Sturgis Hospital Inc.

All Charges

Charge

Type

Setting

Price

SC-3

Facility

$30.95

Hospital Charge Code	3102512
Hospital Revenue Code	300
Min. Negotiated Rate	$21.66
Max. Negotiated Rate	$26.31
Rate for Payer: Cash Price	$20.12
Rate for Payer: Community Health Alliance Commercial	$26.31
Rate for Payer: Priority Health Commercial	$21.66
Rate for Payer: Priority Health PPO	$21.66

SC-4

Facility

$30.95

Hospital Charge Code	3102514
Hospital Revenue Code	300
Min. Negotiated Rate	$21.66
Max. Negotiated Rate	$26.31
Rate for Payer: Cash Price	$20.12
Rate for Payer: Community Health Alliance Commercial	$26.31
Rate for Payer: Priority Health Commercial	$21.66
Rate for Payer: Priority Health PPO	$21.66

SCISSORS, 5MM DISPOSABLE

Facility

$428.00

Hospital Charge Code	27016279
Hospital Revenue Code	270
Min. Negotiated Rate	$299.60
Max. Negotiated Rate	$363.80
Rate for Payer: Cash Price	$278.20
Rate for Payer: Community Health Alliance Commercial	$363.80
Rate for Payer: Priority Health Commercial	$299.60
Rate for Payer: Priority Health PPO	$299.60

SCISSORS,HARMONIC SCALPEL

Facility

$1,478.00

Hospital Charge Code	27022749
Hospital Revenue Code	272
Min. Negotiated Rate	$1,034.60
Max. Negotiated Rate	$1,256.30
Rate for Payer: Cash Price	$960.70
Rate for Payer: Community Health Alliance Commercial	$1,256.30
Rate for Payer: Priority Health Commercial	$1,034.60
Rate for Payer: Priority Health PPO	$1,034.60

SCLERA, WHOLE

Facility

$2,046.00

Hospital Charge Code	27021683
Hospital Revenue Code	278
Min. Negotiated Rate	$1,432.20
Max. Negotiated Rate	$1,739.10
Rate for Payer: Cash Price	$1,329.90
Rate for Payer: Community Health Alliance Commercial	$1,739.10
Rate for Payer: Priority Health Commercial	$1,432.20
Rate for Payer: Priority Health PPO	$1,432.20

SCLERODERMA ANTIBODY

Facility

$92.00

Service Code	HCPCS 86235
Hospital Charge Code	3007330
Hospital Revenue Code	302
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$78.20
Rate for Payer: BCBS BCN 65	$18.83
Rate for Payer: Blue Care Network Medicare Advantage	$18.83
Rate for Payer: Cash Price	$59.80
Rate for Payer: Cash Price	$59.80
Rate for Payer: Community Health Alliance Commercial	$78.20
Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child	$18.83
Rate for Payer: Meridian Health Plan Medicare	$18.83
Rate for Payer: Priority Health Commercial	$64.40
Rate for Payer: Priority Health Medicaid	$18.83
Rate for Payer: Priority Health Medicare	$18.83
Rate for Payer: Priority Health PPO	$64.40
Rate for Payer: United Health Care Medicaid	$18.83
Rate for Payer: United Health Care Medicare Advantage	$8.28

SCP-2

Facility

$5.00

Hospital Charge Code	3102104
Hospital Revenue Code	300
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$4.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Community Health Alliance Commercial	$4.25
Rate for Payer: Priority Health Commercial	$3.50
Rate for Payer: Priority Health PPO	$3.50

SCREENING PAP SMEAR SECOND

Facility

$114.00

Hospital Charge Code	3007662
Hospital Revenue Code	971
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$96.90
Rate for Payer: Cash Price	$74.10
Rate for Payer: Community Health Alliance Commercial	$96.90
Rate for Payer: Priority Health Commercial	$79.80
Rate for Payer: Priority Health PPO	$79.80

SCREW, 90 DEGREE LOCKING

Facility

$277.00

Service Code	HCPCS C1713
Hospital Charge Code	27872252
Hospital Revenue Code	278
Min. Negotiated Rate	$193.90
Max. Negotiated Rate	$235.45
Rate for Payer: Cash Price	$180.05
Rate for Payer: Community Health Alliance Commercial	$235.45
Rate for Payer: Priority Health Commercial	$193.90
Rate for Payer: Priority Health PPO	$193.90

SCREW BIOCOMPOSITE TENODESIS

Facility

$1,271.00

Service Code	HCPCS C1713
Hospital Charge Code	27878095
Hospital Revenue Code	278
Min. Negotiated Rate	$889.70
Max. Negotiated Rate	$1,080.35
Rate for Payer: Cash Price	$826.15
Rate for Payer: Community Health Alliance Commercial	$1,080.35
Rate for Payer: Priority Health Commercial	$889.70
Rate for Payer: Priority Health PPO	$889.70

SCREW,BIOSCREW 7 X 20

Facility

$626.00

Service Code	HCPCS C1713
Hospital Charge Code	27865114
Hospital Revenue Code	278
Min. Negotiated Rate	$438.20
Max. Negotiated Rate	$532.10
Rate for Payer: Cash Price	$406.90
Rate for Payer: Community Health Alliance Commercial	$532.10
Rate for Payer: Priority Health Commercial	$438.20
Rate for Payer: Priority Health PPO	$438.20

SCREW,BIOSCREW 9 X 25

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	27865148
Hospital Revenue Code	278
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$467.50
Rate for Payer: Cash Price	$357.50
Rate for Payer: Community Health Alliance Commercial	$467.50
Rate for Payer: Priority Health Commercial	$385.00
Rate for Payer: Priority Health PPO	$385.00

SCREW, CANCELLOUS

Facility

$15.00

Service Code	HCPCS C1713
Hospital Charge Code	27023382
Hospital Revenue Code	278
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

SCREW CANNULATED 3.0MM

Facility

$367.50

Service Code	HCPCS C1713
Hospital Charge Code	27875732
Hospital Revenue Code	278
Min. Negotiated Rate	$257.25
Max. Negotiated Rate	$312.38
Rate for Payer: Cash Price	$238.88
Rate for Payer: Community Health Alliance Commercial	$312.38
Rate for Payer: Priority Health Commercial	$257.25
Rate for Payer: Priority Health PPO	$257.25

SCREW,CANNULATED 5.0MM/75MM

Facility

$502.00

Service Code	HCPCS C1713
Hospital Charge Code	27866955
Hospital Revenue Code	278
Min. Negotiated Rate	$351.40
Max. Negotiated Rate	$426.70
Rate for Payer: Cash Price	$326.30
Rate for Payer: Community Health Alliance Commercial	$426.70
Rate for Payer: Priority Health Commercial	$351.40
Rate for Payer: Priority Health PPO	$351.40

SCREW, CANNULATED INTERFERENCE

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	27018283
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$318.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Community Health Alliance Commercial	$318.75
Rate for Payer: Priority Health Commercial	$262.50
Rate for Payer: Priority Health PPO	$262.50

SCREW, CONICAL

Facility

$529.00

Service Code	HCPCS C1713
Hospital Charge Code	27868134
Hospital Revenue Code	278
Min. Negotiated Rate	$370.30
Max. Negotiated Rate	$449.65
Rate for Payer: Cash Price	$343.85
Rate for Payer: Community Health Alliance Commercial	$449.65
Rate for Payer: Priority Health Commercial	$370.30
Rate for Payer: Priority Health PPO	$370.30

SCREW, CORTEX 4.5/40MM

Facility

$51.00

Service Code	HCPCS C1713
Hospital Charge Code	27868167
Hospital Revenue Code	278
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

SCREW, CORTEX 4.5MM

Facility

$51.00

Service Code	HCPCS C1713
Hospital Charge Code	27868159
Hospital Revenue Code	278
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

SCREW CORTEX 4.5 X 30MM

Facility

$51.00

Service Code	HCPCS C1713
Hospital Charge Code	27867938
Hospital Revenue Code	278
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$43.35
Rate for Payer: Cash Price	$33.15
Rate for Payer: Community Health Alliance Commercial	$43.35
Rate for Payer: Priority Health Commercial	$35.70
Rate for Payer: Priority Health PPO	$35.70

SCREW, CORTICAL

Facility

$269.50

Service Code	HCPCS C1713
Hospital Charge Code	27873828
Hospital Revenue Code	278
Min. Negotiated Rate	$188.65
Max. Negotiated Rate	$229.07
Rate for Payer: Cash Price	$175.18
Rate for Payer: Community Health Alliance Commercial	$229.07
Rate for Payer: Priority Health Commercial	$188.65
Rate for Payer: Priority Health PPO	$188.65

SCREW,CORTICAL

Facility

$481.00

Service Code	HCPCS C1713
Hospital Charge Code	27266020
Hospital Revenue Code	278
Min. Negotiated Rate	$336.70
Max. Negotiated Rate	$408.85
Rate for Payer: Cash Price	$312.65
Rate for Payer: Community Health Alliance Commercial	$408.85
Rate for Payer: Priority Health Commercial	$336.70
Rate for Payer: Priority Health PPO	$336.70

SCREW CORTICAL 3.0 X 14MM

Facility

$269.50

Service Code	HCPCS C1713
Hospital Charge Code	27881840
Hospital Revenue Code	278
Min. Negotiated Rate	$188.65
Max. Negotiated Rate	$229.07
Rate for Payer: Cash Price	$175.18
Rate for Payer: Community Health Alliance Commercial	$229.07
Rate for Payer: Priority Health Commercial	$188.65
Rate for Payer: Priority Health PPO	$188.65

SCREW, CORTICAL 3.5 X 10MM

Facility

$424.00

Service Code	HCPCS C1713
Hospital Charge Code	27868977
Hospital Revenue Code	278
Min. Negotiated Rate	$296.80
Max. Negotiated Rate	$360.40
Rate for Payer: Cash Price	$275.60
Rate for Payer: Community Health Alliance Commercial	$360.40
Rate for Payer: Priority Health Commercial	$296.80
Rate for Payer: Priority Health PPO	$296.80

SCREW, CORTICAL 3.5 X 12MM

Facility

$424.00

Service Code	HCPCS C1713
Hospital Charge Code	27868985
Hospital Revenue Code	278
Min. Negotiated Rate	$296.80
Max. Negotiated Rate	$360.40
Rate for Payer: Cash Price	$275.60
Rate for Payer: Community Health Alliance Commercial	$360.40
Rate for Payer: Priority Health Commercial	$296.80
Rate for Payer: Priority Health PPO	$296.80

Sturgis Hospital Inc.

Know your out-of-pocket cost for care.

All Charges