Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

GAMMA LAG SCREW 10.5 X 100MM

Facility

$824.00

Service Code	HCPCS C1713
Hospital Charge Code	27868597
Hospital Revenue Code	278
Min. Negotiated Rate	$576.80
Max. Negotiated Rate	$700.40
Rate for Payer: Cash Price	$535.60
Rate for Payer: Community Health Alliance Commercial	$700.40
Rate for Payer: Priority Health Commercial	$576.80
Rate for Payer: Priority Health PPO	$576.80

GAMMA LOCKING SCREW 5X40MM

Facility

$309.00

Service Code	HCPCS C1713
Hospital Charge Code	27868621
Hospital Revenue Code	278
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$262.65
Rate for Payer: Cash Price	$200.85
Rate for Payer: Community Health Alliance Commercial	$262.65
Rate for Payer: Priority Health Commercial	$216.30
Rate for Payer: Priority Health PPO	$216.30

GAMMA TROCHANTERIC NAIL

Facility

$2,083.00

Service Code	HCPCS C1713
Hospital Charge Code	27868605
Hospital Revenue Code	278
Min. Negotiated Rate	$1,458.10
Max. Negotiated Rate	$1,770.55
Rate for Payer: Cash Price	$1,353.95
Rate for Payer: Community Health Alliance Commercial	$1,770.55
Rate for Payer: Priority Health Commercial	$1,458.10
Rate for Payer: Priority Health PPO	$1,458.10

GANG AB-2

Facility

$18.00

Hospital Charge Code	3101253
Hospital Revenue Code	300
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$15.30
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health PPO	$12.60

GANG AB-3

Facility

$18.00

Hospital Charge Code	3101254
Hospital Revenue Code	300
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$15.30
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health PPO	$12.60

GANG AB-4

Facility

$18.00

Hospital Charge Code	3101252
Hospital Revenue Code	300
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$15.30
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health PPO	$12.60

GANG AB-4

Facility

$18.00

Hospital Charge Code	3101255
Hospital Revenue Code	300
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$15.30
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health PPO	$12.60

GANG AB-5

Facility

$18.00

Hospital Charge Code	3101256
Hospital Revenue Code	300
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$15.30
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health PPO	$12.60

GANG AB-6

Facility

$18.00

Hospital Charge Code	3101257
Hospital Revenue Code	300
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$15.30
Rate for Payer: Cash Price	$11.70
Rate for Payer: Community Health Alliance Commercial	$15.30
Rate for Payer: Priority Health Commercial	$12.60
Rate for Payer: Priority Health PPO	$12.60

GANGLIOSIDE ANTIBODIES 1

Facility

$137.00

Service Code	HCPCS 83520
Hospital Charge Code	3004496
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$116.45
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$89.05
Rate for Payer: Cash Price	$89.05
Rate for Payer: Community Health Alliance Commercial	$116.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$95.90
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$95.90
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

GANGLIOSIDE ANTIBODIES 2

Facility

$137.00

Service Code	HCPCS 83520
Hospital Charge Code	3004497
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$116.45
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$89.05
Rate for Payer: Cash Price	$89.05
Rate for Payer: Community Health Alliance Commercial	$116.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$95.90
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$95.90
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

GANGLIOSIDE ANTIBODIES 3

Facility

$137.00

Service Code	HCPCS 83520
Hospital Charge Code	3004498
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$116.45
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$89.05
Rate for Payer: Cash Price	$89.05
Rate for Payer: Community Health Alliance Commercial	$116.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$95.90
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$95.90
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

GANGLIOSIDE ANTIBODIES 4

Facility

$137.00

Service Code	HCPCS 83520
Hospital Charge Code	3004499
Hospital Revenue Code	301
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$116.45
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$89.05
Rate for Payer: Cash Price	$89.05
Rate for Payer: Community Health Alliance Commercial	$116.45
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.13
Rate for Payer: Meridian Health Plan Medicare	$18.13
Rate for Payer: Priority Health Commercial	$95.90
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$95.90
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

GARDNERELLA VAGINALIS

Facility

$10.00

Hospital Charge Code	3002830
Hospital Revenue Code	306
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Community Health Alliance Commercial	$8.50
Rate for Payer: Priority Health Commercial	$7.00
Rate for Payer: Priority Health PPO	$7.00

GASTRIC EMPTYING STUDY

Facility

$838.00

Hospital Charge Code	3400019
Hospital Revenue Code	340
Min. Negotiated Rate	$586.60
Max. Negotiated Rate	$712.30
Rate for Payer: Cash Price	$544.70
Rate for Payer: Community Health Alliance Commercial	$712.30
Rate for Payer: Priority Health Commercial	$586.60
Rate for Payer: Priority Health PPO	$586.60

GASTRIN

Facility

$4.72

Service Code	HCPCS 82941
Hospital Charge Code	3004500
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$18.51
Rate for Payer: BCBS BCN 65	$18.51
Rate for Payer: Blue Care Network Medicare Advantage	$18.51
Rate for Payer: Cash Price	$3.07
Rate for Payer: Cash Price	$3.07
Rate for Payer: Community Health Alliance Commercial	$4.01
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.51
Rate for Payer: Meridian Health Plan Medicare	$18.51
Rate for Payer: Priority Health Commercial	$3.30
Rate for Payer: Priority Health Medicaid	$18.51
Rate for Payer: Priority Health Medicare	$18.51
Rate for Payer: Priority Health PPO	$3.30
Rate for Payer: United Health Care Medicaid	$18.51
Rate for Payer: United Health Care Medicare Advantage	$8.15

GASTROCULT

Facility

$21.00

Service Code	HCPCS 82271
Hospital Charge Code	3001070
Hospital Revenue Code	300
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$17.85
Rate for Payer: BCBS BCN 65	$5.59
Rate for Payer: Blue Care Network Medicare Advantage	$5.59
Rate for Payer: Cash Price	$13.65
Rate for Payer: Cash Price	$13.65
Rate for Payer: Community Health Alliance Commercial	$17.85
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$5.59
Rate for Payer: Meridian Health Plan Medicare	$5.59
Rate for Payer: Priority Health Commercial	$14.70
Rate for Payer: Priority Health Medicaid	$5.59
Rate for Payer: Priority Health Medicare	$5.59
Rate for Payer: Priority Health PPO	$14.70
Rate for Payer: United Health Care Medicaid	$5.59
Rate for Payer: United Health Care Medicare Advantage	$2.46

GASTROINTESTINAL BACTERIAL PAN

Facility

$195.00

Hospital Charge Code	3101121
Hospital Revenue Code	306
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$165.75
Rate for Payer: Cash Price	$126.75
Rate for Payer: Community Health Alliance Commercial	$165.75
Rate for Payer: Priority Health Commercial	$136.50
Rate for Payer: Priority Health PPO	$136.50

GASTROINTESTINAL PARASITE/MICR

Facility

$425.00

Hospital Charge Code	3101122
Hospital Revenue Code	306
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$361.25
Rate for Payer: Cash Price	$276.25
Rate for Payer: Community Health Alliance Commercial	$361.25
Rate for Payer: Priority Health Commercial	$297.50
Rate for Payer: Priority Health PPO	$297.50

GASTROSTOMY BUTTON KIT

Facility

$469.00

Hospital Charge Code	27264736
Hospital Revenue Code	272
Min. Negotiated Rate	$328.30
Max. Negotiated Rate	$398.65
Rate for Payer: Cash Price	$304.85
Rate for Payer: Community Health Alliance Commercial	$398.65
Rate for Payer: Priority Health Commercial	$328.30
Rate for Payer: Priority Health PPO	$328.30

GASTROSTOMY DEVICE

Facility

$483.00

Hospital Charge Code	27265643
Hospital Revenue Code	272
Min. Negotiated Rate	$338.10
Max. Negotiated Rate	$410.55
Rate for Payer: Cash Price	$313.95
Rate for Payer: Community Health Alliance Commercial	$410.55
Rate for Payer: Priority Health Commercial	$338.10
Rate for Payer: Priority Health PPO	$338.10

GASTROSTOMY DEVICE,REPLACEMENT

Facility

$472.00

Hospital Charge Code	27265650
Hospital Revenue Code	272
Min. Negotiated Rate	$330.40
Max. Negotiated Rate	$401.20
Rate for Payer: Cash Price	$306.80
Rate for Payer: Community Health Alliance Commercial	$401.20
Rate for Payer: Priority Health Commercial	$330.40
Rate for Payer: Priority Health PPO	$330.40

GASTROSTOMY INTRO KIT

Facility

$368.00

Hospital Charge Code	27017194
Hospital Revenue Code	272
Min. Negotiated Rate	$257.60
Max. Negotiated Rate	$312.80
Rate for Payer: Cash Price	$239.20
Rate for Payer: Community Health Alliance Commercial	$312.80
Rate for Payer: Priority Health Commercial	$257.60
Rate for Payer: Priority Health PPO	$257.60

GASTROSTOMY TUBE

Facility

$192.00

Hospital Charge Code	27263447
Hospital Revenue Code	272
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$124.80
Rate for Payer: Community Health Alliance Commercial	$163.20
Rate for Payer: Priority Health Commercial	$134.40
Rate for Payer: Priority Health PPO	$134.40

GASTROSTOMY TUBE

Facility

$681.00

Hospital Charge Code	27015552
Hospital Revenue Code	272
Min. Negotiated Rate	$476.70
Max. Negotiated Rate	$578.85
Rate for Payer: Cash Price	$442.65
Rate for Payer: Community Health Alliance Commercial	$578.85
Rate for Payer: Priority Health Commercial	$476.70
Rate for Payer: Priority Health PPO	$476.70

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges