Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

PACE JECTOR

Facility

$321.00

Hospital Charge Code	27013920
Hospital Revenue Code	270
Min. Negotiated Rate	$224.70
Max. Negotiated Rate	$272.85
Rate for Payer: Cash Price	$208.65
Rate for Payer: Community Health Alliance Commercial	$272.85
Rate for Payer: Priority Health Commercial	$224.70
Rate for Payer: Priority Health PPO	$224.70

PACEMAKER

Facility

$9,739.00

Hospital Charge Code	27057562
Hospital Revenue Code	275
Min. Negotiated Rate	$6,817.30
Max. Negotiated Rate	$8,278.15
Rate for Payer: Cash Price	$6,330.35
Rate for Payer: Community Health Alliance Commercial	$8,278.15
Rate for Payer: Priority Health Commercial	$6,817.30
Rate for Payer: Priority Health PPO	$6,817.30

PACEMAKER

Facility

$14,662.00

Hospital Charge Code	27871939
Hospital Revenue Code	275
Min. Negotiated Rate	$10,263.40
Max. Negotiated Rate	$12,462.70
Rate for Payer: Cash Price	$9,530.30
Rate for Payer: Community Health Alliance Commercial	$12,462.70
Rate for Payer: Priority Health Commercial	$10,263.40
Rate for Payer: Priority Health PPO	$10,263.40

PACEMAKER ADAPTA

Facility

$19,254.00

Service Code	HCPCS C1785
Hospital Charge Code	27868704
Hospital Revenue Code	275
Min. Negotiated Rate	$13,477.80
Max. Negotiated Rate	$16,365.90
Rate for Payer: Cash Price	$12,515.10
Rate for Payer: Community Health Alliance Commercial	$16,365.90
Rate for Payer: Priority Health Commercial	$13,477.80
Rate for Payer: Priority Health PPO	$13,477.80

PACEMAKER,D CHAMBER,RATE RESPN

Facility

$29,219.00

Service Code	HCPCS C1785
Hospital Charge Code	27865692
Hospital Revenue Code	275
Min. Negotiated Rate	$20,453.30
Max. Negotiated Rate	$24,836.15
Rate for Payer: Cash Price	$18,992.35
Rate for Payer: Community Health Alliance Commercial	$24,836.15
Rate for Payer: Priority Health Commercial	$20,453.30
Rate for Payer: Priority Health PPO	$20,453.30

PACEMAKER,DDDR

Facility

$19,827.00

Service Code	HCPCS C1785
Hospital Charge Code	27867060
Hospital Revenue Code	275
Min. Negotiated Rate	$13,878.90
Max. Negotiated Rate	$16,852.95
Rate for Payer: Cash Price	$12,887.55
Rate for Payer: Community Health Alliance Commercial	$16,852.95
Rate for Payer: Priority Health Commercial	$13,878.90
Rate for Payer: Priority Health PPO	$13,878.90

PACEMAKER,DDDR

Facility

$28,993.00

Service Code	HCPCS C1785
Hospital Charge Code	27866336
Hospital Revenue Code	275
Min. Negotiated Rate	$20,295.10
Max. Negotiated Rate	$24,644.05
Rate for Payer: Cash Price	$18,845.45
Rate for Payer: Community Health Alliance Commercial	$24,644.05
Rate for Payer: Priority Health Commercial	$20,295.10
Rate for Payer: Priority Health PPO	$20,295.10

PACEMAKER, ENPULSE DDD

Facility

$22,015.00

Service Code	HCPCS C1785
Hospital Charge Code	27868472
Hospital Revenue Code	275
Min. Negotiated Rate	$15,410.50
Max. Negotiated Rate	$18,712.75
Rate for Payer: Cash Price	$14,309.75
Rate for Payer: Community Health Alliance Commercial	$18,712.75
Rate for Payer: Priority Health Commercial	$15,410.50
Rate for Payer: Priority Health PPO	$15,410.50

PACEMAKER, ENPULSE DRIVER

Facility

$18,960.00

Service Code	HCPCS C1785
Hospital Charge Code	27867862
Hospital Revenue Code	275
Min. Negotiated Rate	$13,272.00
Max. Negotiated Rate	$16,116.00
Rate for Payer: Cash Price	$12,324.00
Rate for Payer: Community Health Alliance Commercial	$16,116.00
Rate for Payer: Priority Health Commercial	$13,272.00
Rate for Payer: Priority Health PPO	$13,272.00

PACEMAKER, ENSURE DRIVER

Facility

$18,386.00

Service Code	HCPCS C1785
Hospital Charge Code	27867789
Hospital Revenue Code	275
Min. Negotiated Rate	$12,870.20
Max. Negotiated Rate	$15,628.10
Rate for Payer: Cash Price	$11,950.90
Rate for Payer: Community Health Alliance Commercial	$15,628.10
Rate for Payer: Priority Health Commercial	$12,870.20
Rate for Payer: Priority Health PPO	$12,870.20

PACEMAKER,S CHAMBER,RATE RESPN

Facility

$24,918.00

Service Code	HCPCS C1787
Hospital Charge Code	27865510
Hospital Revenue Code	275
Min. Negotiated Rate	$17,442.60
Max. Negotiated Rate	$21,180.30
Rate for Payer: Cash Price	$16,196.70
Rate for Payer: Community Health Alliance Commercial	$21,180.30
Rate for Payer: Priority Health Commercial	$17,442.60
Rate for Payer: Priority Health PPO	$17,442.60

PACEMAKER,SENSIA

Facility

$9,013.00

Service Code	HCPCS C2619
Hospital Charge Code	27871921
Hospital Revenue Code	275
Min. Negotiated Rate	$6,309.10
Max. Negotiated Rate	$7,661.05
Rate for Payer: Cash Price	$5,858.45
Rate for Payer: Community Health Alliance Commercial	$7,661.05
Rate for Payer: Priority Health Commercial	$6,309.10
Rate for Payer: Priority Health PPO	$6,309.10

PACING KIT - 5FR BALECTRODE

Facility

$560.00

Hospital Charge Code	27013995
Hospital Revenue Code	272
Min. Negotiated Rate	$392.00
Max. Negotiated Rate	$476.00
Rate for Payer: Cash Price	$364.00
Rate for Payer: Community Health Alliance Commercial	$476.00
Rate for Payer: Priority Health Commercial	$392.00
Rate for Payer: Priority Health PPO	$392.00

PACING KIT TORKFLOAT

Facility

$234.00

Hospital Charge Code	27013938
Hospital Revenue Code	272
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$198.90
Rate for Payer: Cash Price	$152.10
Rate for Payer: Community Health Alliance Commercial	$198.90
Rate for Payer: Priority Health Commercial	$163.80
Rate for Payer: Priority Health PPO	$163.80

PACKING ADAPTIC 1/2

Facility

$35.00

Hospital Charge Code	27018374
Hospital Revenue Code	270
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$29.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Community Health Alliance Commercial	$29.75
Rate for Payer: Priority Health Commercial	$24.50
Rate for Payer: Priority Health PPO	$24.50

PACKING IODOFORM GAUZW 1/4"

Facility

$5.46

Hospital Charge Code	27275972
Hospital Revenue Code	272
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$4.64
Rate for Payer: Cash Price	$3.55
Rate for Payer: Community Health Alliance Commercial	$4.64
Rate for Payer: Priority Health Commercial	$3.82
Rate for Payer: Priority Health PPO	$3.82

PACKING PLAIN GAUZE 1/4"

Facility

$3.55

Hospital Charge Code	27275899
Hospital Revenue Code	272
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$3.02
Rate for Payer: Cash Price	$2.31
Rate for Payer: Community Health Alliance Commercial	$3.02
Rate for Payer: Priority Health Commercial	$2.48
Rate for Payer: Priority Health PPO	$2.48

PACKING,SORBSAN WOUND

Facility

$46.00

Hospital Charge Code	27021477
Hospital Revenue Code	270
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$39.10
Rate for Payer: Cash Price	$29.90
Rate for Payer: Community Health Alliance Commercial	$39.10
Rate for Payer: Priority Health Commercial	$32.20
Rate for Payer: Priority Health PPO	$32.20

PACKING STRIP GAUZE

Facility

$15.00

Hospital Charge Code	27012120
Hospital Revenue Code	270
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$12.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Community Health Alliance Commercial	$12.75
Rate for Payer: Priority Health Commercial	$10.50
Rate for Payer: Priority Health PPO	$10.50

PACK LIMB SHEET

Facility

$48.00

Hospital Charge Code	27011478
Hospital Revenue Code	270
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

PAIFX-1

Facility

$90.00

Hospital Charge Code	3100961
Hospital Revenue Code	301
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$76.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Community Health Alliance Commercial	$76.50
Rate for Payer: Priority Health Commercial	$63.00
Rate for Payer: Priority Health PPO	$63.00

PAIFX-2

Facility

$90.00

Hospital Charge Code	3102337
Hospital Revenue Code	300
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$76.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Community Health Alliance Commercial	$76.50
Rate for Payer: Priority Health Commercial	$63.00
Rate for Payer: Priority Health PPO	$63.00

PAIN MGT PANEL A (14 DRUGS)

Facility

$52.50

Service Code	HCPCS 80307
Hospital Charge Code	3100893
Hospital Revenue Code	300
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$65.25
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$34.13
Rate for Payer: Cash Price	$34.13
Rate for Payer: Community Health Alliance Commercial	$44.62
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$65.25
Rate for Payer: Meridian Health Plan Medicare	$65.25
Rate for Payer: Priority Health Commercial	$36.75
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$36.75
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

PAIN MGT PANEL B (10 DRUGS)

Facility

$55.00

Service Code	HCPCS 80307
Hospital Charge Code	3100894
Hospital Revenue Code	300
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$65.25
Rate for Payer: BCBS BCN 65	$65.25
Rate for Payer: Blue Care Network Medicare Advantage	$65.25
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Community Health Alliance Commercial	$46.75
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$65.25
Rate for Payer: Meridian Health Plan Medicare	$65.25
Rate for Payer: Priority Health Commercial	$38.50
Rate for Payer: Priority Health Medicaid	$65.25
Rate for Payer: Priority Health Medicare	$65.25
Rate for Payer: Priority Health PPO	$38.50
Rate for Payer: United Health Care Medicaid	$65.25
Rate for Payer: United Health Care Medicare Advantage	$28.71

PAIN QUANT AMOBARBITAL

Facility

$44.00

Service Code	HCPCS G6043
Hospital Charge Code	3100664
Hospital Revenue Code	309
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$28.60
Rate for Payer: Community Health Alliance Commercial	$37.40
Rate for Payer: Priority Health Commercial	$30.80
Rate for Payer: Priority Health PPO	$30.80

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges