Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

HEMAGGLUTINATION INHIBITION

Facility

$179.00

Service Code	HCPCS 86280
Hospital Charge Code	3006145
Hospital Revenue Code	302
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$152.15
Rate for Payer: BCBS BCN 65	$8.60
Rate for Payer: Blue Care Network Medicare Advantage	$8.60
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Community Health Alliance Commercial	$152.15
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.60
Rate for Payer: Meridian Health Plan Medicare	$8.60
Rate for Payer: Priority Health Commercial	$125.30
Rate for Payer: Priority Health Medicaid	$8.60
Rate for Payer: Priority Health Medicare	$8.60
Rate for Payer: Priority Health PPO	$125.30
Rate for Payer: United Health Care Medicaid	$8.60
Rate for Payer: United Health Care Medicare Advantage	$3.78

HEMASHIELD

Facility

$552.00

Hospital Charge Code	27261477
Hospital Revenue Code	272
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$469.20
Rate for Payer: Cash Price	$358.80
Rate for Payer: Community Health Alliance Commercial	$469.20
Rate for Payer: Priority Health Commercial	$386.40
Rate for Payer: Priority Health PPO	$386.40

HEMASHIELD

Facility

$1,847.00

Hospital Charge Code	27265726
Hospital Revenue Code	272
Min. Negotiated Rate	$1,292.90
Max. Negotiated Rate	$1,569.95
Rate for Payer: Cash Price	$1,200.55
Rate for Payer: Community Health Alliance Commercial	$1,569.95
Rate for Payer: Priority Health Commercial	$1,292.90
Rate for Payer: Priority Health PPO	$1,292.90

HEMASHIELD DOUBLE VELOUR

Facility

$3,181.00

Hospital Charge Code	27022731
Hospital Revenue Code	272
Min. Negotiated Rate	$2,226.70
Max. Negotiated Rate	$2,703.85
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Community Health Alliance Commercial	$2,703.85
Rate for Payer: Priority Health Commercial	$2,226.70
Rate for Payer: Priority Health PPO	$2,226.70

HEMASHIELD GRAFT (ALL SIZES)

Facility

$3,229.00

Hospital Charge Code	27265098
Hospital Revenue Code	272
Min. Negotiated Rate	$2,260.30
Max. Negotiated Rate	$2,744.65
Rate for Payer: Cash Price	$2,098.85
Rate for Payer: Community Health Alliance Commercial	$2,744.65
Rate for Payer: Priority Health Commercial	$2,260.30
Rate for Payer: Priority Health PPO	$2,260.30

HEMATOCRIT

Facility

$20.00

Service Code	HCPCS 85014
Hospital Charge Code	3005545
Hospital Revenue Code	305
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$17.00
Rate for Payer: BCBS BCN 65	$2.49
Rate for Payer: Blue Care Network Medicare Advantage	$2.49
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2.49
Rate for Payer: Meridian Health Plan Medicare	$2.49
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health Medicaid	$2.49
Rate for Payer: Priority Health Medicare	$2.49
Rate for Payer: Priority Health PPO	$14.00
Rate for Payer: United Health Care Medicaid	$2.49
Rate for Payer: United Health Care Medicare Advantage	$1.09

HEMATOX & EOS STAIN TECH

Facility

$48.00

Service Code	HCPCS 88313
Hospital Charge Code	3100290
Hospital Revenue Code	310
Min. Negotiated Rate	$33.60
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	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Community Health Alliance Commercial	$40.80
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	$33.60
Rate for Payer: Priority Health Medicaid	$142.73
Rate for Payer: Priority Health Medicare	$142.73
Rate for Payer: Priority Health PPO	$33.60
Rate for Payer: United Health Care Medicaid	$142.73
Rate for Payer: United Health Care Medicare Advantage	$62.80

HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF PHALANX, EACH

Facility

$3,510.01

Service Code	CPT 28160
Hospital Revenue Code	360
Min. Negotiated Rate	$1,544.41
Max. Negotiated Rate	$3,510.01
Rate for Payer: BCBS BCN 65	$3,510.01
Rate for Payer: Blue Care Network Medicare Advantage	$3,510.01
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$3,510.01
Rate for Payer: Meridian Health Plan Medicare	$3,510.01
Rate for Payer: Priority Health Medicaid	$3,510.01
Rate for Payer: Priority Health Medicare	$3,510.01
Rate for Payer: United Health Care Medicaid	$3,510.01
Rate for Payer: United Health Care Medicare Advantage	$1,544.41

HEMOCLIP, HEMOSTATIC LIGATING

Facility

$88.00

Hospital Charge Code	27265858
Hospital Revenue Code	272
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$74.80
Rate for Payer: Cash Price	$57.20
Rate for Payer: Community Health Alliance Commercial	$74.80
Rate for Payer: Priority Health Commercial	$61.60
Rate for Payer: Priority Health PPO	$61.60

HEMOGLOBIN

Facility

$20.00

Service Code	HCPCS 85018
Hospital Charge Code	3005550
Hospital Revenue Code	305
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$17.00
Rate for Payer: BCBS BCN 65	$2.49
Rate for Payer: Blue Care Network Medicare Advantage	$2.49
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Community Health Alliance Commercial	$17.00
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2.49
Rate for Payer: Meridian Health Plan Medicare	$2.49
Rate for Payer: Priority Health Commercial	$14.00
Rate for Payer: Priority Health Medicaid	$2.49
Rate for Payer: Priority Health Medicare	$2.49
Rate for Payer: Priority Health PPO	$14.00
Rate for Payer: United Health Care Medicaid	$2.49
Rate for Payer: United Health Care Medicare Advantage	$1.09

HEMOGLOBIN A2 ELECTROPHESIS

Facility

$114.00

Service Code	HCPCS 83020
Hospital Charge Code	3005530
Hospital Revenue Code	301
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$96.90
Rate for Payer: BCBS BCN 65	$13.51
Rate for Payer: Blue Care Network Medicare Advantage	$13.51
Rate for Payer: Cash Price	$74.10
Rate for Payer: Cash Price	$74.10
Rate for Payer: Community Health Alliance Commercial	$96.90
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	$79.80
Rate for Payer: Priority Health Medicaid	$13.51
Rate for Payer: Priority Health Medicare	$13.51
Rate for Payer: Priority Health PPO	$79.80
Rate for Payer: United Health Care Medicaid	$13.51
Rate for Payer: United Health Care Medicare Advantage	$5.95

HEMOGLOBIN, FREE PLASMA

Facility

$8.28

Service Code	HCPCS 83051
Hospital Charge Code	3005535
Hospital Revenue Code	301
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$7.68
Rate for Payer: BCBS BCN 65	$7.68
Rate for Payer: Blue Care Network Medicare Advantage	$7.68
Rate for Payer: Cash Price	$5.38
Rate for Payer: Cash Price	$5.38
Rate for Payer: Community Health Alliance Commercial	$7.04
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$7.68
Rate for Payer: Meridian Health Plan Medicare	$7.68
Rate for Payer: Priority Health Commercial	$5.80
Rate for Payer: Priority Health Medicaid	$7.68
Rate for Payer: Priority Health Medicare	$7.68
Rate for Payer: Priority Health PPO	$5.80
Rate for Payer: United Health Care Medicaid	$7.68
Rate for Payer: United Health Care Medicare Advantage	$3.38

HEM-O-LOCK

Facility

$39.42

Hospital Charge Code	27883911
Hospital Revenue Code	278
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$33.51
Rate for Payer: Cash Price	$25.62
Rate for Payer: Community Health Alliance Commercial	$33.51
Rate for Payer: Priority Health Commercial	$27.59
Rate for Payer: Priority Health PPO	$27.59

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS;

Facility

$2,977.57

Service Code	CPT 46260
Hospital Revenue Code	360
Min. Negotiated Rate	$1,310.13
Max. Negotiated Rate	$2,977.57
Rate for Payer: BCBS BCN 65	$2,977.57
Rate for Payer: Blue Care Network Medicare Advantage	$2,977.57
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,977.57
Rate for Payer: Meridian Health Plan Medicare	$2,977.57
Rate for Payer: Priority Health Medicaid	$2,977.57
Rate for Payer: Priority Health Medicare	$2,977.57
Rate for Payer: United Health Care Medicaid	$2,977.57
Rate for Payer: United Health Care Medicare Advantage	$1,310.13

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;

Facility

$2,977.57

Service Code	CPT 46255
Hospital Revenue Code	360
Min. Negotiated Rate	$1,310.13
Max. Negotiated Rate	$2,977.57
Rate for Payer: BCBS BCN 65	$2,977.57
Rate for Payer: Blue Care Network Medicare Advantage	$2,977.57
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$2,977.57
Rate for Payer: Meridian Health Plan Medicare	$2,977.57
Rate for Payer: Priority Health Medicaid	$2,977.57
Rate for Payer: Priority Health Medicare	$2,977.57
Rate for Payer: United Health Care Medicaid	$2,977.57
Rate for Payer: United Health Care Medicare Advantage	$1,310.13

HEMOSIDERIN

Facility

$38.50

Service Code	HCPCS 83070
Hospital Charge Code	3005030
Hospital Revenue Code	301
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$32.73
Rate for Payer: BCBS BCN 65	$4.99
Rate for Payer: Blue Care Network Medicare Advantage	$4.99
Rate for Payer: Cash Price	$25.03
Rate for Payer: Cash Price	$25.03
Rate for Payer: Community Health Alliance Commercial	$32.73
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$4.99
Rate for Payer: Meridian Health Plan Medicare	$4.99
Rate for Payer: Priority Health Commercial	$26.95
Rate for Payer: Priority Health Medicaid	$4.99
Rate for Payer: Priority Health Medicare	$4.99
Rate for Payer: Priority Health PPO	$26.95
Rate for Payer: United Health Care Medicaid	$4.99
Rate for Payer: United Health Care Medicare Advantage	$2.19

HEMOSTATIC ERASER

Facility

$157.00

Hospital Charge Code	27022707
Hospital Revenue Code	272
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$133.45
Rate for Payer: Cash Price	$102.05
Rate for Payer: Community Health Alliance Commercial	$133.45
Rate for Payer: Priority Health Commercial	$109.90
Rate for Payer: Priority Health PPO	$109.90

HEMRRDECTOMY INT/EXT

Facility

$1,333.00

Hospital Charge Code	5150757
Hospital Revenue Code	960
Min. Negotiated Rate	$933.10
Max. Negotiated Rate	$1,133.05
Rate for Payer: Cash Price	$866.45
Rate for Payer: Community Health Alliance Commercial	$1,133.05
Rate for Payer: Priority Health Commercial	$933.10
Rate for Payer: Priority Health PPO	$933.10

HEPARIN ASSAY

Facility

$45.74

Hospital Charge Code	3100541
Hospital Revenue Code	300
Min. Negotiated Rate	$32.02
Max. Negotiated Rate	$38.88
Rate for Payer: Cash Price	$29.73
Rate for Payer: Community Health Alliance Commercial	$38.88
Rate for Payer: Priority Health Commercial	$32.02
Rate for Payer: Priority Health PPO	$32.02

HEPARIN COFACTOR

Facility

$70.37

Hospital Charge Code	3102226
Hospital Revenue Code	300
Min. Negotiated Rate	$49.26
Max. Negotiated Rate	$59.81
Rate for Payer: Cash Price	$45.74
Rate for Payer: Community Health Alliance Commercial	$59.81
Rate for Payer: Priority Health Commercial	$49.26
Rate for Payer: Priority Health PPO	$49.26

HEPARIN I/D PLATELET ANTIBODY

Facility

$14.66

Service Code	HCPCS 86022
Hospital Charge Code	3005230
Hospital Revenue Code	302
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$19.29
Rate for Payer: BCBS BCN 65	$19.29
Rate for Payer: Blue Care Network Medicare Advantage	$19.29
Rate for Payer: Cash Price	$9.53
Rate for Payer: Cash Price	$9.53
Rate for Payer: Community Health Alliance Commercial	$12.46
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$19.29
Rate for Payer: Meridian Health Plan Medicare	$19.29
Rate for Payer: Priority Health Commercial	$10.26
Rate for Payer: Priority Health Medicaid	$19.29
Rate for Payer: Priority Health Medicare	$19.29
Rate for Payer: Priority Health PPO	$10.26
Rate for Payer: United Health Care Medicaid	$19.29
Rate for Payer: United Health Care Medicare Advantage	$8.49

HEPATATIS B SURFACE AB-ML

Facility

$68.00

Hospital Charge Code	3101282
Hospital Revenue Code	302
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$57.80
Rate for Payer: Cash Price	$44.20
Rate for Payer: Community Health Alliance Commercial	$57.80
Rate for Payer: Priority Health Commercial	$47.60
Rate for Payer: Priority Health PPO	$47.60

HEPATATIS B SURF ANTIGEN-ML

Facility

$55.00

Hospital Charge Code	3101289
Hospital Revenue Code	302
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

HEPATATIS C RNA BY PCR QUANT

Facility

$50.00

Service Code	HCPCS 87522
Hospital Charge Code	3005245
Hospital Revenue Code	306
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$44.98
Rate for Payer: BCBS BCN 65	$44.98
Rate for Payer: Blue Care Network Medicare Advantage	$44.98
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	$44.98
Rate for Payer: Meridian Health Plan Medicare	$44.98
Rate for Payer: Priority Health Commercial	$35.00
Rate for Payer: Priority Health Medicaid	$44.98
Rate for Payer: Priority Health Medicare	$44.98
Rate for Payer: Priority Health PPO	$35.00
Rate for Payer: United Health Care Medicaid	$44.98
Rate for Payer: United Health Care Medicare Advantage	$19.79

HEPATIC FUNCTION PANEL

Facility

$64.00

Service Code	HCPCS 80076
Hospital Charge Code	3005135
Hospital Revenue Code	301
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$54.40
Rate for Payer: BCBS BCN 65	$8.58
Rate for Payer: Blue Care Network Medicare Advantage	$8.58
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Community Health Alliance Commercial	$54.40
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$8.58
Rate for Payer: Meridian Health Plan Medicare	$8.58
Rate for Payer: Priority Health Commercial	$44.80
Rate for Payer: Priority Health Medicaid	$8.58
Rate for Payer: Priority Health Medicare	$8.58
Rate for Payer: Priority Health PPO	$44.80
Rate for Payer: United Health Care Medicaid	$8.58
Rate for Payer: United Health Care Medicare Advantage	$3.77

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges