Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

GRAFTON 1CC SYRINGE

Facility

$649.00

Hospital Charge Code	27018770
Hospital Revenue Code	270
Min. Negotiated Rate	$454.30
Max. Negotiated Rate	$551.65
Rate for Payer: Cash Price	$421.85
Rate for Payer: Community Health Alliance Commercial	$551.65
Rate for Payer: Priority Health Commercial	$454.30
Rate for Payer: Priority Health PPO	$454.30

GRAFT VASCULAR

Facility

$3,675.00

Service Code	HCPCS C1768
Hospital Charge Code	27019208
Hospital Revenue Code	278
Min. Negotiated Rate	$2,572.50
Max. Negotiated Rate	$3,123.75
Rate for Payer: Cash Price	$2,388.75
Rate for Payer: Community Health Alliance Commercial	$3,123.75
Rate for Payer: Priority Health Commercial	$2,572.50
Rate for Payer: Priority Health PPO	$2,572.50

GRAFT VASCULAR

Facility

$2,845.00

Service Code	HCPCS C1768
Hospital Charge Code	27018416
Hospital Revenue Code	278
Min. Negotiated Rate	$1,991.50
Max. Negotiated Rate	$2,418.25
Rate for Payer: Cash Price	$1,849.25
Rate for Payer: Community Health Alliance Commercial	$2,418.25
Rate for Payer: Priority Health Commercial	$1,991.50
Rate for Payer: Priority Health PPO	$1,991.50

GRAFT, VASCULAR

Facility

$2,022.00

Service Code	HCPCS C1768
Hospital Charge Code	27019869
Hospital Revenue Code	278
Min. Negotiated Rate	$1,415.40
Max. Negotiated Rate	$1,718.70
Rate for Payer: Cash Price	$1,314.30
Rate for Payer: Community Health Alliance Commercial	$1,718.70
Rate for Payer: Priority Health Commercial	$1,415.40
Rate for Payer: Priority Health PPO	$1,415.40

GRAFT,VASCULAR 4-7MM X 45CM

Facility

$2,022.00

Service Code	HCPCS C1768
Hospital Charge Code	27866468
Hospital Revenue Code	278
Min. Negotiated Rate	$1,415.40
Max. Negotiated Rate	$1,718.70
Rate for Payer: Cash Price	$1,314.30
Rate for Payer: Community Health Alliance Commercial	$1,718.70
Rate for Payer: Priority Health Commercial	$1,415.40
Rate for Payer: Priority Health PPO	$1,415.40

GRAFT VASCULAR 6 X 100 THIN

Facility

$4,342.00

Service Code	HCPCS C1768
Hospital Charge Code	27875462
Hospital Revenue Code	278
Min. Negotiated Rate	$3,039.40
Max. Negotiated Rate	$3,690.70
Rate for Payer: Cash Price	$2,822.30
Rate for Payer: Community Health Alliance Commercial	$3,690.70
Rate for Payer: Priority Health Commercial	$3,039.40
Rate for Payer: Priority Health PPO	$3,039.40

GRAFT,VASCULAR FEP RINGED

Facility

$2,776.00

Service Code	HCPCS C1768
Hospital Charge Code	27867045
Hospital Revenue Code	278
Min. Negotiated Rate	$1,943.20
Max. Negotiated Rate	$2,359.60
Rate for Payer: Cash Price	$1,804.40
Rate for Payer: Community Health Alliance Commercial	$2,359.60
Rate for Payer: Priority Health Commercial	$1,943.20
Rate for Payer: Priority Health PPO	$1,943.20

GRAFT,VASCULAR VANTAGE

Facility

$2,882.00

Service Code	HCPCS C1768
Hospital Charge Code	27061253
Hospital Revenue Code	278
Min. Negotiated Rate	$2,017.40
Max. Negotiated Rate	$2,449.70
Rate for Payer: Cash Price	$1,873.30
Rate for Payer: Community Health Alliance Commercial	$2,449.70
Rate for Payer: Priority Health Commercial	$2,017.40
Rate for Payer: Priority Health PPO	$2,017.40

GRAM STAIN LC

Facility

$5.93

Hospital Charge Code	3102457
Hospital Revenue Code	300
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$5.04
Rate for Payer: Cash Price	$3.85
Rate for Payer: Community Health Alliance Commercial	$5.04
Rate for Payer: Priority Health Commercial	$4.15
Rate for Payer: Priority Health PPO	$4.15

GRAM STAIN PATHOLOGY TECH

Facility

$44.00

Service Code	HCPCS 88312
Hospital Charge Code	3100275
Hospital Revenue Code	310
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$55.90
Rate for Payer: BCBS BCN 65	$55.90
Rate for Payer: Blue Care Network Medicare Advantage	$55.90
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	$55.90
Rate for Payer: Meridian Health Plan Medicare	$55.90
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health Medicaid	$55.90
Rate for Payer: Priority Health Medicare	$55.90
Rate for Payer: Priority Health PPO	$30.80
Rate for Payer: United Health Care Medicaid	$55.90
Rate for Payer: United Health Care Medicare Advantage	$24.60

GRASPING FORCEPS (COOK)

Facility

$616.00

Hospital Charge Code	27020560
Hospital Revenue Code	272
Min. Negotiated Rate	$431.20
Max. Negotiated Rate	$523.60
Rate for Payer: Cash Price	$400.40
Rate for Payer: Community Health Alliance Commercial	$523.60
Rate for Payer: Priority Health Commercial	$431.20
Rate for Payer: Priority Health PPO	$431.20

Grasses-1

Facility

$3.26

Hospital Charge Code	31027594
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

Grasses-2

Facility

$3.26

Hospital Charge Code	31027595
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

Grasses-3

Facility

$3.26

Hospital Charge Code	31027596
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

Grasses-4

Facility

$3.26

Hospital Charge Code	31027597
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

Grasses-5

Facility

$3.26

Hospital Charge Code	31027598
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

Grasses Allergen

Facility

$16.30

Hospital Charge Code	31027593
Hospital Revenue Code	300
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$13.86
Rate for Payer: Cash Price	$10.60
Rate for Payer: Community Health Alliance Commercial	$13.86
Rate for Payer: Priority Health Commercial	$11.41
Rate for Payer: Priority Health PPO	$11.41

GR B STREP AG (MEN PANEL)

Facility

$50.00

Service Code	HCPCS 86403
Hospital Charge Code	3004130
Hospital Revenue Code	300
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$42.50
Rate for Payer: BCBS BCN 65	$12.12
Rate for Payer: Blue Care Network Medicare Advantage	$12.12
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	$12.12
Rate for Payer: Meridian Health Plan Medicare	$12.12
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$12.12
Rate for Payer: Priority Health Medicare	$12.12
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$12.12
Rate for Payer: United Health Care Medicare Advantage	$5.33

GRIMELUS STAIN TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100280
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

GROMMET JOINT

Facility

$368.00

Hospital Charge Code	27015248
Hospital Revenue Code	270
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

GROUP CAREGIVER TRAINING

Facility

$30.00

Hospital Charge Code	4201503
Hospital Revenue Code	420
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

GROUP II TECH

Facility

$53.00

Service Code	HCPCS 88313
Hospital Charge Code	3100510
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

GROUP THERAPY

Facility

$71.00

Service Code	HCPCS 97150 GP
Hospital Charge Code	4200235
Hospital Revenue Code	420
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$60.35
Rate for Payer: Cash Price	$46.15
Rate for Payer: Community Health Alliance Commercial	$60.35
Rate for Payer: Priority Health Commercial	$49.70
Rate for Payer: Priority Health PPO	$49.70

GRP A STREP ONLY-TH

Facility

$4.11

Hospital Charge Code	3102516
Hospital Revenue Code	300
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$3.49
Rate for Payer: Cash Price	$2.67
Rate for Payer: Community Health Alliance Commercial	$3.49
Rate for Payer: Priority Health Commercial	$2.88
Rate for Payer: Priority Health PPO	$2.88

GUANFACINE

Facility

$150.00

Hospital Charge Code	3100875
Hospital Revenue Code	301
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$127.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Community Health Alliance Commercial	$127.50
Rate for Payer: Priority Health Commercial	$105.00
Rate for Payer: Priority Health PPO	$105.00

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges