Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

GLIDEWIRE, STRAIGHT

Facility

$129.00

Service Code	HCPCS C1769
Hospital Charge Code	27015016
Hospital Revenue Code	272
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$109.65
Rate for Payer: Cash Price	$83.85
Rate for Payer: Community Health Alliance Commercial	$109.65
Rate for Payer: Priority Health Commercial	$90.30
Rate for Payer: Priority Health PPO	$90.30

GLOMERULAR BASEMENT MEM ANTIB

Facility

$7.33

Service Code	HCPCS 83520
Hospital Charge Code	3004570
Hospital Revenue Code	301
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$18.13
Rate for Payer: BCBS BCN 65	$18.13
Rate for Payer: Blue Care Network Medicare Advantage	$18.13
Rate for Payer: Cash Price	$4.76
Rate for Payer: Cash Price	$4.76
Rate for Payer: Community Health Alliance Commercial	$6.23
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	$5.13
Rate for Payer: Priority Health Medicaid	$18.13
Rate for Payer: Priority Health Medicare	$18.13
Rate for Payer: Priority Health PPO	$5.13
Rate for Payer: United Health Care Medicaid	$18.13
Rate for Payer: United Health Care Medicare Advantage	$7.98

GLUCAGON

Facility

$17.10

Service Code	HCPCS 82943
Hospital Charge Code	3004560
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$15.00
Rate for Payer: BCBS BCN 65	$15.00
Rate for Payer: Blue Care Network Medicare Advantage	$15.00
Rate for Payer: Cash Price	$11.12
Rate for Payer: Cash Price	$11.12
Rate for Payer: Community Health Alliance Commercial	$14.54
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.00
Rate for Payer: Meridian Health Plan Medicare	$15.00
Rate for Payer: Priority Health Commercial	$11.97
Rate for Payer: Priority Health Medicaid	$15.00
Rate for Payer: Priority Health Medicare	$15.00
Rate for Payer: Priority Health PPO	$11.97
Rate for Payer: United Health Care Medicaid	$15.00
Rate for Payer: United Health Care Medicare Advantage	$6.60

GLUCOSE BLOOD

Facility

$33.00

Service Code	HCPCS 82947
Hospital Charge Code	3004700
Hospital Revenue Code	301
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$28.05
Rate for Payer: BCBS BCN 65	$4.13
Rate for Payer: Blue Care Network Medicare Advantage	$4.13
Rate for Payer: Cash Price	$21.45
Rate for Payer: Cash Price	$21.45
Rate for Payer: Community Health Alliance Commercial	$28.05
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.13
Rate for Payer: Meridian Health Plan Medicare	$4.13
Rate for Payer: Priority Health Commercial	$23.10
Rate for Payer: Priority Health Medicaid	$4.13
Rate for Payer: Priority Health Medicare	$4.13
Rate for Payer: Priority Health PPO	$23.10
Rate for Payer: United Health Care Medicaid	$4.13
Rate for Payer: United Health Care Medicare Advantage	$1.82

GLUCOSE, BODY FLUID

Facility

$2.25

Service Code	HCPCS 82945
Hospital Charge Code	3004710
Hospital Revenue Code	301
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$4.13
Rate for Payer: BCBS BCN 65	$4.13
Rate for Payer: Blue Care Network Medicare Advantage	$4.13
Rate for Payer: Cash Price	$1.46
Rate for Payer: Cash Price	$1.46
Rate for Payer: Community Health Alliance Commercial	$1.91
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.13
Rate for Payer: Meridian Health Plan Medicare	$4.13
Rate for Payer: Priority Health Commercial	$1.57
Rate for Payer: Priority Health Medicaid	$4.13
Rate for Payer: Priority Health Medicare	$4.13
Rate for Payer: Priority Health PPO	$1.57
Rate for Payer: United Health Care Medicaid	$4.13
Rate for Payer: United Health Care Medicare Advantage	$1.82

GLUCOSE-CSF

Facility

$44.00

Service Code	HCPCS 82945
Hospital Charge Code	3009130
Hospital Revenue Code	301
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$37.40
Rate for Payer: BCBS BCN 65	$4.13
Rate for Payer: Blue Care Network Medicare Advantage	$4.13
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.13
Rate for Payer: Meridian Health Plan Medicare	$4.13
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health Medicaid	$4.13
Rate for Payer: Priority Health Medicare	$4.13
Rate for Payer: Priority Health PPO	$30.80
Rate for Payer: United Health Care Medicaid	$4.13
Rate for Payer: United Health Care Medicare Advantage	$1.82

GLUCOSE TOL EA ADDIT SPEC

Facility

$39.00

Service Code	HCPCS 82952
Hospital Charge Code	3000461
Hospital Revenue Code	301
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$33.15
Rate for Payer: BCBS BCN 65	$4.12
Rate for Payer: Blue Care Network Medicare Advantage	$4.12
Rate for Payer: Cash Price	$25.35
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.12
Rate for Payer: Meridian Health Plan Medicare	$4.12
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health Medicaid	$4.12
Rate for Payer: Priority Health Medicare	$4.12
Rate for Payer: Priority Health PPO	$27.30
Rate for Payer: United Health Care Medicaid	$4.12
Rate for Payer: United Health Care Medicare Advantage	$1.81

GLUCOSE TOLERANCE 3 SPECIMENS

Facility

$120.00

Service Code	HCPCS 82951
Hospital Charge Code	3004600
Hospital Revenue Code	301
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$102.00
Rate for Payer: BCBS BCN 65	$13.51
Rate for Payer: Blue Care Network Medicare Advantage	$13.51
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.51
Rate for Payer: Meridian Health Plan Medicare	$13.51
Rate for Payer: Priority Health Commercial	$84.00
Rate for Payer: Priority Health Medicaid	$13.51
Rate for Payer: Priority Health Medicare	$13.51
Rate for Payer: Priority Health PPO	$84.00
Rate for Payer: United Health Care Medicaid	$13.51
Rate for Payer: United Health Care Medicare Advantage	$5.95

GLUCOSE TOLERANCE, 5 HR 3 SPEC

Facility

$120.00

Service Code	HCPCS 82951
Hospital Charge Code	3004611
Hospital Revenue Code	301
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$102.00
Rate for Payer: BCBS BCN 65	$13.51
Rate for Payer: Blue Care Network Medicare Advantage	$13.51
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Community Health Alliance Commercial	$102.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$13.51
Rate for Payer: Meridian Health Plan Medicare	$13.51
Rate for Payer: Priority Health Commercial	$84.00
Rate for Payer: Priority Health Medicaid	$13.51
Rate for Payer: Priority Health Medicare	$13.51
Rate for Payer: Priority Health PPO	$84.00
Rate for Payer: United Health Care Medicaid	$13.51
Rate for Payer: United Health Care Medicare Advantage	$5.95

GLUTARIC ACID

Facility

$50.00

Service Code	HCPCS 82131
Hospital Charge Code	3004930
Hospital Revenue Code	301
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$24.13
Rate for Payer: Blue Care Network Medicare Advantage	$24.13
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	$24.13
Rate for Payer: Meridian Health Plan Medicare	$24.13
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$24.13
Rate for Payer: Priority Health Medicare	$24.13
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$24.13
Rate for Payer: United Health Care Medicare Advantage	$10.62

GLUTATHIONE

Facility

$39.00

Hospital Charge Code	3101851
Hospital Revenue Code	300
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$33.15
Rate for Payer: Cash Price	$25.35
Rate for Payer: Community Health Alliance Commercial	$33.15
Rate for Payer: Priority Health Commercial	$27.30
Rate for Payer: Priority Health PPO	$27.30

GLYCOHEMOGLOBIN (A1C)

Facility

$49.00

Service Code	HCPCS 83036
Hospital Charge Code	3004920
Hospital Revenue Code	301
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$41.65
Rate for Payer: BCBS BCN 65	$10.20
Rate for Payer: Blue Care Network Medicare Advantage	$10.20
Rate for Payer: Cash Price	$31.85
Rate for Payer: Cash Price	$31.85
Rate for Payer: Community Health Alliance Commercial	$41.65
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$10.20
Rate for Payer: Meridian Health Plan Medicare	$10.20
Rate for Payer: Priority Health Commercial	$34.30
Rate for Payer: Priority Health Medicaid	$10.20
Rate for Payer: Priority Health Medicare	$10.20
Rate for Payer: Priority Health PPO	$34.30
Rate for Payer: United Health Care Medicaid	$10.20
Rate for Payer: United Health Care Medicare Advantage	$4.49

GLYCOHEMOGLOBIN (A1C) SBMF

Facility

$2.28

Hospital Charge Code	3101147
Hospital Revenue Code	301
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.48
Rate for Payer: Community Health Alliance Commercial	$1.94
Rate for Payer: Priority Health Commercial	$1.60
Rate for Payer: Priority Health PPO	$1.60

GMS SILVER TECH

Facility

$78.00

Service Code	HCPCS 88312
Hospital Charge Code	3100260
Hospital Revenue Code	310
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$66.30
Rate for Payer: BCBS BCN 65	$55.90
Rate for Payer: Blue Care Network Medicare Advantage	$55.90
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Community Health Alliance Commercial	$66.30
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$55.90
Rate for Payer: Meridian Health Plan Medicare	$55.90
Rate for Payer: Priority Health Commercial	$54.60
Rate for Payer: Priority Health Medicaid	$55.90
Rate for Payer: Priority Health Medicare	$55.90
Rate for Payer: Priority Health PPO	$54.60
Rate for Payer: United Health Care Medicaid	$55.90
Rate for Payer: United Health Care Medicare Advantage	$24.60

GOLD POINT PLUS

Facility

$910.00

Hospital Charge Code	27022715
Hospital Revenue Code	270
Min. Negotiated Rate	$637.00
Max. Negotiated Rate	$773.50
Rate for Payer: Cash Price	$591.50
Rate for Payer: Community Health Alliance Commercial	$773.50
Rate for Payer: Priority Health Commercial	$637.00
Rate for Payer: Priority Health PPO	$637.00

GOMORI STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100270
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

GONADATROPIN CHORIONIC

Facility

$82.00

Service Code	HCPCS 84702
Hospital Charge Code	3007097
Hospital Revenue Code	301
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$69.70
Rate for Payer: BCBS BCN 65	$15.80
Rate for Payer: Blue Care Network Medicare Advantage	$15.80
Rate for Payer: Cash Price	$53.30
Rate for Payer: Cash Price	$53.30
Rate for Payer: Community Health Alliance Commercial	$69.70
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$15.80
Rate for Payer: Meridian Health Plan Medicare	$15.80
Rate for Payer: Priority Health Commercial	$57.40
Rate for Payer: Priority Health Medicaid	$15.80
Rate for Payer: Priority Health Medicare	$15.80
Rate for Payer: Priority Health PPO	$57.40
Rate for Payer: United Health Care Medicaid	$15.80
Rate for Payer: United Health Care Medicare Advantage	$6.95

GONIOPRISM CLIP

Facility

$122.50

Hospital Charge Code	27284663
Hospital Revenue Code	272
Min. Negotiated Rate	$85.75
Max. Negotiated Rate	$104.12
Rate for Payer: Cash Price	$79.63
Rate for Payer: Community Health Alliance Commercial	$104.12
Rate for Payer: Priority Health Commercial	$85.75
Rate for Payer: Priority Health PPO	$85.75

GONIOTOMY

Facility

$4,434.10

Service Code	CPT 65820
Hospital Revenue Code	360
Min. Negotiated Rate	$1,951.00
Max. Negotiated Rate	$4,434.10
Rate for Payer: BCBS BCN 65	$4,434.10
Rate for Payer: Blue Care Network Medicare Advantage	$4,434.10
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4,434.10
Rate for Payer: Meridian Health Plan Medicare	$4,434.10
Rate for Payer: Priority Health Medicaid	$4,434.10
Rate for Payer: Priority Health Medicare	$4,434.10
Rate for Payer: United Health Care Medicaid	$4,434.10
Rate for Payer: United Health Care Medicare Advantage	$1,951.00

GONOCOCCUS BY MAA

Facility

$12.00

Hospital Charge Code	3101504
Hospital Revenue Code	306
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$10.20
Rate for Payer: Cash Price	$7.80
Rate for Payer: Community Health Alliance Commercial	$10.20
Rate for Payer: Priority Health Commercial	$8.40
Rate for Payer: Priority Health PPO	$8.40

GOODE T-TUBE

Facility

$94.00

Hospital Charge Code	27871963
Hospital Revenue Code	272
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

GPB PCR DETECTION

Facility

$45.00

Hospital Charge Code	3100962
Hospital Revenue Code	306
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$38.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Community Health Alliance Commercial	$38.25
Rate for Payer: Priority Health Commercial	$31.50
Rate for Payer: Priority Health PPO	$31.50

GRAFIX CORING REAMER 10MM

Facility

$798.00

Hospital Charge Code	27264587
Hospital Revenue Code	270
Min. Negotiated Rate	$558.60
Max. Negotiated Rate	$678.30
Rate for Payer: Cash Price	$518.70
Rate for Payer: Community Health Alliance Commercial	$678.30
Rate for Payer: Priority Health Commercial	$558.60
Rate for Payer: Priority Health PPO	$558.60

GRAFT, 6x80 RINGED TW

Facility

$3,527.00

Hospital Charge Code	27268787
Hospital Revenue Code	272
Min. Negotiated Rate	$2,468.90
Max. Negotiated Rate	$2,997.95
Rate for Payer: Cash Price	$2,292.55
Rate for Payer: Community Health Alliance Commercial	$2,997.95
Rate for Payer: Priority Health Commercial	$2,468.90
Rate for Payer: Priority Health PPO	$2,468.90

GRAFTJACKET MATRIC 5 x 5 CM

Facility

$5,748.00

Service Code	HCPCS Q4107
Hospital Charge Code	27868803
Hospital Revenue Code	636
Min. Negotiated Rate	$58.74
Max. Negotiated Rate	$4,885.80
Rate for Payer: BCBS BCN 65	$133.50
Rate for Payer: Blue Care Network Medicare Advantage	$133.50
Rate for Payer: Cash Price	$3,736.20
Rate for Payer: Cash Price	$3,736.20
Rate for Payer: Community Health Alliance Commercial	$4,885.80
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$133.50
Rate for Payer: Meridian Health Plan Medicare	$133.50
Rate for Payer: Priority Health Commercial	$4,023.60
Rate for Payer: Priority Health Medicaid	$133.50
Rate for Payer: Priority Health Medicare	$133.50
Rate for Payer: Priority Health PPO	$4,023.60
Rate for Payer: United Health Care Medicaid	$133.50
Rate for Payer: United Health Care Medicare Advantage	$58.74

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges