Priority Health Commercial	$3.42
Rate for Payer: Priority Health PPO	$3.42

FULLER DRESSING SHIELD

Facility

$92.00

Hospital Charge Code	27012625
Hospital Revenue Code	270
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$78.20
Rate for Payer: Cash Price	$59.80
Rate for Payer: Community Health Alliance Commercial	$78.20
Rate for Payer: Priority Health Commercial	$64.40
Rate for Payer: Priority Health PPO	$64.40

FUNCTIONAL CAPACITY EVALUATION

Facility

$135.00

Service Code	HCPCS 97750
Hospital Charge Code	4200121
Hospital Revenue Code	420
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$114.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Community Health Alliance Commercial	$114.75
Rate for Payer: Priority Health Commercial	$94.50
Rate for Payer: Priority Health PPO	$94.50

FUNGAL CULT NON SKIN OR BLOOD

Facility

$49.00

Hospital Charge Code	3004476
Hospital Revenue Code	306
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$41.65
Rate for Payer: Cash Price	$31.85
Rate for Payer: Community Health Alliance Commercial	$41.65
Rate for Payer: Priority Health Commercial	$34.30
Rate for Payer: Priority Health PPO	$34.30

FUNGAL CULTURE AND SKIN SMEAR

Facility

$48.00

Hospital Charge Code	3008581
Hospital Revenue Code	306
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$40.80
Rate for Payer: Cash Price	$31.20
Rate for Payer: Community Health Alliance Commercial	$40.80
Rate for Payer: Priority Health Commercial	$33.60
Rate for Payer: Priority Health PPO	$33.60

FUNGAL SMEAR

Facility

$27.00

Service Code	HCPCS 87205
Hospital Charge Code	3004475
Hospital Revenue Code	306
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$22.95
Rate for Payer: BCBS BCN 65	$4.48
Rate for Payer: Blue Care Network Medicare Advantage	$4.48
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Community Health Alliance Commercial	$22.95
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.48
Rate for Payer: Meridian Health Plan Medicare	$4.48
Rate for Payer: Priority Health Commercial	$18.90
Rate for Payer: Priority Health Medicaid	$4.48
Rate for Payer: Priority Health Medicare	$4.48
Rate for Payer: Priority Health PPO	$18.90
Rate for Payer: United Health Care Medicaid	$4.48
Rate for Payer: United Health Care Medicare Advantage	$1.97

FUNGAL YEAST ID

Facility

$94.00

Hospital Charge Code	3000994
Hospital Revenue Code	306
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$79.90
Rate for Payer: Cash Price	$61.10
Rate for Payer: Community Health Alliance Commercial	$79.90
Rate for Payer: Priority Health Commercial	$65.80
Rate for Payer: Priority Health PPO	$65.80

Fungitell

Facility

$55.00

Hospital Charge Code	31027704
Hospital Revenue Code	300
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$46.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health PPO	$38.50

G212-IGE

Facility

$41.13

Hospital Charge Code	31027692
Hospital Revenue Code	300
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$34.96
Rate for Payer: Cash Price	$26.73
Rate for Payer: Community Health Alliance Commercial	$34.96
Rate for Payer: Priority Health Commercial	$28.79
Rate for Payer: Priority Health PPO	$28.79

GABA-B RECP AB IGG BY IFA

Facility

$200.00

Hospital Charge Code	3101462
Hospital Revenue Code	300
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$170.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Community Health Alliance Commercial	$170.00
Rate for Payer: Priority Health Commercial	$140.00
Rate for Payer: Priority Health PPO	$140.00

GABITRAL LEVEL

Facility

$111.00

Service Code	HCPCS 80299
Hospital Charge Code	3004490
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$94.35
Rate for Payer: BCBS BCN 65	$19.57
Rate for Payer: Blue Care Network Medicare Advantage	$19.57
Rate for Payer: Cash Price	$72.15
Rate for Payer: Cash Price	$72.15
Rate for Payer: Community Health Alliance Commercial	$94.35
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.57
Rate for Payer: Meridian Health Plan Medicare	$19.57
Rate for Payer: Priority Health Commercial	$77.70
Rate for Payer: Priority Health Medicaid	$19.57
Rate for Payer: Priority Health Medicare	$19.57
Rate for Payer: Priority Health PPO	$77.70
Rate for Payer: United Health Care Medicaid	$19.57
Rate for Payer: United Health Care Medicare Advantage	$8.61

GAD 65

Facility

$36.65

Hospital Charge Code	3004345
Hospital Revenue Code	301
Min. Negotiated Rate	$25.66
Max. Negotiated Rate	$31.15
Rate for Payer: Cash Price	$23.82
Rate for Payer: Community Health Alliance Commercial	$31.15
Rate for Payer: Priority Health Commercial	$25.66
Rate for Payer: Priority Health PPO	$25.66

GAD65Ab

Facility

$78.00

Hospital Charge Code	3100064
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

GAD 65 AB WB

Facility

$103.90

Hospital Charge Code	3101205
Hospital Revenue Code	300
Min. Negotiated Rate	$72.73
Max. Negotiated Rate	$88.31
Rate for Payer: Cash Price	$67.54
Rate for Payer: Community Health Alliance Commercial	$88.31
Rate for Payer: Priority Health Commercial	$72.73
Rate for Payer: Priority Health PPO	$72.73

GAIT TRAINING 1-15 MIN

Facility

$52.00

Service Code	HCPCS 97116 GP
Hospital Charge Code	4200141
Hospital Revenue Code	420
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$44.20
Rate for Payer: Cash Price	$33.80
Rate for Payer: Community Health Alliance Commercial	$44.20
Rate for Payer: Priority Health Commercial	$36.40
Rate for Payer: Priority Health PPO	$36.40

GALACTOSE-ALPHA-LC

Facility

$3.26

Hospital Charge Code	3102690
Hospital Revenue Code	300
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.77
Rate for Payer: Cash Price	$2.12
Rate for Payer: Community Health Alliance Commercial	$2.77
Rate for Payer: Priority Health Commercial	$2.28
Rate for Payer: Priority Health PPO	$2.28

GAMMA DRILL BIT 4.2X300MM

Facility

$443.00

Hospital Charge Code	27868613
Hospital Revenue Code	272
Min. Negotiated Rate	$310.10
Max. Negotiated Rate	$376.55
Rate for Payer: Cash Price	$287.95
Rate for Payer: Community Health Alliance Commercial	$376.55
Rate for Payer: Priority Health Commercial	$310.10
Rate for Payer: Priority Health PPO	$310.10

GAMMA K-WIRE 3.2x450MM

Facility

$296.00

Hospital Charge Code	27868639
Hospital Revenue Code	278
Min. Negotiated Rate	$207.20
Max. Negotiated Rate	$251.60
Rate for Payer: Cash Price	$192.40
Rate for Payer: Community Health Alliance Commercial	$251.60
Rate for Payer: Priority Health Commercial	$207.20
Rate for Payer: Priority Health PPO	$207.20

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges